Isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in preschool children 12-72 months for the government of Paraíba

OBJECTIVE: To estimate the isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in pre-school children, as well as the distribution of isolated deficiencies according to gender, age and prior supplementation with vitamin A. METHODS: Cross-sectional study with pre-school children in the state of Paraíba, Brazil. Analysis of the average concentrations of hemoglobin, serum retinol and serum zinc, according to gender, age and previous vitamin A supplementation of children were carried out as well as the risk of simultaneous occurrence of micronutrient deficiencies in the presence of these deficiencies. RESULTS: The prevalence of anemia, vitamin A deficiency and zinc deficiency were 15.4%, 23.3% and 13.8%, respectively. The anemia was significantly associated with age (p<0.01). Children previously supplemented by vitamin A had higher serum retinol concentrations than children without supplements, an effect that was not observed for concentrations of hemoglobin or serum zinc. The prevalence of anemia associated with vitamin A deficiency was 5.8%, with the chance of vitamin A deficiency and anemia coexist 2.21 times (95%CI=1.03-4.84) higher in the case of vitamin A deficiency or anemia rather than in the absence of these conditions. CONCLUSION: The high prevalence of micronutrient deficiencies which are important in child growth, as well as the coexistence of nutritional deficiencies, point out the need to strengthen nutrition intervention strategies that consider this issue.

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Efektivitas Program Fortifikasi Minyak Goreng dengan Vitamin A terhadap Status Gizi Anak Sekolah di Kota Makasar

Kesmas National Public Health Journal ◽

10.21109/kesmas.v4i6.164 ◽

2010 ◽

Vol 4 (6) ◽

pp. 255 ◽

Cited By ~ 1

Author(s):

Endang Achadi ◽

Siti Arifah ◽

Siti Muslimatun ◽

Trisari Anggondowati ◽

Asih Setiarini

Keyword(s):

Vitamin A ◽

School Children ◽

Vitamin A Deficiency ◽

Urban Slum ◽

The Body ◽

Slum Area ◽

Serum Retinol ◽

Significant Public Health ◽

The Impact ◽

Prevalence Of Anemia

Di Indonesia, kekurangan Vitamin A masih menjadi masalah kesehatan masyarakat yang penting seperti terlihat pada balita penderita vitamin A defisiensi subklinis yang tinggi (50%). Hal tersebut akan berpengaruh terhadap berbagai fungsi tubuh yang antara lain meliputi sistem imun, penglihatan, sistem reproduksi dan diferensiasi sel. Tujuan dari penelitian ini adalah untuk mengetahui kontribusi konsumsi minyak yang diperkaya vitamin A dalam memperbaiki status vitamin A dan hemoglobin balita. Penelitian dengan disain studi intervensi Before-After ini dilaksanakan pada anak sehat berusia 7-10 tahun yang diberi obat cacing sebelum intervensi dilakukan. Pengukuran serum retinol dan hemoglobin dilakukan sebelum dan 3 bulan setelah intervensi . Minyak yang difortifikasi vitamin A telah disediakan di warung/ toko di sekitar tempat tinggal responden. Untuk meningkatkan demand, penelitian ini dilengkapi dengan pendekatan pemasaran sosial yang dilakukan pihak lain. Secara umum tidak terlihat perubahan status gizi, tetapi prevalensi anemia turun dari 21,8% menjadi 11,6%. Sementara, prevalens vitamin A defisiensi ditemukan lebih rendah pada anak yang mengkonsumsi ³12 minggu (26,6%) daripada yang mengkonsumsi < 12 minggu (42%) . Hasil tersebut dapat dijadikan pertimbangan untuk merekomendasikan agar minyak difortifikasi vitamin A.Kata kunci: Defisiensi vitamin A, anak sekolah, minyak fortifikasiAbstractVitamin A deficiency (VAD) remains as one of significant public health problems in Indonesia. Around 50% of under five children are suffering from subclinical VAD. Deficiency of vitamin A will affect several important role in the body, such as immune system, vision, reproductive system and cell differentiation. Therefore, guarding Indonesian children to be free from VAD is crucial for their quality as Human Resources. We assessed the impact of the consumption of vitamin A fortified cooking oil on the improvement of vitamin A and hemoglobin status among school children in urban slum area in Makassar City. The study was an intervention design Before-After. Healthy school children 7-10 years were selected from schools and de-wormed before the intervention. Serum retinol and hemoglobin was measured at baseline and at 3 months after. Fortified oil was made available through distribution at shops and accompanied with social marketing. Eventhough overall there was no change in VAD prevalence, the VAD prevalence is lower among children who consumedfortified oil ³12 weeks (26.6%) compared to those who consumed <12 weeks (42%). Prevalence of anemia decreased from 21.8% to 11.6%. We recommended that fortified oil is made mandatory.Key words: Vitamin A deficiency, school children, fortified oil

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Nutritional deficiencies among school children in urban areas of Hyderabad, Telangana, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20170299 ◽

2017 ◽

Vol 4 (2) ◽

pp. 607 ◽

Cited By ~ 1

Author(s):

Sunil Pal Singh Chajhlana ◽

Ramakrishna Narashimha Mahabhasyam ◽

Maruti Sarma Mannava Varaprasada

Keyword(s):

Primary School ◽

School Children ◽

Urban Areas ◽

Primary Schools ◽

Vitamin A Deficiency ◽

Urban Slums ◽

Primary School Children ◽

Nutritional Deficiencies ◽

Unskilled Worker ◽

Micronutrient Deficiencies

Background: The school age period is nutritionally significant because this is the prime time to build up body stores of nutrients in preparation for rapid growth of adolescence. Malnutrition remains the world’s most serious health problem and the single biggest contributor to child mortality, nearly one third of the children in the developing world are either underweight or stunted and more than 30% of the developing world’s population suffer from micronutrient deficiencies. However the data available from urban slums of Hyderabad in this age group is very sparse and hence an attempt has been made to study the same. The objectives were to determine the nutritional status of primary school children and study the factors associated with it.Methods:Study population: Primary school children (6 to 11 years). Study area: primary schools in urban slums of Hyderabad. Study design: a cross sectional study. Sample size: 412 children. Sampling methods: Simple random sampling Data collection: By using pre designed and pre tested and pre coded schedule (interview technique, observation, clinical examination). Analysis: By using Microsoft Excel 2007 and Epi Info 3.5.3.Results: The prevalence of underweight was 28.9%, overweight was 9.2% and obesity was 4.4% . Prevalence of stunted height was found among 21.8%. 5.8% children were suffering from Vitamin’ A’ deficiency, 15.0% were suffering from Vitamin B deficiency, and 15.8% were found to be anemic.Conclusions:The prevalence of underweight, Nutritional deficiencies were found to be significantly higher in children of illiterate parents’ and similarly in unskilled worker fathers’ and unemployed mothers.

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Basis for changes in the global burden of disease estimates related to vitamin A and zinc deficiencies in the GBD 2017 and 2019 studies

Public Health Nutrition ◽

10.1017/s1368980021004821 ◽

2021 ◽

pp. 1-20

Author(s):

Sonja Y. Hess ◽

Alexander C. McLain ◽

Haley Lescinsky ◽

Kenneth H. Brown ◽

Ashkan Afshin ◽

...

Keyword(s):

Vitamin A ◽

Zinc Deficiency ◽

Burden Of Disease ◽

Disease Burden ◽

Vitamin A Deficiency ◽

Global Burden Of Disease ◽

Global Burden ◽

Micronutrient Deficiencies ◽

Global Prevalence ◽

Additional Information

Abstract Background: The Global Burden of Disease (GBD) Study provides estimates of death and disability from 87 risk factors, including some micronutrient deficiencies. Objectives: To review methodological changes that led to large differences in the disease burden estimates for vitamin A and zinc deficiencies between the GBD 2017 and 2019 Studies. Methods: GBD publications were reviewed; additional information was provided by GBD researchers. Results: Vitamin A deficiency prevalence is based on plasma retinol concentration, whereas the estimate for zinc deficiency prevalence uses dietary adequacy as a proxy. The estimated global prevalence of vitamin A deficiency for children aged 1-4 years in the year 2017 decreased from 0.20 (95%CI 0.17-0.24) in GBD 2017 to 0.16 (95%CI 0.15-0.19) in GBD 2019, while the global prevalence of zinc deficiency did not change between the two studies (0.09 (95%CI 0.04-0.17) and 0.09 (95%CI 0.03-0.18)). New to 2019 was that meta-analyses were performed using Meta Regression – Bayesian, Regularized, Trimmed (MR-BRT), a method developed for GBD. Due to this and multiple other methodological changes the estimated number of deaths due to vitamin A deficiency dropped from 233,000 (179,000–294,000) to 24,000 (3,000–50,000) from GBD 2017 to 2019, and for zinc deficiency from 29,000 (1,000–77,000) to 2,800 (700–6,500), respectively. Conclusion: The changes in the estimated disease burdens due to vitamin A and zinc deficiencies in the GBD reports from 2017 to 2019 are due primarily to changes in the analytical methods employed, so may not represent true changes in disease burden. Additional effort is needed to validate these results.

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Serum zinc status is a matter of concern among children and non-pregnant women in a nationwide survey of Nepal

Scientific Reports ◽

10.1038/s41598-021-94344-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Suresh Mehata ◽

Man Kumar Tamang ◽

Kedar Raj Parajuli ◽

Binod Rayamajhee ◽

Uday Narayan Yadav ◽

...

Keyword(s):

Vitamin A ◽

Pregnant Women ◽

Zinc Deficiency ◽

Serum Zinc ◽

Wealth Quintile ◽

Household Wealth ◽

Intervention Programs ◽

Zinc Status ◽

Micronutrient Status ◽

Prevalence Of Anemia

AbstractNationally representative population data on zinc status in Nepal is lacking at present. This study analyzed data from the recent Nepal National Micronutrient status survey 2016 to determine the prevalence of zinc deficiency and associated risk factors among children aged 6–59 months (n = 1462) and non-pregnant women aged 15–49 years (n = 1923). Venous blood was collected from the participants to measure micronutrients such as zinc, markers of anemia, RBP (vitamin A), and markers of inflammation. Stool samples were collected to assess soil-transmitted helminths and Helicobacter pylori infection. Socio-demographic, household, and other relevant factors were collected by a structured questionnaire. Serum zinc concentration was measured by Microwave Plasma Atomic Emission Spectrometry, and zinc deficiency was defined according to the International Zinc Nutrition Consultative Group’s guidelines. Logistic regression was used to examine the predictors of zinc deficiency among the participants. The overall zinc deficiency in children was 22.9%, while it was higher in non-pregnant women (24.7%). The prevalence of anemia among zinc-deficient children was higher (21.3%) than the zinc non-deficit children (18.7%). The prevalence of anemia was 18% among zinc-deficient non-pregnant women compared to 22% non-deficit non-pregnant women. Predictors associated with zinc deficiency among the study children were living in rural areas (AOR = 2.25, 95% CI, [1.13, 4.49]), the occurrence of diarrhea during the two weeks preceding the survey (AOR = 1.57, 95% CI, [1.07, 2.30]), lowest household wealth quintile (AOR = 0.48, 95% CI, [0.25, 0.92]) and lower vitamin A status (AOR = 0.49, 95% CI, [0.28, 0.85]. The predictors associated with zinc deficiency among non-pregnant women were: being underweight (AOR = 1.55, 95% CI, [1.12, 2.15]), fever occurrence during two weeks preceding the survey (AOR = 1.43, 95% CI, [1.04, 1.98]), H. pylori in the stool (AOR = 1.33, 95% CI, [1.04, 1.71]), lowest household wealth quintile (AOR = 0.62, 95% CI,[0.40, 0.94]) and being at risk of folate deficiency (AOR = 0.58, 95% CI,[0.36, 0.94]). We conclude that community-level intervention programs focused on rural children and women to prevent diarrhea, improve nutrition counseling, and provide economic opportunities in rural communities may help to lower zinc deficiency and other micronutrient deficiencies in the Nepalese population. We believe that intervention programs to address zinc deficiency should not be isolated. Instead, integrated approaches are beneficial to improve overall micronutrient status, such as encouraging dietary diversity, providing livelihood opportunities to the unemployed, micronutrient supplementation to vulnerable populations, and consumption of zinc-rich animal-based foods.

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Prevalence of ocular signs and subclinical vitamin A deficiency and its determinants among rural pre-school children in India

Public Health Nutrition ◽

10.1017/s136898001100214x ◽

2011 ◽

Vol 15 (4) ◽

pp. 568-577 ◽

Cited By ~ 18

Author(s):

Avula Laxmaiah ◽

Madhavan K Nair ◽

Nimmathota Arlappa ◽

Pullakhandam Raghu ◽

Nagalla Balakrishna ◽

...

Keyword(s):

Vitamin A ◽

School Children ◽

Rural Areas ◽

Vitamin A Deficiency ◽

Economic Status ◽

Dried Blood Spots ◽

Sampling Procedure ◽

Serum Retinol ◽

Cross Sectional ◽

Ocular Signs

AbstractObjectiveTo assess the magnitude and determinants of vitamin A deficiency (VAD) and coverage of vitamin A supplementation (VAS) among pre-school children.DesignA community-based cross-sectional study was carried out by adopting a multistage, stratified, random sampling procedure.SettingRural areas of eight states in India.SubjectsPre-school children and their mothers were covered.ResultsA total of 71 591 pre-school children were clinically examined for ocular signs of VAD. Serum retinol concentrations in dried blood spots were assessed in a sub-sample of 3954 children using HPLC. The prevalence of Bitot spots was 0·8 %. The total ocular signs were significantly higher (P < 0·001) among boys (2·6 %) compared with girls (1·9 %) and in older children (3–4 years) compared (P < 0·001) with younger (1–2 years), and were also high in children of labourers, scheduled castes and illiterate mothers. The odds of having Bitot spots was highest in children of scheduled caste (OR = 3·8; 95 % CI 2·9, 5·0), labourers (OR = 2·9; 95 % CI 2·1, 3·9), illiterate mothers (OR = 2·7; 95 % CI 2·2, 2·3) and households without a sanitary latrine (OR = 5·9; 95 % CI 4·0, 8·7). Subclinical VAD (serum retinol level <20 μg/dl) was observed in 62 % of children. This was also relatively high among scheduled caste and scheduled tribe children. The rate of coverage of VAS was 58 %.ConclusionsThe study revealed that VAD is a major nutritional problem and coverage of VAS was poor. The important determinants of VAD were illiteracy, low socio-economic status, occupation and poor sanitation. Strengthening the existing VAS programme and focused attention on dietary diversification are essential for prevention of VAD.

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Albendazole increases serum retinol concentration in primary schoolchildren with low serum retinol

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2015.v34.121-128 ◽

2015 ◽

Vol 34 (2) ◽

pp. 121

Author(s):

Jane Florida Kalumpiu ◽

Yenny Djuardi ◽

Taniawati Supali

Keyword(s):

Vitamin A ◽

Primary School ◽

School Children ◽

High Performance ◽

Vitamin A Deficiency ◽

Primary School Children ◽

Serum Retinol ◽

Serum Retinol Concentration ◽

Retinol Concentration ◽

Low Serum

Background Soil-transmitted helminth (STH) infection is still a health problem in Indonesia. Vitamin A deficiency (VAD) is often found together with STH. The effect of the deworming program on the vitamin A status of primary school children is unknown. The objective of this study was to evaluate the effect of albendazole on serum retinol concentrations in primary school children. Methods An experimental study of pre-post test design without control was carried out on 118 children from grades 3-5 at one primary school in North Jakarta, from July to September 2014. Flotac examination was used to determine STH infections and high performance liquid chromatography was performed to measure serum retinol concentration. Stool and blood samples were taken twice: before and three weeks after treatment with albendazole 400 mg single dose for three consecutive days given to all children either infected or uninfected. Paired t-test was used to analyze the data. Results Of the 118 children, the prevalence of STH was 71.2%. The prevalence of low retinol serum (<1.05 mmol/L) was 17 (17.2%) and of mild VAD was 2 (2.0%). Albendazole given in 3 consecutive days could not increase serum retinol concentrations (p=0.055). Serum retinol concentration significantly increased after albendazole treatment in children with low retinol serum at baseline (p=0.001). Conclusions In children with low serum retinol concentration, treatment with albendazole increased retinol concentration. Integrated deworming and vitamin A supplementation strategies should be evaluated in this population.

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Effect of single-dose albendazole and vitamin A supplementation on the iron status of pre-school children in Sichuan, China

British Journal Of Nutrition ◽

10.1017/s0007114516000350 ◽

2016 ◽

Vol 115 (8) ◽

pp. 1415-1423 ◽

Cited By ~ 4

Author(s):

Ke Chen ◽

Hu Mina Xie ◽

Weizheng Tian ◽

Xiaoling Zheng ◽

Alice C. Jiang

Keyword(s):

Single Dose ◽

Vitamin A ◽

School Children ◽

Vitamin A Deficiency ◽

Iron Status ◽

Control Group ◽

Serum Retinol ◽

Group 3 ◽

Group 2

AbstractThe aim of this study was to explore the effect of single-dose albendazole and vitamin A intervention on the anaemic status and Fe metabolism of pre-school children. This study was a randomised, placebo-controlled and double-blinded intervention trial. All eligible anaemic pre-school children were randomly divided into three groups: group 1 received no intervention, which served as the control group, group 2 received 400 mg single-dose albendazole administration and group 3 received a 60000 μg vitamin A capsule combined with 400 mg single-dose albendazole at the beginning of the study. The follow-up period was for 6 months. Anthropometry and biochemical index about Fe metabolism were measured before and after intervention. A total of 209 pre-school anaemic children were randomly divided into three intervention groups (sixty-four, sixty-two and sixty for groups 1, 2 and 3, respectively). The mean age of the children in the study was 4·4 (sd 0·7) years and 50·5 % of the children were female (94/186). After a follow-up period of 6 months, the levels of serum retinol, ferritin, transferrin receptor-ferritin index and body total Fe content of children in group 3 were significantly higher compared with children in groups 1 and 2 (P<0·05). Moreover, the proportion of vitamin A deficiency, marginal vitamin A deficiency and Fe deficiency among children in group 3 were markedly lower compared with children in groups 1 and 2 (P<0·05). Albendazole plus vitamin A administration showed more efficacy on the improvement of serum retinol and Fe metabolic status.

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Re-Defining the Population-Specific Cut-Off Mark for Vitamin A Deficiency in Pre-School Children of Malawi

Nutrients ◽

10.3390/nu13030849 ◽

2021 ◽

Vol 13 (3) ◽

pp. 849

Author(s):

Blessings H. Likoswe ◽

Edward J. M. Joy ◽

Fanny Sandalinas ◽

Suzanne Filteau ◽

Kenneth Maleta ◽

...

Keyword(s):

Vitamin A ◽

School Children ◽

Vitamin A Deficiency ◽

Threshold Concentration ◽

The Body ◽

Retinol Binding Protein ◽

World Health ◽

Target Tissue ◽

Serum Retinol ◽

Health Organization

Retinol Binding Protein (RBP) is responsible for the transport of serum retinol (SR) to target tissue in the body. Since RBP is relatively easy and cheap to measure, it is widely used in national Micronutrient Surveys (MNS) as a proxy for SR to determine vitamin A status. By regressing RBP concentration against SR concentration measured in a subset of the survey population, one can define a population-specific threshold concentration of RBP that indicates vitamin A deficiency (VAD). However, the relationship between RBP and SR concentrations is affected by various factors including inflammation. This study, therefore, aimed to re-define the population-specific cut-off for VAD by examining the influence of inflammation on RBP and SR, among pre-school children (PSC) from the 2015–16 Malawi MNS. The initial association between RBP and SR concentrations was poor, and this remained the case despite applying various methods to correct for inflammation. The World Health Organization (WHO) recommends the threshold of 0.7 µmol/L to define VAD for SR concentrations. Applying this threshold to the RBP concentrations gave a VAD prevalence of 24%, which reduced to 10% after inflammation adjustments following methods developed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA). Further research is required to identify why SR and RBP were poorly associated in this population. Future MNS will need to account for the effect of inflammation on RBP to measure the prevalence of VAD in Malawi.

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Relationship of serum carotenoids and retinol with anaemia among pre-school children in the northern mountainous region of Vietnam

Public Health Nutrition ◽

10.1017/s1368980010000571 ◽

2010 ◽

Vol 13 (11) ◽

pp. 1863-1869 ◽

Cited By ~ 10

Author(s):

Nguyen Cong Khan ◽

Phan Van Huan ◽

Nguyen Van Nhien ◽

Le Danh Tuyen ◽

Saskia de Pee ◽

...

Keyword(s):

Vitamin A ◽

School Children ◽

Vitamin A Deficiency ◽

Geometric Mean ◽

Provitamin A ◽

Mountainous Region ◽

Serum Retinol ◽

Provitamin A Carotenoids ◽

Serum Carotenoids ◽

Β Carotene

AbstractObjectiveTo characterize the relationship between serum carotenoids, retinol and anaemia among pre-school children.DesignA cross-sectional study was conducted in two groups: anaemic and non-anaemic. Serum levels of retinol, α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin were measured in the study subjects.SettingSix rural communes of Dinh Hoa, a rural and mountainous district in Thai Nguyen Province, in the northern mountainous region of Vietnam.SubjectsA total of 682 pre-school children, aged 12–72 months, were recruited.ResultsGeometric mean serum concentrations of carotenoids (μmol/l) were 0·056 for α-carotene, 0·161 for β-carotene, 0·145 for β-cryptoxanthin, 0·078 for lycopene, 0·388 for lutein and 0·075 for zeaxanthin. The mean levels of Hb and serum retinol were 108·8 g/l and 1·02 μmol/l, respectively. The prevalence of anaemia and vitamin A deficiency was 53·7 % and 7·8 %, respectively. After adjusting for sex and stunting, serum retinol concentrations (μmol/l; OR = 2·06, 95 % CI 1·10, 3·86, P = 0·024) and total provitamin A carotenoids (μmol/l; OR = 1·52, 95 % CI 1·01, 2·28, P = 0·046) were independently associated with anaemia, but non-provitamin A carotenoids (μmol/l; OR = 0·93, 95 % CI 0·63, 1·37, P = 0·710) were not associated with anaemia.ConclusionsAmong pre-school children in the northern mountainous region of Vietnam, the prevalences of vitamin A deficiency and anaemia are high, and serum retinol and provitamin A carotenoids are independently associated with anaemia. Further studies are needed to determine if increased consumption of provitamin A carotenoids will reduce anaemia among pre-school children.

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Vitamin A Levels Among Pre-School Children of Central and Western China

Frontiers in Public Health ◽

10.3389/fpubh.2021.694106 ◽

2021 ◽

Vol 9 ◽

Author(s):

Qian Chen ◽

Yongfang Liu ◽

Li Chen ◽

Jie Chen ◽

Ting Yang ◽

...

Keyword(s):

Vitamin A ◽

School Children ◽

Vitamin A Deficiency ◽

Western China ◽

Healthy Children ◽

Serum Retinol ◽

Developing Regions ◽

Children's Caregivers ◽

Social Demographic ◽

And Control

Objective: To investigate vitamin A deficiency of pre-school children in central and western China for developing strategies to prevent and control vitamin A deficiency (VAD) among children.Design: From November 2018 to September 2019, a total of 2,194 healthy children aged 2–6 years were enrolled. Serum retinol levels in the children were detected by liquid-phase tandem mass spectrometry. In addition, social demographic and dietary questionnaires were collected through interviews with children's caregivers.Setting: The participants were enrolled in 12 cities or their subordinate jurisdictions in the central and western regions of China.Participants: Two thousand one hundred and ninety four healthy children aged 2–6 years old.Results: Overall, 35.51% (779/2,194) of the children were found to be vitamin A insufficient (VAI, serum retinol < 1.05 μmol/L). Elder children had a higher risk to suffer from VAI, with proportions of 25.00% (87/348), 28.92% (142/491), 38.38% (256/667), and 42.73% (294/688) among children aged 2, 3, 4, and 5 years, respectively. Vitamin A levels were also positively correlated with per capita income (AOR = 1.18) and regional economic level (0.71), and the frequency of milk intake (0.91).Conclusions: The incidence of VAI was higher among children aged 2–6 years, and the incidence of VAI increases with age. VA levels were positively correlated with levels of economic development in the family and region. So prevention strategies for VAD need to focus on pre-school children, especially dairy intake and developing regions.

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