Illustration of the Importance of Adjustment for within- and between-Person Variability in Dietary Intake Surveys for Assessment of Population Risk of Micronutrient Deficiency/Excess Using an Example Data Set

Nutrition intervention decisions should be evidence based. Single 24-h recalls are often used for measuring dietary intake in large dietary studies. However, this method does not consider the day-to-day variation in populations’ diets. We illustrate the importance of adjustment of single 24-h recall data to remove within-person variation using the National Cancer Institute method to calculate usual intake when estimating risk of deficiency/excess. We used an example data set comprising a single 24-h recall in a total sample of 1326 1–<10-year-old children, and two additional recalls in a sub-sample of 11%, for these purposes. Results show that risk of deficiency was materially overestimated by the single unadjusted 24-h recall for vitamins B12, A, D, C and E, while risk of excess was overestimated for vitamin A and zinc, when compared to risks derived from usual intake. Food sources rich in particular micronutrients seemed to result in overestimation of deficiency risk when intra-individual variance is not removed. Our example illustrates that the application of the NCI method in dietary surveys would contribute to the formulation of more appropriate conclusions on risk of deficiency/excess in populations to advise public health nutrition initiatives when compared to those derived from a single unadjusted 24-h recall.

Bentuk dan Peran Kapital Sosial dalam Percepatan Penurunan Stunting di Desa Pandawangi, Lombok Timur

The Poor nutritional status of children under five years of age remains a major concern in Indonesia. Based on RISKESDAS (Basic Health Survey) 2018, NTB province was listed as one of the 10 provinces with the highest stunting rates in Indonesia with 33,49 children are stunted, and Lombok Timur district was the highest stunting in NTB with prevalence reached 43, 5 %. Considering the long-lasting effects of child malnutrition, the district government of Lombok Timur put stunting reduction program as a priority. In 2017, Pandanwangi village was selected as one pilot village for implementing the national strategy to accelerate stunting prevention and reduction. Pandanwangi village successfully implemented integrated approach dealing with stunting reduction through specific and sensitive nutrition intervention. The aim of the study was to identify the form and role of social capital on stunting reduction program activities in Pandanwangi village. This was a qualitative study on collecting information from informants the health and non-health sector. Data were collected through in-depth interviews, observation and focus group discussion. The results showed that several forms of social capital included in social bonding, bridging, linking and played a role in the acceleration of the decline in stunting. Based on the research results, each type of social capital plays an important role in creating a enabling environment in stunting reduction efforts. The results of the study also showed a synergy between various forms of social capital that allowed the community to accelerate stunting reduction in Pandawangi Village.

DIETARY MANAGEMENT OF CKD IN DIABETIC PATIENT IN A TERTIARY CARE HOSPITAL

Chronic kidney disease (CKD) is perhaps the most pervasive entanglements of diabetes, and patients with diabetic kidney disease (DKD) have a considerably higher danger of cardiovascular disease and demise contrasted with their non-diabetic CKD partners. Notwithstanding pharmacologic management procedures, nutritional and dietary mediations in DKD are a fundamental part of the board with the potential for enhancing kidney function decay and forestalling the improvement of opposite of other end-organ complications. In this study we detailed a patient having CKD and observed all require parameter in dietary management. Initial days, the patients Hb level was below normal, so, he was suggested iron-rich foods like beetroot, turnip, and carrot, raw banana in stewed form or in curry form. Also, in later, as the urea and creatinine content of the patient was too high from the normal patient, he was restricted from consuming protein-rich foods. On the day of discharge, all his reports were up to mark except urea and creatinine, as he was renal patient. Although nutrition intervention for DKD does require calculation of macro- and micronutrient and electrolyte requirements, a growing body of evidence suggests that specific dietary patterns of intake may confer additional therapeutic benefit.

Midday meals as an early childhood nutrition intervention: evidence from plantation communities in Sri Lanka

Background High rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of 5 years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children. Methods The study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data was collected on heights and weights of children, between 2013 and 2015. Standardized weight-for-age, height-for-age and weight-for-height, and binary variables for stunting, wasting and underweight are constructed, following WHO guidelines. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth while random-effects logistic regression is used for the binary outcomes. Robustness analysis involves different estimation methods and subsamples. Results The dataset comprises of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model specifications and across different subsamples by gender, birthweight and birth-year cohort. Conclusions Midday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka.