Efficacy of a community-based dietary intervention to enhance micronutrient adequacy of high-phytate maize-based diets of rural Malawian children

Yeudall, Fiona; Gibson, Rosalind S.; Cullinan, Tim; Mtimuni, Beatrice

doi:10.1079/phn2005744

Cited by 33 publications

(35 citation statements)

References 53 publications

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“…Habitual low Ca intake increases the fractional Ca absorption rate by up-regulating active transcellular Ca transport in the duodenum (16) . On the other hand, phytate and oxalate in vegetables may decrease the fractional Ca absorption rate (17,18) . Several studies have shown that Asian adolescents (13,19) and women (17) have higher fractional Ca absorption compared with Caucasians (20,21) , which seems to be related to Values are presented as number and percentage, except for daily Ca intake (mean and standard error).…”

Section: Discussionmentioning

confidence: 99%

“…the low Ca intake in Asians (2) . However, prevalent vitamin D deficiency (22,23) and the vegetable-rich diet among Asian populations (17,18) may interfere with Ca absorption, resulting in poor mineral accretion and osteoporosis in later life. The 2011 report of the Institute of Medicine stated that the recommended Ca intake ranges from 700 mg/d (1-3 years) to 1300 mg/d (9-18 years) and the EAR from 500 mg/d (1-3 years) to 1100 mg/d (9-18 years) for American and Canadian children and adolescents (24) .…”

Section: Discussionmentioning

confidence: 99%

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Inadequate calcium intake is highly prevalent in Korean children and adolescents: the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2010

Kim

Lee

et al. 2013

Public Health Nutr.

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Objective: The present study aimed to assess the adequacy of Ca intake and major food sources of Ca in Korean children and adolescents. Design: A cross-sectional study. Setting: Data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2007-2010. We analysed the daily Ca intake, major food sources of Ca and the prevalence of inadequate Ca intake in the study population. Ca intake was categorized as inadequate when the participant's daily Ca intake was less than the Estimated Average Requirement. Subject: The study population consisted of 7233 children and adolescents (3973 boys, 3260 girls; aged 1-18 years). Results: Mean Ca intake was 510?2 mg/d in boys and 431?7 mg/d in girls. Overall, 75?0 % of adolescents (boys 71?6 %, girls 79?1 %) had inadequate Ca intake. The prevalence of inadequate Ca intake increased significantly from toddlers (45-55 %) to adolescents (78-86 %) in both genders. The highest ranked food sources for Ca were dairy products (35?0 %), followed by vegetables (17?3 %), grains (11?3 %) and seafood (9?9 %). Ca intake from dairy products decreased significantly from 57 % in toddlers to 30 % in adolescents, while Ca intakes from other foods increased with age. Conclusions: Inadequate Ca intake is highly prevalent and increased with age in Korean children and adolescents. It should be emphasized to encourage children and adolescents to eat more Ca-rich products to meet their Ca needs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inadequate calcium intake is highly prevalent in Korean children and adolescents: the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2010

Kim

Lee

et al. 2013

Public Health Nutr.

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“…The average portion size that a child aged 3-5 y consumes of these foods, and the nutrient composition of the food was assumed to be the same as that in a previous study conducted in this district of Malawi (15). Values for average daily energy and zinc intake were calculated using the reported amount consumed on the food frequency questionnaire and previous portion size and composition data (16,17).…”

Section: Methodsmentioning

confidence: 99%

Perturbed Zinc Homeostasis in Rural 3–5-y-Old Malawian Children Is Associated With Abnormalities in Intestinal Permeability Attributed to Tropical Enteropathy

et al. 2010

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ABSTRACT:Tropical enteropathy and zinc deficiency are major public health problems worldwide. Tropical enteropathy is characterized by reduced mannitol absorption with normal or increased lactulose absorption when a dual sugar absorption test is administered, the results of which are reported as the lactulose:mannitol ratio (L:M). Zinc homeostasis is quantified with a dual stable isotope test. This study tested the hypothesis that endogenous fecal zinc (EFZ) was correlated with the L:M. A dual sugar absorption test and dual stable isotope test were performed on 25 asymptomatic Malawian children aged 3-5 y at risk for tropical enteropathy and zinc deficiency. EFZ and net zinc retention were estimated and correlated with the L:M. Twenty-two children (88%) had an abnormal L:M (L:M Ͼ0.10), and the L:M was 0.24 Ϯ 0.10 (mean Ϯ SD). EFZ was 1.68 Ϯ 1.06 mg/d, a quantity greater than is seen in healthy populations from the developed world. EFZ was positively correlated with the L:M (r ϭ 0.62, p Ͻ 0.001). Net zinc retention (0.67 Ϯ 1.6 mg/d) was negatively correlated with the L:M (r ϭ Ϫ0.47, p ϭ 0.02). This suggests that perturbed zinc homeostasis is associated with subclinical enteropathy in these children. Z inc deficiency is estimated to account for 4.4% of child deaths worldwide, and one-third of the world's children are at risk for zinc deficiency (1). The morbidity associated with zinc deficiency includes stunting, reduced capacity for physical work, and increased susceptibility to infection. Zinc retention in humans is not simply determined by the amount of dietary zinc consumed but also by reabsorption of endogenous zinc secreted into the small intestine. The reabsorption of endogenous zinc from the gut is believed to be a mechanism by which zinc homeostasis is maintained (2). The dual zinc stable isotope test involves administration of different zinc stable isotopes orally and i.v. and has been used to quantify the primary parameters that determine zinc homeostasis (3). Measurements of total dietary absorbed zinc (TAZ), endogenous fecal zinc (EFZ), and net zinc retention (NZR) have been made using this technique (3-6).Tropical enteropathy is a diffuse villous atrophy of the small bowel associated with inflammatory T cell infiltration (7,8). Tropical enteropathy is a chronic, subclinical condition of unknown etiology, distinguished from acute enteropathies associated with gastrointestinal infections. Changes in stool pattern or consistency are not apparent in children with tropical enteropathy. Tropical enteropathy is associated with stunting of otherwise healthy preschool aged children in developing countries (9). The damage to the normal intestinal architecture is associated with compromised capacity to absorb macronutrients (10). Tropical enteropathy is ubiquitous throughout the developing world, prevalence estimates in communities often exceed 75% (11).The dual sugar absorption test uses the nonmetabolized sugars mannitol and lactulose, which are administered orally and measured in the urine. The urinary lactu...

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“…Pre-and post-intervention, women's food intake data were collected using a single four-pass 24-hour diet recall [16,28]. Nutrition knowledge and practices data was collected using an adapted structured questionnaire [29].…”

Section: Data Collectionmentioning

confidence: 99%

Effect of nutrition education and dairy group membership on nutrition knowledge, practices and diet quality for rural Kenyan farm women

Walton¹,

VanLeeuwen²,

MacLellan³

et al. 2017

AJFAND

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The typical high-starch, low diversity diet in developing countries is associated with undernutrition, morbidity and mortality. Previous research with households in Mukurwe-ini Division (Central Kenya) found that members of a community-based dairy development group were more food secure and had higher intake of certain micronutrients compared with non-members; however, the prevalence of inadequate intake of multiple micronutrients was high among all women. A nutrition education intervention was developed to enhance women's nutrition knowledge and food skills to ultimately improve diet quality and micronutrient intakes for women and their families. In addition, it was proposed that the intervention effects would be greater for dairy group members. The Mukurwe-ini study group consisted of 88 women in four dairy membership-duration categories (n=4 x 22) and non-member women (n=23). The study group was previously selected using chain referral sampling. For the intervention, women from each duration-group and non-member women were randomly allocated to intervention (n=55) and control (n=56) groups. Nutrition knowledge and dietary intake (24-hour recall) data were collected from all women over three weeks immediately prior to the intervention (baseline) and again, six months post-intervention, in individual face-to-face interviews. The intervention encouraged food-based strategies to improve intake of vitamin A, iron and zinc and was developed and delivered in collaboration with a Kenyan dietitian. WFood2 was used to compute food and nutrient intakes, dietary diversity and the phytate:zinc molar ratio. Descriptive statistics and linear and logistic regressions analyses were performed using Stata10. Independent of dairy-group membership, a larger proportion of intervention group women, compared to control group women, had the targeted nutrition knowledge and practiced the strategies to improve intake of vitamin A (76% vs 67%, respectively) and zinc and iron (soaked beans and maize 80% vs 13%; avoided tea with meals 67 % vs 5%, respectively). A positive effect of the intervention on dietary diversity was dependent on dairy-group membership status. Positive intervention effects on intake of vitamin A and C were found for non-member women. This study provided evidence that certain intervention effects were dependent on poverty reduction and that all women were able to make positive dietary changes when informed. There is a need to examine longerterm impacts of nutrition education interventions and to explore effective methods to disseminate nutrition information and food-based strategies.

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Efficacy of a community-based dietary intervention to enhance micronutrient adequacy of high-phytate maize-based diets of rural Malawian children

Cited by 33 publications

References 53 publications

Inadequate calcium intake is highly prevalent in Korean children and adolescents: the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2010

Inadequate calcium intake is highly prevalent in Korean children and adolescents: the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2010

Perturbed Zinc Homeostasis in Rural 3–5-y-Old Malawian Children Is Associated With Abnormalities in Intestinal Permeability Attributed to Tropical Enteropathy

Effect of nutrition education and dairy group membership on nutrition knowledge, practices and diet quality for rural Kenyan farm women

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