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Background: Vitamin B12 deficiency is prevalent worldwide especially in vegetarian communities. Its deficiency in early childhood may result in serious neurological and cognitive deficits. It is important to know the prevalence among our infants and toddlers so that nutritional policy changes could be suggested in this regard., Objective: To evaluate the vitamin B12 status of apparently healthy Indian children between 6 and 23 months of age., Methods: Apparently healthy Indian children (n = 210), of age 6 to 23 months, attending pediatric outpatient department were recruited and samples obtained to evaluate their hemogram and levels of vitamin B12, folate, and ferritin. Data were analyzed to obtain the mean levels and the proportion of participants deficient in vitamin B12. The dietary habits of the children were also analyzed and correlated with their vitamin B12 status., Results: Vitamin B12 deficiency was observed in 37.6% of the participants., Conclusions: There is a high prevalence of vitamin B12 deficiency in our infants and toddlers, and there is need to initiate supplement to prevent any possible neurological consequences. Early initiation of animal milk had a positive effect on the vitamin B12 status of the child, though it was not significant.

Background: In Thailand, despite widespread improvements in child nutrition, stunting is still highly prevalent among northern hill tribe children., Objective: To understand how villagers and health workers (volunteers and officials) gauge health of children younger than 5 years, whether growth monitoring is salient, and the relationships of villagers with the health system in this remote location., Methods: Qualitative research was undertaken with 8 hill tribe villages. A workshop on infant and young child health and nutrition was held with 8 village health volunteers, 2 per village, selected by a public health officer. In-depth interviews were conducted with 20 villagers and 2 volunteers who had children 0 to 5 years. Eight other health workers were also interviewed. All dialogue was conducted in Thai through bilingual facilitators and recorded, transcribed, and translated into English. Transcripts were coded and analyzed thematically within and across participant groups., Results: Overall, villagers considered strength and independence of children to be hallmarks of health; the size of children featured rarely. Volunteers did not perceive local benefits of growth monitoring, and the extent of child malnutrition was unclear to them. Nutrition counseling was seldom mentioned by villagers or health workers. Across all accounts, and considering silences, relationships of villagers with the health system seemed fragile., Conclusion: Villagers understand child health in terms of functional abilities rather than size. Volunteer health workers in this remote location have limited resources and support. Together this helps explain why, against a background of poverty and food insecurity, growth monitoring does not translate to improvements in child nutrition.

Background: Understanding the context of infant and young child feeding (IYCF) is recognized as essential for designing appropriate complementary feeding interventions., Objective: Our objective was to study household IYCF behaviors in 2 districts in southern and northern Ghana to identify opportunities to improve existing nutrition programs., Methods: We interviewed 80 caregivers of children aged 6 to 23 months using ethnographic methods, including free listing, guided discussions and cognitive mapping techniques, and 24-hour dietary recall. Descriptive statistics and thematic content analysis were used to analyze quantitative and qualitative data., Results: In both settings, children's diets were predominantly maize based. Fish, the main animal source food, was consumed daily but in very small quantities. Milk was consumed by only a few children, in tea and porridge. Fruits were seldom consumed. Household food production did not meet requirements, and the markets were heavily relied on for staples and other key ingredients. Most caregivers demonstrated basic knowledge and understanding of key health and nutrition concepts. Barriers to optimal child feeding identified were lack of money to purchase the nutritious foods recommended for children, seasonal food insecurity, and some caregiver beliefs, practices, and nutrition knowledge gaps. Positive contextual features include caregiver recognition of the dietary needs of young children and commitment to provide foods to meet these needs., Conclusion: Our findings suggest that complementary feeding in these rural settings can be improved through reinforcement or modification of strategic components of local health and nutrition education in light of existing barriers and enablers to optimal IYCF.

Background: Micronutrient deficiencies are still highly prevalent in countries undergoing the nutrition transition, but nationally representative data documenting their burden in children are exceedingly rare., Objective: To examine the distribution and recent trends in micronutrient status biomarkers of Colombian children., Methods: We compared the distributions of plasma ferritin, serum zinc, and vitamin A in Colombian children between 2005 and 2010 using 2 cross-sectional, nationally representative surveys overall and by categories of sociodemographic variables. Analysis for ferritin included boys and nonpregnant girls aged 1 to 17 years. Analyses for zinc and vitamin A included children aged 1 to 4 years., Results: The mean 2010 to 2005 differences in ferritin, zinc, and vitamin A were 2.5 µg/L (95% confidence interval [CI]: 1.3 to 3.7), -34.9 µg/dL (95% CI: -39.6 to -30.2), and -11.5 µg/dL (95% CI: -12.3 to -10.7), respectively, after adjusting for sociodemographic characteristics. These differences varied significantly by region of residence. In 2010, region of residence was a significant correlate for all 3 micronutrients. Other important correlates included age and maternal education for ferritin and body mass index-for-age Z score, maternal education, wealth index, food insecurity, and urbanicity for vitamin A., Conclusions: Plasma ferritin was slightly higher in 2010 than in 2005, whereas serum zinc and vitamin A were substantially lower in 2010. In the absence of obvious causal explanations, it is uncertain whether this decline represents a worsening of micronutrient status in Colombian children or an artifact due to systematic laboratory or data management errors incurred in the surveys.

Background: Population exposed to chronic undernutrition in early life seems to be more susceptible to obesity in adulthood due to the development of mechanisms that improve the efficiency of energy use. Therefore, these individuals have relatively reduced energy requirements (thrifty phenotype)., Objective: To investigate, among women living on severe socioeconomic vulnerability, whether short stature, a marker for undernutrition in early life, is associated with excess body weight but not with a high energy intake., Methods: This cross-sectional study, carried out between July and November 2008, evaluated 1308 women from all (N = 39) Quilombola communities of Alagoas. Adequacy of energy intake was estimated by the ratio between energetic ingestion and the estimated energy requirement (EER)., Results: The prevalence of short stature (≤ 154.8 cm) was 43.0% and 52.4% had excess body weight (body mass index ≥ 25 kg/m 2 ), being that 33.1% were overweight and 19.3% obese. Excess body weight was higher among women with short stature (56.6% vs 49.2%; P = .008), even after adjusting for age, energy intake, and per capita income (prevalence ratio = 1.16; 95% confidence interval = 1.04; 1.28). The ratio of energy intake/EER was independent of women's stature., Conclusion: Excess body weight among Quilombola women represents a serious health problem. Short stature was significantly associated with excess body weight but not with a high energy intake. "Thrifty phenotype" may be one of the plausible explanations for this finding.

Background: Substantial evidence is emerging on the coexistence of double burden of malnutrition on adolescents of low-income countries, shaping the health challenges of the upcoming adult generation for the worst. Whether nutritional status markers of adolescents in the cash crop setting are on par with economic gains remains uncertain. Thus, we investigated the nutritional outcomes of adolescents and their determinants in coffee farming households., Methods: The survey was carried out in 3 top coffee-producing districts of Jimma Zone, Ethiopia. Five hundred fifty mothers/caregivers and their respective adolescents were selected using multistage random sampling. Anthropometric data were converted into height-for-age and body-mass-index-for-age Z scores using WHO Anthroplus software and analyzed by SPSS for windows., Results: Prevalence of thinness, stunting, and overweight/obesity were 11.6%, 15.6%, and 7.1%, respectively. The odds of stunting among adolescents in households in the lowest wealth tertile was nearly 6-fold higher compared to the highest tertile (adjusted odds ratio [AOR] = 5.6 [2.6-12]). Conversely, the odds of overweight/obesity was higher among adolescents in the households in the middle wealth tertile (AOR = 2.72 [1.08-6.86]) compared to the highest tertile. Adolescents living in households with low-dependent age-groups were more than twice likely to be overweight/obese (AOR = 2.58 [1.06-6.24])., Conclusion: The current study revealed the presence of substantial dual burden of malnutrition. In such a setting, it is critical to draw a fine line and trade-off for eliminating morbidity and mortality of undernutrition, without triggering the risk of overweight/obesity.

Background: Vitamin B12 deficiency in early life can adversely affect the growth of developing brain with myriad of neurodevelopmental manifestations. At this age, the deficiency is usually the result of low maternal levels., Objectives: To assess the vitamin B12 status of healthy exclusively breast-fed Indian infants aged 1 to 6 months and their mothers., Methods: One hundred term exclusively breast-fed infants aged 1 to 6 months attending pediatric outpatient department were recruited. Hemogram, serum B12, folate, and ferritin levels were obtained from each infant-mother pair., Results: The prevalence of B12 deficiency in infants was found to be 57%. Forty-six percent of mothers were deficient. There was a positive correlation ( r = .23) between the B12 levels of the infants and their mothers., Conclusion: There is a high prevalence of vitamin B12 deficiency in Indian infants and their mothers. There is an urgent need to supplement our population with vitamin B12, and the best time to do this would be antenatal.

Background: Height and body segments in children have differential pubertal growth characteristics. Lower leg length is a sensitive indicator of child's nutritional status., Objective: The purpose of this study was to estimate differential timing and tempo of height and knee height (KH) growth in 9- to 17-year-old boys (n = 475) and girls (n = 500) from Merida, Mexico., Methods: In this cross-sectional study, the Preece-Baines growth curves-model 1 (PB 1) was fitted to the anthropometric data for height and KH., Results: Based on the PB 1 model, KH had earlier age at maximum increment than height in boys (height = 12.37 years, KH = 11.54 years) and girls (height = 11.01 years, KH = 10.93 years). Peak velocity of these 2 dimensions was different in both sexes (boys: height = 7.11 cm/yr, KH = 2.25 cm/yr; girls: height = 5.14 cm/yr, KH = 1.45 cm/yr). Differences ( P <.001) by sex were also observed for the estimated size at peak velocity and final size of height and KH., Conclusions: When compared to height, KH was shown to have earlier adolescent growth spurt and a smaller difference between final size and the size at maximum (peak) velocity indicating an earlier age for achieving adult size. Overall, the studied boys and girls had short estimated final size, an earlier age at maximum increment, and a lower peak velocity in height than urban Guatemalan peers, the only regional reference available.

Background: Food banks seeking to rescue and redistribute highly nutritious perishable foods to simultaneously alleviate food insecurity and reduce food waste often encounter practical, ethical, and political dilemmas., Objectives: We present a case study of "Leket Israel," an Israeli food bank that uses an effective large-scale logistical model for the rescue and redistribution of perishable food and discuss the challenges and solutions it offers., Results: The organization operates in a rich country plagued with poverty and inequality, where the government passively encourages nongovernmental organizations to respond to the serious and growing problem of food insecurity. Operating under a business-to-business model, Leket Israel distributes food via intermediary nonprofit organizations (NPOs), enriching the food they provide with fresh produce. Food is obtained through an Agricultural Gleaning project, Self-Growing Farm project, and Meal Rescue project. The partnering NPOs then distribute the food to people in need. Although the rescue and redistribution of highly perishable food is more costly and complex than acquiring, storing, and distributing dried and staple foods and it requires specialized knowledge and infrastructure in order to maintain rigorous safety standards, it improves the nutritional quality of the aid. In 2015, Leket Israel distributed 15 217 389 kg of food, 90% of which was fruit and vegetables, to 180 partnering NPOs nationwide, reaching an estimated 175 000 recipients., Conclusion: "Leket Israel" offers a valuable model that can be studied and emulated by international nutrition scientists, practitioners, and policy makers who are seeking to reduce food insecurity and food waste in other countries.

Background: Fortification of flour is one of the approaches for the control and prevention of vitamin and mineral deficiencies., Objective: To assess the effect of fortification of flour with seven vitamins and minerals on a population of Chinese women., Methods: Farmers who offered their land for reforestation in 25 northwest provinces of China received compensation in the form of wheat flour; the amount of flour given depended on the amount of land that was given up for reforestation. This study observed the effects of providing families with fortified flour in the reforestation areas in Gansu Province. The study was conducted for 3 years. Families in the intervention village who offered land for reforestation received flour fortified with seven vitamins and minerals, and those in the control village received unfortified flour. Seven surveys, spaced at least 6 months apart, were carried out in each village from 2004 to 2007. At baseline and at each annual survey, measurements and blood samples were taken from 300 adult female subjects aged 20 to 60 years to assess dietary intake, height, weight, body fat, hemoglobin, serum retinol, serum iron, free erythrocyte protoporphyrin, serum zinc. Serum folic acid was measured at baseline and 36-month only. At each 6-month survey, data were collected on anthropometric features, hemoglobin, and dietary intake., Results: Consumption of fortified flour in the intervention village ranged from 158.7 to 232.7 g per person per day. Serum retinol status was significantly improved after 12-month intervention until the end of the trial compared with both the control group and the baseline level of the intervention group. Iron status expressed as FEP and SI levels showed higher than that of the control group and baseline levels only at 36-month. Hemoglobin levels of the intervention group were higher than that of the control group and baseline levels, but anemia prevalence of both the intervention and control groups remained unchanged in the intervention period. Levels of serum zinc showed increases compared with the control group and baseline data at 24-month and 36-month, and levels of serum folic acid of intervention group in 36-month was higher than that of both the control group and baseline level., Conclusions: The evidence from this study confirms the positive bioeffectiveness of fortified flour in the rural female population in China, but a higher dosage of electrolytic elementary iron in flour fortification was suggested for anemia prevention and control.

Background: Households affected by HIV/AIDS are at an increased risk for food insecurity and malnutrition. Poor nutrition contributes to more than a third of all deaths associated with infectious diseases among children under 5 years of age in developing countries. With increased household food insecurity, and a greater disease burden associated with HIV/AIDS, the growth of children under five could be impacted, resulting in increased malnutrition for this vulnerable group., Objective: To determine whether there is an association between the type of household (HIV-affected compared with HIV-unaffected) and the nutritional status of children under 5 years of age residing in these households., Methods: The study was set in a Millennium Village Project site in western Kenya and used a cross-sectional design to compare the stunting, wasting, and underweight status among 102 and 99 under-five children living in HIV-affected and -unaffected households, respectively. Height-for-age, weight-for-age, and weight-for-age z-scores were calculated based on the World Health Organization growth standards and compared. Proportions, means, and standard deviations were used to describe the data. The data were analyzed with the use of the chi-square test for comparison of proportions and the independent t-test for comparison of means., Results: Children in HIV-affected households had a significantly higher degree of stunting (height-for-age < -2 SD) than children in unaffected households (25.5% vs. 9.1%, p = .002). The degree of wasting and underweight did not differ significantly between HIV-affected and -unaffected households., Conclusions: Residing in HIV-affected households is associated with stunting in children under 5 years of age.

Background: Socioeconomic status (SES) is postulated to be a major predictor of dietary intake and nutrition-related knowledge in adults. To date, very few studies have addressed this effect among adolescents., Objective: To explore differences in nutrient intake and nutrition-related knowledge among adolescents of contrasting SES in Lebanon., Methods: In a cross-sectional survey, 209 males and females, aged 17 to 19 years, were recruited from a private university with high tuition and a free public university in Beirut. The participants completed a multicomponent, self-administered questionnaire that inquired about demographic characteristics and nutrition-related knowledge. Three nonconsecutive 24-hour dietary recalls were obtained through interviews. Energy-adjusted means of dietary intake and age-adjusted nutrition-related knowledge were compared between groups using a general linear model., Results: Adolescents in the high-SES group consumed more vegetables, meats, and fats and oils (p < .05). Energy and nutrient intake analysis showed that adolescents in the high-SES group consumed significantly higher amounts of calories, protein, fat, vitamin A, vitamin C, and iron (p < .001) and significantly lower amounts of carbohydrates (p < .05). Nutritional knowledge, although high among all participants, was higher in the high-SES group (p < .05)., Conclusions: Although both groups showed good nutrition-related knowledge, SES significantly affected dietary intake in a sample of Lebanese adolescents. This warrants consideration of other factors, such as cost and environment, that may modulate eating behavior among adolescents from different socioeconomic strata.

Background: Preschool children call for focused attention in India because India has the highest percentage of undernourished children in the world., Objective: To compare the growth and nutritional status of Indian preschool children for the periods 1998/99 and 2005/06,, Subjects and Methods: Using data on weight and length/height as well as the sociodemographic background of preschool children from the National Family Health Surveys (NFHS) from 1998/99 and 2005/06, we determined the distribution of weight and length/height and their association with sociodemographic variables., Results: The distributions of weight and length/height around the mean remained remarkably stable over age but were much greater in India than the international norms. The rates of growth of mean weight and length/ height were far lower in India than the international norms up to the age of 2 years. The temporal trend indicates declines in the percentages of undernourished (low weight-for-age) and stunted (low height-for-age) children over the 7-year period, although the degree of improvement was far better for stunting than for underweight. Mother's educational status is the only variable that has been found to influence child nutrition., Conclusion: The level of mothers' education needs urgent attention with top priority to reduce the prevalence of underweight and stunting of children. This also implies that, for future benefit, girls should be given more facilities for better education. Breastfeeding and weaning practices also need special attention.