Selenium intakes and plasma selenium of New Zealand toddlers: secondary analysis of a randomised controlled trial.

Little is known about Se intakes and status in very young New Zealand children. However, Se intakes below recommendations and lower Se status compared with international studies have been reported in New Zealand (particularly South Island) adults. The Baby-Led Introduction to SolidS (BLISS) randomised controlled trial compared a modified version of baby-led weaning (infants feed themselves rather than being spoon-fed), with traditional spoon-feeding (Control). Weighed 3-d diet records were collected and plasma Se concentration measured using inductively coupled plasma mass spectrometry (ICP-MS). In total, 101 (BLISS n 50, Control n 51) 12-month-old toddlers provided complete data. The OR of Se intakes below the estimated average requirement (EAR) was no different between BLISS and Control (OR: 0·89; 95 % CI 0·39, 2·03), and there was no difference in mean plasma Se concentration between groups (0·04 µmol/l; 95 % CI -0·03, 0·11). In an adjusted model, consuming breast milk was associated with lower plasma Se concentrations (-0·12 µmol/l; 95 % CI -0·19, -0·04). Of the food groups other than infant milk (breast milk or infant formula), 'breads and cereals' contributed the most to Se intakes (12 % of intake). In conclusion, Se intakes and plasma Se concentrations of 12-month-old New Zealand toddlers were no different between those who had followed a baby-led approach to complementary feeding and those who followed traditional spoon-feeding. However, more than half of toddlers had Se intakes below the EAR.

Differences in Micronutrient Intakes of Exclusive and Partially Breastfed Indonesian Infants from Resource-Poor Households are Not Accompanied by Differences in Micronutrient Status, Morbidity, or Growth.

BACKGROUND: When maternal micronutrient intakes and statuses are compromised, reductions in micronutrient concentrations in neonatal stores and human milk may result in suboptimal micronutrient intakes, statuses, and functional outcomes of breastfed infants during the critical first 6-month period. OBJECTIVES: We compared the adequacy of micronutrient intakes and statuses at 2 and/or 5 months and morbidity and growth faltering at 2, 5, and 12 months in a cohort of exclusively breastfed (EBF) and partially breastfed (PBF) infants from low-resource Indonesian households. METHODS: At 2 and 5 months, the breastfeeding status and human milk intake of 212 infants were determined using the deuterium oxide dose-to-mother technique, and intakes were calculated from milk micronutrient concentrations and 3-d weighed food intakes. At 5 months, five infant micronutrient biomarkers, hemoglobin, C-reactive protein, and α-1-acid-glycoprotein were measured. Infant morbidity, weight, and length were measured at 2, 5, and 12 months. Means, medians, or proportions were reported for each group and differences between groups were statistically determined. RESULTS: Median intakes of iron, thiamin, niacin, and vitamin B-12 were higher in PBF than EBF infants at 5 months (all P values < 0.05), but intakes in all infants were below adequate intakes. At 5 months, anemia was <20% in both groups, although fewer PBF versus EBF infants had vitamin B-12 deficiency (11.5% vs. 28.6%, respectively; P = 0.011). The mean ± SD length-for-age z-scores for EBF versus PBF infants at 2 months were 0.7 ± 0.9 versus -0.5 ± 1.1, respectively  (P = 0.158), declining to -1.4 ± 0.9 versus -1.1 ± 1.2, respectively, at 12 months (P = 0.059). Reported morbidity rates were generally low, with no evidence of a difference between infant groups (all P values > 0.126). CONCLUSIONS: Irrespective of exclusive or partial breastfeeding status, micronutrient intakes of infants were low, statuses were compromised, and growth faltering during the critical 6 months period of early infancy was present. The findings highlight the importance of improving maternal nutritional statuses and evaluating their impacts on infant outcomes.

Examination of Carbohydrate Products in Feces Reveals Potential Biomarkers Distinguishing Exclusive and Nonexclusive Breastfeeding Practices in Infants.

BACKGROUND: The stable isotope deuterium dose-to-mother (DTM) technique to estimate nonbreast milk water intake demonstrates that maternal self-report methods of infant feeding overestimate the true prevalence of exclusively breastfeeding practices. OBJECTIVE: We aimed to determine potential monosaccharide and oligosaccharide markers that distinguish between exclusively breastfed (EBF) versus nonexclusively breastfed (non-EBF) infants utilizing LC-MS-based methods. METHODS: Data for the analysis were collected as part of a larger, longitudinal study of 192 breastfed Indonesian infants aged 2 mo and followed up at 5 mo. Feces samples were collected from infants aged 2 mo (n = 188) and 5 mo (n = 184). EBF and non-EBF strata at each time point were determined via the DTM technique. Feces samples were analyzed to determine monosaccharide content using ultra-high-performance LC-triple quadrupole MS (UHPLC-QqQ MS). Relative abundances of fecal oligosaccharides were determined using nano-LC-Chip-quadrupole time-of-flight MS (nano-LC-Chip-Q-ToF MS). RESULTS: At age 2 mo, monosaccharide analysis showed the abundance of fructose and mannose were significantly higher (+377% and +388%, respectively) in non-EBF compared with EBF infants (P <0.0001). Fructose and mannose also showed good discrimination with areas under the curve (AUC) of 0.86 and 0.82, respectively. Oligosaccharide analysis showed that a 6-hexose (Hex6) isomer had good discrimination (AUC = 0.80) between EBF and non-EBF groups at 5 mo. CONCLUSION: Carbohydrate products, particularly fecal mono- and oligosaccharides, differed between EBF and non-EBF infants aged under 6 mo and can be used as potential biomarkers to distinguish EBF versus non-EBF feeding practices.

Including 60 mg Elemental Iron in a Multiple Micronutrient Supplement Blunts the Increase in Serum Zinc after 12 Weeks of Daily Supplementation in Predominantly Anemic, Nonpregnant Cambodian Women of Reproductive Age.

BACKGROUND: Multiple micronutrient (MMN) supplementation may result in interaction effects due to competing absorptive pathways of trace elements. OBJECTIVES: The aim of this study was to investigate the effect of MMN supplementation with or without iron on serum zinc, selenium, and copper concentrations in Cambodian women. METHODS: In a 2 × 2 factorial double-blind randomized 12-wk trial, predominantly anemic, nonpregnant women (aged 18-45 y) received daily 60 mg of iron (Fe; n = 201); 14 other micronutrients including zinc (15 mg), selenium (65 µg), and copper (2 mg), but no iron (MMN; n = 202); 60 mg iron plus MMN (Fe + MMN; n = 206); or a placebo (n = 200). Fasting morning blood was collected at baseline and 12 wk from women in 26 villages in Kampong Chhnang province. Serum zinc, selenium, and copper concentrations (secondary outcomes of the randomized controlled trial) were measured using inductively coupled plasma mass spectrometry. Generalized linear regression was used to estimate intervention effects [ß coefficient (95% CI)] for Fe (with or without MMN) and MMN (with or without Fe) after testing for the presence of an Fe × MMN interaction. RESULTS: A total of 760 women completed the trial. Zinc deficiency prevalence at baseline was 45% (inflammation-adjusted serum zinc <10.7 µmol/L). A significant Fe × MMN interaction (P = 0.02) was detected in the 2 × 2 analysis with serum zinc concentration as the outcome: the MMN group had a higher mean serum zinc concentration at 12 wk (12.3 µmol/L; 95% CI: 12.2, 12.4 µmol/L) compared with all other groups, and the Fe + MMN group had a higher mean serum zinc concentration (11.6 µmol/L; 95% CI: 11.5, 11.7 µmol/L) compared with the Fe group (11.0 µmol/L; 95% CI: 10.9, 11.0 µmol/L) and the placebo group (11.2 µmol/L; 95% CI: 11.1, 11.4 µmol/L). CONCLUSIONS: The inclusion of 60 mg iron in the daily MMN formulation may be interfering with the absorption and/or metabolism of supplemental zinc in Cambodian women. This is of particular concern when MMN supplementation is implemented in populations with risk of zinc deficiency. This trial was registered at clinicaltrials.gov as NCT-02481375.

Development of a nutrient quality score for the complementary diets of Indonesian infants and relationships with linear growth and stunting: a longitudinal analysis.

Reducing multifactorial stunting is a priority for the 2025 WHO Global Nutrition Target. In the plant-based complementary diets of low-income countries, deficits in several growth-limiting micronutrients may contribute to stunting. Hence the intercorrelation between multiple micronutrients in terms of their intake and impact is important. Therefore, our aim was to develop a nutrient quality score using principal component analysis (PCA) in a sample of Indonesian infants at 6, 9 and 12 months of age and to evaluate the association of the scores with linear growth and stunting. At 6 months, 217 infants were recruited from Sumedang District, West Java, with 195 and 189 followed at 9 and 12 months of age, respectively. Complementary food intakes were assessed using 2-d weighed food records. Eight correlated nutrients (vitamin A, ascorbic acid, thiamine, riboflavin, niacin, Ca, Fe and Zn) were summarised using PCA into a single nutrient pattern that explained 56-65 % of the total variability. Nutrient quality scores were related to demographic, inflammation and complementary food indicator variables in hypothesised directions. While no significant relationships were apparent with linear growth, the odds of being stunted at ages 9 and 12 months was lower for infants with a higher nutrient quality score at 9 months (OR 0·75, 95 % CI 0·59, 0·95 and OR 0·69, 95 % CI 0·55, 0·88), respectively, for the fully adjusted models. A data-driven nutrient quality score is a valid tool to assess the influence of nutrient quality on stunting in at-risk infants.

Development of a nonlinear hierarchical model to describe the disposition of deuterium in mother-infant pairs to assess exclusive breastfeeding practice.

The World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months after birth. The deuterium oxide dose-to-the-mother (DTM) technique is used to distinguish EBF based on a cut-off (< 25 g/day) of water intake from sources other than breastmilk. This value is based on a theoretical threshold and has not been verified in field studies. The aim of this study was to estimate the water intake cut-off value that can be used to define EBF practice. One hundred and twenty-one healthy infants, aged 2.5-5.5 months who were deemed to be EBF were recruited. After administration of deuterium to the mothers, saliva was sampled from mother and infant pairs over a 14-day period. Validation of infant feeding practices was conducted via home observation over six non-consecutive days with caregiver recall. A fully Bayesian framework using a gradient-based Markov chain Monte Carlo approach implemented in Stan was used to estimate the cut-off of non-milk water intake of EBF infants. From the original data set, 113 infants were determined to be EBF and provided 1500 paired mother-infant observations. The deuterium saliva concentrations were best described by two linked 1-compartment models (mother and infant), with body weight as a covariate on the mother's volume of distribution and infant's body weight on infant's water clearance rate. The cut-off value was based on the 90th percentile of the posterior distribution of non-milk water intake and was 86.6 g/day. This cut-off value can be used in future field studies in other geographic regions to determine exclusivity of breast feeding practices in order to determine their potential public health needs.

Micronutrient status differs among Maasai and Kamba preschoolers in a supplementary feeding programme in Kenya.

Since 2001, ChildFund Kenya has supplied micronutrient fortified school meals to preschoolers from two tribes (Kamba and Maasai) attending early childhood development (ECD) centres in Emali, S.E. Kenya. Lack of information on the micronutrient status of the preschoolers prompted a cross-sectional assessment of micronutrient (iron, zinc, selenium, vitamin A, vitamin D) status and prevalence of deficiencies among the two tribes. Data on sociodemographic, health, anthropometric status, and micronutrient supply from preschool meals were collected from 287 Kamba and 213 Maasai children aged 3 to 5 years attending 23 ECD centres. Nonfasting blood samples were collected for haemoglobin and plasma biomarkers of iron, zinc, selenium, vitamin A, vitamin D, C-reactive protein (CRP), α1 -acid glycoprotein, and immunoglobin G. The prevalence of anaemia was significantly higher in Maasai children than Kamba (38%, 95% CI [31%, 45%], vs. 5%, [3%, 9%]), as well as iron deficiency and its various stages (P < 0.001). No differences were seen in the prevalence of zinc, selenium, vitamin A, or vitamin D deficiencies (all P > 0.05). Body iron, CRP, and age were significant predictors of haemoglobin concentrations for both tribes (all P < 0.006) and plasma 25-OHD for Maasai children only. The higher prevalence of iron deficiency among Maasai than Kamba children was possibly attributed to the high consumption of cow's milk (low in bioavailable iron) in place of micronutrient fortified meals together with a higher prevalence of chronic inflammation and intestinal damage.

Iron, zinc, vitamin A and selenium status in a cohort of Indonesian infants after adjusting for inflammation using several different approaches.

Inflammation confounds the interpretation of several micronutrient biomarkers resulting in estimates that may not reflect the true burden of deficiency. We aimed to assess and compare the micronutrient status of a cohort of Indonesian infants (n 230) at aged 6, 9 and 12 months by ignoring inflammation (unadjusted) and adjusting four micronutrient biomarkers for inflammation with C-reactive protein (CRP) and α-1-glycoprotein (AGP) using the following methods: (1) arithmetic correction factors with the use of a four-stage inflammation model; and (2) regression modelling. Prevalence of infants with any inflammation (CRP>5 mg/l and/or AGP>1 g/l) was about 25% at each age. Compared with unadjusted values, regression adjustment at 6, 9 and 12 months generated the lowest (P50 % across all ages. In conclusion, without inflammation adjustment, Fe deficiency was grossly under-estimated and vitamin A and Zn deficiency over-estimated, highlighting the importance of correcting for the influence of such, before implementing programmes to alleviate micronutrient malnutrition. However, further work is needed to validate the proposed approaches with a particular focus on assessing the influence of varying degrees of inflammation (i.e. recurrent acute infections and low-grade chronic inflammation) on each affected nutrient biomarker.

Micronutrient Adequacy and Dietary Diversity Exert Positive and Distinct Effects on Linear Growth in Urban Zambian Infants.

BACKGROUND: In the monitoring of infant and young child feeding, dietary diversity is used as an indicator of micronutrient adequacy; however, their relation may have weakened with the increasing use of fortified complementary foods. OBJECTIVE: The objectives were to assess the relation between dietary diversity and micronutrient adequacy in an urban infant population with a high consumption of fortified foods and to investigate whether dietary diversity and micronutrient adequacy were independently associated with subsequent growth. METHODS: We used longitudinal data on 811 infants in the Chilenje Infant Growth, Nutrition, and Infection Study conducted in Lusaka, Zambia. The relation between mean micronutrient adequacies and dietary diversity scores derived from 24-h diet recalls at 6 mo of age was investigated with the use of Spearman rank correlation. Multiple linear regression was used to assess the association between micronutrient adequacy, dietary diversity, and subsequent growth to 18 mo of age. RESULTS: Overall mean micronutrient density adequacy (MMDA) and MMDA of "problem micronutrients," defined as those micronutrients (calcium, iron, zinc) with mean density adequacies less than half of estimated needs, were correlated with dietary diversity scores (ρ = 0.36 and 0.30, respectively, both P < 0.0001). Consumption of "sentinel foods" (iron rich, fortified, animal source, dairy) showed better correlation with MMDA than with dietary diversity (ρ = 0.58-0.69, all P < 0.0001). In fully adjusted analyses, MMDA calcium, iron, zinc, and dietary diversity, but not overall MMDA, were associated with linear growth to 18 mo (both P ≤ 0.028). CONCLUSIONS: Micronutrient adequacy in infants consuming fortified foods may be more accurately assessed using locally specific sentinel food indicators rather than dietary diversity scores. Nonetheless, dietary diversity has a positive effect on subsequent linear growth apart from that of micronutrient adequacy, warranting its continued monitoring and further investigation into the mechanisms underlying this finding. This trial was registered at www.controlled-trials.com as ISRCTN37460449.

Serum Zinc Is a Major Predictor of Anemia and Mediates the Effect of Selenium on Hemoglobin in School-Aged Children in a Nationally Representative Survey in New Zealand.

BACKGROUND: Zinc, selenium, and vitamin D status of New Zealand (NZ) school-aged children was examined in a national survey in 2002. To our knowledge, however, the role of these micronutrients as predictors of hemoglobin has not been explored despite plausible mechanisms for such relations. OBJECTIVE: We examined the relations of iron, zinc, selenium, and vitamin D status with hemoglobin and anemia in children of New Zealand European and other (NZEO) ethnicity enrolled in the 2002 Children's Nutrition Survey and explored whether zinc mediated the relation between selenium and hemoglobin. METHODS: Multivariate regression was performed to examine the relations of serum micronutrient biomarkers, acute inflammation, socioeconomic status, and body mass index (BMI) with hemoglobin and anemia of NZEO children aged 5-15 y (n = 503). A mediation analysis also investigated direct and indirect (through zinc) relations between selenium and hemoglobin. RESULTS: In total, 4.6% of the children were anemic, 3.2% had depleted iron stores, and none had iron deficiency anemia. The prevalence of low serum zinc (<8.7-10.1 µmol/L depending on age and sex), selenium (<0.82 µmol/L), and 25-hydroxyvitamin D (<50 nmol/L) was 14.1%, 22.9%, and 48.5%, respectively. Major predictors of hemoglobin were serum zinc, age, and BMI-for-age z score (P < 0.001); log ferritin and being female were also statistically significant (P < 0.05). Selenium had an indirect effect that was mediated by zinc, with a significant effect of selenium on zinc (P = 0.002) and zinc on hemoglobin (P < 0.001). Zinc was the only variable associated with anemia risk (OR: 5.49; 95% CI: 1.95, 15.46). CONCLUSIONS: Low serum zinc was an independent risk factor for anemia in NZEO school-aged children and mediated the effect of low selenium on hemoglobin. These findings emphasize the importance of considering multiple micronutrient deficiencies in addition to iron when interpreting anemia and of appreciating the mechanistic interactions that underlie these associations.

Biomarkers of Nutrition for Development (BOND)-Zinc Review.

Zinc is required for multiple metabolic processes as a structural, regulatory, or catalytic ion. Cellular, tissue, and whole-body zinc homeostasis is tightly controlled to sustain metabolic functions over a wide range of zinc intakes, making it difficult to assess zinc insufficiency or excess. The BOND (Biomarkers of Nutrition for Development) Zinc Expert Panel recommends 3 measurements for estimating zinc status: dietary zinc intake, plasma zinc concentration (PZC), and height-for-age of growing infants and children. The amount of dietary zinc potentially available for absorption, which requires an estimate of dietary zinc and phytate, can be used to identify individuals and populations at risk of zinc deficiency. PZCs respond to severe dietary zinc restriction and to zinc supplementation; they also change with shifts in whole-body zinc balance and clinical signs of zinc deficiency. PZC cutoffs are available to identify individuals and populations at risk of zinc deficiency. However, there are limitations in using the PZC to assess zinc status. PZCs respond less to additional zinc provided in food than to a supplement administered between meals, there is considerable interindividual variability in PZCs with changes in dietary zinc, and PZCs are influenced by recent meal consumption, the time of day, inflammation, and certain drugs and hormones. Insufficient data are available on hair, urinary, nail, and blood cell zinc responses to changes in dietary zinc to recommend these biomarkers for assessing zinc status. Of the potential functional indicators of zinc, growth is the only one that is recommended. Because pharmacologic zinc doses are unlikely to enhance growth, a growth response to supplemental zinc is interpreted as indicating pre-existing zinc deficiency. Other functional indicators reviewed but not recommended for assessing zinc nutrition in clinical or field settings because of insufficient information are the activity or amounts of zinc-dependent enzymes and proteins and biomarkers of oxidative stress, inflammation, or DNA damage.

Understanding the complex determinants of height and adiposity in disadvantaged daycare preschoolers in Salvador, NE Brazil through structural equation modelling.

BACKGROUND: Earlier we reported on growth and adiposity in a cross-sectional study of disadvantaged Brazilian preschoolers. Here we extend the work on these children, using structural equation modelling (SEM) to gather information on the complex relationships between the variables influencing height and adiposity. We hope this information will help improve the design and effectiveness of future interventions for preschoolers. METHODS: In 376 preschoolers aged 3-6 years attending seven philanthropic daycares in Salvador, we used SEM to examine direct and indirect relationships among biological (sex, ethnicity, birth order, maternal height and weight), socio-economic, micronutrient (haemoglobin, serum selenium and zinc), and environmental (helminths, de-worming) variables on height and adiposity, as reflected by Z-scores for height-for-age (HAZ) and body mass index (BMIZ). RESULTS: Of the children, 11 % had HAZ < -1, 15 % had WHZ < -1, and 14 % had BMIZ > 1. Of their mothers, 8 % had short stature, and 50 % were overweight or obese. Based on standardized regression coefficients, significant direct effects (p < 0.05) for HAZ were maternal height (0.39), being white (-0.07), having helminth infection (-0.09), and serum zinc (-0.11). For BMIZ, significant direct effects were maternal weight (0.21), extremely low SES (-0.15), and haemoglobin (0.14). Indirect (p < 0.05) effects for HAZ were sex (being male) (-0.02), helminth infection (-0.01), de-worming treatment (0.01), and serum selenium (-0.02), and for BMIZ were extremely low SES (-0.001), helminth infection (-0.004), and serum selenium (0.02). CONCLUSIONS: Of the multiple factors influencing preschoolers' growth, helminth infection was a modifiable risk factor directly and indirectly affecting HAZ and BMIZ, respectively. Hence the WHO de-worming recommendation should include preschoolers living in at-risk environments as well as school-aged children.

Baby-Led Introduction to SolidS (BLISS) study: a randomised controlled trial of a baby-led approach to complementary feeding.

BACKGROUND: In 2002, the World Health Organization recommended that the age for starting complementary feeding should be changed from 4 to 6 months of age to 6 months. Although this change in age has generated substantial debate, surprisingly little attention has been paid to whether advice on how to introduce complementary foods should also be changed. It has been proposed that by 6 months of age most infants will have developed sufficient motor skills to be able to feed themselves rather than needing to be spoon-fed by an adult. This has the potential to predispose infants to better growth by fostering better energy self-regulation, however no randomised controlled trials have been conducted to determine the benefits and risks of such a "baby-led" approach to complementary feeding. This is of particular interest given the widespread use of "Baby-Led Weaning" by parents internationally. METHODS/DESIGN: The Baby-Led Introduction to SolidS (BLISS) study aims to assess the efficacy and acceptability of a modified version of Baby-Led Weaning that has been altered to address potential concerns with iron status, choking and growth faltering. The BLISS study will recruit 200 families from Dunedin, New Zealand, who book into the region's only maternity hospital. Parents will be randomised into an intervention (BLISS) or control group for a 12-month intervention with further follow-up at 24 months of age. Both groups will receive the standard Well Child care provided to all parents in New Zealand. The intervention group will receive additional parent contacts (n = 8) for support and education on BLISS from before birth to 12 months of age. Outcomes of interest include body mass index at 12 months of age (primary outcome), energy self-regulation, iron and zinc intake and status, diet quality, choking, growth faltering and acceptability to parents. DISCUSSION: This study is expected to provide insight into the feasibility of a baby-led approach to complementary feeding and the extent to which this method of feeding affects infant body weight, diet quality and iron and zinc status. Results of this study will provide important information for health care professionals, parents and health policy makers. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612001133820 .

Selecting desirable micronutrient fortificants for plant-based complementary foods for infants and young children in low-income countries.

The World Health Organization (WHO) recommends that both breast-fed and non-breast-fed children are fed micronutrient fortified complementary foods designed to meet their high nutrient requirements from aged 6 to 23 months of age. This paper summarises the steps recommended by WHO/FAO to identify the country-specific micronutrient shortfalls in complementary diets and establish desirable levels of bioavailable fortificants for centrally processed plant-based complementary foods for infant and young child feeding. The goal of the WHO/FAO guidelines is to achieve a desirably low prevalence of inadequate micronutrient intakes in the target group whilst simultaneously ensuring minimal risk of excessive intakes.

Dietary diversity at 6 months of age is associated with subsequent growth and mediates the effect of maternal education on infant growth in urban Zambia.

BACKGROUND: Although numerous cross-sectional studies have shown an association between WHO infant and young child feeding (IYCF) indicators and child anthropometric measures, limited longitudinal evidence exists linking these indicators with subsequent growth. OBJECTIVES: The purpose of this study was to investigate whether meeting WHO IYCF indicators at 6 and 12 mo of age was associated with growth to 18 mo of age and if dietary diversity mediated the relation between household wealth, maternal education, and child growth. METHODS: We used longitudinal data on 811 infants in the CIGNIS (Chilenje Infant Growth, Nutrition, Infection Study), a randomized controlled trial comparing the effect of micronutrient-fortified porridges on infant growth in Lusaka, Zambia. Twenty-four-h diet recalls were conducted at 6 and 12 mo of age, and length and weight measurements at ages 6 and 18 mo were used to produce height-for-age Z-scores (HAZs) and weight-for-height Z-scores (WHZs). Information on household assets was used to generate a household wealth index, and level of maternal education was collected. RESULTS: In fully adjusted analyses, iron-rich food intake at 6 mo and greater household wealth and maternal education were positively associated with HAZ at 18 mo (all P ≤ 0.016). Iron-rich food intake at 6 and 12 mo, achieving a "minimum acceptable diet" at 12 mo, and higher maternal education were associated with greater WHZ at 18 mo (all P ≤ 0.044). Dietary diversity at 6 mo of age was positively associated with both HAZ and WHZ at 18 mo (both P ≤ 0.001) and mediated 13.4% and 25.9% of the total effect of maternal education on HAZ and WHZ, respectively, at 18 mo. CONCLUSIONS: Our findings indicate that IYCF programs should be targeted toward the early period of complementary food introduction and that policies aimed at increasing formal maternal education may benefit child growth through improved feeding practices. This trial was registered at www.controlled-trials.com as ISRCTN37460449.

Dietary mineral supplies in Africa.

Dietary micronutrient deficiencies (MNDs) are widespread, yet their prevalence can be difficult to assess. Here, we estimate MND risks due to inadequate intakes for seven minerals in Africa using food supply and composition data, and consider the potential of food-based and agricultural interventions. Food Balance Sheets (FBSs) for 46 countries were integrated with food composition data to estimate per capita supply of calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn), and also phytate. Deficiency risks were quantified using an estimated average requirement (EAR) 'cut-point' approach. Deficiency risks are highest for Ca (54% of the population), followed by Zn (40%), Se (28%) and I (19%, after accounting for iodized salt consumption). The risk of Cu (1%) and Mg (<1%) deficiency are low. Deficiency risks are generally lower in the north and west of Africa. Multiple MND risks are high in many countries. The population-weighted mean phytate supply is 2770 mg capita(-1) day(-1). Deficiency risks for Fe are lower than expected (5%). However, 'cut-point' approaches for Fe are sensitive to assumptions regarding requirements; e.g. estimates of Fe deficiency risks are 43% under very low bioavailability scenarios consistent with high-phytate, low-animal protein diets. Fertilization and breeding strategies could greatly reduce certain MNDs. For example, meeting HarvestPlus breeding targets for Zn would reduce dietary Zn deficiency risk by 90% based on supply data. Dietary diversification or direct fortification is likely to be needed to address Ca deficiency risks.

Disadvantaged pre-schoolers attending day care in Salvador, Northeast Brazil have a low prevalence of anaemia and micronutrient deficiencies.

OBJECTIVE: To examine the micronutrient status of disadvantaged pre-schoolers from Northeast Brazil, following the introduction of pro-poor policies, by assessing the prevalence of anaemia and micronutrient deficiencies and the role of sociodemographic factors, genetic Hb disorders and parasitic infections. DESIGN: In a cross-sectional study, data on sociodemographic status, health, growth, genetic Hb disorders, parasites and nutrient supply from day-care meals were obtained. Fasting blood samples were collected and analysed for Hb, serum ferritin, transferrin receptor, folate, vitamin B12, retinol, Zn and Se. SETTING: Seven philanthropic day-care centres serving urban slums in Salvador, Northeast Brazil. SUBJECTS: Pre-schoolers aged 3-6 years from disadvantaged households. RESULTS: Of the 376 sampled children, 94 % were of black or mixed race; 33 % and 29 % had at least one genetic Hb disorder and intestinal parasite, respectively. Stunting and underweight were ≤5 %; 14 % were overweight. Day-care centres supplied micronutrient-dense meals and snacks each weekday. Less than 10 % of pre-schoolers had anaemia and micronutrient deficiencies. Predictors (P < 0·05) of Hb were α(3·7) thalassaemia, Se and retinol (but not ferritin). Micronutrient predictors (P < 0·05) were: elevated α1-glycoprotein for ferritin, Hb AS and BMI Z-score >1 for transferrin receptor, Zn and elevated α1-glycoprotein for retinol, sex and helminths for Se, helminths for vitamin B12, and Giardia intestinalis infection for serum folate. CONCLUSIONS: Impaired growth, anaemia and micronutrient deficiencies were uncommon among these disadvantaged pre-schoolers attending day care. A range of interventions including provision of micronutrient-dense, fortified day-care meals, deworming and vitamin A supplementation likely contributed to improved micronutrient status, suggesting expanded coverage of these programmes.

Establishing desirable fortificant levels for calcium, iron and zinc in foods for infant and young child feeding: examples from three Asian countries.

We used the World Health Organization's recommended procedures to establish desirable fortificant levels for three problem micronutrients in children's diets, based on dietary data collected earlier from Filipino (n = 1374; 6-36 months), Mongolian (n = 179; 12-36 months) and Cambodian (n = 177; 12-36 months) children. Prevalence of inadequate and excessive intakes of calcium and zinc (via cut-point method) and iron (via full-probability approach) was assessed after adjusting usual intake distributions with pc-side using internal or external within-person variances from Filipino (calcium and iron) and US National Health And Nutrition Examination Survey III (zinc) national surveys. Fortificant levels were determined by repositioning usual intake distributions so that the 2.5th percentile of the targeted populations equalled the estimated average requirement (calcium, zinc) or so that full-probability prevalence was no larger than 2.5% (iron). Prevalence of inadequate intakes was ≥70% for calcium and iron, except Filipino infants (30% for Ca) and Cambodian toddlers (41% for Fe); but <1% for zinc for toddlers in Mongolia and 20% in Cambodia. Prevalence of excessive intakes was <1% for zinc, calcium and iron, except for Mongolian toddlers (11% for Zn). Desirable fortificant levels, although apparently negligible for zinc, were 530-783 mg for calcium and 10.8-22.8 mg for iron (per 100 g). Fortificant levels can be estimated from 24-h recalls, preferably by applying internal within-person variances. Fortification with calcium and iron was necessary, but seemingly not for zinc, despite a high prevalence of low serum zinc, suggesting the need for better defined cut-offs for population risk of zinc deficiency based on dietary zinc intake and/or serum zinc.

A high prevalence of zinc- but not iron-deficiency among women in rural Malawi: a cross-sectional study.

BACKGROUND: Zinc deficiency is often associated with nutritional iron deficiency (ID), and may be exacerbated by low selenium status. AIM: To investigate risk of iron and zinc deficiency in women with contrasting selenium status. METHODS: In a cross-sectional study, 1-day diet composites and blood samples were collected from self-selected Malawian women aged 18-50 years from low- (Zombwe) (n=60) and high-plant-available soil selenium (Mikalango) (n=60) districts. Diets were analyzed for trace elements and blood for biomarkers. RESULTS: Zinc deficiency (>90 %) was greater than ID anemia (6 %), or ID (5 %), attributed to diets low in zinc (median 5.7 mg/day) with high phytate:zinc molar ratios (20.0), but high in iron (21.0 mg/day) from soil contaminant iron. Zombwe compared to Mikalango women had lower (p<0.05) intakes of selenium (6.5 vs. 55.3 µg/day), zinc (4.8 vs. 6.4 mg/day), iron (16.6 vs. 29.6 mg/day), lower plasma selenium (0.72 vs. 1.60 µmol/L), and higher body iron (5.3 vs. 3.8 mg/kg), although plasma zinc was similar (8.60 vs. 8.87 µmol/L). Body iron and plasma zinc were positive determinants of hemoglobin. CONCLUSION: Risk of zinc deficiency was higher than ID and was shown not to be associated with selenium status. Plasma zinc was almost as important as body iron as a hemoglobin determinant.

Impact of milk secretor status on the fecal metabolome and microbiota of breastfed infants.

Maternal secretor status has been shown to be associated with the presence of specific fucosylated human milk oligosaccharides (HMOs), and the impact of maternal secretor status on infant gut microbiota measured through 16s sequencing has previously been reported. None of those studies have confirmed exclusive breastfeeding nor investigated the impact of maternal secretor status on gut microbial fermentation products. The present study focused on exclusively breastfed (EBF) Indonesian infants, with exclusive breastfeeding validated through the stable isotope deuterium oxide dose-to-mother (DTM) technique, and the impact of maternal secretor status on the infant fecal microbiome and metabolome. Maternal secretor status did not alter the within-community (alpha) diversity, between-community (beta) diversity, or the relative abundance of bacterial taxa at the genus level. However, infants fed milk from secretor (Se+) mothers exhibited a lower level of fecal succinate, amino acids and their derivatives, and a higher level of 1,2-propanediol when compared to infants fed milk from non-secretor (Se-) mothers. Interestingly, for infants consuming milk from Se+ mothers, there was a correlation between the relative abundance of Bifidobacterium and Streptococcus, and between each of these genera and fecal metabolites that was not observed in infants receiving milk from Se- mothers. Our findings indicate that the secretor status of the mother impacts the gut microbiome of the exclusively breastfed infant.