Murradambirra Dhangaang (make food secure): Aboriginal community and stakeholder perspectives on food insecurity in urban and regional Australia.

BACKGROUND: It is widely acknowledged that the invasion by colonial powers of the Australian continent had profound and detrimental impacts on Aboriginal Communities, including food security. Policies of successive governments since European arrival have since further exacerbated the situation, with food insecurity now affecting 20-25% of Aboriginal and Torres Strait Islander people. Food insecurity contributes to long-term impacts on health, in particular diet-sensitive chronic diseases. This study aimed to describe Aboriginal community and stakeholder perspectives on food insecurity to get a better understanding of the key contributing factors and recommendations for potential strategies to address this issue in Aboriginal communities in urban and regional Australia. METHODS: Semi-structured interviews were conducted with 44 participants who were purposively selected. This included Aboriginal people in two communities and both Aboriginal and non-Aboriginal stakeholders from local food relief agencies, food suppliers, schools, and government in an urban and regional location in NSW. A conceptual framework was developed from literature on food security, and sensitizing concepts of availability, affordability, accessibility and acceptability or the lack thereof of healthy food were used to elicit responses from the participants. Interview transcripts were analysed thematically. RESULTS: All participants felt strongly that food insecurity was a major problem experienced in their local Aboriginal communities. Five core areas impacting on food security were identified: trapped in financial disadvantage; gaps in the local food system; limitations of non-Aboriginal food relief services; on-going impacts of colonization; and maintaining family, cultural and community commitments and responsibilities. Participants suggested a number of actions that could help ease food insecurity and emphasized that Aboriginal values and culture must be strongly embedded in potential programs. CONCLUSIONS: This study found Aboriginal families in urban and regional Australia are experiencing food insecurity on a regular basis, which is impacted by a range of socio-economic, environmental, systemic and cultural factors, as reported by the participants. Study findings highlight the need to address system level changes in the food environment and acknowledge Aboriginal history, culture and food preferences when considering the development of programs to alleviate food insecurity among Aboriginal people.

Shonjibon cash and counselling: a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh.

BACKGROUND: Undernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months. METHOD: The study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child's age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Household food security (10) Number of events for child suffering from diarrhoea, acute respiratory illness and fever (11) Average costs of mobile phone BCC and cash transfer, and benefit-cost ratio for primary and secondary outcomes. DISCUSSION: The proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh. TRIAL REGISTRATION: The study has been registered in the Australian New Zealand Clinical Trials Registry ( ACTRN12618001975280 ).

M-SAKHI-Mobile health solutions to help community providers promote maternal and infant nutrition and health using a community-based cluster randomized controlled trial in rural India: A study protocol.

Reduction of childhood stunting is difficult to achieve by interventions that focus only on improving nutrition during infancy. Comprehensive interventions that extend through the continuum of care from pregnancy to infancy are needed. Mobile phones are now successfully being used for behaviour change communication to improve health. We present the methodology of an mHealth intervention "Mobile Solutions Aiding Knowledge for Health Improvement" (M-SAKHI) to be delivered by rural community health workers or Accredited Social Health Activists (ASHAs) for rural women, below or up to 20 weeks of pregnancy through delivery until their infant is 12 months of age. This protocol paper describes the cluster randomized controlled trial to evaluate the effectiveness of M-SAKHI. The primary objective of the trial is to reduce the prevalence of stunting (height-for-age < -2 z-score) in children at 18 months of age by 8% in the intervention as compared with control. The secondary objectives include evaluating the impact on maternal dietary diversity, birth weight, infant and young child feeding practices, infant development, and child morbidity, along with a range of intermediate outcomes for maternal, neonatal, and infant health. A total of 297 ASHAs, five trained counsellors, and 2,501 participants from 244 villages are participating in this study. The outcome data are being collected by 51 field research officers. This study will provide evidence regarding the efficacy of M-SAKHI to reduce stunting in young children in rural India, and if effective, the cost-effectiveness of M-SAKHI.

Inhibition of iron absorption by calcium is modest in an iron-fortified, casein- and whey-based drink in Indian children and is easily compensated for by addition of ascorbic acid.

BACKGROUND: Calcium inhibits and ascorbic acid (AA) enhances iron absorption from iron-fortified foods. Absorption efficiency depends on iron status, although the interaction is unclear. OBJECTIVE: We investigated the ability of AA to overcome calcium-induced inhibition of iron absorption in children differing in iron status. METHODS: The effect of calcium (0, 100, and 200 mg/test meal) on iron absorption in the absence and presence of AA (0, 42.5, and 85 mg/test meal) from a casein/whey-based drink fortified with ferrous sulfate was assessed in a series of randomized crossover studies both in iron-replete (IR) Indian schoolchildren and in children with iron deficiency anemia (IDA) (6-11 y; n = 14-16/group) by using stable isotopes. RESULTS: In the absence of calcium and AA, iron absorption from the casein/whey-based drink was 20% lower in IR children than in children with IDA. The addition of calcium reduced mean iron absorption by 18-27%, with the effect being stronger for high added calcium (P < 0.01). AA at a 2:1 or 4:1 molar ratio enhanced iron absorption by a factor of 2-4 and greatly overcompensated for the inhibitory effect of calcium on iron absorption in a dose-dependent manner (P < 0.001). The dose-response effect tended to be stronger (P < 0.1) in the IDA group, and iron status was of far less influence on iron absorption than the enhancing effect of AA. CONCLUSION: When adding AA to iron-fortified milk products, care should be taken not to provide absorbable iron in excess of needs.

Vitamin B-12 supplementation during pregnancy and early lactation increases maternal, breast milk, and infant measures of vitamin B-12 status.

Pregnant women in resource-poor areas are at risk of multiple micronutrient deficiencies, and indicators of low vitamin B-12 status have been associated with adverse pregnancy outcomes, including anemia, low birth weight, and intrauterine growth retardation. To evaluate whether daily oral vitamin B-12 supplementation during pregnancy increases maternal and infant measures of vitamin B-12 status, we performed a randomized, placebo-controlled clinical trial. Pregnant women <14 wk of gestation in Bangalore, India, were randomly assigned to receive daily oral supplementation with vitamin B-12 (50 µg) or placebo through 6 wk postpartum. All women were administered iron and folic acid supplements throughout pregnancy. One hundred eighty-three women were randomly assigned to receive vitamin B-12 and 183 to receive placebo. Compared with placebo recipients, vitamin B-12-supplemented women had significantly higher plasma vitamin B-12 concentrations at both the second (median vitamin B-12 concentration: 216 vs. 111 pmol/L, P < 0.001) and third (median: 184 vs. 105 pmol/L, P < 0.001) trimesters. At 6 wk postpartum, median breast milk vitamin B-12 concentration was 136 pmol/L in vitamin B-12-supplemented women vs. 87 pmol/L in the placebo group (P < 0.0005). Among vitamin B-12-supplemented women, the incidence of delivering an infant with intrauterine growth retardation was 33 of 131 (25%) vs. 43 of 125 (34%) in those administered placebo (P = 0.11). In a subset of infants tested at 6 wk of age, median plasma vitamin B-12 concentration was 199 pmol/L in those born to supplemented women vs. 139 pmol/L in the placebo group (P = 0.01). Infant plasma methylmalonic acid and homocysteine concentrations were significantly lower in the vitamin B-12 group as well. Oral supplementation of urban Indian women with vitamin B-12 throughout pregnancy and early lactation significantly increases vitamin B-12 status of mothers and infants. It is important to determine whether there are correlations between these findings and neurologic and metabolic functions. This trial was registered at clinicaltrials.gov as NCT00641862.

Women's participation in household decision-making: Qualitative findings from the Shonjibon Trial in rural Bangladesh.

A key element of women's empowerment is the ability to participate in household decision-making. This study presents the qualitative results from the Shonjibon Cash and Counselling Trial baseline process evaluation with the aim of exploring the status of women's decision-making at the trial's outset and to facilitate the exploration of any changes in women's empowerment over the course of the trial. Between January and March 2021, we conducted forty-one in-depth interviews with pregnant women in rural Bangladesh. The research team translated, transcribed, coded, and discussed the interviews. We used thematic analysis to examine women's experience and perceptions on household decision-making. The key findings that emerged; women jointly participated in financial decision-making with their husbands; men made the final decision regarding seeking healthcare, and women solely made choices regarding infant and young child feeding. Our findings revealed that women felt that they needed to discuss their plans to go outside the house with their husbands, many perceived a lack of importance in the community towards women's participation in decision-making. This study documents current contextual information on the status of women's involvement in household decision-making and intrahousehold power dynamics at the start of the Shonjibon Cash and Counselling Trial.

Development of mobile phone-based dietary data collection applications in pregnant women and infants for the M-SAKHI trial.

In nutritional epidemiological studies, it is imperative to collect high-quality data to ensure accurate dietary assessment. However, dietary data collection using traditional paper forms has several limitations that may compromise data quality. The aim of this study was to propose novel methods to design and develop software applications (Apps) for dietary data collection to assess the nutritional status of pregnant women and infants. This study is part of the M-SAKHI (Mobile-Solutions for Aiding Knowledge for Health Improvement) cluster randomised controlled trial (cRCT) implemented in central India. Three tablet-based software Apps were developed in this study: the ACEC (Automated Coding and Energy Calculation) App to establish a generic cooked food recipe database, the FFQ (Food Frequency Questionnaire), and the IDR (24 h Infant Dietary Recall) Apps to collect dietary data from pregnant women and their infants from rural area of Bhandara and Nagpur districts. Regional food lists, recipes, and portion resource kits were developed to support the data collection using the Apps. In conclusion, the Apps were user-friendly, required minimal prior training, had built-in validation checks for erroneous data entry and provided automated calculations. The Apps were successfully deployed in low-resource rural settings to accurately collect high-quality regional cooked food data and individual-level dietary data of pregnant women and their infants.

Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children.

Wheat is the primary staple food for nearly one-third of the world's population. NaFeEDTA is the only iron (Fe) compound suitable for fortifying high extraction flours. We tested the hypothesis that NaFeEDTA-fortified, whole wheat flour reduces Fe deficiency (ID) and improves body Fe stores (BIS) and cognitive performance in Indian children. In a randomized, double-blind, controlled, school feeding trial, 6- to 15-y-old, Fe-depleted children (n = 401) were randomly assigned to either a daily wheat-based lunch meal fortified with 6 mg of Fe as NaFeEDTA or an otherwise identical unfortified control meal. Hemoglobin (Hb) and Fe status were measured at baseline, 3.5 mo, and 7 mo. Cognitive performance was evaluated at baseline and 7 mo in children (n = 170) at one of the study sites. After 7 mo, the prevalence of ID and ID anemia in the treatment group significantly decreased from 62 to 21% and 18 to 9%, respectively. There was a time x treatment interaction for Hb, serum ferritin, transferrin receptor, zinc protoporphyrin, and BIS (all P < 0.0001). Changes in BIS differed between the groups; it increased in the treatment group (0.04 ± 0.04 mmol/kg body weight) and decreased in the control group (-0.02 ± 0.04 mmol/kg body weight) (P < 0.0001). In sensory tests, NaFeEDTA-fortified flour could not be differentiated from unfortified flour. There were no significant differences in cognitive performance tests between the groups. NaFeEDTA-fortified wheat flour markedly improved BIS and reduced ID in Fe-depleted children. It may be recommended for wider use in national school feeding programs.

Rice fortification: an emerging opportunity to contribute to the elimination of vitamin and mineral deficiency worldwide.

Vitamin and mineral deficiencies are ranked among the top causes of poor health and disability in the world. These deficiencies damage developing brains, impair learning ability, increase susceptibility to infections, and reduce the work productivity of nations. Food fortification is a sustainable, cost-effective approach to reducing vitamin and mineral deficiency. As the staple food for an estimated 3 billion people, rice has the potential to fill an obvious gap in current fortification programs. In recent years, new technologies have produced fortified rice kernels that are efficacious in reducing vitamin and mineral deficiency. There are opportunities to fortify a significant share of rice that comes from large mills supplying centralized markets and national welfare programs in major rice-growing countries. The rice export markets, which handle 30 million MT of rice annually, also present a key fortification opportunity. The cost of fortifying rice is only 1.5% to 3% of the current retail price of rice. Countries that mandate rice fortification have the strongest evidence for achieving wide coverage and impact. The Rice Fortification Resource Group (RiFoRG), a global network of public and private partners that offers technical and advocacy support for rice fortification, has a vision of promoting rice fortification worldwide. It has a targeted approach, engaging multisector partners in key countries where the opportunities are greatest and there is receptivity to early adoption of large-scale rice fortification. The challenges are real, the imperative to address them is powerful, and the opportunities to deliver the promise of rice fortification are clear.

Establishing an enduring co-production platform in Aboriginal health.

Co­production in Aboriginal health research builds on participatory, strength-based approaches where Aboriginal knowledge, expertise and priorities are valued and used to generate evidence to drive improvements in Aboriginal health and healthcare. The Coalition for Research to Improve Aboriginal Health (CRIAH), led by a partnership between the Aboriginal Health & Medical Research Council (AH&MRC), Sax Institute and six Aboriginal Community Controlled Health Services (ACCHSs) in NSW, has a long history of successfully co-producing evidence to guide policy and program planning. Data collected through CRIAH's first project, the Study of Environment on Aboriginal Resilience and Child Health (SEARCH), a cohort of urban Aboriginal children, has been effectively used to improve child health outcomes. An evaluation of CRIAH's co-production model highlighted trusting relationships, sharing of power, valuing Aboriginal knowledge and expertise, respectful communication, strong Aboriginal leadership, and ongoing investment and collaboration as instrumental to the success and longevity of this multidisciplinary partnership. In recent years, CRIAH's co-production platform has responded to emerging areas of need identified by participating ACCHSs. This paper highlights three initiatives driven through the co-production platform: 1) examining how local mental health service systems are working for Aboriginal children and young people and how they can be improved; 2) understanding how the cancer care system is working for older Aboriginal people to develop scalable and sustainable approaches to improving cancer care; and 3) finding effective ways to measure the impact of innovative, Aboriginal-led primary health care programs. These initiatives represent co-produced, fit-for-purpose research aimed at driving tangible improvements in Aboriginal health..

Micronutrient supplementation improves physical performance measures in Asian Indian school-age children.

Micronutrients are important in physical work capacity and therefore performance. The impact of a multi-micronutrient-fortified nutritional beverage on physical performance measures among clinically healthy school-age children was assessed in a double-blind (for test and placebo groups), placebo-controlled, randomized trial in children aged between 7 and 10.5 y (n = 300). The participants with height- and weight-for-age Z-scores between 0 and ≥ -3 were randomized to 1 of 3 study arms: fortified choco-malt beverage powder (F), matched energy equivalent unfortified placebo (U), and untreated control (C). Participants in the F and C groups were given 40 g fortified (19 key vitamins and minerals) and unfortified choco-malt beverage, respectively, daily for 120 d. Primary efficacy outcomes included endurance and aerobic capacity using a 20-m shuttle test and step test. Other physical performance measures included speed (40-m sprint), visual reaction time, maximal hand grip, and forearm static endurance. Micronutrient status included thiamin, riboflavin, folate, niacin, iron, pyridoxal phosphate, and vitamins B-12 and C. All measurements were made at baseline and the end of the intervention. There was a within-subject increase in aerobic capacity and whole body endurance (P < 0.05) accompanied by a significant improvement in the status of iron thiamin, riboflavin, pyridoxal phosphate, folate, and vitamins C and B-12 in the F group compared to the within-subject changes in the other 2 groups (P < 0.05). The study suggests that multiple micronutrient supplementation in similar populations may be beneficial in improving micronutrient status and enhancing aerobic capacity and endurance in children.

Markers of chronic disease risk in a cohort of Aboriginal children: findings from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).

OBJECTIVE: This study investigated chronic disease risk markers among a cohort of Aboriginal children in New South Wales. METHODS: Distributions of body mass index (BMI), blood lipids and haemoglobin A1c (HbA1c) among Aboriginal children aged 5-<19 years were investigated. Prevalence ratios (PR) were calculated for borderline/high total cholesterol, low-density lipoprotein (LDL) cholesterol and HbA1c, and low high-density lipoprotein (HDL) cholesterol, by age group, sex and BMI. RESULTS: Almost half (46.8%) of the cohort, had a normal BMI and 53.3% had overweight or obesity. Prevalence of chronic disease risk markers was low, with no individuals having high total cholesterol (0.0%) and few having high LDL (3.0%) or borderline/high HbA1c (2.6%); 85.5% of the cohort had normal HDL. There was no significant variation in the prevalence of chronic disease risk markers by age group or sex. The prevalence of borderline total cholesterol was 28% higher (PR 1.28, 95%CI 1.06-1.54), and the prevalence of low HDL was double (2.00, 1.19-3.35) for participants with obesity versus normal BMI. CONCLUSIONS: Dyslipidaemia and elevated HbA1c prevalence was low in the cohort, increasing with high BMI. Overweight and obesity were common, which increase the risk of developing chronic disease later in life. Implications for public health: Findings indicate few Aboriginal children have dyslipidaemia and hyperglycaemia, supporting screening for chronic disease risk factors from 18 years of age. Opportunities to reduce overweight and obesity among children should be considered to decrease the future risk of chronic disease.

Assessing the impact of a combined nutrition counselling and cash transfer intervention on women's empowerment in rural Bangladesh: a randomised control trial protocol.

INTRODUCTION: There is growing interest in assessing the impact of health interventions, particularly when women are the focus of the intervention, on women's empowerment. Globally, research has shown that interventions targeting nutrition, health and economic development can affect women's empowerment. Evidence suggests that women's empowerment is also an underlying determinant of nutrition outcomes. Depending on the focus of the intervention, different domains of women's empowerment will be influenced, for example, an increase in nutritional knowledge, or greater control over income and access to resources. OBJECTIVE: This study evaluates the impact of the Shonjibon Cash and Counselling (SCC) Trial that combines nutrition counselling and an unconditional cash transfer, delivered on a mobile platform, on women's empowerment in rural Bangladesh. METHODS AND ANALYSIS: We will use a mixed-methods approach, combining statistical analysis of quantitative data from 2840 women in a cluster randomised controlled trial examining the impact of nutrition behaviour change communications (BCCs) and cash transfers on child undernutrition. Pregnant participants will be given a smartphone with a customised app, delivering nutrition BCC messages, and will receive nutrition counselling via a call centre and an unconditional cash transfer. This study is a component of the SCC Trial and will measure women's empowerment using a composite indicator based on the Project-Level Women's Empowerment in Agriculture Index, with quantitative data collection at baseline and endline. Thematic analysis of qualitative data, collected through longitudinal interviews with women, husbands and mothers-in-law, will elicit a local understanding of women's empowerment and the linkages between the intervention and women's empowerment outcomes. This paper describes the study protocol to evaluate women's empowerment in a nutrition-specific and sensitive intervention using internationally validated, innovative tools and will help fill the evidence gap on pathways of impact, highlighting areas to target for future programming. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the International Centre for Diarrhoeal Disease Research (Ref. PR 17106) and The University of Sydney (Ref: 2019/840). Findings from this study will be shared in Bangladesh with dissemination sessions in-country and internationally at conferences, and will be published in peer-reviewed journals.

Lysine requirement of healthy, school-aged Indian children determined by the indicator amino acid oxidation technique.

We recently reported the lysine requirement of school-aged children living in Canada consuming a mixed diet to be 35 mg.kg(-1).d(-1). Because the majority of children in the world live on cereal-based diets in developing countries, we measured the daily lysine requirement in healthy children living in India and consuming a mostly cereal-based diet. Our objective in this study was to determine the lysine requirement in healthy, school-aged children in the developing world by using the indicator amino acid oxidation method with l-[1-(13)C] phenylalanine. Six healthy, school-aged children consumed 7 levels of lysine (5, 15, 25, 35, 50, 65, and 80 mg.kg(-1).d(-1)) each in a random order along with an amino acid mixture providing energy and protein intakes of 1.7 x resting energy expenditure and 1.5 g.kg(-1).d(-1), respectively. The mean lysine requirement was determined by applying a 2-phase linear regression crossover analysis on tracer oxidation (F(13)CO(2)) data, which identified a breakpoint (requirement) at minimal F(13)CO(2) in response to the graded lysine intakes. The mean lysine requirements with the upper 95% CI for children were determined to be 33.5 and 46.6 mg.kg(-1).d(-1), respectively, by breakpoint analysis of the F(13)CO(2) data. The mean lysine requirements of Indian children were almost identical to that of Canadian children (35 mg.kg(-1).d(-1)). There is no evidence for any adaptation in lysine requirements in children from developing countries such as India.

Higher maternal plasma folate but not vitamin B-12 concentrations during pregnancy are associated with better cognitive function scores in 9- to 10- year-old children in South India.

Folate and vitamin B-12 are essential for normal brain development. Few studies have examined the relationship of maternal folate and vitamin B-12 status during pregnancy and offspring cognitive function. To test the hypothesis that lower maternal plasma folate and vitamin B-12 concentrations and higher plasma homocysteine concentrations during pregnancy are associated with poorer neurodevelopment, 536 children (aged 9-10 y) from the Mysore Parthenon birth cohort underwent cognitive function assessment during 2007-2008 using 3 core tests from the Kaufman Assessment Battery, and additional tests measuring learning, long-term storage/retrieval, attention and concentration, and visuo-spatial and verbal abilities. Maternal folate, vitamin B-12, and homocysteine concentrations were measured at 30 +/- 2 wk gestation. During pregnancy, 4% of mothers had low folate concentrations (<7 nmol/L), 42.5% had low vitamin B-12 concentrations (<150 pmol/L), and 3% had hyperhomocysteinemia (>10 micromol/L). The children's cognitive test scores increased by 0.1-0.2 SD per SD increase across the entire range of maternal folate concentrations (P < 0.001 for all), with no apparent associations at the deficiency level. The associations with learning, long-term storage/retrieval, visuo-spatial ability, attention, and concentration were independent of the parents' education, socioeconomic status, religion, and the child's sex, age, current size, and folate and vitamin B-12 concentrations. There were no consistent associations of maternal vitamin B-12 and homocysteine concentrations with childhood cognitive performance. In this Indian population, higher maternal folate, but not vitamin B-12, concentrations during pregnancy predicted better childhood cognitive ability. It also suggests that, in terms of neurodevelopment, the concentration used to define folate deficiency may be set too low.

Association of birthweight and head circumference at birth to cognitive performance in 9- to 10-year-old children in South India: prospective birth cohort study.

To examine whether birthweight and head circumference at birth are associated with childhood cognitive ability in South India, cognitive function was assessed using three core tests from the Kaufman Assessment Battery for children and additional tests measuring long-term retrieval/storage, attention and concentration, and visuospatial and verbal abilities among 505 full-term born children (mean age 9.7 y). In multiple linear regression adjusted for age, sex, gestation, socioeconomic status, parent's education, maternal age, parity, body mass index, height, rural/urban residence, and time of testing, Atlantis score (learning ability/long-term storage and retrieval) rose by 0.1 SD per SD increase in newborn weight and head circumference, respectively (p < 0.05 for all), and Kohs' block design score (visuospatial ability) increased by 0.1 SD per SD increase in birthweight (p < 0.05). The associations were reduced after further adjustment for current head circumference. There were no associations of birthweight and/or head circumference with measures of short-term memory, fluid reasoning, verbal abilities, and attention and concentration. In conclusion, higher birthweight and larger head circumference at birth are associated with better childhood cognitive ability. The effect may be specific to learning, long-term storage and retrieval, and visuospatial abilities, but this requires confirmation by further research.

Undernutrition, fatty acid and micronutrient status in relation to cognitive performance in Indian school children: a cross-sectional study.

While undernutrition and anaemia have previously been linked to poor development of children, relatively little is known about the role of B-vitamins and fatty acids on cognition. The present study aims to explore the associations between indicators of body size, fatty acid and micronutrient status on cognitive performance in 598 Indian school children aged 6-10 years. Baseline data of a clinical study were used to assess these associations by analyses of variance adjusting for age, sex, school, maternal education and cognitive tester. The Kaufman Assessment Battery for Children II was used to measure four cognitive domains, including fluid reasoning, short-term memory, retrieval ability and cognitive speediness. Scores were combined into an overall measure, named mental processing index (MPI). Body size indicators and Hb concentrations were significantly positively related to cognitive domains and MPI, such that increases of 1 sd in height-for-age and weight-for-age z-scores would each translate into a 0.09 sd increase in MPI, P = 0.0006 and 0.002, respectively. A 10 g/l increase in Hb concentrations would translate into a 0.08 sd increase in MPI, P = 0.0008. Log-transformed vitamin B12 concentrations were significantly inversely associated with short-term memory, retrieval ability and MPI (beta (95 % CI) = - 0.124 (- 0.224, - 0.023), P = 0.02). Other indicators of Fe, iodine, folate and fatty acid status were not significantly related to cognition. Our findings for body size, fatty acids and micronutrients were in agreement with previous observational studies. The inverse association of vitamin B12 with mental development was unexpected and needed further study.

Maternal nutrition & low birth weight - what is really important?

The prevalence of low birth weight (LBW) is higher in Asia than elsewhere, predominantly because of undernutrition of the mother prior to and during pregnancy. There are qualitative differences in dietary requirements during early and late pregnancy - micronutrients and proteins required in early pregnancy, and calories and other nutrients later. A paradigm shift from efforts to improve size at birth, to efforts to improve foetal growth and development might provide fresh insight into the problem. Micronutrient deficiencies during pregnancy have been shown to have serious implications on the developing foetus. Nearly half the pregnant women still suffer from varying degree of anaemia, with the highest prevalence in India, which also has the highest number of maternal deaths in the Asian region. Of specific concern is compliance with iron supplementation, cultural beliefs regarding diet in pregnancy, and the issue of nutrition supplementation and fortification. The coexistence of risk of LBW or intra uterine growth retardation (IUGR) associated with essential fatty acid docosahexaenoic acid (DHA) and vitamin B12 intake or status observed in the Indian sub-continent also requires further examination. There is a significant protective effect of higher maternal education (beyond high school). Optimal weight gain during pregnancy and a desirable foetal outcome may be a result of synergistic effects of improved food intake, food supplementation, improved micronutrient intake, education and the environment of the pregnant woman and her family.

Aboriginal childhood overweight and obesity: the need for Aboriginal designed and led initiatives.

Childhood obesity poses an urgent and serious public health challenge in Australia. Aboriginal children are more profoundly affected than non-Aboriginal children, with the gap in weight status between the two groups widening, indicating an increased risk of metabolic disorders earlier in life. Obesity is the second biggest contributor (16%) to the gap in health status between Aboriginal and non-Aboriginal people. The bulk of this gap is attributable to people living in non-remote settings who make up 81% of the total Aboriginal population in Australia. The complex interplay of socio-environmental factors that contribute to obesity are well known and include prolonged financial stress associated with food insecurity, urbanisation, substandard and overcrowded housing, and lack of adequate access to health services. In addition, Aboriginal people, specifically, contend with the loss of traditional lands, and poor dietary behaviours due to the transition from traditional to Western diets as a result of colonisation. There are very few national policies and guidelines for obesity prevention and treatment for Australian children. This is especially the case for Aboriginal children. Most Australian states and territories have a suite of programs targeting obesity in childhood through healthy eating and active living strategies but with the exception of a few programs, the reach and effectiveness among Aboriginal children is either not known or has not been adequately assessed. Where programs have assessed Aboriginal participation, completion rates have generally been lower compared with the general population. The problem cannot be addressed without proper Aboriginal governance and leadership, and collaborative program development for Aboriginal-specific obesity interventions. Meaningful engagement and empowering Aboriginal communities to have control over programs that affect their health and wellbeing are more likely to result in positive health outcomes. Importantly, appropriate funding and support is essential to simultaneously facilitate the building of an Aboriginal health workforce to develop, coordinate, deliver and evaluate programs.

Consumption of a mid-morning snack improves memory but not attention in school children.

Muthayya, S., T. Thomas, K. Srinivasan, K. Rao, A. V. Kurpad, J.-W. Van Klinken, G. Owen and E.A. de Bruin: Consumption of a mid-morning snack improves memory but not attention in school children. Physiol Behav 00(0) 000-000, 2006.--This study aimed to determine whether consumption of a mid-morning snack with appropriate energy compensation through a smaller breakfast or lunch, resulted in improved cognitive performance of 7-9 year old children with a low and high socioeconomic status (LSES and HSES, n=35 and 34 respectively). The children were each randomly assigned to three iso-caloric dietary interventions: control (standard breakfast, no snack and standard lunch), intervention A (small breakfast, snack, and standard lunch) and intervention B (standard breakfast, snack, and small lunch), using a cross-over design. The children were tested on three different days, each one week apart. Computerised tests of cognitive performance, consisting of memory, sustained attention and psychomotor speed, were performed during four sessions, i.e., prior to breakfast, after breakfast, after a mid-morning snack and after lunch. Having a mid-morning snack resulted in a smaller decline in immediate and delayed memory in LSES but not in HSES children. Having a snack did not influence sustained attention and psychomotor speed in either LSES or HSES children. This study shows that a more evenly distributed energy intake throughout the morning by consuming a mid-morning snack improves memory performance in school-age LSES children even when the total amount of energy consumed during the morning is not altered.