Cohort profile: the Taicang and Wuqiang mother-child cohort study (TAWS) in China.

PURPOSE: The Taicang and Wuqiang cohort study (TAWS) was established to examine the association between early-life nutrition and children's health, and to explore the potential roles of maternal health, metabolites and microbiota in children's health in two different regions of China. PARTICIPANTS: A total of 7041 mother-child pairs were recruited during early pregnancy (n=4035, 57.3%) or delivery phase (n=3006, 42.7%) from health centres or hospitals in Taicang and Wuqiang. Mother-child pairs were followed up three times during pregnancy, once during delivery, and 7-10 times in the 3 years after delivery. Questionnaires were used to collect data on diet, supplementary intake, physical activity, depression scale, disease occurrence, feeding practice and development quotient of children. Anthropometric measurements of mothers and their children were assessed at each visit. Pregnancy outcomes were extracted from medical records. Biospecimens were collected and stored, including venous blood, cord blood, urine, stool, breast milk, cord and placenta. FINDINGS TO DATE: Data from the TAWS cohort showed different baseline characteristics of participants at the two sites of TAWS. Abnormal metabolism occurred among newborns whose mothers were diagnosed with gestational diabetes mellitus. Maternal serum folic acid above 14.5 ng/mL at early pregnancy was associated with a reduced risk of delivering small-for-gestational-age newborns. FUTURE PLANS: The association between maternal nutrition and the health of offspring will be examined at various follow-up visits. Biomarkers will be analysed to assess the associations between early-life nutrition and child development, immunity and health. Strategic recommendations for optimal infant feeding practices, obesity prevention and routine healthcare items will be developed and proposed based on the findings from the study. Children in this prospective cohort study will be followed up once a year until age 12 years to further examine the relationships between early-life nutrition and children's long-term development and health.

Human milk cholesterol is associated with lactation stage and maternal plasma cholesterol in Chinese populations.

BACKGROUND: Milk cholesterol concentrations throughout lactation were analyzed, and the relationship between maternal plasma cholesterol and milk cholesterol in various Chinese populations was examined. METHODS: A sub-sample of 1138 lactating women was randomly selected from a large cross-sectional study in China (n = 6481). Milk cholesterol concentrations were determined by HPLC, and concentrations of maternal plasma lipids were determined by an automated biochemical analyzer. RESULTS: The mean cholesterol concentrations were 200, 171, and 126 mg/L for colostrum, transitional milk, and mature milk, respectively. Cholesterol concentrations differed significantly between stages of lactation (colostrum vs. transitional milk, colostrum vs. mature milk, transitional milk vs. mature milk, all p < 0.001). Concentrations of maternal plasma total cholesterol (TC) (p = 0.02) and low-density lipoprotein cholesterol (LDL-C) (p = 0.03) were significantly associated with milk cholesterol. Milk cholesterol concentrations varied among different ethnicities (Tibetan vs. Hui: 164 vs. 131 mg/L, p = 0.027) but not among different geographic regions. CONCLUSIONS: The concentration of cholesterol in human milk changes dynamically throughout lactation. Milk cholesterol concentrations are significantly associated with maternal plasma concentrations of TC and LDL-C, and milk cholesterol concentrations vary across ethnicities in China. IMPACT: Concentrations of milk cholesterol were measured in various Chinese populations. Cholesterol concentrations differ significantly between stages of lactation. Maternal plasma total cholesterol and low-density lipoprotein cholesterol are associated with milk cholesterol. Milk cholesterol concentrations vary across ethnicities in China.

Sodium Thiosulfate Ameliorates Renovascular Hypertension-Induced Renal Dysfunction and Injury in Rats.

BACKGROUND/AIMS: Arterial stenosis activates the renin-angiotensin-aldosterone system subsequently resulting in renovascular hypertension (RVHT) and renal oxidative injury. We explored the effect of sodium thiosulfate (STS, Na2S2O3), a developed antioxidant in clinical trial, on RVHT-induced hypertension and renal oxidative injury in rats. METHODS: We induced RVHT in male Wistar rats with bilaterally partial ligation of renal arteries in the 2-kidney 2-clip model. We evaluated the STS effect on RVHT-induced oxidative injury and apoptosis by a chemiluminescence amplification method, Western blot, and immunohistochemistry. RESULTS: We found STS displayed a dose-dependent antioxidant H2O2 activity and adapted the maximal scavenging H2O2 activity of STS at the dosage of 0.1 g/kg intraperitoneally 3 times/week for 4 weeks in RVHT rats. RVHT induced a significant elevation of arterial blood pressure, blood reactive oxygen species amount, neutrophil infiltration, 4-HNE and NADPH oxidase gp91 expression, Bax/Bcl-2/poly(ADP-ribose) polymerase (PARP)-mediated apoptosis formation, blue Masson-stained fibrosis, and urinary protein level. STS treatment significantly reduced hypertension, oxidative stress, neutrophil infiltration, fibrosis, and Bax/Bcl-2/PARP-mediated apoptosis formation and depressed the urinary protein level in the RVHT models. CONCLUSION: Our results suggest that STS treatment could ameliorate RVHT hypertension and renal oxidative injury through antioxidant, antifibrotic, and antiapoptotic mechanisms.

Concentration of Lactoferrin in Human Milk and Its Variation during Lactation in Different Chinese Populations.

BACKGROUND: Lactoferrin (Lf) is a multifunctional protein and one of the most abundant proteins in human milk. Various factors may affect its concentration in human milk, such as stage of lactation, ethnicity, and diet. OBJECTIVES: The objectives of the present study were to examine the dynamic change in milk Lf throughout the course of lactation and explore factors associated with milk Lf concentrations in various Chinese populations. METHODS: This investigation was a part of a large cross-sectional study conducted in 11 provinces/autonomous regions/municipalities (Beijing, Gansu, Guangdong, Guangxi, Heilongjiang, Inner Mongolia, Shandong, Shanghai, Xinjiang, Yunnan, and Zhejiang) across China between 2011 and 2013. Lactating women (n = 6481) within 0⁻330 days postpartum were recruited in the original study. A sub-sample of 824 women was randomly selected, and milk Lf concentrations were determined by UPLC/MS. RESULTS: The Lf concentration in milk from women delivering at term was 3.16 g/L, 1.73 g/L and 0.90 g/L for colostrum, transitional milk, and mature milk, respectively. Lf concentrations differed significantly between stages of lactation (colostrum vs. transitional milk, colostrum vs. mature milk, transitional milk vs. mature milk, all p < 0.001). Maternal BMI, age, mode of delivery, parturition, protein intake, and serum albumin concentration were not correlated with milk Lf concentration. However, milk Lf concentrations varied among different geographical regions (Guangdong (1.91 g/L) vs. Heilongjiang (1.44 g/L), p = 0.037; Guangdong (1.91 g/L) vs. Gansu (1.43 g/L), p = 0.041) and ethnicities (Dai (1.80 g/L) vs. Tibetan (0.99 g/L), p = 0.007; Han (1.62 g/L) vs. Tibetan (0.99 g/L), p = 0.002) in China. CONCLUSIONS: The concentration of Lf in human milk changes dynamically throughout lactation. Few maternal characteristics affect the milk Lf concentration, but it varies across different geographical regions and ethnicities in China.

Lactoferrin level in breast milk: a study of 248 samples from eight regions in China.

Lactoferrin plays an important role in infant gastrointestinal health and immunity responses. This study measured the change of the lactoferrin level in breast milk over the lactation time in Chinese women, and explored potential influencing factors in terms of various maternal factors. 248 lactating women were recruited from eight different regions across China, covering 330 days of lactation. The nutrition information of each woman as well as the gender information of infants were collected. Breast milk lactoferrin level was determined by ultra-performance liquid chromatography (UPLC). A twenty-four-hour maternal food recall was used to collect the dietary information. The lactoferrin level decreased progressively from day 1 to day 30 (p < 0.01), and remained constant from day 31 to day 330. Among the eight regions, the breast milk samples from Gansu contained the highest mean lactoferrin level (1.40 g L-1) while the breast milk samples from Zhejiang contained the least mean lactoferrin level, 0.94 g L-1 (p < 0.01). Dietary pattern and maternal BMI showed no correlation with the breast milk lactoferrin level. Maternal ethnicity and age were associated with the breast milk lactoferrin level. The breast milk samples collected from Tibetan ethnicity had 1.45 g L-1 lactoferrin while those collected from Dai ethnicity had 1.02 g L-1 lactoferrin. Women in the elder age group (30 years old and above) had 0.95 g L-1 breast milk lactoferrin, which was significantly lower than the lactoferrin level (1.3 g L-1) in the younger age group (20-25 years old) (p < 0.01). In conclusion, this study showed that lactoferrin levels in the breast milk of Chinese lactating women were influenced by lactation time. Besides, ethnicity and maternal age were two impact factors on the breast milk lactoferrin level.

Exclusive Breastfeeding Rate and Complementary Feeding Indicators in China: A National Representative Survey in 2013.

Appropriate infant and young child feeding could reduce morbidity and mortality and could improve cognitive development of children. However, nationwide data on exclusive breastfeeding and complementary feeding status in China are scarce. The aim of this study was to assess current exclusive breastfeeding and complementary feeding status in China. A national representative survey (Chinese National Nutrition and Health Survey) of children aged under 6 years was done in 2013. Stratified multistage cluster sampling was used to select study participants. World Health Organization (WHO) infant and young child feeding indicators were firstly used to assess exclusive breastfeeding and complementary feeding practice nationwide. In total, 14,458 children aged under two years (0 to <730 days) were studied from 55 counties in 30 provinces in China. The crude exclusive breastfeeding rate under 6 months was 20.7% (908/4381) and the weighted exclusive breastfeeding rate was 18.6%. The crude prevalence of minimum dietary diversity, minimum meal frequency and minimum acceptable diet were 52.5% (5286/10,071), 69.8% (7027/10,071), and 27.4% (2764/10,071) among children aged 6-23 months, respectively. The weighted rate was 53.7%, 69.1%, and 25.1%, respectively. Residential area, household income and maternal education were positively associated with the three complementary feeding indicators. The exclusive breastfeeding rate under 6 months was low and complementary feeding practice was not optimal in China. Residential area, household income and maternal education might be used to target infants and young children to improve complementary feeding practice.

Vitamin D status and the prevalence of deficiency in lactating women from eight provinces and municipalities in China.

BACKGROUND: Vitamin D deficiency has become prevalent worldwide in recent years. However, less evidence was available for lactating women. OBJECTIVE: The purpose of the study was to understand vitamin D status and prevalence of deficiency in lactating women and associated risk factors for vitamin D deficiency from eight provinces and municipalities in China. METHODS: Lactating women within 1-10 months postpartum were recruited in 2011-2013 from eight provinces and municipalities in China. Radioimmunoassay was used to measure serum 25-hydroxyvitamin D [25(OH)D] concentration. Standardized questionnaire was used to collect information on season, living site, ethnicity and socio-demographic characteristics. RESULTS: Totally 2004 lactating women were recruited. The median (p25, p75) of 25(OH)D was 15.8 (10.5, 24.0) nmol/L. The prevalence of vitamin D deficiency was 85.3% as 25(OH)D <30nmol/L. Serum 25(OH)D levels of lactating women were significantly lower during October-January (14.0nmol/L) than during February-May (18.0nmol/L) (P<0.001), and were significantly higher in Dai ethnicity (22.5nmol/L) than in Hui ethnicity (Chinese Muslims) (9.0nmol/L) (P<0.001). For every 10,000 CNY annual income per capita increasing, serum 25(OH)D levels significantly increased 1.04 times (P<0.001). The odds of vitamin D deficiency in winter were 2.56 times higher than that in spring (OR 2.56, 95%CI: 1.91-3.43). CONCLUSIONS: Vitamin D deficiency of lactating women was highly prevalent in the eight provinces and municipalities in China. It is urgent to study the strategy and intervention ways for improving vitamin D status of lactating women, especially for certain population groups during low sunlight exposure season.

Effectiveness of community-based complementary food supplement (Yingyangbao) distribution in children aged 6-23 months in poor areas in China.

BACKGROUND: Poor growth and micronutrient deficiency mainly attack older infants and young children. Some countries have adopted clinically effective measures to combat malnutrition, but the compliance and improvement in efficacy of intervention vehicles in national programs require evaluation. METHODS: Baseline and follow-up cross-sectional surveys were conducted before and after a nutrition intervention program in 3 national poverty counties in China. Soybean-based complementary food supplements called Yingyangbao (YYB) in Chinese and training materials on child feeding were distributed to households with children aged 6-23 months for 18 months. Representative children were selected by probability proportional to size sampling methods to assess compliance of YYB and the intervention efficacy. A questionnaire was designed to collect data on basic characteristics of children, breastfeeding, 24-hour dietary intake, and consumption and appetite of YYB. Anthropometrics and hemoglobin were measured in the field, and anemia prevalence was evaluated. Venous blood was drawn from children aged 12-35 months to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children's anemia. RESULTS: Of the children involved in the follow-up survey (n = 693), the P50 (P25, P75) intake of YYB was 6.7 (3.5, 7.0) sachets weekly, and 54.7% of the children liked the taste of YYB. Compared with the baseline situation (n = 823), the proportion of children fed a diverse diet and foods rich in iron or vitamin A increased (P < 0.01) in the follow-up study. The prevalence of stunting and underweight decreased (P < 0.05), the prevalence of anemia decreased from 28.0% to 19.9% (P < 0.01), and the prevalence of vitamin B12 deficiency decreased from 26.8% to 15.4% (P < 0.01). For children aged 12-23 months, those who liked YYB and consumed 6 or more sachets of YYB weekly were at lower risk for anemia (OR = 0.34, 95% CI 0.13-0.90, P < 0.05), but the risk of stunting was associated with a non-diverse diet (OR = 1.48, 95% CI 1.06-2.07, P < 0.05). CONCLUSION: The quality of diet and nutritional status of children aged 6-23 months are significantly improved by the intervention of YYB and nutrition education, and good compliance to YYB contributes to a low risk for anemia. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-OOC-16008846.

Comparison of macronutrient contents in human milk measured using mid-infrared human milk analyser in a field study vs. chemical reference methods.

Macronutrient contents in human milk are the common basis for estimating these nutrient requirements for both infants and lactating women. A mid-infrared human milk analyser (HMA, Miris, Sweden) was recently developed for determining macronutrient levels. The purpose of the study is to compare the accuracy and precision of HMA method with fresh milk samples in the field studies with chemical methods with frozen samples in the lab. Full breast milk was collected using electric pumps and fresh milk was analyzed in the field studies using HMA. All human milk samples were thawed and analyzed with chemical reference methods in the lab. The protein, fat and total solid levels were significantly correlated between the two methods and the correlation coefficient was 0.88, 0.93 and 0.78, respectively (p < 0.001). The mean protein content was significantly lower and the mean fat level was significantly greater when measured using HMA method (1.0 g 100 mL-1 vs 1.2 g 100 mL-1 and 3. 7 g 100 mL-1 vs 3.2 g 100 mL-1 , respectively, p < 0.001). Thus, linear recalibration could be used to improve mean estimation for both protein and fat. There was no significant correlation for lactose between the two methods (p > 0.05). There was no statistically significant difference in the mean total solid concentration (12.2 g 100 mL-1 vs 12.3 g 100 mL-1 , p > 0.05). Overall, HMA might be used to analyze macronutrients in fresh human milk with acceptable accuracy and precision after recalibrating fat and protein levels of field samples.

An on-line database for human milk composition in China.

BACKGROUND AND OBJECTIVES: Understanding human milk composition is critical for setting nutrient recommended intakes (RNIs) for both infants and lactating women. However, nationwide human milk composition remains unavailable in China. METHODS AND STUDY DESIGN: Through cross-sectional study, human milk samples from 11 provinces in China were collected and their compositions were analyzed. Nutritional and health status of the lactating women and their infants were evaluated through questionnaire, physical examination and biochemical indicators. RESULTS: A total of 6,481 breast milk samples including colostrum (1,859), transitional milk (1,235) and mature milk (3,387) were collected. Contents of protein, fat, lactose, total solid and energy of more than 4,500 samples were analyzed using a human milk analyzer. About 2,000 samples were randomly selected for 24 mineral analyses. Free B-vitamins including thiamin, riboflavin, pyridoxal, pyridomine, pyridoxamine, nicotinamide, nicotinic acid, flavin adenine dinucleotide (FAD), biotin and pantothenic acid were analyzed in 1,800 samples. Amino acids (~800) and proteins (alpha-lactoalbumin, beta-casein, and lactoferrin) were analyzed. In addition, serum retinol and carotenoids, 25(OH)D, vitamin B-12, folic acid, ferritin and biochemical indicators (n=1,200 to 2,000) were analysed in the lactating women who provided the breast milk. Ongoing work: Fatty acids (C4-C24), fatsoluble vitamins and carotenoids, are on-going analysis. CONCLUSIONS: A regional breast milk compositional database is at an advanced stage of development in China with the intention that it be available on-line.

[Effects of text message intervention on infant growth and anemia at 6 month old].

OBJECTIVE: To investigate the effects of delivering infant feeding knowledge using text messages from cell phones on improving infant growth and anemia. METHODS: A community-based intervention study was conducted in four community health centers in Tumoteyou County, Baotou, Inner Mongolia, one of which was the intervention group and the other three locating nearby were assigned into the control group. Pregnant women were recruited from peri-natal care center. In the intervention group, infant feeding knowledge was sent by the staff of health care center using text messages to the subjects. Meanwhile, no intervention was given in the control group. The growth status and anemia prevalence were assessed at 6 month in both groups. The WHO growth standard for children under 5 years was used to assess the growth status, using the Anthro software v3. 2. 2 to calculate Z scores. Anemia was defined as the concentration of hemoglobin less than 110 g/L. Hemoglobin was measured in duplicate by Hemocue 301 instrument. RESULTS: Totally 214 pregnant women were recruited at the baseline. At the 6 months of postpartum, 192 mothers and infants were investigated. The percentage of lost follow-up was 10.3%. The LAZ, HCZ and hemoglobin concentration of infants were significantly greater,in'the intervention group than in the control group at 6 month old (P < 0.01). The prevalence of stunting (P < 0.01), overweight and obesity (P = 0.02), and anemia (P < 0.01) were significantly lower in the intervention group. CONCLUSIONS: Using text messages from cell phones to deliver infant feeding knowledge may improve the growth and anemia status of infants aged 6 month.

[Status of exclusive breastfeeding and influencing factors for 1,882 pairs of mother and neonate during 0- 7 days postpartum in China].

OBJECTIVE: To investigate the status of exclusive breastfeeding(EBF) and possible influencing factors during 0-7 days postpartum in China. METHODS: During 2011 to 2013, healthy mothers and neonates who were in the period of 0- 7 days postpartum from 8 provinces across different regions of China were recruited to take the questionnaire investigations and physical examinations. Information about socio-economic, pregnant, and delivery status, infant healthy situation and feeding indicators was collected to calculate the rate of exclusive breastfeeding during 0- 7 days postpartum and analyze the influencing factors. RESULTS: A total of 1 882 pairs of mothers and neonates were covered by this study. The rate of EBF was 13.3% (250 cases) during 0- 7 days postpartum. Bottle feeding (OR=0.08, 95% CI: 0.05- 0.12), the mothers themselves mixed fed at their 0-4 months old (OR=0.22, 95%CI: 0.08-0.58), the mothers who had used methods to stimulate milk secretion (OR=0.58, 95% CI: 0.35- 0.94) might decrease the EBF rate. Compared with the mothers who believed that their breast milk was not enough for their infants, the mothers who believed breastmilk was enough may increase the EBF rate (OR=6.04, 95%CI: 3.34-10.94). Comparing to the EBF rate of Beijing, Yunnan (OR=0.10, 95%CI: 0.04-0.24), and Gansu(OR=0.03,95%CI: 0.01-0.08) had lower EBF rate during 0-7 days postpartum. What's more, the EBF rate increased with the increasing neonates' age (OR=1.33, 95% CI: 1.16- 1.53). CONCLUSION: The EBF rate during 0- 7 days postpartum is still low in China and had significant differences in different regions. Suboptimal feeding knowledge and practices affected the EBF rate significantly.

The relationship between socioeconomic development and malnutrition in children younger than 5 years in China during the period 1990 to 2010.

UNLABELLED: BACKGROUND AND OBJECTIVES：More than 30 years of socioeconomic development in China has improved living conditions which contributed to a steep decline in malnutrition prevalence of children under 5 years. To elucidate the role of socioeconomic development in improving nutritional status and to identify appropriate policy priorities for intervention in nutrition improvement for younger children. METHODS AND STUDY DESIGN: We collected data on socioeconomic development, education, cultural and recreational services, food consumption, average family size and malnutrition prevalence from national surveys. RESULTS: From 1990 to 2010, Gross Domestic Product (GDP) per capita increased from 1644 Chinese Yuan (CNY) to 30,015 CNY; average disposable income and food expenditure per capita significantly increased in urban and rural areas; per capita consumption for education increased from 112 CNY to 1628 CNY and from 15.3 CNY to 367 CNY for other cultural services; illiteracy rate decreased from 15.9% to 4.1%; average family size from 3.97 to 3.10; and prevalence of stunting and underweight decreased from 33.1% to 9.9% and 13.7% to 3.6%, respectively. However, anaemia prevalence did not obviously decline between 1992 and 2000. After adjusting confounding effects of variables, negative relationships were observed between GDP per capita, average family size and stunting or underweight prevalence. However, no association was observed between illiteracy rate and prevalence of stunting and underweight, and there was no correlation between GDP per capita, illiteracy rate, average family size and anaemia prevalence. CONCLUSIONS: Our results indicated that economic development cannot solve all nutritional problems and comprehensive national developmental strategies should be considered to combat malnutrition.

The Influence of Malnutrition and Micronutrient Status on Anemic Risk in Children under 3 Years Old in Poor Areas in China.

BACKGROUND: Malnutrition and anemia affect large numbers of young children living in poor areas of China. Multi-micronutrient deficiencies may be related to the prevalence of anemia in different populations, and identifying the risk factors that render children susceptible to anemia is the first step in combating anemia effectively. METHODS: In this cross-sectional study, a total of 1370 children under 3 years old were selected based on probability proportional to size sampling principles from poor counties of China. Basic characteristics data were collected by questionnaire; then anthropometrics and hemoglobin were measured in the field and anemia prevalence evaluated. Venous blood was drawn from children aged 12-35 months (N = 553) to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children's anemia. RESULTS: Among children aged 0-35 months, the prevalence of stunting, low body weight and wasting was 17.5%, 8.6% and 5.1%, respectively, and 25.6% of the children were affected by anemia, with more anemic infants and younger children than older children (P <0.01). There were 26.5%, 12.8%, 14.1% and 20.0% of the children aged 12-35 months affected by iron deficiency, vitamin D deficiency, folic acid deficiency and vitamin B12 deficiency, respectively. For children aged 0-11 months who were breastfed, the mothers' anemic status was the only factor associated with the child's anemia (OR = 2.6; 95% CI: 1.2-5.4, P < 0.05). For children aged 12-35 months, multivariate logistic regression indicated that anemia was significantly associated with iron and vitamin B12 deficiency (OR = 5.3; 95% CI: 1.9-14.5, P < 0.01) and monotonous diet (OR = 2.3; 95% CI: 1.1-4.7, P < 0.05) after adjusting for age and gender. CONCLUSION: The prevalence of anemia was higher in children under 2 years old and requires urgent intervention. An effective intervention strategy should include iron and vitamin B12 supplements, improving dietary diversity and controlling breastfeeding mothers' anemia.

B-Vitamin Levels in Human Milk among Different Lactation Stages and Areas in China.

To determine the contents of B-vitamins in human milk in China, we analyzed 1778 human milk samples from the sample bank of the National High Technique R & D Program (863 Projects) which was a cross-sectional survey and covered 6419 human milk samples from healthy lactating mothers who were at different stages of lactation (0-330 days postpartum) in 11 provinces of China. The contents of free forms of six B-vitamins in these human milk samples were analyzed by using UPLC-MS/MS. The median concentrations of free form of 6 B-vitamins in colostrums, transitional milk, 15-180 d mature milk and 181-330 d mature milk were respectively as follows: thiamin 5.0 µg/L, 6.7 µg/L, 21.1 µg/L and 40.7 µg/L; riboflavin 29.3 µg/L, 40.6 µg/L, 33.6 µg/L and 29.6 µg/L; niacin 470.7 µg/L, 661.3 µg/L, 687.0 µg/L and 571.3 µg/L; vitamin B-6 4.6 µg/L, 16.1 µg/L, 62.7 µg/L and 80.7 µg/L; flavin adenine dinucleotide (FAD) 808.7 µg/L, 1162.8 µg/L, 1023.9 µg/L and 1057.2 µg/L; pantothenic acid 1770.9 µg/L, 2626.8 µg/L, 2213.0 µg/L and 1895.5 µg/L. The contents of 6 B-vitamins varied significantly among the different lactation stages and different areas (coastal area vs inland area, rural area vs urban area). The present study indicated that the concentrations of B-vitamins in colostrum were generally much lower than those in transitional milk and mature milk. Further studies are warranted for their roles and significance on B-vitamins in colostrum in nutrition and metabolism of neonates.

Comparison of the China growth charts with the WHO growth standards in assessing malnutrition of children.

OBJECTIVES: To compare the difference between the China growth reference and the WHO growth standards in assessing malnutrition of children under 5 years. SETTINGS: The households selected from 31 provinces, autonomous regions and municipalities in mainland China (except Taiwan, Hong Kong and Macao). PARTICIPANTS: Households were selected by using a stratified, multistage probability cluster sampling. Children under 5 years of age in the selected households were recruited (n=15,886). PRIMARY AND SECONDARY OUTCOME MEASURES: Underweight, stunting, wasting, overweight and obesity. RESULTS: According to the China growth reference, the prevalence of underweight (8.7% vs 4.8%), stunting (17.2% vs 16.1%) and wasting (4.4% vs 3%) was significantly higher than that based on the WHO growth standards, respectively (p<0.001); the prevalence of overweight was lower than that based on the WHO growth standards (9.4% vs 10.2%, p<0.001). In most cases, the prevalence of undernutrition assessed by using the China growth reference was significantly higher. However, the prevalence of overweight was significantly lower by using China charts for boys aged 3-4, 6, 8, 10, 12-18 and 24 months. CONCLUSIONS: The WHO growth standards could be more conservative in undernutrition estimation and more applicable for international comparison for Chinese children. Future researches are warranted for using the WHO growth standards within those countries with local growth charts when there are distinct differences between the two.

Evaluating the micronutrient status of women of child-bearing age living in the rural disaster areas one year after Wenchuan Earthquake.

Populations with special physiological state, such as pregnant, nursing and women of child-bearing age, have been identified as nutritionally vulnerable during natural disaster. The objective of this survey was to evaluate the prevalence of anaemia and micronutrient status of women of reproductive age in April 2009 one year after the Wenchuan Earthquake. The survey recruited 58 pregnant, 66 lactating and 242 women of child-bearing age from 19 to 45 years. The concentrations of haemoglobin in whole blood and ferritin and micronutrients in serum were assayed. Among the three groups (pregnant, nursing and child-bearing women), respectively, the prevalence of anaemia was 29.1%, 25.5% and 28.8%; that of iron deficiency was 45.4%, 49.0% and 52.9%; and that of zinc deficiency was 45.4%, 23.0% and 33.5%. The sum of vitamin D deficiency and insufficiency was more than 90% in each group, and the total vitamin B12 deficiency and marginal deficiency prevalence percentages were 47.3%, 17.7% and 35.7%, respectively. The prevalence of vitamin A deficiency and marginal deficiency was 1.8% and 9.1% in pregnant women, 6.1% and 15.2% in nursing women and 8.6% and 21.3% in women of child-bearing age, respectively. Our findings indicated that the micronutrient status of women of reproductive age was poor in the disaster areas. Therefore, improving the micronutrient status of these women should be an urgent priority in these areas.

Growth and anaemia among infants and young children for two years after the Wenchuan earthquake.

BACKGROUND: In order to monitor malnutrition morbidity and anaemic prevalence of infants and young children in rural disaster areas affected by Wenchuan earthquake. METHODS: About three months, one year and two years after earthquake (including 77, 102 and 307 children, respectively), by using the questionnaires, information on nutritional and health status of infants and young children aged 6-23 months was collected and evaluated, and anthropometry and haemoglobin concentration were measured. RESULTS: Most of families could not prepare complementary foods for their children so that the children only ate the same meals as adults which resulted in very poor situation in the quantity and quality of complementary food for infants and young children. The main nutritional problems in children included the lack of feeding knowledge in parents; only 10% children could have breast feeding within one hour after delivery, and the basic exclusive breastfeeding was lower. More than 90% children never received nutrient supplements. The malnutrition prevalence was significantly increased two years after the earthquake. The decrease of body weight was rapid (underweight prevalence from 0 at three months to 5.9% after two years), and then a lasting effect resulted in decrease of length shown by stunting prevalence from 6.6% at three months to 10.8% after two years and wasting prevalence from 1.3% at three months to 4.0% after two years. From three months to two years after earthquake, anaemic prevalence markedly increased from 36.5% to 67.5% and the increasing percentage of anaemia was more obvious in girls than boys. CONCLUSION: The child's nutritional status continuously worsened and anaemic prevalence was high in areas affected by the earthquake. It is recommended that in the future nutrition interventions should begin immediately.

The micronutrient status of children aged 24-60 months living in rural disaster areas one year after the Wenchuan Earthquake.

OBJECTIVE: In order to evaluate micronutrient status of children aged 24-60 months living in rural disaster areas after one year of the earthquake in Wenchuan. DESIGN: After one year of Wenchuan Earthquake, using PPS sampling methods, a total of 270 children from six-randomized townships near seismic center, in each township sample size consisted of 30 to 50 children, were sampled for evaluating Z-score of children's growth status, anemia prevalence, vitamin A, vitamin D, vitamin B12, folic acid status. Final sample consisted of 152 boys and 118 girls, and blood samples were drawn from 206 children. RESULTS: The stunting (HAZ<2SD) and wasting (WHZ<2SD) were respectively 14.7% and 0.7%. Prevalence of anemia was 17.3% and percentage of iron deficiency was 45.7%. The prevalence of vitamin A deficiency and marginal deficiency was 15.4% and 30.3%, respectively. The sum of vitamin D deficiency and marginal deficiency was near 90%. Percentages of Zinc deficiency including marginal and deficiency were 65.5%. Percentages of vitamin B12 marginal and deficiency were 8.6% and 10.6% and the prevalence of marginal deficiency was significantly higher in boys than in girls. Folic acid deficiency was not found in surveyed children using serum folic acid level <16.9 ng/ml. CONCLUSION: In areas affected by Earthquake, preschool children had higher stunting prevalence and a relatively higher prevalence suffered from micronutrient deficiencies, including iron-deficiency anemia, and deficiencies of iron, zinc, vitamin A and vitamin B12.

Prospective study on the effectiveness of complementary food supplements on improving status of elder infants and young children in the areas affected by Wenchuan earthquake.

OBJECTIVE: To prospectively evaluate the efficiency of daily providing complementary food supplements decreasing malnutrition and anemia prevalence in elder infants and young children living in areas affected by Wenchuan Earthquake. DESIGN: Using promotional probability sampling method, 250 to 300 children from six-randomized townships (30 to 50 children in each township) in Kang County affected by the Earthquake were randomly chosen for follow up to evaluate intervention effectiveness using anthropometric measurement and hemoglobin level at six, twelve and eighteen months after start of intervention. SETTING AND SUBJECTS: All children from 6 to 18 months of age in Kang County (in North Western China) were daily provided with complementary food supplements containing multiple vitamins and minerals for up to 24 months of age. The intervention period lasted for one and half year. RESULTS: At beginning of intervention, malnutrition prevalence, including underweight, stunting and wasting were respectively 4.5%, 8.9% and 3.5%; anemia prevalence was 74.3%. After one and half year intervention, the growth and anemia status were significantly improved; the percentages of wasting, stunting underweight prevalence were decreased from 3.5%, 8.9% and 4.5% to 1.7%, 5.0% and 3.3% respectively, and the anemia rates were significantly decreased. CONCLUSIONS: Our results indicated that an intervention using complementary food supplements could improve nutritional status and elevate hemoglobin level in elder infants and young children, which would significantly decrease the prevalence of malnutrition and anemia.