Integrating Vitamin A Supplementation at 6 months into the Expanded Program of Immunization in Sierra Leone.

Since 2004, twice-yearly mass vitamin A supplementation (VAS) has equitably reached over 85% of children 6-59 months old in Sierra Leone. However infants who turn 6 months after the event may wait until they are 11 months old to receive their first dose. The effectiveness of integrating VAS at 6 months into the Expanded Program of Immunization (EPI) in a revised child health card was studied. Health facilities matched according to staff cadre and work load were assigned to provide either a 'mini package' of VAS and infant and young child feeding (IYCF), a 'full package' of VAS, IYCF and family planning (FP), or 'child health card' only. 400 neonates were enrolled into each group, caregivers given the new child health card and followed until they were 12 months old. More infants in the full: 74.5% and mini: 71.7% group received VAS between 6 and 7 months of age compared with the new CH card only group: 60.2% (p = 0.002, p < 0.001 respectively). FP commodities were provided to 44.5% of caregivers in the full compared with <2.5% in the mini and new child health card only groups (p < 0.0001). Integration of VAS within the EPI schedule achieved >60% coverage for infants between 6 and 7 months of age. Provision of FP and/or IYCF further improved coverage. Funding was provided by the Canadian Department of Foreign Affairs, Trade and Development who had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

A multicomponent intervention reduces body weight and cardiovascular risk at a GEICO corporate site.

PURPOSE: To determine whether a multicomponent nutrition intervention program at a corporate site reduces body weight and improves other cardiovascular risk factors in overweight individuals. DESIGN: Prospective clinical intervention study. SUBJECTS/SETTING: Employees of the Government Employees Insurance Company (GEICO) (N = 113), aged 21 to 65 years, with a body mass index > or =25 kg/m(2) and/or previous diagnosis of type 2 diabetes. INTERVENTION: A 22-week intervention including a low-fat, vegan diet. MEASURES: Changes in body weight, anthropometric measures, blood pressure, lipid profile, and dietary intake. ANALYSIS: Multivariate analyses of variance were calculated for clinical and nutrient measures, followed by univariate analyses of variance, to determine the significance of differences between groups in changes over time. RESULTS: Intervention-group participants experienced greater weight changes compared with control-group participants (mean, -5.1 [SE, .6] kg vs. + .1 [SE, .6] kg, p < .0001), as well as greater changes in waist circumference (mean, -4.7 [SE, .6] cm vs. + .8 [SE, .6] cm, p < .0001) and waistratiohip ratio (mean, -.006 [SE, .003] vs. + .014 [SE, .005], p = .0007). Weight loss of 5% of body weight was more frequently observed in the intervention group (48.5%) compared with the control group (11.1%) (chi(2)[1, N = 113] = 16.99, p < .0001). CONCLUSIONS: Among individuals volunteering for a 22-week worksite research study, an intervention using a low-fat, vegan diet effectively reduced body weight and waist circumference.

A worksite vegan nutrition program is well-accepted and improves health-related quality of life and work productivity.

BACKGROUND/AIMS: Vegetarian and vegan diets are effective in preventing and treating several chronic diseases. However, their acceptability outside a clinical trial setting has not been extensively studied. The aim of this study was to determine the acceptability of a worksite vegan nutrition program and its effects on health-related quality of life and work productivity. METHODS: Employees of a major insurance corporation with a body mass index > or =25 kg/m(2) and/or a previous diagnosis of type 2 diabetes received either weekly group instruction on a low-fat vegan diet (n = 68) or received no diet instruction (n = 45) for 22 weeks. RESULTS: The vegan group reported improvements in general health (p = 0.002), physical functioning (p = 0.001), mental health (p = 0.03), vitality (p = 0.004), and overall diet satisfaction (p < 0.001) compared with the control group. The vegan group also reported a decrease in food costs (p = 0.003), and increased difficulty finding foods when eating out (p = 0.04) compared with the control group. The vegan group reported a 40-46% decrease in health-related productivity impairments at work (p = 0.03) and in regular daily activities (p = 0.004). CONCLUSIONS: A worksite vegan nutrition program is well-accepted and can be implemented by employers to improve the health, quality of life, and work productivity of employees.

The effects of a whole grain-enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome.

BACKGROUND: Whole-grain foods are associated in observational studies with a lower body mass index and lower cardiovascular disease (CVD) risk. However, few clinical trials have tested whether incorporating whole grains into a hypocaloric diet increases weight loss and improves CVD risk factors. OBJECTIVE: The aim of this study was to determine whether including whole-grain foods in a hypocaloric (reduced by 500 kcal/d) diet enhances weight loss and improves CVD risk factors. DESIGN: Obese adults (25 M, 25 F) with metabolic syndrome were randomly assigned to receive dietary advice either to avoid whole-grain foods or to obtain all of their grain servings from whole grains for 12 wk. All participants were given the same dietary advice in other respects for weight loss. RESULTS: Body weight, waist circumference, and percentage body fat decreased significantly (P<0.001) in both groups over the study period, but there was a significantly (P=0.03) greater decrease in percentage body fat in the abdominal region in the whole-grain group than in the refined-grain group. C-reactive protein (CRP) decreased 38% in the whole-grain group independent of weight loss but was unchanged in the refined-grain group (P=0.01 for group x time interaction). Total, LDL, and HDL cholesterol decreased in both diet groups (P<0.05). Dietary fiber and magnesium intakes increased in the whole-grain but not the refined-grain group (P=0.007 and P<0.001, respectively, for group x time interaction). CONCLUSIONS: Both hypocaloric diets were effective means of improving CVD risk factors with moderate weight loss. There were significantly (P<0.05) greater decreases in CRP and percentage body fat in the abdominal region in participants consuming whole grains than in those consuming refined grains.

Coverage of vitamin A supplementation and deworming during Malezi Bora in Kenya.

Twice-yearly child health weeks are an effective way of reaching children with essential child survival services in developing countries. In Kenya, child health weeks, or Malezi Bora, were restructured in 2007 from an outreach-based delivery structure to a health facility-based delivery structure to reduce delivery costs and increase sustainability of the events. Administrative data from 2007 to 2011 have demonstrated a decrease in coverage of Malezi Bora services to targeted children. A post-event coverage (PEC) survey was conducted after the May 2012 Malezi Bora to validate coverage of vitamin A supplementation (VAS) and deworming and to inform program strategy. Nine hundred caregivers with children aged 6-59months were interviewed using a randomized, 30×30 cluster design. For each cluster, one facility-based health worker and one community-based health worker were also interviewed. Coverage of VAS was 31.0% among children aged 6-59months and coverage of deworming was 19.6% among children aged 12-59months. Coverage of VAS was significantly higher for children aged 6-11months (45.7%, n=116) than for children aged 12-59months (28.8%, n=772) (p<0.01). Eighty-five percent (51/60) of health workers reported that Malezi Bora was implemented in their area while 23.6% of primary caregivers reported that Malezi Bora occurred in their area. The results of this PEC survey indicate that the existing Malezi Bora programmatic structure needs to be reviewed and reformed to meet WHO guidelines of 80% coverage with VAS.

High and equitable mass vitamin A supplementation coverage in Sierra Leone: a post-event coverage survey.

BACKGROUND: In Sierra Leone, children ages 6-59 months receive twice-yearly vitamin A supplementation (VAS) through Maternal and Child Health Week (MCHW) events. VAS coverage in 2011 was calculated using government tally sheets of vitamin A capsule distribution and outdated population projections from the 2004 census. We conducted a national post-event coverage (PEC) survey to validate coverage and inform strategies to reach universal coverage of VAS in Sierra Leone. METHODOLOGY: Immediately following the November 2011 MCHW event, we conducted a national PEC survey by interviewing caregivers with children ages 6-59 months using a randomized 30X30 cluster design (N = 900). We also interviewed one health worker and one community health worker in each cluster to determine their knowledge about VAS (N = 60). RESULTS: VAS coverage was 91.8% among children ages 6-59 months, which was lower than the 105.1% reported through tally sheets. Coverage was high and equitable among all districts and between age groups (98.5% for infants ages 6-11 months and 90.5% for children ages 12-59 months). Major reasons for not receiving VAS were that the child was out of the area (42.4%), the household was not visited by community health workers (28.0%), and the caretaker was not aware of the event (11.9%). CONCLUSION: Twice-yearly delivery of VAS through MCHW events achieved consistently high and equitable coverage in Sierra Leone. Universal coverage may be achieved through continued focus on communication and targeted outreach to hard-to-reach areas during the MCHWs.

Continuous glucose monitoring during pregnancy in women with polycystic ovary syndrome.

OBJECTIVE: To estimate whether women with polycystic ovary syndrome (PCOS) will display ambient hyperglycemia (as measured by continuous glucose monitoring) early in pregnancy that progressively exacerbates with advancing pregnancy. METHODS: This was a case-control study during singleton pregnancies of 17 women with PCOS and 17 healthy women. A 75-g oral glucose tolerance test (OGTT) followed by 24-hour continuous glucose monitoring was obtained four times throughout the pregnancy (visit 1: 6-10 weeks; visit 2: 12-16 weeks; visit 3: 24-28 weeks; visit 4: 34-38 weeks). RESULTS: Eight women with PCOS (47%) and two women in the control group (12%) developed gestational diabetes mellitus (GDM) as defined by World Health Organization criteria. Women with PCOS had a higher area under the curve for glucose during the OGTT at visit 1, visit 2, and visit 3, and for insulin at visit 1, compared with the control group. No differences were found between groups for any of the continuous glucose monitoring parameters studied. The free androgen index significantly decreased over the course of the study in both groups with a stronger decrease in the PCOS group at visit 1 (P=.003), visit 2 (P=.07), and visit 3 (P=.04). The difference in birth weight between groups was not significant: 3,346 g in women with PCOS and 3,633 g in women in the control group, and there was no perinatal morbidity. CONCLUSION: Women with PCOS are at increased risk for GDM, which manifests early in pregnancy and is detectable by OGTT. Serial 24-hour glucose monitoring did not reveal changes in glucose metabolism, although our sample size was small. Hyperandrogenemia improves with progressive pregnancy in women with PCOS. LEVEL OF EVIDENCE: II.

Lifestyle approaches and dietary strategies to lower LDL-cholesterol and triglycerides and raise HDL-cholesterol.

This article discusses specific dietary factors as well as dietary patterns that affect the major coronary heart disease (CHD) lipid risk factors (ie, LDL-C, HDL-C, and TG). Based on a very large evidence base, it is clear that diet and lifestyle practices can markedly affect these major CHD lipid risk factors, and consequently decrease CHD risk substantively.

Vegetarian and vegan diets in type 2 diabetes management.

Vegetarian and vegan diets offer significant benefits for diabetes management. In observational studies, individuals following vegetarian diets are about half as likely to develop diabetes, compared with non-vegetarians. In clinical trials in individuals with type 2 diabetes, low-fat vegan diets improve glycemic control to a greater extent than conventional diabetes diets. Although this effect is primarily attributable to greater weight loss, evidence also suggests that reduced intake of saturated fats and high-glycemic-index foods, increased intake of dietary fiber and vegetable protein, reduced intramyocellular lipid concentrations, and decreased iron stores mediate the influence of plant-based diets on glycemia. Vegetarian and vegan diets also improve plasma lipid concentrations and have been shown to reverse atherosclerosis progression. In clinical studies, the reported acceptability of vegetarian and vegan diets is comparable to other therapeutic regimens. The presently available literature indicates that vegetarian and vegan diets present potential advantages for the management of type 2 diabetes.

Comparison of hormonal and metabolic markers after a high-fat, Western meal versus a low-fat, high-fiber meal in women with polycystic ovary syndrome.

OBJECTIVE: To determine the effect of meal composition on postprandial T levels in women with polycystic ovary syndrome (PCOS). DESIGN: Randomized, crossover design. SETTING: Academic research center. PATIENT(S): Fifteen women with PCOS. INTERVENTION(S): We evaluated changes in T, sex hormone binding globulin (SHBG), DHEAS, cortisol, glucose, and insulin for 6 hours after a high-fat, Western meal (HIFAT) (62% fat, 24% carbohydrate, 1 g fiber) and an isocaloric low-fat, high-fiber meal (HIFIB) (6% fat, 81% carbohydrate, 27 g fiber). MAIN OUTCOME MEASURE(S): Change in T levels. RESULT(S): Testosterone decreased 27% within 2 hours after both meals. However, T remained below premeal values for 4 hours after the HIFIB meal and 6 hours after the HIFAT meal. Insulin was twofold higher for 2 hours after the HIFIB meal compared with the HIFAT meal. Glucose was higher for 1 hour after the HIFIB meal compared with the HIFAT meal. DHEAS decreased 8%-10% within 2-3 hours after both meals, then increased during the remainder of the study period. Cortisol decreased during the 6-hour period after both meals. CONCLUSIONS: Diet plays a role in the regulation of T levels in women with PCOS. Further studies are needed to determine the role of diet composition in the treatment of PCOS.

Obesity and the role of gut and adipose hormones in female reproduction.

Reproductive function declines at both extremes of human energy balance. The relationship between obesity and reproductive function is complex and incompletely understood. The literature has established the negative impact of excess energy stores on ovulatory function and investigated the mechanisms whereby this occurs. Furthermore, weight loss in obese anovulatory women increases ovulation and conception. Obesity and anti-obesity therapy effects on the endometrium, implantation and early fetal development have received less attention. The discovery of adipokines and enterokines greatly expands the ability to investigate the relationship between obesity, therapies to produce weight loss and reproductive function. In this review, we discuss select adipose and enteric signals. We focus on in vitro, animal and human data that lend biological plausibility to adipokines and enterokines as mediators of obesity and reproduction. Very little published work exists that directly addresses adipocyte and enteric signals in this specific role; therefore, much of this review is on the basis of a synthesis of the literature in three areas: (i) in vitro and in vivo evidence regarding the reproductive effects of these signals; (ii) adipokine and enterokine changes that occur with weight-loss therapies, focusing on hypocaloric diets, bariatric surgery and drugs that target adipocyte or enteric signals and (iii) reproductive changes produced by these weight-loss therapies.