UK Internet antenatal dietary advice: a content accuracy and readability analysis.

The aim of the study was to assess the accuracy and readability of Internet prenatal nutrition advice. Between August and December 2018, 130 Internet pages returned from Google searches on foods to avoid, foods to eat and supplements use were compared with UK government advice for pregnant women. Readability was assessed using the Flesch Readability Ease (FRE) tool. Descriptive and non-parametric tests were used. Spearman's correlation explored associations between accuracy and readability. Kruskal-Wallis tests with Bonferroni correction were used for multiple pairwise tests and Mann-Whitney U tests for two-sample differences in medians. A total of 130 Internet pages were examined: 48 % from publishers, 27 % from other commercial organisations, 22 % from charities and 3 % from governments. Eighty-three (64 %) pages contained inaccurate and accurate advice, twenty-three (18 %) were accurate and complete, twenty-one (16 %) were inaccurate, and three (2 %) lacked any relevant advice. The median percentage accuracy of all advice was 83 (lower quartile, upper quartile: 48, 100). Median FRE was 55 (46, 61) 'fairly difficult'. Eighty-seven pages (67 %) scored below the recommended FRE for public Internet pages. There was a weak positive correlation between accuracy and readability of Internet pages (rho = 0·241, P = 0·006). Accuracy of Internet pages did not differ by dietary theme. Pages on supplements were the most difficult to read. Internet pages from publishers and other commercial organisations were significantly less accurate than those from not-for-profit organisations (median percentage difference -8 (-29, 0·00), P = 0·019). Much pregnancy-related dietary advice online is inaccurate and difficult to read. Advice should be developed in consultation with qualified nutritionists and dietitians.

Effect of combining multiple micronutrients with iron supplementation on Hb response in children: systematic review of randomized controlled trials.

OBJECTIVES: To study the effect of combining multiple (two or more) micronutrients with Fe supplementation on Hb response, when compared with placebo and with Fe supplementation, in children. DATA SOURCES: Electronic databases, personal files, hand search of reviews, bibliographies of books, and abstracts and proceedings of international conferences. REVIEW METHODS: Randomized controlled trials evaluating change in Hb levels with interventions that included Fe and multiple-micronutrient supplementation in comparison to placebo alone or Fe alone were analysed in two systematic reviews. RESULTS: Twenty-five trials were included in the review comparing Fe and micronutrient supplementation with placebo. The pooled estimate (random effects model) for change in Hb with Fe and micronutrient supplementation (weighted mean difference) was 0.65 g/dl (95 % CI 0.50, 0.80, P < 0.001). Lower baseline Hb, lower height-for-age Z score, non-intake of 'other micronutrients' and malarial non-hyperendemic region were significant predictors of greater Hb response and heterogeneity. Thirteen trials were included in the review comparing Fe and micronutrient supplementation with Fe alone. The pooled estimate for change in Hb with Fe and micronutrient supplementation (weighted mean difference) was 0.14 g/dl (95 % CI 0.00, 0.28, P = 0.04). None of the variables were found to be significant predictors of Hb response. CONCLUSIONS: Synthesized evidence indicates that addition of multiple micronutrients to Fe supplementation may only marginally improve Hb response compared with Fe supplementation alone. However, addition of 'other micronutrients' may have a negative effect. Routine addition of unselected multiple micronutrients to Fe therefore appears unjustified for nutritional anaemia control programmes.

Potential impacts of iron biofortification in India.

Iron deficiency is a widespread nutrition and health problem in developing countries, causing impairments in physical activity and cognitive development, as well as maternal mortality. Although food fortification and supplementation programmes have been effective in some countries, their overall success remains limited. Biofortification, that is, breeding food crops for higher micronutrient content, is a relatively new approach, which has been gaining international attention recently. We propose a methodology for ex ante impact assessment of iron biofortification, building on a disability-adjusted life years (DALYs) framework. This methodology is applied in an Indian context. Using a large and representative data set of household food consumption, the likely effects of iron-rich rice and wheat varieties are simulated for different target groups and regions. These varieties, which are being developed by an international public research consortium, based on conventional breeding techniques, might be ready for local distribution within the next couple of years. The results indicate sizeable potential health benefits. Depending on the underlying assumptions, the disease burden associated with iron deficiency could be reduced by 19-58%. Due to the relatively low institutional cost to reach the target population, the expected cost-effectiveness of iron biofortification compares favourably with other micronutrient interventions. Nonetheless, biofortification should not be seen as a substitute for other interventions. Each approach has its particular strengths, so they complement one another.

Estimating the global costs of vitamin A capsule supplementation: a review of the literature.

BACKGROUND: Vitamin A supplementation reduces child mortality. It is estimated that 500 million vitamin A capsules are distributed annually. Policy recommendations have assumed that the supplementation programs offer a proven technology at a relatively low cost of around US$0.10 per capsule. OBJECTIVES: To review data on costs of vitamin A supplementation to analyze the key factors that determine program costs, and to attempt to model these costs as a function of per capita income figures. METHODS: Using data from detailed cost studies in seven countries, this study generated comparable cost categories for analysis, and then used the correlation between national incomes and wage rates to postulate a simple model where costs of vitamin A supplementation are regressed on per capita incomes. RESULTS: Costs vary substantially by country and depend principally on the cost of labor, which is highly correlated with per capita income. Two other factors driving costs are whether the program is implemented in conjunction with other health programs, such as National Immunization Days (which lowers costs), and coverage in rural areas (which increases costs). Labor accounts for 70% of total costs, both for paid staff and for volunteers, while the capsules account for less than 5%. Marketing, training, and administration account for the remaining 25%. CONCLUSIONS: Total costs are lowest (roughly US$0.50 per capsule) in Africa, where wages and incomes are lowest, US$1 in developing countries in Asia, and US$1.50 in Latin America. Overall, this study derives a much higher global estimate of costs of around US$1 per capsule.

Plant breeding to control zinc deficiency in India: how cost-effective is biofortification?

OBJECTIVE: To estimate the potential impact of zinc biofortification of rice and wheat on public health in India and to evaluate its cost-effectiveness compared with alternative interventions and international standards. DESIGN: The burden of zinc deficiency (ZnD) in India was expressed in disability-adjusted life years (DALYs) lost. Current zinc intakes were derived from a nationally representative household food consumption survey (30-day recall) and attributed to household members based on adult equivalent weights. Using a dose-response function, projected increased zinc intakes from biofortified rice and wheat were translated into potential health improvements for pessimistic and optimistic scenarios. After estimating the costs of developing and disseminating the new varieties, the cost-effectiveness of zinc biofortification was calculated for both scenarios and compared with alternative micronutrient interventions and international reference standards. SETTING: India. SUBJECTS: Representative household survey (n = 119 554). RESULTS: The calculated annual burden of ZnD in India is 2.8 million DALYs lost. Zinc biofortification of rice and wheat may reduce this burden by 20-51% and save 0.6-1.4 million DALYs each year, depending on the scenario. The cost for saving one DALY amounts to $US 0.73-7.31, which is very cost-effective by standards of the World Bank and the World Health Organization, and is lower than that of most other micronutrient interventions. CONCLUSIONS: Not only may zinc biofortification save lives and prevent morbidity among millions of people, it may also help accommodate the need to economise and to allocate resources more efficiently. Further research is needed to corroborate these findings.

Effect of iron supplementation on haemoglobin response in children: systematic review of randomised controlled trials.

OBJECTIVE: To evaluate the effect of iron supplementation on haemoglobin (Hb) in children through a systematic review of randomised controlled trials. MATERIALS AND METHODS: Electronic databases, personal files, hand search of reviews, bibliographies of books, and abstracts and proceedings of international conferences were reviewed. Randomised controlled trials evaluating change in Hb levels with interventions that included oral or parenteral iron supplementation or iron-fortified formula milk or cereals were analysed. RESULTS: A total of 55 trials (56 cohorts) provided relevant information. Publication bias was evident (P < 0.001). The pooled estimate (random-effects model) for change in Hb with iron supplementation (weighted mean difference) was 0.74 g/dL (95% CI, 0.61-0.87; P < 0.001; P < 0.001 for heterogeneity). Lower baseline Hb level, oral medicinal iron supplementation, and malarial nonhyperendemic region were significant predictors of greater Hb response and heterogeneity. Projections suggested that, on average, between 37.9% and 62.3% of baseline anaemia (Hb <11 g/dL) was responsive to iron supplementation among children under 6 years of age; the corresponding range for malarial hyperendemic regions was 5.8% to 31.8%. CONCLUSIONS: This systematic review indicates that iron supplementation increases Hb levels in children significantly but modestly. The increase is greater in subjects who are anaemic at the start of the trial and lower in malarial hyperendemic areas and in those consuming iron-fortified food. The projected reductions in prevalence of anaemia with iron supplementation alone highlight the need for additional area-specific interventions, particularly in malaria-prone regions.

Effect of iron supplementation on physical performance in children and adolescents: systematic review of randomized controlled trials.

OBJECTIVE: To evaluate the effect of iron supplementation on physical performance in children (0-18 years) through systematic review of randomised controlled trials (RCTs). DATA SOURCES: Electronic databases, personal files, handsearch of reviews, bibliographies of books, abstracts and proceedings of international conferences. REVIEW METHODS: RCTs with interventions that included oral or parenteral iron supplementation, fortified formula milk, or cereals were evaluated. The physical performance outcomes studied were heart rate, treadmill endurance times, blood lactate, and oxygen consumption. RESULTS: A total of three studies were included, in all of which iron was supplemented in the form of oral medicinal iron. At 5, 6 and 7 miles per hour running speeds, the pooled weighted mean (95% Cl) difference (WMD) in the heart rate (per minute) between the iron and the placebo, following exercise was -7.3 (-19.6, 4.9; p = 0.241), -6.6 (- 19.9, 6.6; p = 0.327), and -8.0 (-19.7, 3.7; p = 0.182), respectively. After excluding the study with nonanemic subjects, the corresponding figures were -13.1 (-23.2, -3.1; p= 0.01), -14.2 (-22.3, -6.1; p = 0.001) and -12.7 (-23.5, 1.9; p = 0.021), respectively. Oxygen consumption, estimated in two studies, showed no significant difference between the treatment groups. Blood lactate levels were estimated in one study only at two different doses of iron, and were significantly lower (p < 0.05) in iron supplemented group in comparison to placebo both before (7.71 and 7.55 mg/dL versus 8.43 mg/dL) and after (14.36 and 14.35 mg/dL versus 16.48 mg/dL) exercise. Treadmill endurance time was significantly better in iron supplemented group when compared with placebo in one study. CONCLUSIONS: Iron supplementation may have a positive effect on the physical performance of children, as evaluated through the post exercise heart rate in anemic subjects, blood lactate levels and treadmill endurance time. In view of the limited data availability, this finding cannot be considered conclusive.

Effect of iron supplementation on physical growth in children: systematic review of randomised controlled trials.

OBJECTIVE: To evaluate the effect of iron supplementation on physical growth in children through a systematic review of randomised controlled trials (RCTs). DATA SOURCES: Electronic databases, personal files, and hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences. REVIEW METHODS: RCTs evaluating change in anthropometry with interventions that included oral or parenteral iron supplementation, or iron-fortified formula milk or cereals, were analysed. RESULTS: Twenty-five trials (26 cohorts) had relevant information. There was no evidence of publication bias. The pooled estimates (random effects model) did not document a statistically significant (P>0.05) positive effect of iron supplementation on any anthropometric variable (weight-for-age, weight-for-height, height-for-age, mid upper-arm circumference, skinfold thickness, head circumference). Significant heterogeneity was evident, and its predictors included greater weight-for-age in supplemented children in malaria hyperendemic regions and greater weight-for-height for children above 5 years of age, but a negative effect on linear growth in developed countries and with supplementation for 6 months or longer. CONCLUSIONS: This review did not document a positive effect of iron supplementation on the physical growth of children. The identified predictors of heterogeneity should be considered as exploratory and requiring confirmation, not conclusive.

Biofortification of staple food crops.

Deficiencies of vitamin A, iron, and zinc affect over one-half of the world's population. Progress has been made to control micronutrient deficiencies through supplementation and food fortification, but new approaches are needed, especially to reach the rural poor. Biofortification (enriching the nutrition contribution of staple crops through plant breeding) is one option. Scientific evidence shows this is technically feasible without compromising agronomic productivity. Predictive cost-benefit analyses also support biofortification as being important in the armamentarium for controlling micronutrient deficiencies. The challenge is to get producers and consumers to accept biofortified crops and increase their intake of the target nutrients. With the advent of good seed systems, the development of markets and products, and demand creation, this can be achieved.

Beta-carotene-rich orange-fleshed sweet potato improves the vitamin A status of primary school children assessed with the modified-relative-dose-response test.

BACKGROUND: Beta-carotene-rich orange-fleshed sweet potato (OFSP) is an excellent source of provitamin A. In many developing countries, sweet potato is a secondary staple food and may play a role in controlling vitamin A deficiency. OBJECTIVE: The objective was to determine the efficacy of daily consumption of boiled and mashed OFSP in improving the vitamin A status of primary school children. DESIGN: Children aged 5-10 y were randomly assigned to 2 groups. The treatment group (n = 90) consumed 125 g boiled and mashed OFSP (1031 retinol activity equivalents/d as beta-carotene), and the control group (n = 90) consumed an equal amount of white-fleshed sweet potato devoid of beta-carotene for 53 school days. All children were dewormed to exclude helminthic infection. The modified-relative-dose-response test for vitamin A status was conducted before and after intervention. RESULTS: The estimated intervention effect for the ratio of 3,4-didehydroretinol to retinol (DR:R) was -0.008 (95% CI: -0.015, -0.001; P = 0.0203), which indicated a greater improvement in vitamin A liver stores in the treatment group than in the control group. The proportions of children with normal vitamin A status (DR:R < 0.060) in the treatment group tended to increase from 78% to 87% (P = 0.096) and did not change significantly (from 86% to 82%) in the control group (P = 0.267). These proportions were not used to test the intervention effect or within-group changes because the study was powered to test the intervention effect on DR:R. CONCLUSIONS: Consumption of OFSP improves vitamin A status and can play a significant role in developing countries as a viable long-term food-based strategy for controlling vitamin A deficiency in children.

Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials.

OBJECTIVE: To evaluate the effect of iron supplementation on mental and motor development in children through a systematic review of randomised controlled trials (RCTs). DATA SOURCES: Electronic databases, personal files, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences. REVIEW METHODS: RCTs with interventions that included oral or parenteral iron supplementation, fortified formula milk or cereals were evaluated. The outcomes studied were mental and motor development scores and various individual development tests employed, including Bayley mental and psychomotor development indices and intelligence quotient. RESULTS: The pooled estimate (random effects model) of mental development score standardised mean difference (SMD) was 0.30 (95% confidence interval (CI) 0.15 to 0.46, P<0.001; P<0.001 for heterogeneity). Initial anaemia and iron-deficiency anaemia were significant explanatory variables for heterogeneity. The pooled estimate of Bayley Mental Development Index (weighted mean difference) in younger children (<27 months old) was 0.95 (95% CI -0.56 to 2.46, P=0.22; P=0.016 for heterogeneity). For intelligence quotient scores (> or =8 years age), the pooled SMD was 0.41 (95% CI 0.20 to 0.62, P<0.001; P=0.07 for heterogeneity). There was no effect of iron supplementation on motor development score (SMD 0.09, 95% CI -0.08 to 0.26, P=0.28; P=0.028 for heterogeneity). CONCLUSIONS: Iron supplementation improves mental development score modestly. This effect is particularly apparent for intelligence tests above 7 years of age and in initially anaemic or iron-deficient anaemic subjects. There is no convincing evidence that iron treatment has an effect on mental development in children below 27 months of age or on motor development.

Undernutrition among Honduran children 12-71 months old

In 1996, the Ministry of Health of Honduras conducted a national micronutrient survey that included anthropometric measurements to determine the nutrition status of children 12-71 months old. Among the 1 744 children who participated, 38 percent of them were stunted, including 14 percent who were severely stunted; 24 percent were underweight, of which 4 percent were severely underweight; and 1 percent were wasted, of which 0.1 percent were severely wasted. The country can be divided into three groupings based on the level of stunting and underweight: 1) lowest prevalence: Tegucigalpa, San Pedro Sula, and medium cities; 2) medium prevalence: other urban areas, the rural north, and the rural south; and 3) highest prevalence: the rural west. Using logistic regression analysis, the important determinants of stunting were found to be: mother/caretaker's and father's schooling, source of water, the dominion (geographic location and strata) in which the child lived, and the "possession score" for ownership of such items as a radio, television, refrigerator, stereo system, and electric iron. The predictors for underweight were micronutrient status, diarrhea, maternal/caretaker's schooling, type of toilet, and possession score. Historical data include that the national prevalence of chronic undernutrition has changed little over the last 10 years despite the number of national food and nutrition plans implemented and the significant improvements in health services. It is possible that these positive interventions have been offset by the slow progress in economic development. Future nutrition interventions should take into account household-level perceived needs and priorities in order to set realistic nutrition targets (AU) (AU)

Vitamin A deficiency and anemia among children 12-71 months old in Honduras / Deficiencia de vitamina A y anemia en niños de 12 a 71 meses de edad en Honduras

Vitamin A deficiency (VAD) and iron deficiency anemia (IDA) have been recognized as public health problems in Honduras for over 30 years. This paper, based on the 1996 National Micronutrient Survey on 1.678 children 12-71 months of age, presents the results for vitamin A status and anemia prevalence, as well as the level of vitamin A in sugar at the household level. The results showed that 14 per cent of the children were subclinically vitamin A deficient (plasma retinol < 20 ug/dL) and 32 per cent were at risk of VAD (plasma retinol 20-30 ug/dL). These data indicate that VAD is a moderate public health problem in Honduras. Logistic regression analysis showed that children 12-23 monts old living in areas other than the rural south of the country were at greatest risk of subclinical VAD. Infection, indicated by an elevated alpha-1-acid-glycoprotein level, increased the risk of subclinical VAD more than three-fold. Children from households that obtained water from a river, stream, or lake were at twice the risk of subclinical VAD compared with other children. That same doubled risk was found for children from a household with an outside toilet. VAD can be controlled by fortifying sugar. Retinol levels in sugar at the household level were about 50 per cent of those mandated by Honduran law. There appears to be significant leakage of unfortified sugar into the market. This is particularly true in the rural north, where 33 per cent of samples contained no retinol. Overall, 30 per cent of children were anemic (Hb < 11 g/dL). Logistic regression analysis showed that children whose fathers lived with them but who had not attended at least grade 4 of primary school were at 33 per cent greater risk of being anemic. Infection and being underweight increased the risk of being anemic by 51 per cent and 21 per cent, respectively. Many of the anemic children had not been given iron supplements, suggesting health care providers may not be aware that anemia is widespread among young children and/or know how to diagnose it

En Honduras, la deficiencia de vitamina A (DVA) y la anemia ferropénica (AF) han sido problemas de salud pública reconocidos desde hace más de 30 años. Este trabajo, que se basa en la Encuesta Nacional de Micronutrientes de 1996 aplicada a 1 678 niños de 12 a 71 meses de edad, presenta los resultados relacionados con la situación de la vitamina A y la prevalencia de anemia, así como con las concentraciones de vitamina A en el azúcar de consumo domiciliario. Según los resultados, 14% de los niños tenían deficiencia subclínica de vitamina A (retinol plasmático < 20 g/dL) y 32% estaban en riesgo de DVA (retinol en plasma 20­30 g/dL). Estos datos indican que en Honduras la DVA es un problema de salud pública de importancia moderada. Un análisis de regresión logística demostró que los niños de 12­23 meses de edad que no vivían en la zona rural del sur del país corrían el mayor riesgo de DVA subclínica. El tener una infección, reflejada en una elevación de las concentraciones de alfa-1-glucoproteína ácida, aumentó más de tres veces el riesgo de DVA subclínica. Los niños de hogares con agua extraída de ríos, arroyos o lagos mostraron un riesgo doble de DVA subclínica, en comparación con otros niños. Ese mismo riesgo doble se encontró en niños de hogares con el baño situado en el exterior. La VDA puede controlarse mediante la fortificación del azúcar. Las concentraciones de retinol en el azúcar de consumo domiciliario fueron de alrededor de 50% de las dictadas por la ley en Honduras. Hay una filtración importante de azúcar sin fortificar en el mercado, particularmente en la zona rural del norte, donde 33% de las muestras no tenían retinol. En general, 30% de los niños mostraron anemia (Hb < 11 g/dL). Un análisis de regresión logística reveló que los niños cuyos padres vivían con ellos pero no habían cursado por lo menos el cuarto año de primaria corrían un riesgo 33% mayor de tener anemia. La presencia de una infección y el tener insuficiencia de peso aumentaron el riesgo de anemia en 51 y 21%, respectivamente, lo cual indica que los proveedores de atención de salud no siempre saben que la anemia es un problema muy diseminado en niños pequeños ni tampoco saben diagnosticarla

Vitamin A deficiency and anemia among children 12-71 months old in Honduras

Vitamin A deficiency (VAD) and iron deficiency anemia (IDA) have been recognised as public health problems in Honduras for over 30 years. This paper, based on the 1996 National Micronutrient Survey on 1 678 children 12-71 months of age, presents the results for vitamin A status and anemia prevalence, as well as the level of vitamin A in sugar at the household level. The results showed that 14 percent of the children were subclinically vitamin A deficient (plasma retinol < 20 ug/dL) and 32 percent were at risk of VAD (plasma retinol 20-30 ug/dL). These data indicate that VAD is a moderate public health problem in Honduras. Logistic regression analysis showed that children 12-23 months old living in areas other than the rural south of the country were at greatest risk of subclinical VAD. Infection, indicated by an elevated alpha-1-acid-glycoprotein level, increased the risk of subclinical VAD more than three-fold. Children from households that obtained water from a river, stream, or lake were at twice the risk of subclinical VAD compared to other children. That same double risk was found for children from a household with an outside toilet. VAD can be controlled by fortifying sugar. Retinol levels in sugar at the household level were about 50 percent of those mandated by Honduran law. There appears to be a significant leakage of unfortified sugar into the market. This is particularly true in the rural north, where 33 percent of samples contained no retinol. Overall 30 percent of children were anemic (Hb < 11g/dL). Logistic regression analysis showed that children whose fathers lived with them but who had not attended at least grade 4 of primary school were at 33 percent greater risk of being anemic. Infection and being underweight increased the risk of being anemic by 51 percent and 21 percent respectively. Many of the anemic children had not been given iron supplements, suggesting health care providers may not be aware that anemia is widespread among young children and/or know how to diagnose it (AU)

Nutrition of Honduran mothers/caretakers / La nutrición de madres y guardianas en Honduras

In 1996, the Honduran Ministry of Health conducted a national micronutrient survey of children 12-71 months old, which also included an assessment of the nutrition status of their mothers/caretakers. The 1.126 mothers/caretakers who participated in the survey tended to be short and plump. About 15 per cent of them were at obstetric risk by virtue of their short stature and/or low body weight. About 9 per cent had chronic energy deficiency (CED), but 27 per cent were at least 20 per cent overweight. CED was associated with socioeconomic indicators of poverty. Risk factors for being at least 20 per cent overweight included being over 30 years old, not breast-feeding, having attended no higher than grade 4, 5, or 6 of primary school, coming from a wealthier household, and living in San Pedro Sula or medium-sized cities. Among the women surveyed, 26 per cent of nonpregnant and 32 per cent of pregnant mothers/caretakers were anemic. The likely principal cause of anemia was the low intake of bioavailable iron from food and, in some cases, excessive iron loss associated with intestinal parasites, especially hookworm. Only 50 per cent of the mothers/caretakers participating in this study had received iron during their las pregnancy, and just 13 per cent had received post-partum vitamin A. The results highlight the need to develop and implement an effective program to control iron deficiency anemia in women of reproductive age, including by fortifying such widely consumed foods as processed wheat and maize flour and by routinely administering iron supplements to high-risk groups. Postpartum vitamin A supplementation should be encouraged to protect both the mother and newborn infant against vitamin A deficiency

En 1996, el Ministerio de Salud de Honduras realizó una encuesta nacional sobre los micronutrientes en niños de 12 a 71 meses de edad, en la cual también se evaluó el estado nutricional de las madres o guardianas. Las 1 126 madres o guardianas que participaron en la encuesta mostraron la tendencia a ser de estatura baja y a tener un exceso de peso. Alrededor de 15% eran de riesgo obstétrico elevado debido a su baja estatura, su poco peso corporal, o ambas cosas. Cerca de 9% tenían deficiencia energética crónica (DEC), pero 27% tenían un sobrepeso mínimo de 20%. La DEC se asoció con indicadores socioeconómicos de pobreza. Entre los factores de riesgo de tener un sobrepeso mínimo de 20% figuraron tener más de 30 años de edad, no haber amamantado, no haber cursado más allá de cuarto, quinto o sexto año de primaria, venir de un hogar más próspero, y vivir en San Pedro Sula o en una ciudad de tamaño mediano. De las mujeres encuestadas, 26% de las madres y guardianas no embarazadas y 32% de las embarazadas tenían anemia. La causa más probable de la afección fue la poca ingestión de hierro biodisponible en los alimentos y, en algunos casos, la pérdida excesiva de hierro ocasionada por la parasitosis intestinal, especialmente la anquilistomiasis. Solamente 50% de las madres o guardianas que participaron en el estudio habían recibido hierro durante el embarazo previo, y apenas 13% habían recibido vitamina A después del parto. Los resultados subrayan la necesidad de crear y poner en marcha un programa eficaz para controlar la anemia por deficiencia de hierro en mujeres de edad reproductiva aplicando determinadas medidas, entre ellas la fortificación de alimentos de consumo general, como las harinas procesadas a base de trigo y maíz, y la administración periódica de suplementos de hierro a grupos de alto riesgo. La suplementación con vitamina A después del parto debe fomentarse con el fin de proteger a la madre y al recién nacido de la deficiencia de esta vitamina.

Nutrition of Honduran mothers/caretakers

In 1966, the Honduran Ministry of Health conducted a national micronutrient survey of children 12-71 months old, which also included an assessment of the nutrition status of their mothers/caretakers. THe 1 126 mothers/caretakers who participated in the survey tended to be short and plump. About 15 percent of them were at obstetric risk by virtue of their short stature and/or low body weight. About 9 percent had chronic energy deficiency (CED), but 27 percent were at least 20 percent overweight. CED was associated with socioeconomic indicators of poverty. Risk factors for being at higher than grade 4, 5, or 6 of primary school, coming from a wealthier household, and living in San Pedro Sula or medium-sized cities. Among the women surveyed, 26 percent of nonpregnant and 32 percent of pregnant mothers/caretakers were anemic. The likely principal cause of anemia was the low intake of bioavailable iron from food and, in some cases, excessive iron loss associated with intestinal parasities, especially hookworm. Only 50 percent of the mothers/caretakers participating in this study had received iron during their last pregnancy, and just 13 percent had received postpartum vitamin A. The results highlighted the need to develop and implement an effective program to control iron deficiency anemia in women of reproductive age, including by fortifying such widely consumed foods as processed wheat and maize flour and by routinely administering iron supplements to high-risk groups. Postpartum vitamin A supplementation should be encouraged to protect both the mother and newborn infant against vitamin A deficiency (AU)