The complexities of selling fruits and vegetables in remote Navajo Nation retail outlets: perspectives from owners and managers of small stores.

OBJECTIVE: Navajo Nation residents experience extreme rates of poverty, food insecurity and diet-related diseases. While many residents travel far to shop at grocery stores, there are small stores closer to home that could provide more healthy options, like fruits and vegetables (F&V). Little is known from the perspective of store owners and managers regarding the barriers and facilitators to offering F&V; the present study contributes to filling that gap. DESIGN: Data were collected through structured interviews from a sampling frame of all store owners or managers in the setting (n 29). SETTING: Small stores in Navajo Nation, New Mexico, USA. Navajo Nation is predominantly rural and the largest federally recognized Native American tribe in the USA. PARTICIPANTS: Sixteen managers and six owners at twenty-two stores. RESULTS: When asked about the types of foods that were most commonly purchased at their stores, most participants reported snacks and drinks (82 and 68 %, respectively). Many participants reported they would like to offer more fresh F&V. However, barriers included varying perceived customer demand, limited F&V choices from distributors and (for some managers) limited authority over product selection. CONCLUSIONS: Findings contribute to the discussion on engaging store owners and managers in providing quality, healthy foods close to home in low-income, rural regions.

Remuneration systems of community health workers in India and promoted maternal health outcomes: a cross-sectional study.

BACKGROUND: This study assessed the association of remuneration systems of paid-for-performance Accredited Social Health Activists (ASHAs) and salaried Anganwadi workers (AWWs) on seven maternal health outcomes in four states in India: Andhra Pradesh (AP), Chhattisgarh, Odisha (Orissa), and Uttar Pradesh (UP). METHODS: The cross-sectional study surveyed mothers of children aged 6-23 months. A total of 3455 mothers were selected via multistage cluster sampling. The seven health outcomes related to the community health worker (CHW) visits were: institutional delivery, complete immunization, exclusive breastfeeding for six months, timely introduction of complementary feeding, continued breastfeeding during child's illness, handwashing, and awareness of Nutrition and Health Days (NHDs). RESULTS: The results varied by state. Mothers who received ASHA visits were significantly less likely to have an institutional delivery, timely introduction of complementary feeding, awareness of Nutrition and Health Days (NHDs), proper handwashing, and exclusive breastfeeding for the first six months in at least one of the four states. Conversely, AWW's home visits were positively predictive of the following health outcomes in certain states: complete immunization for index child, continued breastfeeding during the child's illness, handwashing, and awareness of NHDs. CONCLUSIONS: ASHAs' home visits were not more strongly associated with health outcomes for which they were paid than outcomes for which they were unpaid. AWWs' home visits were positively associated with awareness of NHDs, and associations varied for other recommended health behaviors. Further research could elucidate the causes for successes and failures of CHW programs in different states of India.

Factors associated with alcohol consumption patterns in a Puerto Rican urban cohort.

OBJECTIVE: There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts. DESIGN: Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender. SETTING: Greater Boston area, MA, USA. SUBJECTS: Puerto Rican adults (n 1292), aged 45-75 years. RESULTS: Eight per cent of men and 39% of women were lifetime abstainers; 40% of men and 25% of women were former drinkers; 31 % of men and 27% of women were moderate drinkers; and 21% of men and 8% of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers. CONCLUSIONS: High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.

Household-level dietary quality indicator for countries in nutritional transition: application to vulnerable communities in El Salvador.

OBJECTIVE: To develop a household-level diet quality indicator (HDQI) using the Salvadorian dietary guidelines to assess the dietary quality of households in vulnerable communities in El Salvador. DESIGN: The Salvadorian dietary guidelines were reviewed and eighteen HDQI components were identified (nine foods and nine nutrients). The components were evaluated using a proportional scoring system from 0 to 1, penalizing over- and under-consumption, where appropriate. The HDQI was validated in consultations with experts in El Salvador and by statistical analyses of the study sample data. Dietary variety and energy, nutrient and food intakes were compared among households above and below the median HDQI score using Student's t test. SETTING: Vulnerable, border communities in El Salvador. SUBJECTS: Households (n 140) provided food consumption information using an FFQ and sociodemographic data. RESULTS: The mean HDQI score was 63·5, ranging from 43·6 to 90·0. The indicator showed a positive, significant association with the dietary variety components. The statistical associations of the indicator with the energy and nutrient components were as expected. CONCLUSIONS: Based on the indicator's demonstrated face validity and the results of the expert consultations, the indicator is suggested as a good measure of diet quality for households in El Salvador.

Associations between three school-based measures of health: is BMI enough?

School-based body mass index (BMI) notification programs are often used to raise parental awareness of childhood overweight and obesity, but how BMI results are associated with physical fitness and diet is less clear. This study examined the relationship between BMI, fitness, and diet quality in a diverse sample of urban schoolchildren (n = 122) utilizing a school-based cardiorespiratory fitness test and a food frequency questionnaire. Fifty-two percent of children were overweight/obese. Fit children were more likely to be normal weight than unfit children (p < .001). Weight status was not associated with adherence to any specific dietary guidelines; however, greater overall adherence to the recommendations was associated with normal weight (p < .05). These findings suggest a potential benefit may be gained by combining BMI reports with results of in-school fitness testing and basic information on how children's diets compare to recommendations.

Dietary supplement use pattern of U.S. adult population in the 2007-2008 National Health and Nutrition Examination Survey (NHANES).

Data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) suggested that nearly half of U.S. adults aged 20 to 69 reported taking at least one dietary supplement in the past month. Logistic regression showed that the following factors were independently associated with a greater likelihood of supplement use: being female, older, white, having higher level of education, non-SNAP participation, and living in a food-secure household. To compare nutrient intakes between supplement users and non-supplement users, daily intakes of eight nutrients were examined. When considering nutrients from food, supplement users tended to consume greater amounts of vitamin A, vitamin C, vitamin E, folic acid, calcium, and iron; meanwhile there was no association between supplement use and daily intakes of vitamin B12 and zinc from food sources only. Including nutrients from daily supplement use, supplement users consumed greater amounts of all eight nutrients.

Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India.

Anemia and micronutrient deficiencies are common among Indian schoolchildren. We assessed the effectiveness of micronutrient fortification of meals cooked and fortified at school on anemia and micronutrient status of schoolchildren in Himalayan villages of India. In this placebo-controlled, cluster-randomized study, 499 schoolchildren (6-10 y) received either multiple micronutrients (treatment group) or placebo (control group) as part of school meals (6 d/wk) for 8 mo. Both groups were dewormed at the beginning of the study. The micronutrient premix provided 10 mg iron, 375 microg vitamin A, 4.2 mg zinc, 225 microg folic acid, and 1.35 microg vitamin B-12 for each child per day (approximately 75% recommended dietary allowance). Blood samples drawn before and after the intervention were analyzed for hemoglobin, ferritin, retinol, zinc, folate, and vitamin B-12. Baseline prevalence of anemia (37%), iron deficiency anemia (10%), low serum ferritin (24%), retinol (56%), zinc (74%), folate (68%), and vitamin B-12 (17%) did not differ between groups. Postintervention, fewer in the treatment group had lower serum retinol [odds ratio (OR) (95% CI): 0.57 (0.33-0.97)] and folate [OR (95% CI): 0.47 (0.26-0.84)] than the control group. The serum vitamin B-12 concentration decreased in both groups, but the magnitude of change was less in the treatment than in the control group (P < 0.05). Total body iron (TBI) increased in both groups; however, the change was greater in the treatment than in the control group (P < 0.05). Micronutrient fortification of school meals by trained school personnel was effective in improving vitamin A, folate, and TBI status while also reducing the magnitude of a decrease in vitamin B-12 status.

Environmental Factors Variably Impact Tea Secondary Metabolites in the Context of Climate Change.

Climate change is impacting food and beverage crops around the world with implications for environmental and human well-being. While numerous studies have examined climate change effects on crop yields, relatively few studies have examined effects on crop quality (concentrations of nutrients, minerals, and secondary metabolites). This review article employs a culturally relevant beverage crop, tea (Camelia sinensis), as a lens to examine environmental effects linked to climate change on the directionality of crop quality. Our systematic review identified 86 articles as relevant to the review question. Findings provide evidence that shifts in seasonality, water stress, geography, light factors, altitude, herbivory and microbes, temperature, and soil factors that are linked to climate change can result in both increases and decreases up to 50% in secondary metabolites. A gap was found regarding evidence on the direct effects of carbon dioxide on tea quality, highlighting a critical research area for future study. While this systematic review provides evidence that multiple environmental parameters are impacting tea quality, the directionality and magnitude of these impacts is not clear with contradictory evidence between studies likely due to confounding factors including variation in tea variety, cultivar, specific environmental and agricultural management conditions, and differences in research methods. The environmental factors with the most consistent evidence in this systematic review were seasonality and water stress with 14 out of 18 studies (78%) demonstrating a decrease in concentrations of phenolic compounds or their bioactivity with a seasonal shift from the spring and /or first tea harvest to other seasons and seven out of 10 studies (70%) showing an increase in levels of phenolic compounds or their bioactivity with drought stress. Herbivory and soil fertility were two of the variables that showed the greatest contradictory evidence on tea quality. Both herbivory and soil fertility are variables which farmers have the greatest control over, pointing to the importance of agricultural management for climate mitigation and adaptation. The development of evidence-based management strategies and crop breeding programs for resilient cultivars are called for to mitigate climate impacts on crop quality and overall risk in agricultural and food systems.

Practitioners' opinions on Food and Nutrition Care Indicators in assisted living facilities for older adults.

This study assessed the utility of the 57-indicator Food and Nutrition Care Indicators Checklist for assessing food and nutrition services in assisted-living facilities for older adults among registered dietitians (RDs). They were members of two American Dietetic Association practice groups focusing on aging and long-term care and were also employed in assisted-living facilities. The 1,281 respondents rated the importance of each checklist item and provided their views on the role of assisted-living facilities and their level of agreement with statements regarding the importance of residents' autonomy for making food choices and their ability to make wise dietary choices. Registered dietitians practicing in assisted-living facilities considered all of the domains on food and nutrition quality indicators on the Food and Nutrition Care Indicators Checklist to be highly important (92% of dining room environment items, 83% of foodservice operations, 92% of general nutrition, and 89% of therapeutic nutrition items). They preferred a service style that included both health and amenities, as did national health and aging experts. Registered dietitians should work with other professionals to further validate the checklist, promote its use, and establish optimal service models for food and nutrition services in assisted-living facilities for older adults.

Experts stress both wellness and amenity aspects of food and nutrition services in assisted living facilities for older adults.

OBJECTIVES: There has been no consensus on best practices in food and nutrition services in assisted living facilities for older adults. We documented experts' views on optimal food and nutrition services emphases in assisted living facilities, and factors affecting their views. METHODS: One hundred thirty-five national experts specializing in health, aging, nutrition and assisted living facilities completed a survey consisting four scenarios (ie, home-style, restaurant/hotel, and health/medical, and a combination of these three) in six food and nutrition services areas: dining room environment, meal services, meal quality, nutrition services, employees' qualifications, and therapeutic nutrition services. RESULTS: Sixty-three percent of experts favored the combination scenario. Dietetics education and experts' beliefs that assisted living facilities should be health promotion and maintenance facilities were significant predictors of emphases, including wellness considerations. Experts' personal views exerted a powerful influence. CONCLUSIONS: Experts chose food and nutrition service quality indicators that emphasized a focus on both wellness and amenities as their ideal scenarios for optimal food and nutrition services in assisted living facilities.

Comfort and utility of school-based weight screening: the student perspective.

BACKGROUND: Weight screening in schools has been proposed as one strategy to address childhood obesity. Students' response to such screening is unexplored, however. In this study we evaluated the perceived comfort, utility and impact of school-based weight screening from the perspective of middle school-aged students. METHODS: A cross-sectional study of 852 ethnically diverse 5th-8th grade students. Associations were investigated between measured height and weight screening data and responses to a self-administered questionnaire completed immediately following weight screening in physical education class. BMI categories were based on the revised 2000 CDC growth chart and definitions: 5th-85th BMI percentile = healthy weight, 85th-95th BMI percentile = at risk for overweight, and >95th percentile BMI = overweight. RESULTS: Overall, students' comfort level with weight screening varied depending on the student's own weight status. More overweight students (38.1%) reported being uncomfortable than healthy weight students (8.1%) (p < 0.001). In particular, overweight female students (54.8%) compared to healthy weight female students (21.6%) reported being uncomfortable (p < 0.01). About half (54.9%) of all students reported knowing their weight prior to screening, and 58.9% reported that it was useful to learn their height and weight. Compared to healthy weight students, overweight students were significantly more likely to report the intention to perform weight modification related activities such as visiting a doctor (Odds ratio (OR) = 2.0, 95% CI = 1.3, 3.1), eating more fruits and vegetables (OR = 2.7, 95% CI = 1.7, 4.1), and increasing physical activity (OR = 4.3, 95% CI = 2.7, 7.0). CONCLUSION: Overall, the majority of the middle school students did not report discomfort with school-based weight screening, did report that receiving height and weight information was useful, and generally report appropriate weight control intentions. These proportions varied across weight status categories, however, with students who were at risk for overweight or overweight reporting higher levels of discomfort. For schools that conduct weight screening, it is essential that they also provide comfortable and private settings as well as education or counseling regarding healthy weight control practices.

Diet quality among US-born and foreign-born non-Hispanic blacks: NHANES 2003-2012 data.

Background: Non-Hispanic blacks in the United States are less likely to not meet national dietary recommendations than non-Hispanic whites; however, most studies do not consider nativity of US blacks. Objective: With the use of the Alternative Healthy Eating Index-2010 (AHEI-2010) and the Dietary Approach to Stop Hypertension (DASH) scores, this cross-sectional study compared diet quality between US-born (n = 3,911) and foreign-born (n = 408) non-Hispanic black adults aged 22-79 y, based on pooled nationally representative data (NHANES 2003-2012) as well as by length of US residency. Design: The association between nativity and diet quality was determined by using multivariable-adjusted linear regression for the continuous total diet quality scores and their components or multinomial (polytomous) logistic regression for categorical tertiles (low, medium, or high) of the total scores and their components. Results: Foreign-born blacks had significantly higher AHEI-2010 (ß: 9.3; 95% CI: 7.5, 11.0) and DASH (ß: 3.1; 95% CI: 2.5, 3.8) scores compared with US-born blacks and more favorable intakes for many of the score components. Among foreign-born blacks, diet quality did not significantly differ by length of residency. Foreign-born blacks were more likely to be in the high than in the low tertile for vegetables [excluding starchy vegetables; relative risk ratio (RRR): 1.68; 95% CI: 1.24, 2.29], fruit [excluding and including fruit juice-RRR: 2.42 (95% CI: 1.69, 3.47) and RRR: 2.95 (95% CI: 1.90, 4.59), respectively], percentage of whole grains (RRR: 2.39; 95% CI: 1.64, 3.49), and omega-3 (ω-3) fatty acids (RRR: 2.03; 95% CI: 1.38, 2.97). Conclusions: Foreign-born blacks have better diet quality than their US-born counterparts. In nutrition research and public health efforts, considering the place of birth among US blacks may improve the accuracy of characterizing dietary intakes and facilitate the development of targeted nutrition interventions to reduce diet-related diseases in the diverse black population in the United States.

Food and nutrition care indicators: experts' views on quality indicators for food and nutrition services in assisted-living facilities for older adults.

This study assessed the views of 153 national experts in nutrition, health, and aging services in assisted-living facilities; including gerontological nutrition (39%), foodservice (14%), aging and disability (22%), geriatric medicine (9%), and assisted living (16%); on the practices that serve as indicators of the quality of food and nutrition services provided in assisted-living facilities and ascertained the most favored style of service delivery: health, amenities, or both. An 88-item Food and Nutrition Care Indicators survey was developed from assisted-living facility regulations in 50 states and other quality indicators of nutrition services. Respondents rated each item on a scale from 1 (not important) to 5 (extremely important). Results show that at least 80% of experts rated the majority of indicators in each domain as highly important (57% of dining room, 67% of foodservice indicators, 65% of general nutrition, and 70% of therapeutic nutrition indicators). Most experts (89%) rated a combination of indicators that included both health (general and therapeutic) and amenities service styles as being highly important. The 57 items rated most important were consolidated into a checklist. A service model that incorporates all of these elements appears to be most appropriate.

Dietary supplement use and nutrient intake in HIV-infected persons.

Dietary supplement use was assessed in 368 HIV-infected patients enrolled in the Nutrition for Healthy Living cohort. The objective was to describe the dietary, demographic, and health characteristics of the HIV-infected persons who use different types of dietary supplements. Each patient was categorized in 1 of 4 dietary supplement groups. Extremes in intake of micronutrients were common. Men and women who consumed no supplements reported inadequate intakes of a number of micronutrients. Men using nonvitamin/nonmineral (NVNM) supplements had diets higher in fiber, protein, and 13 of 14 vitamins and minerals. Almost 90% of male NVNM supplement users ingested 1 or more vitamins or minerals in amounts above the tolerable upper limit. Male NVNM supplement users were more likely to be white, well educated, and receiving highly active antiretroviral therapy and more likely to have higher annual incomes, higher CD4 counts, and lower HIV RNA levels. HIV-infected women who were using NVNM supplements exhibited similar trends. Micronutrient inadequacy and excess are relatively common in persons living with HIV infection. Practitioners need to judiciously address optimal nutrient intake from both diet and dietary supplements in this population.

Hypertension among US-born and foreign-born non-Hispanic Blacks: National Health and Nutrition Examination Survey 2003-2014 data.

OBJECTIVES: Non-Hispanic Blacks in the United States have the highest reported prevalence of hypertension (44%) worldwide. However, this does not consider the heterogeneity of Blacks within the United States, particularly comparing US-born to long-standing or recent (foreign-born) immigrants. The objective of this study is to compare odds of hypertension between US-born and foreign-born Blacks in the United States. METHODS: We assessed the prevalence of hypertension among US-born (n = 4511) vs. foreign-born (n = 522) non-Hispanic Black adults aged 22-79 years, based on pooled nationally representative data (2003-2014); as well by length of US residency among immigrants. Multivariable-adjusted logistic regression was used to investigate the association between nativity and hypertension odds. RESULTS: Nearly half (42.8%) of US-born Blacks but only 27.4% of foreign-born Blacks had hypertension. After adjusting for major covariates, foreign-born Blacks were 39.0% less likely (odds ratio 0.61 95% confidence interval 0.49, 0.77) to have hypertension than their US-born counterparts. Among foreign-born Blacks, length of US residency was not significantly associated with odds of hypertension. CONCLUSION: Foreign-born vs. US-born non-Hispanic Blacks have substantially lower prevalence of hypertension. Considering nativity among US Blacks in clinical research and public health efforts may improve accuracy of characterizing health disparities and facilitate development of targeted interventions to reduce hypertension in this diverse population.

Dietary Approaches to Stop Hypertension Diet, Weight Status, and Blood Pressure among Children and Adolescents: National Health and Nutrition Examination Surveys 2003-2012.

BACKGROUND: The Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower blood pressure and reduced risk of cardiovascular disease among adults, but little is known about accordance with this dietary pattern or health benefits among children and adolescents. OBJECTIVE: The objectives were to evaluate accordance with the DASH diet, differences over time, and the association with health attributes among a nationally representative sample of US children and adolescents. DESIGN: Cross-sectional data from the 2003-2012 National Health and Nutrition Examination Surveys (NHANES) were analyzed. PARTICIPANTS/SETTING: Data from 9,793 individuals aged 8 to 18 years were examined. MAIN OUTCOME MEASURES: DASH accordance was estimated based on nine nutrient targets: total fat, saturated fat, protein, cholesterol, fiber, calcium, magnesium, potassium, and sodium; possible score range is 0 to 9. STATISTICAL ANALYSES PERFORMED: Accordance with the DASH diet across time was examined comparing the 2011-2012 to 2003-2004 NHANES surveys. The association between DASH score and weight status was examined using multinomial logistic regression, and the associations with waist circumference, systolic blood pressure, and diastolic blood pressure were examined using multivariable linear regression. RESULTS: Accordance with the DASH diet was low across the age groups, with a range of mean DASH scores from 1.48 to 2.14. There were no significant changes across time. DASH score was inversely associated with systolic blood pressure (mm Hg) among 14- to 18-year-olds (ß=-.46; 95% CI -.83 to -.09) among the larger sample of participants who completed at least one dietary recall, but no significant differences were seen in other age categories. In the subsample of participants with both dietary recalls, a significant inverse association was seen between DASH score and systolic blood pressure for 11- to 13-year-olds (ß=-.57; 95% CI -1.02 to -.12). There were no significant associations between this dietary pattern and weight status, waist circumference, or diastolic blood pressure. CONCLUSIONS: Few US children and adolescents have diets that are in alignment with the DASH diet. Future research should explore strategies to encourage fruit, vegetable, and whole-grain consumption, as well as sodium reductions to help meet DASH nutrient targets in children and adolescents, as well as examine the potential benefits of this eating pattern on health in this population group.

Predictors of anemia in pregnant women residing in rural areas of the Oromiya region of Ethiopia.

BACKGROUND: Anemia in pregnancy is associated with higher risk of low birth weight and both maternal and perinatal mortality. While previous studies in Ethiopia have examined factors associated with anemia, which factors are the most important determinants of anemia in this population remain unclear. The objective of this study was to examine the association between anemia status in pregnant women with different health, behavioral, and socioeconomic factors in Oromiya province of Ethiopia. METHODS: This study used pregnancy enrollment data from a longitudinal birth cohort study conducted in Ethiopia. Survey data on maternal and household characteristics were collected at enrollment and maternal hemoglobin levels were measured. The analysis includes 4600 pregnant women. Logistic regression models were used to identify factors associated with maternal anemia in pregnancy. RESULTS: Controlling for geographic location and religion, low maternal MUAC and previous pregnancies were associated with increased odds of anemia, with odds ratios of 1.30 (p < 0.001, CI 1.12-1.51), and 1.50 (p = 0.002, CI 1.16-1.95), respectively. For each additional point on the handwashing score scale, the odds of being anemic were reduced by 12% (p < 0.001, CI 0.82-0.94). Numerate women compared to non-numerate women had 30% lower odds (p < 0.001, CI 0.57-0.85). CONCLUSION: Controlling for woreda and religion, low maternal MUAC, and previous pregnancy increased odds of anemia while numeracy and better handwashing practices significantly reduced the odds of anemia in pregnancy. Further investigation is needed to determine the cause of anemia in pregnant women in Oromiya and to determine the effects of maternal anemia on birth outcomes.

Nutrition information sources vary with education level in a population of older adults.

Education level, more than any other socioeconomic factor, can predict disease risk, health behavior patterns, and diet quality. It has been suggested that one reason higher education promotes more healthful diets is that better-educated people may get better nutrition information. We present data from a survey examining specific sources of nutrition information among an older adult population (age >50 years, n=176), and compare the difference in sources associated with extent of education. Reliance on doctors, television, and neighbors was significantly higher among those with less education (P<0.05). Our results also show that less-educated older adults rely more upon different specific sources for their nutrition information than those who have attained a higher level of education. Strategies to improve and/or ensure the quality of the specific nutrition information sources this vulnerable group relies on may be needed.

A positive deviance-based antenatal nutrition project improves birth-weight in Upper Egypt.

The positive deviance approach identifies and promotes existing uncommon healthy behaviours. A positive deviance-informed antenatal project was pilot-tested in Al-Minia Governorate, Upper Egypt, during 2003-2004, after a positive deviance study in 2000 found that successful pregnancies had increased consumption of meat and vegetables, daytime rest, and antenatal care; less second-hand smoke exposure; and symptoms of no urinary tract infection. Accordingly, health facilities were upgraded in target and comparison areas to provide quality antenatal care, including treatment of urinary tract infection. Additionally, in the target villages, women at-risk of delivering low-birth-weight infants were enrolled in weekly 'IMPRESS' (improved pregnancy through education and supplementation) sessions with counselling and supplemental food. In total, 519 women (344 target, 175 comparison) were enrolled in the third or fourth month of pregnancy and were followed through delivery. Birth-weights of the target mothers increased 2.2 times more than birth-weights of the comparison mothers over baseline (mean increase: 0.58 vs 0.26 g respectively, p<0.01). Similarly, the decrease in prevalence of low birth-weight from baseline was greater in the target villages than in the comparison mothers (% of decrease: 26.9 vs 11.9 respectively, p<0.01). The target at-risk women were far more likely than their counterparts to report eating more food (54.9% vs 10.6%), more meat (57.1% vs 4.2%), more vegetables (66.9% vs 5.3%), increasing daytime rest (64.1% vs 11.7%), and avoiding second-hand smoke (91.3% vs 51.6%) during pregnancy. The cost per 100 g of improvement in birth-weight was US$ 3.98. The Government of Egypt and partners are scaling up the elements of the project.

Dietary intake in HIV-positive persons with and without malabsorption.

This review examines the relationship among malabsorption, diarrhea, dietary intake, and body composition in an outpatient cohort of individuals with HIV infection. Twenty-three percent of the participants had malabsorption, which was not associated with the presence of current or chronic diarrhea. In this "outpatient" HIV cohort with a mean body-mass index (BMI) of 25 kg/m2, the presence of malabsorption did not have adverse nutritional outcomes in terms of body weight, lean body mass, hemoglobin, or albumin. The diets of those with or without malabsorption did not meet the goals of the Dietary Guidelines for Americans. Median dietary intake was high in percentage of total fat and saturated fat and low in total fiber intake and some key micronutrients.