Enhancing child dietary diversity through cooking demonstration and nutritional education in rural Lao PDR.

BACKGROUND: Efforts to prevent malnutrition in children under five are crucial for both short-term and long-term impact, especially in resource-constrained low- and middle-income countries, where ensuring minimal food diversity remains an urgent challenge. Our organization implemented initiatives to improve dietary diversity among children under five in rural areas of Lao People's Democratic Republic (Lao PDR). METHODS: We carried out educational and awareness programs directed at caregivers of children aged 6-59 months. These programs were delivered by healthcare professionals and trained community volunteers in specific areas of Xaybouathong District, Khammouane Province. To evaluate the impact of our interventions, we conducted surveys both at the beginning and end of the project. We designated the Individual Dietary Diversity Score IDDS as the objective variable, serving as an indicator of child dietary diversity. Using sociodemographic and economic indicators as explanatory variables, we assessed the impact of the intervention through multivariate analysis with a generalized linear model as well as a bivariate analysis. RESULTS: The comparison between 210 children at baseline and 205 children at endline revealed a significant increase in IDDS among children aged 6-23 months (from 3.36 to 4.22) and children aged 24-59 months (from 3.29 to 3.83). Multivariate analysis indicated a significant association between the intervention effect (baseline vs. endline) and the village of residence. Furthermore, significant improvements were observed in each food group that constitute IDDS, including vegetables and fruits, eggs, and legumes and nuts. CONCLUSIONS: Even in resource-limited settings, such as rural areas of Lao PDR, it is possible to improve child dietary diversity through educational approaches that encourage the utilization of locally available foods.

Correction: Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka.

[This corrects the article DOI: 10.1371/journal.pone.0224222.].

Parent-child cooking meal together may relate to parental concerns about the diets of their toddlers and preschoolers: a cross-sectional analysis in Japan.

BACKGROUND: Parents often have concerns about the food habits of their young children. Cooking is a frequent behavior related to dietary activities at home. We hypothesized that "a parent cooking meals together with young children might alleviate dietary concerns." The aim of this study was to identify the relationship between parental cooking practices (e.g., cooking meals together with the child) and diet-related concerns. METHODS: Data were extracted from the "National nutrition survey on preschool children" conducted among nation-wide households with toddlers and preschoolers in 2015 by the Ministry of Health, Labour and Welfare of Japan. Parents were classified into two groups comprising those who cooked meals together with their children and those who did not. The following variables were compared: taking too much time to eat (slow eaters), "picky" eating (eating only certain foods), inconsistent food intake (eating too much or too little), playing with food/utensils while eating, preferring sweetened beverages and snacks over meals, eating too fast to chew well, not swallowing food, disinterested in eating, and spitting out food. The associations between parent-child cooking meals together and the concerns pertaining to the child's dietary habits and food intake were analyzed and compared between the two groups. RESULTS: The concerns of "picky eating" and "playing with food/utensils while eating" were lower, while "eating too much" was higher in the parent-cooking together group. The intake frequency of fish, soybeans/soy products, vegetables, and milk among children were higher in the "cooking together" group than among those in the "not cooking together" group. Children in the "cooking together" group consumed a significantly greater variety of foods than those in the "not cooking together" group. CONCLUSIONS: Cooking a meal together with a child may be related to the parent's lower concerns about the dietary habits of the child, including "picky eating" and "playing with food/utensils while eating," but may also be related to the higher concerns of "eating too much."

Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka.

Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5-10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m2) was 36.5%. A positive correlation was found between maternal body mass index and the child's body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08-5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16-0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition.

Combined associations of physical activity and dietary intake with health status among survivors of the Great East Japan Earthquake.

BACKGROUND AND OBJECTIVES: Each of the effects of physical activity and dietary intake on health is well known, but combined associations of physical activity and dietary intake on health has not been reported yet. Physical activity and dietary intake are key factors for maintaining health of survivors of the Great East Japan Earthquake in 2011. This study aimed to examine combined associations of physical activity and dietary intake with survivors' health status. METHODS AND STUDY DESIGN: We used data from 6668 participants of a cross-sectional survey taken 3 years (2013) after the disaster. To evaluate combined associations of physical activity and dietary intake, answers to questions regarding these two variables were categorized into four groups: poor physical activity and poor dietary intake (Group 1), poor physical activity and good dietary intake (Group 2), good physical activity and poor dietary intake (Group 3), and good physical activity and good dietary intake (Group 4). Multiple logistic regression analyses were performed by sex, with good self-rated health and good mental health as dependent variables, and age, place of residence, living conditions and physical activity/dietary intake group (with Group 1 as the reference category) as independent variables. RESULTS: Good self-rated health was associated with age in both sexes, and Groups 3 (male: odds ratios (ORs) 1.84 (95% confidence intervals (95% CIs) 1.32-2.57), female: OR 1.82 (95% CI 1.32-2.51)) and 4 (male: OR 1.96 (95% CI 1.39-2.76), female: OR 1.94 (95% CI 1.42-2.64)). Good mental health was associated with Groups 3 (OR 1.48 (95% CI 1.10-1.97)) and 4 (OR 1.86 (95% CI 1.37-1.97)) for male respondents; and living place (other than temporary housing) (OR 1.45 (95% CI 1.26-1.68)) was associated with Group 4 (OR 1.42 (95% CI 1.09-1.85)) for female respondents. CONCLUSIONS: Good physical activity alone or combined with good dietary intake was associated with good self-rated health and good mental health. Further interventions regarding physical activity and dietary intake are needed to improve the health status of survivors.

[Epidemiological aspects of overweight and obesity in Japan--international comparisons].

Prevalence of obesity (BMI > or = 30) in Japanese adults (aged 20 years and over) was 3.8% in males and 3.2% in females (National Health and Nutrition Survey, 2010), being quite low compared with other countries listed in the Global Database on Body Mass Index (WHO). On the other hand, prevalence of overweight (BMI > or = 25) was 30.4% in males and 21.1% in females, of which overweight in males has increased in recent 35 years almost twice from 15% to 30%. Although the prevalence of overweight and obesity in Japanese adults is rather low in international comparisons, control for the obesity-associated risks through the promotion of appropriate body weight management has been prioritized in the national health programs.

School lunch program for health promotion among children in Japan.

In Japan, the present school lunch program has been implemented under the "School Lunch Act" enacted in 1954. The main purpose of the school lunch program is to promote healthy development of the minds and bodies of school children. Later, "The School Lunch Act" was revised in 2008 and its aim was changed to "promoting Shokuiku". As of May 2009, approximately 10 million school children participate in the school lunch program. This program itself is an educational activity. School children are responsible for serving lunch and clearing the dishes. They could also learn proper manners, by having meals together with classmates. Furthermore, understanding of balanced diet and food culture can be enhanced through learning the menu of each meal. Recently, as eating disorders and obesity increase among adults and school children, there is rising concern on development of lifestyle-related diseases. Under this circumstance, the Basic Law on Shokuiku was enacted in 2005. Besides, in order to enhance Shokuiku to school children, the Ministry of Education, Culture, Sports, Science and Technology established the Diet and Nutrition Teacher System in April 2007. It is reported that, in those schools with Diet and Nutrition Teachers, a positive impact has been observed in terms of awareness and interest in diet among teachers and guardians. It is also reported that proportion of children skipping breakfast has decreased, and quality of life has been improved. In this way, the Japanese school lunch program system is essential for fostering healthy mind and bodies for the next generation.

School-based "Shokuiku" program in Japan: application to nutrition education in Asian countries.

This paper provides the overview of "Shokuiku" in Japan, and discusses the future perspective on application of its concepts to nutrition education in other Asian countries. In Japan, there has been a growing concern on increase of obesity and the metabolic syndrome among middle-aged men. Additionally, child obesity has also become one of the important health problems. The increased obesity among them is possibly associated with inappropriate dietary habits (eg skipping breakfast, excessive fat intake and insufficient vegetable). Under this circumstance, the "Basic Law on Shokuiku" was enacted in 2005, which was the first law that regulates one's diets and eating habits. For effective implementation of Shokuiku program, dietitians and registered dietitians would play important roles in various settings. Japan has a long history of dietitian system as well as school-lunch programs. Later, in order to further enhance the school-based Shokuiku programs, the Diet and Nutrition Teacher System was established in April 2007. From an international point of view, "nutrition education" programs aim to improve dietary practices so as to ensure adequate energy or nutrient intake and also to reduce obesity and lifestyle-related diseases, whereas the concepts of Shokuiku have very wide approaches. Shokuiku's efforts expand to support food culture, especially through school-based programs, as well as to improve food environment by providing information on appropriate diets. These approaches can be introduced in nutrition education in other Asian countries, not only to improve one's health and nutritional status but also to secure food culture and food safety in each country.

Association between vegetable intake and dietary quality in Japanese adults: a secondary analysis from the National Health and Nutrition Survey, 2003.

OBJECTIVE: To investigate dietary quality among Japanese adults with a high vegetable diet, to consider dietary recommendation for vegetable intake. DESIGN AND SETTING: In the cross-sectional study of the National Health and Nutrition Survey 2003, we conducted the secondary analyses. The food-weighing method in one-day assessed the dietary intake. From 11,630 subjects, 2,305 men and 2,312 non-pregnant/lactating women, aged 20-69 y, and with an energy intake between 1,500 and 3,712 kcal were selected. Associations between vegetable, nutrient-density, and food intake were analyzed according to tertile cutoff: low vegetable diet (LVD), medium vegetable diet (MVD), or high vegetable diet (HVD). Differences across subgroups were tested after age adjustment. RESULTS: Mean vegetable intakes were 309 g for men and 318 g for women. Only 35% of Japanese met the vegetable intake (VI) recommendation of > or =350 g/d. VI had a positive association with age. Men 20-29 y-old and women 30-39 y-old were the subjects with the lowest VI. HVD subjects had higher intake for most food groups, whereas wheat in men; and wheat, sweets, and alcohol in women were negatively associated with VI. Main sources of energy for men and women with HVD were rice, wheat, and meat. HVD also had higher micronutrient-density. CONCLUSION: These analyses demonstrated the beneficial effects of HVD on dietary quality in the population studied. We concluded recommendations for adequate vegetable intake are expected to improve diet quality among Japanese adults, especially for the group aged 20-39.

Overview of nutrition reference and dietary recommendations in Japan: application to nutrition policy in Asian countries.

The nutritional needs of Asian populations have changed dramatically in the last century. The role of nutrition, not only in preventing diseases associated with deficiency, but also in preventing lifestyle diseases such as cardiovascular disease and cancer, has become increasingly clear. Japan established the world's first nutrition institute almost 100 years ago, and initially focused on combating malnutrition and food insecurity. The current focus is prevention of lifestyle diseases, and along with revised dietary reference intakes, Japan has launched a program of Shokuiku (eating education) for children and families. As developing countries are simultaneously facing continuing undernutrition and increasing obesity and lifestyle diseases, collaboration in research and programs is urgently needed to prevent disease through nutrition intervention. This symposium and the Asian network are initial steps toward integrating nutriology into Asia-wide nutrition-based public health research and programs such as Japanese Shokuiku (eating education).

Mid-term evaluation of "Health Japan 21": focus area for the nutrition and diet.

This paper provides a review of the mid-term evaluation of "Health Japan 21" and dis-cusses the status of progress towards the goals of items within the "Nutrition and diet" area. Among 14 items investigated, an improving trend was observed in eight items, though there was no improvement in five items. Whilst the percentage of obese individuals significantly increased during the 25 years from 1976 to 1999, secular trend showed that it has become unchanged since 2000, when "Health Japan 21" was enacted, regardless of gender and age. Another favorable finding was a decreasing trend of salt intake especially in the age group of 50-59 years. Besides, the analyses of the proportion of the persons "who have interest in dietary improvement" among the ones "who believe there are problems in their diet" showed that an increased awareness of inappropriate diet and also in the motivation to improve it, especially among males aged 50-59 years. On the other hand, some items showed worsening trend; e.g. decrease in vegetable intake, decrease of persons who are aware of their own optimal weight and practice weight control. Thus, the progress within Health Japan 21 was assessed as not necessarily satisfactory. In order to ensure the progress of "Health Japan 21" towards 2010, it is now crucial to effectively incorporate "Japanese Food Guide Spinning Top" and a new strategy of non-communicable diseases prevention focusing on the control of metabolic syndrome, which will be launched in April 2008, into the national health promotion program.

Study of animal species (human, dog and cat) identification using a multiplex single-base primer extension reaction in the cytochrome b gene.

We developed a simple method for animal species identification of humans, dogs and cats, using a multiplex single-base primer extension reaction in the cytochrome b gene. Using this method, three points of a single nucleotide in the cytochrome b gene were examined in these species using primers of different lengths. Our method was found to be able to successfully identify humans (26 samples), dogs (21 samples) and cats (9 samples), and no differences were found among the samples from each animal species in this study. The amount of template DNA required was over 0.01 ng for humans and dogs, and over 0.1 ng for cats. The present method was able to identify animal species from hair shaft (2 cm) and forensic casework samples (blood stains and hair shafts), and is thus a useful tool for animal species (human, dog and cat) identification in forensic science.

Prevalence and determinants of obesity and dietary habits among adults in rural area, Chile.

This study was undertaken to examine the prevalence of obesity and its determinants among adults in a rural area of Chile. A community-based cross-sectional study was conducted in April-June 2004 in San Carlos (8th region). Height, weight, and waist and hip circumferences were measured for 603 adults (female 447, male 156) aged 20-64 years, and data on socio-economic factors, dietary intake, and dietary habits were obtained by questionnaire interviews. The prevalence of obese individuals was 45.2% among females and 30.1% among males, whereas that of overweight individuals was higher among males than females. Obesity was associated with socio-economic factors for females but not for males. With regard to diet, different patterns between females and males were observed in terms of frequency of food intake, as well as in dietary habits. Our findings of a high prevalence of obese/overweight individuals, together with the characteristics of their diets including changes in the cooking process, suggest that nutrition transition is underway in rural regions as well. Appropriate interventions, therefore, should be introduced to control obesity among women and to enhance health awareness among men throughout the country.

Cloning of the chicken interleukin-13 receptor alpha 2 gene and production of a specific monoclonal antibody.

Mammalian interleukin-13 (IL-13) is an important regulatory T2 cytokine secreted by activated T lymphocytes. The IL-13 receptor (IL-13R) has two different chains, IL-13Ralpha1 and IL-13Ralpha2. Although the chicken IL-13 gene is well characterized, little is known about IL-13Rs. We cloned a cDNA encoding the 380 amino acid pro-peptide of chicken IL-13Ralpha2 (chIL-13Ralpha2) and developed a monoclonal antibody (mAb), HU13-1, against it. The chIL-13Ralpha2 amino acid sequence showed 37-39% sequence identity with mammalian homologs. High levels of chIL-13Ralpha2 mRNA were expressed in liver, testis, ovary, brain, and lipopolysaccharide (LPS)-stimulated IN24 cells. HU13-1 specifically recognized recombinant chIL-13Ralpha2 in ELISAs, and western blots identified a 45-kDa glycoprotein or a 41-kDa non-glycosylated protein in LPS-stimulated IN24 cell lysates. LPS induced a gradual increase in HU13-1-positive IN24 cells over 20 h. These results indicate that mAb HU13-1 recognizes native chIL-13Ralpha2 and will be valuable for further studies of chIL-13Rs.

Prevalence of asthma, rhinitis, and eczema among children in Vientiane city, Lao PDR.

An International Study of Asthma and Allergy in Childhood (ISAAC) revealed a wide range of prevalences of childhood asthma in the world. Lao PDR had no such epidemiological data yet. This study aimed to investigate the epidemiology of asthma, rhinitis, and eczema in children in the country. A cross-sectional study was conducted in Vientiane City, the capital of Lao PDR, in 1997 using the ISAAC questionnaire. From three primary schools and one high school, 395 children, age 6-7 years, and 468 children, age 13-14 years, were chosen. The prevalence of asthma for children aged 13-14 years in Lao PDR was 25.6%, which ranks the highest in international asthma prevalence. The prevalence in allergic-rhinoconjunctivitis of children was 24.4% and atopic eczema was 7.1%. Contrary to generally accepted risk factors, there were no associations revealed between asthma prevalence and smoking of family members (especially mothers), intake of fish/meat, and male gender.

Health-care waste management in Lao PDR: a case study.

This study investigated the health-care waste (HCW) management at each health-care facility level at two selected sites in the Lao People's Democratic Republic (Lao PDR): Vientiane Municipality; and Bolikhamxay province. It focused on the amount of HCW, its segregation and the factors influencing HCW management, particularly segregation procedures. A high proportion of incorrectly segregated medical waste was found at each level of health-care facility. Re-segregation revealed 39, 62, 57 and 37% at national hospital, provincial hospital, district hospital and health centre level, respectively, was poorly segregated. The mean of generated HCW was 0.62 kg/bed per day (Vientiane Municipality) and 0.38 kg/bed per day (Bolikhamxay) at two study sites. A higher proportion of medical waste (MW) from the inpatient department at the primary health-care level was found. Thus, HCW management at primary health-care facilities needs more attention and should be better understood.

Hidden reality on the introduction of auto-disable syringes in developing countries.

With the growing concerns about the risk of unsafe injections (e.g. unsterilized injection practices), WHO, UNICEF and UNFPA decided to introduce the auto-disable (AD) syringe for immunization in the world. The AD syringe is designed to be automatically locked after a single use, hence no chance of reuse. Consequently, the risk of infection can be reduced for the recipient. On the other hand, the management of increased medical waste is becoming difficult, as the waste volume of AD syringes would be 200 times as much as those of sterilizable syringes. The used and improperly disposed AD syringes could be a huge source of blood-borne infections and environmental pollution at the community level. This study attempted to explore the present situation with regard to the introduction of AD syringes for immunization in Lao PDR. We conclude that reviewing the present 'safe injection' policy is urgently required in Lao PDR, as well as in other developing countries where the disposal system for medical wastes is not yet well established.