Effects of Cucurbita Moschata squash (Butternut) seed paste in improving zinc and iron status in children attending Early Childhood Development centres in Limpopo province, South Africa.

Cucurbita moschata (Butternut squash) seeds are a rich source of nutrition containing nutrients including iron, zinc, copper, calcium, potassium, and phosphorus. The aim of this study was to determine if Cucurbita Moschata squash seed paste improves zinc and iron status, anthropometric status, and dietary intake in preschool children. A pretest-posttest control group trial using cluster randomisation was conducted over 6 months. Four preschools were randomly assigned to receive 100 g of intervention or 100 g of a placebo as the control to enhance iron and zinc status. A total of 276 preschool children were recruited from eight government registered Early Childhood Development centres in Limpopo province, South Africa. The control group consumed Cucurbita moschata flesh twice-weekly, while the intervention group consumed Cucurbita moschata seed paste twice-weekly during a six-month period. Iron (serum iron, transferrin, transferrin saturation, ferritin) and zinc (serum zinc) status and anthropometric indices such as weight, height and mid upper arm circumference for children were evaluated at baseline and the endpoint. Iron and zinc-rich food consumption was measured using a 24-hour dietary recall and food record during the study, and dietary intake was estimated using a food frequency questionnaire which was conducted at the beginning and endpoint. The intervention group significantly improved in the mean serum iron 0.23 µg/dL (95% CI: 0.11;0.33); ferritin 0.21µg/dL (95% CI: 0.13;0.39), transferrin saturation 0.33% (0.23;0.74) and zinc 0.16 µmol/dl (95% CI: 0.13;0.25) at the end of the study. In addition, the intervention group exhibited greater mean weight for age of 0.13 z-score (95% CI: 0.28; 0.34) and weight for height of 0.04 z-score (95% CI: 0.12,0.05), as well as the consumption of iron (p < 0,001), zinc (p < 0,001), and vitamin C (p < 0.001). At the end of the trial, fiber (p < 0.001), riboflavin (p = 0.001), vitamin B6 (p < 0.001), and vitamin B12 (p < 0.001) were significantly higher in the control group. Thus, the inclusion of intervention in the diet of children in an impoverished area of South Africa improved the iron and zinc status of these children. This supplement could be a cost effective and sustainable approach to improve nutrient status in rural South Africa. Trial registration: Pan African Clinical Trial Registry (PACTR202308740458863).

Why Acute Undernutrition? A Qualitative Exploration of Food Preferences, Perceptions and Factors Underlying Diet in Adolescent Girls in Rural Communities in Nigeria.

BACKGROUND: Adolescent girls are nutritionally vulnerable due to their rapid growth and increased nutrient requirements. Nigeria has the sixth-largest population in the world. This study qualitatively explored the food preferences, perceptions of nutritive value and factors underlying food consumption of adolescent girls in rural communities in Nigeria. METHODS: The data were collected via the free listing of foods and focus group sessions conducted in the Hausa language with 48 unmarried adolescent girls. The discussions were audio-recorded, transcribed, translated into English, and analyzed using a deductive thematic framework. RESULTS: The mean age of the respondents was 13.0 ± 2.7, and almost half (48%) had a primary school education. A total of 19 and 23 foods were identified as preferred, and perceived as nourishing, respectively. The top 10 foods present on both free lists overlapped considerably in terms of cognitive salience. The focus group themes included nutrition knowledge, food preferences, autonomy, household food allocation, courtship practices, and agricultural landscapes and economic access. The participants had minimal knowledge of nutrients and food groups, and their preferred foods were limited in diversity. The key factors in food preferences were desirable health effects, sensory attributes, and the contribution of foods to a desirable body image for marriage. Household food choices depended on parents. Thus, a desire for independence was an incentive for early marriage, mostly at 13 to 17 years. Gender inequities in household food distribution (quantity) and animal protein intake were reported. The participants believed that boys need more food for strength to impregnate girls. As part of a courtship practice, the girls received gifts of animal source foods from potential suitors. The food options were limited by financial challenges and low agricultural diversity. CONCLUSION: To interrupt the cycle of inadequate food consumption and undernutrition in these adolescent girls, policy makers need to promote nutrition education and address the underlying determinants of inequitable access to nutritious foods.

Development and validation of the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa.

BACKGROUND: In Sub-Saharan Africa, the nutritional status of children born to teenage mothers deserves critical attention. Maternal knowledge and attitudes concerning infant and young child feeding (IYCF) may predict actual practices and child nutritional status. This study created and validated the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. METHODS: A literature search on IYCF knowledge and attitude gaps in teenage mothers generated scale items. Ten nutrition experts and six teenage mothers assessed content validity and comprehensibility, respectively. Construct validation was conducted by item response theory (IRT) and confirmatory factor analysis (CFA), in 150 teenage mothers in rural communities of Abuja, Nigeria. Model fit parameters were estimated by standardized chi-square tests. Internal consistency reliability was determined by marginal reliability and Cronbach's alpha. In a sub-sample of 40 women who completed the questionnaire two weeks later, test-retest reliability was assessed via intraclass correlations. RESULTS: The IRT analysis retained 23 knowledge items on infant food type, breastfeeding and complementary feeding, with acceptable discrimination and difficulty. CFA produced a six-factor solution (exclusive breastfeeding, breast milk expression, meal frequency, responsive feeding, dietary diversity, and barriers) with 17 attitude items. Confirmatory fit and Tucker Lewis indices > 0.9; Root Mean Square Errors of Approximation and Standardized Root Mean Square Residuals < 0.08, showed good model fit. Overall Cronbach's alpha of the attitude scale (0.843), subscales (≥ 0.6) and high intraclass correlation coefficients (> 0.75) indicated reliability. CONCLUSION: The Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa is a valid assessment tool for IYCF knowledge and attitudes of teenage mothers.

Dietary diversity and nutritional status of children attending early childhood development centres in Vhembe District, Limpopo province, South Africa.

The present study assessed dietary diversity and anthropometric status of children attending early development centres in South Africa. In the Vhembe District of Limpopo province, South Africa, 273 children were conveniently chosen from 8 randomly selected early childhood development centres for a cross-sectional study. Data were gathered via a questionnaire administered by the interviewer in June 2021. Height, body weight and mid-upper arm circumference were measured to assess anthropometric status. A 24-h dietary recall was obtained to provide information on dietary diversity. The prevalence of underweight, wasting and stunting was 9, 4 and 26 %, respectively. More than half of the children had a low dietary diversity score, according to the Food and Agriculture Organization scoring system for children. Grains, roots, tubers, dairy products, other fruits and vegetables, and flesh-based foods were the highest consumed food groups. The lowest consumption was for eggs, vitamin A-rich fruits and vegetables, legumes and nuts. Height for age and weight for age were significantly associated with dietary diversity score, but not weight for height. Children who did not meet the reference value of greater than 4 for dietary diversity had a significant risk of being underweight (AOR 0⋅25, 95 % CI 0⋅08, 0⋅75) and stunted (AOR 0⋅32, 95 % CI 0⋅14, 0⋅74). The nutritional status of the children was impacted by a lack of adequate dietary diversity. Young children in rural areas need to receive a wide range of food to promote greater diversification of diets in order to diminish the risk of undernutrition.

Iron and zinc status of children aged 3 to 5 years attending Early Childhood Development centres in Venda, South Africa.

This study assessed iron and zinc levels of preschoolers. 276 children were randomly chosen from 8 preschools. Weight and height were measured using standard techniques. After blood was obtained, serum zinc, iron, ferritin, transferrin saturation, and transferrin were assessed. Dietary intake was calculated using the Food Frequency Questionnaire. Prevalence of severe underweight, stunted, and acute malnutrition was 4.7%, 12.7% and 2.9%. Using transferrin saturation<5%, one-quarter were iron deficient. Using serum iron<40 µg/dl as indicative of depletion, 8% exhibited low serum iron while 18% were mildly deficient. Based on ferritin<12 µg/L, 99% had iron deficiency.

Low diet quality is associated with adverse levels of metabolic health markers and clustering of risk factors in adults with type 2 diabetes.

BACKGROUND: Nutritional recommendations for diabetes management emphasise an overall, healthful diet consistent with the guidelines for the general population. The present study assessed the relationship of diet quality, as measured by Healthy Eating Index-2015 (HEI-2015), with metabolic health markers and risk factor clustering in type 2 diabetes patients using National Health and Nutrition Examination Survey 2011-2016 data. METHODS: HEI-2015 diet quality scores were calculated using 24-h dietary recalls. Adults with type 2 diabetes (n = 2220) were assessed for: (1) hyperglycaemia; (2) overweight/obesity; (3) dyslipidaemia; and (4) hypertension. Logistic regression examined associations of diet quality quartiles with odds of hyperglycaemia, overweight/obesity, dyslipidaemia and hypertension, as well as odds of clustering of these risk factors. RESULTS: Odds of overweight/obesity and hyperglycaemia were significantly greater for participants in the lowest HEI-2015 quartile compared to those in the highest quartile. Furthermore, individuals in the bottom two HEI-2015 quartiles had increased odds of dyslipidaemia. Those in the lowest quartile also had significantly higher odds of having ≥ 2, ≥ 3 and 4 risk factors (vs. having ≤ 1 risk factor). CONCLUSIONS: Low diet quality was related to increased odds of hyperglycaemia, dyslipidaemia, overweight/obesity and risk factor clustering. Findings imply poorer prognosis of diabetes in individuals with low diet quality.

Food Security Status, WIC Participation, and Early Childhood Caries in a Nationally Representative Sample of Children.

BACKGROUND: Despite the potential role of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in mitigating the adverse effects of food insecurity on oral health, to our knowledge, no study has examined whether WIC participation could modify the association between food insecurity with caries in young children. OBJECTIVE: Our aim was to investigate the impact of WIC participation in modifying the association between food insecurity and early childhood caries. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: Using 2011-2018 National Health and Nutrition Examination Survey data, children aged 2 through 5 years; with household income ≤185% of the Federal Poverty Level; and with data on WIC participation, food security, and dental examinations were included (n = 1,921). STUDY EXPOSURES: Food-security status and WIC participation were the study exposures. MAIN OUTCOME MEASURES: Total and untreated dental caries were the main outcome measures. STATISTICAL ANALYSES: Logistic regression examined associations of food security (household-level and child-level) and WIC participation with odds of caries. Interactions between food security and WIC participation were examined using multiplicative interaction terms. RESULTS: Marginal child food security was significantly related to higher odds of total caries in income-eligible WIC nonparticipants (odds ratio 1.92; 95% CI 1.07 to 3.46); however, this relationship was not observed in WIC participants. Furthermore, food insecurity was significantly associated with greater odds of untreated caries only among income-eligible WIC nonparticipants (odds ratio 1.79; 95% CI 1.12 to 2.85). CONCLUSIONS: In this sample of preschool-aged children, the relationship of food insecurity with caries differed by WIC participation status. Findings suggest that WIC participation could improve the oral health of income-eligible children with lower levels of food security.

The Special Supplemental Nutrition Program for Women, Infants, and Children food package revisions and anemia in children aged 2-5 years.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional assistance to low-income women and children in the United States. The WIC food package was revised to align more closely to dietary recommendations in October 2009. The revised package included more fruits, vegetables, whole grains, and low-fat milk. OBJECTIVES: The objective of this study was to examine the association of the revised WIC package with anemia indicators and iron intake in children. METHODS: A quasi-experimental difference-in-difference design compared anemia and iron intake variables between WIC (n = 1497 and n = 1626 for anemia and iron intake variables, respectively) and WIC-eligible nonparticipating children (n = 1183 and n = 1322 for anemia and iron intake variables, respectively), aged 2-5 y, before and after the 2009 revisions. The NHANES 2003-2008 and 2011-2018 data represented the period pre- and post-2009 revisions, respectively. RESULTS: The 2009 package revisions were significantly associated with reduced probability of anemia (-4.3% points; 95% CI: -7.5, -1.1% points) and nonthalassemic microcytic anemia (-1.7% points; 95% CI: -3.3, -0.1% points) in children from WIC-participating households. The revised WIC package also was significantly related to higher nutrient adequacy ratio (0.04; 95% CI: 0.02, 0.07) and greater probability of meeting the RDA (12.1% points; 95% CI: 3.2, 21.0% points) for iron among WIC participants. CONCLUSIONS: This study found that the WIC 2009 revisions were associated with lower probability of nonthalassemic microcytic anemia and better adequacy of dietary iron intake, thereby suggesting the beneficial impact of WIC revisions on iron deficiency anemia in children. The current study findings suggest that nutritional policies could play a crucial role in supporting the health of vulnerable children in the United States.

Alcohol consumption according to socioeconomic and hypertensive status among Korean adults.

This research investigated variations in alcohol consumption by socioeconomic factors and hypertensive status in South Korean adults, aged ≥19 years. This is a secondary data analysis using the Korea National Health and Nutrition Examination Survey (KNHANES). Alcohol intake by socioeconomic and hypertensive status was examined using data from the 2013 to 2016 KNHANES. Total participants were 19,641 adults, with 8,123 men and 11,518 women. Consumption of alcohol in the Korean population was estimated from a single 24-hour dietary recall. Alcohol intake differed, according to socioeconomic status, and, particularly, by occupation among Korean adults. Women with lower education consumed more alcohol daily than those with a higher education (p = 0.018). Furthermore, adult men with hypertension consumed a greater amount of alcohol daily, 30.9 g, than those with pre-hypertension, 23.7 g, followed by those without hypertension, 15.9 g (p < 0.001). In women, adults with pre-hypertension and hypertension consumed more alcohol daily, 9.4 g and 9.0 g, respectively, than those without, 6.6 g (p < 0.001). In addition, men with hypertension who were unaware of their disease and those who were cognizant consumed a higher amount of alcohol daily, 32.4 g and 28.6 g, respectively, than individuals without hypertension, 19.7 g (p < 0.001). Moreover, men with hypertension who had not been treated for hypertension and those in treatment consumed a greater amount of alcohol daily, 32.6 g and 28.0 g, respectively, than those without hypertension, 19.7 g (p < 0.001). In conclusion, Korean adults consume alcohol differently by socioeconomic status, and alcohol intake was more prevalent among people with hypertension.

Birth weight and prediabetes in a nationally representative sample of US adolescents.

Prediabetes affects about 20% of adolescents in the United States. Previous studies have shown that low and high birth weight impairs glucose homeostasis in adults; however, limited research has examined this relationship in adolescents. To investigate association of birthweight with prediabetes in US adolescents using data from NHANES 2005-2016 and examine whether sex and obesity moderate this relationship. Adolescents, aged 12-15 years without diagnosed/undiagnosed diabetes and extreme birthweight (n = 1396), were classified as low birth weight (LBW), normal birthweight (NBW) and high birth weight (HBW). Logistic regression examined relationship of birthweight with odds of prediabetes. Likelihood ratio test tested interactions of birthweight with sex and obesity measures. In this nationally representative cross-sectional study, LBW adolescents had significantly higher odds of prediabetes compared to NBW counterparts (Odds ratio [95% confidence interval] = 1.93 (1.10, 3.38); p < .05). Sex and obesity moderated the association, such that the strength of the relationship of LBW with increased prediabetes odds was greater among male adolescents (Odds ratio [95% confidence interval] = 2.40 (1.02, 5.67); p < .05) and those with overweight/obesity (Odds ratio [95% confidence interval] = 2.13 (1.01, 4.49); p < .05). Findings imply that the adverse effects of LBW on glucose homeostasis could be manifested early in life. Further, the higher odds of prediabetes among LBW adolescents who are male or have overweight/obesity underscore the heightened need for prediabetes screening of these subgroups.

Associations Between Diet Quality and Dental Caries in Low-Income Women.

BACKGROUND: The Healthy Eating Index 2015 (HEI-2015) is a diet quality measure of conformity of diet to the 2015-2020 Dietary Guidelines for Americans. This tool is being used increasingly to assess relationships between diet quality and health outcomes. OBJECTIVE: The objective of this research was to investigate the relationships between diet quality as measured by HEI-2015 total and component scores and Decayed, Missing, Filled Teeth Index (DMFT) scores in low-income women. DESIGN: In this cross-sectional study, low-income women were administered questionnaires and dental examinations on 1 occasion. The questionnaires included demographics, food frequency, and oral health questionnaires, and the US Adult Food Security Survey Module. PARTICIPANTS/SETTINGS: Participants in this study were part of a larger research project-Impact of Diet and Nutrition on Dental Caries in Low-Income Women. For the larger research project, a total of 255 women aged 18 to 50 years with annual income <250% of the Federal Poverty Line were recruited from low-income housing units in Central Texas from June 1, 2018 to December 30, 2018. Of the 255 women, 28 underwent dental screenings but did not complete the questionnaires. Seven women were excluded because energy intakes exceeded 4,000 kcal/d. The final sample for the current analysis was 220 women who had completed their dental examinations and provided complete data. MAIN OUTCOME MEASURES: The exposure was diet quality and the main outcome measure was DMFT score. STATISTICAL ANALYSIS: Dental caries scores were calculated by addition of decayed, missing, and filled teeth. Descriptive statistics were conducted on the variables of age, race and ethnicity, education, annual household income, food security status, and frequency of brushing and flossing. Linear regression analysis was used to discern relationships between diet quality-as assessed by HEI-2015 total and component scores-and dental caries experience, adjusting for the covariates. RESULTS: Caries in permanent teeth was present in 95.6% of participants. HEI-2015 total scores were inversely associated with dental caries. An increase of 1 point in total HEI-2015 score was accompanied by a decrease in DMFT score by 0.569 (P = .001). In addition, component scores for total vegetables (P = .001), greens and beans (P = .002), dairy (P = .004), refined grains (P = .001), and added sugars (P = .001) were inversely related to DMFT scores. CONCLUSIONS: This research suggests that diet quality, as measured by the HEI-2015, is inversely associated with DMFT scores in low-income women. Future research is needed to investigate the influence of diet and nutrition on the integrity of oral health.

Role of Dental Nutrition Knowledge and Socioecological Factors in Dental Caries in Low-Income Women.

Dental caries is a chronic oral condition that disproportionately affects low-income women. The aim of this research was to investigate relationships between dental nutrition knowledge, socioecological factors, and prevalence of dental caries in low-income women. This quantitative cross-sectional study involved 220 women who were recruited from Central Texas. Participants completed demographics, the Dental Nutrition Knowledge Competency Scale, United States Adult Food Security Survey Module, and the Multidimensional Home Environment Scale. Two dentists measured dental caries via the Decayed, Missing, Filled Teeth Index. Regression models were conducted to test the effects of dental nutrition knowledge and Multidimensional Home Environment Scale factors on dental caries. Finally, mediation analysis explored relationships between dental nutrition knowledge and dental caries, adjusting for Multidimensional Home Environment Scale scores. Results showed that dental nutrition knowledge and Multidimensional Home Environment Scale score were significantly associated with dental caries. Subscales of self-efficacy for eating healthy, oral hygiene practices, emotional eating, availability of unhealthy foods at home, and social support were related to dental caries. The relationship between dental nutrition knowledge and caries was mediated by Multidimensional Home Environment Scale scores. This research emphasizes the role of dental nutrition knowledge and socio-ecological factors on prevalence of dental caries. Public health interventions to reduce dental caries should involve strategies that increase dental nutrition knowledge and encourage behavior change in low-income populations.

Differences in factors associated with anemia in Haitian children from urban and rural areas.

BACKGROUND: In Haiti, differences in the prevalence of anemia between urban and rural areas have been observed. OBJECTIVE: To identify moderating factors that may help explain the difference in the prevalence of anemia in children from poor urban vs. rural areas of Haiti. METHODS: This cross-sectional study used secondary data from urban and rural school-based trials that assessed the effectiveness of a nutrition intervention. The study was registered at ClinicalTrials.gov as NCT02747524. A total of 300 rural- and 981 urban- children between 2.5-13 years of age were included in this analysis. Effect modification in a binary logistic generalized linear mixed model was conducted using sample weights in SPSS® version 26. Models were adjusted for age and income. School cluster was included as random effect. RESULTS: In rural areas, stunting was more prevalent in children with anemia vs. no anemia, (16.6%, and 6.3%, P = 0.008), respectively. Also, rural children with anemia lived with fewer adults vs. rural children with no anemia, ([Formula: see text] = 2.83±1.29, and 3.30±1.54, P = 0.005), respectively. In poor urban areas, helminth morbidities were more frequent in children with anemia vs. no anemia, (21.9% vs. 13.9, P = 0.011), respectively. In the combined sample, stunting, [AOR = 2.05; 95%CI (1.32-3.18)], age [AOR = 0.89; 95%CI (0.85-0.93)], and households with more adults [AOR = 0.77; 95%CI (0.67-0.87)] were associated with anemia. Effect modification by place of residence was observed in households with more adults (t = 3.83, P<0.001). No other nutritional, dietary, sanitation or morbidity factors or effect modifiers were observed. CONCLUSIONS: In this sample, factors associated with anemia differed in poor urban and rural children from Haiti including family structure and helminth morbidities. Stunting and lower age increased the odds of anemia in the combined sample. Family structure appears to have an important role in anemia, and further research understanding the influence of family structures in anemia is needed.

Association of loss of Supplemental Nutrition Assistance Program benefits with food insecurity and dietary intake of adults and children.

BACKGROUND: Supplemental Nutrition Assistance Program (SNAP) disenrollment among income-eligible households could limit their ability to access food. OBJECTIVES: To assess the association of loss of SNAP benefits on food security status and dietary intake of household members, using 2011-2016 NHANES data. METHODS: SNAP participation status among those with a household income ≤130% of the federal poverty level was categorized as 1) current participants, 2) former participants with benefits cut off in the past year, and 3) former participants with benefits cut off for more than a year. Logistic regression examined associations of SNAP participation status with odds of household (n = 7387), adult (n = 7387), and child (n = 5898) food security. Linear regression examined associations of participation status with Healthy Eating Index-2015 (HEI-2015) total and component scores in adults (n = 2784) and children/adolescents (n = 2553). RESULTS: Former SNAP participants with benefits cut off in the past year had greater odds of severe household (OR: 2.18; 95% CI: 1.25, 3.78) and adult (OR: 2.09; 95% CI: 1.24, 3.54) food insecurity compared with current participants. Benefit cutoff in the past year was significantly related to low child food security (OR: 1.80; 95% CI: 1.04, 3.11) and lower child/adolescent greens and beans score (estimate: -0.40; SE: 0.18). Loss of benefits for more than a year was significantly associated with increased marginal child food security odds (OR: 2.07; 95% CI: 1.23, 3.47), lower adult dairy score (estimate: -0.63; SE: 0.24), and lower child/adolescent greens and beans (estimate: -0.34; SE: 0.16), whole grains (estimate: -0.50; SE: 0.21), and dairy scores (estimate: -0.93; SE: 0.29). CONCLUSIONS: This study suggests that loss of benefits may increase household food insecurity. Although child/adolescent intakes of certain HEI-2015 adequacy components were lower among former SNAP participants, overall diet quality score did not differ. Findings collectively imply the need for policies that protect households from the adverse effects of benefits loss.

Twenty-year trends in vegetable consumption by preparation method and eating location for Korean population from 1998 to 2017.

Vegetables are an important source for the essential vitamins and minerals that are necessary for optimal health. This research investigated changes in vegetable intake over time in the Korean population from 1998 to 2017, focusing on preparation methods of vegetables and location of consumption. This cross-sectional study is based on the Korea National Health and Nutrition Examination Survey (KNHANES) that was established in 1998 to assess the health and nutritional status of the South Korean population. This research utilised information from 1998 to 2017 which is the extent of all available KNHANES data. Vegetable consumption was grouped, according to preparation methods and common eating locations. Both crude and age-standardised means of vegetable intake were derived via a 24-h dietary recall. All participants who completed a 24-h dietary recall survey were selected for the analyses. This included 109 220 individuals (49 069 men and 60 151 women) over the course of 20 years of the KNHANES. Total vegetable intake decreased over time (Pfor trends < 0·001), specifically, steamed and salted vegetables (Pfor trends < 0·001). In contrast, Koreans consumed noticeably more raw vegetables from 1998 to 2017 (Pfor trends < 0·001). Vegetable intake at home significantly declined (Pfor trends < 0·001), while that eaten at restaurants or outside the home increased greatly (Pfor trends < 0·001). Over 20 years, Koreans have ingested decreasing amounts of vegetables, but the intake of raw vegetables has escalated. However, the location of vegetable consumption has changed, with an increase at both restaurants and outside the home (approximately 70·0 %).

Global diversity of dietary intakes and standards for zinc, iron, and copper.

BACKGROUND: The essentiality of trace elements in human diets is well recognized and adequate levels are a critical component of optimal health. To date, public health efforts have focused primarily on macronutrients or trace minerals that are easily analyzed. The goal of this research is to provide assessment of the dietary standards developed for Zn, Fe, and Cu in 100+ developed, marginal, and developing countries. We summarize the current recommendations and changes from the last decade, categorize and provide scientific basis for values established, factors that affect requirements, and current global challenges. METHODS: The electronic databases of Google Scholar, PubMed, Embase, Web of Science and Cochrane Library were searched using the keywords "trace minerals," "micronutrients, ""zinc," "iron," "copper," "dietary standards" and "recommendations." A total of 123 studies published from 1965 to 2019 were included. RESULTS: The World Health Organization (WHO) has established dietary standards to address nutrient deficiencies, prevent infections and ensure basic metabolic functions; these are utilized by most developing countries. Developed countries or their alliances have established values similar to or higher than the WHO, primarily for promotion of optimal health and well-being. Transitional countries are more concerned with issues of bioavailability, food security and undernutrition. Globally, Zn and Cu recommendations are lower in women than in men; Fe requirements are higher to compensate for menstrual losses. Important considerations in establishing guidelines for these minerals include bioaccessibility, dietary practices and restrictions, food processing, interactions, and chemical forms. The global challenges of the triple burden of malnutrition, hidden hunger, increased consumption of ultra-processed foods and obesity have been associated with Zn, Fe, and Cu deficiencies. CONCLUSION: This research provides public policy and health professionals evidenced-based information useful for the establishment of dietary standards world-wide.

Development and validation of the Dental Nutrition Knowledge Competency Scale for low-income women.

OBJECTIVE: To develop and validate a Dental Nutrition Knowledge Competency Scale to assess dental health-related nutrition knowledge of low-income women. DESIGN: This is a cross-sectional study. A literature search for foods/dietary practices related to dental caries was conducted and the items were incorporated into an initial questionnaire. A panel of ten nutrition experts evaluated it for its content, readability and relevance, and a focus group of six low-income women determined its readability and comprehension. Then the questionnaire was administered to 150 low-income women. Construct validity was evaluated by item difficulty, item discrimination and factor analysis. Internal consistency reliability was tested via Cronbach's α. In a sub-sample of forty women, test-retest reliability was established. Paired-sample t tests were conducted to examine differences between test scores at the two time points, 2 weeks apart. SETTINGS: Community centres in low-income housing in Central Texas, USA. PARTICIPANTS: A total of 150 low-income women, aged 18-50 years; annual household income <250 % of the federal poverty level. RESULTS: Item difficulty and discrimination analysis resulted in elimination of eight questions. Factor analysis identified twenty-four items that loaded on three factors related to knowledge. These included foods/dietary practices that affect dental caries, added sugars in foods and on food labels, and recommended frequency of oral hygiene practices. The subscales and the completed scale exhibited good internal consistency (mean 0·7 (sd 0·97)) and test-retest reliability (mean 0·8 (sd 0·013)). CONCLUSIONS: The Dental Nutrition Knowledge Competency Scale is a validated and reliable instrument to assess nutrition knowledge related to dental health in low-income women.

Zinc deficiency associated with anaemia among young children in rural Guatemala.

One in four children younger than age five in Guatemala experiences anaemia (haemoglobin <11.0 g/dl). This study characterized the factors and micronutrient deficiencies associated with anaemia in a baseline cross-sectional sample of 182 Guatemalan infants/toddlers and 207 preschoolers, using generalized linear mixed models. Associations between anaemia and maternal, child and household variables, and biomarkers (soluble transferrin receptor, ferritin, zinc, folate, vitamin B12, C-reactive protein, and α1-acid glycoprotein) were explored. Rates of anaemia were 56% among infants/toddlers and 12.1% among preschoolers. In children with anaemia, rates of iron deficiency (low ferritin based on inflammation status, and/or high soluble transferrin receptor, ≥1.97 mg/L) and zinc deficiency (serum zinc <65 µg/dl) were 81.1% and 53.7%, respectively. Folate deficiency (either plasma folate <3 ng/ml or erythrocyte folate <100 ng/ml) was 3.3%. Vitamin B12 deficiency (plasma vitamin B12 <148 pmol/L) was 7.5%. For infants and toddlers (<24 months), the odds ratio of anaemia was lower when higher number of adults lived in the household (OR = 0.69; 95% CI [0.53, 0.90]), and higher when children were zinc deficient (OR = 3.40; 95% CI [1.54, 7.47]). For preschoolers (36-60 months), the odds ratio of anaemia was lower for every additional month of age (OR = 0.90; 95% CI [0.81, 1.00]). Findings suggest that micronutrient deficiencies coexist in Guatemalan rural children, and zinc deficiency is associated with anaemia in children <24 months, highlighting the need of continued multidisciplinary interventions with multiple micronutrients. Further research examining how household composition, feeding practices, and accessibility to micronutrient supplements and to animal source foods is needed to incorporate strategies to improve the nutritional status of Guatemalan children.

Nineteen-year trends in fermented food consumption and sodium intake from fermented foods for Korean adults from 1998 to 2016.

OBJECTIVE: Fermented foods such as kimchi are traditional foods in Korea and could provide beneficial health effects. However, fermented foods also contribute to increased Na intake since salt is added during the fermentation process. The present research aimed to examine trends in the consumption of fermented foods and Na intake over time by Korean adults, using data from the Korea National Health and Nutrition Examination Survey (KNHANES). DESIGN: KNHANES is a cross-sectional survey; data from 1998 to 2016 were divided into seven groups from KNHANES I to VII. SETTING: Demographic information on sex, age, education and income were collected. Assessment of fermented food and Na consumption was conducted via analysis of 24 h dietary recall data. Multivariate linear regressions and logistic regressions were performed to calculate the P for trends by applying strata, cluster and sampling weights by SAS PROC SURVEY. PARTICIPANTS: The target population was Korean adults, aged ≥19 years, who participated in a 24 h dietary recall. The total number was 76 199, with 32 324 men and 43 875 women. RESULTS: A significant decline in fermented food consumption was observed from 1998 to 2016 in both men and women (P < 0·0001). Among fermented foods, kimchi consumption was greatly reduced while pickled vegetables consumption showed a marked increase. Similarly, Na intake from fermented foods declined significantly over time in both men and women (P < 0·0001). CONCLUSIONS: The consumption of fermented foods and Na intake from fermented foods by Korean adults decreased significantly over time from 1998 to 2016.