One of the health problems in Indonesia is the high prevalence of stunting in infants. Determinan... more One of the health problems in Indonesia is the high prevalence of stunting in infants. Determinants and specifically the relative contribution of prenatal and postnatal factors to growth and nutritional status of Indonesian infants were investigated. Newborn infants, from women recruited at 18 wk of pregnancy from 9 rural villages in West Java, Indonesia, were followed until 12-15 mo of
The objective of this longitudinal study was to investigate the association between the premature... more The objective of this longitudinal study was to investigate the association between the premature initiation of complementary feeding and physical growth of children. Four cohorts of newborn children were included, consisting of 90 infants born in 1981, 90 in 1982, 60 infants in 1983 and 60 in 1984. The weights and heights of children were measured monthly up to 1 y, then every 3 mo for y 2 and 3, and once every 6 mo in y 4. Information on feeding practices and diseases of the children was obtained by interviewing the mothers at each home visit. All but three children (98.6%) were breast-fed. Although 87.1% of the mothers breast-fed their children for at least 1 y, only 3.3% of the infants were breast-fed exclusively at the age of 4 mo. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean and confounding. There was little association between feeding pattern at 15 d and growth in length in mo 1. However, partially breast-fed and...
Although several studies have dealt with the patterns of cytokine production in tuberculosis, lit... more Although several studies have dealt with the patterns of cytokine production in tuberculosis, little is known about the association between nutrient deficiencies and cytokines in tuberculosis. The objective of this study was to assess the concentration of cytokines related to nutritional status during tuberculosis. In 41 untreated tuberculosis patients and matched healthy controls in an urban hospital in Indonesia, we measured: height and weight, parameters of iron, vitamin A and zinc; and cytokines concentrations in the circulation and production in whole blood cultures. Plasma interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) were significantly higher in patients than in controls. Patients with cavities (n=26) had higher concentrations of IL-6 than patients without cavities (n=15). Body mass index <18.5 kg/m2 was associated with high concentrations of tumor necrosis factor-alpha (TNF-alpha) and IL-6. Anaemia was associated with high concentrations of IL-6 and ...
Background. Because of the rapid growth of the urban population in Peru, food and nutrition insec... more Background. Because of the rapid growth of the urban population in Peru, food and nutrition insecurity will occur increasingly in this population. For appropriate policy setting and programming, the food and nutrition situation of the urban poor requires better understanding.
Objective. To gain information about the nature, magnitude, severity, and causes of the nutritional problems of the population in low-income areas of the city of Chiclayo, Peru.
Methods. A cross-sectional nutrition survey was conducted in 1,604 households, covering children under 5 years of age and their parents.
Results. The prevalence rates of stunting, wasting, overweight. and anemia in children were 15.4%, 1.3%, 4.6%, and 65.7%, respectively; one third of adults were overweight, and one tenth were obese; 2.1% of the mothers were underweight; and 34.3% of mothers and 12.2% of fathers had anemia. Governmental feeding programs did not address these problems adequately.
Conclusions. Interventions must have adequate targeting; address appropriate responses at the household, community, and national levels; and reduce stunting, obesity, and iron-deficiency anemia.
Global population growth is concentrated in urban areas, but there is little understanding of how... more Global population growth is concentrated in urban areas, but there is little understanding of how to implement the necessary interventions to control food and nutrition insecurity. In the urban area of Peru, food insecurity is characterized mainly by micronutrient deficiencies and not by energy deficiency. To increase the effectiveness and cost-effectiveness of weekly multimicronutrient supplementation programs in poor urban communities. A series of operational studies were conducted of preventive weekly multimicronutrient supplementation to reduce micronutrient-deficiency anemia in a population consisting of 8,081 children under 5 years of age and 20,082 women and adolescent girls of reproductive age (12 through 44 years). This is one of a series of papers that describe in as much detail as possible the experiences of a multimicronutrient intervention program for poor urban mothers and their young children and summarizes the lessons learned for consideration of future programming. ...
Background. Weekly multimicronutrient supplementation was initiated as an appropriate interventio... more Background. Weekly multimicronutrient supplementation was initiated as an appropriate intervention to protect poor urban populations from anemia.
Objective. To identify the lessons learned from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) weekly multimicronutrient supplementation program implemented in poor urban populations of Chiclayo, Peru.
Methods. Data were collected from a 12-week program in which multimicronutrient supplements were provided weekly to women and adolescent girls 12 through 44 years of age and children under 5 years of age. A baseline survey was first conducted. Within the weekly multimicronutrient supplementation program, information was collected on supplement distribution, compliance, biological effectiveness, and cost.
Results. Supplementation, fortification, and dietary strategies can be integrated synergistically within a micronutrient intervention program.
Conclusions. To ensure high cost-effectiveness of a weekly multimicronutrient supplementation program, the following conditions need to be met: the program should be implemented twice a year for 4 months; the program should be simultaneously implemented at the household (micro), community (meso), and national (macro) levels; there should be governmental participation from health and other sectors; and there should be community and private sector participation. Weekly multimicronutrient supplementation programs are cost effective options in urban areas with populations at low risk of energy deficiency and high risk of micronutrient deficiencies.
Anemia, micronutrient deficiencies, and growth faltering are still common in Peru. The study obje... more Anemia, micronutrient deficiencies, and growth faltering are still common in Peru. The study objective was to determine the efficacy of different micronutrient supplements in preventing growth failure, anemia, and micronutrient deficiencies in Peruvian infants. Three hundred and thirteen infants aged 6 to 12 mo participated in a double-blind, masked, controlled trial in which they were randomly assigned to receive either a daily dose of iron (DI), a daily dose of multiple micronutrients (DMM), a weekly dose of multiple micronutrients, or a placebo (P) for 6 mo. None of the supplements tested prevented growth faltering or the morbidities common during infancy. Anemia and plasma homocysteine concentrations fell significantly in all groups during the study, but the mean change of plasma homocysteine during the trial period was significantly smaller in the DI group than in other groups, and the increase in hemoglobin concentrations was smaller in the P group than the micronutrient treatment groups. Plasma ferritin concentrations decreased least in the groups taking daily micronutrient supplements containing iron (DI and DMM). There were no significant differences among groups in mean final values or changes in plasma zinc, retinol, tocopherol, or riboflavin. Although the DMM intervention was the most efficacious for preventing anemia, iron, and zinc deficiencies, 15%, 20%, and 50% of this group still remained anemic, zinc deficient, and iron deficient, respectively, at the end of the study. Further research thus should investigate whether higher doses of iron and zinc, together with infection control measures, are more efficacious.
Recently, clinical data has emerged suggesting that the fluoroquinolone, gatifloxacin, can affect... more Recently, clinical data has emerged suggesting that the fluoroquinolone, gatifloxacin, can affect glucose homeostosis through an unknown mechanism. In order to explore the potential effects of moxifloxacin on glucose metabolism in humans, a pooled analysis of phase II/III clinical trials and postmarketing studies was performed and compared with results from an investigation in laboratory animals. A pooled analysis of 30 (26 controlled, 4 uncontrolled) oral and two intravenous/oral prospective, controlled phase II/III moxifloxacin studies was performed to evaluate the frequency of hyper- and hypoglycaemic episodes and glucose-related adverse events and adverse reactions (i.e. those considered to be drug related) versus comparator antimicrobials (penicillins, cephalosporins, macrolides, doxycycline, fluoroquinolones). Similar evaluations were conducted on data pooled from five postmarketing surveillance studies. In addition, potential effects of supratherapeutic doses of moxifloxacin ...
The results of cross-sectional studies indicate that micronutrient deficiencies are common in pat... more The results of cross-sectional studies indicate that micronutrient deficiencies are common in patients with tuberculosis. No published data exist on the effect of vitamin A and zinc supplementation on antituberculosis treatment. Our goal was to investigate whether vitamin A and zinc supplementation increases the efficacy of antituberculosis treatment with respect to clinical response and nutritional status. In this double-blind, placebo-controlled trial, patients with newly diagnosed tuberculosis were divided into 2 groups. One group (n = 40) received 1500 retinol equivalents (5000 IU) vitamin A (as retinyl acetate) and 15 mg Zn (as zinc sulfate) daily for 6 mo (micronutrient group). The second group (n = 40) received a placebo. Both groups received the same antituberculosis treatment recommended by the World Health Organization. Clinical examinations, assessments of micronutrient status, and anthropometric measurements were carried out before and after 2 and 6 mo of antituberculosi...
To empower local authorities to plan and evaluate adequate interventions, appropriate iodine defi... more To empower local authorities to plan and evaluate adequate interventions, appropriate iodine deficiency disorders (IDD) indicators need to be identified. The aim of this study was to describe the magnitude and severity of IDD with different outcome indicators and associate them with functional indicators. Schoolchildren (n = 544) aged 8-10 y were assessed in 11 villages within five subdistricts of Malang District, East Java, Indonesia. Outcome indicators of IDD were goiter size as measured by palpation and ultrasonography (USG), urinary iodine excretion (UIE) and serum thyroid stimulating hormone (TSH) concentration in blood as well as functional indicators such as intellectual performance (IQ: Catell's Culture Fair Intelligence Test) and anthropometric indices. The total goiter rate (TGR) measured by palpation and USG were 35.7 and 54.4%, respectively. Based on UIE and TSH, the prevalence of iodine deficiency was 63.7 and 3.4%, respectively. In individuals, goiter, thyroid volu...
Background. The Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PI... more Background. The Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) implemented a campaign to promote weekly multimicronutrient supplementation among women and adolescent girls of childbearing age and children under 5 years of age.
Objectives. To assess the impact of the campaign on the growth of children and on anemia among children and among women and adolescent girls of childbearing age.
Methods. Weekly multimicronutrient supplementation was provided for 8 weeks. Weights, heights, and hemoglobin concentrations were assessed at the beginning and end of the campaign.
Results and conclusions. Although supplementation did not significantly increase the hemoglobin concentrations of children (p = .80) or women and adolescent girls (p = .65) in the intervention group, the hemoglobin concentrations of the comparison groups were significantly lower after 8 weeks (p = .001 for children and p = .03 for women and adolescent girls). Furthermore, the percentage of anemic children in the comparison group increased significantly (p < .001), and the final value was significantly higher than that for the intervention group (p = .004). There were no significant effects of weekly multimicronutrient supplementation on the growth of children, but the study was too short to reliably determine any effects on growth.
In Indonesia, four target groups were identified for interventions to reduce iron deficiency: inf... more In Indonesia, four target groups were identified for interventions to reduce iron deficiency: infants, schoolchildren, adolescents, and adult women (female employees, pregnant and lactating women). Adequate strategies require not only curative but also preventive actions, need to reach all major risk groups in the society, need components to improve compliance, and be feasible in terms of costs and efforts. Preventive
Effects of iron supplementation on growth and hematological status of Indonesian anemic preschool... more Effects of iron supplementation on growth and hematological status of Indonesian anemic preschool children with low weight-for-age were investigated. A treatment group (n = 39) received daily supplements of3O mg Fe and 20 mg vitamin C, whereas a control group (n = 37) received 20 mg vitamin C only for a period of 2 mo. Supplement allocation was double blind.
Iron deficiency is a public health problem in infancy. We assessed the efficacy of iron supplemen... more Iron deficiency is a public health problem in infancy. We assessed the efficacy of iron supplements in infants with inflammation on iron status and subsequent inflammation. This was a prospective, nested, case-control study of 6- to 12-mo-old infants participating in the International Research on Infant Supplementation study, Indonesia. Cases (n = 46) were selected on the basis of their inflammation status at baseline, C-reactive protein (>5 mg/L) or alpha-1 acid glycoprotein (>1 g/L); there were 44 controls without inflammation. Infants received 10 mg/d of elemental iron alone or in combination with multimicronutrients, or placebo. Blood samples were collected at baseline and at 6 mo for determinations of plasma ferritin, zinc, copper, retinol, beta-carotene, alpha-tocopherol, and inflammation status. Data on breast-feeding and acute respiratory infections (ARI) were collected daily. At baseline, 33% of infants had iron deficiency, and those with inflammation had lower retino...
Background:Infantsarehighlyvulnerabletoiodinedeficiency,and little data exist on the effect of mu... more Background:Infantsarehighlyvulnerabletoiodinedeficiency,and little data exist on the effect of multiple micronutrient supplemen- tation on their iodine status. Objective: We aimed to compare the efficacy of daily and weekly multiple micronutrient food-like tablets (foodLETs) on increasing iodine status among infants. Design: In a double-blind, placebo-controlled trial, 133 Indonesian males aged 6-12 mo were randomly assigned to 1 of 4 groups: a daily
Micronutrient supplementation in pregnancy. By - Sandra L Huffman, Jean-Pierre Habicht, Nevin Scr... more Micronutrient supplementation in pregnancy. By - Sandra L Huffman, Jean-Pierre Habicht, Nevin Scrimshaw.
During the second half of 1986 the health and nutritional status of 254 children aged up to six y... more During the second half of 1986 the health and nutritional status of 254 children aged up to six years was studied, as well as the socio-economic situation of their parents in two favelas (shantytowns) in Belo Horizonte, Brazil. The nutritional status of the children was characterized by stunting (Z-score: 20.1% less than -2) but not by wasting (Z-score: 3.7% less than -2). Consideration was also given to how far stunting was caused by high morbidity such as acute respiratory infections (point prevalence: 38.5%), diarrheal diseases (point prevalence: 11.5%) and parasitosis (point prevalence: 70.3%). Furthermore, anemia (point prevalence: 29.7%) appeared as another health problem. The most important determinant of anthropometric indices turned out to be the mother&#39;s schooling. From the present data it can be hypothesized that the nutritional status of the children was limited less by the lack of food than by their poor health status.
Resumo A anemia por deficiência de ferro em crianças é um dos maiores problemas nutricionais enfr... more Resumo A anemia por deficiência de ferro em crianças é um dos maiores problemas nutricionais enfrentados pelos países em desenvolvimento. Estudos controlados indicam que doses intermitentes de sais de ferro podem ter eficácia semelhante à obtida com o ...
One of the health problems in Indonesia is the high prevalence of stunting in infants. Determinan... more One of the health problems in Indonesia is the high prevalence of stunting in infants. Determinants and specifically the relative contribution of prenatal and postnatal factors to growth and nutritional status of Indonesian infants were investigated. Newborn infants, from women recruited at 18 wk of pregnancy from 9 rural villages in West Java, Indonesia, were followed until 12-15 mo of
The objective of this longitudinal study was to investigate the association between the premature... more The objective of this longitudinal study was to investigate the association between the premature initiation of complementary feeding and physical growth of children. Four cohorts of newborn children were included, consisting of 90 infants born in 1981, 90 in 1982, 60 infants in 1983 and 60 in 1984. The weights and heights of children were measured monthly up to 1 y, then every 3 mo for y 2 and 3, and once every 6 mo in y 4. Information on feeding practices and diseases of the children was obtained by interviewing the mothers at each home visit. All but three children (98.6%) were breast-fed. Although 87.1% of the mothers breast-fed their children for at least 1 y, only 3.3% of the infants were breast-fed exclusively at the age of 4 mo. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean and confounding. There was little association between feeding pattern at 15 d and growth in length in mo 1. However, partially breast-fed and...
Although several studies have dealt with the patterns of cytokine production in tuberculosis, lit... more Although several studies have dealt with the patterns of cytokine production in tuberculosis, little is known about the association between nutrient deficiencies and cytokines in tuberculosis. The objective of this study was to assess the concentration of cytokines related to nutritional status during tuberculosis. In 41 untreated tuberculosis patients and matched healthy controls in an urban hospital in Indonesia, we measured: height and weight, parameters of iron, vitamin A and zinc; and cytokines concentrations in the circulation and production in whole blood cultures. Plasma interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) were significantly higher in patients than in controls. Patients with cavities (n=26) had higher concentrations of IL-6 than patients without cavities (n=15). Body mass index <18.5 kg/m2 was associated with high concentrations of tumor necrosis factor-alpha (TNF-alpha) and IL-6. Anaemia was associated with high concentrations of IL-6 and ...
Background. Because of the rapid growth of the urban population in Peru, food and nutrition insec... more Background. Because of the rapid growth of the urban population in Peru, food and nutrition insecurity will occur increasingly in this population. For appropriate policy setting and programming, the food and nutrition situation of the urban poor requires better understanding.
Objective. To gain information about the nature, magnitude, severity, and causes of the nutritional problems of the population in low-income areas of the city of Chiclayo, Peru.
Methods. A cross-sectional nutrition survey was conducted in 1,604 households, covering children under 5 years of age and their parents.
Results. The prevalence rates of stunting, wasting, overweight. and anemia in children were 15.4%, 1.3%, 4.6%, and 65.7%, respectively; one third of adults were overweight, and one tenth were obese; 2.1% of the mothers were underweight; and 34.3% of mothers and 12.2% of fathers had anemia. Governmental feeding programs did not address these problems adequately.
Conclusions. Interventions must have adequate targeting; address appropriate responses at the household, community, and national levels; and reduce stunting, obesity, and iron-deficiency anemia.
Global population growth is concentrated in urban areas, but there is little understanding of how... more Global population growth is concentrated in urban areas, but there is little understanding of how to implement the necessary interventions to control food and nutrition insecurity. In the urban area of Peru, food insecurity is characterized mainly by micronutrient deficiencies and not by energy deficiency. To increase the effectiveness and cost-effectiveness of weekly multimicronutrient supplementation programs in poor urban communities. A series of operational studies were conducted of preventive weekly multimicronutrient supplementation to reduce micronutrient-deficiency anemia in a population consisting of 8,081 children under 5 years of age and 20,082 women and adolescent girls of reproductive age (12 through 44 years). This is one of a series of papers that describe in as much detail as possible the experiences of a multimicronutrient intervention program for poor urban mothers and their young children and summarizes the lessons learned for consideration of future programming. ...
Background. Weekly multimicronutrient supplementation was initiated as an appropriate interventio... more Background. Weekly multimicronutrient supplementation was initiated as an appropriate intervention to protect poor urban populations from anemia.
Objective. To identify the lessons learned from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) weekly multimicronutrient supplementation program implemented in poor urban populations of Chiclayo, Peru.
Methods. Data were collected from a 12-week program in which multimicronutrient supplements were provided weekly to women and adolescent girls 12 through 44 years of age and children under 5 years of age. A baseline survey was first conducted. Within the weekly multimicronutrient supplementation program, information was collected on supplement distribution, compliance, biological effectiveness, and cost.
Results. Supplementation, fortification, and dietary strategies can be integrated synergistically within a micronutrient intervention program.
Conclusions. To ensure high cost-effectiveness of a weekly multimicronutrient supplementation program, the following conditions need to be met: the program should be implemented twice a year for 4 months; the program should be simultaneously implemented at the household (micro), community (meso), and national (macro) levels; there should be governmental participation from health and other sectors; and there should be community and private sector participation. Weekly multimicronutrient supplementation programs are cost effective options in urban areas with populations at low risk of energy deficiency and high risk of micronutrient deficiencies.
Anemia, micronutrient deficiencies, and growth faltering are still common in Peru. The study obje... more Anemia, micronutrient deficiencies, and growth faltering are still common in Peru. The study objective was to determine the efficacy of different micronutrient supplements in preventing growth failure, anemia, and micronutrient deficiencies in Peruvian infants. Three hundred and thirteen infants aged 6 to 12 mo participated in a double-blind, masked, controlled trial in which they were randomly assigned to receive either a daily dose of iron (DI), a daily dose of multiple micronutrients (DMM), a weekly dose of multiple micronutrients, or a placebo (P) for 6 mo. None of the supplements tested prevented growth faltering or the morbidities common during infancy. Anemia and plasma homocysteine concentrations fell significantly in all groups during the study, but the mean change of plasma homocysteine during the trial period was significantly smaller in the DI group than in other groups, and the increase in hemoglobin concentrations was smaller in the P group than the micronutrient treatment groups. Plasma ferritin concentrations decreased least in the groups taking daily micronutrient supplements containing iron (DI and DMM). There were no significant differences among groups in mean final values or changes in plasma zinc, retinol, tocopherol, or riboflavin. Although the DMM intervention was the most efficacious for preventing anemia, iron, and zinc deficiencies, 15%, 20%, and 50% of this group still remained anemic, zinc deficient, and iron deficient, respectively, at the end of the study. Further research thus should investigate whether higher doses of iron and zinc, together with infection control measures, are more efficacious.
Recently, clinical data has emerged suggesting that the fluoroquinolone, gatifloxacin, can affect... more Recently, clinical data has emerged suggesting that the fluoroquinolone, gatifloxacin, can affect glucose homeostosis through an unknown mechanism. In order to explore the potential effects of moxifloxacin on glucose metabolism in humans, a pooled analysis of phase II/III clinical trials and postmarketing studies was performed and compared with results from an investigation in laboratory animals. A pooled analysis of 30 (26 controlled, 4 uncontrolled) oral and two intravenous/oral prospective, controlled phase II/III moxifloxacin studies was performed to evaluate the frequency of hyper- and hypoglycaemic episodes and glucose-related adverse events and adverse reactions (i.e. those considered to be drug related) versus comparator antimicrobials (penicillins, cephalosporins, macrolides, doxycycline, fluoroquinolones). Similar evaluations were conducted on data pooled from five postmarketing surveillance studies. In addition, potential effects of supratherapeutic doses of moxifloxacin ...
The results of cross-sectional studies indicate that micronutrient deficiencies are common in pat... more The results of cross-sectional studies indicate that micronutrient deficiencies are common in patients with tuberculosis. No published data exist on the effect of vitamin A and zinc supplementation on antituberculosis treatment. Our goal was to investigate whether vitamin A and zinc supplementation increases the efficacy of antituberculosis treatment with respect to clinical response and nutritional status. In this double-blind, placebo-controlled trial, patients with newly diagnosed tuberculosis were divided into 2 groups. One group (n = 40) received 1500 retinol equivalents (5000 IU) vitamin A (as retinyl acetate) and 15 mg Zn (as zinc sulfate) daily for 6 mo (micronutrient group). The second group (n = 40) received a placebo. Both groups received the same antituberculosis treatment recommended by the World Health Organization. Clinical examinations, assessments of micronutrient status, and anthropometric measurements were carried out before and after 2 and 6 mo of antituberculosi...
To empower local authorities to plan and evaluate adequate interventions, appropriate iodine defi... more To empower local authorities to plan and evaluate adequate interventions, appropriate iodine deficiency disorders (IDD) indicators need to be identified. The aim of this study was to describe the magnitude and severity of IDD with different outcome indicators and associate them with functional indicators. Schoolchildren (n = 544) aged 8-10 y were assessed in 11 villages within five subdistricts of Malang District, East Java, Indonesia. Outcome indicators of IDD were goiter size as measured by palpation and ultrasonography (USG), urinary iodine excretion (UIE) and serum thyroid stimulating hormone (TSH) concentration in blood as well as functional indicators such as intellectual performance (IQ: Catell's Culture Fair Intelligence Test) and anthropometric indices. The total goiter rate (TGR) measured by palpation and USG were 35.7 and 54.4%, respectively. Based on UIE and TSH, the prevalence of iodine deficiency was 63.7 and 3.4%, respectively. In individuals, goiter, thyroid volu...
Background. The Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PI... more Background. The Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) implemented a campaign to promote weekly multimicronutrient supplementation among women and adolescent girls of childbearing age and children under 5 years of age.
Objectives. To assess the impact of the campaign on the growth of children and on anemia among children and among women and adolescent girls of childbearing age.
Methods. Weekly multimicronutrient supplementation was provided for 8 weeks. Weights, heights, and hemoglobin concentrations were assessed at the beginning and end of the campaign.
Results and conclusions. Although supplementation did not significantly increase the hemoglobin concentrations of children (p = .80) or women and adolescent girls (p = .65) in the intervention group, the hemoglobin concentrations of the comparison groups were significantly lower after 8 weeks (p = .001 for children and p = .03 for women and adolescent girls). Furthermore, the percentage of anemic children in the comparison group increased significantly (p < .001), and the final value was significantly higher than that for the intervention group (p = .004). There were no significant effects of weekly multimicronutrient supplementation on the growth of children, but the study was too short to reliably determine any effects on growth.
In Indonesia, four target groups were identified for interventions to reduce iron deficiency: inf... more In Indonesia, four target groups were identified for interventions to reduce iron deficiency: infants, schoolchildren, adolescents, and adult women (female employees, pregnant and lactating women). Adequate strategies require not only curative but also preventive actions, need to reach all major risk groups in the society, need components to improve compliance, and be feasible in terms of costs and efforts. Preventive
Effects of iron supplementation on growth and hematological status of Indonesian anemic preschool... more Effects of iron supplementation on growth and hematological status of Indonesian anemic preschool children with low weight-for-age were investigated. A treatment group (n = 39) received daily supplements of3O mg Fe and 20 mg vitamin C, whereas a control group (n = 37) received 20 mg vitamin C only for a period of 2 mo. Supplement allocation was double blind.
Iron deficiency is a public health problem in infancy. We assessed the efficacy of iron supplemen... more Iron deficiency is a public health problem in infancy. We assessed the efficacy of iron supplements in infants with inflammation on iron status and subsequent inflammation. This was a prospective, nested, case-control study of 6- to 12-mo-old infants participating in the International Research on Infant Supplementation study, Indonesia. Cases (n = 46) were selected on the basis of their inflammation status at baseline, C-reactive protein (>5 mg/L) or alpha-1 acid glycoprotein (>1 g/L); there were 44 controls without inflammation. Infants received 10 mg/d of elemental iron alone or in combination with multimicronutrients, or placebo. Blood samples were collected at baseline and at 6 mo for determinations of plasma ferritin, zinc, copper, retinol, beta-carotene, alpha-tocopherol, and inflammation status. Data on breast-feeding and acute respiratory infections (ARI) were collected daily. At baseline, 33% of infants had iron deficiency, and those with inflammation had lower retino...
Background:Infantsarehighlyvulnerabletoiodinedeficiency,and little data exist on the effect of mu... more Background:Infantsarehighlyvulnerabletoiodinedeficiency,and little data exist on the effect of multiple micronutrient supplemen- tation on their iodine status. Objective: We aimed to compare the efficacy of daily and weekly multiple micronutrient food-like tablets (foodLETs) on increasing iodine status among infants. Design: In a double-blind, placebo-controlled trial, 133 Indonesian males aged 6-12 mo were randomly assigned to 1 of 4 groups: a daily
Micronutrient supplementation in pregnancy. By - Sandra L Huffman, Jean-Pierre Habicht, Nevin Scr... more Micronutrient supplementation in pregnancy. By - Sandra L Huffman, Jean-Pierre Habicht, Nevin Scrimshaw.
During the second half of 1986 the health and nutritional status of 254 children aged up to six y... more During the second half of 1986 the health and nutritional status of 254 children aged up to six years was studied, as well as the socio-economic situation of their parents in two favelas (shantytowns) in Belo Horizonte, Brazil. The nutritional status of the children was characterized by stunting (Z-score: 20.1% less than -2) but not by wasting (Z-score: 3.7% less than -2). Consideration was also given to how far stunting was caused by high morbidity such as acute respiratory infections (point prevalence: 38.5%), diarrheal diseases (point prevalence: 11.5%) and parasitosis (point prevalence: 70.3%). Furthermore, anemia (point prevalence: 29.7%) appeared as another health problem. The most important determinant of anthropometric indices turned out to be the mother&#39;s schooling. From the present data it can be hypothesized that the nutritional status of the children was limited less by the lack of food than by their poor health status.
Resumo A anemia por deficiência de ferro em crianças é um dos maiores problemas nutricionais enfr... more Resumo A anemia por deficiência de ferro em crianças é um dos maiores problemas nutricionais enfrentados pelos países em desenvolvimento. Estudos controlados indicam que doses intermitentes de sais de ferro podem ter eficácia semelhante à obtida com o ...
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Papers by Ricko Gross
Objective. To gain information about the nature, magnitude, severity, and causes of the nutritional problems of the population in low-income areas of the city of Chiclayo, Peru.
Methods. A cross-sectional nutrition survey was conducted in 1,604 households, covering children under 5 years of age and their parents.
Results. The prevalence rates of stunting, wasting, overweight. and anemia in children were 15.4%, 1.3%, 4.6%, and 65.7%, respectively; one third of adults were overweight, and one tenth were obese; 2.1% of the mothers were underweight; and 34.3% of mothers and 12.2% of fathers had anemia. Governmental feeding programs did not address these problems adequately.
Conclusions. Interventions must have adequate targeting; address appropriate responses at the household, community, and national levels; and reduce stunting, obesity, and iron-deficiency anemia.
Objective. To identify the lessons learned from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) weekly multimicronutrient supplementation program implemented in poor urban populations of Chiclayo, Peru.
Methods. Data were collected from a 12-week program in which multimicronutrient supplements were provided weekly to women and adolescent girls 12 through 44 years of age and children under 5 years of age. A baseline survey was first conducted. Within the weekly multimicronutrient supplementation program, information was collected on supplement distribution, compliance, biological effectiveness, and cost.
Results. Supplementation, fortification, and dietary strategies can be integrated synergistically within a micronutrient intervention program.
Conclusions. To ensure high cost-effectiveness of a weekly multimicronutrient supplementation program, the following conditions need to be met: the program should be implemented twice a year for 4 months; the program should be simultaneously implemented at the household (micro), community (meso), and national (macro) levels; there should be governmental participation from health and other sectors; and there should be community and private sector participation. Weekly multimicronutrient supplementation programs are cost effective options in urban areas with populations at low risk of energy deficiency and high risk of micronutrient deficiencies.
Objectives. To assess the impact of the campaign on the growth of children and on anemia among children and among women and adolescent girls of childbearing age.
Methods. Weekly multimicronutrient supplementation was provided for 8 weeks. Weights, heights, and hemoglobin concentrations were assessed at the beginning and end of the campaign.
Results and conclusions. Although supplementation did not significantly increase the hemoglobin concentrations of children (p = .80) or women and adolescent girls (p = .65) in the intervention group, the hemoglobin concentrations of the comparison groups were significantly lower after 8 weeks (p = .001 for children and p = .03 for women and adolescent girls). Furthermore, the percentage of anemic children in the comparison group increased significantly (p < .001), and the final value was significantly higher than that for the intervention group (p = .004). There were no significant effects of weekly multimicronutrient supplementation on the growth of children, but the study was too short to reliably determine any effects on growth.
Objective. To gain information about the nature, magnitude, severity, and causes of the nutritional problems of the population in low-income areas of the city of Chiclayo, Peru.
Methods. A cross-sectional nutrition survey was conducted in 1,604 households, covering children under 5 years of age and their parents.
Results. The prevalence rates of stunting, wasting, overweight. and anemia in children were 15.4%, 1.3%, 4.6%, and 65.7%, respectively; one third of adults were overweight, and one tenth were obese; 2.1% of the mothers were underweight; and 34.3% of mothers and 12.2% of fathers had anemia. Governmental feeding programs did not address these problems adequately.
Conclusions. Interventions must have adequate targeting; address appropriate responses at the household, community, and national levels; and reduce stunting, obesity, and iron-deficiency anemia.
Objective. To identify the lessons learned from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) weekly multimicronutrient supplementation program implemented in poor urban populations of Chiclayo, Peru.
Methods. Data were collected from a 12-week program in which multimicronutrient supplements were provided weekly to women and adolescent girls 12 through 44 years of age and children under 5 years of age. A baseline survey was first conducted. Within the weekly multimicronutrient supplementation program, information was collected on supplement distribution, compliance, biological effectiveness, and cost.
Results. Supplementation, fortification, and dietary strategies can be integrated synergistically within a micronutrient intervention program.
Conclusions. To ensure high cost-effectiveness of a weekly multimicronutrient supplementation program, the following conditions need to be met: the program should be implemented twice a year for 4 months; the program should be simultaneously implemented at the household (micro), community (meso), and national (macro) levels; there should be governmental participation from health and other sectors; and there should be community and private sector participation. Weekly multimicronutrient supplementation programs are cost effective options in urban areas with populations at low risk of energy deficiency and high risk of micronutrient deficiencies.
Objectives. To assess the impact of the campaign on the growth of children and on anemia among children and among women and adolescent girls of childbearing age.
Methods. Weekly multimicronutrient supplementation was provided for 8 weeks. Weights, heights, and hemoglobin concentrations were assessed at the beginning and end of the campaign.
Results and conclusions. Although supplementation did not significantly increase the hemoglobin concentrations of children (p = .80) or women and adolescent girls (p = .65) in the intervention group, the hemoglobin concentrations of the comparison groups were significantly lower after 8 weeks (p = .001 for children and p = .03 for women and adolescent girls). Furthermore, the percentage of anemic children in the comparison group increased significantly (p < .001), and the final value was significantly higher than that for the intervention group (p = .004). There were no significant effects of weekly multimicronutrient supplementation on the growth of children, but the study was too short to reliably determine any effects on growth.