Postura de la Sociedad Latinoamericana de Nutrición (SLAN) sobre el manejo de conflicto de intereses / Position of the Latin American Society of Nutrition (SLAN) on the management of conflict of interest

Resumen: Existe evidencia sólida de la existencia de relaciones entre la industria de alimentos y bebidas y la academia. Ésta sugiere que la investigación patrocinada por la industria es susceptible de conferir sesgos a su favor en los resultados. En América Latina, se han documentado ejemplos de estas situaciones en México, Brasil, Chile, Perú, Colombia y Ecuador, por citar a algunos países. Ante la necesidad urgente de estudiar y gestionar las relaciones entre la industria de alimentos y bebidas y el campo de investigación en salud y nutrición, en 2017 el Presidente de la Sociedad Latinoamericana de Nutrición (SLAN) designó a un Comité de Conflicto de Intereses (CCI). El CCI tuvo la encomienda de hacer una propuesta de postura sobre manejo de conflicto de intereses (CDI) de la SLAN. El presente artículo refleja los trabajos del CCI y la postura que adoptó la SLAN.

Abstract: There is solid evidence documenting relationships between the food and beverage industry and academia that shows that industry sponsored research is likely to bias results in favor of industry. In Latin America, examples of these situations have been documented in Mexico, Brazil, Chile, Peru, Colombia, and Ecuador, among others. Due to the urgent need for studying and managing relationships between the food and beverage industry and the field of health and nutrition research, in 2017, the President of the Latin American Society of Nutrition (SLAN) appointed a Conflict of Interest Committee (CCI). The CCI was charged with the development of a proposal of a position for the management of conflict of interest (COI) for consideration by SLAN. This document details the work of CCI, and the position adopted by SLAN.

The Effects of Selling Micronutrient Powders on Morbidity Incidence among Preschool Children in Western Kenya.

Objectives: Although micronutrient powders (MNPs) are considered the preferred approach for childhood anemia control, concerns about iron-related morbidity from clinical trials challenge programmatic scale-up. We aimed to measure the association of community-based sales of MNPs with incidence of diarrhea, fever, and cough in children 6-35 months. Methods: The study was a community-based, cluster-randomized trial in 60 villages in western Kenya. MNPs and other health products (e.g., insecticide-treated bednets, soap, water disinfectant) were marketed in 30 intervention villages from July 2007-March 2008, followed by expansion of the intervention to both arms. Biweekly household visits monitored self-reported MNP use and morbidity. Using morbidity as the outcomes and MNP as the exposure variable, relative risks were estimated via generalized mixed models with random intercepts for repeated measures within a child and for multiple children from a household, while accommodating potential confounders as fixed effects. Results: Of the 1079 children enrolled, 881 (81.6%) had data on MNP use; average intake in intervention villages was 0.9 sachets/week. MNP intake was captured as continuous mean sachets and categories of use, but no significant effects were observed on incidence of diarrhea, fever or cough. Conclusions: Increased MNP use in western Kenya through community-based marketing did not result in increased incidence of infectious morbidity among young children. Integrated distribution of MNPs with other health interventions should be explored further in settings with high child malnutrition and infection burden.

Nutritional Supplement Adherence among Women of Reproductive age Participating in a Randomized Controlled Trial in Northern Vietnam.

Objectives: Identify factors that influence adherence to consumption of micronutrient supplements before and during pregnancy among participants of a double-blind randomized controlled trial (PRECONCEPT) assessing the impact of weekly preconceptional multiple micronutrient supplements on maternal and child health outcomes in 20 rural communes in northern Vietnam. Methods: In-depth interviews were conducted with PRECONCEPT participants, including 15 prepregnant women receiving weekly micronutrient supplements, 8 pregnant women receiving daily iron-folate supplements, 8 women who had delivered and 8 drop-outs. Domains of interest included participants' experiences with supplements and knowledge about nutritional needs, micronutrient deficiencies, and the study. Four focus groups (one per participating district) were also conducted with Village Health Workers who distributed the supplements. Data were transcribed, translated, and coded and analyzed using MAXQDA software, applying the principles of grounded theory. Results: Knowledge about iron's value for maternal health was more widespread compared to other micronutrients. The importance of ensuring adequate "nutrient" levels during pregnancy for proper fetal development was also recognized, but supplements were considered as curative rather than preventive for maternal health. Functional support, positive reinforcement from health workers and family members, and perceived health benefits for mother and child were associated with improved adherence to supplement consumption, whereas misinformation and poor management of side effects may be associated with reduced adherence. Conclusions: Programs that distribute micronutrient supplements should include counseling materials that emphasize the preventive value of supplements for maternal health. Additional efforts that incorporate strategies to improve social support will also help improve community trust, increase adherence, and reduce dropout rates.

A Formative Research Study to Integrate Home Fortification of Complementary Foods into a Family Health Program in Bihar: Process and Methodology.

Objectives: The objective of this formative research was to develop a locally appropriate home fortification program for children (6-24mo) and to explore feasibility and acceptability within an integrated family health program in Bihar. Methods: The study consisted of three phases over a six month period. In Phase 1, we tested the acceptability of multiple micronutrient powders and developed contextualized packaging and counseling materials integrated with existing complementary feeding messages. We used focus group discussions (FGD, n=11) with frontline workers (FLWs), community members, mothers, mothers-in-law, and fathers to obtain feedback on product and supportive tools. In Phase 2, we explored community acceptability in 27 households (HHs) with children 6-24mo using a Trials of Improved Practices methodology. In-depth interviews (IDI) were held with HHs at baseline, midline and endline (day 10). Phase 3 was designed to evaluate the implementation process using existing program delivery platforms with FLWS in 3 health sub-centers (HSC). FLWs were trained to distribute products and counsel HHs on home fortification and complementary feeding. 5 FGDs and 3 IDIs were held with FLWs in addition to monthly HH monitoring data (n=20/HSC). Results: As a result of this formative work, counseling materials, FLW trainings and delivery approach were substantially revised to better reflect local context and program realities. Preliminary data suggest home fortification is well-accepted by community members and FLWs are willing to incorporate into existing work activities. Conclusions: This formative research methodology was vital for developing an integrated and locally acceptable home fortification program and informing future scale-up activities.

An Implementation Study to Assess a Health Worker-based Platform for a Home Fortification Program in Bihar.

Objectives: The main objectives of the study were to explore the feasibility of using Frontline health Workers (FLW) as a platform to deliver Multiple Micronutrient Powders (MMP) to the target population (children of 6-18 months) and to assess the acceptability of MMP among the community. This work was part of a multi-phase formative research study for contextualizing a home fortification strategy in Bihar. Methods: The program was implemented in three Health Sub Centers (HSCs) in West Champaran over a two-month duration. Key programmatic activities included FLW training for MMP distribution and counseling on complementary feeding; and community sensitization events to increase MMP acceptability. We conducted 5 focus group discussions and 3 in-depth interviews with FLWs along with monthly monitoring at the household level (n=20/HSC) to assess the program implementation. Results: Important implementation findings emerged through the soft roll-out. Firstly, the HSC meetings were found to be suitable as a FLW training platform but not for MMP distribution to FLWs due to logistical constraints. Secondly, the counseling brochures and community sensitization meetings were perceived to be important facilitators for MMP uptake by the community. Thirdly, FLWs reported positive levels of engagement, low perceptions of work burden and adopted diverse strategies for program delivery. Lastly, community uptake was found to be positive and primary barriers to compliance were mainly associated with supply issues rather than user preferences. Conclusions: The implementation study proved to be a valuable step in identifying critical operational and programmatic factors to inform future large-scale program activities.

Comparing three body mass index classification systems to assess overweight and obesity in children and adolescents / Comparación de tres sistemas de clasificación de los índices de masa corporal para evaluar el sobrepeso y la obesidad en niños y adolescentes

OBJECTIVE: To compare the International Obesity Task Force (IOTF) 2005, Centers for Disease Control and Prevention (CDC) 2000, and World Health Organization (WHO) 2007 body mass index (BMI) classification systems in terms of prevalence estimation and association with demographic factors. METHODS: The 18 265 children and adolescents ages 5 to 18 years (mean = 11.2 years, standard deviation = 3.9 years) in the nationally representative Colombian National Nutrition Survey of 2005 were classified as overweight or obese according to IOTF, CDC, and WHO criteria. Prevalence estimates were compared according to each system and associations with age, sex, socioeconomic status, and population density were tested. RESULTS: Prevalence estimates of combined overweight and obesity differed by system (males: IOTF = 8.5%, CDC = 10.8%, WHO = 14.1%; females: IOTF = 14.6%, CDC = 13.8%, WHO = 17.1%; P < 0.001). The association between combined overweight and obesity and age and sex varied by system. The odds of having overweight and obesity in children (5 to 10 years) compared with adolescents (11 to 18 years) were: IOTF, odds ratio (OR) = 0.87 and 95% confidence interval (CI) = 0.77-0.98; CDC, OR = 1.27 and CI = 1.14-1.42; WHO, OR = 1.21 and CI = 1.08-1.35. The values for females compared with males were: IOTF, OR = 1.84 and CI = 1.6-2.10; CDC, OR = 1.33 and CI = 1.17-1.51; WHO, OR = 1.25 and CI = 1.12-1.41. CONCLUSIONS: There is a lack of consistency among the three main international systems in assessing overweight and obesity in children and adolescents. Appreciably different estimates of prevalence and associations with age and sex are obtained depending on which system is used. Future studies should assess how well each system reflects valid measures of body composition.

OBJETIVO: Comparar los sistemas de clasificación de los índices de masa corporal (IMC) del Grupo de Trabajo Internacional sobre la Obesidad (IOTF) de 2005, de los Centros para el Control y la Prevención de Enfermedades (CDC) de 2000, y de la Organización Mundial de la Salud (OMS) de 2007, en cuanto a la estimación de la prevalencia y la asociación con factores demográficos. MÉTODOS: Los 18 265 niños y adolescentes de ambos sexos y de edades comprendidas entre 5 y 18 años (media = 11,2 años, desviación estándar = 3,9 años) que participaron en la Encuesta Nacional de la Situación Nutricional en Colombia del 2005, representativa a escala nacional, fueron clasificados como afectados de sobrepeso u obesidad según los criterios del IOTF, los CDC y la OMS. Se compararon los cálculos de la prevalencia según cada sistema y se analizaron las asociaciones con la edad, el sexo, la situación socioeconómica y la densidad de población. RESULTADOS: Los cálculos de la prevalencia del sobrepeso y la obesidad combinados diferían según el sistema (varones: IOTF = 8,5%, CDC = 10,8%, OMS = 14,1%; mujeres: IOTF = 14,6%, CDC = 13,8%, OMS = 17,1%; P < 0,001). La asociación entre el sobrepeso y la obesidad combinados y la edad y el sexo también variaban según el sistema de clasificación. Las probabilidades de tener sobrepeso y obesidad en los niños (de 5 a 10 años) en comparación con los adolescentes (de 11 a 18 años) fueron: IOTF, razón de posibilidades (OR) = 0,87 e intervalo de confianza del 95% (IC) 0,77-0,98; CDC, OR = 1,27 e IC 1,14-1,42; OMS, OR = 1,21 e IC 1,08-1,35. Los valores observados en las mujeres en comparación con los varones fueron: IOTF, OR = 1,84 e IC 1,6-2,10; CDC, OR = 1,33 e IC 1,17-1,51; OMS, OR = 1,25 e IC 1,12-1,41. CONCLUSIONES: Existe una falta de uniformidad entre los tres principales sistemas internacionales en la evaluación del sobrepeso y la obesidad en niños y adolescentes. Se obtienen cálculos apreciablemente diferentes de la prevalencia y de las asociaciones con la edad y el sexo según el sistema que se adopte. Los estudios futuros deben evaluar hasta qué punto cada sistema refleja adecuadamente mediciones válidas de la composición corporal.

Anaemia among Students of Rural China’s Elementary Schools: Prevalence and Correlates in Ningxia and Qinghai’s Poor Counties.

Although the past few decades have seen rising incomes and increased government attention to rural development, many children in rural China still lack regular access to micronutrient-rich diets. Insufficient diets and poor knowledge of nutrition among the poor result in nutritional problems, including irondeficiency anaemia, which adversely affect attention and learning of students in school. Little research has been conducted in China documenting the prevalence of nutritional problems among vulnerable populations, such as school-age children, in rural areas. The absence of programmes to combat anaemia among students might be interpreted as a sign that the Government does not recognize its severity. The goals of this paper were to measure the prevalence of anaemia among school-age children in poor regions of Qinghai and Ningxia, to identify individual-, household- and school-based factors that correlate with anaemia in this region, and to report on the correlation between the anaemic status and the physical, psychological and cognitive outcomes. The results of a cross-sectional survey are reported here. The survey involved over 4,000 fourth and fifth grade students from 76 randomly-selected elementary schools in 10 poor counties in rural Qinghai province and Ningxia Hui Autonomous Region, located in the northwest region of China. Data were collected using a structured questionnaire and standardized tests. Trained professional nurses administered haemoglobin (Hb) tests (using Hemocue finger prick kits) and measured heights and weights of children. The baseline data showed that the overall anaemia rate was 24.9%, using the World Health Organization’s blood Hb cut-offs of 120 g/L for children aged 12 years and older and 115 g/L for children aged 11 years and under. Children who lived and ate at school had higher rates of anaemia, as did children whose parents worked in farms or were away from home. Children with parents who had lower levels of education were more likely to be anaemic. The anaemic status correlated with the adverse physical, cognitive and psychological outcomes among the students. Such findings are consistent with findings of other recent studies in poor, northwest areas of China and led to conclude that anaemia remains a serious health problem among children in parts of China.

Prevención de la desnutrición de la madre y el niño: el componente de nutrición de la Iniciativa Salud Mesoamérica 2015 / Preventing maternal and child malnutrition: The nutrition component of the Mesoamerican Health Initiative 2015

Describir un plan maestro para el desarrollo de planes nacionales para prevenir la desnutrición materno-infantil en Mesoamérica en un plazo de cinco años. Para ello se elaboró un análisis sobre los principales problemas, políticas y programas de nutrición en Mesoamérica. A partir del análisis y de la revisión de la literatura sobre las mejores prácticas en el combate a la desnutrición, el Grupo Técnico de Nutrición desarrolló, discutió y validó el plan durante varias reuniones presenciales. Se desarrolló la teoría de cambio que identifica los problemas y barreras, las acciones propuestas, los cambios e impactos esperados. Se propone la implementación de paquetes de intervenciones para reducir la desnutrición y deficiencia de micronutrientes de utilidad para diversos contextos epidemiológicos. El plan maestro de nutrición constituye un insumo que puede facilitar la elaboración de propuestas de programas y políticas dirigidos a reducir la desnutrición y promover la toma de decisiones basadas en evidencia.

To describe the regional master plan of nutrition to address maternal and child malnutrition in a 5- year period developed by the Nutrition Technical Group. The Nutrition Technical Group developed a situation analysis describing the main nutrition problems, policies and programs in Mesoamerica. The situation analysis and a literature review about effective interventions to address malnutrition were conducted to develop a nutrition master plan. The Nutrition Technical Group held various meetings to develop, discuss and validate the master plan. Theory of change identified problems and barriers, the actions to be developed, the changes and impacts expected. A package of interventions is proposed to reduce undernutrition and micronutrient deficiencies useful under different epidemiological contexts. The nutrition master plan provides a guideline of best practices that can be used for evidence-informed decision making and the development of national policies and programs to reduce malnutrition.

Risk factors associated with hemoglobin levels and nutritional status among Brazilian children attending daycare centers in Sao Paulo city, Brazil / Factores de riesgo asociados al nivel de hemoglobina y estado nutricional de niños que asisten a jardines de la infancia en el municipio de Sao Paulo, Brasil

Like many other developing countries, Brazil has been going a nutritional transition which presence both malnutrition and overweight. Stunting and overweight are the major public health problems in Brazilian children. The objective of this study was to document the prevalence of stunting, overweight and anemia in preschool children and examine if those nutritional problems are related; also identify if these nutritional problems have the same risk factors. Data from the “Efficient Daycare Center Project” which include 270 children attending nurseries of eight daycare centers in Sao Paulo city, Brazil were used for this study. Data on height and weight were converted to z-scores using WHO anthro software. Hemoglobin (Hb) concentrations were determined on finger-prick blood samples. The co-occurrence of stunting, overweight and anemia was investigated by contingency tables a log-linear model. Univariate and multiple regression analyses were performed to estimate the association of HAZ, WAZ, WHZ and Hb levels with their risk factors. The results showed high prevalence of overweight (22.2 percent), risk of stunting (22.6 percent) and anemia (37 percent). Percent of daycare attendance, age, number of siblings under 5 years old and per capita income are associated with Hb levels. This study provides evidence that Brazil is going through a nutritional transition and suggest that the adoption of public policies to expand and improve services in daycare centers may help to prevent multi-nutritional problems in preschool children.

Como muchos otros países en desenvolvimiento Brasil esta pasando por la transición nutricional, la cual tiene presente a la desnutrición y sobrepeso. Este estudio tuvo como objetivo mostrar la prevalencia de baja estatura, sobrepeso y anemia en niños en edad preescolar y analizar si esos problemas nutricionales están relacionados; también identificar si esos problemas nutricionales presentan los mismos factores de riesgo. Fueron utilizados datos del “Proyecto CrechEficiente” el cual estudio 270 niños que asisten a cunas de ocho jardines de la infancia en la ciudad de Sao Paulo, Brasil. Los datos de peso y estatura fueron convertidos en z-escore utilizando el software WHO Anthro. La extracción de sangre para la determinación de hemoglobina (Hb) se realizó por punción digital. La co-ocurrencia de baja estatura, sobrepeso y anemia fue investigada a tráves de tablas de contingencia y modelo log-linear. Fueron realizados análisis univariados y regresión múltiple para determinar la asociación entre TEZ, PEZ, PTZ y niveles de hemoglobina con sus factores de riesgo. Los resultados mostraran elevada prevalencia de sobrepeso (22,2 por ciento), riesgo para baja estatura (22,6 por ciento) y anemia (37 por ciento). El porcentaje de frecuencia a los jardines infantiles, edad, número de hermanos menores de 5 años y renta per cápita están asociados con los niveles de hemoglobina. Este estudio muestra evidencia de que el Brasil esta pasando por una transición nutricional y sugiere adopción de políticas públicas para difundir y mejorar los servicios de los jardines infantiles pudiendo ayudar a prevenir varios problemas nutricionales en niños en edad preescolar.

Prenatal multiple micronutrient supplementation impact on biochemical indicators during pregnancy and postpartum / Efecto de la suplementación prenatal con micronutrimentos múltiples en indicadores bioquímicos durante el embarazo y el posparto

Objective. The objective of this analysis was to test the impact of daily supplementation with multiple micronutrients (MM) during pregnancy on Zn, vitamin A and folate status compared to iron only (Fe). Material and Methods. The study was carried out during 1997-2000 in a semi-urban community in Morelos state, Mexico. Women were randomly assigned to MM (n= 249) or Fe (n= 258) and received supplements daily (6 d/wk) under supervision by the field team from recruitment (approximately 9 weeks pregnancy) until delivery. Blood samples were collected on a sub-sample of women at baseline, 32 weeks pregnancy and one month postpartum (1PP) and assessed for serum zinc, retinol and whole blood folate (baseline and 1PP only). A breast milk sample was extracted at 1PP and assessed for retinol content. Result. At baseline there was no significant difference between supplementation groups in mean Zn, retinol or folate concentrations or the prevalence of deficiencies (Zn 12.2%, vitamin A 2.8%, folate 5.3%). Mean change in Zn and retinol concentrations from baseline to 32 weeks pregnancy did not differ between groups or between baseline and 1PP for Zn, retinol or folate. At 1PP, there was a tendency (p= 0.09) towards a lower prevalence of folate deficiency/depletion in the MM group (10.0%) than the Fe group (18.5%). Conclusions. MM supplementation during pregnancy did not improve zinc or vitamin A status compared to Fe only. There is some indication that folate status may have improved with MM supplementation despite low prevalence of deficiency. While lack of response in serum retinol may be explained by generally adequate status, the lack of impact on zinc status requires further exploration.

Objetivo. Evaluar el efecto de la suplementación diaria con múltiples micronutrimentos (MM) durante el embarazo en el estado de zinc, vitamina A y folato comparado con la suplementación sólo con hierro (Fe). Material y métodos. El estudio se realizó en una comunidad semiurbana en el estado de Morelos, México, entre 1997 y 2000. Las mujeres fueron asignadas aleatoriamente a recibir un suplemento de MM (n= 249) o Fe (n= 258) diariamente (6 días/semana), cuyo consumo fue supervisado por personal de campo, desde la evaluación basal (aproximadamente 9 semanas de gestación) hasta el parto. En una submuestra de mujeres participantes, se tomaron muestras de sangre venosa, a las 9 y 32 semanas de embarazo y al mes posparto (1PP). Se midieron las concentraciones séricas de zinc y retinol y la concentración de folato en sangre total, esta última sólo en la evaluación basal y al 1PP. Además se colectó una muestra de leche materna al 1PP, en donde se midió la concentración de retinol. Resultados. En la evaluación basal no hubo diferencias significativas entre grupos en las concentraciones promedio de zinc y retinol, ni en la concentración de folato o en la prevalencia de deficiencias (Zn 12.2%, vitamina A 2.8%, folato 5.3%). El cambio promedio en zinc y retinol de la evaluación basal a la semana 32 de embarazo, no fue diferente entre grupos, tampoco entre la evaluación basal y al 1PP en zinc, retinol o folato. Al 1PP hubo una tendencia (p= 0.09) a menor prevalencia de deficiencia/depleción de folato en el grupo de MM (10.0%) que en el grupo Fe (18.5%). Conclusiones. La suplementación con MM durante el embarazo no mejoró el estado de zinc y vitamina A comparada con la suplementación sólo con Fe. Sin embargo, el estado de folato puede haber mejorado con la suplementación con MM, a pesar de la baja prevalencia de deficiencia de folato. La falta de efecto...

Multiple micronutrient supplementation and dietary energy intake in pregnant women

OBJECTIVE: To compare dietary intake of women supplemented with multiple micronutrients (MM) or iron only during pregnancy. MATERIALS AND METHODS: Design: Randomized, double-blind, controlled community-based trial. Setting: One semi-urban community in Central Mexico. Subjects: Pregnant women identified before week 13 of pregnancy, willing to provide informed consent. Interventions: Women were randomly assigned to receive daily supplementation with MM or iron only from recruitment until delivery. Supplements were delivered to the participants' home and compliance observed daily. Dietary intake was assessed by repeat 24-hr recall. Data were analyzed using non-parametric tests and multiple regression analysis to determine the impact of MM supplementation on dietary intake of energy and select micronutrients. RESULTS: During the third trimester, women in the MM group consumed more energy and iron from dietary sources than women in the iron only group. After adjustment for differences between the groups at baseline, women in the MM group consumed 111.3 kcal/day more (p<0.05) energy. The difference in iron intake was not significant after adjusting for the increase in energy intake. CONCLUSIONS: Women consuming MM supplements during pregnancy increased energy intake from dietary sources without a concurrent increase in micronutrient density. Future studies should include measures of appetite and physical activity during pregnancy to determine the implications of additional energy intake for weight gain and retention.

OBJETIVO: Comparar la dieta de mujeres suplementada con múltiples micronutrimentos (MM) o sólo con hierro durante el embarazo. MATERIAL Y MÉTODOS: Diseño: ensayo comunitario, aleatorizado, controlado, doble ciego. Lugar: una comunidad semiurbana en el México central. Participantes: mujeres embarazadas identificadas antes de la semana 13 de embarazo, dispuestas a entregar el consentimiento informado. Actividades: las mujeres fueron asignadas en forma aleatoria a recibir suplementación diaria con MM o exclusivamente hierro desde el reclutamiento hasta el parto. Los suplementos se entregaron en la casa de las participantes y se observó su cumplimiento con frecuencia diaria. El consumo dietético fue valorado por mediciones repetidas de recordatorio de alimentos de 24 h. Los datos se analizaron mediante pruebas no paramétricas y análisis de regresión múltiple, para determinar el impacto de la suplementación MM en el consumo dietético de energía y micronutrimentos seleccionados. RESULTADOS: durante el tercer trimestre, la mujer asignada al grupo MM consumió más energía y hierro de fuentes dietéticas que la mujer asignada al grupo de sólo hierro. Después de los ajustes para las diferencias entre grupos en la línea basal, la mujer del grupo MM consumió 111.3 kcal/día más (p< 0.05) de energía. La diferencia en el consumo de hierro no fue significante después de los ajustes para el incremento en el consumo de energía. CONCLUSIONES: la mujer que consume suplementos MM durante el embarazo aumenta el consumo de energía a partir de fuentes dietéticas sin un incremento concurrente en la densidad de micronutrimentos. Estudios futuros deberían incluir mediciones del apetito y de la actividad física durante el embarazo para determinar las consecuencias del consumo de energía adicional en la ganancia de peso y la retención.

Risk factors for anemia in Vietnam.

Anemia is a significant public health problem in Vietnam, but representative national data and comprehensive risk factors analysis are lacking. The objectives of this study were to: 1) determine the distribution and severity of anemia in Vietnam, and 2) to assess potential risk factors for anemia. Nine thousand five hundred fifty households in 53 provinces were covered using a stratified two-stage cluster survey carried out in 1995. Selected household members were interviewed; intestinal helminthes were tested in non-pregnant women by Kato-Katz technique; hemoglobin concentrations were measured with Hemocue. Data were weighted and analyzed by survey procedures using SAS 9.0. Overall, 60% of children under 2 years old, 53% of pregnant women, 40% of non-pregnant women and 15.6% of men were anemic. Hookworm infection was the strongest factor associated with anemia (OR = 1.7; 2.9 and 4.5 for 11,999, 2,000-3,999 and > or = 4,000 hookworm egg counts, respectively) and accounted for 22% of anemia. Hookworm intensity was significantly associated with hemoglobin level; for each 1,000 egg increase, hemoglobin was reduced by 2.4 g/l. Living in different ecological zones, eating < 1 serving of meat/ week, and farming were significantly associated with anemia in women and children. Other risk factors in women included having > 3 children and having a child < 24 months old. In men, no variables were found significantly associated with anemia.

Intestinal helminth infections among reproductive age women in Vietnam: prevalence, co-infection and risk factors.

Intestinal helminth infections are a significant public health problem for Vietnamese women, but prevalence and risk factor data are scarce. The objectives of this paper were to (1) determine the prevalence of helminth infections among women; (2) investigate interactions among intestinal helminth species in individuals and (3) identify risk factors that contribute to intestinal helminth infections. In a nationwide survey conducted in 1995, 9550 households in 53 provinces were covered using a stratified two-stage cluster survey. Stool specimens were examined by Kato-Katz technique. Of 5,127 women, 76% were infected with one or more helminth species, 36% with hookworm, 59% with Ascaris lumbricoides and 28% with Trichuris trichiura. A. lumbricoides and T. trichiura were more likely to be concurrent than expected by chance. There was significant interaction between prevalence and intensity of infection in all three species. All three helminth species were more common in certain ecologic zones than others. Hookworm infection was associated with farming [Odd ratio (OR) = 2.1] and lack of a closed latrine (OR = 2.0), A. lumbricoides with use of untreated feces as fertilizer (OR = 1.2) and coinfection with T. trichiura (OR = 2.1) and T trichiura with A. lumbricoides co-infection (OR = 2.1). Our findings suggest that reproductive-age women, especially rural farmers, should be included among the high priority groups for helminth control programs through mass chemotherapy and improving sanitation.

El uso de la investigación operacional para la evaluación de aspectos funcionales de programas de alimentación complementaria: estudio de caso: Care Guatemala

En 1994, el Instituto de Nutrición de Centro América y Panamá (INCAP/OPS) realizó una investigación operacional para: 1) evaluar los aspectos funcionales de los principales programas de alimentación complementaria de Guatemala; y 2) generar recomendaciones orientadas a mejorar los aspectos funcionales que se encuentran débiles. Las instituciones que participaron en el estudio fueron CARE, Catholic Relief Services (CRS) y SHARE International de Guatemala. Funcionarios de estas instituciones colaboraron en el diseño de la investigación operacional para evaluar su programa, en la elaboración de un Modelo Operativo e instrumentos para la recolección de datos y en la discusión e interpretación de los resultados. La presente monografía es un estudio de caso el cual describe la experiencia del Programa CARE, ilustrando el uso y aplicación de la metodología de investigación operacional en programas de alimentación complementaria. Se definió el Modelo Operativo del sistema a estudiar, el cual incluyó los siguientes componentes: 1)Abastecimiento de los alimentos; 2)Almacenamiento; 3)Selección de beneficiarios y 4)Distribución de alimentos. Además se incluyeron las siguientes actividades paralelas: 1)Monitoreo dl Crecimiento; 2)Educación Alimentario-nutricional y 3)Supervisión...