Effect of antenatal zinc supplementation on impetigo in infants in Bangladesh.

We sought to determine the effects of maternal zinc supplementation on skin infections among infants in poor urban areas of Dhaka, Bangladesh. A double-blind, placebo-controlled, randomized trial was conducted among 199 and 221 Bangladeshi infants whose mothers were administered 30 mg daily of zinc or placebo, respectively. The mothers received zinc supplementation from 12-16 weeks' gestation until delivery, and the infants were followed up until 6 months of age. Among the infants of mothers who received zinc supplementation during the antenatal period, 10.6% had at least 1 episode of impetigo compared with 19.6% of the infants of mothers in the placebo group (P = 0.01). Infants in the treatment group had a 54% reduction in incidence rate of episodes of impetigo when compared with infants in the placebo group (P = 0.01). The effect of zinc supplementation was more pronounced among male infants (64% reduction) and intrauterine growth restricted and low birth weight infants (73% reduction) and among infants of mothers with increased parity (60% reduction) or decreased socioeconomic status (71% reduction).

Intakes of retinol and carotenoids and its determining factors in the Red River Delta population of northern Vietnam.

OBJECTIVE: To describe the household intakes of retinol and carotenoids and social economic factors determining their intakes. SUBJECTS: Data on a total of 1001 households (771 in rural areas and 230 in urban areas) were used in the analyses. Interviewed person was household food preparer. RESULTS: Mean (s.d.) intake of carotenoids was 4178 (3154) microg/capita/day in rural and 4208 (3408) microg/capita/day in urban areas and intake of retinol was 101 (275) microg/capita/day in rural and 201 (470) microg/capita/day in urban areas. Multivariate analyses show that the subjects in households with four or more members consume about 700 microg carotenoids less compared to households with less than three members. Households with a higher expenditure (fourth quartile) consumed about 100 microg retinol/day more than those with a lower expenditure (first quartile). CONCLUSION: Carotenoids from plant food sources is the main source of vitamin A intake of the population and its main determinants are household expenditure and size of household. Food fortification and dietary diversification with special emphasis on promotion of consumption of animal foods should be key strategies for overcoming vitamin A deficiency in Vietnam.

The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-month-old disadvantaged urban South African infants.

The study was conducted to look at the effectiveness of a multimicronutrient-fortified complementary food on the micronutrient status, linear growth and psychomotor development of 6- to 12-month-old infants from a black urban disadvantaged community in the Western Cape, South Africa. The study was designed as an intervention study. In both the experimental and control groups, serum retinol concentration showed a decline over the intervention period of 6 months. The decline was less pronounced in the experimental group. This resulted in a significantly (P<005) higher serum retinol concentration at 12 months in the experimental group (26.8+/-5.8 microg/dl) compared with the control group (21.4+/-5 microg/dl). Serum iron concentration also declined over the intervention period. The decline was less pronounced in the experimental group. No difference was observed in haemoglobin levels between the groups at 12 months. Serum zinc concentration did not differ significantly between the two groups at follow up. Weight gain over the 6 months period did not differ significantly between the experimental (2.1+/-0.9 kg) and control groups (2.1+/-1.2 kg). There was no difference in linear growth between the experimental (10.0+/-1.5 cm) and control group (10.1+/-2.1 cm) at the end of the follow-up period. Weight and length at 6 months significantly predicted weight and length at 12 months. No difference was observed in psychomotor developmental scores between the two groups after 6 months of intervention. Introducing a multimicronutrient-fortified complementary food into the diet of 6- to 12-month-old infants seemed to have an arresting effect on declining serum retinol and iron concentration in the experimental group. No benefit was observed in serum zinc concentration, linear growth and psychomotor development.

Energy stress during pregnancy and lactation: consequences for maternal nutrition in rural Bangladesh.

OBJECTIVE: To assess the relationship of energy stress during pregnancy and lactation to maternal body stores in marginally nourished rural Bangladeshi women. SUBJECTS AND METHODS: Two-hundred and fifty-two women were followed from 5-7 months of pregnancy until 6 months postpartum. Energy intake was estimated during pregnancy and at 1, 3 and 6 month(s) postpartum using 24 h dietary recall. Body weight was measured on enrollment, another once or twice during pregnancy, and at 1, 3 and 6 month(s) postpartum. The weekly rates of pregnancy weight gain and postpartum weight changes were determined. Weight and length of the infants were measured at birth and at approximately 1, 3 and 6 month(s). RESULTS: Maternal energy intake at 5-7 months of gestation was 1464+/-416 kcal/day (mean+/-s.d.). Women gained a mean of 200 g/week or a total of 4 kg during the second half of pregnancy. An analysis of maternal weight showed no indication of accrual of fat stores during pregnancy. Dietary energy during lactation exceeded the intake during pregnancy by 248-354 kcal/day. Mothers lost an estimated average of 1 kg of weight during the first 6 months of lactation. The mean (+/-s.d.) birth weight was 2.55+/-0.38 kg, and the prevalence of low birth weight (<2500 g) was 48%. Infants exhibited some catch-up growth only during the first 3 months but overall growth during the first 6 months did not change from their relative status at birth when compared with NCHS reference. CONCLUSIONS: These rural Bangladeshi women failed to gain sufficient weight during the last half of pregnancy to maintain body weight during lactation when the energy demand is high. Poor growth of their primarily breastfed infants raises concern about the adequacy of lactation in this community.

Effects of multivitamin-multimineral supplementation on appetite of stunted young Beninese children.

In the developing world, food intake of young children is often insufficient for growth. Reduced appetite due to several factors including micronutrient deficiencies might be an explanation. We hypothesized that a multivitamin-multimineral supplementation will improve appetite of stunted children in south of Benin. Multivitamin-multimineral supplements (VITALIA-tablets) contain 11 vitamins and 8 minerals. Stunted children (Ht/Age Z score < -2) of 17-32 months old were randomly assigned to multivitamin-multimineral (n = 48) or placebo (n = 53) group. Supplementation was daily and supervised throughout 6 weeks. Knee-heel length, length, weight, arm circumference and appetite were assessed once a week for the three weeks preceding and the three weeks following the six-week intervention period. Growth was additionally assessed 4 months after intervention. Each appetite test day, morbidity data and mother's report on child's appetite throughout the preceding day were recorded. Reported appetite, intake of test food and knee-heel length increased after supplementation in both groups (p < 0.05), but were not different between groups. Growth was similar 4 months after the intervention. Morbidity was comparable in both groups before as well as after supplementation. We conclude that 6-week multivitamin-multimineral supplementation alone failed to improve appetite and growth of stunted young children.

Determinants of weight and length of Indonesian neonates.

OBJECTIVE: To investigate the determinants of neonatal weight and length. DESIGN: From 16-20 week of pregnancy, 366 mothers of the neonates had participated in the community-based study to investigate the effect of weekly supplementation during pregnancy with iron and vitamin A on infant growth. Women from five villages were allocated randomly to receive two tablets each containing 60 mg iron as ferrous sulphate and 250 micro g folic acid (n=121) or two tablets each containing 2400 RE vitamin A in addition to the same amount of ferrous sulphate and folic acid (n=122). A third ('daily') group (n=123) participating in the national iron supplementation programme was recruited from four neighbouring villages. RESULTS: Neonatal weight and length did not differ between the two weekly groups and between the weekly iron group and the 'daily' group. Iron and vitamin A status during pregnancy did not influence neonatal weight and length significantly. Boys were 100 g heavier and 0.53 cm longer than girls (P<0.05). First born neonates were lighter (P<0.01) and tended to be shorter (P=0.070) than neonates of higher birth order. Maternal age and education as well as other socioeconomic determinants were not associated with neonatal weight and length. Neonatal weight was 32% explained by gestational age, maternal weight, postnatal measurement, gender and parity, while neonatal length was 28% explained by gestational age, maternal weight, postnatal measurement, gender and maternal height. CONCLUSIONS: Gestational age, maternal weight at second trimester and infant gender were the main predictors of neonatal weight and length. SPONSORSHIP: The study was supported by The Netherlands Organization for Scientific Research-Netherlands Foundation for the Advancement of Tropical Research (NWO-WOTRO; WV 93-280) and Neys-van Hoogstraten Foundation (IN 114), The Netherlands, and German Agency for Technical Cooperation (GTZ)/South East Asian Ministers of Education Organization (SEAMEO), Indonesia.

Disadvantaged black and coloured infants in two urban communities in the Western Cape, South Africa differ in micronutrient status.

OBJECTIVES: To determine the nutritional and health status of urban infants in two disadvantaged communities in the Western Cape, South Africa with special reference to micronutrient status. The results of this study will serve to plan an intervention study in these communities in the same age group. DESIGN: Cross-sectional study. SETTING: Two disadvantaged urban black and 'coloured' communities in the Western Cape, South Africa. SUBJECTS: Sixty infants aged 6-12 months from each community. OUTCOME MEASURES: Dietary intake, anthropometric measurements, micronutrient status and psychomotor development. RESULTS: Stunting and underweight were more prevalent in coloured infants (18% and 7%, respectively) than in black infants (8% and 2%, respectively). Anaemia (haemoglobin (Hb) < 11 g dl(-1) was prevalent in 64% of coloured and 83% of black infants. Iron-deficiency anaemia (Hb < 11 g dl(-1) and ferritin < 10 ng ml(-1) was found in 32% of coloured infants and in 46% of black infants. Zinc deficiency was prevalent in 35% and 33% of the coloured and black infants, respectively. Marginal vitamin A deficiency (serum retinol < 20 microg dl(-1) was observed in 23% of black infants compared with 2% of coloured infants. Of black infants, 43% and of coloured infants 6% were deficient in two or more micronutrients. Six per cent of coloured infants had C-reactive protein concentrations above 5 mg l(-1) compared with 38% of the black infants. The dietary intake of micronutrients was in general lower in black infants than in coloured infants. The overall psychomotor development, assessed by the Denver Developmental Screening Test, was different between the two groups. The coloured infants scored higher in three out of the four categories as well as in their overall score. CONCLUSIONS: This study shows that information on stunting and wasting only in urban disadvantaged infants is not sufficient to make recommendations about specific community intervention programmes. Information on the micronutrient status, independent of wasting and stunting, is necessary to design nutrition programmes for different communities. The study also showed a substantially higher prevalence of micronutrient deficiencies among black infants.

An appropriate tool for appetite testing and evaluation in young children in Benin.

Appetite measurements were performed in 109 Beninese children aged 18-30 months to develop a tool for appetite evaluation in young children in nutritional intervention programmes. Two test foods were identified as appropriate for these children: a maize porridge (aklui) and rice (riz-au-gras). Ad libitum intakes of the foods served after an overnight fast according to a standardized offering procedure were measured on 3 days. The children's habitual intakes were measured during 3 consecutive days not overlapping with the days when the test meals were provided. Energy intake from the test foods was comparable to breakfast energy intake which was 0.8-1.0 MJ, representing 21% of total daily energy intake. Energy intake from aklui was significantly correlated with daily intake (r=0.41, n=38, p<0.05) and with energy intake from breakfast (r=0.52, p<0.01). Correlations concerning riz-au-gras were less pronounced and non-significant. Reproducibility (as coefficient of variation) of the appetite test as calculated from the triplicate measurements was 40% for aklui and 25% for riz-au-gras. This reproducibility is better than that of the habitual breakfast intake (43-45%). In conclusion, the appetite test used in our studies can be considered as an appropriate tool in appetite evaluations.

Randomised double-blind trial of the effect of vitamin A supplementation of Indonesian pregnant women on morbidity and growth of their infants during the first year of life.

OBJECTIVE: To investigate whether supplementation with vitamin A together with iron of Indonesian pregnant women decreases morbidity and improves growth of their infants during the first year of life. DESIGN: Women from a rural area in West Java, Indonesia, were randomly assigned on an individual basis to double-blind supplementation once weekly from approximately 18 weeks of pregnancy until delivery. Supplementation comprised 120 mg iron and 500 microg folic acid with or without 4800 RE vitamin A. Their newborn infants were followed up during the first year of life: weight, length, morbidity and food intake were assessed monthly. RESULTS: Infants whose mothers had taken vitamin A supplements during pregnancy had similar weight, length, weight gain and growth as their counterparts during the follow-up period. The proportions of infants with reported symptoms of morbidity were similar in the vitamin A plus iron group and the iron group. In addition immunisation coverage and feeding mode did not differ between the groups. All infants were breast-fed, but exclusive breast-feeding rapidly declined at 4 months of age. Infants with serum retinol concentrations >0.70 micromol/l increased their weight and length more during the first 6 months of life and had higher weight-for-age Z-scores during the first year of life than infants with serum retinol concentrations

Vitamin A and iron supplementation of Indonesian pregnant women benefits vitamin A status of their infants.

Many Indonesian infants have an inadequate nutritional status, which may be due in part to inadequate maternal nutrition during pregnancy. This study was designed to investigate whether infant nutritional status could be improved by maternal vitamin A and Fe supplementation during gestation. Mothers of these infants from five villages had been randomly assigned on an individual basis, supervised and double-blind, to receive supplementation once weekly from approximately 18 weeks of pregnancy until delivery. Supplementation comprised 120 mg Fe and 500 microg folic acid with or without 4800 retinol equivalent vitamin A. Mothers of infants from four other villages who participated in the national Fe and folic acid supplementation programme were also recruited; intake of tablets was not supervised. Anthropometric and biochemical parameters of infants and their mothers were assessed approximately 4 months after delivery. Infants of mothers supplemented with vitamin A plus Fe had higher serum retinol concentrations than infants of mothers supplemented with Fe alone. However, the proportion of infants with serum retinol concentrations <0.70 micromol/l was >70 % in all groups. Maternal and infant serum retinol concentrations were correlated. Fe status, weight and length of infants were similar in all groups. Fe status of girls was better than that of boys, but boys were heavier and longer. We conclude that supplementation with vitamin A in conjunction with Fe supplementation of women during pregnancy benefits vitamin A status of their infants. However, considering the large proportion of infants with marginal serum retinol concentrations, it may still be necessary to increase their vitamin A intake.

Multivitamin-multimineral and iron supplementation did not improve appetite of young stunted and anemic Beninese children.

In developing countries, low food intake is often reported in children < 5 y old. Reduced appetite may be a contributing factor. We investigated whether a combination of a multivitamin-multimineral supplement and additional iron treatment improved appetite and growth of 18- to 30-mo-old stunted and anemic Beninese children. The study was placebo-controlled using VITALIA tablets (11 vitamins and 10 minerals) and ferrous fumarate tablets (66 mg of iron). One hundred fifty stunted (height-for-age Z score < -2) and anemic children (hemoglobin < 110 g/L) were randomly assigned to one of four groups: group 1, multivitamin-multimineral plus iron; group 2, multivitamin-multimineral plus placebo; group 3, placebo plus placebo; and group 4, placebo plus iron. Supplementation was daily and supervised for 6 wk. Appetite, knee-heel length, dietary intakes and morbidity were assessed before and after supplementation. Length, weight, arm circumference and hemoglobin concentration were assessed before, just after supplementation and 4 mo after the intervention. Appetite was assessed by means of an appetite test using a test food, riz-au-gras, eaten ad libitum after an overnight fast. Dietary intakes were assessed during three consecutive days in a subsample by means of the observed weighed record method. Energy intake from the habitual breakfast was significantly correlated with that from the test food (r = 0.49, n = 38, P = 0.002). There were no differences among groups in changes in appetite and growth performance. The habitual diet of the children was monotonous and contained only small amounts of animal products. The morbidity status of the children was comparable in all study groups, before as well as after supplementation. We conclude that the 6-wk multivitamin-multimineral supplementation with additional iron treatment failed to improve the appetite and growth of the children.

Weekly vitamin A and iron supplementation during pregnancy increases vitamin A concentration of breast milk but not iron status in Indonesian lactating women.

Studies on the effect of vitamin A and iron supplementation during pregnancy on maternal iron and vitamin A status postpartum are scarce. We investigated whether retinol and iron variables in breast milk and in serum postpartum were enhanced more with weekly vitamin A and iron supplementation during pregnancy than with weekly iron supplementation. During pregnancy, subjects were randomly allocated to two groups and received either (n = 88) a weekly supplement of iron (120 mg Fe as FeSO(4)) and folic acid (500 microg) or (n = 82) the same amount of iron and folic acid plus vitamin A [4800 retinol equivalents (RE)]. Transitional milk (4-7 d postpartum) had higher (P < 0.001) concentrations of retinol and iron than mature milk (3 mo postpartum). Compared with the weekly iron group, the weekly vitamin A and iron group had a greater (P < 0.05) concentration of retinol in transitional milk (as micromol/L) and in mature milk (as micromol/g fat). Although serum retinol concentrations approximately 4 mo postpartum did not differ significantly, the weekly vitamin A and iron group had significantly fewer (P < 0.01) subjects with serum retinol concentrations < or = 0.70 micromol/L than the weekly iron group. Iron status and concentrations of iron in transitional and mature milk did not differ between groups. We have shown that weekly vitamin A and iron supplementation during pregnancy enhanced concentrations of retinol in breast milk although not in serum by approximately 4 mo postpartum. However, no positive effects were observed on iron status and iron concentration in breast milk.

Serum thyroglobulin and urinary iodine concentration are the most appropriate indicators of iodine status and thyroid function under conditions of increasing iodine supply in schoolchildren in Benin.

Iodine deficiency control programs have greatly reduced iodine deficiency disorders worldwide. For monitoring changes in iodine status, different indicators may be used. The aim of this study was to evaluate the suitability of indicators of iodine status and thyroid function, thyroglobulin (Tg), thyroid-stimulating hormone (TSH) and free thyroxine (FT4) in serum, thyroid volume and urinary iodine concentration, in iodine-deficient schoolchildren under conditions of increasing iodine supply. The study was established as a double-blind, placebo-controlled oral administration of a single dose of iodized oil to schoolchildren (7-10 y old), living in an iodine-deficient area of Benin, with an observation period of 10 mo. However, 3-4 mo after supplementation, iodized salt became available in the area. The study population therefore comprised an iodized oil-supplemented group and a nonsupplemented group, both of which had variable, uncontrolled intakes of iodized salt during the last 6 mo of the study. Initial mean serum concentrations of TSH and FT4 were within the normal range, whereas serum Tg concentration, urinary iodine concentration and thyroid volume were indicative of moderate-to-severe iodine deficiency. At the end of the study, all indicators had improved significantly, except thyroid volume, which had decreased only in the supplemented group. The supplemented group also still had significantly lower serum Tg and higher urinary iodine concentrations than the nonsupplemented group. Serum Tg and urinary iodine concentrations are the indicators most influenced by a changing iodine supply. Current normal reference ranges of serum concentrations of TSH and FT4 are too wide for detecting iodine deficiency in this age group.

Mild iodine deficiency is associated with elevated hearing thresholds in children in Benin.

OBJECTIVE: Elevated hearing thresholds have been demonstrated in populations afflicted by endemic cretinism as a result of severe iodine deficiency. However, data on the effects of less severe iodine deficiency on hearing thresholds in apparently normal children are scant. This study addresses the question whether there is a relationship among iodine variables, hearing and mental performance in a mildly iodine-deficient population. DESIGN: A randomized, placebo-controlled intervention trial with an observation period of 11 months. SETTING: An iodine-deficient area in northern Benin. SUBJECTS: A total of 197 school children, aged 7-11 y. INTERVENTIONS: A total of 97 children received an oral dose of iodized oil, containing 540 mg I, while 100 children received a placebo. About 3-4 months after supplementation, the whole population began to have access to iodized salt. Non-verbal mental tests were administered and biochemical indicators (thyrotropin, free thyroxine, thyroglobulin and urinary iodine) were measured at the beginning and the end of the study. Hearing was measured at the end of the study in both ears by pure-tone audiometry at seven frequencies. RESULTS: In this mildly iodine-deficient child population children with higher serum thyroglobulin concentrations had significantly higher hearing thresholds in the higher frequency range (> or = 2000 Hz) than children with lower serum thyroglobulin concentration. Moreover children with lower hearing thresholds performed significantly better on the mental tests used. CONCLUSIONS: Even when iodine deficiency is 'mild', promotion of adequate iodine intake through salt iodization programs and other means remains crucial. SPONSORSHIP: Nestlé Foundation, Lausanne, Switzerland; Wageningen University, Wageningen, The Netherlands.

Body fat measurement among Singaporean Chinese, Malays and Indians: a comparative study using a four-compartment model and different two-compartment models.

This cross-sectional study compared body fat percentage (BF%) obtained from a four-compartment (4C) model with BF% from hydrometry (using 2H2O), dual-energy X-ray absorptiometry (DXA) and densitometry among the three main ethnic groups (Chinese, Malays and Indians) in Singapore, and determined the suitability of two-compartment (2C) models as surrogate methods for assessing BF% among different ethnic groups. A total of 291 subjects (108 Chinese, seventy-six Malays, 107 Indians) were selected to ensure an adequate representation of age range (18-75 years) and BMI range (16-40 kg/m2) of the general adult population, with almost equal numbers from each gender group. Body weight was measured, together with body height, total body water by 2H2O dilution, densitometry with Bodpod and bone mineral content with Hologic QDR-4500. BF% measurements with a 4C model for the subgroups were: Chinese females 33.5 (sd 7.5), Chinese males 24.4 (sd 6.1), Malay females 37.8 (sd 6.3), Malay males 26.0 (sd 7.6), Indian females 38.2 (sd 7.0), Indian males 28.1 (sd 5.5). Differences between BF% measured by the 4C and 2C models (hydrometry, DXA and densitometry) were found, with underestimation of BF% in all the ethnic-gender groups by DXA of 2.1-4.2 BF% and by densitometry of 0.5-3.2 BF%). On a group level, the differences in BF% between the 4C model and 2H2O were the lowest (0.0-1.4 BF% in the different groups), while differences between the 4C model and DXA were the highest. Differences between the 4C model and 2H2O and between the 4C model and DXA were positively correlated with the 4C model, water fraction (f(water)) of fat-free mass (FFM) and the mineral fraction (f(mineral)) of FFM, and negatively correlated with density of the FFM (D(FFM)), while the difference between 4C model and densitometry correlated with these variables negatively and positively respectively (i.e. the correlations were opposite). The largest contributors to the observed differences were f(water) and D(FFM). When validated against the reference 4C model, 2C models were found to be unsuitable for accurate measurements of BF% at the individual level, owing to the high errors and violation of assumptions of constant hydration of FFM and D(FFM) among the ethnic groups. On a group level, the best 2C model for measuring BF% among Singaporeans was found to be 2H2O.

Impact of iron supplementation and deworming on growth performance in preschool Beninese children.

OBJECTIVE: To assess the effects of iron and deworming on linear growth performance of preschoolers. DESIGN: Three-month randomized, double-blind and placebo-controlled trial. The children were allocated to four treatments: iron (60 mg elemental iron/day) + albendazole (200 mg/day for 3 consecutive days, repeated 1 month later), iron + albendazole-placebo, albendazole + iron-placebo or placebos. The supplementation was supervised. SUBJECTS: A group of 177 children aged 3-5 y was selected from low-income households in a rural area in southern Bénin. A complete data set was analysed for 140 subjects. Many children were stunted (58% had height-for-age Z-score <-2), none were wasted (2% had weight-for-height Z-score < -2) and 76% were anemic (Hb < 110 g/l). MAIN OUTCOME MEASURES: Anthropometric parameters, hemoglobin and eggs per gram feces. RESULTS: No significant difference in changes in anthropometric parameters was observed between study groups, and also not in a sub-sample of stunted and anemic subjects. Changes in hemoglobin were highest in the iron-treated subjects at the end of the 3-month intervention period (P = 0.032). The difference between the iron and the placebo groups remained significant even 7 months later (P = 0.022). The difference was 5 g/l in both periods. Ascaris lumbricoides and hookworm infections decreased significantly in albendazole-treated subjects (P < 0.05). CONCLUSIONS: In addition to recurrent parasitic infection burden, the children may have multiple micronutrient deficiencies. Therefore, it may be interesting to study appetite and food intake of young toddlers in relation to health and linear growth performance in poor environments.

Zinc supplementation during pregnancy and effects on growth and morbidity in low birthweight infants: a randomised placebo controlled trial.

BACKGROUND: Infant malnutrition and mortality rates are high in less-developed countries especially in low-birthweight infants. Zinc deficiency is also widely prevalent in these circumstances. We aimed to assess the effect of daily zinc supplements given to pregnant mothers on their infants' growth and morbidity. METHODS: We did a double-blind, placebo controlled, randomised trial in 199 and 221 Bangladeshi infants whose mothers took 30 mg daily elemental zinc or placebo, respectively, from 12 to 16 weeks' gestation until delivery. Infants were followed up until 6 months of age. We obtained data for morbidity every week by mothers' recall. Infants' anthropometric measurements were done every month, and their serum zinc was assessed at 1 and 6 months of age. FINDINGS: Infants of mothers who received zinc during pregnancy had at age 6 months reduced risks compared with those in the placebo group for acute diarrhoea (risk ratio 0.84; 95% CI 0.72-0.98), dysentery (0.36; 0.25-0.84), and impetigo (0.53; 0.34-0.82). These reductions were seen in low-birthweight infants but not in those with normal birthweight. There were no differences in infant growth or serum zinc concentrations between treatment groups. INTERPRETATION: Maternal zinc supplementation during pregnancy resulted in a reduction of the health risks in Bangladeshi low-birthweight infants, although this intervention did not improve birthweight. Whether zinc should be added to usual antenatal supplements in regions with high rates of low birthweight should be reviewed.

Poor micronutrient status of active pulmonary tuberculosis patients in Indonesia.

Malnutrition is observed frequently in patients with pulmonary tuberculosis (TB), but their nutritional status, especially of micronutrients, is still poorly documented. The objective of this study was to investigate the nutritional status of patients with active TB compared with that of healthy controls in Jakarta, Indonesia. In a case-control study, 41 out-patients aged 15-55 y with untreated active pulmonary TB were compared with 41 healthy controls selected from neighbors of the patients and matched for age and sex. Cases had clinical and radiographic abnormalities consistent with pulmonary TB and at least two sputum specimens showing acid-fast bacilli. Anthropometric and micronutrient status data were collected. Compared with the controls, TB patients had significantly lower body mass index, skinfold thicknesses (triceps, biceps, subscapular, suprailiac), mid-upper arm circumference, proportion of fat, and concentrations of serum albumin, blood hemoglobin, plasma retinol and plasma zinc, whereas plasma zinc protoporphyrin concentration, as a measure of free erythrocyte protoporphyrin concentration, was greater. When patients and controls were subdivided on the basis of nutritional status, concentrations of serum albumin, blood hemoglobin, and zinc and retinol in plasma were lower in malnourished TB patients than in well-nourished healthy controls, well-nourished TB patients and malnourished healthy controls. In conclusion, the nutritional status of patients with active pulmonary TB was poor compared with healthy subjects, i.e., significantly more patients were anemic and more had low plasma concentrations of retinol and zinc. Low concentrations of hemoglobin, and of retinol and zinc in plasma were more pronounced in malnourished TB patients.

Improved iodine status is associated with improved mental performance of schoolchildren in Benin.

BACKGROUND: An adequate iodine supply in utero and shortly after birth is known to be crucial to an individual's physical and mental development. The question of whether iodine supplementation later in life can exert a favorable influence on the mental performance of iodine-deficient populations was addressed in various studies, but with contradictory results. OBJECTIVE: The aim of this study was to examine the effect of an improvement in iodine status on mental and psychomotor performance of schoolchildren (7-11 y) who were moderately to severely iodine deficient. DESIGN: The study, which was originally planned as a double-blind, randomized, placebo-controlled intervention, was carried out in an iodine-deficient population of schoolchildren (n = 196) in northern Benin. As the population began to have access to iodized salt during the 1-y intervention period, the study population was split post hoc-on the basis of urinary iodine concentrations-into a group with improved iodine status and a group with unchanged iodine status. Changes in mental and psychomotor performance over the intervention period were compared. RESULTS: Children with increased urinary iodine concentrations had a significantly greater increase in performance on the combination of mental tests than did the group with no change in urinary iodine concentrations. CONCLUSIONS: An improvement in iodine status, rather than iodine status itself, determined mental performance in this population, which was initially iodine deficient. These findings suggest a "catch-up" effect in terms of mental performance.

Efficacy of oral iodised oil is associated with anthropometric status in severely iodine-deficient schoolchildren in rural Malawi.

The effect of anthropometric status on the efficacy of an oral supplement of iodised oil (1 ml Lipiodol Ultrafluide, 490 mg I; Laboratoire Guerbet, Aulnay-sous-Bois, France) was examined in 8-10-year-old schoolchildren (n 197) of Ntcheu, a severely I-deficient district of Malawi. The study was a controlled trial using the I concentration of casual urine samples to monitor the I status. The median urinary I concentration increased from 0.15 micromol/l at baseline (51.3 % of children < 0.16 micromol/l, 89.7 % < 0.40 micromol/l, 95.7 % 0.79 micromol/l) to 0.32 micromol/l at 40 weeks (29.1 % of the children < 0.16 micromol/l, 71.0 % < 0.40 micromol/l, 96.1 % < 0.79 micromol/l) while the total goitre prevalence fell from 63 % to 21 %. Variables of efficacy were estimated from a hyperbolic function describing the longitudinal pattern of urinary I excretion after the dose. The I retention and I elimination rate, and the periods of protection from mild (< 0.79 micromol/l) or moderate (< 0.40 micromol/l) I deficiency were obtained for groups of children with differing anthropometric status at baseline. Initial height-for-age and mid upper-arm circumference were not significantly related to efficacy. However, both the I retention and I elimination rate were reduced in children with lower initial weight-for-height. Children with lower skinfold thickness at baseline also had reduced I retention, which resulted in shorter protection periods from recurrent moderate and mild I deficiency. The efficacy of the oral iodised-oil supplement was not related to changes in anthropometric status during follow-up, nor was it related to the consumption of a food supplement of 1610 kJ immediately before the iodised-oil dose. Very low (< 0.16 micromol/l) urinary I concentration, and the presence of goitre at baseline were both associated with higher I retention and elimination rate. Children with goitre at baseline were found to have a prolonged duration of protection against recurrent moderate I deficiency. We conclude that in apparently healthy schoolchildren in I-deficient areas, general anthropometric status has a little influence on the efficacy of oral iodised oil for correcting I deficiency.