Discordance in exclusive breastfeeding between maternal recall and deuterium dose-to-mother technique during the first 6 months of infants: A multi-country study in Asia.

PURPOSE: This study aimed to assess the agreement in EBF between maternal recall and the dose-to-mother (DTM) technique. METHODS: Indonesia, Malaysia, Mongolia, Pakistan, Sri Lanka, Thailand, and Vietnam participated in the study. A total of 207 and 118 mother-infant pairs were assessed at 3 and 6 months of child's age. Using a standardized questionnaire, mothers were asked to recall child feeding during the previous 24 h, at 3 and 6 months. Those recalled to be EBF proceeded to be assessed using DTM technique. Non-milk oral intake (NMOI) cutoff of 86.6 g/d was used to classify EBF. RESULTS: According to DTM, 66% of infants were EBF at 3 months, while only 22% were EBF at 6 months. At 3 months, the overall % agreement between maternal recall and DTM method was 68%, kappa 0.06 (95% CI: 0.07-0.20), and at 6 months, the % agreement was only 21%, kappa -0.031 (95% CI -0.168 to 0.107). Human milk intakes were similar at 3 months and 6 months when expressed as g/d, but decreased when expressed as g/kg/d, with a large variation within and between countries; Pakistan being the lowest. CONCLUSION: This study showed there were declining levels of EBF from 3 to 6 months in the participating countries from Asia and the agreement between maternal recall and DTM technique to classify EBF was low. To ensure that the DTM technique can be more widely used in evaluating breastfeeding promotion programs, consensus on the appropriate NMOI cutoff and simplification of the DTM protocol is necessary.

Effect of 24-Week, Late-Evening Ingestion of a Calcium-Fortified, Milk-Based Protein Matrix on Biomarkers of Bone Metabolism and Site-Specific Bone Mineral Density in Postmenopausal Women with Osteopenia.

Dietary calcium intake is a modifiable, lifestyle factor that can affect bone health and the risk of fracture. The diurnal rhythm of bone remodelling suggests nocturnal dietary intervention to be most effective. This study investigated the effect of daily, bed-time ingestion of a calcium-fortified, milk-derived protein matrix (MBPM) or control (CON), for 24 weeks, on serum biomarkers of bone resorption (C-terminal telopeptide of type I collagen, CTX) and formation (serum pro-collagen type 1 N-terminal propeptide, P1NP), and site-specific aerial bone mineral density (BMD), trabecular bone score (TBS), in postmenopausal women with osteopenia. The MBPM supplement increased mean daily energy, protein, and calcium intake, by 11, 30, and 107%, respectively. 24-week supplementation with MBPM decreased CTX by 23%, from 0.547 (0.107) to 0.416 (0.087) ng/mL (p < 0.001) and P1NP by 17%, from 60.6 (9.1) to 49.7 (7.2) µg/L (p < 0.001). Compared to CON, MBPM induced a significantly greater reduction in serum CTX (mean (CI95%); −9 (8.6) vs. −23 (8.5)%, p = 0.025 but not P1NP −19 (8.8) vs. −17 (5.2)%, p = 0.802). No significant change in TBS, AP spine or dual femur aerial BMD was observed for CON or MBPM. This study demonstrates the potential benefit of bed-time ingestion of a calcium-fortified, milk-based protein matrix on homeostatic bone remodelling but no resultant treatment effect on site-specific BMD in postmenopausal women with osteopenia.

Validation of the Sinhalese Version of Brief COPE Scale for patients with cancer in Sri Lanka.

BACKGROUND: Coping strategies play a vital role in cancer management and has been an integral part in the recovery process of cancer patients worldwide. Coping refers to specific efforts; both behavioral and psychological, that diminishes stresses emerged in cancer patients. This study evaluated the psychometric properties of the Sinhalese version of the Coping Orientation to Problems Experienced Inventory (S-BC) which was developed based on the Brief COPE scale  for cancer patients in Sri Lanka. METHODS: The original Brief COPE is a self-administered tool with 28 items designed to measure coping methods used by people in stressful life events. It consisted of statements related to adaptive and maladaptive coping strategies. Forty patients with cancer who were registered at the Oncology ward, Teaching Hospital, Galle, Sri Lanka were included in the study. A cross-cultural adaptation of the Brief COPE was done using WHO guidelines. Reliability of the S-BC was assessed using test-retest and internal consistency procedures. The construct validity of the tool was assessed by performing exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent and discriminant validity of the S-BC was tested using World Health Organization-Quality of Life-Brief scale (WHOQOL-BREF) and Centre for Epidemiological Studies-Depression scale (CES-D). RESULTS: The mean (± SD) age of the sample was 61(± 12) years, and 52.5% (n = 21) of the participants were men. Eighty percent (n = 32) of the participants were more than one year of treatment from diagnosing as a cancer patient. The test-retest reliability of the S-BC was 0.66, and the internal consistency of the S-BC was good (Cronbach's alpha - 0.819). Both EFA and CFA revealed a structure comprised of seven factors. Such factors were Avoidance/Behavioral disengagement, Religious faith/Acceptance, Seeking support, Planning, Substance use/Venting, Self-blame and Active/positive coping. The scores of the adaptive coping of the S-BC was negatively and the scores of the maladaptive coping of the S-BC was positively correlated with the CES-D score.   The scores of the adaptive coping of the S-BC was  positively correlated with the total score of the WHOQOL-BREF questionnaire indicating the S-BC's convergent and discriminant validity properties. CONCLUSION: The Sinhalese version of the Brief COPE is found to be a valid and a reliable measure to assess coping strategies used by  patients with cancer in Sri Lanka.

Cost-Effective Analysis of the Congenital Hypothyroidism Screening Program in Sri Lanka.

INTRODUCTION: Economic evaluations will determine policy decisions on any screening programs as estimates of short-term or long-term clinical and economic outcomes are analyzed through a systematic approach. This cost-effectiveness analysis was aimed to assess newborn screening for congenital hypothroidism (CH) in Sri Lanka as a important tool to allocate funds and make decisions on feasibility of new interventions with budget constraint in healthcare costs. METHODS: The newborn screening database was retrospectively analyzed to assess key performance indicators of the program. Program cost included capital investment, sampling, forms, analytical cost, follow-up, and confirmatory costs. Treatments and management care were calculated up to the age of 75 years excluding other cost to the family for support. Total benefits to the society and disability-adjusted life-years are calculated for each year. RESULTS: During 2019, 159 559 newborns underwent screening with over 92% coverage while 126 babies of 192 screening positive babies were confirmed as having the disease. The annual incidence of hypothyroidism was 1 in 1266 live births among the screened population. The positive predictive value of the program was 66% with a false-positive rate of <0.04% among those screened. The benefit-to-cost ratio was 3.60 with total cost of the program 98 924 300LKR with total benefit of 356 553 781LKR in 2019. CONCLUSION: The CH screening program proved its effectiveness in both timely detecting at-risk babies as well as being appropriately effective in economic impact to society. The improved health outcomes are of utmost importance considering screening expansions and policy decisions.

Psychological experiences of healthcare professionals in Sri Lanka during COVID-19.

BACKGROUND: The upsurge of COVID-19 has caused numerous psycho-social challenges for healthcare professionals because of its ability to spread rapidly in the community and high mortality rate. The seriousness of the disease has led many healthcare professionals plagued by stigma as well as discrimination. In this study, depressive symptomatology, levels of anxiety, and related psychosocial and occupational factors experienced by healthcare professionals in Sri Lanka during COVID -19 were investigated. METHODS: A total of 512 healthcare professionals were surveyed using an online survey. The Generalized Anxiety Disorder 7-item scale, the Center for Epidemiologic Studies Depression Scale-Revised-10, and psychosocial and occupational factors predictive of depression and anxiety were included in the survey questionnaire. Logistic regression determined the factors associated with the presence of depressive symptoms and anxiety. RESULTS: Results showed that elevated depressive symptoms and anxiety were experienced by 53.3% and 51.3%, respectively, of the participants. No differences in the prevalence of elevated depressive symptoms and anxiety were found between those who were exposed and non-exposed to COVID-19 confirmed or suspected patients. Having a fear of being infected with COVID-19 and spreading it among family members were associated with increased risk of depression. Among those exposed to COVID-19 confirmed or suspected patients, poor occupational safety (OR = 2.06, 95% CI 1.25-3.39), stigmatization (OR = 2.19, 95% CI 1.29-3.72), and heavy workload (OR = 2.45, 95% CI 1.53-3.92) were associated with increased risk of elevated depressive symptoms, whilst poor self-confidence (OR = 2.53, 95% CI 1.56-4.09) and heavy workload (OR = 1.94. 95% CI 1.22-3.12) were associated with increased risk of anxiety. CONCLUSIONS: Fear of being infected and distress caused by fear of spreading it among family members, stigmatization, poor self-confidence, poor occupational safety and heavy workload are vital risk factors that need to be considered in future psychological support services designed for the healthcare professionals in unprecedented outbreaks like COVID-19.

Temporal Change in Biomarkers of Bone Turnover Following Late Evening Ingestion of a Calcium-Fortified, Milk-Based Protein Matrix in Postmenopausal Women with Osteopenia.

The diurnal rhythm of bone remodeling suggests nocturnal dietary intervention to be most effective. This study investigated the effect of bedtime ingestion of a calcium-fortified, milk-derived protein matrix (MBPM) or maltodextrin (CON) on acute (0-4 h) blood and 24-h urinary change in biomarkers of bone remodeling in postmenopausal women with osteopenia. In CON, participants received 804 ± 52 mg calcium, 8.2 ± 3.2 µg vitamin D and 1.3 ± 0.2 g/kg BM protein per day. MBPM increased calcium intake to 1679 ± 196 mg, vitamin D to 9.2 ± 3.1 µg and protein to 1.6 ± 0.2 g/kg BM. Serum C-terminal cross-linked telopeptide of type I collagen (CTX) and procollagen type 1 amino-terminal propeptide (P1NP), and urinary N-telopeptide cross-links of type I collagen (NTX), pyridinoline (PYD) and deoxypyridinoline (DPD) was measured. Analyzed by AUC and compared to CON, a -32% lower CTX (p = 0.011, d = 0.83) and 24% (p = 0.52, d = 0.2) increase in P1NP was observed for MBPM. Mean total 24 h NTX excreted in MBPM was -10% (p = 0.035) lower than CON. Urinary PYD and DPD were unaffected by treatment. This study demonstrates the acute effects of bedtime ingestion of a calcium-fortified, milk-based protein matrix on bone remodeling.

Urinary iodine and thyroid determinants in pregnancy: a follow up study in Sri Lanka.

BACKGROUND: Iodine deficiency and thyroid dysfunction during pregnancy is associated with number of adverse outcomes that includes mental and physical disabilities creating a huge human and economic burden in later life. Several indicators are used to assess the iodine status of a population: thyroid size by palpation and/or by ultrasonography, urinary iodine excretion and the blood thyroid hormone profile. METHODS: This prospective study was designed to assess the iodine nutrition during the course of pregnancy with reference to urine iodine concentration (UIC) and thyroid determinants among 425 pregnant women from Galle district, Sri Lanka. UIC was estimated in all three trimesters and thyroid functions were assessed in first and third trimesters. RESULTS: Median (inter-quartile range IQR) UIC was 170.9 (100.0-261.10) µg/L, 123.80 (73.50-189.50) µg/L and 105.95 (67.00-153.50) µg/L in the first, second and third trimesters respectively (p < 0.001). Median thyroid stimulating hormone (TSH) level in the first trimester was 1.30 (0.80-1.80) µIU/mL. This value significantly increased (p < 0.001) to 1.60 (1.20-2.10) µIU/mL at the 3rd trimester even though it was maintained within the reference range (0.3 - 5.2 µIU/mL). In the assessment of thyroid gland, 67 (16.0 %) women had palpable or visible goitres and 55 (13.1 %) had a goitre that was palpable but not visible. The median thyroid volume of the sample was 5.16 mL (4.30; 6.10 mL) as measured by ultra sound (US) scanning. In multiple regression analysis after controlling for other independent variables (anthropometric, demographic and biochemical parameters); initial body mass index (BMI), goitre size, thyroid volume and parity had significant correlations with the third trimester urinary iodine levels. The thyroid volume accounted for 4.5 % of the urinary iodine variation. CONCLUSIONS: Even though iodine status was progressively worsening with the advancement of pregnancy and iodized salt consumption has not met with the increasing demand for iodine, it was not reflected in the serum TSH level. Therefore, it is worthwhile to assess the long term effects of rising TSH levels and inadequate iodine nutrition during pregnancy on the offspring to prevent even mild iodine deficiency.

Maternal iodine status and the thyroid function of pregnant mothers and their neonates in Jaffna District of Sri Lanka.

INTRODUCTION: Iodine status of pregnant women and their newborns have not been studied in Jaffna District, Sri Lanka. This study was planned to assess the maternal iodine status and thyroid function at the third trimester of gestation and the thyrotrophin level of their neonate. METHODS: Four hundred and seventy-seven pregnant women and their newborns were randomly selected among six Medical Officers of Health Divisions out of 12 in Jaffna District, Sri Lanka. Maternal thyroid stimulating hormone (TSH), free thyroxine (fT4), thyroglobulin (Tg), urinary iodine levels, and the neonatal thyrotrophin (nTSH) level were assessed. RESULTS: In this study, mean age, weight, height, and gestational age of the mothers were 28.95 (±5.46) years, 63.02 (±11.56) kg, 154.39 (±6.00) cm, and 39.33 (±1.37) weeks, respectively. Maternal median urinary iodine concentration (UIC) was 140.0 µg/L (inter-quartile range 126.0-268.0 µg/L). Median values of the maternal serum TSH, fT4, and Tg were 1.9 mIU/L, 12.6 pmol/L, and 21.4 IU/L, respectively. Among the 477 newborns, 50.5% (n = 239) were males. Mean birth weight of newborn was 3.03 (±0.43) kg, while the mean length was 51.1 (±2.1) cm. Among the newborns, 18% (n = 86) had nTSH level > mIU/L and 37.7% (n = 180) within TSH level > mIU/L. nTSH level had positive but very weak correlations with maternal thyroid parameters, that is, UIC (r = 0.06, P = 0.13), fT4 (r = 0.01, P = 0.05), TSH (r = 0.09, P = 0.05), and Tg (r = 0.12, P = 0.03). CONCLUSION: On the basis of the World Health Organization criteria, the iodine status of pregnant women was inadequate in this region and also nTSH levels indicate moderate iodine deficiency during pregnancy. Therefore, the continuous education on adequate iodine intake during pregnancy and monitoring of iodine status are useful.

Body composition among Sri Lankan infants by ¹8O dilution method and the validity of anthropometric equations to predict body fat against ¹8O dilution.

BACKGROUND: Body composition indicators provide a better guidance for growth and nutritional status of the infants. This study was designed to (1) measure the body composition of the Sri Lankan infants using a reference method, the (18)O dilution method; (2) calculate the body fat content of the infants using published skinfold prediction equations; and (3) evaluate the applicability of the skinfold equations to predict body fat among Sri Lankan infants against the (18)O dilution method. METHODS: Twenty five healthy, exclusively breast-fed infants were randomly recruited at well-baby clinics, for this cross-sectional study. Body composition was measured using (18)O dilution. Infant body weight, length, skinfold thicknesses and mid upper-arm circumference were measured using standard procedures. The Bland and Atlman pair-wise comparison method was used to evaluate the agreement of body fat generated using the anthropometric prediction equations against the (18)O dilution values as the reference. RESULTS: Mean (SD) body weight and length of the infants were 6.5 kg (0.9) and 64.7 cm (2.8) respectively. Mean total body water, fat free mass, fat mass and % fat mass as measured by (18)O dilution method were 58.8% (5.0), 4.6 kg (0.8), 1.9 (0.5) and 29.5% (6.1). Total body water and fat free mass were significantly higher in boys when compared to girls. With the exception of three prediction equations (Bandana et al., Goran et al. and Durnin and Wormsley), most of the other commonly used anthropometry-based prediction equations yielded a bias which was not constant but a function of the % fat mass. CONCLUSIONS: Body composition of Sri Lankan infants is comparable to the normative data available from the industrialized countries. Most of the commonly used anthropometric prediction equations generated a bias which varies with the size of the body fat. Only three prediction equations (Bandana, Goran, Durnin & Wormsley) yield a constant bias. The Durnin & Wormsely equation showed the smallest bias when compared to the (18)O dilution values with the narrowest limits of agreement. Accuracy of some of the prediction equations is a function of gender.

The Deuterium Oxide-to-the-Mother Method Documents Adequate Breast-Milk Intake among Sri Lankan Infants.

BACKGROUND: The WHO recommends that exclusive breastfeeding should last up to 6 mo. However, human milk intake of Sri Lankan infants has not been quantified scientifically. OBJECTIVES: The objectives of this study were to measure the human milk intake of Sri Lankan infants during the first 6 mo of age and to document the breastfeeding practices of their mothers. METHODS: Forty-eight healthy mother-infant dyads were randomly recruited for this cross-sectional study at well-baby clinics. Milk intake was measured using the deuterium oxide-to-the-mother technique over a period of 2 wk. Information on breastfeeding practice and living standards of the participants were gathered using an interviewer-administered questionnaire. RESULTS: Human milk intake was 672 ± 123 g ⋅ d(-1) (mean ± SD), 776 ± 212 g ⋅ d(-1), and 801 ± 51 g ⋅ d(-1) for infants <2 mo, 2 to <4 mo, and 4-6 mo of age, respectively. The milk intakes were not different among the age groups. Maternal body composition, age, or parity had no effects on milk intake of the infants. However, mother's education : P < 0.05, r = 0.35), infant's age (P < 0.05, r = 0.30), and body mass index (P < 0.05, r = 0.41 : positively correlated with the milk intake. Over 63% of mothers had commenced breastfeeding within 30 min of delivery. About 60% of the mothers were feeding the baby 6-10 times during the daytime and >81% intended to continue exclusive breastfeeding until 6 mo of age. CONCLUSION: This study, for the first time, documented the adequacy of breast-milk intake among Sri Lankan infants and the nutrition status of the mothers.

Indicators of newborn screening for congenital hypothyroidism in Sri Lanka: program challenges and way forward.

BACKGROUND: Many of the countries in the Asia Pacific Region are just initiating newborn screening programs for selected metabolic and other congenital disorders. The present study is aimed at evaluating the congenital hypothyroidism screening program in the Southern region of Sri Lanka in terms of coverage, effectiveness of detecting and managing the cases. METHODS: The Newborn Screening System Database of Sri Lanka was reviewed from January 2011 to December 2012. The data of 47 babies who tested positive for hypothyroidism were analyzed. RESULTS: Total of 78,167 babies (99.0% of live births) were screened. Of them, 5.8% (n = 4,472) were discharged within 12 hrs of delivery where as 58.1% (n = 44969) were discharged afterwards but within next 12 hrs (i.e., day 1). The positive predictive value for congenital hypothyroidism (CH) was 9.0%. The incidences of primary CH among screened infants were 1:1682. False positive rate among screened infants was maintained below 0.70%. Mean age of serum confirmation was 23.8 (±8) days. CONCLUSIONS: In the light of the present findings, we would suggest direct communication systems, linking newborn screening program to the family unit. This would enhance timely follow-up for screen-positive infants and facilitate information sharing. Establishing a program with, public-private sector partnership should be considered. Costs could be contained if the specimen collection, its transportation and communication are carried out by this partnership and the laboratory tests are conducted by a non-profit organization such as a University in order to achieve the goal of universal coverage.

How does the quality of life and the underlying biochemical indicators correlate with the performance in academic examinations in a group of medical students of Sri Lanka?

BACKGROUND: Individual variation of examination performance depends on many modifiable and non-modifiable factors, including pre-examination anxiety. Medical students' quality of life (QoL) and certain biochemical changes occurring while they are preparing for examinations has not been explored. PURPOSE: We hypothesize that these parameters would determine the examination performance among medical students. METHODS: Fourth-year medical students (n=78) from the University of Ruhuna, Sri Lanka, were invited. Their pre- and post-exam status of QoL, using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, and the level of biochemical marker levels (i.e., serum levels of thyroid profile including thyroglobulin, cortisol and ferritin) were assessed. Differences between the scores of QoL and serum parameters were compared with their performance at the examination. RESULTS: The mean QoL score was significantly lower at pre-exam (56.19±8.1) when compared with post-exam (61.7±7.1) levels (p<0.001). The median serum TSH level prior to the exam (0.9 mIU/L; interquartile range 0.74-1.4 mIU/L) was significantly lower (p=0.001) when compared with the level after the exam (median of 2.7 mIU/L; IQR 1.90-3.60). The mean±SD fT4 level was significantly higher before the exam (19.48±0.4 pmol/L at study entry vs. 17.43±0.3 pmol/L after the exam; p<0.001). Median serum ferritin (SF) level prior to the exam (43.15 (23.5-63.3) µg/L) was significantly lower (p≤0.001) when compared with after-exam status (72.36 (49.9-94.9) µg/L). However, there was no difference in mean serum cortisol levels (16.51±0.7 at pre-exam and 15.88±0.7 at post-exam, respectively; p=0.41). CONCLUSIONS: Students had higher fT4 and low ferritin levels on pre-exam biochemical assessment. It was evident that students who perform better at the examination had significantly higher QoL scores at each domain tested through the questionnaire (Physical health, Psychological, Social interaction and Environment). The higher the QoL scores, the better the grades were. It was also found that students who failed exhibited profound differences in the QoL score.

Coexisting micronutrient deficiencies among Sri Lankan pre-school children: a community-based study.

Assessing micronutrient status in children may also have the benefit of addressing the problems of various micronutrient deficiencies with a unified programmatic approach on a public health scale. A cross-sectional survey in the Galle district of the micronutrient and anthropometric status of 248 children of ages 3-5 years was performed to determine the prevalence of micronutrient deficiencies [iron, zinc (Zn), folate, calcium, caeruloplasmin, iodine, vitamin A and vitamin D] and the extent to which multiple micronutrient deficiencies coexist. The prevalence of anaemia [haemogbolin (Hb) < 110.0 g L⁻¹] was 34.0% in males and 33.0% in females (overall 33.5%, gender difference, P = 0.92). In anaemic children, 7.0% of males and 15.0% of females were iron deficient (serum ferritin < 15.0 µg L⁻¹). Folate deficiency (<3.00 ng mL⁻¹) was found in 41.0% and 33.0% of male and female, respectively, whereas Zn deficiency (<9.95 µmol L⁻¹) occurred in 57.0% and 50.0% of male and female, respectively. Serum vitamin D deficiency (<35.0 nmol L⁻¹) was found in 26% and 25% of male and female, respectively. Anaemic males had a 3.0-fold (95% confidence interval (CI) 1.1-8.3) and 2.3-fold (95% CI 0.8-6.6) greater risk of being underweight and thin, whereas the risk among anaemic females was 0.7-fold (95% CI 0.3-1.8) and 0.9-fold (95% CI 0.3-2.6) for being underweight and thin. Only 7.3% of the subjects did not have any micronutrient deficiency, 38.3% were deficient in two micronutrients, 17.7% had three micronutrient deficiencies and 6.0% had four or more micronutrient deficiencies. Multiple micronutrient deficiencies are prevalent in Sri Lankan pre-school children and established baseline data for future studies.

Effects of zinc and multimineral vitamin supplementation on glycemic and lipid control in adult diabetes.

AIMS: To evaluate the effects of zinc with or without other antioxidants on blood glucose, lipid profile, and serum creatinine in adult diabetics on long-term follow-up. MATERIALS AND METHODS: Patients (n = 96) were randomly allocated to three groups: group A (n = 29) was supplemented with oral zinc sulfate (22 mg/day) and multivitamin/mineral (zinc+MVM) preparation; group B (n = 31) was given the same preparation without zinc (MVM); and group C (n = 36) was given a matching placebo for a period of 4 months in a single-blinded study. Blood samples were taken at baseline and after 4 months of supplementation to assess blood glucose (fasting and postprandial) and glycosylated hemoglobin (Hb(A1C)%) and serum levels of zinc, creatinine, and lipids. RESULTS: The zinc+MVM group had a mean change of fasting blood sugar -0.33 mmol/L (standard error of the mean 0.21 mmol/L) and was significant (P = 0.05) when compared with the other two groups (mean change in the MVM group +0.19 (0.31) mmol/L and +0.43 (0.23) mmol/L in the control group, respectively). The Hb(A1C)% level reduced significantly, irrespective of the baseline level, in zinc+MVM-supplemented individuals. In the other two groups, the change of Hb(A1C)% level was not significant. Serum lipid levels reduced significantly in the zinc+MVM and MVM groups. CONCLUSIONS: Zinc+MVM supplementation showed beneficial effects in the metabolic control of adult diabetics in addition to elevating their serum zinc level. Zinc supplementation improved glycemic control measured by Hb(A1C)% and fasting and postprandial glucose. Furthermore, zinc supplementation lowered serum cholesterol and cholesterol/high-density lipoprotein ratio.

Long-term cereal-based nutritional supplementation improved the total spine bone mineral density amongst Sri Lankan preschool children: a randomized controlled study.

BACKGROUND: The Thriposha programme in Sri Lanka provides a combination of energy, protein and micronutrients as a 'ready-to-eat' cereal-based food. OBJECTIVE: To assess the effectiveness of calcium and vitamin D3 in the Thriposha on bone mineralization among preschool children aged 3-5 years. DESIGN: Subjects (n = 30) were fed with conventional Thriposha while the control group (n = 30) children were fed without mineral and vitamin premix (Corn-Soya-Blend - CSB) for a period of nine months. Dual-energy X-ray absorptiometry (DXA) of total spine was measured at the baseline and after the intervention. RESULTS: The mean baseline total spine BMD was 0.464 (0.050) g/cm2 in the interventional group and 0.453 (0.035) g/cm2 in the control group (p = 0.09). At the end of the study, the BMD levels were 0.487 (0.047) and 0.454 (0.031) g/cm2 (p < 0.001) respectively. CONCLUSION: Daily supplementation of cereal based food supplement over a period of nine months improved the total spine BMD.

Changing the zinc:iron ratio in a cereal-based nutritional supplement has no effect on percent absorption of iron and zinc in Sri Lankan children.

The Thriposha programme is a community-level nutrition intervention in Sri Lanka that provides a combination of energy, protein and micronutrients as a 'ready-to-eat' cereal-based food. We measured the bioavailability of Fe and Zn from Thriposha formula at two different molar ratios of Zn:Fe in order to determine the effect on Fe and Zn absorption. Children 4-7 years (n 53) were given a meal prepared with 50 g Thriposha containing 1.5 mg Zn as zinc sulphate and either 9 mg (high Fe concentration (HiFe)) or 4.5 mg (low Fe concentration (LoFe)) Fe as ferrous fumarate. Zn and Fe percent absorption were measured using stable isotopes by tracer:tracee ratio and by incorporation of erythrocytes, respectively. Percent Fe absorption from the two meals was similar (6.6 % (4.8) v. 4.8 % (2.6); P = 0.15), but total Fe absorption was significantly higher from the HiFe meal (0.59 (0.43) mg) than the LoFe meal (0.20 (0.12) mg; P = 0.01). There was no significant difference between the two groups in Zn absorption (10.7 % (0.9) v. 8.8 % (1.4), P = 0.13, respectively). Decreasing the amount of Fe in Thriposha did not cause a significant change in the percent absorption of Fe and Zn, but significantly lowered the total amount of absorbed Fe. These results demonstrate the utility of maintaining a higher Fe content in this supplement. Further studies to increase Zn content are warranted while maintaining a HiFe.

Adequacy of vitamin A and fat in the breast milk of lactating women in south Sri Lanka.

OBJECTIVE: To determine vitamin A (retinol) and fat concentrations in breast milk during early lactation. METHODS: Healthy lactating women (n 88) aged between 18 and 35 years were randomly selected for the study from urban, semi-urban, rural and estate (plantation) sectors of Galle District. Their anthropometry was recorded; breast milk samples were collected from the right breast one hour after the last feed. Breast milk retinol was determined by HPLC and fat content by the crematocrit method. RESULTS: Subjects were in the 2nd to 9th month of lactation. Retinol concentrations of the breast milk samples ranged from 0.10 to 2.46 micromol/l, with a mean of 0.50 micromol/l, and correlated positively with parity (Pearson correlation coefficient, r = 0.307; P = 0.01) and negatively with period of lactation (r = -0.209; P = 0.05). The fat content of breast milk ranged between 5.09 and 56.46 g/l with a mean of 26.95 g/l. A significant difference in either breast milk fat or retinol content and mean birth weight of the babies was not seen between the groups. The ratio of retinol to fat in breast milk was positively correlated with weight (r = 0.274; P = 0.01) and height (r = 0.328; P < 0.001) of the mothers. CONCLUSIONS: In this primary investigation on breast milk quality the fat content was found to be marginal; the majority of lactating mothers (92.0%) were not providing the minimum daily requirement (1.05 micromol/l) of retinol to their babies.

Prevalence and severity of micronutrient deficiency: a cross-sectional study among adolescents in Sri Lanka.

In order to determine the prevalence of micronutrient deficiencies (iron, zinc and folate) in Sri Lankan adolescent school children and the extent to which multiple micronutrient deficiencies exist in this population, a cross-sectional survey (2003) in the Galle district of the micronutrient and anthropometric status of 945 school children of ages 12-16 years was performed. The prevalence of anemia (Hb < 120.0 g/L) was 49.5% in males and 58.1% in females (overall 54.8%, gender difference, P = 0.004). In anemic children 30.2% of males and 47.8% of females were iron deficient (serum ferritin < 30.0 microg/L). Folate deficiency (<6.80 nmol/L) was found in 54.6% and 52.5% of boys and girls respectively whereas zinc deficiency (<9.95 micromol/L) occurred in 51.5% and 58.3%. Anemic boys had a 1.5 (95% confidence interval (CI) 0.9-2.6) and 1.6-fold (CI; 1.1-2.6) greater risk of being stunted and underweight, whereas the risk among anemic girls was 1.7 (CI; 1.1-2.7) and 1.0 (CI; 0.7-1.5) for being stunted and underweight. The relative risks of having at least two deficiencies in iron, zinc and folate among anemic children were 1.6 (CI; 0.6-4.2) among boys and 0.8 (CI; 0.5-1.5) among girls. Iron deficient subjects had a significantly increased risk of 1.8 (CI, 1.1-3.0) of being deficient in folate and 1.7 (CI, 1.2-2.6) of being deficient in zinc. Zinc deficient subjects had a risk of 1.3 (CI, 1.0-1.8) being iron deficient and 1.2 (CI, 0.9-1.7) of being folate deficient. Multiple micronutrient deficiencies are prevalent in Sri Lankan adolescents.

Nutrient intake and growth of adolescents in southern Sri Lanka.

OBJECTIVE: Growth and dietary intake data are essential for formulation of nutritional policies and interventions for children. DESIGN: 945 school children (11-16 years) were subjected to growth assessment and their nutrient intake was determined using the 24-hour dietary recall method on three consecutive days. RESULTS: 21.3% of boys and 21.1% of girls were stunted (-2SD below the median height-for-age). 141 (14.9%) children were both stunted and wasted (-2 SD below the median weight-for-age). Mean body mass index of girls was significantly higher (p < 0.001) than boys at all ages. The mean daily dietary intake of energy was 3.2 (+/- 2.4) MJ, protein 29.1 (+/- 2.1) g, fat 4.5 (+/- 1.1) g, iron 11.5 (+/- 1.0) mg, and zinc 0.8 (+/- 0.7) mg among boys. Among girls, energy intake was 4.2 (+/- 1.8) MJ, protein 29.0 (+/- 2.3) g, fat 4.4 (+/- 1.0) g, iron 11.4 (+/- 1.0) mg, and zinc 0.5 (+/- 0.6) mg. Fat comprised about 4.0% of the daily energy intake. CONCLUSIONS: High rate of growth deficiency and undernutrition among adolescents mandates innovative nutritional intervention strategies. The observed mean intakes of nutrients in the sample showed a worrisome deviation from the recommendations of the dietary guidelines for Sri Lanka.