South East Asian Nutrition Surveys (SEANUTS) II - a multi-country evaluation of nutrition and lifestyle indicators in children aged 12 years and below: rationale and design.

OBJECTIVE: To assess the nutritional status, growth parameters and lifestyle behaviours of children between 0·5 and 12 years in nationally representative samples in Malaysia, Indonesia, Thailand and Vietnam. DESIGN: A cross-sectional study was conducted in the four countries, between May 2019 and April 2021. Data collected can be categorised into four categories: (1) Growth - anthropometry, body composition, development disorder, (2) nutrient intake and dietary habits - 24-h dietary recall, child food habits, breast-feeding and complementary feeding, (3) socio-economic status - food insecurity and child health status/environmental and (4) lifestyle behaviours - physical activity patterns, fitness, sunlight exposure, sleep patterns, body image and behavioural problems. Blood samples were also collected for biochemical and metabolomic analyses. With the pandemic emerging during the study, a COVID-19 questionnaire was developed and implemented. SETTING: Both rural and urban areas in Malaysia, Indonesia, Thailand and Vietnam. PARTICIPANTS: Children who were well, with no physical disability or serious infections/injuries and between the age of 0·5 and 12 years old, were recruited. RESULTS: The South East Asian Nutrition Surveys II recruited 13 933 children. Depending on the country, data collection from children was conducted in schools and commune health centres, or temples, or sub-district administrative organisations. CONCLUSIONS: The results will provide up-to-date insights into nutritional status and lifestyle behaviours of children in the four countries. Subsequently, these data will facilitate exploration of potential gaps in dietary intake among Southeast Asian children and enable local authorities to plan future nutrition and lifestyle intervention strategies.

Food safety-related perspectives and practices of consumers and vendors in Ethiopia: A scoping review.

Despite being one of the first African countries to prioritize food safety, foodborne diseases are of acute concern in Ethiopia. This review aims to understand food safety-related perspectives and practices among consumers and food vendors in Ethiopia to identify motivations, beliefs, and values that shape and/or drive their practices. A well-defined search and review identified 116 relevant articles. These spanned eight of the ten regional states and two chartered cities, with most work focusing on urban areas and on a sample within one state or chartered city. Ninety-four studies focused on vendors or food handlers; fifteen articles examined both consumers and vendors, but only four assessed interactions between the groups. Meat, dairy products, and ready-to-eat (street) foods were the most studied food groups. Food service establishments were the most examined outlets. Forty-six studies examined generic food safety issues or concerns. Overall, 102 studies assessed food safety practices; 53 studies examined knowledge, and 19 studies assessed attitudes. A gap in vendors' observed practices versus knowledge and attitudes was noted. Consumer deductions of food safety were based on vendor practices. Both groups used physical attributes based on senses to assess quality and safety of animal-source foods, had their own 'coping' strategies to address food safety-related concerns, and had similar views on consumer choice motives. Analysis of food and the food handling environment revealed a high level of contamination. An additional study, included after the original search, identified training to be effective in influencing knowledge, attitudes, and practices - though results for attitudes and practices were not sustained in the long term. Future research should address consumers and consumer-vendor interactions and include the full triad of knowledge-attitudes-practices. It is also recommended to focus on nutrient-rich foods as well as on traditional markets and local eateries. Improving the quality of research will be critical to improve food safety in Ethiopia.

Animal source foods, rich in essential amino acids, are important for linear growth and development of young children in low- and middle-income countries.

Growth faltering under 5 years of age is unacceptably high worldwide, and even more children, while not stunted, fail to reach their growth potential. The time between conception and 2 years of age is critical for development. The period from 6 to 23 months, when complementary foods are introduced, coincides with a time when growth faltering and delayed neurocognitive developments are most common. Fortunately, this is also the period when diet exercises its greatest influence. Growing up in an adverse environment, with a deficient diet, as typically seen in low- and middle-income countries (LMICs), hampers growth and development of children and prevents them from realising their full developmental and economic future potential. Sufficient nutrient availability and utilisation are paramount to a child's growth and development trajectory, especially in the period after breastfeeding. This review highlights the importance of essential amino acids (EAAs) in early life for linear growth and, likely, neurocognitive development. The paper further discusses signalling through mammalian target of rapamycin complex 1 (mTORC1) as one of the main amino acid (AA)-sensing hubs and the master regulator of both growth and neurocognitive development. Children in LMICs, despite consuming sufficient total protein, do not meet their EAA requirements due to poor diet diversity and low-quality dietary protein. AA deficiencies in early life can cause reductions in linear growth and cognition. Ensuring AA adequacy in diets, particularly through inclusion of nutrient-dense animal source foods from 6 to 23 months, is strongly encouraged in LMICs in order to compensate for less than optimal growth during complementary feeding.

Prevalence of functional gastrointestinal disorders in infants and young children in China.

BACKGROUND: The prevalence of functional gastrointestinal disorders (FGIDs) in children, particularly from Asia, is largely unknown. There are not many studies done in Asia especially using the Rome IV criteria. The aim of this study is to assess the prevalence of FGIDs in infants and young children in a representative sample in China. METHODS: A prospective, cross-sectional, community-based survey was conducted among healthy infants and young children between the ages of 0-4 years in Jinhua and Shanghai, China. A total of 2604 subjects (1300 subjects from Jinhua and 1304 subjects from Shanghai) completed a validated questionnaire on pediatric gastrointestinal symptoms. FGIDs in infants and young children were diagnosed using the Rome IV criteria. RESULTS: According to the Rome IV criteria, the prevalence of having a FGID in Chinese infants and young children is 27.3%. Infant regurgitation (33.9%) was the most common FGID among the 0-6 months old while functional constipation (7.0%) was the most common among the 1-4 years old. Risk factor analysis revealed that prevalence of infantile colic was higher with better maternal education and low birth weight. Prevalence of infantile regurgitation was significantly greater in males, living in a rural area, being exclusively breast fed at least up to 4 months and starting formula feeds within the first month. The risk of functional constipation was lower for infants who were delivered vaginally. CONCLUSIONS: Infantile regurgitation was the most common FGID in Chinese infants while functional constipation was most prevalent among young Chinese children. TRIAL REGISTRATION: Netherlands Trial Registry Identifier: NL6973/NTR7161 .

Nutritional Support of Neurodevelopment and Cognitive Function in Infants and Young Children-An Update and Novel Insights.

Proper nutrition is crucial for normal brain and neurocognitive development. Failure to optimize neurodevelopment early in life can have profound long-term implications for both mental health and quality of life. Although the first 1000 days of life represent the most critical period of neurodevelopment, the central and peripheral nervous systems continue to develop and change throughout life. All this time, development and functioning depend on many factors, including adequate nutrition. In this review, we outline the role of nutrients in cognitive, emotional, and neural development in infants and young children with special attention to the emerging roles of polar lipids and high quality (available) protein. Furthermore, we discuss the dynamic nature of the gut-brain axis and the importance of microbial diversity in relation to a variety of outcomes, including brain maturation/function and behavior are discussed. Finally, the promising therapeutic potential of psychobiotics to modify gut microbial ecology in order to improve mental well-being is presented. Here, we show that the individual contribution of nutrients, their interaction with other micro- and macronutrients and the way in which they are organized in the food matrix are of crucial importance for normal neurocognitive development.

Effect of milk fat-based infant formulae on stool fatty acid soaps and calcium excretion in healthy term infants: two double-blind randomised cross-over trials.

BACKGROUND: Palmitic acid (PA) is predominantly esterified at the SN-2 position of triacylglycerols in human milk. PA at the SN-2 position is more efficiently absorbed and results in reduced formation of PA soaps, as well as reduced fatty acid (FA) and calcium malabsorption. Bovine milk fat (MF), a natural source of SN-2-palmitate, was used in the fat blend of infant formulae (IF) in the current study to investigate its effect on stool fatty acid soaps, calcium excretion and stool characteristics. METHODS: Two double-blind, randomised cross-over trials (CS1, CS2) were conducted in parallel with healthy term, formula-fed infants aged 9-14 weeks. After a two-week run-in period, infants in CS1 (n = 17) were randomly allocated to receive either a 50% MF-based formula (50MF) or a 100% vegetable fat (VF) formula; in CS2 (n = 18), infants received either a 20% MF-based formula (20MF) or the VF formula, in a 2 × 2-week cross-over design. At the end of each two-week intervention period, stool samples were collected for FA, FA soaps and calcium excretion analysis and stool consistency was assessed according to the Amsterdam Infant Stool Scale (AISS). RESULTS: MF-based groups showed no significant difference in PA in stools compared to VF group, although reduced stool PA soaps (CS1: 111.28 ± 18.33 vs. 220.25 ± 29.35 mg/g dry weight, p < 0.0001; CS2: 216.24 ± 25.16 vs. 233.94 ± 35.12 mg/g dry weight, p = 0.0023), total FA soaps and calcium excretion (CS1: 46.40 ± 5.27 vs. 49.88 ± 4.77 mg/g dry weight, p = 0.0041; CS2: 46.20 ± 4.26 vs. 50.47 ± 6.71 mg/g dry weight, p = 0.0067) were observed. Furthermore, the 50MF group showed a favourable lower mean stool consistency score compared to the VF group (1.64 ± 0.49 vs. 2.03 ± 0.19, p = 0.0008). CONCLUSIONS: While the use of bovine MF in IF did not affect PA concentrations in stool, lower excretion of palmitate soaps, total FA soaps and calcium was seen in healthy term infants. 50MF formula also showed improved stool consistency. The use of MF in IF could be an interesting approach to improve gut comfort and stool characteristics in infants, warranting further research. TRIAL REGISTRATION: Netherlands Trial Registry Identifier: NTR6702. Date registered: December 01, 2017.

A Combined Nutrition and Exercise Intervention Influences Serum Vitamin B-12 and 25-Hydroxyvitamin D and Bone Turnover of Healthy Chinese Middle-Aged and Older Adults.

BACKGROUND: Hong Kong faces several public health problems including malnutrition and osteoporosis. Considering the typical Chinese diet and overall low physical activity levels of Chinese adults, timely interventions to improve nutritional status and bone health are needed. OBJECTIVES: We examined the effects of a nutrition plus exercise intervention on serum vitamin B-12 and 25-hydroxyvitamin D [25(OH)D], bone turnover markers, and parathyroid hormone (PTH) concentrations in apparently healthy Chinese middle-aged and older adults. METHODS: In this 24-wk randomized controlled trial, 180 Chinese adults (85 women, mean ± SD age: 61 ± 6 y) were randomly assigned to receive a fortified milk supplement (2 × 30 g/d) and an exercise program (2 × 1 h/wk including resistance, balance, and aerobic training) or no intervention. The primary outcome was physical performance. In this article we analyzed the secondary outcomes serum vitamin B-12 and 25(OH)D concentrations, assessed at baseline, 12 wk, and 24 wk. Also, bone turnover markers and PTH concentrations were studied. Linear mixed models evaluated group differences over time. RESULTS: A significant time × group interaction (P < 0.001) was found for serum vitamin B-12 and 25(OH)D concentrations and the bone turnover markers, but not for serum PTH concentrations (P = 0.09). The intervention increased mean ± SD vitamin B-12 concentrations from baseline (345 ± 119 pmol/L) to 24 wk (484 ± 136 pmol/L), whereas concentrations remained stable within the control. For 25(OH)D concentrations, the intervention group had a greater increase from baseline (54.7 ± 14.2 nmol/L) to 24 wk (80.1 ± 19.2 nmol/L) than the control (60.6 ± 15.2 compared with 65.6 ± 14.6 nmol/L). The ratio of the net effect of bone formation and resorption was greater in the intervention group, suggesting less bone remodeling, irrespective of sex. CONCLUSIONS: A fortified milk supplement and exercise intervention successfully improved vitamin B-12 and 25(OH)D concentrations as well as the balance of bone turnover markers of Chinese middle-aged and older adults.This trial was registered at trialregister.nl as NTR6214.

Reduced Occurrence of Gastrointestinal Symptoms in Chinese Infants Fed Minimally Processed Commercially Available Formula: A Cross-Sectional Observational Study.

Healthy Chinese infants consuming one of four commercially available infant formulas (IF) were assessed on the occurrence of gastrointestinal symptoms associated with suboptimal digestion of processed milk proteins. The IF differed in blocked lysine (BL) levels, a proxy indicator of heat processing as well as the nutritional quality of milk. A cross-sectional, observational study of one week was conducted in healthy, term, exclusively formula-fed Chinese infants (n = 452) fed with one of four commercially available IF (IF A n = 106, BL 9%; IF B n = 119, BL 12%; IF C n = 113, BL 11%; IF D n = 114 BL 20%). Parents/caretakers were requested to report feeding quantity, gastrointestinal symptoms, crying behavior, and stool characteristics daily using subject dairy and Amsterdam Infant Stool Scale (AISS). Infants fed with IF A reported less "hard" and "watery" stools and more "soft/formed" stools. Higher percentages of score I (yellow/golden) or II (orange) and less green (score III) coloured stools were noted for IF A-fed infants compared to all other formulas according to AISS. Night time crying was also significantly lower in the IF A groups compared to all other formulas. Furthermore, a higher percentage of parents/caretakers of IF A-fed infants reported absence or no complaints of abdominal distension, burping, flatulence, diarrhea, and constipation. Results suggest lower occurrence of GI symptoms and lower crying time at night in infants fed with minimally processed formula (indexed by BL levels). Future studies are required to confirm the association between minimal processing of milk formula and improved gut comfort in healthy infants.

Reduced crying and favourable stool characteristics in Chinese infants fed milk fat-based formula.

BACKGROUND AND OBJECTIVES: Chinese infants consuming four different commercially-available infant formulas were evaluated on gut comfort and stool consistency parameters. METHODS AND STUDY DESIGN: Gut comfort characteristics were evaluated during a 7-day cross-sectional observational study in 409 healthy, term, exclusively formula-fed infants via questionnaires and fecal parameters. RESULTS: The stool consistency and color scores were different between the infants consuming one of the four commercially-available infant formulas including different fat sources, i.e. one milk fat-based (IF1), two structured vegetable fat blend-based (IF2 and IF4) and one palm oil-free vegetable fat blend-based (IF3). The scoring pattern showed more 'soft-formed' stools for IF1- consuming infants compared to infants consuming IF2, IF3 or IF4. In addition, a lower amount of green feces was observed in combination with an increase in golden-colored feces for IF1-consuming infants compared to the other groups. Furthermore, IF1-consuming infants reported less fussy/crying time during the night and less gut discomfort. Infants consuming milk fat-based IF1 showed significantly lower fatty acid soaps compared to palmoil free IF3-fed infants. CONCLUSIONS: Infants consuming milk fat-based IF1 experienced less gut discomfort compared to infants consuming other commercially-available infant formula. Lower fecal fatty acid soap levels, fussy/crying time during the night and gut discomfort were observed. These findings contribute to the current understanding of the association between lipid structure and gut comfort parameters. However, the suggested benefits noted cannot be fully linked to the effect of fat blend differences since formulas differ in ingredient-sourcing and processing. Future research should confirm the added benefit of milk fat-based infant formulas to improve gut comfort parameters.

Randomized Controlled Trial of Exercise and Nutrition Supplementation on Physical and Cognitive Function in Older Chinese Adults Aged 50 Years and Older.

OBJECTIVES: To assess whether a 24-week multidomain lifestyle intervention including a nutritional milk supplement and an exercise program had any effect on physical and cognitive function, self-rated health, and health-related quality of life in older Chinese adults. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: Community-living people aged 50 years and older. METHODS: 180 participants (mean age 61 ± 6 years) were randomized to 24 weeks of exercise plus nutrition supplementation or no intervention. The primary outcome was gait speed, with additional physical and cognitive function measures, self-rated health, and health-related quality of life as secondary outcomes. Information collected also included dietary intake by 3-day dietary records, and blood sampling for renal function, glycated hemoglobin, serum vitamin B12, 25-hydroxyvitamin D, and biochemical indices of bone turnover. RESULTS: There was no significant group difference in the change of gait speed, muscle strength, muscle power, cardiovascular fitness, or cognitive function over time, either by intention-to-treat or per-protocol analysis. A significant time × group effect (P = .039) on self-rated health was detected, but there was no significant time or time × group difference in the change of physical and mental health-related quality of life measures over time. In addition, moderate physical activity level was greatly increased from baseline to 24 weeks in the intervention group compared with the control group. CONCLUSIONS AND IMPLICATIONS: A 24-week exercise and nutrition supplementation program among community-living people in late midlife to early old age improved self-rated health and the overall level of physical activity, without objective improvements in physical and cognitive function.

Addressing nutritional requirements of ageing consumers in Asia-recommendations from an expert workshop.

The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-communicable chronic diseases, malnutrition, and geriatric syndromes, which influences the burden on the cost related to healthcare, health outcomes, and the quality of life. Experts in the field of older adult nutrition from Asia, Australia, and Europe were invited to participate in a two-day workshop to review the available data, current policies and programs for the ageing population in different countries of Asia to identify the gaps in knowledge and to develop recommendations for action. In Asia, most of the data pertaining to health status, nutritional status, and nutrient intake of the older persons were mainly obtained by conducting studies in nursing homes or hospitals and small cohort studies. There were limited country-specific data on this population. Moreover, the available data pertaining to different countries were difficult to compare due to differences in the reporting format and reference values used. Although nutrition initiatives and policies were realized and public education was conducted to support the older persons, most of these efforts targeted the general population rather than the older persons population segment. In healthcare management, a higher amount of education is required pertaining to the knowledge of nutritional requirements and appropriate feeding of the older persons to reduce underfeeding and its consequences. The expert group recommended the use of a systematic approach for reviewing data pertaining to different countries, initiatives, and programs to further evaluate the available data to underpin future research.

Low socioeconomic status and severe obesity are linked to poor cognitive performance in Malaysian children.

BACKGROUND: Socioeconomic factors and nutritional status have been associated with childhood cognitive development. However, previous Malaysian studies had been conducted with small populations and had inconsistent results. Thus, this present study aims to determine the association between socioeconomic and nutritional status with cognitive performance in a nationally representative sample of Malaysian children. METHODS: A total of 2406 Malaysian children aged 5 to 12 years, who had participated in the South East Asian Nutrition Surveys (SEANUTS), were included in this study. Cognitive performance [non-verbal intelligence quotient (IQ)] was measured using Raven's Progressive Matrices, while socioeconomic characteristics were determined using parent-report questionnaires. Body mass index (BMI) was calculated using measured weight and height, while BMI-for-age Z-score (BAZ) and height-for-age Z-score (HAZ) were determined using WHO 2007 growth reference. RESULTS: Overall, about a third (35.0%) of the children had above average non-verbal IQ (high average: 110-119; superior: ≥120 and above), while only 12.2% were categorized as having low/borderline IQ (< 80). Children with severe obesity (BAZ > 3SD), children from very low household income families and children whose parents had only up to primary level education had the highest prevalence of low/borderline non-verbal IQ, compared to their non-obese and higher socioeconomic counterparts. Parental lack of education was associated with low/borderline/below average IQ [paternal, OR = 2.38 (95%CI 1.22, 4.62); maternal, OR = 2.64 (95%CI 1.32, 5.30)]. Children from the lowest income group were twice as likely to have low/borderline/below average IQ [OR = 2.01 (95%CI 1.16, 3.49)]. Children with severe obesity were twice as likely to have poor non-verbal IQ than children with normal BMI [OR = 2.28 (95%CI 1.23, 4.24)]. CONCLUSIONS: Children from disadvantaged backgrounds (that is those from very low income families and those whose parents had primary education or lower) and children with severe obesity are more likely to have poor non-verbal IQ. Further studies to investigate the social and environmental factors linked to cognitive performance will provide deeper insights into the measures that can be taken to improve the cognitive performance of Malaysian children.

25-hydroxy-vitamin D demography and the risk of vitamin D insufficiency in the South East Asian Nutrition Surveys (SEANUTS).

The South East Asian Nutrition Surveys (SEANUTS) were conducted in 2010/2011 in Indonesia, Malaysia, Thailand and Vietnam in country representative samples totalling 16,744 children aged 0.5 to 12 years. Information on socio-demographic and behavioural variables was collected using questionnaires and anthropometric variables were measured. In a sub-sample of 2016 children, serum 25-hydroxy-vitamin D (25(OH)D) was determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Children were categorized as deficient (<25 nmol/L), insufficient (<50 nmol/L), inadequate (<75 nmol/L) or desirable (>=75 nmol/L). In Malaysia and Thailand, urban children had lower 25(OH)D than rural children. In all countries, except Vietnam, boys had higher 25(OH)D levels and older children had lower 25(OH)D. Regional differences after correcting for age, sex and area of residence were seen in all countries. In Thailand and Malaysia, 25(OH)D status was associated with religion. The percentage of children with adequate 25(OH)D (>=75 nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50 nmol/L) was noted in 40 to 50% of children in all countries. Logistic regression showed that girls, urban area, region within the country and religion significantly increased the odds for being vitamin D insufficient. The high prevalence of vitamin D insufficiency in the (sub) tropical SEANUTS countries suggests a need for tailored approach to successfully combat this problem. Promoting active outdoor livestyle with safe sunlight exposure along with food-based strategies to improve vitamin D intake can be feasible options.

Physical Activity of Malaysian Primary School Children: Comparison by Sociodemographic Variables and Activity Domains.

This study describes the physical activity of primary school children according to sociodemographic characteristics and activity domains. Using the Malaysian South East Asian Nutrition Surveys data, 1702 children aged 7 to 12 years were included in the analysis. Physical activity was reported as a total score and categorized into low, medium, and high levels based on Physical Activity Questionnaire for Older Children. Higher overall activity scores were found in boys, younger age, non-Chinese ethnicity, and normal body mass index category. Sex, age, and ethnicity differences were found in structured or organized, physical education, and outside-of-school domain scores. Transport-related scores differed by age group, ethnicity, household income, and residential areas but not among the three physical activity levels. Participation of girls, Chinese, and older children were low in overall and almost all activity domains. Sociodemographic characteristics are important factors to consider in increasing the different domains of physical activity among Malaysian children.

Design of the South East Asian Nutrition Survey (SEANUTS): a four-country multistage cluster design study.

Nutrition is a well-known factor in the growth, health and development of children. It is also acknowledged that worldwide many people have dietary imbalances resulting in over- or undernutrition. In 2009, the multinational food company FrieslandCampina initiated the South East Asian Nutrition Survey (SEANUTS), a combination of surveys carried out in Indonesia, Malaysia, Thailand and Vietnam, to get a better insight into these imbalances. The present study describes the general study design and methodology, as well as some problems and pitfalls encountered. In each of these countries, participants in the age range of 0·5-12 years were recruited according to a multistage cluster randomised or stratified random sampling methodology. Field teams took care of recruitment and data collection. For the health status of children, growth and body composition, physical activity, bone density, and development and cognition were measured. For nutrition, food intake and food habits were assessed by questionnaires, whereas in subpopulations blood and urine samples were collected to measure the biochemical status parameters of Fe, vitamins A and D, and DHA. In Thailand, the researchers additionally studied the lipid profile in blood, whereas in Indonesia iodine excretion in urine was analysed. Biochemical data were analysed in certified laboratories. Study protocols and methodology were aligned where practically possible. In December 2011, data collection was finalised. In total, 16,744 children participated in the present study. Information that will be very relevant for formulating nutritional health policies, as well as for designing innovative food and nutrition research and development programmes, has become available.

Relationship between anthropometric indicators and cognitive performance in Southeast Asian school-aged children.

Nutrition is an important factor in mental development and, as a consequence, in cognitive performance. Malnutrition is reflected in children's weight, height and BMI curves. The present cross-sectional study aimed to evaluate the association between anthropometric indices and cognitive performance in 6746 school-aged children (aged 6-12 years) of four Southeast Asian countries: Indonesia; Malaysia; Thailand; Vietnam. Cognitive performance (non-verbal intelligence quotient (IQ)) was measured using Raven's Progressive Matrices test or Test of Non-Verbal Intelligence, third edition (TONI-3). Height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ) and BMI-for-age z-scores (BAZ) were used as anthropometric nutritional status indices. Data were weighted using age, sex and urban/rural weight factors to resemble the total primary school-aged population per country. Overall, 21% of the children in the four countries were underweight and 19% were stunted. Children with low WAZ were 3·5 times more likely to have a non-verbal IQ < 89 (OR 3·53 and 95% CI 3·52, 3·54). The chance of having a non-verbal IQ < 89 was also doubled with low BAZ and HAZ. In contrast, except for severe obesity, the relationship between high BAZ and IQ was less clear and differed per country. The odds of having non-verbal IQ levels < 89 also increased with severe obesity. In conclusion, undernourishment and non-verbal IQ are significantly associated in 6-12-year-old children. Effective strategies to improve nutrition in preschoolers and school-aged children can have a pronounced effect on cognition and, in the longer term, help in positively contributing to individual and national development.

Micronutrient supplementation improves physical performance measures in Asian Indian school-age children.

Micronutrients are important in physical work capacity and therefore performance. The impact of a multi-micronutrient-fortified nutritional beverage on physical performance measures among clinically healthy school-age children was assessed in a double-blind (for test and placebo groups), placebo-controlled, randomized trial in children aged between 7 and 10.5 y (n = 300). The participants with height- and weight-for-age Z-scores between 0 and ≥ -3 were randomized to 1 of 3 study arms: fortified choco-malt beverage powder (F), matched energy equivalent unfortified placebo (U), and untreated control (C). Participants in the F and C groups were given 40 g fortified (19 key vitamins and minerals) and unfortified choco-malt beverage, respectively, daily for 120 d. Primary efficacy outcomes included endurance and aerobic capacity using a 20-m shuttle test and step test. Other physical performance measures included speed (40-m sprint), visual reaction time, maximal hand grip, and forearm static endurance. Micronutrient status included thiamin, riboflavin, folate, niacin, iron, pyridoxal phosphate, and vitamins B-12 and C. All measurements were made at baseline and the end of the intervention. There was a within-subject increase in aerobic capacity and whole body endurance (P < 0.05) accompanied by a significant improvement in the status of iron thiamin, riboflavin, pyridoxal phosphate, folate, and vitamins C and B-12 in the F group compared to the within-subject changes in the other 2 groups (P < 0.05). The study suggests that multiple micronutrient supplementation in similar populations may be beneficial in improving micronutrient status and enhancing aerobic capacity and endurance in children.

Polyunsaturated fatty acid consumption and concentration among South Indian women during pregnancy.

In recent years there is growing interest on the role of long chain omega-3 polyunsaturated fatty acids (omega-3 LC-PUFA) in pregnancy and the growth and development of the offspring. We aim to characterize and provide baseline data on the intake of LCPUFA (omega-3 and omega-6) in a prospective cohort of 829 pregnant Indian women and report associations between LCPUFA intake and erythrocyte membrane phospholipid fatty acid concentration in a sub-group at baseline (1st trimester), the 2nd and 3rd trimesters of pregnancy. The dietary intake of all the macronutrients and of alpha-linolenic acid(ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) significantly increased over the 3 trimesters of pregnancy while that of omega-6 fatty acids (FA) remained unchanged. Median omega-3 FA intakes of ALA, EPA and DHA, however, were on average low at 0.56, 0.003 and 0.011 g/d, respectively while LA was 14.6 g/d during pregnancy. Consequently, the intake ratio of ALA to LA in the women in the present study was very low at 1:26. A significant decline in erythrocyte membrane arachidonic acid (AA) concentration but not of DHA was observed throughout pregnancy. This might be due to increased efficiency in terms of elongation of parent omega-3 FA. Dietary methods for improving the consumption of omega-3 FA need to be considered in the diets of young women as well as during pregnancy. As newborns primarily depend on placental transfer of omega-3 FA there is need to examine the omega-3 LC-PUFA concentration in infants of mother's with low intakes of omega-3 FA.

Role of Spirulina in the Control of Glycemia and Lipidemia in Type 2 Diabetes Mellitus.

Spirulina, with its high concentration of functional nutrients, is emerging as an important therapeutic food. This study aimed to evaluate the hypoglycemic and hypolipidemic role of Spirulina. Twenty-five subjects with type 2 diabetes mellitus were randomly assigned to receive Spirulina (study group) or to form the control group. At baseline, the control and study groups were matched for various variables. The efficacy of Spirulina supplementation (2 g/day for 2 months) was determined using the preintervention and postintervention blood glucose levels, glycosylated hemoglobin (HbA(1c)) levels, and lipid profiles of the diabetic subjects. Two-month supplementation with Spirulina resulted in an appreciable lowering of fasting blood glucose and postprandial blood glucose levels. A significant reduction in the HbA(1c) level was also observed, indicating improved long-term glucose regulation. With regard to lipids, triglyceride levels were significantly lowered. Total cholesterol (TC) and its fraction, low-density lipoprotein cholesterol (LDL-C), exhibited a fall coupled with a marginal increase in the level of high-density lipoprotein cholesterol (HDL-C). As a result, a significant reduction in the atherogenic indices, TC:HDL-C and LDL-C: HDL-C, was observed. The level of apolipoprotein B registered a significant fall together with a significant increment in the level of apolipoprotein A1. Therefore, a significant and favorable increase in the ratio of A1:B was also noted. These findings suggest the beneficial effect of Spirulina supplementation in controlling blood glucose levels and in improving the lipid profile of subjects with type 2 diabetes mellitus.