Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects.

BACKGROUND: Neural tube defects continue to be one of the main congenital malformations affecting the development of the nervous system and a significant cause of disability and disease burden to individuals living with these conditions. Mandatory food fortification with folic acid is, by far, one of the most efficacious, safe, and cost-effective interventions to prevent neural tube defects. However, most countries fail to effectively fortify staple foods with folic acid, impacting public health and healthcare systems and generating dismal disparities. AIM: This article discusses the main barriers and facilitators for implementing mandatory food fortification as an evidence-based policy to prevent neural tube defects worldwide. METHODS: A comprehensive review of the scientific literature allowed the identification of the determinant factors acting as barriers or facilitators for the reach, adoption, implementation, and scaling up of mandatory food fortification with folic acid as an evidence-based policy. RESULTS: We identified eight barriers and seven facilitators as determinant factors for food fortification policies. The identified factors were classified as individual, contextual, and external, inspired by the Consolidated Framework for Implementation of Research (CFIR). We discuss mechanisms to overcome obstacles and seize the opportunities to approach this public health intervention safely and effectively. CONCLUSIONS: Several determinant factors acting as barriers or facilitators influence the implementation of mandatory food fortification as an evidence-based policy worldwide. Notoriously, policymakers in many countries may lack knowledge of the benefits of scaling up their policies to prevent folic acid-sensitive neural tube defects, improve the health status of their communities, and promote the protection of many children from these disabling but preventable conditions. Not addressing this problem negatively affects four levels: public health, society, family, and individuals. Science-driven advocacy and partnerships with essential stakeholders can help overcome the barriers and leverage the facilitators for safe and effective food fortification.

Consumption of Fortified Wheat Flour and Associations with Anemia and Low Serum Ferritin in Colombia / Consumo de harina de trigo fortificada en Colombia y su asociación con anemia y ferritina sérica baja

Background: Colombia's mandatory wheat flour fortification program has yet to be evaluated. Objective: Examine associations between consumption of fortified wheat flour and low serum fer¬ritin (LSF) and anemia prevalence. Materials and Methods: A secondary analysis of the 2005 national nutrition survey (ENSIN) was completed for 3988 children 2-4 y, 5669 children 5-12 y and 2053 nonpregnant women 13-49 y. The relationship between consumption (quartiles) of wheat flour containing food (WFCF) and LSF and anemia was examined using chi-square analyses and logistic regression models. Results: In adjusted models, controlling for socio-economic status, intake of animal-origin foods, and supplement use in the last 24 hours, a correlation was found between WFCF and anemia in the preschool aged group, when comparing the quartile of highest WFCF consumption with the lowest quartile (OR: 0.7, 95 % CI: 0.6-0.9). The prevalence of LSF was similar across all quartiles of WFCF consumption in all age groups. The highest prevalence of anemia was observed in the lowest WFCF consumption quartiles in all age groups, but was not significantly different in non-pregnant women 13-49 y. No association between WFCF and LSF was observed in adjusted or unadjusted models. Conclusions: In Colombia, consumption of wheat flour containing foods is associated with lower levels of anemia in pre-school aged children.

Antecedentes: la fortificación obligatoria de harina de trigo en Colombia no se ha evaluado. Objetivo: examinar las asociaciones entre el consumo de harina y ferritina sérica baja (BSF) y la prevalencia de anemia. Materiales y métodos: se completó un análisis secundario de la Encuesta Nacional de la Situación Nutricional de 2005 (ENSIN) para 3988 niños de 2-4 años, 5669 escolares de 5-12 años y 2053 mujeres no embarazadas de 13-49 años. Se examinó la relación entre el consumo (cuartiles) de alimentos que contenían harina (ACHT) y la BSF y la anemia mediante análisis de ji al cuadrado y modelos de regresión logística. Resultados: en modelos ajustados, controlando por el estado socioeconómico, alimentos de origen animal y la ingesta de suplementos en las 24 horas anteriores, existía relación entre ACHT y la anemia en los preescolares, al comparar el cuartil más alto del consumo de ACHT con el cuartil más bajo (OR: 0,7; IC 95 %: 0,6-0,9). No se observó asociación entre ACHT y BFS en modelos ajustados. Conclusiones: en Colombia, el consumo de alimentos que contienen harina de trigo se asocia con niveles más bajos de anemia en preescolares.

Consumption of Fortified Wheat Flour and Associations with Anemia and Low Serum Ferritin in Colombia.

BACKGROUND: Colombia's mandatory wheat flour fortification program has yet to be evaluated. OBJECTIVE: Examine associations between consumption of fortified wheat flour and low serum ferritin (LSF) and anemia prevalence. MATERIALS AND METHODS: A secondary analysis of the 2005 national nutrition survey (ENSIN) was completed for 3988 children 2-4 y, 5669 children 5-12 y and 2053 non-pregnant women 13-49 y. The relationship between consumption (quartiles) of wheat flour containing food (WFCF) and LSF and anemia was examined using chi-square analyses and logistic regression models. RESULTS: In unadjusted analyses, the prevalence of LSF was similar across all quartiles of WFCF consumption in all age groups. The highest prevalence of anemia was observed in the lowest WFCF consumption quartiles in all age groups, but was not significantly different in non-pregnant women 13-49 y. In adjusted models this relationship between WFCF and anemia remained for children 2-4 y when comparing the highest WFCF intake quartile with the lowest quartile (OR: 0.7, 95 % Cl: 0.6-0.9). No association between WFCF and LSF was observed in adjusted (or unadjusted) models. CONCLUSIONS: In Colombia, consumption of wheat flour containing foods is associated with lower levels of anemia in pre-school children.

ANTECEDENTES: la fortificación obligatoria de harina de trigo en Colombia no se ha evaluado. OBJETIVO: examinar las asociaciones entre el consumo de harina y ferritina sérica baja (BSF) y la prevalencia de anemia. MATERIALES Y MÉTODOS: se completó un análisis secundario de la Encuesta Nacional de la Situacion Nutricional de 2005 (ENSIN) para 3988 niños de 2­4 años, 5669 escolares de 5­12 años y 2053 mujeres no embarazadas de 13­49 años, Se examino la relacion entre el consumo (cuartiles) de alimentos que contenían harina (ACHT) y la BSF y la anemia mediante análisis de ji al cuadrado y modelos ae regresión logística. RESULTADOS: en modelos ajustados, controlando por el estado socioeconomico, alimentos de origen animal y la ingesta de suplementos en las 24 horas anteriores, existía relacion entre ACHT y la anemia en los preescolares. al comparar el cuartil más alto del consumo de ACHT con el cuartil más bajo (OR: 0.7: IC 95 %: 0,6­0,9). No se observó asociación entre ACHT y BFS en modelos ajustados. CONCLUSIONES: en Colombia, el consumo de alimentos que contienen harina de trigo se asocia con niveles más bajos de anemia en preescolares.

Public and Private Sector Dynamics in Scaling Up Rice Fortification: The Colombian Experience and its Lessons.

BACKGROUND: Fortification of cereal grains with at least iron or folic acid is legislated in 85 countries worldwide. Relative to wheat and maize flour, rice fortification is relatively new and provides an opportunity to deliver essential micronutrients to populations that consume rice as a dietary staple. OBJECTIVE: To describe miller and public sector experiences and perspectives on rice fortification with micronutrients in Colombia and offer recommendations for policy makers. METHODS: Interviews with Colombian rice millers, research and development personnel, and public sector leaders; desk review of key documents. RESULTS: In Colombia, rice fortified with micronutrients is market driven and a few very large rice millers, currently representing about 35% of the market, have voluntarily fortified rice since 2002. The technology used (spraying) is unique to Colombia and to date there is no independent verification of nutrient retention after washing and cooking rice fortified through this technology. Millers are unwilling to switch to more proven methods, such as extrusion or coating, which will incur higher capital investment and recurring costs. Despite interest from multiple stakeholders between 2002 and 2011, mandatory rice fortification is not part of the Colombian government policy as of July 2015. CONCLUSION: Rice fortified with micronutrients through spraying technology has achieved moderate coverage in Colombia, but the technology is unproven, its effectiveness unknown, and public health impact likely limited. For rice fortification to be an effective nutrition intervention to improve micronutrient status, policy makers should explore standards to guide industry and improvements to regulatory capacity.

The nutrition transition in Colombia over a decade: a novel household classification system of anthropometric measures.

BACKGROUND: Overweight and underweight increase the risk of metabolic impairments and chronic disease. Interventions at the household level require the diagnosis of nutritional status among family members. The aim of this study was to describe the prevalence and patterns of various anthropometric typologies over a decade in Colombia using a novel approach that considers all children in the household as well as the mother. This approach also allows identifying a dual burden of malnutrition within a household, where one child may be overweight and another one undernourished. METHODS: This study used data from the Demographic and Health Survey and the Colombian National Nutrition Survey [2000 n = 2,876, 2005 n = 8,598, and 2010 n = 11,349]. Four mutually exclusive household (HH) anthropometric typologies - normal, undernourished, overweight/obese, and dual burden - were created. Anthropometric information of height-for-age Z-scores (HAZ) and body-mass-index-for-age Z-scores (BMIz) in children under the age of 5 y, and on body mass index (BMI) in mothers, 18-49 y was used. RESULTS: Prevalence of overweight/obese HHs increased between 2000 (38.2%) and 2010 (43.1%) (p < 0.05), while undernourished and dual burden HHs significantly decreased between 2005 (13.7% and 10.6%, respectively) and 2010 (3.5% and 5.1%, respectively) (p < 0.05). A greater increase of overweight/obesity was observed for the lowest quintile of wealth index (WI), with an increase of almost 10% between 2000 and 2010, compared to 2% and 4% for the fourth and highest WI, respectively. Although in 2010 there is still a higher prevalence of overweight/obesity HHs in urban areas (43.7%), the prevalence of overweight/obesity HHs in rural areas increased sharply between 2000 (34.3%) and 2010 (41.6%) (p < 0.05). CONCLUSION: The observed prevalence of dual burden households was not different from the expected prevalence. Results from this study indicate that although overweight/obesity continues to be more prevalent among high-income Colombian households, it is growing at a faster pace among the most economically disadvantaged.

Experiencias globales de la fortificación de la harina con ácido fólico para disminuir los defectos del tubo neural / Global experiences with folic acid fortification of flour to reduce neural tube defects

Los defectos del tubo neural son defectos congénitos del cerebro y la médula espinal que pueden provocar discapacidad permanente o muerte en los bebés afectados. Se estima que globalmente hay 320.000 defectos del tubo neural cada año. De estos, aproximadamente tres cuartos se pueden prevenir si la mujer tiene un buen estado de folato en el periodo alrededor de la concepción. La fortificación masiva de alimentos aporta ácido fólico a la dieta de mujeres en el periodo peri-concepcional. De los 81 países que requieren la fortificación de harina de trigo o maíz, 77 obligan la adición de ácido fólico. Se ha documentado en varios países que la fortificación obligatoria y masiva de harina con ácido fólico aumenta niveles séricos de folatos y reduce defectos del tubo neural. Una meta-análisis ha estimado en 46% la reducción promedio en defectos del tubo neural a raíz de la fortificación masiva de harina con ácido fólico. La espina bífida es uno de los defectos del tubo neural que se puede prevenir con ácido fólico; el costo:beneficio de prevenir la espina bífida es favorable y se ha estimado entre 1:12 y 1:48. A pesar de estos éxitos, se estima que solamente 15% de los defectos del tubo neural que se pudieran prevenir con ácido fólico se están previniendo con fortificación masiva de harina. Existen lineamientos y experiencias globales para guiar aquellos países interesados en fortificar la harina con ácido fólico para reducir defectos del tubo neural(AU)

Neural tube defects are congenital anomalies of the brain and spine that can lead to permanent disability or death in affected babies. There are an estimated 320,000 neural tube defects annually throughout the world. Of these, approximately three-fourths are preventable if women have sufficient folate status in the peri-conceptional period. Mass food fortification contributes folic acid to women's diets in the peri-conceptional period. Of 81 countries that mandate wheat flour or maize flour fortification, 77 require the addition of folic acid. It has been documented in several countries that mandatory mass fortification of flour with folic acid increases blood folate levels and reduces neural tube defects. A metaanalysis estimated a 46% average reduction in neural tube defects due to folic-acid fortification of flour. The cost:benefit ratio of preventing spina bifida, a type of neural tube defect that can be prevented with folic acid, is favorable and estimated to be between 1:12 and 1:48. Despite these successes, it is estimated that only 15% of those neural tube defects that can be prevented by folic acid are being prevented through mass fortification of flour. There are international guidelines and experiences that interested countries can draw upon to fortify flour with folic acid to reduce neural tube defects(AU)

Infant and young child feeding in four departments in Haiti: mixed-method study on prevalence of recommended practices and related attitudes, beliefs, and other determinants / Alimentación de los lactantes y niños pequeños en cuatro departamentos de Haití: un estudio con diseño de método mixto sobre la prevalencia de las prácticas recomendadas y las actitudes, las creencias y otros determinantes relacionados

OBJECTIVE: To determine and describe the prevalence and patterns of three recommended practices for infant and young child feeding-exclusive breastfeeding (EB), continued breastfeeding (CB), and achievement of minimum dietary diversity-in four regions in Haiti, and to identify the attitudes and beliefs that inform these practices and any other factors that may facilitate or impede their implementation. METHODS: This study utilized a mixed-methods approach consisting of 1) a cross-sectional survey (n = 310) and 2) 12 focus group discussions among women ≥18 years old with children ≤ 2 years old. Multivariable logistic regression analyses were conducted to identify factors associated with 1) EB during the first six months of life, 2) CB for children ≥ 2 years old, and 3) receipt of a diverse variety of complementary foods. Qualitative data were recorded, transcribed verbatim, and analyzed for common themes. Data were collected in June and July 2013 in four departments in Haiti: Artibonite, Nippes, Ouest, and Sud-Est. RESULTS: Prevalence of EB, CB, and achievement of minimum dietary diversity was 57.0%, 11.9%, and 21.2% respectively. EB was statistically significantly associated with infant's age when controlling for annual household income, location of most recent birth, or receipt of CB counseling (odds ratio (OR) = 0.67 (95% CI: 0.47-0.97)). CB was not statistically significantly associated with rural place of residence, receipt of CB counseling, parity, or infant's age. Meeting minimum dietary diversity was not significantly associated with parity, receipt of postnatal care, rural place of residence, location of most recent birth, receipt of infant and young child feeding counseling, or level of schooling. Beliefs surrounding the relationship between the mother's health and her diet on the quality of breast milk may prohibit EB and CB. Qualitative data revealed that dietary diversity may be low because 1) mothers often struggle to introduce complementary foods and 2) those that are traditionally introduced are not varied and primarily consist of grains and starches. CONCLUSIONS: Prevalence of the three recommended infant and young child feeding practices examined in this study is suboptimal, particularly CB and achievement of minimum dietary diversity. Future communication and programming efforts should address the misunderstandings and concerns identified through the qualitative methods used in this research.

OBJETIVO: Determinar y describir la prevalencia y los modelos de tres prácticas recomendadas para la alimentación de los lactantes y los niños pequeños (la lactancia materna exclusiva [LME], la lactancia materna continuada [LMC] y el logro de una diversidad alimentaria mínima, en cuatro regiones de Haití, y determinar las actitudes y creencias en las que se basan estas prácticas y otros factores que puedan facilitar o impedir su implantación. MÉTODOS: Este estudio utilizó un diseño de método mixto que consistió en 1) una encuesta transversal (n = 310) y 2) 12 grupos de discusión formados por mujeres de ≥ 18 años de edad o mayores con niños de ≤ 2 años de edad o menores. Se llevaron a cabo análisis de regresión logística multivariable para determinar los factores asociados con 1) la LME durante los seis primeros meses de vida, 2) la LMC en niños de ≥ 2 años de edad o mayores, y 3) el aporte de una amplia variedad de alimentos complementarios. Se registraron, se transcribieron al pie de la letra y se analizaron los datos cualitativos referentes a temas comunes. Estos datos se recopilaron en junio y julio del 2013, en cuatro departamentos de Haití: Artibonite, Nippes, Oeste y Sudeste. RESULTADOS: Las prevalencias de la LME, la LMC y el logro de una diversidad alimentaria mínima fueron de 57,0, 11,9 y 21,2%, respectivamente. La LME se asoció de manera estadísticamente significativa con la edad del lactante si se controlaban las variables de ingresos familiares anuales, ubicación del parto más reciente, o provisión de orientación en materia de LMC (razón de posibilidades [OR] = 0,67 [IC de 95%:0.47-0.97]). La LMC no se asoció de una manera estadísticamente significativa con la residencia en un entorno rural, la provisión de orientación en materia de LMC, la paridad o la edad de lactante. El logro de una diversidad alimentaria mínima no se asoció significativamente con la paridad, la provisión de atención posnatal, la residencia en un entorno rural, la ubicación del parto más reciente, la provisión de orientación en materia de alimentación de los lactantes y los niños pequeños, o el nivel de escolarización. Las creencias con respecto a la relación entre la salud de la madre y su régimen alimentario con la calidad de la leche materna pueden limitar la LME y la LMC. Los datos cualitativos revelaron que la diversidad alimentaria puede ser escasa como consecuencia de que 1) las madres a menudo se esfuerzan por introducir los alimentos complementarios, y 2) los que se introducen tradicionalmente no son variados y consisten principalmente en cereales y féculas. CONCLUSIONES: Las prevalencias de las tres prácticas de alimentación de los lactantes y los niños pequeños recomendadas analizadas en este estudio son subóptimas, en particular las correspondientes a la LMC y al logro de una diversidad alimentaria mínima. Las futuras iniciativas de comunicación y programación deberían abordar los malentendidos y las inquietudes detectadas mediante los métodos cualitativos utilizados en esta investigación.

Avances en la fortificación de harina de trigo a nivel global / Advances in the fortification of wheat flour

: Por 90 años, alimentos han sido industrialmente fortificados (o enriquecidos) con vitaminas y minerales. Los granos básicos, específicamente la harina de trigo, la harina de maíz y el arroz, son aptos para la fortificación debido a su alta disponibilidad en la mayoría de países del mundo. El propósito de este artículo es revisar la evidencia del impacto en salud pública de la fortificación de granos básicos (con un enfoque en harina de trigo), describir los retos mundiales que enfrenta la fortificación y enlistar las herramientas que puedan ayudar con el diseño, el monitoreo y la evaluación de programas de fortificación de alimentos. Hay evidencia sólida y consistente que la fortificación con ácido fólico aumenta el folato sérico y reduce defectos del tubo neural, además de que la fortificación con hierro aumenta la ferritina sérica. Sin embargo, para la hemoglobina, los resultados son contradictorios: algunos estudios reportan un aumento, otros una disminución y otros ningún cambio en hemoglobina después de fortificar los granos básicos con diferentes nutrientes. Los dos retos principales de la fortificación mundial es que varios países se podrían beneficiar de la fortificación de granos cereales, sin embargo, no implementan esta intervención de salud pública. Además, son pocos los países que de manera consistente reportan los resultados de monitoreo y evaluación de sus programas de fortificación. Para abordar estos retos, hay varias herramientas disponibles o en desarrollo que guían el diseño, el monitoreo y la evaluación de programas de fortificación de alimentos(AU)

Food has been industrially fortified (or enriched) with vitamins and minerals for 90 years. Cereal grains, specifically wheat flour, maize flour and rice, are good vehicles for fortification because they are available in large amounts in most countries around the world. The purpose of this paper is to review the evidence for the public-health impact of fortification, describe challenges to worldwide fortification, and list tools that are available to aid in the design, monitoring and evaluation of food-fortification programs. There is strong and consistent evidence that folic-acid fortification of cereal grains improves serum folate and reduces neural tube defects, and that iron-fortification increases serum ferritin levels. The results for hemoglobin are equivocal: some studies report increases, others decreases, and others no change in hemoglobin after cereal-grain fortification commenced with several nutrients. The two main challenges to worldwide fortification are that many countries that could benefit from cereal-grain fortification do not undertake this public-health intervention, and that few countries consistently report monitoring or evaluation data that suggests they are keeping track of the implementation of fortification. Finally, to overcome these challenges, many tools are available or under development to help with the design, monitoring and evaluation of food-fortification programs(AU)

Infant and young child feeding in four departments in Haiti: mixed-method study on prevalence of recommended practices and related attitudes, beliefs, and other determinants.

OBJECTIVE: To determine and describe the prevalence and patterns of three recommended practices for infant and young child feeding-exclusive breastfeeding (EB), continued breastfeeding (CB), and achievement of minimum dietary diversity-in four regions in Haiti, and to identify the attitudes and beliefs that inform these practices and any other factors that may facilitate or impede their implementation. METHODS: This study utilized a mixed-methods approach consisting of 1) a cross-sectional survey (n = 310) and 2) 12 focus group discussions among women ≥18 years old with children ≤ 2 years old. Multivariable logistic regression analyses were conducted to identify factors associated with 1) EB during the first six months of life, 2) CB for children ≥ 2 years old, and 3) receipt of a diverse variety of complementary foods. Qualitative data were recorded, transcribed verbatim, and analyzed for common themes. Data were collected in June and July 2013 in four departments in Haiti: Artibonite, Nippes, Ouest, and Sud-Est. RESULTS: Prevalence of EB, CB, and achievement of minimum dietary diversity was 57.0%, 11.9%, and 21.2% respectively. EB was statistically significantly associated with infant's age when controlling for annual household income, location of most recent birth, or receipt of CB counseling (odds ratio (OR) = 0.67 (95% CI: 0.47-0.97)). CB was not statistically significantly associated with rural place of residence, receipt of CB counseling, parity, or infant's age. Meeting minimum dietary diversity was not significantly associated with parity, receipt of postnatal care, rural place of residence, location of most recent birth, receipt of infant and young child feeding counseling, or level of schooling. Beliefs surrounding the relationship between the mother's health and her diet on the quality of breast milk may prohibit EB and CB. Qualitative data revealed that dietary diversity may be low because 1) mothers often struggle to introduce complementary foods and 2) those that are traditionally introduced are not varied and primarily consist of grains and starches. CONCLUSIONS: Prevalence of the three recommended infant and young child feeding practices examined in this study is suboptimal, particularly CB and achievement of minimum dietary diversity. Future communication and programming efforts should address the misunderstandings and concerns identified through the qualitative methods used in this research.

Being overweight or obese is associated with lower prevalence of anemia among Colombian women of reproductive age.

Overweight and micronutrient deficiencies have manifested in the same individuals. This study investigated the association among iron deficiency (ID), anemia, and weight status among nonpregnant Colombian females aged 13-49 y (n = 3267). Data from the 2005 National Survey of the Nutrition Situation were used. The prevalence of ID (plasma ferritin <12.0 µg/L; individuals with CRP >0.012 g/L excluded) and anemia (altitude-adjusted hemoglobin <120 g/L) was estimated separately. The likelihood of having ID or anemia was tested as a function of overweight (BMI-age Z-score 1-1.9 SD for 13-17 y, BMI 25.0-29.9 kg/m² for 18-49 y) and obesity (≥2 SD for 13-17 y, ≥30 kg/m² for 18-49 y) using multivariate logistic regressions accounting for survey design. Additionally, demographic predictors of combined overweight/obesity with ID or anemia were identified. The prevalence of overweight and obesity was 29.2 and 13.1%, respectively, whereas that of ID and anemia was 16.1 and 32.5%, respectively. Contrary to previous reports, overweight and obese women had a lower likelihood of anemia [OR (95% CI) = 0.8 (0.7, 0.9) and 0.8 (0.6, 1.0), respectively] than normal-weight women. Overweight/obesity combined with ID or anemia was present among 6.3 and 12.8% of women, respectively. Although overweight and obesity were associated with a lower likelihood of anemia, a sizeable group of women was identified as experiencing both over- and undernutrition. Because of the potential for exacerbated health problems in the presence of over- and undernutrition, these conditions should continue to be monitored.

Factores asociados con la seguridad alimentaria en un Municipio Rural del norte del Cauca, Colombia

La seguridad alimentaria (SA) es el acceso suficiente a alimentos inocuos y nutritivos para satisfacer las necesidades alimentarias y preferencias personales, y llevar una vida sana y activa. En el presente estudio se determinó la seguridad alimentaria de 302 familias de escolares de un municipio rural del departamento de Cauca, Colombia; y los factores asociados a la misma. Los hogares seleccionados hacían parte de un proyecto de impacto nutricional de maíz con mayores nutrientes realizado en esta zona. En estos hogares se aplicó una escala de SA compuesta por 12 ítems y un cuestionario sociodemográfico. Los hogares se clasificaron con seguridad e inseguridad alimentaria leve, moderada y severa. El 44,37% de los hogares se encontró en SA y el 55,63% con inseguridad alimentaria (IA), (41,39% presentó inseguridad leve, 12,25% inseguridad moderada y 1,99% inseguridad severa). Las familias que se encontraron en IA tenían hogares en donde el número de personas que trabajaban es relativamente menor al número de personas que allí vivían, contaban con menos de 4 bienes o servicios y el (los) niño (s) tenían menos apetito en comparación con las familias que se encontraban con SA. En conclusión más de la mitad de las familias encuestadas se encontraron en IA y los factores que la influencian están asociados al ingreso familiar.

Factors associated with food security in a rural Municipality in northern Cauca, Colombia. Food security is sufficient access to safe and nutritious foods to satisfy nutritional needs and personal preferences, and to lead a healthy and active life. The current study evaluated food security in 302 families with school-age children living in a rural municipality in Cauca, Colombia, and factors associated with food security. Families were participating in an evaluation of the nutrition impact of an intervention with nutritionally improved maize. A12-item food security scale was applied to the household head, as well as a sociodemographic survey. Families were classified as food secure, or mildly, moderately or severely food insecure. Among households, 44,37% were classified as food secure and 55,63% as food insecure (with 41,39% as mildly insecure, 12,25% as moderately insecure and 1,99% as severely insecure). Food-insecure families had fewer persons working relative to the total individuals in the home, 4 or fewer services or assets, and children with a reduced appetite, in comparison with food-secure households. In conclusion, more than half of the sample was food insecure; the factors associated with food insecurity relate to family income.

Food prices and poverty negatively affect micronutrient intakes in Guatemala.

Limited empirical evidence exists for how economic conditions affect micronutrient nutrition. We hypothesized that increasing poverty and rising food prices would reduce consumption of high-quality "luxury" foods, leading to an increased probability of inadequacy for several nutrients. The 2006 Guatemala National Living Conditions Survey was analyzed. First, energy and nutrient intakes and adequacy levels were calculated. Second, the income-nutrient relationships were investigated by assessing disparities in intakes, determining income-nutrient elasticities, and modeling nutrient intakes by reductions in income. Third, the food price-nutrient relationships were explored through determination of price-nutrient elasticities and modeling 2 price scenarios: an increase in food prices similar in magnitude to the food price crisis of 2007-2008 and a standardized 10% increase across all food groups. Disparities in nutrient intakes were greatest for vitamin B-12 (0.38 concentration index) and vitamin A (0.30 concentration index); these nutrients were highly and positively correlated with income (r = 0.22-0.54; P < 0.05). Although the baseline probability of inadequacy was highest for vitamin B-12 (83%), zinc showed the greatest increase in probability of inadequacy as income was reduced, followed by folate and vitamin A. With rising food prices, zinc intake was most acutely affected under both scenarios (P < 0.05) and folate intake in the poorest quintile (+7 percentage points) under the 10% scenario. Price-nutrient elasticities were highest for vitamin B-12 and the meat, poultry, and fish group (-0.503) and for folate and the legumes group (-0.343). The economic factors of food prices and income differentially influenced micronutrient intakes in Guatemala, notably zinc and folate intakes.

Actividad antioxidante en guanábana (Annona muricata l): una revisión bibliográfica / Soursop (Annona muricata L) antioxidant activity: a literature review

An antioxidant is a compound capable of inhibiting molecular oxidation and therefore of protecting biological molecules from reactive oxygen species or free radicals. Antioxidants can be synthesized by the body or obtained from a diet containing fruit, such as soursop. The aim of this project was to review the literature on antioxidant activity of the soursop and compounds that might be responsible for this activity. From the analysis of fourteen studies, we found that in most cases soursop did not contain high activity or concentration of antioxidants in fresh or frozen pulp, in comparison with highly consumed fruits in Colombia. The leaves, as well as the juice and wine from the plant, do not contain high activity or concentration of antioxidants. In-depth characterization of antioxidant activity and compounds in soursop is lacking; additional studies are required to identify the mechanisms of action of the compounds present in the whole fruit (peel and seed) for different varieties of this tropical fruit.

Los compuestos antioxidantes están en la capacidad de inhibir la oxidación de moléculas y por lo tanto actuar como protectores de moléculas biológicas contra especies reactivas de oxígeno o radicales libres. Muchos antioxidantes pueden ser sintetizados en el cuerpo u obtenidos a partir de una dieta basada en frutas, como la guanábana. El propósito del presente trabajo fue revisar las principales investigaciones relacionadas con el estudio de la capacidad antioxidante de la guanábana y los compuestos presentes que le otorgan dicha propiedad. A partir del análisis de catorce investigaciones halladas sobre el tema, se encontró que en la mayoría de los casos la guanábana no contiene concentraciones elevadas de actividad o compuestos antioxidantes en su pulpa fresca o congelada comparada con frutos de mayor consumo en Colombia. Sus hojas, al igual que sus jugos y vinos, no contienen concentraciones elevadas de actividad o compuestos antioxidantes. Sin embargo, el tema de investigación de compuestos antioxidantes en guanábana se ha realizado con poca profundidad, hace falta estudios adicionales con métodos que logren la identificación de los mecanismos de acción de los compuestos presentes en el fruto completo (cáscara y semilla) de las diferentes variedades que se conocen de este fruto tropical.

[Factors associated with food security in a rural municipality in northern Cauca, Colombia]. / Factores asociados con la seguridad alimentaria en un Municipio Rural del norte del Cauca, Colombia.

Food security is sufficient access to safe and nutritious foods to satisfy nutritional needs and personal preferences, and to lead a healthy and active life. The current study evaluated food security in 302 families with school-age children living in a rural municipality in Cauca, Colombia, and factors associated with food security. Families were participating in an evaluation of the nutrition impact of an intervention with nutritionally improved maize. A12-item food security scale was applied to the household head, as well as a sociodemographic survey. Families were classified as food secure, or mildly, moderately or severely food insecure. Among households, 44.37% were classified as food secure and 55.63% as food insecure (with 41.39% as mildly insecure, 12.25% as moderately insecure and 1,99% as severely insecure). Food-insecure families had fewer persons working relative to the total individuals in the home, 4 or fewer services or assets, and children with a reduced appetite, in comparison with food-secure households. In conclusion, more than half of the sample was food insecure; the factors associated with food insecurity relate to family income.

Validación de una metodología analítica para la cuantificación de glucósidos cianogénicos en productos comerciales de yuca / Validation of an analytical methodology to quantify cyanogenic glucosides in commercial cassava products

En este trabajo se valida un método espectrofotométrico para la determinación de glucósidos cianogénicos (CGs) de acuerdo a los requerimientos de IUPAC y ICH para nuevos métodos. El método demuestra una buena linealidad en el rango de 0,1-0,88 μgg-1 de ácido cianhídrico (HCN). La exactitud del método está entre 95,2 y 96,4%. La precisión del método reflejada como la desviación estándar relativa de los replicados es menor al 12%. El método se compara con el método más usado para la detección de CGs en raíces de yuca, el método de Essers et al. Ambos métodos se usan en la cuantificación de CGs en productos comerciales de yuca. El nuevo método es una herramienta útil y confiable para monitorear los niveles de CGs en productos comerciales de yuca.

Preferencia y aceptabilidad de la variedad de arroz IACuba 30 con alto contenido de hierro y zinc por mujeres gestantes en Cuba / Sensory evaluation of the high-iron and -zinc rice variety IACuba 30 among pregnant women in Cuba

Objetivo: al introducir un alimento al mercado o cambiar algún aspecto se requieren pruebas sensoriales para asegurar su aceptación por el grupo al cual va dirigido el alimento. El objetivo del estudio fue evaluar la preferencia y aceptabilidad de la variedad de arroz IACuba 30 con alto contenido de hierro y zinc por mujeres gestantes, empleando como testigo una variedad de arroz importada que se consume diariamente. Materiales y metódos: se realizó la evaluación de la aceptabilidad de las características organolépticas textura, olor, color y sabor del arroz IACuba 30 comparado con una variedad de consumo local, por 98 gestantes del municipio de Bauta la y aceptabilidad de las características organolépticas, mediante una escala hedónica de cuatro categorías, también se evaluó la preferencia entre estas dos variedades. Resultados: 73,5% de las gestantes participantes en la prueba prefirieron la variedad IACuba 30 frente al testigo (p<0,05). Así mismo, para las cuatro características organolépticas evaluadas (textura, olor, color y sabor), el número de madres que respondieron ''me gusta'' y ''me gusta mucho'' sumaron más de 80% en todos los casos, con diferencias estadísticas entre el valor observado con referencia al esperado (p<0,05). Conclusiones: la variedad IACuba 30 es una buena candidata para promover su consumo en la isla y contribuir con el manejo y prevención de anemia e incrementar el aporte de zinc.

Objective: prior to introducing a new food on the market or changing any aspect of a food, sensory tests with the target group for that food are important. The objective of this study was to test the acceptability and preference for the nutritionally enhanced rice variety IACuba 30, compared with an imported variety that is consumed daily by pregnant women. Materials and methods: the sensory tests were completed with 98 pregnant women in the Bauta municipality. Acceptability of texture, smell, color and taste were assessed for both rice varieties using a hedonic scale with four categories. The preference for one variety over the other was also assessed. Results: 73,5% of the women preferred IACuba 30 over the comparison rice (p<0,05). For the four organoleptic characteristics evaluated (texture, smell, color and taste), more than 80% of women responded ''I like'' and ''I like very much''; the observed values were statistically different from the expected values (p<0,05). Conclusions: results confirm that IACuba 30 is a good candidate to be grown and eaten as a greater nutritional source that can contribute to addressing the problem of anemia and increasing zinc intake on the Island.

Evaluación sensorial de arroz (Oryza sativa) variedad Azucena en la Región Autónoma del Atlántico Norte en Nicaragua / Sensory evaluation of the Azucena rice (Oryza sativa) variety in Nicaragua's Región Autónoma del Atlántico Norte

Objetivo: evaluar las características sensoriales de la variedad tradicional de arroz (Oryza sativa) Azucena, que por su mayor contenido de hierro y zinc podría beneficiar nutricionalmente a poblaciones vulnerables. Materiales y metódos: la evaluación sensorial del arroz Azucena versus una variedad de consumo local, se realizó en cinco comunidades de la Región Autónoma del Atlántico Norte en Nicaragua, mediante la aplicación de dos pruebas a 203 consumidores: aceptabilidad y preferencia. Resultados: con respecto a la aceptabilidad (en una escala de uno a cuatro), Azucena alcanzó un promedio ± DE de 3,1±0,7 para textura, 3,1±0,8 para olor, 3,0±0,9 para sabor y 3,0±0,8 para color. Usando un análisis no paramétrico, se determinó que la aceptabilidad fue mayor (p<0,05) para el testigo en todas las cualidades evaluadas: 3,2±0,8 en textura, 3,2±0,7 en olor, 3,2±0,7 en sabor y 3,3±0,7 en color. La preferencia no fue estadísticamente mayor (56,4%) para el testigo (p=0,23). Conclusiones: el arroz variedad Azucena, por sus caracterÍsticas endógenas y desde el punto de vista sensorial, no tiene una gran aceptación en la población de estudio. Por lo tanto, en caso de lanzarse al comercio se recomiendan campañas estratégicas para promocionar su consumo.

Objective: evaluate the sensory characteristics of Azucena, a traditional landrace rice (Oryza sativa) with elevated iron and zinc levels which can nutritionally benefit vulnerable populations. Materials and methods: in five communities from Nicaragua’s Región Autónoma del Atlántico Norte, Azucena was compared to a local rice variety using sensory evaluation methods. Two tests were applied to 203 household heads: acceptability and preference. Results: for acceptability (on a scale of 1 to 4), Azucena scored a mean ± DE of 3,1±0,7 for texture, 3,1±0,8 for smell, 3,0±0,9 for taste, and 3,0±0,8 for color. Using a non-parametric statistic, acceptability was deemed higher (p<0,05) for the local variety in all of the qualities assessed: 3,2±0,8 for texture, 3,2±0,7 for smell, 3,2±0,7 for taste, and 3,3±0,7 for color. Fifty six percent of consumers preferred the local variety over Azucena; this was not statistically different from the expected 50% (p=0,23). Conclusions: due to its inherent qualities and sensory properties, Azucena was not accepted by the study population. Therefore, if Azucena is to be commercially released in Nicaragua, strategic campaigns are recommended to promote its consumption.