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Dietary Inadequacies in HIV-infected and Uninfected School-aged Children in Johannesburg, South Africa.
Journal of Pediatric Gastroenterology and Nutrition. 2017 Mar 22;OBJECTIVES: The World Health Organization (WHO) recommends that HIV-infected children increase energy intake and maintain a balanced macronutrient distribution for optimal growth and nutrition. Few studies have evaluated dietary intake of HIV-infected children in resource-limited settings. METHODS: We conducted a cross-sectional analysis of the dietary intake of 220 perinatally HIV-infected children and 220 HIV-uninfected controls ages 5–9 years in Johannesburg, South Africa. A standardized 24-hour recall questionnaire and software developed specifically for the South African population was used to estimate intake of energy, macronutrients, and micronutrients. Intake was categorized based on recommendations by the WHO and Acceptable Macronutrient Distribution Ranges (AMDRs) established by the Institute of Medicine (IOM). RESULTS: The overall mean age was 6.7 years and 51.8% were boys. Total energy intake was higher in HIV-infected than HIV-uninfected children (1341 vs. 1196 kcal/day, p=0.002), but proportions below the recommended energy requirement were similar in the two groups (82.5 vs. 85.2%, p=0.45). Overall, 51.8% of the macronutrient energy intake was from carbohydrates, 13.2% from protein, and 30.8% from fat. The HIV-infected group had a higher percentage of their energy intake from carbohydrates and lower percentage from protein compared to the HIV-uninfected group. Intakes of folate, vitamin A, vitamin D, calcium, iodine, and selenium were suboptimal for both groups. CONCLUSIONS: Our findings suggest that the typical diet of HIV-infected children as well as uninfected children in Johannesburg, South Africa does not meet energy or micronutrient requirements. There appear to be opportunities for interventions to improve dietary intake for both groups.
Energy intake from human milk covers the requirement of 6-month-old Senegalese exclusively breast-fed infants.
British Journal of Nutrition. 2013 Nov; 110(10):1849-55.Exclusive breast-feeding until 6 months is advised by the WHO as the best practice to feed infants. Yet, some studies have suggested a gap between energy requirements and the energy provided by human milk for many infants at 6 months. In order to assess the adequacy of WHO recommendations in 6-month-old Senegalese lactating infants, a comprehensive study was designed to measure human milk intake by the dose-to-the mother 2H2O turnover method. Infants' energy intakes were calculated using daily breast milk intake and the energy content of milk was estimated on the basis of creamatocrit. Of the fifty-nine mother-infant pairs enrolled, fifteen infants were exclusively breast-fed (Ex) while forty-four were partially breast-fed (Part). Infants' breast milk intake was significantly higher in the Ex group (993 (SD 135) g/d, n 15) compared with the Part group (828 (SD 222) g/d, n 44, P(1/4)0.009). Breast milk energy content as well as infants' growth was comparable in both groups. However, infants' energy intake from human milk was significantly higher (364 (SD 50) kJ/kg per d (2586 (SD 448) kJ/d)) in the Ex group than in the Part group (289 (SD 66) kJ/kg per d (2150 (SD 552) kJ/d), P,0.01). Compared with WHO recommendations, the results demonstrate that energy intake from breast milk was low in partially breast-fed infants while exclusively breast-fed 6-month-old Senegalese infants received adequate energy from human milk alone, the most complete food for infants. Therefore, advocacy of exclusive breast-feeding until 6 months should be strengthened.
Environment International. 2012 Oct 15; 47:17-22.There is an assumption that pyrethroid pesticides are converted to non-toxic metabolites by hydrolysis in mammals. However, some recent works have shown their bioaccumulation in human breast milk collected in areas where pyrethroids have been widely used for agriculture or malaria control. In this work, thirteen pyrethroids have been studied in human breast milk samples coming from areas without pyrethroid use for malaria control, such as Brazil, Colombia and Spain. The concentrations of pyrethroids ranged from 1.45 to 24.2 ng g- 1 lw. Cypermethrin, -cyhalothrin, permethrin and esfenvalerate/fenvalerate were present in all the studied samples. The composition of pyrethroid mixture depended on the country of origin of the samples, bifenthrin being the most abundant in Brazilian samples, -cyhalothrin in Colombian and permethrin in Spanish ones. When the pyrethroid concentrations were confronted against the number of gestations, an exponential decay was observed. Moreover, a time trend study was carried out in Brazil, where additional archived pool samples were analyzed, corresponding to years when pyrethroids were applied for dengue epidemic control. In these cases, total pyrethroid levels reached up to 128 ng g- 1 lw, and concentrations decreased when massive use was not allowed. Finally, daily intake estimation of nursing infants was calculated in each country and compared to acceptable WHO levels. The estimated daily intakes for nursing infants were always below the acceptable daily intake levels, nevertheless in certain samples the detected concentrations were very close to the maximum acceptable levels.
Update on technical issues concerning complementary feeding of young children in developing countries and implications for intervention programs.
Food and Nutrition Bulletin. 2003; 24(1):5-28.This paper provides an update to the 1998 WHO/ UNICEF report on complementary feeding. New research findings are generally consistent with the guidelines in that report, but the adoption of new energy and micronutrient requirements for infants and young children will result in lower recommendations regarding minimum meal frequency and energy density of complementary foods, and will alter the list of “problem nutrients.” Without fortification, the densities of iron, zinc, and vitamin B6 in complementary foods are often inadequate, and the intake of other nutrients may also be low in some populations. Strategies for obtaining the needed amounts of problem nutrients, as well as optimizing breastmilk intake when other foods are added to the diet, are discussed. The impact of complementary feeding interventions on child growth has been variable, which calls attention to the need for more comprehensive programs. A six-step approach to planning, implementing, and evaluating such programs is recommended. (author's)
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1985; (724):1-206.In 1981, participants in the Joint FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements met in Italy to reexamine the interrelationships between energy and protein requirements and to recommend methods to integrate requirement scales for energy and proteins. They stated that the use of a reference man or woman to determine energy requirements should no longer be used since it is unduly restrictive and there is a wide range of body size and patterns of physical activity. The tables exhibit this wide range so users can use those values that best apply to his or her conditions. Overall the participants agreed that estimates of energy requirements should be based on actual or desirable energy requirement estimates. In terms of children, however, this principle cannot be applied since there is not enough information available about their energy expenditure. Further no one could agree on how to determine what actual intakes are needed to maintain health in its broadest sense in either developing or developed countries since observed actual intakes are not necessarily those that maintain a desirable body weight or optimal levels of physical activity. Divers patterns of physical activity in different age and sex groups are presented nonetheless to guide users in applying requirement estimates. The maintenance protein requirements identified by the 1971 consultation for the young child < 6 years old, e.g. 1 g/kg.day for 5-6 year old, and the young male adult (.54-.99 g.kg/day) remained the same. The participants made indirect estimates of protein needs for the remaining age and sex groups. They acknowledged that digestibility can affect the availability of protein and protein requirements need to be adjusted for fecal losses of nitrogen. They concluded that the natural diets for infants and preschool children contain sufficient amount of essential amino acids, but not those of the remaining groups.
SCN NEWS. 1997 Dec; (15):35-6.In line with recent recommendations by WHO and the Committee on International Nutrition, WFP and UNHCR will now use 2100 kcal/person/day as the initial energy requirement for designing food aid rations in emergencies. In an emergency situation, it is essential to establish such a value to allow for rapid planning and response to the food and nutrition requirements of an affected population. An in-depth assessment is often not possible in the early days of an emergency, and an estimated value is needed to make decisions about the immediate procurement and shipment of food. The initial level is applicable only in the early stages of an emergency. As soon as demographic, health, nutritional and food security information is available, the estimated per capita energy requirements should be adjusted accordingly. Food rations should complement any food that the affected population is able to obtain on its own through activities such as agricultural production, trade, labor, and small business. An understanding of the various mechanisms used by the population to gain access to food is essential to give an accurate estimate of food needs. Therefore, a prerequisite for the design of a longer-term ration is a thorough assessment of the degree of self-reliance and level of household food security. Frequent assessments are necessary to adequately determine food aid needs on an ongoing basis. The importance of ensuring a culturally acceptable, adequate basic ration for the affected population at the onset of an emergency is considered to be one of the basic principles in ration design. The quality of the ration provided, particularly in terms of micronutrients, is stressed in the guidelines, and levels provided will aim to conform with standards set by other technical agencies. (full text)
New York, New York, UNICEF, 1992 Jun.  p.This compendium provides statistical profiles for 136 UNICEF countries on the status of children. Statistics pertain to basic population, infant and child mortality, and gross national product data; child survival and development; nutrition; health; education; demography; and economics. Official government sources are used whenever possible. The nine major sources include the UN Statistical Office, UNICEF, the UN Population Division, the Organization for Economic Cooperation and Development, the World Health Organization, the Food and Agriculture Organization of the UN, the World Bank, Demographic and Health Surveys, and UNESCO. Statistics rely on internationally standardized estimates, and whenever standardized estimates were unavailable, UNICEF field office data were used. Some statistics may be more reliable than others. Countries are divided into four groups for under-five mortality: very high (140 deaths per 1000 live births); high (71-140/1000); middle (21-70/1000); and low (20/1000 and under). The median value is the preferred figure, but the mean is used if the range in data is not extensive. Data are footnoted by definitions, sources, explanations of signs, and individual notation where figures are different from the general definition being used. Comprehensive and representative data are used where possible. Data should not be used to delineate small differences. Countries with very high child mortality include Afghanistan, Angola, Bangladesh, Benin, Bhutan, Bolivia, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Comoros, Djibouti, Equatorial Guinea, Ethiopia, Gabon, Guinea, Guinea-Bissau, India, Laos, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Nepal, Niger, Nigeria, Pakistan, Rwanda, Senegal, Sierra Leone, Somalia, Sudan, Swaziland, Tanzania, Togo, Uganda, and Yemen.
Washington, D.C., World Bank, 1992. 36 p.This atlas presents social, economic, and environmental statistics for 200 economies throughout the world, including statistics for 15 economies throughout the world, including statistics for 15 economies of the former Soviet Union. The following social/demographic indices are presented: population growth rate, 1980-1991; under-5 mortality rate, 1991; daily calorie supply/capita, 1989; illiteracy rate, 1990; and female labor force, 1991. GNP/capita, 1991; GNP/capita growth rate, 1980-91; and shares of agriculture, exports, and investment in GDP in 1991 comprise the economic data. Finally, GDP output/kilogram energy used, 1990; annual water use and annual water use/capita, 1970-87; forest coverage, 1989; and change in forest coverage, 1980-89, are presented as economic indicators. All figures are reported in color graphic format. Technical notes and World Bank structure and functions are discussed in closing sections. The text also cautions that the differing statistical systems and data collection methods and capabilities employed internationally demand that caution be taken against directly comparing statistical coverages and definitions.
Washington, D.C., World Bank, 1991. 29 p.The 1991 World Bank Atlas provides 1990 statistics in 1 table for 185 countries on the following: gross national product (GNP) and rate, population and growth rate, GNP/capita and real growth rate, agriculture's share of gross domestic product (GDP), daily calorie supply/capita, life expectancy at birth, total fertility rate (TFR), and school enrollment (%) and literacy (%). Charts in 6 colors depict GNP/capita, the population growth rate between 1980-90 and ranking by country, GNP/capita growth rate between 1980-90 and ranking by country, GDP share in agriculture and ranking, daily calorie supply/capita in 1988 and ranking, life expectancy at birth and ranking, TFR and ranking, and illiteracy rate in 1985 and ranking. The ranking is of GNP/capita from lowest to highest by country against the indicator and the trend line.
Social Science and Medicine. 1992 Apr; 34(8):837-42.Researchers analyzed data from 117 countries taken from 2 1988 World Bank publications to determine the relative importance of health care resources in predicting infant mortality within developed, developing and underdeveloped countries. Overall the variance of infant mortality, accounted by only socioeconomic resources, was 32.8% in underdeveloped (p<.01), 34.3% in developing countries (p<.05), and 60.6% in developed countries (p<.1). Further almost all these variables had constant directions of relationship with infant mortality across the 3 subgroups. For example, GNP and education were always negatively associated with infant mortality and urbanization and water were always positively associated with infant mortality. In fact, water had the greatest effect in developing countries and the smallest in underdeveloped countries. Further education was the only statistically significant socioeconomic variable in underdeveloped and developing countries (p<.05). Energy was inversely related with infant mortality in underdeveloped and developing countries, but positively related with it in industrialized countries. Further calorie had an inverse relationship with infant mortality in underdeveloped countries, but a positive relationship in developing and developed countries. In terms of health resources, the variance of infant mortality was not significant and was only an additional 8.6% of that above the variance explained by socioeconomic resources in underdeveloped countries, 5.6% in developing countries, and 3.3% in industrialized countries. Yet the association between inhabitants/ physician was consistent across all subgroups. Further the physician's role in reducing infant mortality was greatest in developing countries. The other 2 health care variables were inhabitants/nurse and inhabitants/hospital bed. In addition, as life expectancy increased, the effects of health care resources on infant mortality fell.
Washington, D.C., World Bank, 1988. 29 p.This 21st edition of the Atlas presents economic, social and demographic indicators in the form of tables and charts covering the world. The main yardstick of economic activity in a country is the gross national product. 60 developing countries have had declining gross national product, although for most countries real per capita income has risen. Social indicators show evidence of improved standards of living since the early 1980s. Population estimates and other demographic data are from the UN Population Division; education data are from the United Nations Educational Scientific and Cultural Organization, and calorie data are from the Food and Agriculture Organization. A total of 10 charts and maps show world population; statistics on 185 countries and territories; gross national product, 1987; population growth rate, 1980-87; gross national product per capita growth rate, 1980-87; agriculture in gross domestic product, 1987; daily calorie supply, 1985; life expectancy at birth, 1987; total fertility rate, 1987; and school enrollment ratio, 1985. Throughout the Atlas, data for China do not include Taiwan. The World Bank, a multilateral development institution, consists of 2 distinct entities: the International Bank for Reconstruction and Development, which finances its lending operations from borrowings in the world capital markets, and the International Development Association, which extends assistance to the poorest countries on easier terms.