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Mathilde Kersting - One of the best experts on this subject based on the ideXlab platform.
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effects of lc pufa supply via Complementary Food on infant development a Food based intervention rct embedded in a total diet concept
European Journal of Clinical Nutrition, 2020Co-Authors: Hermann Kalhoff, Berthold Koletzko, Christina M Mesch, Madlen Stimming, Andreas Israel, Christoph Spitzer, Latifa Beganovic, Rocio Estella Perez, Petra Warschburger, Mathilde KerstingAbstract:With the introduction of Complementary Food, long-chain PUFA (LC-PUFA) supply usually decreases during the second 6 months of life. However, the need for LC-PUFA is still high for infant’s rapid development. The aim of this randomized, controlled intervention trial was to examine the effects of an increased n-3 (LC-)PUFA supply using alternative Complementary Foods on infants’ visual and cognitive development. Mother–child dyads of term infants were recruited in maternity hospitals and randomly assigned to one of three study groups, which all were fed according to the German dietary schedule for infant nutrition. Intervention group IG-R (n = 54) received jars of Complementary Food with rapeseed oil, IG-F (n = 48) jars with oily fish twice a week and the control group (CG, n = 58) the same jars as IG-R with corn oil instead of rapeseed oil during the intervention period (5th–10th month of age). The outcome measures were latencies of FVEP, Bayley’s mental developmental index (MDI), and psychomotor developmental index (PDI). At 10 months of age, there were no significant differences in latencies of FVEP, Bayley’s MDI, or in PDI index between the intervention and control groups. Fish and rapeseed oil used as (LC-)PUFA sources provided with Complementary feeding embedded in a structured infant diet did not affect visual or cognitive development of term infants.
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association between full breastfeeding timing of Complementary Food introduction and iron status in infancy in germany results of a secondary analysis of a randomized trial
European Journal of Nutrition, 2018Co-Authors: Lars Libuda, Annett Hilbig, Hermann Kalhoff, Seda Berberaltawil, Mathilde KerstingAbstract:Considering the low content in breast milk breastfed infants might be at particular risk for depleted iron stores after the first months of life. This study evaluates the association of the mode of milk feeding and the timing of Complementary Food (CF) introduction with parameters of iron status in term healthy infants in Germany. In this secondary analysis of a randomized controlled trial, parents recorded all Foods consumed by their infants from the age of 8 weeks onwards. Mothers were advised on the German Food-based dietary guidelines for infants. Accordingly, CF was introduced between the fifth and seventh month of age. Blood samples were taken at 4 and at 10 months of age for analyses of iron status parameters. Iron depletion was defined as serum ferritin 34% without general differences according to the mode of milk feeding or the timing of CF introduction. The high prevalence of depleted iron stores observed in both breastfed and formula-fed infants illustrates the need for further studies to improve our understanding of the optimal iron intake and sensitive parameters of iron status in infancy.
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Complementary Food with low 8 or high 12 meat content as source of dietary iron a double blinded randomized controlled trial
European Journal of Nutrition, 2010Co-Authors: Katharina Dube, Jana Schwartz, Manfred J Mueller, Hermann Kalhoff, Mathilde KerstingAbstract:Background To investigate whether a low meat content of Complementary Food as accepted by EU law increases the risk of well-nourished infants to develop iron deficiency during the Complementary feeding period.
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iodine intake in the youngest impact of commercial Complementary Food
European Journal of Clinical Nutrition, 2009Co-Authors: Ute Alexy, Claudia Drossard, Mathilde Kersting, Thomas RemerAbstract:Iodine is a nutrient contributing to the development of the central nervous system. To assure a sufficient iodine intake, iodine fortification of Complementary Food (CF) is recommended. We describe the current fortification practice of commercial CF and formula in Germany as an example for other European countries, based on a market survey conducted in autumn 2008. In addition, we estimated the iodine intake of an 8-month-old infant, fed one portion of milk and three Complementary meals per day. All formulae were fortified with iodine, and half of CF products. Iodine concentration varied depending on product groups. A partially breast-fed infant getting homemade CF reached less than 50% of the recommended iodine intake. Using infant formula and commercial CF, the recommended intake was exceeded by 39 or 100%, depending on which products were chosen. A well-balanced fortification of commercial CF, including pure infant cereals, would be required to ensure an adequate iodine supply.
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modification of dietary polyunsaturated fatty acids via Complementary Food enhances n 3 long chain polyunsaturated fatty acid synthesis in healthy infants a double blinded randomised controlled trial
Archives of Disease in Childhood, 2009Co-Authors: Jana Schwartz, Katharina Dube, Hermann Kalhoff, Wolfgang Sicherthellert, Frank Kannenberg, Clemens Kunz, Mathilde KerstingAbstract:Objective: To study the effect of modified PUFA profiles of Complementary Food on LC-PUFA composition in healthy infants. Design: Double blinded, randomized, controlled intervention trial. Setting: Dortmund, Germany. Patients: free-living sample of healthy term infants. Methods: Participants were randomized within the first 2 months of life. During the intervention period from 4 to 10 months, the control group (CG, n=53) received commercial Complementary meals with corn oil (3.4 g/meal) rich in n-6 linoleic acid (LA), the intervention group (IG, n=49) received the same meals with rapeseed oil (1.6 g/meal) rich in n-3 alpha-linoleinic acid (ALA). FA intake was assessed from dietary records throughout the intervention period. FA proportions (% of total FA) in total plasma were analyzed before and after the intervention. Results: Plasma FA profiles did not differ between the IG and CG before the intervention. During the intervention, the only difference in FA intake between the IG and CG was a higher intake of ALA in the IG, 21 % deriving from study Food, and a lower ratio of LA/ALA (10.7 vs 14.8). At the end of the intervention, the plasma proportions of total n-3 FA and of n-3 LC-PUFA, but not of ALA were higher and the ratios of n-6/n-3 FA were lower in the IG. Conclusions: Feasible dietary modifications of the precursor FA profile via n-3 PUFA rich vegetable oil favored n-3 LC-PUFA synthesis in the Complementary feeding period when LC-PUFA intake from breast milk and formula is decreasing.
Ute Alexy - One of the best experts on this subject based on the ideXlab platform.
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commercial Complementary Food consumption is prospectively associated with added sugar intake in childhood
British Journal of Nutrition, 2016Co-Authors: Kristina Foterek, Anette E Buyken, Katja Bolzenius, Annett Hilbig, Ute Nothlings, Ute AlexyAbstract:Given that commercial Complementary Food (CF) can contain high levels of added sugar, a high consumption may predispose to a preference for sweet taste later in life. This study examined cross-sectional associations between commercial CF consumption and added sugar intake in infancy as well as its prospective relation to added sugar intake in pre-school and primary-school age children. In all, 288 children of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with 3-d weighed dietary records at 0·5 and 0·75 (infancy), 3 and 4 (pre-school age) and 6 and 7 years of age (primary-school age) were included in this analysis. Individual commercial CF consumption as percentage of total commercial CF (%cCF) was averaged at 0·5 and 0·75 years. Individual total added sugar intake (g/d, energy percentage/d) was averaged for all three age groups. Multivariable logistic and linear regression models were used to analyse associations between %cCF and added sugar intake. In infancy, a higher %cCF was associated with odds for high added sugar intake from CF and for high total added sugar intake (>75th percentile, P<0·033). Prospectively, a higher %cCF was related to higher added sugar intake in both pre-school (P<0·041) and primary-school age children (P<0·039), although these associations were attenuated in models adjusting for added sugar intake in infancy. A higher %cCF in infancy may predispose to higher added sugar intake in later childhood by virtue of its added sugar content. Therefore, offering home-made CF or carefully chosen commercial CF without added sugar might be one strategy to reduce sugar intake in infancy and later on.
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associations between commercial Complementary Food consumption and fruit and vegetable intake in children results of the donald study
Appetite, 2015Co-Authors: Kristina Foterek, Annett Hilbig, Ute AlexyAbstract:Objectives: Fruit and vegetable (FV) consumption is influenced by individual taste and Food preferences that are developed early in life. Thus, the sensory properties of Foods given during Complementary feeding may shape later Food acceptance and dietary intake. However, those experiences differ with respect to the preparation method of Complementary Food (CF), that is, homemade and commercial CF. The aim of this study therefore was to examine the association between the infant's consumption of commercial CF and FV intake and variety during infancy, preschool and school age. Methods: In total, 281 children of the DONALD Study with 3-day weighed dietary records at 0.5 and 0.75 (infancy), 3 and 4 (preschool age), 6 and 7 years of age (school age) were included in this analysis. Percentage of commercial CF (%cCF) was averaged at 0.5 and 0.75 years. Individual FV intake (g/day) and FV variety scores were calculated and averaged separately for all three age groups. Multivariate linear regression was used to analyse associations between %cCF and FV intake and variety. Models were adjusted for early life and socioeconomic factors. Results: For boys, higher %cCF was associated with lower vegetable intake in infancy (p < 0.0001) and preschool age (p = 0.036) as well as lower total FV intake in preschool and school age (p < 0.009). For girls, higher %cCF was associated with lower vegetable intake (p < 0.0001) in infancy. FV variety scores showed no clear associations with %cCF in girls and boys. Conclusion: The results of the DONALD Study suggest that the preparation method of CF is associated with FV consumption in infancy and at least for boys also in preschool and school age.
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iodine intake in the youngest impact of commercial Complementary Food
European Journal of Clinical Nutrition, 2009Co-Authors: Ute Alexy, Claudia Drossard, Mathilde Kersting, Thomas RemerAbstract:Iodine is a nutrient contributing to the development of the central nervous system. To assure a sufficient iodine intake, iodine fortification of Complementary Food (CF) is recommended. We describe the current fortification practice of commercial CF and formula in Germany as an example for other European countries, based on a market survey conducted in autumn 2008. In addition, we estimated the iodine intake of an 8-month-old infant, fed one portion of milk and three Complementary meals per day. All formulae were fortified with iodine, and half of CF products. Iodine concentration varied depending on product groups. A partially breast-fed infant getting homemade CF reached less than 50% of the recommended iodine intake. Using infant formula and commercial CF, the recommended intake was exceeded by 39 or 100%, depending on which products were chosen. A well-balanced fortification of commercial CF, including pure infant cereals, would be required to ensure an adequate iodine supply.
Jie Wang - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of community based Complementary Food supplement yingyangbao distribution in children aged 6 23 months in poor areas in china
PLOS ONE, 2017Co-Authors: Jie Wang, Suying Chang, Robert W Scherpbier, Liyun Zhao, Jian Zhang, Qingqing Man, Yifan Duan, Hui Wang, Shian YinAbstract:Background Poor growth and micronutrient deficiency mainly attack older infants and young children. Some countries have adopted clinically effective measures to combat malnutrition, but the compliance and improvement in efficacy of intervention vehicles in national programs require evaluation. Methods Baseline and follow-up cross-sectional surveys were conducted before and after a nutrition intervention program in 3 national poverty counties in China. Soybean-based Complementary Food supplements called Yingyangbao (YYB) in Chinese and training materials on child feeding were distributed to households with children aged 6–23 months for 18 months. Representative children were selected by probability proportional to size sampling methods to assess compliance of YYB and the intervention efficacy. A questionnaire was designed to collect data on basic characteristics of children, breastfeeding, 24-hour dietary intake, and consumption and appetite of YYB. Anthropometrics and hemoglobin were measured in the field, and anemia prevalence was evaluated. Venous blood was drawn from children aged 12–35 months to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children’s anemia. Results Of the children involved in the follow-up survey (n = 693), the P50 (P25, P75) intake of YYB was 6.7 (3.5, 7.0) sachets weekly, and 54.7% of the children liked the taste of YYB. Compared with the baseline situation (n = 823), the proportion of children fed a diverse diet and Foods rich in iron or vitamin A increased (P < 0.01) in the follow-up study. The prevalence of stunting and underweight decreased (P < 0.05), the prevalence of anemia decreased from 28.0% to 19.9% (P < 0.01), and the prevalence of vitamin B12 deficiency decreased from 26.8% to 15.4% (P < 0.01). For children aged 12–23 months, those who liked YYB and consumed 6 or more sachets of YYB weekly were at lower risk for anemia (OR = 0.34, 95% CI 0.13–0.90, P < 0.05), but the risk of stunting was associated with a non-diverse diet (OR = 1.48, 95% CI 1.06–2.07, P < 0.05). Conclusion The quality of diet and nutritional status of children aged 6–23 months are significantly improved by the intervention of YYB and nutrition education, and good compliance to YYB contributes to a low risk for anemia. Trial Registration Chinese Clinical Trial Registry ChiCTR-OOC-16008846
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effect of home based Complementary Food fortification on prevalence of anemia among infants and young children aged 6 to 23 months in poor rural regions of china
Food and Nutrition Bulletin, 2015Co-Authors: Zheng Fang, Jie Wang, Suying Chang, Liyun Zhao, Ping Fu, Jian Huang, Lijuan Wang, David B HipgraveAbstract:Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of Complementary Food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children’s caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and...
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effect of home based Complementary Food fortification on prevalence of anemia among infants and young children aged 6 to 23 months in poor rural regions of china
Food and Nutrition Bulletin, 2015Co-Authors: Junsheng Huo, Jie Wang, Suying Chang, Zheng Fang, Liyun Zhao, Jian Huang, Lijuan Wang, Jing Sun, David B HipgraveAbstract:Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of Complementary Food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children's caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and 11.7 g/dL at 18 months after introduction of YYB. Moderate anemia (hemoglobin: 70-99 g/dL) decreased from 20.3% at baseline to 7.5%, 5.8%, and 7.3% after 6, 12, and 18 months of home fortification, respectively (P < .001), whereas mild anemia (hemoglobin: 100-110 g/dL) decreased from 29.0% to 16.7%, 18.1%, and 15.4%, respectively (P < .001). Among infants aged 6 to 23 months, 95% had regularly been fed YYB during the observation period. Regression analysis showed that the duration of YYB consumption and number of sachets consumed per week correlated positively with hemoglobin levels and negatively with anemia rates. Home Food fortification with YYB is feasible and effective for nutrition promotion among IYC in high-risk regions of China.
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prospective study on the effectiveness of Complementary Food supplements on improving status of elder infants and young children in the areas affected by wenchuan earthquake
PLOS ONE, 2013Co-Authors: Caixia Dong, Xiaolan Ren, Jie Wang, Haoqiang Fan, Xiang Yan, Shian YinAbstract:Objective To prospectively evaluate the efficiency of daily providing Complementary Food supplements decreasing malnutrition and anemia prevalence in elder infants and young children living in areas affected by Wenchuan Earthquake. Design Using promotional probability sampling method, 250 to 300 children from six-randomized townships (30 to 50 children in each township) in Kang County affected by the Earthquake were randomly chosen for follow up to evaluate intervention effectiveness using anthropometric measurement and hemoglobin level at six, twelve and eighteen months after start of intervention. Setting and Subjects All children from 6 to 18 months of age in Kang County (in North Western China) were daily provided with Complementary Food supplements containing multiple vitamins and minerals for up to 24 months of age. The intervention period lasted for one and half year. Results At beginning of intervention, malnutrition prevalence, including underweight, stunting and wasting were respectively 4.5%, 8.9% and 3.5%; anemia prevalence was 74.3%. After one and half year intervention, the growth and anemia status were significantly improved; the percentages of wasting, stunting underweight prevalence were decreased from 3.5%, 8.9% and 4.5% to 1.7%, 5.0% and 3.3% respectively, and the anemia rates were significantly decreased. Conclusions Our results indicated that an intervention using Complementary Food supplements could improve nutritional status and elevate hemoglobin level in elder infants and young children, which would significantly decrease the prevalence of malnutrition and anemia.
Parul Christian - One of the best experts on this subject based on the ideXlab platform.
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micronutrient and inflammation status following one year of Complementary Food supplementation in 18 month old rural bangladeshi children a randomized controlled trial
Nutrients, 2020Co-Authors: Rebecca Campbell, Saijuddin Shaikh, Keith P West, Kerry Schulze, Margia Arguello, Hasmot Ali, Parul ChristianAbstract:Background: Four fortified Complementary Food supplements (CFSs) in a randomized controlled trial (RCT) were found to improve childhood linear growth in rural Bangladesh. We hypothesized children receiving these supplements would have improved micronutrient status. Methods: In the RCT, we assessed hemoglobin and serum ferritin, retinol, zinc, C-reactive protein (CRP), and α-1-acid glycoprotein (AGP) at endline (18 mo) in a subsample of children (n = 752). The impact of supplementation on mean concentrations and the prevalence of nutrient deficiency and inflammation were evaluated using adjusted generalized estimating equation (GEE) linear and log-binomial regression models. Results: In the control arm at age 18 months, 13% of children were anemic (hemoglobin 5 mg/L) and AGP (>1 g/L) was 23% and 66%, respectively, in the control group. AGP trended lower in CFS groups (p = 0.04), while CRP did not. Mean ferritin (p < 0.001) and retinol (p = 0.007) were higher in all supplemented groups relative to control, whereas hemoglobin improved with two of the four CFSs (p = 0.001), and zinc was equal or lower in supplemented groups relative to control (p = 0.017). Conclusions: CFSs improved iron status and vitamin A concentrations and lowered inflammation in a context of low underlying nutrient deficiency but high inflammation.
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Complementary Food supplements increase dietary nutrient adequacy and do not replace home Food consumption in children 6 18 months old in a randomized controlled trial in rural bangladesh
Journal of Nutrition, 2018Co-Authors: Rebecca Campbell, Abu Ahmed Shamim, Saijuddin Shaikh, Sucheta Mehra, Kristen M Hurley, Zaynah T Chowdhury, Parul ChristianAbstract:Background Inadequate Complementary feeding is common in low- and middle-income countries, contributing to growth deficits. Complementary Food supplements (CFSs) aim to fill dietary gaps, but few CFS studies have measured nutrient intake. In a community-based, randomized CFS trial in Bangladesh, we previously reported poor dietary diversity in 6-18-mo-old participants. Objective We investigated, in a secondary analysis in the same trial, micronutrient intake adequacy in supplemented compared with control-arm children. Methods At age 6 mo, children were assigned to 1 y of child-feeding counseling for mothers (control) or counseling plus 1 of 4 CFS formulations. Mothers were administered quantitative past 24-h diet questionnaires for their children at ages 6, 9, 12, 15, and 18 mo. Nutrient intakes were estimated with local recipes and Food composition tables assuming average age-specific breastmilk intake. Adequacy was evaluated relative to estimated average requirements or adequate intakes. Multivariate analysis of variance and generalized estimating equation (GEE) regression models estimated the effect of each CFS on nutrient adequacy. GEE models tested dietary predictors of nutrient adequacy in the control arm. Results A total of 25,964 dietary modules across 5 interviews were completed. Nutrient adequacy from home Foods combined with assumed breastmilk intake was low. Only 5 of 16 micronutrients were adequately consumed by >60% of children at 18 mo of age. Daily CFSs did not affect energy-adjusted micronutrient intake from home Foods at any follow-up age (P > 0.05). CFSs increased the mean adequacy ratio for all micronutrients (P < 0.001 at all ages), to ≥1 for 14 of 16 micronutrients at 18 mo. Dietary diversity predicted adequate iron, zinc and calcium intake at 15 mo in unsupplemented controls. Conclusions Home Foods did not meet the estimated micronutrient needs of 9-18-mo-old children in rural Bangladesh. Daily supplementation with fortified Complementary Foods filled many micronutrient intake gaps and did not displace home Foods. Previously, CFSs were shown to also improve linear growth and reduce stunting in this cohort. Findings support the need for CFSs in similar settings to promote nutritional well being and growth. This trial was registered at clinicaltrials.gov as NCT01562379.
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effect of Complementary Food supplementation on breastfeeding and home diet in rural bangladeshi children
The American Journal of Clinical Nutrition, 2016Co-Authors: Rebecca K Campbell, Abu Ahmed Shamim, Saijuddin Shaikh, Tahmeed Ahmed, Sucheta Mehra, Kristen M Hurley, Zaynah T Chowdhury, Saskia De Pee, Keith P West, Parul ChristianAbstract:Background: Complementary Food supplements (CFSs) can enhance growth where stunting is common, but substitution for the usual diet may reduce observed benefits. Objective: We aimed to characterize dietary diversity from home Foods in a CFS efficacy trial and determine whether supplementation reduced breastfeeding frequency or displaced home Foods. Design: In a cluster-randomized controlled trial in rural Bangladesh, children (n = 5499) received, for 1 y starting at age 6 mo, periodic child feeding counseling for mothers (control) or counseling plus 1 of 4 CFSs fed as a daily snack. Breastfeeding status and past 24-h diet were assessed at enrollment and every 3 mo thereafter until 18 mo of age. A 7–Food group dietary diversity score (DDS) was calculated from home Foods only, and a DDS ≥4 constituted minimum dietary diversity (MDD). Results: Most children (97%) were breastfed through 18 mo of age, and 24-h breastfeeding frequency did not differ by supplementation group. Child dietary diversity was low; only 51% of children met the MDD by 18 mo. Rice, potatoes, and biscuits (cookies) were the most frequently consumed Foods, whereas the legumes, dairy, eggs, and vitamin A–rich fruit and vegetable Food groups were each consumed by <50% of children. The odds of meeting the MDD through the consumption of home Foods were equal or greater in the supplemented groups compared with the control group at all ages. High socioeconomic status and any maternal education were associated with increased odds of MDD at age 18 mo, whereas child sex and household Food security were not associated with MDD. Conclusions: In a setting where daily Complementary Food supplementation improved linear growth, there was no evidence that supplementation displaced breastfeeding or home Foods, and the supplementation may have improved dietary diversity. Pathways by which supplementation with fortified Foods may enhance dietary diversity, such as an improved appetite and increased body size, need elucidation. This trial was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT01562379","term_id":"NCT01562379"}}NCT01562379.
Suying Chang - One of the best experts on this subject based on the ideXlab platform.
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monitoring and evaluating the adherence to a Complementary Food supplement ying yang bao among young children in rural qinghai china a mixed methods evaluation study
Journal of Global Health, 2017Co-Authors: Yanfeng Zhang, Wei Wang, Michelle Helena Van Velthoven, Suying Chang, Huijun Han, Min Xing, Li Chen, Robert W ScherpbierAbstract:BACKGROUND Large investments are currently made in community-based Complementary Food supplement (Ying Yang Bao, YYB) programs to improve nutrition of young children in rural areas in China. However, there is a lack of knowledge about the experience and challenges of implementing YYB programs in China. We aimed to: 1) monitor distribution of YYB; 2) assess children's adherence to and acceptability of YYB; and 3) evaluate community-based strategies to improve the program. METHODS This mixed methods evaluation study combined data from surveys and focus groups that took place during a controlled interventional evaluation trial. The trial aimed to evaluate the effectiveness of community-based YYB distribution on improving children's health status in rural areas in China. We conducted five cross-sectional surveys with caregivers of children aged 6-23 months (baseline survey (N = 1804) in August 2012 and four follow-up cross-sectional surveys: 1) N = 494 in January 2013; 2) N = 2187 in August 2013; 3) N = 504 in January 2014; and 4) N = 2186 in August 2014) in one rural county in Qinghai Province. We used a two-stage cluster sampling technique to select mothers with eligible children for each survey. Information was collected from caregivers on household characteristics, YYB consumption and acceptability in the surveys. High adherence in each survey was defined as children who consumed at least four YYB sachets during the previous week. A logistic regression model was developed to obtain odds ratios (OR) with 95% confidence intervals of factors associated with high adherence. Also, we conducted 10 focus groups with73 caregivers and health workers involved in the YYB distribution. Content analysis was used to explore qualitative findings, which were used to gain deeper insight into the quantitative results. RESULTS Around 90% of caregivers had ever received YYB and more than 80% of children ever took YYB. Caregivers mainly knew about YYB through their village doctors. High adherence to YYB increased from 49.4% in the first follow-up survey (January 2013) to 81.4% in the last follow-up survey (August 2014; P < 0.0001). Repeated training sessions with village doctors could increase adherence. However, due to unplanned YYB stock-out, caregivers did not receive YYB for six months, which may have led to a decrease of high adherence from 64.1% in the second follow-up survey (August 2013) to 53.6% in the third follow-up survey (January 2014; P < 0.0001). Self-reported acceptability increased from 43.2% to 71.8%, partly due to improving the taste of YYB, which was the main reason that children disliked taking YYB. Unfortunately, more than 60% of caregivers did not perceive positive health improvement in their children after taking YYB. Multivariate analysis showed that children with diarrhea (OR = 1.216, 95% CI 1.025-1.442), cough or fever (OR = 1.222, 95% CI 1.072-1.393) during the past two weeks had significantly lower adherence. CONCLUSIONS This evaluation study showed that program monitoring in rural West China was critically important for understanding program implementation and adherence trends. This led to strategic changes to the intervention over time: improving the taste of YYB; strengthening health education of village doctors and caregivers; and ensuring continuity of YYB supply. Future programs need to monitor program implementation in other settings in China and elsewhere.
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effectiveness of community based Complementary Food supplement yingyangbao distribution in children aged 6 23 months in poor areas in china
PLOS ONE, 2017Co-Authors: Jie Wang, Suying Chang, Robert W Scherpbier, Liyun Zhao, Jian Zhang, Qingqing Man, Yifan Duan, Hui Wang, Shian YinAbstract:Background Poor growth and micronutrient deficiency mainly attack older infants and young children. Some countries have adopted clinically effective measures to combat malnutrition, but the compliance and improvement in efficacy of intervention vehicles in national programs require evaluation. Methods Baseline and follow-up cross-sectional surveys were conducted before and after a nutrition intervention program in 3 national poverty counties in China. Soybean-based Complementary Food supplements called Yingyangbao (YYB) in Chinese and training materials on child feeding were distributed to households with children aged 6–23 months for 18 months. Representative children were selected by probability proportional to size sampling methods to assess compliance of YYB and the intervention efficacy. A questionnaire was designed to collect data on basic characteristics of children, breastfeeding, 24-hour dietary intake, and consumption and appetite of YYB. Anthropometrics and hemoglobin were measured in the field, and anemia prevalence was evaluated. Venous blood was drawn from children aged 12–35 months to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children’s anemia. Results Of the children involved in the follow-up survey (n = 693), the P50 (P25, P75) intake of YYB was 6.7 (3.5, 7.0) sachets weekly, and 54.7% of the children liked the taste of YYB. Compared with the baseline situation (n = 823), the proportion of children fed a diverse diet and Foods rich in iron or vitamin A increased (P < 0.01) in the follow-up study. The prevalence of stunting and underweight decreased (P < 0.05), the prevalence of anemia decreased from 28.0% to 19.9% (P < 0.01), and the prevalence of vitamin B12 deficiency decreased from 26.8% to 15.4% (P < 0.01). For children aged 12–23 months, those who liked YYB and consumed 6 or more sachets of YYB weekly were at lower risk for anemia (OR = 0.34, 95% CI 0.13–0.90, P < 0.05), but the risk of stunting was associated with a non-diverse diet (OR = 1.48, 95% CI 1.06–2.07, P < 0.05). Conclusion The quality of diet and nutritional status of children aged 6–23 months are significantly improved by the intervention of YYB and nutrition education, and good compliance to YYB contributes to a low risk for anemia. Trial Registration Chinese Clinical Trial Registry ChiCTR-OOC-16008846
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effectiveness of Complementary Food supplements and dietary counselling on anaemia and stunting in children aged 6 23 months in poor areas of qinghai province china a controlled interventional study
BMJ Open, 2016Co-Authors: Yanfeng Zhang, Wei Wang, Michelle Helena Van Velthoven, Suying Chang, Huijun Han, Min Xing, Li Chen, Robert W ScherpbierAbstract:Objective To assess the effectiveness of dietary counselling and Complementary Food supplements on anaemia and stunting prevalence in children aged 6–23 months. Design A controlled intervention study with measurements of height and haemoglobin levels, and cross-sectional surveys in August 2012 (baseline), 2013 (mid-term) and 2014 (end-line). Setting One intervention county and one control county in rural Qinghai Province, China. Intervention Complementary Food supplements (containing protein, fat, carbohydrate, vitamin A, B1, B2, B12, D3, folic acid, iron, zinc and calcium) and Complementary feeding counselling were given in the intervention county. Participants Caregivers and their children aged 6–23 months. Primary and secondary outcome measures Effect of the interventions on the prevalence of anaemia (haemoglobin Results The surveys were conducted on 1804, 2187 and 2186 children aged 6–23 months in the intervention county in August 2012, 2013 and 2014, respectively, and 804, 680 and 790 children in the control county, respectively. Between the baseline and end-line surveys, anaemia prevalence decreased more in the intervention county than in the control county (71.1% to 47.8% vs 86.3% to 75.3%, respectively; p Conclusions We found much higher anaemia prevalence in poor rural areas of Qinghai Province compared with the national data. Community-based Complementary Food supplements combined with dietary counselling can improve feeding practices and reduce anaemia prevalence. Future studies should use longer follow-up to assess the effects on stunting. Strengths and limitations We included a large number of participants and assessed a combined Complementary Food supplements and dietary counselling intervention in a poor rural area in China with high anaemia prevalence. Although the study took place in only one intervention county and one control county, we conducted an analysis that controlled for differences between the two counties. Also, although we made significant efforts to train village doctors, their education was not systematically assessed after training and thus their delivery of the interventions may have been variable. Trial registration number ChiCTRPRC12002444; Pre-results.
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effect of home based Complementary Food fortification on prevalence of anemia among infants and young children aged 6 to 23 months in poor rural regions of china
Food and Nutrition Bulletin, 2015Co-Authors: Zheng Fang, Jie Wang, Suying Chang, Liyun Zhao, Ping Fu, Jian Huang, Lijuan Wang, David B HipgraveAbstract:Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of Complementary Food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children’s caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and...
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effect of home based Complementary Food fortification on prevalence of anemia among infants and young children aged 6 to 23 months in poor rural regions of china
Food and Nutrition Bulletin, 2015Co-Authors: Junsheng Huo, Jie Wang, Suying Chang, Zheng Fang, Liyun Zhao, Jian Huang, Lijuan Wang, Jing Sun, David B HipgraveAbstract:Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of Complementary Food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children's caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and 11.7 g/dL at 18 months after introduction of YYB. Moderate anemia (hemoglobin: 70-99 g/dL) decreased from 20.3% at baseline to 7.5%, 5.8%, and 7.3% after 6, 12, and 18 months of home fortification, respectively (P < .001), whereas mild anemia (hemoglobin: 100-110 g/dL) decreased from 29.0% to 16.7%, 18.1%, and 15.4%, respectively (P < .001). Among infants aged 6 to 23 months, 95% had regularly been fed YYB during the observation period. Regression analysis showed that the duration of YYB consumption and number of sachets consumed per week correlated positively with hemoglobin levels and negatively with anemia rates. Home Food fortification with YYB is feasible and effective for nutrition promotion among IYC in high-risk regions of China.
