1,721,068 research outputs found
Recommended from our members
Helping or hindering? Public Health Implications of Market-led Food Fortification in the United States
No full textMicronutrients are essential for tissue function, metabolism, disease prevention,and growth, especially during pregnancy and early childhood. Both deficiency and
excess can significantly impact health, often disproportionately affecting subgroups,
such as pregnant and lactating women, people of underrepresented races and
ethnicities, low income or food insecure groups, and individuals from households with
lower educational attainment, in the U.S. Food fortification, the addition of
micronutrients to foods during production, is a cost-effective strategy to improve
population-wide micronutrient intake. However, its impacts may vary based on
governmental regulation. In the U.S., fortification is governed by both mandatory and
voluntary policies. Mandatory fortification, regulated by FDA Standards of Identity,
requires that foods labeled as "enriched" contain specific nutrient levels, however,
beyond these requirements, manufacturers have significant discretion in selecting
nutrients and their quantities. This market-driven approach may address nutrient
deficiencies; however it also poses potential risks for excessive intake if fortified foods
are consumed by individuals with adequate intake or status. Additionally, fortified foods
may contain high levels of added sugars, sodium, and saturated fats, which contribute
to non-communicable diseases. Research on the extent of fortification and its
consumption patterns is limited in the US, leaving gaps in understanding its effects on
dietary quality and population health.
Chapter 1 describes a scoping review to map current evidence (since 2013) on
the nutrition and health impacts of U.S. food fortification. Using JBI methodology,
searches in PubMed, Scopus, and Web of Science identified 964 articles, of which 55
were included. Studies showed that fortification helps meet micronutrient needs and
provides broader benefits, such as reductions in neural tube defect rates. However,
some groups face risks of excessive intake. Evidence on the types of foods that are
fortified and the amount of micronutrients in them, as well as on the types of people that
consume or purchase fortified foods was limited. Additionally, research on nutrients
beyond folic acid remains sparse due to limited food composition data. The review
highlights the need for updated datasets, enhanced monitoring, and studies examining
the nutritional quality of fortified foods, and consumption patterns.
Chapter 2 aimed to 1) establish methods to identify fortified foods (with vitamin A,
vitamin C, calcium, or iron fortification) in the Circana Consumer Network Panel (CNP)
database, and 2) analyze fortification patterns in beverages and grain products. Using
an ingredient- and nutrient-based classification approach, 59,919 products were
categorized as fortified or not, with 36,021 purchased by households in 2017. Validation
showed strong consistency between classification methods. Results indicated that 24%
of beverages and 73% of grain products were fortified, with variations by category.
Vitamin A and C fortification were common in 100% juices and ready-to-eat cereals,
while calcium and iron fortification were prevalent in breads and cereals. Fortified foods
contained higher nutrient levels than unfortified counterparts, and some of the fortified
products contained substantial amounts of micronutrients per serving. The methods and
findings can help better understand the role of fortification in nutrient intake and diet
quality, informing fortification policy.
Building on Chapter 2, Chapter 3 examined household demographics and their
association with fortified food purchases. Using CNP data from 66,093 households in
2017, purchasing patterns were analyzed for specific beverage (e.g., juices, coffee,
sodas) and grain products (e.g., breads, cereals). The primary outcome was the weight
of purchased products on fortified products as a proportion of total weight purchased,
calculated separately for each food group subcategory. Associations were tested using
non-parametric ranked ANCOVA. Fortified food purchases were greater in households
with children, low-income households, households with lower educational attainment,
and households in non-metro areas. However, there were lower purchases of calcium-
and iron-fortified foods among low-income households and Non-Hispanic Black headed
households. Additionally, households with poorer Healthy Eating Index scores
purchased more fortified foods. These results suggest that micronutrient-fortified foods
may provide essential vitamins and minerals to various population groups in the US;
however purchase of fortified foods was associated with higher purchases of poor-
quality foods, and food fortification may not contribute to equitable food access and
optimal nutrition across different subgroups in the US.
Chapter 4 analyzed the added sugar content and in fortified vs nonfortified
beverages. The products assessed included fruit drinks, sodas, sport drinks, energy
drinks, coffee, tea and smoothie drinks reported as purchases in the 2017 CNP scanner
data. Sugar-sweetened (SS) products were assessed separately from zero-sugar
products, as well as in combined categories (SS and zero-sugar products), for fruit
drinks, sport drinks, and energy drinks. Each product was classified as fortified if it was
fortified with vitamin A, vitamin C, iron or calcium. Added-sugar content was obtained
from Label Insight, hand-searched online or derived from total sugars. Kruskal-Wallis
tests was used to examine the association between product fortification status and
grams of added sugars/100 ml as well as DV%, and Chi-square tests to assess the
relationship between fortification status and high-added-sugar status (>20% of DV of
added sugar per serving). To assess whether these relationships were similar when
accounting for sales volume, each of these three analyses were also repeated in sales-
weighted models. Out of all beverages (N= 6940), 43%, regardless of fortification, were
high in added sugars (>20% DV per serving). Fortified beverages often had higher
added sugar content, particularly in any fruit beverage (which included 100% juice),
combined fruit drinks and coffee beverages. For example, among the combined
category for any fruit beverages, fortified beverages contained an average of 0.3 grams
more added sugar per 100 grams than unfortified versions. Sales-weighted analyses
suggested that consumers tend to purchase fewer fortified high-sugar products.
Unweighted results suggest that selecting fortified products could have a neutral or a
negative impact on added sugar intake, depending on the category. However further
research is needed to understand the contribution of fortified foods to total added sugar
intake. Nevertheless, regardless of fortification status, beverages are high in added
sugar and policies such as high in added sugar warning labels may help consumers
select beverages that are consistent with dietary guidelines.
Together, these studies answer important questions regarding the types of
products that are fortified in the US, households characteristics associated with fortified
food purchase, and nutritional quality of fortified beverages. Future is research is
needed on fortification patterns of other micronutrients and food groups, contribution of
fortified foods to nutrient intake, across different socio-demographic groups, and the role
of fortified foods to micronutrient adequacy and diet quality. Certain policies and
regulations may help consumers in selecting foods aligned with dietary guidelines
including limiting fortification claims on products high in added sugars, mandating "high
in" added sugar front of package labeling, considering stricter fortification policies,
especially for SSBs, and supporting healthier diets though individual and community
level interventions and support
Recommended from our members
Modeling the Potential Impact of Fortification Programs on Dietary Micronutrient Intakes among Young Children and Women of Reproductive Age in Low- and Middle-income Countries: Case Studies from Cameroon and Zambia
No full textABSTRACTIn low- and middle-income countries (LMICs), the prevalence of inadequate micronutrient intake and micronutrient deficiency is high, particularly among women and young children. Sub-Saharan Africa is disproportionally affected by micronutrient deficiencies (MNDs) and the progress towards sustained reduction in MNDs has been limited. In recent years, large-scale food fortification has gained traction in LMICs, including sub-Saharan African countries, to address micronutrient deficiency. Given the long-term effort and investment that is needed to implement and sustain fortification programs, dietary intake data should be used in overall planning of fortification programs to make informed judgments about the appropriateness of the food vehicle, and the types and amounts of the specific nutrients to be added. Simulation studies provide insights about the potential contributions of food fortification to micronutrient intakes and, alongside information on program costs, can provide an efficient way of comparing hypothetical fortification scenarios that can then be translated into nutrition policies and practices. However, the usefulness of simulation modeling studies depends on the validity of dietary requirements applied and assumptions taken into consideration.
Zinc Nutrient Reference Values (NRVs) set by several expert groups differ widely. The effects of these differences on the predicted impacts and on the cost-effectiveness of zinc fortification programs have not been fully explored. In the first study, we estimated the prevalence of inadequate zinc intake and the predicted impact and cost-effectiveness of zinc fortification programs using NRVs published by different authorities based on data from a nationally representative nutrition survey among children and women in Cameroon. The distribution of usual zinc intakes was estimated using the National Cancer Institute (NCI) method. Prevalence of total zinc intake below the estimated average requirement (i.e. dietary requirement) and prevalence of “absorbable zinc intake” below the physiological requirement were estimated using NRVs from 4 expert groups: World Health Organizations (WHO), Institute of Medicine (IOM), International Zinc Nutrition Consultative Group (IZiNCG) and European Food Safety Authority (EFSA). The estimated prevalence of inadequate zinc intake varied substantially ranging from 10% (IZiNCG-physiological requirement) to 81% (EFSA-physiological requirement) among children, and from 9.4% (WHO-physiological requirement) to 94% (IOM-physiological requirement) among women. These differences observed in the prevalence of inadequate intake translated to differences in the estimated benefits and cost-effectiveness of zinc fortification programs. Therefore, depending on the NRVs applied, assessments will differ regarding the need for, and the benefits and cost-effectiveness of, zinc fortification programs. Efforts are needed to harmonize NRVs for zinc.
Snack products that are voluntarily fortified with micronutrients are increasingly available but are not necessarily formulated to meet known dietary nutrient gaps, so the potential impacts on population micronutrient intake adequacy are uncertain. In the second study, we predicted the impacts of hypothetical micronutrient-fortified biscuits on inadequate micronutrient intake among children and women of reproductive age (WRA) based on nationally representative data in Cameroon. We estimated usual nutrient intake distributions using the NCI method and simulated the impacts of biscuit fortification on prevalence of micronutrient intake (vitamin A (VA), folate, vitamin B-12, iron, and zinc) below the estimated average requirement, given observed biscuit consumption, in the presence and absence of large-scale food fortification (LSFF) programs. In the absence of LSFF programs, biscuits fortified with retinol (600μg/100g), folic acid (300μg/100g), and zinc (8mg/100g) were predicted to reduce the prevalence of inadequacy among children by 10.3 ± 4.4, 13.2 ± 4.2 and 12.0 ± 6.1 percentage points, respectively, in Yaoundé/Douala. However, when the impact of existing national VA-fortified oil, and folic acid and zinc-fortified wheat flour programs were considered, the additional impacts of fortified biscuits were reduced substantially. Micronutrient-fortified biscuits were predicted to have minimal impacts on dietary inadequacy among WRA, with or without LSFF programs. Given observed patterns of biscuit consumption in Cameroon, biscuit fortification is unlikely to reduce dietary inadequacy of studied micronutrients, except possibly for selected nutrients among children in urban areas, but only in the absence of LSFF programs.
Zambia has been implementing mandatory sugar fortification with VA, however the contribution of VA-fortified sugar to VA intakes and status has not been directly assessed. In the third study, we predicted the potential impacts of sugar fortification with VA on prevalence of VA inadequacy, and examine its association with plasma and breast milk retinol among lactating women based on baseline data from a randomized trial from Mkushi District in rural Zambia. We simulated VA intake under various sugar fortification scenarios: 3.1 and 8.8 mg/kg (measured median fortification levels of VA in sugar from previous studies), 10 mg/kg (minimum legal requirement) and 15 mg/kg (minimum legal requirement at factory level). We applied the NCI’s bivariate model to examine associations of usual intake of sugar and dietary VA with plasma and breast milk retinol concentrations measured by high performance liquid chromatography.
Our model predicted that sugar fortification with VA at 3.1 mg/kg, 8.8 mg/kg, 10 mg/kg and 15 mg/kg would reduce the prevalence of VA inadequacy by 7 (SE:6), 24 (SE:14), 30 (SE:15) and 47 (SE:18) percentage points, respectively, without increasing the risk of retinol intake above the UL. Usual sugar intake and usual VA intake were not associated with plasma retinol (β = 0.003; 95% CI: -0.015, 0.020) or with breastmilk retinol concentrations (β = 0.012; 95% CI: -0.002, 0.026). Usual VA intake from other foods sources was significantly associated with the log of breast milk retinol in µmol/ L (β = 0.001; 95% CI: 0.0002, 0.002), but not with plasma retinol (β = -0.0001; 95% CI: -0.001, 0.001). In Zambia, sugar fortification has the potential to reduce dietary VA inadequacy. However, the impacts on VA intakes and any improvements in VA status are likely to be limited if the program is not implemented as planned. Even if target fortification levels are achieved (10 mg/kg), sugar fortification alone is unlikely to eliminate dietary VA inadequacy among lactating women in Zambia.
Together, the three studies from the dissertation provide evidence on the effect of using different zinc reference values on the predicted benefits and cost-effectiveness of zinc fortification programs, and the impacts of voluntary snack food fortification and mandatory sugar fortification on prevalence of inadequate intake. These findings have important implications with regard to planning and evaluation of fortification programs in LMIC contexts.
Recommended from our members
Noncommunicable Disease Risk in Global Settings: An Examination of Potential Contributors and Assessment Methods
Full text linkNoncommunicable diseases, including cardiovascular diseases, diabetes, and others, are the leading cause globally of premature mortality (death before the age of 70), with the majority of deaths occurring in low- and lower-middle-income countries. Two prominent conditions contributing to noncommunicable disease risk include overweight or obesity and hypertension. Worldwide, >40% of adults and almost 6% of children experience overweight and obesity, and >15% of adults have raised blood pressure. Alongside rising prevalence of overweight or obesity and hypertension, micronutrient deficiencies persist, especially in low- and lower-middle-income countries. The United Nations’ Sustainable Development Goal (SDG) 2.2 calls for an end to malnutrition in all its forms by 2030, and SDG 3.4 aims to reduce premature deaths from noncommunicable diseases by one-third by 2030 (relative to 2015 levels). However, progress towards these goals is slow, with most countries worldwide off track. Given the potential for conditions of both undernutrition and overnutrition to increase the risk of developing noncommunicable diseases, a greater understanding of the relationships between selected contributors to noncommunicable disease risk, and how they are measured, are needed to reach the SDG targets. Inflammation is the body’s physiological response to injury, illness, infection, or environmental insult, and is characterized by the presence of pro-inflammatory cytokines and acute-phase proteins, such as C-reactive protein (CRP) and α-1-acid glycoprotein (AGP). In populations in LIC and LMIC, inflammation may be more likely associated with illnesses such as diarrhea or helminth infections, while populations in upper-middle and high-income countries may more commonly experience the chronic inflammation associated with obesity. Inflammation confounds the assessment of the micronutrients iron and vitamin A, as the biomarkers commonly used to measure iron and vitamin A status are also acute phase proteins. In the presence of inflammation, serum or plasma concentrations of ferritin transiently decrease, and serum or plasma concentrations of retinol and retinol-binding protein (RBP) increase. In Chapters 2 and 3, I explored the extent to which adiposity-related inflammation may influence ferritin and retinol or RBP interpretation.
In Chapter 2, I describe relationships between weight status, inflammation, and ferritin among non-pregnant women of reproductive age (15-49 years, WRA) and preschool-age children (6-59 months, PSC) with normal weight to overweight or obesity in differing geographic settings. Cross-sectional data were separately analyzed from n=18 surveys (WRA) and n=25 surveys (PSC) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, excluding observations with underweight, wasting, pregnancy, or malaria. Relationships were assessed between BMI (WRA) or BMI-for-age z-score (BAZ, PSC), inflammatory biomarkers CRP and/or AGP, and ferritin by linear regression, and potential mediation by CRP and/or AGP in relationships between BMI or BAZ and ferritin with structural equation modeling. Regression and mediation models accounted for complex survey designs, and results were grouped by World Bank income classifications. In 5 of 6 surveys among WRA from upper-middle and high-income countries, ferritin was significantly positively associated with BMI, and this relationship was partially (or fully in the survey from the United States) mediated by CRP and/or AGP. Mediation was present in 4 of 12 surveys for WRA in low- and lower-middle income countries. Among PSC, ferritin was positively associated with CRP and/or AGP in all surveys, but there were no significant CRP- or AGP-mediated relationships between ferritin and BAZ, except a negative relationship in the Philippines. I concluded that where overweight and obesity are common among WRA, measurement of inflammatory biomarkers and their use in interpreting ferritin may improve iron status assessment. While these relationships were inconsistent among PSC, inflammation was common and should be measured to interpret iron status.
In Chapter 3, I conducted similar analyses to examine relationships between weight status, inflammation, and retinol or RBP among WRA and PSC with normal weight to overweight or obesity. BRINDA data from n=13 surveys (WRA) and n=22 surveys (PSC) were separately analyzed, excluding observations with underweight, wasting, pregnancy, or malaria. Relationships were assessed between BMI (WRA) or BAZ (PSC), CRP and/or AGP, and retinol or RBP by linear regression, and potential mediation by CRP and/or AGP in relationships between BMI or BAZ and retinol or RBP with structural equation modeling. All regression and mediation models accounted for complex survey designs. Among WRA, greater BMI was positively associated with retinol or RBP in 5 of 13 surveys, BMI was positively associated with CRP and/or AGP in 10 of 13 surveys, but associations between biomarkers of inflammation and retinol or RBP were inconsistent. Among PSC, BMI was not associated with retinol, RBP, CRP, or AGP, but biomarkers of inflammation were consistently negatively associated with retinol or RBP. In 3 of 13 surveys among WRA and 1 of 22 surveys among PSC, inflammation partially mediated the relationship between BMI or BAZ and retinol or RBP, however the direction of association varied. I concluded that in these surveys, inflammation associated with overweight and obesity does not appear to impact vitamin A assessment when measured with retinol or RBP; however, inflammation should continue be measured to interpret vitamin A status among PSC.
Chapter 4 explores salt consumption in Ghana, where salt consumption ranges 6-12 g/d, and salt consumption ≥5 g/d is associated with increased risk of noncommunicable diseases. To develop salt reduction strategies that are relevant to this context, understanding salt usage and consumption patterns is necessary. My objectives for this chapter were to: 1) estimate consumption of salt, including salt from bouillon, among households, women, and children, and compare to global recommendations; 2) estimate the proportion of salt consumed from bouillon; and 3) identify factors, including knowledge, attitudes, and practices (KAP), associated with household salt consumption in 2 districts in Northern Region, Ghana. Employing mixed-methods methodology, households were enrolled from 14 urban and 14 rural clusters from Tolon and Kumbungu districts in a pilot survey and focus group discussions (FGDs, n=20). Using the Fortification Assessment Coverage Toolkit, households (n=369) reported most recent purchases of discretionary salt (DS, ‘table salt’) and bouillon cubes. From purchase data, median (IQR) household consumption (g/d) of DS and total salt (TS, DS + salt from bouillon, assumed to be 55% salt) were calculated, including the proportion of salt from bouillon. DS and TS consumption for women (15-49 y) and children (2-5 y) were estimated with the Adult Male Equivalent method and compared to global recommendations. Salt intake from urinary sodium excretion was predicted with the INTERSALT equation (women only). Associations between DS and TS consumption and household and individual (women’s) characteristics, including KAP, were tested with mixed effects ANOVA. Minimally-adjusted and multivariable models included district, setting (urban/rural), household size, and participant type (non-lactating or lactating woman) as fixed effects, and the random effect of cluster. Qualitative themes were generated from FGDs using the Framework Method. From reported household purchase data, estimated consumption of DS and TS appeared to exceed global recommendations for many children (TS: 2.9 [1.9, 5.2] g/d) and the majority of women (TS: 6.0 [4.0, 10.2] g/d). Women’s mean urinary sodium excretion also suggested high sodium exposure (7.1 g/d). Bouillon contributed <25% to households’ daily TS consumption. Household salt consumption was greater among households in 3rd-5th (highest) asset quintiles and those with severe food insecurity. Few other characteristics were associated with household salt consumption. Salient qualitative themes included salt’s ubiquity as a seasoning, and how intra-household dynamics, taste preferences, and perceptions about salt and health shaped salt usage and consumption. These results suggest that salt consumption among women and children in this area exceeds recommendations; food prepared outside the home may further contribute to salt consumption. Salt reduction interventions may be warranted in this context.
Together, these studies broaden our understanding of how measuring indicators of iron and vitamin A status relate to noncommunicable disease risk assessment in different global settings, which will aid global nutrition status surveillance efforts. Also, the salt consumption results from Ghana will help inform nutrition and policy discussions related to salt in Ghana, including the development of salt-reduction behavior change communication strategies
Recommended from our members
Child Dietary Patterns and Impact of Multiple Micronutrient Fortified Bouillon Cubes on Child Development Outcomes among Children 2 to 5 Years of Age in Northern Ghana
No full textChildren under 5 in low-and-middle-income countries (LMICs) are facing multiple forms of malnutrition, including stunting, wasting, micronutrient deficiencies and overweight and obesity. Poor diet quality and shifting dietary patterns are thought to contribute to the multiple forms of malnutrition observed. Diverse and nutrient dense diets are important for children’s growth and development, but the diets of young children in LMICs, predominantly reliant on starchy staples, often fail to meet their needs. At the same time there have been increases in availability and consumption of sugar sweetened beverages and processed snack foods that are often energy dense but lacking in micronutrients. These same patterns have been observed in Ghana. Overweight and obesity prevalence has been increasing among adults and adolescents while stunting, wasting and micronutrient deficiencies among children under 5 years remain a public health concern, particularly in the Northern Region. Diet quality of children 6-23 months is poor and there have been increases in availability and consumption of SSB and snack foods in urban areas like Accra. Yet, the dietary patterns of pre-school age children are not well characterized, and it is unclear the extent to which SSBs and snack food consumption is prevalent among this age group and among more rural populations. In Chapter 2, I described prevalence and frequency of consumption of fruits, vegetables, sugar-sweetened beverages (SSB), salty snacks and sweet snacks (i.e., food categories) among children 2-5y in northern Ghana. I then identified factors associated with consumption and examined relationships between consumption and nutritional status. In this cross-sectional study, households were recruited from urban and rural clusters in Tolon and Kumbungu districts. Children’s (n=243) dietary data were collected using a questionnaire modeled after the WHO STEPS tool. Children’s height, weight, hemoglobin and micronutrient biomarker (n=125) concentrations were assessed. Multi-variable logistic and linear regression were used to identify individual, maternal and household factors that predicted consumption of food categories and relationships between consumption and nutritional status. In a typical week, most children vegetables (98%), sweet snacks (81%), and fruits (76%); 50% consumed salty snacks and 46% consumed SSB. Average [mean (SD)] servings consumed weekly were: 7.86 (7.26) vegetables, 2.86 (2.54) sweet snacks, 2.63 (3.85) SSB, 1.80 (1.68) fruits, and 1.16 (1.68) salty snacks. Children in households with higher food insecurity were more likely to report consumption of all food categories (fruits, SSB, salty snacks and sweet snacks; ≥7 servings vegetables), but other characteristics did not consistently predict diet. Consumption was generally not associated with nutritional status. I concluded that fruit and vegetable consumption was severely inadequate with respect to recommendations and while SSB and snack food consumption was common, average servings consumed were low. Interventions to increase fruit and vegetable consumption while minimizing SSB, salty snack and sweet snack consumption are needed but require further research to design.
It is estimated that over 250 million children in LMICs are at risk of not reaching their developmental potential, which has been associated with poor school performance and poor economic outcomes later in life. Children’s development can be negatively impacted by numerous environmental factors such as poverty, lack of early stimulation in the home and malnutrition. Micronutrients, such as vitamin A, vitamin B12, folic acid, iron and zinc are required for numerous processes in brain development, deficiencies in these nutrients can result in developmental delays. Nutrition interventions, such as micronutrient supplementation have been shown to have small positive effects on child development outcomes. Large scale food fortification (LSFF) improves micronutrient status among populations, but it is unclear if the amounts received would be enough to impact developmental outcomes.
To better evaluate impacts of interventions on child development outcomes, we first need to identify valid and reliable developmental assessment methods feasible for use in LMIC settings. Child development assessment methods can be time extensive and require substantial resources. Many developmental assessment methods were developed in high income countries and are not appropriate for use in LMICs without adaptations. Tablet based assessments where children interact directly with the tablet, may address some of these challenges. They are quick to administer, gamified making them fun for children and may be cross culturally appropriate. However, there is limited data on their use in LMIC settings.
In Chapter 3, I examined the feasibility, test-retest reliability of the Early Years Toolbox (EYT) Go/No-go (GNGT) iPad task for measuring inhibition and evaluated the sensitivity of inhibition to factors expected to be related to inhibition as an indicator of convergent validity. Data for chapter 3 were from the Condiment Micronutrient Innovation Trial (CoMIT) Project. Children 2-5 y (n=689) were recruited from 14 rural/peri-urban and 14 urban clusters in northern Ghana. Following demographic data collection and administration of the home observation for the measurement of the environment (HOME inventory), children completed the EYT GNGT. In the task, children were presented with stimuli (fish and sharks) and instructed to press the fish (go-trial) and resist pressing the sharks (no-go trial). All GNGT assessments were administered offline. Impulse control score (go-accuracy x no-go accuracy), the tasks indicator of inhibition, was calculated. Implausible trials and blocks of trials (25 trials/block) were removed according to EYT guidelines. To assess feasibility, we examined the distribution of scores, calculated the percent of children that refused the EYT GNGT and the percent of implausible trials and blocks of trials removed. To assess test-retest reliability, a convenience sample of 30 children attempted the GNGT a second time one week after their first assessment. We calculated the intraclass correlation coefficient (ICC) of impulse control score. We used Pearson’s correlation to examine the association of impulse control score, and environmental factors expected to be related to impulse control score as an indicator of convergent validity. Average (SD) child age was 41.2 (10.0) months. Many children resided in a household with no touchscreen devices (42%). Of the 682 participants, 5 (< 1%) refused to attempt the GNGT. Data cleaning resulted in the removal of 4.6% of trials, 7.0% of blocks, and 3 children (< 1%) had all blocks removed. The task took an average of 7 minutes to complete. Impulse control scores were normally distributed with no floor or ceiling effect. The ICC was moderate (0.4-0.75) for impulse control score (0.53). Impulse control score was significantly positively correlated with child age (r = 0.20; p = <0.0001) and HOME inventory score (r = 0.09; p = 0.03) but was not correlated with any other environmental factors measured. I concluded that the EYT GNGT is a feasible and reliable assessment of impulse control among children in Northern Ghana.
In chapter 4 I evaluated the impact of household use of multiple micronutrient fortified bouillon cubes on child development outcomes among children 2-5 years of age enrolled in the CoMIT project, a double blind randomized controlled trial. Children were recruited from 14 rural and 14 urban/semi-urban clusters. Enrolled children’s households were randomized to receive the multiple micronutrient (MMN)-fortified bouillon (iodine, vitamin A, folic acid, vitamin B12, iron and zinc) or the control bouillon (iodine only). Bouillon cubes were delivered to households by study staff every two weeks for 9 months. Child development was assessed prior to randomization and at the end of the intervention. We used the Malawi Developmental Assessment Tool (MDAT) to assess gross motor, fine motor, personal social and language development, and the Early Years Toolbox Go/No-go Task (EYT GNGT) to assess inhibition. For each outcome, minimally-adjusted (controlled for baseline measure, recruitment site, child age and sex only) and fully adjusted ANCOVA models were used to estimate endline mean differences between the intervention and control group. Of the 670 children randomized, 645 completed the endline MDAT and 633 completed the endline EYT GNGT. Children receiving the MMN-fortified bouillon had higher language development scores in the minimally (β = 0.12, 95% CI = 0.03, 0.21) and fully adjusted models (β = 0.13, 95% CI = 0.04, 0.21) and gross motor in the fully adjusted model (β = 0.12, 95% CI = 0.02, 0.22). However, personal social, fine motor and inhibition scores did not differ between groups at endline. I concluded that bouillon fortification with micronutrients may modestly improve certain development outcomes among children
Recommended from our members
The potential benefits and challenges of micronutrient interventions for public health nutrition
Full text linkThe purpose of this dissertation is to evaluate the landscape of currently-recommended public health interventions to address micronutrient deficiencies and associated conditions, and to describe the effectiveness of those interventions to successfully reduce or eliminate micronutrient deficiencies. Further, this dissertation aims to understand the effect of one specific micronutrient intervention, large-scale food fortification, on the microbiome of women of reproductive age and their children. The dissertation is divided into four chapters with the corresponding objectives:1. The first chapter is a literature review of current public health interventions with micronutrients, and a summary of their estimated impacts, and challenges associated with each intervention strategy.2. The second chapter is a secondary analysis of a larger clinical trial, the Zinc in Powders trial (ZiPT), which aims to evaluate the risk factors for anemia among Bangladeshi children who received micronutrient powders (MNPs) for 24 weeks as a part of the clinical trial.3. The third chapter aims to evaluate the effect of LSFF with quintuply-fortified salt (QFS) on microbiome outcomes (diversity and relative abundance of taxa) among a subgroup of women of reproductive age in Punjab, India who participated in the Multiply-Fortified Salt (MFS) trial.4. The fourth chapter aims to evaluate the effect of LSFF with QFS on microbiome outcomes (diversity and relative abundance of taxa) among a subgroup of children in Punjab, India who participated in the Multiply-Fortified Salt (MFS) trial
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
- …
