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Journal Current Developments in Nutrition

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Jowel Choufani, Zeina Jamaluddine, Sciprofile linkKenda Cunningham
Current Developments in Nutrition; doi:10.1093/cdn/nzz135

Abstract:Background Few intervention studies have focused on how inputs link with outcomes. Objective This study tested whether Suaahara I program inputs translated into intended outcomes and identified gaps along the theorized program impact pathway (PIP) to improved nutrition, care and water, sanitation, and hygiene behaviors. Methods We used household-level, cross-sectional survey data from a process evaluation of Suaahara I conducted in 2014. A total of 480 households with a pregnant women or child under 2 years of age were selected with an equal split between intervention and comparison arms. We used regression models to test associations between exposure to Suaahara 1 and three primary outcomes and three parallel knowledge mediators child minimum dietary diversity, child feeding during illness, and proper handwashing during child care. We used generalized structural equation modelling using full information maximum likelihood to test whether knowledge mediated associations between exposure and outcomes. Results In the adjusted regression models between maternal exposure to Suaahara I and three behavioral outcomes, we found a small, positive association for handwashing (β 0.21; CI 0.10 – 0.31), but no association with the other two outcomes. In the mediation analysis, maternal exposure to Suaahara I, however, was associated with the mediator (knowledge) for all three outcomes: handwashing with soap and water (β 0.05; SE 0.02), child minimum dietary diversity (logit 0.06; P = 0.03), and child feeding during illness (logit 0.09; SE 0.02). We found a positive, significant association for the full indirect pathway of program input to output via knowledge for child feeding during illness (logit 0.07; SE 0.03) only. Conclusion Exposure to Suaahara I behavior change interventions improved knowledge, but this did not always translate into improved practices. It is important to address barriers to optimal practices beyond knowledge in future nutrition programs in Nepal.
Phuong Hong Nguyen, Sciprofile linkYves Martin-Prevel, Mourad Moursi, Lan Mai Tran, Purnima Menon, Marie T Ruel, Mary Arimond
Current Developments in Nutrition; doi:10.1093/cdn/nzz134

Abstract:Background The Minimum Dietary Diversity for Women (MMD-W) was validated as a proxy of micronutrient adequacy for non-pregnant women, with proposed data collection being either a list-based or a qualitative open recall method. Few studies have compared the performance of these two methods. Objectives We compared performance in predicting micronutrient adequacy of food group indicators (FGIs) measured by the list-based and the quantitative open recall method using varying quantity cutoffs. We also examined the agreement between list-based and open recall FGIs. Methods Data were collected in Bangladesh (n = 600 pregnant women) and India (n = 655). The performance of different indicators to predict micronutrient adequacy was compared using receiver operating characteristic (ROC) analysis. Correlations between list-based and open recall FGIs were calculated using Spearman's rank test; agreement was assessed by intraclass correlation (ICC) and kappa statistics. Food groups that were most often misreported by the list-based method were identified. Results There were no statistically significant differences in ROC curves between list-based and open recall FGIs in either country. In Bangladesh, correlations between list-based and open recall FGIs varied between 0.6 and 0.8; ICC values were 0.43–0.75; Kappa values were 0.51–0.53 when using a cutoff of any quantity or 15 g for open recall, but were lower (k = 0.24) with the cutoff of one portion. In India, these values were lower: ∼0.4 for correlation, 0.32–0.37 for ICCs, and 0.17–0.22 for Kappas. Food groups most susceptible to misreporting using list-based method were beans/peas in Bangladesh and other vegetables in India. Conclusions Our study provides initial support for the use of list-based questionnaires in assessing food group diversity or prevalence of MDD-W in pregnant women. Additional and context-specific work may be required to understand the potential of simple methodologies to assess consumption of specific food groups.
Stephanie P Gilley, Nicholas E Weaver, Evan L Sticca, Purevsuren Jambal, Alexandra Palacios, Mattie E Kerns, Pratibha Anand, Jennifer F Kemp, Jamie E Westcott, Lester Figueroa, et al.
Current Developments in Nutrition; doi:10.1093/cdn/nzz132

Abstract:Background Maternal dietary restriction and supplementation of one carbon (1C) metabolites can impact offspring growth and DNA methylation. However, longitudinal research of 1C metabolite and amino acid (AA) concentrations over the reproductive cycle of human pregnancy is limited. Objective To investigate longitudinal 1C metabolite and AA concentrations prior to and during pregnancy and the effects of a lipid-based nutrition supplement (LNS) containing more than 20 micronutrients, and pre-pregnancy BMI (ppBMI). Methods This study was an ancillary study of the Women First Trial (NCT01883193, focused on a subset of Guatemalan women (n = 134), 49% of whom entered pregnancy with a BMI ≥ 25 kg/m2. Ninety-five women received LNS during pregnancy (+LNS group), while the remainder did not (-LNS group). A subset of women from the Pakistan study site (n = 179) were used as a replication cohort, 124 of whom received LNS. Maternal blood was longitudinally collected on dried blood spot (DBS) cards at preconception, and at 12 and 34 weeks gestation. A targeted metabolomics assay was performed on DBS samples at each time point using liquid chromatography/tandem mass spectrometry. Longitudinal analyses were performed using linear mixed modeling to investigate the influence of time, LNS, and ppBMI. Results Twenty-three of 27 metabolite concentrations including betaine, choline, and serine, changed from preconception across gestation after applying a Bonferroni multiple testing correction (P < 0.00185). Sixteen of those showed similar changes in the replication cohort. Asymmetric and symmetric dimethylarginine were decreased by LNS in Guatemala. Only tyrosine was statistically associated with ppBMI at both study sites. Conclusions Time influenced most 1C metabolite and AA concentrations with a high degree of similarity between two diverse populations. These patterns were not significantly altered by LNS consumption or ppBMI. Future investigations will focus on 1C metabolite changes associated with infant outcomes, including DNA methylation.
Julie C Ruel-Bergeron, Kristen M Hurley, Audrey Buckland, Trust Mlambo, Yunhee Kang, Ephraim Chirwa, Arghanoon Farhikhtah, Nancy Aburto, Parul Christian
Current Developments in Nutrition; doi:10.1093/cdn/nzz131

Abstract:Background Global attention to the study of nutrition program implementation has been inadequate yet is critical for effective delivery and impact at scale. Objective The objective of this mixed-methods process evaluation study was to measure the recruitment, fidelity, and reach of a large-scale, community-based nutrition program in Malawi. Methods The nutrition program delivered a small-quantity lipid-based nutrient supplement (SQ-LNS) and social and behavior change communication (SBCC) to improve infant and young child feeding (IYCF) and water, sanitation, and hygiene (WASH) practices in households with children aged 6–23 months. Program monitoring and evaluation data was used to measure program recruitment, reach, and fidelity. Structured direct observations and knowledge questionnaires with program volunteers measured quality aspects of program fidelity. The number of times activities were done correctly was used to tabulate proportions used to represent program functioning. Results Half (49.5%) of eligible children redeemed program benefits by 8 months of age during the first four years of program implementation. Implementation of training activities for SBCC cadres exceeded program targets (100.6%), but the completion of certain modules (breastfeeding and complementary feeding) was lower (22.9% and 18.6%, respectively). Knowledge of IYCF, WASH, and SQ-LNS messages by volunteers was > 85% for most messages, except ability to list the 6 food groups (35.7%). Structured direct observations of SQ-LNS distributions indicated high fidelity to program design, while those of household-level counseling sessions revealed lack of age-appropriate messaging. Program reach showed participation in monthly distribution sessions of 81.0%, group counseling of 93.3%, and individual-level counseling of 36.9%. Conclusion This community-based nutrition program was implemented with high fidelity and quality, with specific interventions requiring further attention. The documentation of implementation contributes to our understanding about how program impacts were achieved.
Catherine E Cioffi, Jean A Welsh, Jessica A Alvarez, Terryl J Hartman, K M Venkat Narayan, Miriam B Vos
Current Developments in Nutrition; doi:10.1093/cdn/nzz130

Abstract:BACKGROUND The relative distribution of upper- versus lower-body fat may be an important determinant of cardiometabolic disease risk in youth. Dietary correlates of adolescent regional body fat distribution are under-studied. OBJECTIVE To evaluate associations of added sugar intake overall and from sugar-sweetened beverages (SSBs) with relative upper-body fat deposition in U.S. adolescents. METHODS This was a cross-sectional analysis of data from 6,585 adolescents (12–19 years) in the National Health and Nutrition Examination Survey cycles 1999–2006. Trunk, leg, and total fat mass were assessed by dual-energy x-ray absorptiometry. Participants were grouped into categories of total and SSB added sugar intake as a percentage of total energy intake (TEI) in 5% increments. Stepwise multivariable linear regression was used to examine associations of added sugar intake with trunk fat/leg fat ratio (TLR) and trunk fat/total fat ratio (TTR). RESULTS There were no associations of total added sugar intake with TLR or TTR. For SSB added sugar, compared to the lowest category of intake (22% TEI) was associated with higher log-TLR (β (95% CI).>22% TEI vs. < 2% TEI: 0.05 (0.01, 0.09)] and TTR [1.30 (0.53, 2.07)] in the partially-adjusted model with sex, age, race/ethnicity, income, physical activity, smoking status as covariates (P-trend = 0.0001 for both). When body mass index (BMI) z-score and total energy intake were added as covariates, the magnitude of the associations were attenuated, but remained significant [log-TLR β (95% CI): 0.03 (0.005, 0.06), P-trend = 0.0018; TTR β (95% CI): 0.75 (0.27, 1.23), P-trend = 0.0004]. CONCLUSIONS These findings support that added sugar from beverages is associated with higher upper-body adiposity, though the magnitude and clinical significance of the associations may be small, especially when adjusted for BMI and TEI. Additional studies are needed to elucidate the underlying biological mechanisms to explain these findings.
Kathryn E Hopperton, Deborah L O'connor, Nicole Bando, Aisling M Conway, Dawn V Y Ng, Alex Kiss, Jacqueline Jackson, Linh Ly, Sharon L Unger, the OptiMoM Feeding Group
Current Developments in Nutrition; doi:10.1093/cdn/nzz129

Abstract:Background Bovine milk-based fortifiers (BMBF) have been standard of care for nutrient fortification of feeds for very low birthweight (VLBW) infants, however there is increasing use of human milk-based fortifiers (HMBF) in neonatal care despite additional costs and limited supporting data. No randomized clinical trial has followed infants fed these fortifiers after initial hospitalization. Objective To compare neurodevelopment in infants born weighing Methods This is a follow-up of a completed pragmatic, triple-blind, parallel randomized clinical trial conducted in Southern Ontario between August 2014 and March 2016 (NCT02137473) with feeding tolerance as the primary outcome. Infants weighing Results Of the 127 infants randomized, 109 returned for neurodevelopmental assessment. No statistically significant differences between fortifiers were identified for cognitive composite scores (adjusted scores 94.7 in the HMBF group and 95.9 in the BMBF group; fully adjusted mean difference, −1.1 [95% CI: −6.5 to 4.4]), language composite scores (adjusted scores 92.4 in the HMBF group and 93.1 in the BMBF; fully adjusted mean difference, −1.2 [−7.5 to 5.1]), or motor composite scores (adjusted scores 95.6 in the HMBF group and 97.7 in the BMBF; fully adjusted mean difference, −1.1 [−6.3 to 4.2]). There was no difference in the proportion of participants that died or had neurodevelopmental impairment or disability between groups. Conclusions Providing HMBF compared to BMBF does not improve neurodevelopment scores at 18-months corrected age in infants born Trial Registration: NCT02137473,
Mario Vailati-Riboni, Fernanda Batistel, Rainie R C S Yambao, Claudia Parys, Sciprofile linkYuan-Xiang Pan, Sciprofile linkJuan J Loor
Current Developments in Nutrition; doi:10.1093/cdn/nzz128

Abstract:Background Post-ruminal supply of Met during the periparturient period enhances production efficiency (feed conversion to milk) in dairy cows partly through alleviation of oxidant and inflammatory status. Whether alterations in hepatic one-carbon (major contributor of antioxidants) and/or energy-metabolism contribute to these beneficial effects is unknown. Objectives Investigate alterations in hepatic one-carbon and energy metabolism and associations with plasma amino acids (AA) and production efficiency in response to enhanced post-ruminal supply of Met. Methods Holstein cows (n = 30/group) were fed during the last 28 days of pregnancy a control diet (CON) or the control plus ethyl-cellulose rumen-protected methionine (MET; 0.9 g·kg−1 of dry matter intake). Plasma (n = 15/group) and liver tissue (n = 10/group) were collected throughout the periparturient period to evaluate AA profiles, activity of TCA cycle, and one-carbon metabolism via mRNA abundance, enzyme activity, and targeted metabolomics. Results Cows in MET had greater overall (27%, P = 0.027) plasma Met concentrations, but had similar total plasma AA concentrations. Although mRNA abundance of one-carbon metabolism enzymes did not differ, hepatic activity of cystathionine β-synthase (CBS) (51.2 vs. 44.4 mmol·h−1·mg−1 protein; P = 0.032) and concentration (19%, P = 0.048) of the cellular antioxidant glutathione were greater overall in MET. mRNA abundance of aconitase 2 and fumarate hydratase was greater overall (P = 0.049), and phosphoenolpyruvate carboxykinase 1 tended (P = 0.093) to be greater overall in cows fed MET. There was a tendency (P ≤ 0.093) for greater overall hepatic concentrations of malic acid, α-ketoglutaric acid, and isocitric acid in cows fed MET. Conclusions Greater activity of CBS in response to enhanced post-ruminal supply of Met likely contributes to alleviating oxidant status by increasing concentrations of glutathione. Hence, transsulfuration plays an important role in the observed improvements in production efficiency of dairy cows during the periparturient period.
Amanda E Bries, Chong Wang, Isaac Agbemafle, Brian Wels, Manju B Reddy
Current Developments in Nutrition; doi:10.1093/cdn/nzz127

Abstract:Background Iron deficiency anemia (IDA) is a widespread nutritional deficiency and iron supplementation, especially with ferrous sulfate (FeSO4) is the most common strategy to treat IDA; however, compliance is often poor with daily FeSO4 due to negative side effects. In a previous study, iron from iron-enriched A. oryzae (Ultimine, ULT) was similarly absorbed as FeSO4. The main objective of this study was to assess the safety of consuming ULT in terms of increasing non-transferrin bound iron (NTBI) and gastrointestinal distress. Methods Young female participants (n = 16) with serum ferritin Results Serum iron, TS and NTBI were all markedly higher from hours 2–8 (P < 0.001) with FeSO4, compared to ULT. Oxidative stress, inflammatory, kidney and liver function markers remained unchanged with both supplementations compared to placebo. Changes in iron status markers were not significantly different among three treatments. Individual or global side effects were not significantly different among all treatments. Even when common side effects of nausea, constipation and diarrhea were combined, only at week 3 FeSO4 treatment had significantly higher effect than ULT (P = 0.04) and placebo (P = 0.004) but the difference was not significant between ULT and placebo. Conclusions Low NTBI production, and less of common gastrointestinal side effects with ULT suggest that it is a safe oral iron supplement to treat IDA. This trial was registered at as NCT04018300.
Victor L Fulgoni, P Courtney Gaine, Maria O Scott, Laurie Ricciuto, Loretta DiFrancesco
Current Developments in Nutrition; doi:10.1093/cdn/nzz126

Abstract:Background A concern about the excessive consumption of added sugars is the potential for micronutrient dilution, particularly for children and adolescents; however, the evidence is inconsistent. Objective We examined the associations between added sugars intake and micronutrient adequacy in U.S. children and adolescents using data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014. Methods Children and adolescents 2–18 (n = 7,754), 2–8 (n = 3,423), and 9–18 y (n = 4,331) were assigned to deciles of added sugars intake based on the average of two days of dietary recall. Usual intake of micronutrients was determined using two dietary recalls and the National Cancer Institute method. Within each age group, regression analyses were used to assess the relationship between added sugars intake decile and percentage of the population below the Estimated Average Requirements (EARs) for 17 micronutrients. Results Deciles of added sugars intake (% of calories) ranged from 22.8 among children and adolescents 2–18 y, with a median intake of 13.3% of calories. Significant positive associations (P < 0.01) between added sugars intake and percentage of the population (2–18 y) below the EAR were found only for calcium, magnesium, and vitamin D. These associations virtually disappeared after dropping the two highest and lowest deciles of intake, suggesting a threshold effect; intakes below approximately 19% of calories from added sugars were generally not associated with micronutrient inadequacy. Conclusions As added sugars intake increased, there was a threshold above which an increase in the prevalence of inadequate intakes for calcium, magnesium, and vitamin D among U.S. children and adolescents was observed. However, even at the lower deciles of added sugars, large percentages of the population were below the EAR for these nutrients, suggesting that adequate intakes of these nutrients are difficult to achieve independent of added sugars intake.
Onagh W MacKenzie, Carmen V George, Rafael Pérez-Escamilla, Jessica Lasky-Fink, Emily M Piltch, Sharon M Sandman, Clarina Clark, Que'Sha Jodeci Avalos, Danya S Carroll, Taylor M Wilmot, et al.
Current Developments in Nutrition; doi:10.1093/cdn/nzz125

Abstract:Background American Indians and Alaska Natives experience diet-related health disparities compared to non-Hispanic Whites. Navajo Nation's colonial history and remote setting present unique challenges for healthy food access. Objective This study aims to understand the impact of the Healthy Navajo Stores Initiative on fruit and vegetable purchasing on Navajo Nation. Methods A cross-sectional survey of 692 customers shopping at 28 convenience stores, trading posts, and grocery stores on Navajo Nation. Individual and household-level sociodemographic data and food purchasing behaviors were collected. Descriptive and bivariate analyses for customers’ individual and household-level characteristics were conducted using chi-squared tests. The impact of individual, household, and store-level factors on fruit and vegetable purchasing was assessed using multiple logistic regression modeling. Results Store participation in the Healthy Navajo Stores Initiative was significantly associated with customers’ purchase of produce. Customers experienced 150% higher odds of purchasing produce if they shopped in participating stores, compared to non-participating stores (P < 0.001). Store type was strongly associated with customers’ purchase of fruits or vegetables. Customers shopping at a grocery store had 520% higher odds of purchasing produce, compared to customers shopping at convenience stores (P < 0.001). Customers shopping at trading posts had 120% higher odds of purchasing fruits or vegetables, compared to customers shopping at convenience stores (P = 0.001). Conclusion Our findings reveal increased produce purchasing at stores participating in the Healthy Navajo Stores Initiative. Customers were significantly more likely to purchase fruits or vegetables in stores enrolled in a healthy store intervention, compared to non-enrolled stores, after controlling for quantity of produce stocked and store type. Customers shopping in grocery stores and trading posts were significantly more likely to purchase produce than customers shopping in convenience stores. These findings have implications for food access in rural, tribal communities.
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