Both acculturation and poverty have roles in children's diets and in household food insufficiency. Culturally specific public health and nutrition education should complement efforts to improve the financial security of low-income households.

Several reviews and meta-analyses have examined the effects of iodine on mental development. None focused on young children, so they were incomplete in summarizing the effects on this important age group. The current systematic review therefore examined the relationship between iodine and mental development of children 5 years old and under. A systematic review of articles using Medline (1980–November 2011) was carried out. We organized studies according to four designs: (1) randomized controlled trial with iodine supplementation of mothers; (2) non-randomized trial with iodine supplementation of mothers and/or infants; (3) prospective cohort study stratified by pregnant women’s iodine status; (4) prospective cohort study stratified by newborn iodine status. Average effect sizes for these four designs were 0.68 (2 RCT studies), 0.46 (8 non-RCT studies), 0.52 (9 cohort stratified by mothers’ iodine status), and 0.54 (4 cohort stratified by infants’ iodine status). This translates into 6.9 to 10.2 IQ points lower in iodine deficient children compared with iodine replete children. Thus, regardless of study design, iodine deficiency had a substantial impact on mental development. Methodological concerns included weak study designs, the omission of important confounders, small sample sizes, the lack of cluster analyses, and the lack of separate analyses of verbal and non-verbal subtests. Quantifying more precisely the contribution of iodine deficiency to delayed mental development in young children requires more well-designed randomized controlled trials, including ones on the role of iodized salt.

The negative association between breastfeeding and linear growth reflected reverse causality. Increased breastfeeding did not lead to poor growth; children's poor growth and health led to increased breastfeeding. Children's health must be considered when evaluating the association of breastfeeding with anthropometric outcomes.

We used direct observer techniques to measure the frequency with which toddler-aged children were contaminated by poultry feces in homes in a peri-urban shanty town in Lima, Peru. The mean number of fowl was 5.4 (SD 3.1), with 10.0 (SD 10.7) poultry defecations per 12 hours. Toddlers' hand contact with poultry feces occurred a mean of 2.9 (SD 3.0) times/12 hours. A mean of 3.9 (SD 4.6) feces-to-mouth episodes per household/12 hours occurred both by direct hand-to-mouth contamination and indirectly by handling soiled objects which were then placed in the mouth. There was a strong correlation between feces-to-hand contamination and feces-to-mouth contamination (r = 0.94). There was also an IntroductionDiarrheal disease is an important factor in the infectionmalnutrition cycle of infants and young children in developing countries. In Peru, children under three years of age have a diarrheal incidence of 10 episodes per child-year, which can significantly affect their growth rates.' One important cause of diarrhea in Lima children less than one year of age is

To gain perspective on breastfeeding initiation and duration among poor women in the southeastern United States, the authors interviewed a random sample of 150 mothers (93% African American) at a county health clinic in Birmingham, Alabama. Forty-one percent of women initiated breastfeeding, 24% breastfed for at least 1 month, and 8.3% breastfed for 3 months or more. Initiation of breastfeeding was positively associated with the mother having been breastfed herself and having breastfed a previous infant, and negatively associated with premature delivery. Breastfeeding at 1 month was more likely among older women and women with close relatives who breastfed. Duration of breastfeeding beyond 1 month was associated only with the mother having been breastfed and having breastfed a previous infant. Maternal and familial breastfeeding experiences eliminated the effect of more distal factors, such as income or education, on some feeding decisions. The strong influence of breastfeeding experiences must be considered in infant feeding interventions.

HIV infection did not influence vitamin D status. The prevalence of vitamin D insufficiency in both HIV-positive and HIV-negative REACH subjects was high, perhaps because these disadvantaged, largely urban youth have limited sun exposure.

Although breast-feeding is widely accepted as important for infant health, its benefits during the second year of life have been questioned. We analyzed data from 107 breast-fed and weaned Peruvian children living in a periurban community to determine whether breast milk contributed to improved linear growth between 12 and 15 mo of age. Breast-feeding frequency was self-reported; intakes of complementary foods and animal products were estimated from a food-frequency survey. Multivariate-linear-regression analysis was used to predict the length of the children at 15 mo of age. Determinants of length included length and weight-for-length at 12 mo of age (US National Center for Health Statistics standards), interval between 12- and 15-mo measurements, breast-feeding frequency, incidence of diarrhea, and intakes of complementary and animal-product foods. Complementary foods, animal-product foods, and breast milk all promoted toddlers' linear growth. In subjects with low intakes of animal-product foods, breast-feeding was positively associated (P < 0.05) with linear growth. There was a 0.5-cm/3 mo difference in linear growth between weaned toddlers and children who consumed the average number of feedings of breast milk. Linear growth was also positively associated with intake of animal-product foods in children with low intakes of complementary foods. The negative association between diarrhea and linear growth did not occur in subjects with high complementary-food intakes. When the family's diet is low in quality, breast milk is an especially important source of energy, protein, and accompanying micronutrients in young children. Thus, continued breast-feeding after 1 y of age, in conjunction with feeding of complementary foods, should be encouraged in toddlers living in poor circumstances.

BackgroundAnthropometric characteristics and iron status affect cognitive performance in children. In addition, selenium can influence cognitive outcomes; protection of the brain from oxidative stress and its role in thyroid hormone metabolism are putative mechanisms.MethodsTo investigate their association with cognitive performance, anthropometric indicators, iron biomarkers, and serum selenium of children (n = 541) of 54-60mo of age from rural Ethiopia were assessed. Cognitive assessment was conducted with the administration of two reasoning subtests of the Wechsler Preschool and Primary Scale of Intelligence and the school readiness test.ResultsStunting was found in 41.4 % of children, 28.7 % were underweight, and 6.3 % were wasted. The mean score of stunted children was lower than that of non-stunted children on non-verbal reasoning (7.0 ± 3.2vs7.9 ± 3.1; p = 0.01) and the school readiness tests (4.3 ± 2.2 vs 3.3 ± 2.1; p < 0.001). Compared to non-anemic children, anemic children had lower score for the verbal reasoning test (9.5 ± 1.7 vs 8.9 ± 2.2; p = 0.02). However, except for hemoglobin, none of the iron biomarkers had significant associations with the cognitive score of the study children (p > 0.05). Selenium deficient children had lower scores on all cognitive tests than normal children (p < 0.05).ConclusionThe present study finding linking chronic undernutrition and micronutrient deficiency to cognitive deficits suggests the need for designing effective intervention programmes to control for protein energy malnutrition and micronutrient deficiency and address cognitive development in children.