Women of reproductive age living in resource-poor settings are at high risk of inadequate micronutrient intakes when diets lack diversity and are dominated by staple foods. Yet comparative information on diet quality is scarce and quantitative data on nutrient intakes is expensive and difficult to gather. We assessed the potential of simple indicators of dietary diversity, such as could be generated from large household surveys, to serve as proxy indicators of micronutrient adequacy for population-level assessment. We used 5 existing data sets (from Burkina Faso, Mali, Mozambique, Bangladesh, and the Philippines) with repeat 24-h recalls to construct 8 candidate food group diversity indicators (FGI) and to calculate the mean probability of adequacy (MPA) for 11 micronutrients. FGI varied in food group disaggregation and in minimum consumption required for a food group to count. There were large gaps between intakes and requirements across a range of micronutrients in each site. All 8 FGI were correlated with MPA in all sites; regression analysis confirmed that associations remained when controlling for energy intake. Assessment of dichotomous indicators through receiver-operating characteristic analysis showed moderate predictive strength for the best choice indicators, which varied by site. Simple FGI hold promise as proxy indicators of micronutrient adequacy.

The effects of consuming water with meals rather than drinking no beverage or various other beverages remains under-studied. This systematic review of English language studies compared the effects of drinking water and various beverage alternatives on energy intake and/or weight status. We collected relevant clinical trials, epidemiologic, and intervention studies and summarized findings across the literature. Using clinical trials, average differences in total energy intake at test meals (ΔTEI) were calculated across studies for each of several beverage categories compared to water. The literature for these comparisons is sparse and somewhat inconclusive. One of the most consistent sets of findings comes from comparing adults drinking sugar-sweetened beverages (SSB’s) vs. water before a single meal. Total energy intakes were increased 7.8% (ΔTEI range −7.5 to 18.9) when SSBs were consumed. Studies comparing nonnutritive sweeteners with water were also relatively consistent and found no impact on energy intake among adults (ΔTEI = −1.3, range −9 to13.8). Much less conclusive evidence replacing water with milk and juice estimated increases in TEI of 14.9% (range 10.9 to 23.9). These findings, along with epidemiologic and intervention studies suggested a potentially important role for water in reducing energy intakes, and by this means a role in obesity prevention. A need for randomized-controlled trials exists.

Several studies link childhood malnutrition to adverse schooling outcomes, including delayed or diminished enrollment and increased grade repetition. However, the effects of nutrition on schooling trajectories are obscured by the cross-sectional nature of most previous research and the complex array of other phenomena that affect schooling outcomes. We explored the association between height-for-age Z-score (HAZ) at 2 y and schooling trajectory among 2198 children from the Cebu Longitudinal Health and Nutrition Survey. Parity, parental education, maternal height, household assets, environmental cleanliness, presence of electricity, and household income were identified as potential confounders. Crude and adjusted logistic and multinomial regressions of schooling outcomes (entrance age, grade repetition, and grades completed) were conducted. Entrance age and IQ were evaluated as potential mediators between HAZ and schooling outcomes. After adjustment for confounders, greater height for age protected against late enrollment among both boys and girls and predicted early enrollment among boys. Taller children were less likely to repeat grades [girls OR = 0.78 (0.67, 0.89); boys OR = 0.86 (0.74, 0.99)] and less likely to drop out during grade school rather than graduate from high school [girls OR = 0.74 (0.56, 0.98; boys OR = 0.66 (0.51, 0.84)]. Models predicting the changes in school outcomes associated with a change in overall height from -2 to 0 SD of HAZ were simulated. Absolute probability of late enrollment dropped substantially, from 6% for both boys and girls to 2% for boys and 1% for girls. Absolute grade repetition dropped approximately 7% for boys and 9% for girls. Improving early childhood nutrition may have long-lasting educational benefits, increasing the likelihood of high school completion in developing countries.

The importance of breast-feeding (BF) for cognitive development has been researched widely over the past several decades. Although scholars agree that children who breast-feed are generally more intelligent, it is uncertain whether this advantage is due to BF effects or to other accompanying healthy characteristics of women who breast-feed. This is a problem in nearly every study, and even in studies controlling for known confounding variables, residual confounding remains a concern. This study tried a new approach, evaluating the relation between BF and cognitive development or ability in a population in which BF was inversely correlated with socioeconomic advantages and other healthy maternal behaviors. Normal birthweight (NBW, n = 1790) and low birthweight (LBW, n = 189) (<2500 g) infants born in 1983-84 in Metropolitan Cebu, Philippines were followed from birth through middle childhood. Cognitive ability was assessed at ages 8.5 and 11.5 y with the Philippines Nonverbal Intelligence Test. Multivariable linear regressions were created to estimate crude and adjusted relations of various BF measures and later cognitive ability. After controlling for confounding variables, scores at 8.5 y were higher for infants breast-fed longer (1.6 points and 9.8 points higher among NBW and LBW infants, respectively, breast-fed for 12 to <18 mo vs. <6 mo). BF coefficients in both NBW and LBW 11.5-y models were attenuated but remained positive. This analysis highlights the importance of long-term BF after initial introduction of complementary foods, particularly in LBW infants born close to term.

Objectives: Early childhood malnutrition is a pressing international concern which dietary diversity scores (summary scores of food groups in the diet) may be helpful in addressing. We explored three current research needs surrounding diversity scores: the impact of portion size on score function, the relationship of scores to nutrient adequacy and density and the ability of scores to function as screening tools. Subjects/Methods: 1810 children, age 24 months. Cross sectional study of a birth cohort. Results: We evaluated two nine food group dietary diversity scores based on 0 and 10 g minimum food group requirements for their relationship to nutrient adequacy and nutrient density. Both scores were significantly correlated with nutrient adequacy and density and predicted statistically significant increases (Po0.05) in the probability of adequacy for all nutrients. However, correlations and predicted increases were somewhat larger for the 10 g score. We also considered the sensitivity and specificity of each score for detecting low and high nutrient adequacy in the population. The 10 g cutoff improved score ability to predict low nutrient adequacy, and reduced the misclassification of subjects for all comparisons. Conclusions: This research suggests that the score without portion requirements reflects dietary adequacy, but when feasible, further refinement of diversity scores is desirable through the application of minimum portion requirements.