Nutrition Surveillance System Research Articles

Paternal smoking is associated with greater food insecurity among poor families in rural Indonesia.

Food insecurity is common in developing countries and related to the physical well being of families. Household food insecurity is intended to reflect a household's access, availability, and utilization of food. The relationship between paternal smoking and household food insecurity has not been well characterized. The objective of this study was to examine the relationship of paternal smoking with household food insecurity among poor families in rural Indonesia. In a cross-sectional study of 26,380 rural households in the Indonesian Nutrition Surveillance System in 2003, we examined the relationship between paternal smoking and household food insecurity score, as measured using a 9-item food security questionnaire. The prevalence of paternal smoking was 72.9%. In families with and without a father who smoked, the mean (standard error) household food insecurity score was 1.83 (0.01) and 1.48 (0.02), respectively (p<0.0001). Paternal smoking was associated with greater household food insecurity score (p<0.0001) in a multivariable linear regression model, adjusting for maternal age, maternal education, weekly household expenditure per capita, and province. Among poor families in rural Indonesia, households with a father who smokes are at greater risk of household food insecurity.

Nutritional Status of Children during and post-Global Economic Crisis in China

Objective To describe the impact of the global economic crisis on the nutritional status of children in China during and after the crisis. Methods Data from 1990 to 2010 were sourced from the National Food and Nutrition Surveillance System. Approximately 16 000 children under 5 years old were selected using a stratified random cluster method from 40 surveillance sites. Anthropometric and hemoglobin measurements for children under 5 were conducted. Nutritional status was determined according to WHO child growth standards. Results Prevalence of underweight and stunting in children under 5 had a downward trend. Underweight prevalence was close to normal (less than 5%), with prevalence of stunting 12.6% in 2009 and 12.1% in 2010 in rural areas. Prevalence of stunting in infants under 6 months and 6–12 months old in poorer rural areas increased from 5.7%–9.1% and 6.7%–12.5%, respectively, in 2008–2009. This trend also continued post-crisis in 2010. Prevalence of stunting in children left behind by mothers was 20%–30% higher than in children the same age in general and poorer rural areas. Prevalence of anemia in children did not change in rural areas, but prevalence of anemia in all age groups increased in poorer rural areas, especially in children under 24 months old. Level reached 30%–40% in 2009, and fluctuated in 2010. Conclusion The nutritional status of children under 5 was comparatively stable during and after the global economic crisis, attributable to the Chinese government's policy response. The nutritional status in poorer rural areas fluctuated in response to the economic crisis and, thus, relevant action and intervention must be taken immediately to help the most vulnerable population in poorer rural areas. A proper national nutritional strategy for children under 2 years old, including nutrition supplementation for pregnant women and in-home fortification for complementary feeding, should be initiated.

Relationship of household food insecurity to anaemia in children aged 6–59 months among families in rural Indonesia

Anaemia is a significant global public health problem in developing countries with adverse health effects on young children. Household food insecurity, which reflects a household's access, availability and utilisation of food, has not been well characterised in relation to anaemia in children. To examine the relationship of household food insecurity with anaemia (Hb <11 g/dl) in children. In a cross-sectional study of 4940 rural households participating in the Indonesian Nutrition Surveillance System, household food insecurity was measured using a modified 9-item food security questionnaire and related to anaemia in children aged 6-59 months. The proportion of households with an anaemic child was 56·6%. In households with and without anaemic children, the mean (SD) food insecurity score was 1·82 (1·72) vs 1·55 (1·54) (p<0·0001), respectively. In a multivariate logistic regression model, food insecurity score was related to anaemia in children (odds ratio 0·77, 95% confidence interval 0·63-0·95, p=0·01) when the highest quintile of food insecurity score was compared with the lowest quintile, adjusting for potential confounders. A higher household food insecurity score is associated with greater prevalence of anaemia in children in rural families in Indonesia.

Prepregnancy Obesity Trends Among Low-Income Women, United States, 1999–2008

There is limited data on prepregnancy obesity trends specifically among low-income women, a population at high risk for obstetric complications. Using the Pregnancy Nutrition Surveillance System, we assessed prepregnancy obesity [body mass index (BMI) ≥ 30 kg/m(2)] trends among women who participated in the Supplemental Nutrition Program for Women, Infants, and Children in 1999, 2004, and 2008. Prepregnancy BMI was calculated using measured height and self-reported prepregnancy weight. We report unadjusted contributor (state, territory or Indian tribal organization) specific trends, and both unadjusted and adjusted overall trends, to account for changes in maternal age and race-ethnic distributions, using 1999 as the referent. Of the 27 contributors in 1999, 2 had a prepregnancy obesity prevalence <20%, and 1 had a prevalence ≥ 30%. Of the 35 contributors in 2008, none had a prepregnancy obesity prevalence <20%, and 14 had a prevalence ≥ 30%. From 1999 to 2008, the overall prevalence of prepregnancy obesity increased among all racial-ethnic groups, except among American Indian/Alaskan Natives, where it remained high, but stable. Overall prepregnancy obesity increased most rapidly among Hispanics, and remained stable from 2004 to 2008 among non-Hispanic blacks. In 2008, prevalence was highest among American Indian/Alaskan Natives (36.1%) and lowest among Asians/Pacific Islanders (10.8%). The adjusted prepregnancy obesity prevalence increased from 24.8% in 1999 to 28.3% in 2008, a relative increase of 14.1%. Prepregnancy obesity among low-income women increased from 1999 to 2008 and varied by race-ethnicity. These data can be used by obesity prevention programs to better target high-risk women.

WIC and Breastfeeding Support Services: Does the Mix of Services Offered Vary with Race and Ethnicity?

The U.S. Department of Agriculture's Supplemental Nutrition Program for Women, Infants, and Children (WIC) nutrition services provides supplemental nutrition and counseling to more than 50% of families with young children in the United States. Given the program's significant reach, as well as large differences in rates of breastfeeding among whites, African Americans, and Hispanics, we explored the associations among breastfeeding initiation, the availability of WIC-based breastfeeding support, and the racial/ethnic composition of WIC clients in North Carolina. An electronic survey gathered data on ongoing breastfeeding support activities from local WIC directors in North Carolina. North Carolina Pregnancy and Nutrition Surveillance System data provided racial/ethnic composition and breastfeeding initiation rates. Linear and logistic regression models were used to examine county-level associations among (1) racial/ethnic composition of clients, (2) breastfeeding initiation, and (3) availability of the identified WIC breastfeeding support services. Responses were received from 50 of the state's 100 counties and were generally representative of the state. Breastfeeding initiation by site was negatively associated with percentage of African American clients and positively associated with percentage of white or Hispanic clients (p<0.05). The availability and intensity of breastfeeding support services varied widely, with 50% offering clinic-based services, 46% offering home visits, 38% offering peer counseling, and 76% offering some other form of counseling. The WIC sites with larger Hispanic populations were more likely to be providing a broad base of services, including clinic-based services, peer counseling, and home visits (p<0.05); those with higher African American populations were significantly less likely to offer clinic-based breastfeeding support services (p<0.05) and trended toward fewer services in general. Results confirmed previous findings of racial/ethnic disparities in breastfeeding rates. We also found that differences in the availability of breastfeeding support services were associated with the racial/ethnic composition of the catchment area. This apparent inequity in the availability of breastfeeding support services at different WIC sites may merit further exploration and may inform implementation of aspects of the U.S. Surgeon General's Call to Action to Support Breastfeeding.

Pediatric obesity epidemiology

To provide updated summary of recently published data regarding pediatric obesity epidemiology. There is a burgeoning literature of pediatric obesity epidemiology, with type 2 diabetes trends serving as the harbinger for obesity related diseases in children. The National Health and Nutrition Examination Survey and Pediatric Nutrition Surveillance System report a tripling of the prevalence of BMI at least 95% (obesity) among US school-age children and adolescents over the past three decades. Recent updates provide insight into infants and toddler obesity and explore the impact of ethnicity, socioeconomic status, school setting and geographic variations. International data confirm similar upward shifts in pediatric BMI distribution, especially in countries undergoing economic transitions favoring industrialized, western urban lifestyles. The health and financial consequences of this epidemic are a complex global public health dilemma. International efforts are underway to reverse these obesity trends. On-going analysis of obesity prevalence and exploration of potential causal associations are required to implement and assess the effectiveness of interventions and policies.

Gestational weight gain in obese mothers and associations with fetal growth

In 2009, the Institute of Medicine recommended gestational weight gains (GWGs) of 5-9 kg for all obese women. Recommendations by severity of obesity were not specified because of a lack of available data. Our objective was to examine associations between GWG and fetal growth in obese women and assess interactions with obesity severity. We used 2004-2006 Pregnancy Nutrition Surveillance System data from 122,327 obese mothers [prepregnant body mass index (BMI; in kg/m(2)) ge 30]. We used logistic regression to estimate measures of fetal growth including small-for-gestational-age, which was defined as birth weight (BW) lt 2 SDs below the sex and race-ethnicity-specific mean BW (SGA(2SD)), and macrosomia (BW ge 4500 g). We tested for interactions between obesity severity (class I: BMI of 30-34.9; class II: BMI of 35.0-39.9; class III: BMI ge 40) and GWG. Obesity severity modified associations between GWG and fetal growth. Compared with weight gains of 5-9 kg, weight loss in class I women significantly increased the odds of SGA(2SD), whereas a GWG from 0.1 to 4.9 kg was not associated with SGA(2SD) and did not decrease the odds of macrosomia. In class II and III women, compared with weight gains of 5-9 kg, a GWG from minus 4.9 to +4.9 kg was not associated with SGA(2SD) but did decrease the odds of macrosomia. Our study suggests a GWG below the Institute of Medicine guidelines may be associated with more favorable BW for all obese women, and GWG may need to be further defined by obesity severity.

Gestational weight gain in consecutive pregnancies

The purpose of this study was to examine the association between gestational weight gain (GWG) in a woman's first and second pregnancies. We conducted a retrospective observational cohort study of 27,771 women with their first and second births in North Carolina's Pregnancy Nutrition Surveillance System database from 1996-2004. GWG was categorized as inadequate, appropriate, or excessive, according to 2009 Institute of Medicine guidelines. Covariate adjusted polytomous logistic regression was used to test the association between GWG category in the first and second pregnancy. Compared with women with appropriate GWG in their first pregnancy, women with excessive GWG in their first pregnancy had an odds ratio of 2.6 (95% confidence interval, 2.4-2.7) for excessive GWG in their second pregnancy. Women with inadequate GWG in their first pregnancy were similarly likely to repeat this category in their subsequent pregnancy. GWG category in a woman's first pregnancy is a significant predictor of GWG category in her subsequent pregnancy.

Kuwaiti Mothers' Perception of Their Preschool Children's Weight Status

To examine the accuracy of mothers' perceptions of their children's weight status, factors associated with their perceptions, and their plans for controlling their children's weights. Four hundred eighty-two overweight Kuwaiti preschool children and their mothers were selected from a sample of 2329 from the Kuwait Nutrition Surveillance System from September 2003 to June 2004. Heights and weights were measured for the children and their mothers to identify their weight status. Mothers were interviewed using a questionnaire to assess their perceptions and plans for their children's weights. Mothers of overweight children (97%), male children (88.4%), and children without a family history of obesity (89%) showed significantly incorrect perception of their children's weight. Interestingly, the age of the child, the mother's education level, the mother's working status, and the mother's body mass index did not significantly contribute to correct perception of weight status. However, two-thirds of mothers had a plan to control their children's weight. The child's age, the body mass index of mother and child, the family history of obesity, and a correct perception of a child's weight by the mother were significantly associated with a plan for weight control. A majority of Kuwaiti mothers were unable to correctly perceive their children's weight status, especially for their male, overweight children. Two-thirds of the mothers had a plan to control their weight if the children become obese. The child's age, the child and mother's body weight, and the mother's correct perception mainly affected the selection of the plan.

Physical Growth and Development of the Malnourished Child: Contributions from 50 years of Research at INCAP

This paper reviews the main findings and policy implications of 50 years (1949-1999) of research conducted by INCAP on growth and development. Topical areas reviewed include a) maternal size and birthweight and the causes of intrauterine growth retardation (IUGR), b) patterns and causes of postnatal growth retardation, c) the relative importance of genetics and the environment in explaining differences in growth among populations, d) the implications of being small, for both children and adults, e) bone growth and maturation and dental development, f) menarche, and g) methodological contributions such as anthropometric reference data, quality control of data collection, development of risk indicators and use of anthropometry in nutrition surveillance systems. Key contributions to knowledge by INCAP include a) characterization of growth failure and maturational delays as mainly occurring during the intrauterine period and the first 3 years of life b) clarification of the role of small maternal size and of inadequate dietary intakes during pregnancy as major causes of intrauterine growth failure, c) evidence that diarrheal diseases and poor dietary intakes are the principal causes of growth failure in early childhood, d) demonstration that environmental factors related to poverty, and not genetic or racial ancestry, account for most of the differences in growth between populations, e) evidence that growth failure predicts functional impairment in the child as well as in the adult andf) demonstration that nutrition interventions are effective in preventing growth failure and its consequences, if targeted to needy women and young children. INCAP's work has contributed knowledge that has informed and improved policies and programs aimed at overcoming maternal and child undernutrition and promoting optimal growth and development.

Maternal and Young Child Nutrition Adversely Affected by External Shocks Such As Increasing Global Food Prices ,

Rising food prices, resulting from the ongoing global economic crisis, fuel price volatility, and climate change, have an adverse impact upon the poor, especially those in food-importing, resource-limited countries. The conventional approach by large organizations has been to advocate for increased staple crop yields of mainly cereals. High food prices are predicted to continue to at least 2015. Past shocks and their known impacts upon nutrition were reviewed. Price instability and increases have long been an existing global problem, which has been exacerbated by recent macroeconomic shocks such as acute emergencies due to war and civil strife, acute climatic events, increase in food prices, fuel price volatility, dysfunction of the global financial systems, long-term climate change, and the emergence of failed states. The FAO estimated that there were 815 million “hungry” people in 2006, with a now additional 75–135 million with increased vulnerability, and currently it is estimated that there are one billion people at risk of food insecurity. The shocks initially compromise maternal and child nutrition, mainly through a reduction in dietary quality and an increase in micronutrient deficiencies and concomitant increases in infectious disease morbidity and mortality. A further reduction in the quantity of diet may follow with greater underweight and wasting. Recent macroeconomic shocks have greatly increased the number of people who are vulnerable to hunger in developing countries. Nutritional surveillance systems need to be strengthened and expanded to inform policy decisions.

A organização da Vigilância Alimentar e Nutricional no Sistema Único de Saúde: histórico e desafios atuais

A Política Nacional de Alimentação e Nutrição ressalta a importância do Sistema de Vigilância Alimentar e Nutricional - SISVAN, que se destina à identificação do diagnóstico descritivo e analítico da situação alimentar e nutricional da população brasileira, contribuindo para que se conheça a natureza e a magnitude dos problemas nutricionais do país. Este artigo visa apresentar o histórico das ações da Vigilância Alimentar e Nutricional no Brasil, desde sua idealização até a prática atual, destacando a superação das limitações encontradas ao longo dos anos, o fortalecimento obtido por meio dos marcos legais e os desafios enfrentados neste momento. Entende-se hoje que o SISVAN só pode ser conduzido utilizando-se uma combinação de estratégias, sendo as principais: o sistema informatizado do SISVAN, os inquéritos populacionais, as Chamadas Nutricionais, a análise das bases de dados nacionais da saúde, o acesso à produção científica e o financiamento de pesquisas sobre o tema.

Avaliação do estado nutricional de escolares segundo três referências

OBJETIVO: Comparar a avaliação do estado nutricional de escolares de acordo com as três curvas de referências. MÉTODOS: AS variáveis peso e estatura de 181 crianças na faixa etária de cinco a dez anos foram obtidas de um banco de dados de vigilância nutricional de escolares da Ilha de Paquetá, organizado de acordo com as recomendações do Sistema de Vigilância Alimentar e Nutricional (Sisvan). O gráfico de Bland Altman e a razão de desvios foram empregados para construir perfis de concordância entre as três curvas de referência de avaliação nutricional dois a dois, utilizando-se os valores do índice de massa corporal. Na determinação da prevalência de déficit pôdero-estatural e sobrepeso, utilizaram-se os pontos de cortes recomendados por Cole, pelo Centers for Diseases Control and Prevention e por Conde e Monteiro. RESULTADOS: A prevalência de obesidade em meninas foi igual (3,1%) para Cole e Conde e Monteiro e ambas se sobrepuseram à obtida por meio da curva do Centers for Diseases Control and Prevention de 2000 (2,0%). Em relação aos meninos, a prevalência de obesidade obtida por Conde e Monteiro (4,8%) foi menor do que os percentuais encontrados por Cole (7,2%) e pelo CDC (7,2%). CONCLUSÕES: Os resultados sugerem que a escolha do referencial brasileiro (Conde e Monteiro) não dificulta a comparação com outros critérios internacionais, principalmente no que tange à classificação de obesidade em escolares do gênero masculino.

KARAKTERISTIK DAN STATUS GIZI ANAK UMUR 6-24 BULAN DI DAERAH KUMUH PERKOTAAN JAKARTA

Nutrition and Health Surveillance System (NSS) year 1999 - 2003 shows prevalence of underweight (weightfor age &lt; -2 SD from NCHS media) was very high, that is above 30% on infant at rural and urban slum areas. An underweight prevalence at urban slum areas is higher than rural slum areas, especially is at urban slum area of Jakarta. In this area prevalence of underweight children 12 -23 months of age (June-September 2003) was 42%. This study aims at know the characteristic of children 6 until 24 months and factors related with their nutrient status in urban slum of Jakarta. This study was using NSS secondary data period of June-September 2003. The study results show that child 18-24 months of age have risk in having underweight 2, 8 times compared with child 12-1 7 months and child 6-11 months. Moreover, child with birth weight &lt; 2,5 kilo (OR = 2,9 times) and birth from mother with Body Mass Index d" 18,5 (OR = 1,64 times) and upper arm circumference &lt; 23,5 cm ( OR = 1,48 times) have bigger risk in having underweight. The cause was cumulative effect of being underweight along life. Beside that, child with low birth weight record is difficult to catch up their growth if they do not get a good caring, especially adequate food.

Evaluation of the Missouri WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) breast-feeding peer counselling programme

To evaluate the effectiveness of the peer counselling (PC) programme on breast-feeding initiation among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Missouri, and to identify factors that facilitate breast-feeding initiation. We used the data from the 2006 Missouri Pregnancy Nutrition Surveillance System, Missouri Live Birth Records and the Missouri WIC programme to compare breast-feeding initiation rates between PC and non-PC agencies. We used multilevel logistic regression, with individual participants being nested within agencies, to control for individual- and agency-level characteristics. The breast-feeding initiation rate in PC agencies was significantly higher than in non-PC agencies among prenatal participants, but the difference was not significant among postpartum participants. After controlling for maternal sociodemographic characteristics, compared with prenatal cases in non-PC agencies, prenatal cases in PC agencies were more likely to initiate breast-feeding (OR = 1.21; 95 % CI 1.03, 1.43), whereas postpartum cases were less likely to initiate breast-feeding. Among prenatal participants in PC agencies, longer duration of prenatal WIC enrolment was associated with a higher rate of breast-feeding initiation. After adjusting for maternal sociodemographic characteristics and other agency-level characteristics, participants of PC agencies with an international board-certified lactation consultant were more likely to initiate breast-feeding than participants of PC agencies without such a consultant (OR = 1.21; 95 % CI 1.01, 1.45). Prenatal participation in the WIC breast-feeding PC programme (especially participation early during pregnancy) was associated with an increased rate of breast-feeding initiation in Missouri.

Relationship of Household Food Insecurity to Neonatal, Infant, and Under-Five Child Mortality among Families in Rural Indonesia

Food insecurity is common in developing countries and is related to the physical well-being of families. Household food insecurity is intended to reflect a household's access, availability, and utilization of food, but its relationship with child mortality has not been well characterized. To examine the relationship of a modified household food insecurity score with a history of neonatal, infant, and under-five child mortality. In a cross-sectional study of 26,339 rural households in the Indonesian Nutrition Surveillance System, 2000-03, household food insecurity was measured with the use of a modified nine-item food security questionnaire. A simple food insecurity score of O to 9 was calculated based on responses and related to mortality history in the family. The proportion of households with neonatal, infant, and under-five child mortality was 4.6%, 8.8%, and 10.6%, respectively. In households with and without neonatal, infant, and under-five child mortality, the mean (+/- SD) food insecurity scores were 2.19 +/- 1.89 vs. 1.72 +/- 1.65, 2.29 +/- 1.94 vs. 1.69 +/- 1.63, and 2.29 +/- 1.93 vs. 1.68 +/- 1.62 (all p < .0001), respectively. The food insecurity score was related to mortality among neonates (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02 to 1.09; p = .003), infants (OR, 1.06; 95% CI, 1.03 to 1.09; p < .0001), and children under five (OR, 1.07; 95% CI, 1.04 to 1.10; p < .0001) after adjustment for potential confounders. Higher household food insecurity score is associated with greater neonatal, infant, and under-five child mortality among rural families in Indonesia. Greater household food insecurity may signify a higher risk of infant and young child mortality.

US National Breastfeeding Monitoring and Surveillance: Current Status and Recommendations

Eleven federally funded datasets assessing breastfeeding behaviors in the United States (Early Childhood Longitudinal Survey, Infant Feeding Practices Survey II, National Health and Nutrition Examination Survey, National Immunization Survey, National Survey of Children's Health, National Survey of Early Childhood Health, National Survey of Family Growth, Pediatric Nutrition Surveillance System, Pregnancy Nutrition Surveillance System, Pregnancy Risk Assessment Monitoring Survey, and WIC Participant and Program Characteristics) were reviewed to evaluate breastfeeding variables (initiation, duration and exclusivity) and determine whether relevant breastfeeding determinants were collected to evaluate breastfeeding practices from a health disparities perspective. The datasets used inconsistent breastfeeding definitions, limited ethnic descriptors, and varied regarding availability of relevant determinants. Multiple datasets collect breastfeeding data, but a coordinated US breastfeeding monitoring and surveillance system does not exist. Suggestions to improve this system include: standardizing breastfeeding definitions, expanding ethnic/racial descriptors, collecting additional relevant variables, and reducing recall periods.

Maternal Smoking and the Timing of WIC Enrollment

To investigate the association between the timing of enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and smoking among prenatal WIC participants. We use WIC data from eight states participating in the Pregnancy Nutrition Surveillance System (PNSS). We adjust the association between the timing of WIC participation and smoking behavior with a rich set of maternal characteristics. Women who enroll in WIC in the first trimester of pregnancy are 2.7% points more likely to be smoking at intake than women who enroll in the third trimester. Among participants who smoked before pregnancy and at prenatal WIC enrollment, those who enrolled in the first trimester are 4.5% points more likely to quit smoking 3 months before delivery and 3.4% points more likely to quit by postpartum registration, compared with women who do not enroll in WIC until the third trimester. However, among pregravid smokers who report quitting by the first prenatal WIC visit, first-trimester enrollment is associated with a 2% point increase in relapse by postpartum registration. These results differ by race/ethnicity; white women who enroll early are 3.6% points more likely to relapse, while black women are 2.5% points less likely to relapse. Early WIC enrollment is associated with higher quit rates, although changes are modest when compared to the results from smoking cessation interventions for pregnant women. Given the prevalence of prenatal smoking among WIC participants, efforts to intensify WIC's role in smoking cessation through more frequent, and more focused counseling should be encouraged.

Indonesian women of childbearing age are at greater risk of clinical vitamin A deficiency in families that spend more on rice and less on fruits/vegetables and animal-based foods

Clinical vitamin A deficiency is characterized by night blindness and greater morbidity and mortality. The aim of this study was to examine the relationships between household food expenditures and night blindness among nonpregnant women of childbearing age among families in the slums of Jakarta, Indonesia. In a cross-sectional study of 42 974 households in the Indonesian Nutrition Surveillance System, 1998 to 2003, night blindness was assessed in nonpregnant women. Food expenditures were divided into 5 major categories as follows: plant-based foods (fruits and vegetables), animal-based foods, eggs, other nongrain foods, and grain foods (primarily rice), calculated as percentage of total weekly per capita food expenditure, and expressed in quintiles. The proportion of households with night blindness in nonpregnant women was 0.72%. Plant-based food, animal-based food, and eggs were associated with reduced odds of night blindness (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.33-0.67; P < .0001, and OR, 0.47; 95% CI, 0.29-0.76; P = .002; OR, 0.62; 95% CI, 0.44-0.85; P = .004), respectively, among families in the highest compared with the lowest quintile, adjusting for potential confounders. Grain food expenditures were associated with increased odds of night blindness among nonpregnant women (OR, 2.80; 95% CI, 1.86-4.22; P < .0001) among families in the highest compared with the lowest quintile, adjusting for potential confounders. This study suggests that nonpregnant women are at greater risk of clinical vitamin A deficiency where families spend more on rice and less on animal and plant-based foods, a situation that is more typical when food prices are high.

Greater Household Expenditures on Fruits and Vegetables but Not Animal Source Foods Are Associated with Decreased Risk of Under-Five Child Mortality among Families in Rural Indonesia

The specific aims of this study were to examine the relationships between household food expenditures and under-5 child mortality among families in rural Indonesia. Data collected between 2000 and 2003 in the Indonesia Nutrition and Health Surveillance System, a population-based surveillance system conducted in 7 rural provinces, were utilized for the analysis. Food expenditures were divided into 4 major categories: plant foods (fruits and vegetables), animal foods, other nongrain foods, and grain foods (primarily rice) and expressed as quintiles of proportional food expenditure. Of 292,894 households, 32,777 (11.2%) households reported a history of under-5 child mortality. Plant food expenditures were associated with reduced odds of under-5 child mortality [odds ratio (OR), 0.70; 95% CI, 0.67–0.73; P < 0.0001) among families in the highest quintile compared with the lowest quintile, adjusting for potential confounders. Grain food expenditures were associated with increased odds of under-5 child mortality (OR, 1.25; 95% CI, 1.20–1.30; P < 0.0001) among families in the highest quintile compared with the lowest quintile, adjusting for potential confounders. Animal food expenditures were not consistently and significantly associated with under-5 child mortality across quintiles of expenditures. These findings suggest that lower under-5 child mortality is found in households that spend a greater proportion of income on plant foods and less on grain foods in rural Indonesia.