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André Briend

Publications and source records attributed to André Briend.

At least 19 recordsLinked to original sources
PubMed2006

Distributions of mortality risk attributable to low nutritional status in Niakhar, Senegal.

This study proposes a method for computing the distributions of mortality risk attributable to malnutrition among children of developing countries. Population distributions of nutritional status were adjusted with a normal curve and the relation between mortality and nutritional status was fitted with a linear logistic model after controlling for age. The attributable risk for mortality could therefore be computed at any threshold of low nutritional status. The method was applied in Niakhar, Senegal, where a comprehensive study of the relation between nutritional status and mortality was conducted in 1983-1984 on approximately 5,000 children, 6-59 mo of age. The anthropometric indicators used were Z-scores of weight-for-age, weight-for-height, height-for-age, head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age, and subscapular skinfold-for-age, plus arm circumference, body mass index, and 2 composite indicators. Population attributable fraction varied according to indicators selected and ranged from 31% (head circumference) to 65% (arm circumference). The 2 composite indicators summarizing the whole nutritional status provided the same value for the population attributable fraction (59 and 60%, respectively). Classic thresholds of mild, moderate, and severe malnutrition are presented, as well as the bivariate distribution of wasting and stunting. Whatever the indicator used, mortality attributable risks appeared evenly distributed along the scale of low nutritional status. Our findings question the value of using classic thresholds of mild, moderate, and severe malnutrition (developed by clinicians for practical purposes) for nutritional epidemiology.

Child, Preschool↗
PubMed2006

Growth and change in blood haemoglobin concentration among underweight Malawian infants receiving fortified spreads for 12 weeks: a preliminary trial.

OBJECTIVE: Fortified spreads (FSs) have proven effective in the rehabilitation of severely malnourished children. We examined acceptability, growth and change in blood haemoglobin (Hb) concentration among moderately underweight ambulatory infants given FS. METHODS: This was a randomised, controlled, parallel-group, investigator-blind clinical trial in rural Malawi. Six- to 17-month-old underweight infants (weight for age < -2), whose weight was greater than 5.5 kg and weight-for-height z score greater than -3 received for 12 weeks at home 1 of 8 food supplementation schemes: nothing, 5, 25, 50, or 75 g/day milk-based FS or 25, 50, or 75 g/day soy-based FS. Outcome measures included change in weight, length and blood Hb concentration. RESULTS: A total of 126 infants started and 125 completed the intervention. All infants accepted the spread well, and no intolerance was recorded. Average weight and length gains were higher among infants receiving daily 25 to 75 g FS than among those receiving only 0 to 5 g FS. Mean Hb concentration remained unchanged among unsupplemented controls but increased by 10 to 17 g/L among infants receiving any FS. All average gains were largest among infants receiving 50 g of FS daily: mean difference (95% confidence interval) in the 12-week gain between infants in 50 g milk-based FS group and the unsupplemented group was 290 g (range, -130 to 700 g), 0.9 cm (range, -0.3 to 2.2 cm), and 17 g/L (range, 0 to 34 g/L) for weight, length and blood Hb concentration, respectively. In soy- vs milk-based FS groups, average outcomes were comparable. CONCLUSIONS: Supplementation with 25 to 75 g/day of highly fortified spread is feasible and may promote growth and alleviate anaemia among moderately malnourished infants. Further trials should test this hypothesis.

Anemia↗
PubMed2005

Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial.

BACKGROUND: Childhood malnutrition is common in Malawi, and the standard treatment, which follows international guidelines, results in poor recovery rates. Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food (RUTF). OBJECTIVE: The objective was to compare the recovery rates among children with moderate and severe wasting, kwashiorkor, or both receiving either home-based therapy with RUTF or standard inpatient therapy. DESIGN: A controlled, comparative, clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children. Children were systematically allocated to either standard therapy (186 children) or home-based therapy with RUTF (992 children) according to a stepped wedge design to control for bias introduced by the season of the year. Recovery, defined as reaching a weight-for-height z score > -2, and relapse or death were the primary outcomes. The rate of weight gain and the prevalence of fever, cough, and diarrhea were the secondary outcomes. RESULTS: Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received standard therapy (79% compared with 46%; P < 0.001) and were less likely to relapse or die (8.7% compared with 16.7%; P < 0.001). Children who received home-based therapy with RUTF had greater rates of weight gain (3.5 compared with 2.0 g . kg(-1) . d(-1); difference: 1.5; 95% CI: 1.0, 2.0 g . kg(-1) . d(-1)) and a lower prevalence of fever, cough, and diarrhea than did children who received standard therapy. CONCLUSION: Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is standard therapy.

Child, Preschool↗
PubMed2005

Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition.

The study was a controlled, comparative clinical effectiveness trial of two supplementary feeding regimens in children at risk of malnutrition from seven centres in rural Malawi. Being at risk of malnutrition was defined as weight-for-height <85%, but >80% of the international standard. A stepped-wedge design with systematic allocation was used for assigning children to receive either ready-to-use therapeutic food (RUTF) (n=331) or micronutrient-fortified corn/soy-blend (n=41) for up to eight weeks. The primary outcomes were recovery, defined as weight-for-height >90%, and the rate of weight gain. Children receiving RUTF were more likely to recover (58% vs 22%; difference 36%; 95% confidence interval [CI] 20-52) and had greater rates of weight gain (3.1 g/kg.d vs 1.4 g/kg x d; difference 1.7; 95% CI 0.8-2.6) than children receiving corn/soy-blend. The results of this preliminary work suggest that supplementary feeding with RUTF promotes better growth in children at risk of malnutrition than the standard fortified cereal/legume-blended food.

Child Nutrition Disorders↗
PubMed2004

Energy-dense diets are associated with lower diet costs: a community study of French adults.

OBJECTIVE: High consumption of energy-dense foods has been linked to high energy intakes and excess weight gain. This study tested the hypothesis that high energy density of the total diet is associated with lower diet costs. DESIGN: Dietary intakes of 837 French adults, aged 18-76 years, were assessed using a dietary history method. Dietary energy density (MJ kg(-1)) was calculated by dividing total energy by the edible weight of foods consumed. Daily diet cost ( in day(-1)) was estimated using mean national food prices for 57 food items. The relationship between dietary energy density and diet cost at each level of energy intake was examined in a regression model, adjusted for gender and age. RESULTS: The more energy-dense refined grains, sweets and fats provided energy at a lower cost than did lean meats, vegetables and fruit. Within each quintile of energy intake, diets of lower energy density (MJ kg(-1)) were associated with higher diet costs ( in day(-1)). CONCLUSION: In this observational study, energy-dense diets cost less whereas energy-dilute diets cost more, adjusting for energy intakes. The finding that energy-dilute diets are associated with higher diet costs has implications for dietary guidelines and current strategies for dietary change.

Adolescent↗
PubMed2004

Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6 y.

BACKGROUND: Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia, 2 conditions that affect entire generations of children in deprived populations. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available. OBJECTIVE: The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals, with or without antiparasitic metronidazole treatment, in correcting retarded linear growth and reducing anemia in stunted children. DESIGN: Saharawi refugee children (n = 374) aged 3-6 y with initial height-for-age z scores <-2 were assigned to 1 of 5 groups: fortified spread (FS), fortified spread plus metronidazole (FS+M), unfortified spread (US), unfortified spread plus metronidazole (US+M), or control. Supervised supplementation was given daily for 6 mo. Weight, height, knee-heel length, hematologic indexes, parasitic infections, and morbidity were assessed at 0, 3, and 6 mo. RESULTS: Linear growth of children fed FS was 30% faster at 3 mo than in US and control groups, after which height-for-age z scores increased only slightly in the FS group and remained unchanged in the other groups. No additional benefits from metronidazole were observed. Increase in hemoglobin concentrations in the FS group at 6 mo was twofold that in the US and control groups (37 +/- 40, 19 +/- 15, and 16 +/- 17 g/L, respectively; P < 0.0001), and anemia was reduced by nearly 90%. CONCLUSIONS: FS, and not US, induces catch-up growth in stunted children whose diets are poor in micronutrients. Our trial provides support for delivering multiple micronutrients to reverse stunting and reduce anemia in children up to age 6 y.

Algeria↗
PubMed2004

Food-based dietary guidelines can be developed and tested using linear programming analysis.

Effective food-based dietary guidelines (FBDGs) are required to combat micronutrient deficiencies. This study aimed to develop a rigorous approach for designing population-specific FBDGs. A 4-phase approach based on linear programming analysis was used to design, test, and refine the FBDGs. This was illustrated for Malawian children. In phase I, the objective function minimized the difference in the energy contributed by different food groups between modeled and observed diets for 16 observed diet types, while preferentially selecting foods most often consumed. Constraints ensured nutrient adequacy and diet palatability. In phase II, the meal/snack patterns of the phase I modeled diets were examined to develop season-specific FBDGs. In phase III, the robustness of these FBDGs, for ensuring a nutritionally adequate diet, was tested. The objective function, in this analysis, minimized selected nutrient levels in the modeled diets (i.e., chose the "worst-case scenario"), while respecting the FBDGs, palatability, and energy constraints. The FBDGs were refined in phase IV. In the Malawian example used to illustrate our approach, the FBDGs promoted daily consumption of maize flour, small dry fish (>or=20 g), leaf relish, and 2-3 snacks. The last mentioned included mangoes, in the food-shortage season, and pumpkin in the food-plenty season. In addition, legume relish was recommended in the food-shortage season. The approach presented here can be used to design and then test the robustness of FBDGs for meeting nutrient recommendations.

Animals↗
PubMed2004

Supplementary feeding of underweight, stunted Malawian children with a ready-to-use food.

OBJECTIVE: Maize and soy flour mixes are often used in the treatment of moderate malnutrition in Malawi. Their efficacy has not been formally evaluated. A recently developed ready-to-use food (RTUF) effectively promotes growth among severely malnourished children. The authors compared the effect of maize and soy flour with that of RTUF in the home treatment of moderately malnourished children. METHODS: Sixty-one underweight, stunted children 42 to 60 months of age were recruited in rural Malawi, in southeastern Africa. They received either RTUF or maize and soy flour for 12 weeks. Both supplements provided 2 MJ (500Kcal) of energy daily but had different energy and nutrient densities. Outcome variables were weight and height gain and dietary intake. RESULTS: Before intervention, the mean dietary intake and weight and height gain were similar in the two groups. During the supplementation phase, the consumption of staple food fell among children receiving maize and soy flour but not among those receiving RTUF. There was thus higher intake of energy, fat, iron, and zinc in the RTUF group. Both supplements resulted in modest weight gain, but the effect lasted longer after RTUF supplementation. Height gain was not affected in either group. Periodic 24-hour dietary recalls suggested that the children received only 30% and 43%, respectively, of the supplementary RTUF and maize and soy flour provided. CONCLUSIONS: RTUF is an acceptable alternative to maize and soy flour for dietary supplementation of moderately malnourished children. Approaches aimed at increasing the consumption of supplementary food by the selected recipients are needed.

Body Height↗
PubMed2004

Home-based treatment of malnourished Malawian children with locally produced or imported ready-to-use food.

OBJECTIVES: To determine the efficacy of home-based therapy with ready-to-use food (RTUF) in producing catch-up growth in malnourished children and to compare locally produced RTUF with imported RTUF for this purpose. METHODS: After a brief inpatient stabilization, 260 children with severe malnutrition were enrolled and systematically allocated to receive home therapy with either imported, commercially produced RTUF or locally produced RTUF. Each child received 730 kJ/kg/day and was followed up fortnightly. Children completed the study when they reached a weight-for-height Z score > -0.5 (WHZ), relapsed, died, or failed to achieve WHZ > -0.5 after 16 weeks. Analyses were stratified by human immunodeficiency virus (HIV) status. RESULTS: 78% of all children reached WHZ > -0.5, 95% of those with HIV-negative status and 59% of those with HIV-positive status. Eighty percent of those receiving locally produced RTUF and 75% of those receiving imported RTUF reached WHZ > -0.5. The difference between recovery rates was 5% (95% confidence interval [CI], -5-15%). The rate of weight gain was 0.4 g/kg/day (95% CI, -0.6, 1.4) greater among children receiving locally produced RTUF. The prevalence of diarrhea reported by mothers was 3.7% for locally produced RTUF and 4.3% for imported RTUF. After completion of home therapy and resumption of habitual diet for 6 months, 91% of all children maintained a normal WHZ. CONCLUSIONS: Home-based therapy with RTUF was successful in affecting complete catch-up growth. In this study, locally produced and imported RTUF were similar in efficacy in treating of severe childhood malnutrition.

Body Height↗
PubMed2004

Replacing fats and sweets with vegetables and fruits--a question of cost.

OBJECTIVES: We examined the association between diet quality and estimated diet costs. METHODS: Freely chosen diets of 837 French adults were assessed by a dietary history method. Mean national food prices for 57 foods were used to estimate diet costs. RESULTS: Diets high in fat, sugar, and grains were associated with lower diet costs after adjustment for energy intakes, gender, and age. For most levels of energy intake, each additional 100 g of fats and sweets was associated with a 0.05-0.40 per day reduction in diet costs. In contrast, each additional 100 g of fruit and vegetables was associated with a 0.18-0.29 per day increase in diet costs. CONCLUSIONS: Diets high in fats and sweets represent a low-cost option to the consumer, whereas the recommended "prudent" diets cost more.

Adult↗
PubMed2003

Do economic constraints encourage the selection of energy dense diets?

Economic constraints, by inducing the selection of low cost energy dense diets, could indirectly be responsible for the high prevalence of obesity in low socio-economic status groups. Diet optimisation by linear programming was used to test this hypothesis, by examining the relationship between the cost and the energy density (ED) of modelled diets. Models were developed that minimized the departure from the mean adult French diet estimated from a cross-sectional dietary survey. Palatability constraints were introduced into all models. The impacts of cost on ED and of ED on cost were explored by introducing and strengthening first a constraint on cost and then a constraint on ED. Forcing the cost of the linear programming diets to decrease induced a strong increase in their EDs. In contrast, forcing the ED to increase induced only a moderate decrease in diet costs. These results suggest that, although an energy dense diet can be selected at a relatively high cost, when cost is not influencing food choices, an energy dense diet will be preferentially selected to maintain habitual French dietary patterns when the budget for food is low. This supports the hypothesis that economic constraints play a role in the high prevalence of obesity in low-income people.

Adult↗
PubMed2003

Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial.

BACKGROUND: The World Health Organization recommends a liquid, milk-based diet (F100) during the rehabilitation phase of the treatment of severe malnutrition. A dry, solid, ready-to-use food (RTUF) that can be eaten without adding water has been proposed to eliminate the risk of bacterial contamination from added water. The efficacies of RTUF and F100 have not been compared. OBJECTIVE: The objective was to compare the efficacy of RTUF and F100 in promoting weight gain in malnourished children. DESIGN: In an open-labeled, randomized trial, 70 severely malnourished Senegalese children aged 6-36 mo were randomly allocated to receive 3 meals containing either F100 (n = 35) or RTUF (n = 35) in addition to the local diet. The data from 30 children in each group were analyzed. RESULTS: The mean (+/- SD) daily energy intake in the RTUF group was 808 +/- 280 (95% CI: 703.8, 912.9) kJ x kg body wt(-1) x d(-1), and that in the F100 group was 573 +/- 201 (95% CI: 497.9, 648.7) kJ. kg body wt(-1) x d(-1) (P < 0.001). The average weight gains in the RTUF and F100 groups were 15.6 (95% CI: 13.4, 17.8) and 10.1 (95% CI: 8.7, 11.4) g x kg body wt(-1) x d(-1), respectively (P < 0.001). The difference in weight gain was greater in the most wasted children (P < 0.05). The average duration of rehabilitation was 17.3 (95% CI: 15.6, 19.0) d in the F100 group and was 13.4 (95% CI: 12.1, 14.7) d in the RTUF group (P < 0.001). CONCLUSIONS: This study indicated that RTUF can be used efficiently for the rehabilitation of severely malnourished children.

Child Nutritional Physiological Phenomena↗
PubMed2003

Linear programming: a mathematical tool for analyzing and optimizing children's diets during the complementary feeding period.

During the complementary feeding period, children require a nutrient-dense diet to meet their high nutritional requirements. International interest exists in the promotion of affordable, nutritionally adequate complementary feeding diets based on locally available foods. In this context, two questions are often asked: 1) is it possible to design a diet suitable for the complementary feeding period using locally available food? and 2) if this is possible, what is the lowest-cost, nutritionally adequate diet available? These questions are usually answered using a "trial and error" approach. However, a more efficient and rigorous technique, based on linear programming, is also available. It has become more readily accessible with the advent of powerful personal computers. The purpose of this review, therefore, is to inform pediatricians and public health professionals about this tool. In this review, the basic principles of linear programming are briefly examined and some practical applications for formulating sound food-based nutritional recommendations in different contexts are explained. This review should facilitate the adoption of this technique by international health professionals.

Diet↗
PubMed2003

The evolving applications of spreads as a FOODlet for improving the diets of infants and young children.

Action is needed to reduce the burden of micronutrient malnutrition in developing countries, and because low-income populations are vulnerable to deficiencies of multiple micronutrients, we need to move beyond approaches that comprise only single nutrients. The normal and evolutionary manner in which to consume nutrients is in the context of foods, both snacks and meals. Spreads are high-viscosity-fat products prepared by mixing dried powdered ingredients with a vegetable fat chosen for its viscosity. Spreads are not traditionally used for feeding infants or young children and were initially proposed as a way to treat children recovering from severe malnutrition. In preparation for the International Research Group on Infant Supplementation (IRIS) III intervention, a sequel to the IRIS I study (which was the focus of a workshop in Lima, Peru, from May 30-June 1, 2001), the feasibility of preparing a FOODlet for feeding infants and young children was explored. Within the spectrum of intervention tools for micronutrient supplementation, tablets are a pharmaceutical form, fortified spreads are a food, and sprinkles are an intermediate approach. The issues still to be discussed and resolved with regard to creating such a spread include its specific micronutrient formulation, the capacity of young children to consume the required amounts (from either the FOODlet alone or the FOODlet mixed with other foods), the iron content and overall antioxidant protection of the spread matrix and its vitamins, potential allergenicity of proteins, and the economic implications of using such a FOODlet in low-income societies.

Child↗
PubMed2002

Linear and nonlinear programming to optimize the nutrient density of a population's diet: an example based on diets of preschool children in rural Malawi.

BACKGROUND: Food consumption surveys are often used to detect inadequate nutrient intakes but not to determine whether inadequate nutrient intakes are due to suboptimal use of locally available foods or to insufficient availability of nutrient-dense foods. OBJECTIVES: The objectives were to describe the use of linear programming as a method to design nutrient-adequate diets of optimal nutrient density and to identify the most stringent constraints in nutritional recommendations and food consumption patterns in a population's diet. DESIGN: This analysis was conducted with the use of food consumption data collected during 2 seasons from rural Malawian children aged 3-6 y. Linear programming was used to select diets based on local foods that satisfied a set of nutritional constraints while minimizing the total energy content of the diet. Additional constraints on daily intakes of foods and food groups were also introduced to ensure that the diets were compatible with local food patterns. The strength of the constraints was assessed by analyzing nonlinear programming sensitivity. RESULTS: In the harvest season, it was possible to satisfy nutritional recommendations with little departure from the local diet. In the nonharvest season, nutritional adequacy was impaired by the low availability of riboflavin- and zinc-rich animal or vegetable foods and by the high phytate content of other foods. CONCLUSIONS: This analysis suggests that nutrition education may help improve the diets of children in the harvest season, whereas changes in the range of available foods might be needed in the nonharvest season. Linear and nonlinear programming can be used to formulate recommendations with the use of data from local food consumption surveys.

Child↗