Papers by Laura Murray-kolb
Current Developments in Nutrition
Objectives Poor complementary feeding practices pose a major challenge for early childhood growth... more Objectives Poor complementary feeding practices pose a major challenge for early childhood growth and development in Côte d'Ivoire, where more than 20% children under five suffer from stunting. We aimed to examine the trends and risk factors of suboptimal complementary feeding among children aged 6–23 months in Côte d'Ivoire. Methods We estimated the country-level prevalence, trends, and risk factors of four complementary feeding indicators: introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). Data was extracted from Demographic and Health Surveys (1994 to 2011) and Multiple Indicator Cluster Surveys (2000–2016) to estimate the complementary feeding indicators for children between 6 to 23 months in Côte d'Ivoire. Multilevel logistic regression models were used to identify factors associated with these complementary feeding indicators in 2016. Results On average, 59.2% of children ag...
Current Developments in Nutrition
Objectives To examine the trends and influencing factors of suboptimal complementary feeding (CF)... more Objectives To examine the trends and influencing factors of suboptimal complementary feeding (CF) practices among children aged 6–23 months in Niger using national data from 2000 to 2018. Methods Using data from the 2000 Multiple Indicator Cluster Survey, 2012 Demographic and Health Surveys (DHS), and 2018 Standardized Monitoring and Assessment of Relief and Transitions survey in Niger, the trends and predictors of WHO-UNICEF CF indicators including timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) were estimated. Using the most completed data in CF and influencing factors (available from 2012 DHS), multilevel logistic regression models were applied to identify factors at the individual, household and community levels that were associated with meeting INTRO, MMF, MDD, and MAD. Results The weighted proportion of children aged 6–8 months meeting INTRO increased from 56.0% in 2000 to 84.4...
Current Developments in Nutrition
Objectives (To 1) describe trends of iodine status among infants from 6–24 mos old and (2) assess... more Objectives (To 1) describe trends of iodine status among infants from 6–24 mos old and (2) assess associations between iodine status, intestinal permeability, and inflammation from 6–15 mos old. Methods Data from 1565 children enrolled in the MAL-ED birth cohort were included in these analyses from eight sites (Dhaka, Bangladesh (BGD); Fortaleza, Brazil (BRF); Vellore, India (INV); Bhaktapur, Nepal (NEB); Loreto, Peru (PEL); Naushero Feroze, Pakistan (PKN); Venda, South Africa (SAV); and Haydom, Tanzania (TZH)) from enrolment (≤17 d old) to 24 mos old. Urinary iodine concentration (UIC) was measured at 6, 15, and 24 mos of age using the Sandell-Kolthoff technique. Gut inflammation and permeability were assessed via fecal neopterin (NEO), myeloperoxidase (MPO) and alpha-1-anti-trypsin (AAT) concentrations (monthly in first year and quarterly in second) and the lactulose-mannitol (LM) test (3, 6, 9, 15 mos). The mean of fecal biomarkers available up to 94 days (interquartile range: 92...
Current Developments in Nutrition
Objectives 1) To describe the trends of complementary feeding since 2010; 2) to understand the fa... more Objectives 1) To describe the trends of complementary feeding since 2010; 2) to understand the factors influencing the sub-optimal feeding practices; and 3) to generate recommendations to inform future interventions. Methods Mixed methods study with an iterative, two phase design. Phase 1: quantitative data analysis of 13 key complementary feeding indicators reported in 68 national survey reports from 2010 to 2018. Phase 2: semi-structured qualitative interviews with 14 regional informants (UN, Government, NGO, and donor communities). We conducted a literature review of grey and peer-reviewed publications in 2010–2019 to contextualize the results. Results Phase 1. Across 24 WCAR countries, mean continued breastfeeding at 1y was 89%, but halved to 44% by 2y. Introduction of complementary foods occurred in 64% of children 6–8 mos. Minimum meal frequency in children 6–23 mos increased over time from 27% to 38% while minimum dietary diversity and minimum acceptable diet were stagnant (2...
Current Developments in Nutrition
Objectives To assess the following relations in women of reproductive age: 1) food security (FS) ... more Objectives To assess the following relations in women of reproductive age: 1) food security (FS) and iron status, 2) iron status and depressive symptoms (DS), 3) FS and DS and if iron status mediates this relation. Methods From the NHANES 2005–2010 cycles, we included 2507 non-pregnant women (20–44 yrs) with complete data for iron biomarkers, DS (Patient Health Questionnaire-9), FS (Food Security Survey Module), BMI, and sociodemographic variables. Ferritin (Ft), transferrin receptor (TfR), body iron (BI) and hemoglobin (Hb) were used to classify iron sufficient (IS), ID, and ID anemic (IDA). Logistic regression models were run (entire sample and within poverty income ratio (PIR) categories). A mediation model was also run. Age, race/ethnicity, marital status, total number of people in the household, PIR, education level, health insurance, parity, BMI, welfare status, and antidepressant use were potential covariates. Results The prevalence of ID was 43% (Ft), 2% (TfR), 37% (BI) and ...
Nutrients
We examined the association between food insecurity (FIS) and micronutrient status among Ghanaian... more We examined the association between food insecurity (FIS) and micronutrient status among Ghanaian women planning to become pregnant. A cross-sectional analysis was completed of 95 women aged 18–35 years, living in the Upper Manya Krobo District in the Eastern Region of Ghana. Questionnaires were administered to collect sociodemographic and food security data; weight and height were measured. Blood was drawn from an antecubital vein; one drop was used to assess hemoglobin via Hemocue. Zinc and copper were analyzed using flame atomic spectrophotometry while iron biomarkers, retinol and 25-hydroxyvitamin D were analyzed using ELISA, ultra-performance liquid chromatography and liquid chromatography-tandem mass spectrometry, respectively. Logistic regression models were used to determine the relationship between food insecurity (FIS) and micronutrient deficiencies. FIS was reported among 23% of the households, while micronutrient deficiencies ranged from 7–28% irrespective of FIS status....
PLOS ONE
Background Globally more than 150 million children under age 5 years were stunted in 2018, primar... more Background Globally more than 150 million children under age 5 years were stunted in 2018, primarily in low-and middle-income countries (LMICs), and the impact of early-onset, persistent stunting has not been well explored. To explore the association between early-onset persistent stunting in children and cognitive development at 5 years of age, and to identify the factors associated with early-onset stunting. Methods and findings Children from the MAL-ED cohort study were followed from birth to 5 years of age in six LMICs. The Wechsler Preschool Primary Scales of Intelligence (WPPSI) was used to assess cognitive abilities (fluid reasoning) at 5 years and was adapted for each culture. Stunting was categorized as early-onset persistent (first stunted at 1-6 months and persisting at 60 months), early-onset recovered (first stunted at 1-6 months and not stunted at 60 months), late-onset persistent (first stunted at 7-24 months and persisting at 60 months), late-onset recovered (first stunted at 7-24 months and not stunted at 60 months), and never (never stunted). Mixed effects linear models were used to estimate the relationship between stunting status and cognitive development. Children with early-onset persistent stunting had significantly lower cognitive scores (-2.10 (95% CI:-3.85,-0.35)) compared with those who were never stunted. Transferrin receptor (TfR) was also negatively associated with cognitive development (-0.31 (95% CI:-0.49,-0.13)), while the HOME inventory, an index of quality of the home environment (0.46 (95% CI: 0.21, 0.72)) and socioeconomic status (1.50 (95% CI: 1.03, 1.98)) were positively associated with cognitive development.
Nutrients
Considering the high burden of micronutrient deficiencies in Bangladeshi children, this analysis ... more Considering the high burden of micronutrient deficiencies in Bangladeshi children, this analysis aimed to identify the factors associated with micronutrient deficiencies and association of plasma micronutrient concentration trajectories from 7 to 24 months with the concentrations at 60 months of age. Plasma samples were collected at 7, 15, 24, and 60 months of age, and hemoglobin, ferritin, zinc, and retinol concentrations of 155, 153, 154, and 155 children were measured, respectively. A generalized estimating equation was used to identify the factors associated with micronutrient deficiencies, while latent class growth modeling identified the trajectories of plasma micronutrients from 7 to 24 months and its association with the concentrations of micronutrients at 60 months was examined using multiple linear regression modeling. Early (AOR = 2.21, p < 0.05) and late convalescence (AOR = 1.65, p < 0.05) stage of an infection, low ferritin (AOR = 3.04, p < 0.05), and low reti...
Current Developments in Nutrition
Objectives To examine the associations between iron status, depressive symptoms, anxiety and qual... more Objectives To examine the associations between iron status, depressive symptoms, anxiety and quality of life (QoL) in 1st, 2nd and 3rd trimesters (TT) of pregnancy Methods A longitudinal study was conducted among pregnant women in Central Region of Ghana. Women were recruited in their 1st TT (<13 weeks; n = 118) and followed at their 2nd (n = 73) and 3rd (n = 72) TTs. Sociodemographic variables, food security (8-item version of US Household Food Security Survey Module), anxiety (Beck Anxiety Inventory; BAI), depressive symptoms (Center for Epidemiological Studies-Depression Inventory; CESD) and QoL (RAND SF-36), were collected. We determine hemoglobin (Hb) concentrations via Hemocue; ferritin (Ft) via ELISA; serum iron and total iron binding capacity via colorimetric methods and calculated transferrin saturation (TSAT). Stepwise regressions were run to determine predictors of psychosocial wellbeing and ANCOVA's for differences between iron status (ID = iron deficient; IS = ir...
Current Developments in Nutrition
Objectives To examine the association between iron status and mother-infant interactions in dyads... more Objectives To examine the association between iron status and mother-infant interactions in dyads from rural Bangladesh. Methods Maternal-infant interactions were assessed in dyads from a substudy nested within a randomized controlled trial in rural Bangladesh. Recorded interactions (10 minutes free-play; 2 minutes diapering) at baseline (BL) (infant age 6–18 mo; n = 116), midline (ML) (+ 3 mo; n = 324), and endline (EL) (+ 6 mo; n = 336) were coded per the Emotional Availability Scales (EAS; 4 maternal scales: sensitivity, structuring, non-intrusiveness, non-hostility; 2 child scales: responsiveness, involvement). Ferritin (Ft), transferrin receptor (TfR), and hemoglobin (Hb; in infants only) concentrations were measured at BL and EL. Group differences (categorized by iron status irrespective of intervention group) were assessed via ANCOVA (covariates: socioeconomic status, mean upper arm circumference, weight-for-age Z-score, child sex and age and maternal depressive symptoms (Cen...
Current Developments in Nutrition
Objectives We tested whether environmental enteric dysfunction (EED) is associated with risk of m... more Objectives We tested whether environmental enteric dysfunction (EED) is associated with risk of micronutrient deficiencies adjusting for diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status. Methods Data from 1283 children in the MAL-ED birth cohort were examined to evaluate risk of anemia, low plasma retinol, zinc, and ferritin, and high plasma transferrin receptor (TfR) at 15 months. We characterized gut inflammation and permeability by myeloperoxidase, neopterin, and alpha-1-antitrypsin concentrations from monthly asymptomatic fecal samples averaged from 9–15 months, and urinary recovery of lactulose (L) and mannitol (M) from LM tests at 9 and 15 months, converted to a ratio z score (LMZ) and averaged. Nutrient intakes from complementary foods were quantified monthly from 9–15 months and densities were averaged. Plasma alpha-1 acid glycoprotein at 15 months characterized systemic inflammation. Relationships among variables w...
Current Developments in Nutrition
Objectives To identify factors associated with improvement (‘catch-up’) in height and weight from... more Objectives To identify factors associated with improvement (‘catch-up’) in height and weight from 24–60 mo of age, and to determine whether associated factors differ depending on the metric used (absolute or relative difference from WHO growth standards). Methods At seven MAL-ED sites, 942 children had anthropometry data at 24 and 60 mo, as well as information about socioeconomic status, maternal height, gut permeability (lactulose-mannitol z-score (LMZ)), dietary intake from 9–24 mo, and micronutrient status. Anthropometric changes were categorized in terms of positive changes in Height- or Weight for-Age Z-score (HAZ, WAZ) or their differences (HAD, WAD) and recovery from stunting/underweight, and then modeled using multivariate linear regression. Results 42% of the children were stunted at 24 or 60 mo, and 24% of the children were underweight at 24 or 60 mo. 44% of the children who were stunted at 24 mo were not at 60 mo, and 34% of those underweight at 24 mo were no longer at 60...
Current Developments in Nutrition
Objectives To identify clusters of cognitive developmental trajectories and associated differenti... more Objectives To identify clusters of cognitive developmental trajectories and associated differentiating factors of children aged 6 to 60 months old in 5 low to middle-income sites. Methods We followed 835 children and assessed anthropometry at enrolment (≤ 17 d old); bi-weekly illness data (0–24 and 60 mo); non-diarrheal and diarrheal stools (0–24 mo) analyzed for a panel of enteropathogens; quantitative complementary food intakes (9–24 and 60 mo); micronutrient status (Fe, Zn, Vit A; 7, 15, and 24 mo); quality of the child's home environment (6, 24, and 60 mo) and maternal reasoning ability and depressive symptoms via questionnaire. Child cognitive development was assessed by the Bayley Scales of Infant Development III (6, 15 and 24 mo) and Wechsler Preschool and Primary Scale of Intelligence (60 mo). Clusters of trajectories were identified using a latent class mixed model. Differences between clusters were described using discriminant analysis to rank the contribution of each ...
Current Developments in Nutrition
Background: Micronutrients are important for reproductive health and pregnancy, but the status of... more Background: Micronutrients are important for reproductive health and pregnancy, but the status of multiple vitamins and minerals is rarely measured in women before pregnancy. Objectives: We aimed to assess the status and concurrent deficiencies of micronutrients among women before pregnancy and their relation with common health indicators. Methods: This was a cross-sectional study that recruited women who expected to become pregnant within the next 6 mo in Asesewa, Ghana, a semi-urban community. Women self-reported demographics and health history. We measured blood pressure, height, and weight and conducted a blood draw and hemoglobin assessment (n = 98). We measured serum/plasma concentrations of ferritin, iron, total iron binding capacity, zinc, copper, retinol, and 25-hydroxyvitamin D, in addition to markers of inflammation. We used established cutoffs for deficiency and insufficiency/low status for each micronutrient after adjusting ferritin, zinc, and retinol for inflammation. We compared biomarker distributions by common health indicators. Results: Forty percent of women had overweight/obesity, 33% were anemic, and 23% had elevated blood pressure. Overall, 27% had ≥1 deficiencies, whereas only 4% had 2 deficiencies. Fifty-eight percent of women had ≥1 insufficiencies and 18% had ≥2 insufficiencies. Prevalence of individual deficiencies was 12%, 7%, 7%, 4%, and 0% and prevalence of individual insufficiencies was 18%, 12%, 29%, 13%, and 13% for iron, copper, vitamin A, zinc, and vitamin D, respectively. Iron biomarkers and retinol concentrations differed by anemia status, and copper was higher in those with elevated blood pressure. Micronutrient concentrations were not associated with self-reported medical history (parity or history of anemia, malaria, or night blindness). Conclusions: In Asesewa, Ghana, there was a relatively low prevalence of individual micronutrient deficiencies, but the majority of women were insufficient in ≥1 micronutrients. Iron and vitamin A status was lower in those with anemia, but otherwise, micronutrient status did not relate to common health markers. Curr Dev Nutr 2019;3:nzz053.
Journal of Trace Elements in Medicine and Biology
The Journal of nutrition, Jan 17, 2018
Iron deficiency remains the most prevalent micronutrient deficiency globally, but few studies hav... more Iron deficiency remains the most prevalent micronutrient deficiency globally, but few studies have examined how iron status relates to cognition in adolescents. Iron biofortification of staple food crops is being scaled up, yet it is unknown whether consuming biofortified crops can benefit cognition. Our objective was to determine the efficacy of iron-biofortified pearl millet in improving attention and memory in Indian school-going adolescents. A double-blind, randomized, intervention study was conducted in 140 Indian boys and girls, aged 12-16 y, who were assigned to consume iron-biofortified [Fe = 86 parts per million (ppm)] or conventional (Fe = 21-52 ppm) pearl millet. Hemoglobin, ferritin, and transferrin receptor (TfR) were measured and body iron (BI) was calculated at baseline and after 4 and 6 mo. Five measures of cognitive function were obtained at baseline and 6 mo: simple reaction time (SRT), Go/No-Go (GNG) task, Attentional Network Task (ANT), Composite Face Effect (CFE...
Food and nutrition bulletin, Sep 1, 2017
Iron deficiency is a global public health concern and has implications on the health status of wo... more Iron deficiency is a global public health concern and has implications on the health status of women in reproductive age. We hypothesized that improving iron intake with double fortified salt would improve food intake, resulting in higher energy, nutrient intakes, and weight indicators of female tea plantation workers. In this randomized double-masked study, the participants (n = 245) were assigned to receive salt double fortified with iron and iodine (DFS; treatment) or salt fortified with iodine (control) and followed for 7.5 to 9 months. Dietary intakes were measured at three time points, baseline, midpoint, and end line using (1) food frequency questionnaire, (2) 24-hour recall, and (3) weighed lunch intake. Anthropometric measures of height (cm), weight (kg), and mid-upper arm circumference (cm) were also recorded at three time points. Mixed-model repeated-measures approach was used to detect group differences across time. Double fortified salt improved dietary iron intake in t...
The Journal of nutrition, Nov 1, 2017
Background: Evidence shows that iron deficiency in adulthood may affect cognitive performance, po... more Background: Evidence shows that iron deficiency in adulthood may affect cognitive performance, possibly by disrupting neurotransmitter regulation or brain energy metabolism. Women of reproductive age (WRA) are among those who are most vulnerable to iron deficiency; however, they have been largely ignored in the literature relating iron status to cognition.Objective: Our aim was to determine the efficacy of iron-biofortified beans in improving cognition in WRA compared with control beans.Methods: A double-blind, randomized intervention study was conducted in 150 women aged 18-27 y with low iron status (ferritin <20 μg/L). Women were randomly assigned to consume iron-biofortified beans (86.1 ppm iron) or control beans (50.1 ppm iron) daily for 18 wk. Iron status was assessed based on hemoglobin, ferritin, transferrin receptor, and body iron values and on cognitive performance on 5 computerized tasks at baseline and endline.Results: Groups did not differ on any variables at baseline...
The Journal of nutrition, Dec 11, 2017
Background: Iron deficiency and iron deficiency anemia have been shown to have negative effects o... more Background: Iron deficiency and iron deficiency anemia have been shown to have negative effects on aspects of perception, attention, and memory.Objective: The purpose of this investigation was to assess the extent to which increases in dietary iron consumption are related to improvements in behavioral measures of perceptual, attentional, and mnemonic function.Methods: Women were selected from a randomized, double-blind, controlled food-fortification trial involving ad libitum consumption of either a double-fortified salt (DFS) containing 47 mg potassium iodate/kg and 3.3 mg microencapsulated ferrous fumarate/g (1.1 mg elemental Fe/g) or a control iodized salt. Participants' blood iron status (primary outcomes) and cognitive functioning (secondary outcomes) were assessed at baseline and after 10 mo at endline. The study was performed on a tea plantation in the Darjeeling district of India. Participants (n = 126; 66% iron deficient and 49% anemic at baseline) were otherwise health...
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Papers by Laura Murray-kolb