FOREWORD

EXECUTIVE SUMMARY

AUTHORS

ACKNOWLEDGEMENTS

LIST OF ABBREVIATIONS

GLOSSARY

INTRODUCTION

Undernutrition Throughout the Life Cycle

Research on Interventions to Combat Undernutrition

Conceptual Framework

PREVENTING LOW BIRTHWEIGHT

Definitions and Indicators

Wasting or Stunting in utero

Prevalence of Intrauterine Growth Retardation (IUGR)

Consequences of Low Birthweight

Increased Mortality and Morbidity

Greater Risk of Stunting

Poor Neurodevelopmental Outcomes

Reduced Strength and Work Capacity

Increased Risk of Chronic Disease

Causes of Intrauterine Growth Retardation

Prenatal Food Supplementation

Beneficial Nutrition Interventions

Nonbeneficial Nutrition Interventions

Optimizing Interventions

Targeting Supplements to Undernourished Women

Best Predictors for Women at Greatest Risk of IUGR

Prepregnancy Weight

Attained Maternal Weight at 20, 28 or 36 Weeks of Gestation

Additional, Less Useful Predictors of Women at Greatest Risk of IUGR

Low Maternal Body Mass Index (BMI)

Pregnancy Weight Gain

Maternal Height

Timing of Supplementation

Duration of Supplementation

Micronutrient Supplementation During Pregnancy

Supplementation with Single Micronutrients

Iron

Folic Acid

Zinc

Vitamin A

Calcium

Iodine

Supplementation with Multiple Micronutrients

Non-Nutritional Interventions During Pregnancy

Adolescent Nutrition

Adolescent Growth

Adolescent Pregnancy

Adolescent Nutritional Status

Can Adolescents Catch-Up Incomplete Childhood Growth?

Intervening in Adolescence

Improving Dietary Intake

Improving Iron and Folate Status

Delaying First Pregnancy

Summary and Conclusions

IMPROVING CHILD GROWTH

Growth Patterns of Infants and Children

Stunting

Underweight

Wasting

Causes of Poor Growth

Interactions Between Undernutrition and Diseases

Consequences of Poor Growth

The Fundamental Importance of Care

Exclusive Breastfeeding

Complementary Feeding

Recommendations for Complementary Feeding

Estimating the Amount of Nutrients Needed in Complementary Foods

Improving the Nutrient Content of Complementary Foods

Increasing Energy Intake

Increasing Protein Intake

Improving the Micronutrient Content (Quality) of Complementary Foods

Increasing the Consumption of Animal Products

Improving the Content and Bioavailability of Nutrients in Plant-Based Complementary Foods

Fortification of Complementary Foods with Micronutrients

Efficacy Trials of Complementary Foods

Micronutrient Supplementation to Improve Growth

Iron

Zinc

Vitamin A

Calcium

Iodine

Multiple Micronutrients

Summary and Conclusions

PREVENTING AND TREATING ANAEMIA

The Prevalence of Anaemia and of Iron Deficiency

Causes of Anaemia

Consequences of Anaemia

Efficacy Trials of Iron Supplementation

Supplementation in Pregnancy

Iron Supplementation of Infants and Preschool Children

Iron Supplementation of School Children and Adolescents

Frequency, Duration and Prioritization of Iron Supplementation

The Role of Other Micronutrients in Anaemia

Dietary Interventions to Reduce and Prevent Iron Deficiency

Iron Fortification of Foods

Efficacy Trials

Effectiveness Trials

Maize and Wheat Flour Fortification

Condiment Fortification

Fortification of Foods for Infants and Children

Safety of Iron Fortification Programmes

Complementary Parasite Control Strategies for Prevention of Anaemia

Summary and Conclusions

PREVENTING AND TREATING IODINE DEFICIENCY

Prevalence of Iodine Deficiency

Causes of Iodine Deficiency

Consequences of Iodine Deficiency Disorders

Cretinism

Goitre

Impaired Cognitive Function

Increased Perinatal Morbidity and Mortality

Iodine Efficacy Trials

Effects on Goitre Reduction

Effects on Pregnancy Outcome

Effects on Infant Mortality

Effect on Child Growth

Potential for Iodine Toxicity

Summary and Conclusions

PREVENTING AND TREATING VITAMIN A DEFICIENCY (VAD)

Prevalence of Vitamin A Deficiency

Consequences of Vitamin A Deficiency

Efficacy Trials to Improve Vitamin A Status

Effect on Pregnancy Outcome

Impact on Morbidity and Mortality of Infants and Children

Prevention of Childhood Illness

Benefits of Providing Vitamin A to Infants in the Expanded Programme in Immunization

Improved Growth

Impact on HIV Infection

The Efficacy of Food-Based Strategies to Improve Vitamin A Status

Summary and Conclusions

EFFECTIVENESS OF LARGE SCALE NUTRITION INTERVENTIONS

Growth Monitoring and Promotion

Integrated Care and Nutrition Interventions

Communications for Behavioural Change

Specific Nutrition-Related Recommendations

Supplementary Feeding of Young Children and Women

School Feeding

Health-Related Services

Complementarities Between Health Service Delivery and Community Nutrition

Effectiveness of Supplementation for the Control of Iron and Vitamin A Deficiency

Iron

Vitamin A

Food-Based Strategies for Control of Iron and Vitamin A Deficiency

Control of Iodine Deficiency Disorders

PRIORITIZING OPTIONS

Benefit-Cost and Cost-Effectiveness Analyses

Determining Unit Costs of Interventions

Cost-Effectiveness

Key “Minimum Packages”

Programme Management Principles

Contextual Success Factors

Programme Success Factors

Role of Programmes in National Nutrition Improvement

REFERENCES

APPENDIX 1. PROFILES OF SOME COMMUNITY-BASED NUTRITION INTERVENTIONS IN ASIAN COUNTRIES, FROM THE ASIAN DEVELOPMENT BANK REGIONAL TECHNICAL ASSISTANCE (RETA) PROJECT 5671 ON “INVESTING IN CHILD NUTRITION IN ASIA” AND OTHER RELEVANT PROJECTS AND STUDIES

Bangladesh

Cambodia

People's Republic of China

India

Pakistan

Sri Lanka

Viet Nam

ACC/SCN NUTRITION POLICY PAPERS

ASIAN DEVELOPMENT BANK NUTRITION AND DEVELOPMENT SERIES

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