For design of healthy and sustainable diets and food systems, it is important to consider not only the quantity but also the quality of nutrients. This is particularly important for proteins, given ...the large variability in amino acid composition and digestibility between dietary proteins. This article reviews measurements and metrics in relation to protein quality, but also their application. Protein quality methods based on concentrations and digestibility of individual amino acids are preferred, because they do not only allow ranking of proteins, but also assessment of complementarity of protein sources, although this should be considered only at a meal level and not a diet level. Measurements based on ileal digestibility are preferred over those on faecal digestibility to overcome the risk of overestimation of protein quality. Integration of protein quality on a dietary level should also be done based on measurements on an individual amino acid basis. Effects of processing, which is applied to all foods, should be considered as it can also affect protein quality through effects on digestibility and amino acid modification. Overall, protein quality data are crucial for integration into healthy and sustainable diets, but care is needed in data selection, interpretation and integration.
DHIS2 is a web-based platform primarily used in developing countries, ensuring reliable data and aiding decentralized decision-making. The Ministry of Health and Population has greatly emphasized ...using DHIS2 for data entry and reporting. However, studies regarding health workers' experiences on DHIS2 and the utilization of data at the local level remain limited. Therefore, this study aims to investigate the usage and practical experience of DHIS2 at the local levels of Gandaki province, Nepal. An exploratory qualitative study was conducted in the Gandaki province from February to August 2023. We conducted twenty in-depth interviews among the DHIS2 users at local levels, health posts, and provincial health directorate using in-depth interview guidelines. The study participants were selected purposively. Thematic analysis was conducted to analyze the data, and NVivo was used to facilitate data analysis. Health professionals demonstrated dedication and commitment to use DHIS2 for reporting. DHIS2 has facilitated timely reporting, data storage, data analysis and visualization, feedback and communication mechanisms, and service delivery. Users' self-motivation and support from the local and provincial levels and regular review and program-specific review meetings were major facilitators for DHIS2 use. Similarly, technical issues, poor internet connectivity, power outages, and inexperienced health professionals were the significant challenges to using DHIS2. The basic and refresher training needed improvement at all levels, and learning materials were unavailable in health facilities. In addition, the data utilization at the local level in various actions was unsatisfactory despite sufficient data. Health professionals have been facilitated by DHIS2 in various actions. Capacity building of health professionals on data analysis and interpretations, continued onsite coaching, reliable internet connectivity, availability of learning materials, and improved server capacity are needed to enhance the performance of DHIS2 at the local level.
Human breast milk (BM) is the best source of nutrition in early life, particularly during the first 6 months. Nevertheless, human BM composition is variable, and more insight in the exact factors ...contributing to this variability is warranted. In this review, we explored the impact of maternal dietary intake and nutritional status (e.g. anthropometric measures, BMI, bioimpedance) on human milk macronutrient composition. PubMed, Scopus and Cochrane were systematically searched till November 2019. In total, 4946 publications underwent title–abstract screening; 101 publications underwent full-text screening. Eventually, fifty publications were included in this review, investigating either associations between maternal dietary intake (n 29) and/or maternal nutritional status (n 29), and macronutrient composition of human BM. Reported energy composition ranged from 213 to 301 kJ/100 ml, and 67 % and 54 % of the studies reported associations between with maternal nutritional intake and status, respectively. Protein content ranged from 0·8 to 3·3 g/100 ml, and four studies suggested a negative association with nutritional status. Fat content ranged from 2·1 to 9·8 g/100 ml, and 68 % of the studies reported positive associations with nutritional status. Carbohydrate content ranged from 5·8 to 7·5 g/100 ml, and 67 % of the included studies did not report an association between intake and status. Literature investigating associations of maternal dietary intake and nutrition status with BM composition of macronutrients and energy content is diversified, both in terms of used methodology and results. Further studies using well-defined and standard parameters are essential to aid the formulation of scientific recommendations.
Current evaluation systems for protein quality focus only on indispensable amino acids (IAAs) and do not consider the dispensable amino acids (DAAs). However, at excess levels of IAAs, DAAs may ...become limiting. Here, we used published ileal amino acid digestibility data determined in growing pigs and currently assumed protein and IAA recommendations to estimate utilizable, oxidized, and non‐absorbed amino acids in different dietary protein and to compare these utilizable amino acid values to digestible indispensable amino acid score (DIAAS) values. For dietary protein sources with a DIAAS value <90, the amount of calculated utilizable amino acids increased proportionally with the DIAAS value according to “utilizable amino acids (mg/g protein) = DIAAS × 10”; for dietary protein sources with a DIAAS value >90, the amount of utilizable amino acid stays within the range 800–1000 mg/g protein. Cereals contained the lowest levels of utilizable amino acids and the highest amount of oxidized amino acids. Dairy and meat have the highest amount of utilizable amino acids followed by nuts and pulses. For many mixtures of protein sources, the highest value for utilizable amino acids, which considers both IAAs and DAAs, occurred at a different ratio of protein sources than the maximum DIAAS value, which only considers IAAs. From this theoretical study and based on the assumptions made, we conclude that estimation of utilizable amino acids from data typically reported in DIAAS studies further enables complementary insights next to DIAAS values. Careful consideration of protein and IAA requirements is critical in further work.
Utilizable amount of total amino acids in individual and mixtures of dietary protein sources taking dispensable amino acids do not always correspond to the respective digestible indispensable amino acids scores.
Background: Malnutrition is a common public health problem among children in low and middle-income developing countries. Orphan's children are vulnerable and neglected groups in society and are more ...prone to malnutrition. The study aims to identify the prevalence of underweight, stunting, thinness, and factors associated with nutritional status among orphan children. Methods: Quantitative method & analytical cross-sectional research design were used to assess the nutritional status and its associated factors among orphan children in Pokhara Valley, Nepal. The sample size of 160 children was obtained by a simple random technique. The semi-structured questionnaire, digital bathroom scale, stadiometer was used as the data collection technique. Data management and analysis were done from Epi-info, SPSS 25 version, and WHO Anthro plus. Findings: The majority of children were malnourished (80.6%) with the prevalence of stunting (55.1%), thinness (13.8%), and overweight (6.9%). Prevalence of underweight, stunting, and thinness was high among the boys (85.5%, 26.3%, and 15.8%), but overweight was more prevalent among the girls (7.1%). Ethnicity, sex, age, stay duration in an orphanage, and education of caregivers was associated with the nutritional status of orphan children (p <0.05). Non-privileged children and children below 11 years were more prone to malnutrition. Conclusion: Malnutrition is highly prevalent in orphan children and needs to be addressed. There is still limited study available on the nutritional status of orphan children in Nepal. Nutritional status should be monitored regularly for early identification and timely intervention of malnutrition to promote the nutrition health status of orphan children
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