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Author Contributions
Conceptualization, J.B.-A., Y.G. and M.L.F.; methodology, J.B.-A., Y.G. and M.L.F.; validation, J.B.-A., Y.G. and A.E.; formal analysis, Y.G.; investigation, J.B.-A., Y.G., K.P. and J.Z.; resources, J.B.-A.; data curation, Y.G., K.P., J.Z. and J.A.; writing—original draft preparation, Y.G.; writing—review and editing, ...
PMC9865189
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki and the guidelines of the Council of International Organizations of Medical Sciences (CIOMS). The study was approved by the Institutional Review Board (or Ethics Committee) of the University Research Headquarters of the University of Antioquia (prot...
PMC9865189
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
PMC9865189
Data Availability Statement
The data presented in this study are available on request from the corresponding author. The data are not publicly available as analyses are still underway for additional publications.
PMC9865189
Conflicts of Interest
The authors declare no conflict of interest. Avinal had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
PMC9865189
SUMMARY
Author disclosureAKN, IHP and AH report speaker fees from Baxter. DSM Nutritional Products Inc. provided the AA and DHA supplement Formulaid
PMC10512593
Background & aim:
Preterm infants risk deficits of long-chain polyunsaturated fatty acids (LCPUFAs) that may contribute to morbidities and hamper neurodevelopment. We aimed to determine longitudinal serum fatty acid profiles in preterm infants and how the profiles are affected by enteral and parenteral lipid sources.
PMC10512593
Methods:
Cohort study analyzing fatty acid data from the Mega Donna Mega study, a randomized control trial with infants born <28 weeks of gestation (n = 204) receiving standard nutrition or daily enteral lipid supplementation with arachidonic acid (AA):docosahexaenoic acid (DHA) (100:50 mg/kg/day). Infants received an intraveno...
PMC10512593
Results:
Higher parenteral lipid administration resulted in lower serum proportion of AA and DHA relative to other fatty acids during the first 13 weeks of life (p < 0.001 for the 25th vs the 75th percentile). The enteral AA:DHA supplement increased the target fatty acids with little impact on other fatty acids. The absolute co...
PMC10512593
Conclusions:
Our data show that parenteral lipids aggravate the postnatal loss of LCPUFAs seen in preterm infants and that serum AA available for accretion is below that
PMC10512593
Introduction
ROP, MDM
SECONDARY, RETINOPATHY OF PREMATURITY
Extremely preterm infants (born <28 weeks’ gestation) often show low postnatal levels of long-chain polyunsaturated fatty acids (LCPUFA) associated with an increased risk for neonatal morbidities [Fortification of intravenous lipid emulsions and enteral supplementation have been assessed as ways to improve LCPUFA statu...
PMC10512593
Materials and methods
PMC10512593
Study design
The current study was performed within the randomized, open-labeled Mega Donna Mega trial [
PMC10512593
Participants and intervention
The Regional Ethical Review Board at the University of Gothenburg approved the study (Dnr 303–11, T570–15). The study was performed following theethical standards of the Helsinki Declaration of 1975, as revised in 1983. Informed signed consent for all participants was obtained from parents or legal guardians. Infants w...
PMC10512593
Collection of clinical data
Nutritional-, growth-, morbidity-, and mortality data were collected according to the study protocol, following infants from birth to 40 weeks PMA [
PMC10512593
Nutritional practices
Details of the nutritional strategy have been described [
PMC10512593
Blood sample collection and fatty acid analysis
BLOOD, CLOT
Blood was collected in serum separator tubes from cord blood (2 mL) and infant arterial or venous blood (0.6 mL) at postnatal age (PNA) 1, 3, 7, 14, 28, and 42 days and at postmenstrual age (PMA) 30, 32, 34, 36, and 40 weeks. Blood samples were allowed to clot for a minimum of 0.5 h and a maximum of 2 h before centrifu...
PMC10512593
Statistical analyses
We previously [Infants were classified into three categories based on the administration of parenteral lipids during the first four weeks of life. Per each infant and day, the amount of administered parenteral lipids was standardized into a parenteral lipid standard deviation score (PNSDS) using the studied population’...
PMC10512593
Results
PMC10512593
Clinical characteristics of the study cohort
An overview of the study cohort and samples used for fatty acid analysis is shown in
PMC10512593
Relation between parenteral lipids and serum phospholipids
Total phospholipid fatty acids increased rapidly from cord blood until postnatal day 3 (median [Q1-Q3] 2238 [1885–2696] μmol lTo further investigate the relationship between serum fatty acids and parenteral lipids, infants were grouped into three categories based on percentiles of their standardized daily parenteral li...
PMC10512593
Effect of parenteral lipids on serum AA and DHA
Over the first 13 postnatal weeks, infants with the highest intake of parenteral lipids (≥75th percentile) showed significantly lower relative serum levels of AA and DHA compared to infants with the lowest intake (≤25th percentile) (
PMC10512593
Enteral AA:DHA supplementation increases target fatty acids in infant serum
As we previously reported, infants who received the enteral AA:DHA supplement displayed higher relative levels of AA and DHA (
PMC10512593
Absolute and relative serum fatty acid levels over time
We visualized the fatty acid data for the cohort as a whole in heatmaps to further explore postnatal level changes. This showed prominent pattern differences when levels were expressed in relative (mol%, Clustering the different fatty acids according to their postnatal level changes (Concerning the absolute quantificat...
PMC10512593
The inter-individual variation in fatty acid profiles changes with postnatal age
We used Uniform Manifold Approximation and Projection (UMAP) to reduce the dimensionality of the data and compare individuals’ complete fatty acid profiles (Cord blood and day 1 samples clustered together while samples collected from postnatal day 3 to postnatal week 4 displayed higher heterogeneity; the latter was esp...
PMC10512593
Discussion
This study provides a comprehensive overview of the extremely preterm infants’ fatty acid status during early postnatal life and how fatty acid levels are affected by external lipid sources. The largest changes in serum fatty acid levels occurred in the first few weeks after birth. This period was also defined by a siz...
PMC10512593
Effect of parenteral lipids on infant serum phospholipids and LCPUFAs
lIntravenous lipid emulsions, ≤28
EXTREMELY LOW BIRTH WEIGHT INFANT, ROBINSON
The strikingly different patterns observed for relative (mol%) and absolute (μmol lIntravenous lipid emulsions and fat-soluble vitamin supplements are emulsified with egg yolk phospholipids that contain some DHA and AA [As seen over the whole study period, infants on high parenteral lipids displayed lower relative leve...
PMC10512593
Longitudinal AA and DHA and the impact of enteral supplementation
In preterm infant blood, AA and DHA are mainly transported as esters of phospholipids in lipoproteins that supply tissues with the material needed for metabolism and cell expansion [As we reported previously [Collins et al. investigated dose–response of emulsified DHA via tube feeding on circulating RBC levels in infan...
PMC10512593
Fatty acid clustering
We grouped fatty acids according to postnatal level profiles and found several distinct clusters. Some fatty acids clustered according to class; for example, the proportion of the n–3 fatty acids, except DHA, were found in one cluster. The proportion of DHA, on the other hand, shared profile with the long-chain saturat...
PMC10512593
Strengths and limitations
blood transfusions
There are limitations to our study. First, infants in the control group did not receive a placebo treatment. However, there was no difference in total lipid intake between the active and the control group. Second, when investigating the impact of parenteral lipids on infant LCPUFA levels we did not account for other po...
PMC10512593
Conclusions
PRETERM BIRTH
Following preterm birth, infant LCPUFA levels fall below those of the fetus
PMC10512593
Supplementary Material
PMC10512593
References
PMC10512593
Relationship between serum phospholipids and administration of parenteral lipids.
Infants are categorized into three groups according to their parenteral lipid intake in the first four weeks of life. (
PMC10512593
Relationship between parenteral lipids and infant serum AA and DHA levels.
Infants are categorized into three groups according to their parenteral lipid intake in the first four weeks of life. Shown are relative levels (mol%) of AA (
PMC10512593
Infant serum fatty acid profiles.
Heatmaps showing the mean serum levels of phospholipid fatty acids over the 16 first weeks of infant life based on relative (
PMC10512593
Changes in serum fatty acids relative to cord blood levels.
Postnatal serum fatty acid normalized to concentrations in cord blood (n = 65). (Uniform Manifold Approximation and Projection (UMAP) of all samples collected from birth to postnatal week 16 based on relative (Infant characteristics.SDS = standard deviation score.For categorical variables n (%) is presented.For continu...
PMC10512593
Abstract
CARDIOVASCULAR DISEASE
Postprandial glycemia (PPG) predicts cardiovascular disease, and short‐term physical inactivity increases PPG in young, active adults. Whether this occurs in older, active adults who may be more prone to bouts of inactivity is unknown. This study determined if postprandial interstitial glucose (PPIG) was impaired in ac...
PMC9875817
INTRODUCTION
TYPE 2 DIABETES
The global prevalence of type 2 diabetes continues to rise. By the year 2030, an estimated 7079 individuals per 100,000 will have type 2 diabetes (Khan et al., Advancements in glucose monitoring make assessing free‐living postprandial blood glucose levels convenient and feasible (Grant & Golden, 
PMC9875817
METHODS
PMC9875817
Study design
This randomized, cross‐over, exploratory study design included 20 participants (9 young, active participants and 11 older, active participants). Participants had glycemic control assessed via CGMS (iPro2, Enlite Sensors, Medtronic Plc.) for 3 days while performing their normal habitual exercise (EX) and for 3 days whil...
PMC9875817
Participants
This study was approved by the Old Dominion University Institutional Review Board and written informed consent was obtained from all participants. Further, this research was done in accordance with the Declaration of Helsinki. This study was registered on Demographics Abbreviations: BMI, body mass index; EX, exercise p...
PMC9875817
Interventions
PMC9875817
Removal of exercise phase
During the removal of exercise phase (NOEX), participants refrained from completing exercise for 3 days. Further, participants were encouraged not to compensate for the removal of exercise by increasing their leisure time physical activity levels. An Actigraph accelerometer (wGT3X‐BT) was worn around the waist during t...
PMC9875817
Accelerometry
Total daily steps acquired each day and total daily physical activity intensities (light physical activity (LPA), moderate physical activity (MPA), vigorous physical activity (VPA), and moderate to vigorous physical activity (MVPA)) were downloaded from the accelerometer and averaged across each 3‐day phase (Figure The...
PMC9875817
Body composition measurement
Thomas
Body composition was assessed once during the study via bioelectrical impedance (InBody 770) following the removal of the glucose sensor after completing the EX or NOEX phase. Participants were instructed not to consume food or drink (other than water) for 4 h prior to testing or exercise for 24 h prior to the test. Fu...
PMC9875817
Continuous glucose monitoring
Participants wore CGMS for 3 days during the removal of exercise and 3 days while performing habitual exercise. Briefly, the glucose sensor (Enlite™ glucose sensor, Medtronic Inc) was inserted subcutaneously into the abdomen approximately 3 inches to the right or left of the umbilicus on the day prior to the 3‐day moni...
PMC9875817
Dietary intake
To control for the effect of meal composition on blood glucose levels, participants consumed the same foods and volume of foods, and at the same time each day, over the course of each study phase. Further, participants were encouraged to wait at least 2 h between subsequent meals and/or snacks to allow for quantificati...
PMC9875817
Statistical analysis
Statistical analyses were performed using SigmaPlot 12.5. Given that PPIG was our first variable of interest, we calculated our sample size utilizing 1‐h PPIG levels from Emerson et al. (Differences in steps/day, LPA, MPA, VPA, MVPA, PPIG AUC, peak PPIG, glucose standard deviation, and maximum glucose values in the you...
PMC9875817
RESULTS
Participant characteristics are listed in Table Steps/day and 3‐day, 24‐h averages of LPA, MPA, VPA, and MVPA minutes/day are represented in Figure Old participants self‐reported that during the EX phase, they participated in walking/running (Significant main effects of age (
PMC9875817
DISCUSSION
cardiovascular disease
DILATION, EVENTS, CARDIOVASCULAR DISEASE, INSULIN SENSITIVITY
Three days of exercise removal impairs glycemic control in older adults as well as young adults. Twenty‐four‐hour blood glucose standard deviation, an indicator of the variability of blood glucose concentrations, and 24‐h maximum glucose values were both elevated in the NOEX phase compared to the EX phase, suggesting g...
PMC9875817
CONFLICT OF INTEREST
The authors report no conflicts of interest. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.
PMC9875817
ACKNOWLEDGMENTS
HEART
Glucose sensors for this study were provided by Medtronic Plc., Northridge CA, USA (LJR). LJR was supported by the American Heart Association AIREA (Award ID: 953463).
PMC9875817
REFERENCES
PMC9875817
1. Introduction
abdominal obesity, metabolic syndrome, dyslipidemia
BLOOD, IMPAIRED GLUCOSE TOLERANCE, INSULIN RESISTANCE, ELEVATED BLOOD PRESSURE, REGRESSION, METABOLIC SYNDROME, TYPE 2 DIABETES, CARDIOVASCULAR COMPLICATIONS, METABOLIC SYNDROME, DYSLIPIDEMIA
Dietary strawberries have been shown to improve cardiometabolic risks in multiple clinical trials. However, no studies have reported effects on serum metabolomic profiles that may identify the target pathways affected by strawberries as underlying mechanisms. We conducted a 14-week randomized, controlled crossover stud...
PMC9916764
2. Results
PMC9916764
2.2. Features of Metabolic Syndrome
METABOLIC SYNDROME
The features of metabolic syndrome, including body weight, waist circumference, blood pressure, blood glucose, triglycerides, and HDL-cholesterol levels, did not differ at the end of each treatment group, as previously reported [
PMC9916764
3. Discussion
obesity, metabolic syndrome, diabetes
OBESITY, DISEASE, INSULIN RESISTANCE, METABOLIC SYNDROME, DIABETES
In our clinical trial of dietary strawberry supplementation in adults with features of metabolic syndrome and insulin resistance, several targeted and untargeted serum metabolites were shown to be modulated. When analyzed by treatment phases, the serum valine and leucine were significantly lower following the high-dose...
PMC9916764
4. Materials and Methods
This was a randomized, double-blind, controlled crossover trial conducted at the Oklahoma Clinical and Translational Sciences Institute (OCTSI) at the University of Oklahoma Health Sciences Center (OUHSC), Department of Nutritional Sciences at Oklahoma State University (OSU), and the Section of Endocrinology at the Uni...
PMC9916764
4.1. Study Criteria and Protocol
The study design has been previously reported [
PMC9916764
4.2. Intervention and Control Powders
The compositions of the control and freeze-dried strawberry powders, provided by the California Strawberry Commission (Watsonville, CA, USA), were as follows: the low-dose strawberry group (one serving/day) received approximately 123 kcal, 28 g carbohydrates, 2 g dietary fiber, 26 mg vitamin C, 400 mg total polyphenols...
PMC9916764
4.3. Biochemical Analyses
INSULIN RESISTANCE
The serum levels of glucose, insulin, and lipids were analyzed at the University of Oklahoma Medical Center laboratory (Oklahoma City, OK, USA) and at Quest Diagnostics (Las Vegas, NV, USA) according to the manufacturer’s protocols. Serum glycated hemoglobin was analyzed with the use of a DCA 2000+ Analyzer (Bayer, Lev...
PMC9916764
4.4. Serum Metabolomic Assay
WEST
Serum samples were sent to the West Coast Metabolomics Center (Davis, CA, USA) for the analyses of primary metabolites and complex lipids by combining three analytical platforms, including gas chromatography–time-of-flight mass spectrometry (Ann Arbor, MI, USA), hydrophilic interaction chromatography–quadrupole time-of...
PMC9916764
4.5. Statistical Analyses
REGRESSION
The summary statistics are presented as means ± SD for continuous variables and counts and percentages for discrete variables. Our primary objective was to examine if the targeted metabolites were different after each of the strawberry vs. control phases as well as the baseline. To assess differences, we used a mixed-m...
PMC9916764
5. Conclusions
cardiometabolic dysfunction, endothelial dysfunction, diabetes
METABOLIC SYNDROME, INSULIN RESISTANCE, ENDOTHELIAL DYSFUNCTION, DIABETES
Our clinical study supports the role of strawberry supplementation in improving the serum metabolic profiles associated with decreased risks of insulin resistance and diabetes, as well as endothelial dysfunction in adults with features of metabolic syndrome. The significant decreases in the targeted metabolites, such a...
PMC9916764
Author Contributions
Conceptualization, A.B. and J.L.E.; Formal analysis, A.H.; Funding acquisition, A.B.; Investigation, A.B. and H.R.S.; Methodology, A.B., K.I., and H.R.S.; Writing—original draft, A.B. and K.I.; Writing—review and editing, A.B., A.H., H.R.S., and J.L.E. All authors have read and agreed to the published version of the ma...
PMC9916764
Institutional Review Board Statement
This study was conducted in accordance with the guidelines of the Declaration of Helsinki and approved by the Ethics and Research Committee of the University of Nevada at Las Vegas (code: NCT03441620).
PMC9916764
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
PMC9916764
Data Availability Statement
These data are not publicly available as the funding agency requires only the authorized research team to collect and store data.
PMC9916764
Conflicts of Interest
The authors declare no conflict of interest.
PMC9916764
References
±
REGRESSION, METABOLIC SYNDROME, OBESE
LASSO logistic regression analyses comparing significant metabolites (untargeted platform) at baseline and after strawberry intervention in adults with features of metabolic syndrome.Baseline characteristics of the study participants in the clinical trial.Data are presented as means and standard deviations (SD). Count ...
PMC9916764
Abbreviations:
Linear growth, an important indicator of a child’s present and future health, is influenced by a complex interaction of environmental factors including intra-uterine growth restriction, household socio-economic status, parental education levels, inadequate maternal and child nutrition and frequent infectionsSe is an es...
PMC10551473
Methods
PMC10551473
Study area and subjects
HIGH RISK PREGNANCIES, SECONDARY, HYPERCALCAEMIA
We used observational Se biomarker data collected as part of double-blinded, dose-varying, placebo-controlled, randomised trial of the effect of maternal vitamin DExclusion criteria included high risk pregnancies, women who had pre-existing medical conditions or those who were taking medications that could put them at ...
PMC10551473
Blood collection
Maternal and VC blood samples were collected at delivery by trained phlebotomists. Trace metal-free EDTA-coated tubes were used to draw maternal samples, and whole-blood aliquots were drawn prior to centrifugation. Cord blood was collected within 30 min of delivery from a site on the umbilical cord attached to the plac...
PMC10551473
Measurement of selenium biomarkers
DISEASE
Whole blood and serum Se were measured at the US Centers for Disease Control and Prevention (CDC). WBSe was measured at delivery and in VC blood using inductively coupled plasma MS
PMC10551473
Outcome assessment
Details of outcome assessment have been elaborated on elsewhereTwo independent personnel measured each child, and repeated measurements were taken. Measurements that differed between the two personnel by 7 mm for length or 50 g for weight were taken again. Means of the final pairs were used in further analysis. Inter-r...
PMC10551473
Covariates
Covariates adjusted for in models included infant characteristics, such as sex, gestational age at birth and season of birth, and maternal characteristics including age, education, height, BMI, gravidity, vitamin D treatment group, daily protein intake (kg), urinary cotinine levels, maternal smoking and tobacco use dur...
PMC10551473
Statistical analysis
REGRESSION, SECONDARY
All analyses were conducted using SAS 9.4 (SAS Institute). A We assessed normality of all variables in this analysis using histograms and kernel density plots in order to determine their distribution. Outliers were flagged and examined to determine their biological plausibility, using box plots. Data for this secondary...
PMC10551473
Selenium biomarkers and birth outcomes
Descriptive statistics for
PMC10551473
Mediation analysis
In addition to linear models for growth outcomes, we conducted mediation analyses using observed variables to explore potential causal pathways for associations between cord WB
PMC10551473
Longitudinal models and generalised additive models
We applied a gate-keeper approach to assess longitudinal associations between growth outcomes and Se biomarkers based on significant associations observed in cross-sectional linear analyses at ages 0, 1 and 2 years. We used unadjusted multilevel models of change (‘proc mixed’) to assess whether relevant Se biomarkers i...
PMC10551473
Results
PMC10551473
Participant characteristics
Se deficiency
DEFICIENCY
A detailed description of analytical sample sizes across growth outcomes in our study of mother–infant dyads is presented in Socio-demographic characteristics and Se status of women and children in the study sample(Mean values and standard deviations; medians and inter-quartile ranges; numbers and percentages)SEPP1, s...
PMC10551473
Modelling analyses
REGRESSION
Linear regression analyses are presented for unadjusted and adjusted associations between Se biomarkers and growth outcomes in Linear and longitudinal regression analyses for associations between Se biomarkers and growth outcomes(95 % confidence intervals)WBSe, whole blood selenium; SEPP1, selenoprotein P; LAZ, length...
PMC10551473
Whole blood selenium and growth outcomes
LBW
REGRESSION
We examined associations between WBSe and birth weight among infants in our sample. We found negative associations between delivery WBSe and birth weight in unadjusted models, where per scaled unit increased in WBSe, birth weight decreased by 10 g, although results were not statistically significant.Likewise, we found ...
PMC10551473
Serum selenium and growth outcomes
LBW
In line with our observations for WBSe, we found similar trends for associations between serum Se at delivery and growth measures, although associations were small and non-significant. Risk ratios were also higher for SGA and LBW per unit increase in serum Se concentrations. Similar to results for WBSe, associations be...
PMC10551473
Selenoprotein P and growth outcomes
SE, LBW
SEPP1, unlike serum and WBSe, showed positive associations with infant birth weight in unadjusted and adjusted models, although results for statistical significance were not consistent across models. Based on our findings, a per unit increase in VC blood SEPP1 was associated with a large increase in birth weight, with ...
PMC10551473
Mediation analyses and generalised additive model analyses
Results from mediation path analysis are presented in Mediation path analysis exploring associations between WAZ at birth and venous cord Se biomarkers. Mediation path analysis exploring associations between birth weight and venous cord Se biomarkers. Mediation path analysis exploring associations between WAZ at 12 ...
PMC10551473
Discussion
toxicity, inflammation, PTB, weight gain
INFLAMMATION, IUGR, DISEASE, OSTEOCHONDROPATHY, MISCARRIAGE, OXIDATIVE STRESS, INFLAMMATORY RESPONSE
In this study of mother–infant dyads, we found measures of Se status in maternal delivery and VC blood serum, whole blood and plasma SEPP1 to be modestly associated with infant growth outcomes at birth, 12 months and 24 months of age, with variability in the strength and magnitude of associations across biomarkers and ...
PMC10551473
Acknowledgements
Tariq, Infections
ROTH, SECONDARY, INFECTIONS
We wish to thank Dr. Daniel E. Roth, PI of the MDIG Trial for providing conceptual inputs to this study, review of methods and results and access to the MDIG data. We thank Huma Qamar, Ulaina Tariq and the SickKids team for their contributions to methods and review of findings and overall contributions to the MDIG stud...
PMC10551473
Supplementary material
For supplementary material accompanying this paper visit https://doi.org/10.1017/S0007114523000739.click here to view supplementary material
PMC10551473
References
PMC10551473
Introduction
Animal source foods (ASFs) provide essential nutrients and are important for child growth and development [In Rwanda prior to the 1994 genocide, traditional gender roles for women included childcare and food preparation. A gender analysis study showed that cultural norms limited women’s ability to work outside the home...
PMC10081762
Methods
PMC10081762
Study overview
RTI
This was a follow-on study to a trial that tested the effects of an SBCC intervention promoting ASF consumption by children in households that received an exotic or crossbred cow through the Government of Rwanda’s Girinka “One Cow Per Poor Family” program (NCT0345567) [The follow-on study used a pre/post evaluation des...
PMC10081762
Intervention
Intervention design was based on findings from the initial study plus additional formative research with men, women, and key informants conducted as part of the follow-on study to learn about the barriers to and enablers of men’s participation in nutrition and the best channels to reach them [The formative research was...
PMC10081762
Participants and sample size
The sampling procedure for the initial study, from which the participants in the follow-on study were recruited, has been described elsewhere [The survey sample size for the follow-on study was based on comparisons of proportions in one sample. Assuming sample estimates were 20% at baseline and would increase 10 percen...
PMC10081762
Data collection
Data were collected during or immediately following the short rainy season, which is typically from October to December, when cow milk production is high. Baseline quantitative survey data was collected from December 2020 to January 2021, and endline survey data was collected from October to November 2021. The enumerat...
PMC10081762
Measures
SECONDARY
Outcome variables were measured at baseline and endline. An ASF frequency questionnaire was used to measure children’s consumption of milk and other ASFs during the last 7 days, which were considered the main outcome variables. Fathers reported the number of times their child ate each type of ASF in the last 7 days in ...
PMC10081762