Participatory nutrition education and adoption of new feeding practices are associated with improved adequacy of complementary diets among rural Malawian children: a pilot study

OBJECTIVE: To introduce practices for improving complementary feeding and evaluate their adoption and association with improved dietary intakes. DESIGN: A quasiexperimental pilot study comparing dietary intakes from complementary foods among three intervention communities and one control community before and after the intervention, and adoption of new complementary feeding practices among intervention communities following the intervention. SETTING: Rural subsistence communities in southern Malawi, Central Africa. SUBJECTS: Mothers and their children aged 6 to 23 months receiving complementary foods. INTERVENTIONS: A participatory, nutrition education intervention based on four locally adapted lessons for complementary feeding practices designed to increase: (i) total complementary food intake; (ii) energy and nutrient density of the complementary diet, and; (iii) iron and zinc bioavailability of the complementary diet. RESULTS: Adoption rates for the four practices ranged from 25% for preparation of enriched porridges, to 10% for preparing soaked, pounded maize. The amount of complementary foods (g/day) and intakes of energy, animal protein, niacin, riboflavin, calcium, iron, and zinc, but not vitamin A, were significantly greater (P<0.05) in the intervention compared to control group, as were the energy, iron, and riboflavin density, and the estimated amount of bioavailable iron and zinc. CONCLUSIONS: Several intervention practices were well accepted and adopted and were associated with improved adequacy of energy and nutrient intakes from the complementary diet. Such improvements were attributed mainly to greater total intakes and, to a lesser extent, enhanced dietary quality of the complementary foods.     

Complementary feeding and nutritional status of 6-24-month-old children in Acrelândia, Acre State, Western Brazilian Amazon

Our objective was to investigate nutritional status and complementary feeding practices in children from 6 to 24 months of age living in the Western Brazilian Amazon. A cross-sectional study was conducted within an urban area of Acrelandia, Acre State. A total of 164 children were studied. Prevalence rates for stunting and anemia were 12% and 40%, respectively, and overall prevalence of iron deficiency was 85%. Vitamin A and B12 serum levels were below normal thresholds in 15% and 12% of children, respectively. Low intake was observed for the following nutrients (% of children): folic acid (33%), vitamin C (40%), vitamin A (42%), zinc (46%), and iron (71%). Iron bioavailability in the diet was approximately 8%. Very low dietary intakes of fruits, vegetables, and meats were observed, in contrast with excessive consumption of cow's milk and porridge.     

中国部分农村地区2～7岁留守儿童膳食营养现况研究

目的 了解中国农村留守儿童膳食营养状况,为农村留守儿童营养干预提供科学依据.方法 采用多阶段分层整群随机抽样方法,随机选择农村2～7岁留守儿童1278名和对照儿童1273名作为调查对象.采用3日膳食称重法和食物摄人频率法进行膳食调查,并以中国营养学会推荐的膳食营养素参考摄入量(DRIs)为依据,评价农村留守儿童膳食能量和各种营养素的摄人状况.结果 农村留守儿童膳食以粮谷类和蔬菜类为主,留守儿童肉禽水产类、水果类及零食类等食物的摄入量低于对照儿童,差异有统计学意义.农村留守儿童能量、三大产热营养素及部分矿物质(钙、锌、硒、钾)和维生素(维生素A、维生素B1、维生素B2)的摄入量均低于推荐摄入量.农村留守儿童能量及主要营养素普遍摄入不足,能量摄入不足率在50%以上,蛋白质摄人不足率达80%以上,而钙、锌等矿物质和维生素B1、维生素B1等维生素的摄入不足率达90%以上.蛋白质来源中,优质蛋白质摄入量仅占总蛋白质摄入量的35%,而植物蛋白质占65%.此外植物性铁的摄入比例明显偏高,达到87%.结论 中国农村留守儿童的膳食结构不尽合理,能量和多种营养素摄入不足,能量、蛋白质及铁的来源不合理,膳食营养状况有待改善.     

The contribution of breast milk to toddler diets in western Kenya

OBJECTIVE: To understand the relative contributions of breast milk and the weaning diet to overall nutrient intake, with a view to designing and implementing appropriate programmes to improve complementary feeding in developing countries. METHODS: Complementary food intake was measured in a sample of 250 toddlers (mean baseline age: 13.9 +/- 2.4 months) using 24-h dietary recall interviews administered once every 3 weeks over a 6-month period. Breast-milk intake over a 24-h period was measured using the test-weighing method in a subsample of 50 children. Regression effects of age and sex on observed milk intakes were estimated and imputed to the whole sample to estimate mean intake over the observation period. Total energy and nutrient intakes were evaluated for adequacy with reference to published estimates of toddler requirements. FINDINGS: Total energy intake (1029 kcal/day) was adequate, with breast milk supplying an average of 328 kcal/day (32%), but vitamin A, riboflavin, calcium, iron and zinc intakes were below current estimates of required intakes. Observed limitations in nutrient intake were consistent with the finding that almost half of the toddlers were stunted. The prevalence of wasting was 6% at baseline and 4% at final assessment. Although food consumption increased when breastfeeding stopped, it could not fully compensate for the fat and vitamin A previously supplied by breast milk. CONCLUSIONS: The nutritional role of mother's milk in the second year is inversely related to the adequacy of the complementary diet. In this study, breast milk was an irreplaceable source of fat and vitamin A. When the weaning diet is inadequate for key nutrients because of low intake or poor bioavailability, breast milk assumes greater nutritional significance in the second year of life but does not guarantee adequate nutrient intakes.     

Chemical and Toxicological Evaluation of Extracts of Fermented Red Acalypha (A Calypha Wilkes/A Na) : A Suggested Tea Adjunct

This study aimed to develop and assess the feasibility of a home-based method to reduce the phytate content of maize and improve zinc bioavailability from maizebased complementary diets in rural Malawi. A method of extracting phytate through the soaking of pounded maize was developed, and found to reduce phytate content to 49% of unrefined maize. An educational program was used to teach the processing method to mothers of children receiving complementary foods in rural Malawian communities. Samples of maize flour prepared by this process by participants were collected and analysed for phytate and zinc content. Of these, 70% of samples were found to be adequately prepared; mean phytate content of these samples was 48% of unprocessed, unrefined maize flour controls. Most participants found the cooked product to have an acceptable taste (99%) and texture (68%), and felt the processing method took little or no extra time (86%) and was culturally acceptable (96%). The phytate and zinc content of the processed maize flour samples analysed from community prepared samples was substituted into the dietary analysis of complementary foods for 9- to 11-month-old children (n = 31). The bioavailability of zinc from the complementary diet would predict an increase from low (24%) to moderate (33%) levels.     

A home-based method to reduce phytate content and increase zinc bioavailability in maize-based complementary diets

This study aimed to develop and assess the feasibility of a home-based method to reduce the phytate content of maize and improve zinc bioavailability from maize-based complementary diets in rural Malawi. A method of extracting phytate through the soaking of pounded maize was developed, and found to reduce phytate content to 49% of unrefined maize. An educational program was used to teach the processing method to mothers of children receiving complementary foods in rural Malawian communities. Samples of maize flour prepared by this process by participants were collected and analysed for phytate and zinc content. Of these, 70% of samples were found to be adequately prepared; mean phytate content of these samples was 48% of unprocessed, unrefined maize flour controls. Most participants found the cooked product to have an acceptable taste (99%) and texture (68%), and felt the processing method took little or no extra time (86%) and was culturally acceptable (96%). The phytate and zinc content of the processed maize flour samples analysed from community prepared samples was substituted into the dietary analysis of complementary foods for 9- to 11-month-old children (n = 31). The bioavailability of zinc from the complementary diet would predict an increase from low (24%) to moderate (33%) levels.     

中国城乡居民膳食营养素摄入状况及变化趋势

目的:描述中国城乡居民膳食营养素摄入状况及变化趋势。方法:采用连续3d24h回顾法的食物记录数据及“称重法”记录的家庭调味品消费量数据,分析居民营养素摄入量。结果:全国23470户,68962人的膳食调查结果显示:我国居民每标准人日能量平均摄入量为9.42MJ(2250.5kcal),蛋白质65.9g,脂肪76.2g,视黄醇当量469.2μg,核黄素0.8mg,抗坏血酸88.4mg,钙388.8mg,铁23.2mg,锌11.3mg。结论:我国城乡居民理论得到保障,膳食质量有所提高,钙、视黄醇、抗坏血酸等营养素摄入不足仍是膳食中的主要问题。城乡差别明显,农村居民膳食质量亟待提高。     

Iron status in Swedish teenage girls: impact of low dietary iron bioavailability

OBJECTIVE: Although it is well known that bioavailability of iron in the diet is important, it has not been fully elucidated in practice. We investigated iron intake and iron absorption in the ordinary diet of free-living individuals in relation to iron status and assessed iron requirements. METHODS: From a total of 1245 adolescent boys and girls included in the G?teborg Adolescence Study of food habits, 28 adolescent girls registered their food intake during 7 d. Iron intake was assessed on the basis of these 7-d dietary records. Iron absorption was calculated using an algorithm including enhancing and inhibiting dietary factors on iron absorption in relation to individual iron status. RESULTS: Available iron intake was 11.5 +/- 2.8 mg/d (mean +/- SD). The proportion of girls with an iron intake below the Nordic nutrition recommendations was 85% (n = 24). Calculated iron absorption was 1.09 +/- 0.59 mg/d (mean +/- SD). Only four girls satisfied their estimated individual iron requirement concerning the absorbed amount of iron. Iron depletion (serum ferritin concentration < or = 15 microg/L) was present in 10 girls (36%), 2 of whom were also anemic (hemoglobin concentration < or = 120 g/L). CONCLUSION: Swedish adolescent girls seemed to have difficulties satisfying their iron requirement in terms of absorbed amount. The data support the view that iron intake and bioavailability of dietary iron is important when evaluating whether iron requirements have been met.     

中国居民微量营养素的摄入

目的：依据１９９２ 年第三次全国营养调查的结果,分析全国各年龄居民１００ ２０１ 人的微量营养素摄入情况。方法：以中国的食物成分表为计算依据,用１９８８年修订的“推荐每日膳食中营养素供给量（ Ｒ Ｄ Ａ）”作为评价指标,用 Ｓ Ａ Ｓ 统计软件进行分析。结果：钙是中国居民膳食中缺乏最明显的营养素,有５１ ．０ ％ ～６７ ．６ ％ 的城乡个体每日钙摄入量不足１／２ Ｒ Ｄ Ａ; 全国平均视黄醇当量的摄入量占 Ｒ Ｄ Ａ 的６１７ ％ ;核黄素的摄入量占 Ｒ Ｄ Ａ 的５８ ．４ ％ ;铁的摄入量并不低,然而缺铁性贫血是我国居民中普遍存在的营养缺乏病;居民膳食中锌、硒、硫胺素摄入量在８０ ％ ～９０ ％ Ｒ Ｄ Ａ;烟酸、抗坏血酸、维生素 Ｅ 比较充足。结论：对于钙和铁的缺乏应调整膳食结构或适当使用强化食品加以改善。     

中国居民微量营养素的摄入

目的：依据１９９２年第三次全国营养调查的结果,分析全国各年龄居民１００２０１人的微量营养素摄入情况。方法：以中国的食物成分表为计算依据,用１９８８年修订的“推荐每日膳食中营养素供给量（ＲＤＡ）”作为评价指标,用ＳＡＳ统计软件进行分析。结果：钙是中国居民膳食中缺乏最明显的营养素,有５１．０％～６７．６％的城乡个体每日钙摄入量不足１／２ＲＤＡ;全国平均视黄醇当量的摄入量占ＲＤＡ的６１．７％;核黄素的摄入量占ＲＤＡ的５８．４％;铁的摄入量并不低,然而缺铁性贫血是我国居民中普遍存在的营养缺乏病;居民膳食中锌、硒、硫胺素摄入量在８０％～９０％ＲＤＡ;烟酸、抗坏血酸、维生素Ｅ比较充足。结论：对于钙和铁的缺乏应调整膳食结构或适当使用强化食品加以改善。     

Does the diet of the Balearic population, a Mediterranean type diet, still provide adequate antioxidant nutrient intakes?

AIMS: To evaluate the intake of antioxidant nutrients, as important components of the diet of the Balearic population, a typical Mediterranean type diet, as well as socio-demographic, lifestyle and dietary factors that could be associated to their consumption. METHODS: Cross sectional survey: dietary information (replicated 24-h recall) and socio-demographic and lifestyle data were collected from a representative sample of the Balearic Islands population (n = 1200, 498 males and 702 females) aged 16-65 years (response rate 77.22%). A Dietary Antioxidant Quality Score (DAQS) was computed considering the risk of inadequate intakes (< 2/3 RDI) for selenium, zinc, beta-carotene, vitamins C and E. This score (ranged from 0, very poor dietary antioxidant quality, to 5, high quality diet) was divided into quartiles. Those pertaining to the lower quartile were defined as low antioxidant consumers and compared to those in the upper quartile in terms of their socio-demographic, lifestyle and dietary characteristics. RESULTS: Inadequate intakes (< 2/3 RDI) were estimated in nearly half of the sample for zinc, beta-carotene and vitamin E. Of the study population, 12.4% were identified as low antioxidant consumers according to DAQS. Pertaining to lower socioeconomic and educational level and being born in a non-Mediterranean Spanish region were the most important determinants for being a low antioxidant consumer. A diet high in saturated fat but low in total fat, fruit, vegetables and fibre also determined a low intake of antioxidants. CONCLUSIONS: These findings suggest a possible departure from the traditional Balearic diet among certain groups of the Balearic Islands population, and this trend may be responsible for the observed low intake of antioxidant nutrients.     

447例喀什农村维吾尔族住校中学生膳食营养状况调查

目的:了解喀什地区农村住校中学生的膳食结构和存在的问题,为改善当地学生膳食营养提供依据。方法:采用24 h膳食回顾法对喀什地区两所中学的447例住校中学生的膳食情况进行调查,并根据《中国居民膳食指南及平衡膳食宝塔》和《中国居民膳食营养素参考摄入量(DRIs)》作出评价。结果:被调查学生膳食构成中谷类、畜禽肉和油脂摄入过多,而其他食物摄入较少;三餐能量和三大营养素分配也不合理,午餐能量偏低、晚餐能量偏高,碳水化合物摄入严重偏高、而脂肪摄入严重偏低;维生素A和钙摄入严重不足,维生素C、钾、铁、锌、硒摄入量也较低,而维生素B2、烟酰胺、铜的摄入则偏高,钠的摄入严重过量。结论:学生膳食构成不合理、营养素摄入不均衡,应采取相应措施改善这一现状,倡导学生平衡膳食。     

Interaction of iron, zinc and copper in the body of animals and humans

In the light of the pertinent literature the sites and mechanisms of interactions of iron, zinc and copper in the human and animal organism are discussed. Both low and high intake of any of them may influence the utilization and metabolism of both remaining ones. E.G. dietary copper deficiency impairs the mobilization of iron reserves from the liver, and its excess inhibits the intestinal absorption of iron and zinc. Iron in excess may antagonize copper and zinc in the intestinal mucosa. Zinc excess has an unfavourable influence on iron balance by reducing the bioavailability of copper, and zinc deficiency reduces the rate of protein synthesis impairing, among others, the transport of these elements with blood. The occurrence of interaction depends on the mutual proportions of components and their sum in the diet. Attention is called to these interrelationships which are of practical importance in human nutrition.     

Phytate intake and molar ratios of phytate to zinc, iron and calcium in the diets of people in China

OBJECTIVE: To assess the phytate intake and molar ratios of phytate to calcium, iron and zinc in the diets of people in China. DESIGN: 2002 China Nationwide Nutrition and Health Survey is a cross-sectional nationwide representative survey on nutrition and health. The information on dietary intakes was collected using consecutive 3 days 24 h recall by trained interviewers. SUBJECTS: The data of 68 962 residents aged 2-101 years old from 132 counties were analyzed. RESULTS: The median daily dietary intake of phytate, calcium, iron and zinc were 1186, 338.1, 21.2 and 10.6 mg, respectively. Urban residents consumed less phytate (781 vs 1342 mg/day), more calcium (374.5 vs 324.1 mg/day) and comparable amounts of iron (21.1 vs 21.2 mg/day) and zinc (10.6 vs 10.6 mg/day) than their rural counterparts. A wide variation in phytate intake among residents from six areas was found, ranging from 648 to 1433 mg/day. The median molar ratios of phytate to calcium, iron, zinc and phytate x calcium/zinc were 0.22, 4.88, 11.1 and 89.0, respectively, with a large variation between urban and rural areas. The phytate:zinc molar ratios ranged from 6.2 to 14.2, whereas the phytate x calcium/zinc molar ratios were from 63.7 to 107.2. The proportion of subjects with ratios above the critical values of phytate to iron, phytate to calcium, phytate to zinc and phytate x calcium/zinc were 95.4, 43.7, 23.1 and 8.7%, respectively. All the phytate/mineral ratios of rural residents were higher than that of their urban counterparts. CONCLUSIONS: The dietary phytate intake of people in China was higher than those in Western developed countries and lower than those in developing countries. Phytate may impair the bioavailability of iron, calcium and zinc in the diets of people in China.     

Meat consumption in a varied diet marginally influences nonheme iron absorption in normal individuals

It is widely recognized that the intake of animal foods is the most important dietary determinant of the iron status of a population. The primary reason is the high bioavailability of heme iron, but it is also known from radiolabeled single-meal feeding studies in humans that muscle tissue facilitates absorption of nonheme iron. In the present study, we examined the effect of meat intake on nonheme iron absorption from a whole diet. Iron absorption was measured during 3 separate dietary periods in 14 volunteers (7 men and 7 women) by having them ingest a radioiron-labeled wheat roll with every meal for 5 d. The diet was freely chosen for the first dietary period and altered to eliminate or maximally increase the intake of muscle foods during the second and third periods. Nonheme iron absorption did not differ for the 3 dietary periods although the geometric mean of 4.81% when subjects consumed a freely chosen diet increased by 35% to 6.47% with maximum meat consumption (P = 0.075). When nonheme absorption was adjusted to normalize for differences in iron status using serum ferritin correction and the 3 absorption periods were pooled, multiple regression analysis indicated no significant relation with heme or nonheme iron, vitamin C, calcium, phosphorus, fiber, or tea content of the diet with the exception of animal tissue (P = 0.013). We conclude that the higher iron status associated with the consumption of an omnivorous diet is due more to the intake of heme iron than to the enhancing effect on nonheme iron absorption.     

Iron deficiency due to consumption of a habitual diet low in bioavailable iron: a longitudinal cohort study in Moroccan children

BACKGROUND: In many developing countries, cereal and legume-based diets contain low amounts of bioavailable iron, which may increase the risk of iron deficiency. OBJECTIVE: The objective was to measure change in iron status in Moroccan children who consumed their habitual diet containing low amounts of bioavailable iron. DESIGN: The design was a prospective, longitudinal, free-living cohort study in iron-replete, nonanemic 6-10-y-old children (n = 126). Hemoglobin, serum ferritin, and transferrin receptor were measured at baseline. The children then consumed their habitual cereal and legume-based diet for 15 mo, when their iron status was retested. We used weighed food records and direct food analysis to calculate dietary iron intake and iron bioavailability. On the basis of the change in hemoglobin and body iron stores calculated from the serum transferrin receptor-to-ferritin ratio, iron balance and iron absorption were estimated over the 15-mo period. RESULTS: Mean daily iron intake was 10.8 mg/d, 97% of which was nonheme iron. Estimated nonheme-iron bioavailability from algorithms was 1.0-4.3% adjusted for low body iron stores. Over 15 mo, the mean change in total body iron was -142 mg, and mean iron absorption was estimated to be 0.22 mg/d, or 2% of dietary iron. Mean hemoglobin concentration decreased 12 g/L. At 15 mo, 75% of the cohort had deficits in tissue iron, and one-third had mild iron deficiency anemia. CONCLUSION: Low iron bioavailability from legume and cereal-based diets is a cause of iron deficiency anemia in children in rural Africa.     

中国南北方居民一年中营养素摄入量的变化趋势研究

目的　了解我国南北方居民一年内营养素摄入量的变化 ,判定营养素摄入是否具有季节性差异。方法　采用 2 4小时膳食回顾调查法对中国典型的北方农村和南方城乡三地合计约 30 0名健康成年居民进行膳食调查 ,一年内共调查 6次 ,两月一次 ,每次连续调查 3天。根据食物摄入量的调查结果 ,计算出每人每天能量和各种营养素的摄入量。结果　三地居民平均每天的能量、蛋白质以及脂肪的摄入量是充足的。我国典型南北方居民能量以及三大营养素 (蛋白质、脂肪和碳水化合物 )摄入量的季节性差异较小 ;硫胺素、核黄素、维生素E、烟酸以及锌的季节性变化也不大 ;视黄醇当量、抗坏血酸、钾和钙的摄入量则存在明显季节性差异。结论　通过对我国南北方三地一年多次的膳食调查结果分析 ,农村地区若避开 1月份的农闲季节和 7月份的农忙季节 ,其它月份进行的营养调查结果可以代表调查对象平常的膳食摄入情况 ;城市地区在一年的任何月份进行营养调查 ,对结果的影响都不大     

Adequacy of a vegetarian diet at old age (Dutch Nutrition Surveillance System)

To assess the adequacy of a vegetarian diet at old age, the dietary intake (assessed through dietary history with cross-check) of 44 apparently healthy lacto-(ovo-)vegetarians, aged 65-97 years, was evaluated. Adequacy was assessed by a comparison of nutrient intake with (Dutch) recommendations and by evaluating data on nutritional status. The results were also compared with data of elderly omnivores. In contrast to elderly omnivores, percentages of energy from protein (13%), fat (37%), and carbohydrates (50%) as well as P/S ratio (0.63) were close to or within the range of Dutch guidelines regarding a healthy diet (percentages of energy from protein, fat, and carbohydrates 10-15, 30-35, and 55%, respectively: P/S ratio 0.5-1.0). For most of the micronutrients studied intake was adequate, and nutrient density of the vegetarian diet was higher than of the omnivorous diet. However, the supply of zinc (average daily intake 8.5 and 7.6 mg for men and women, respectively), iron (because of lower bioavailability of nonheme iron), vitamin B12 (women only: intake 2.3 micrograms/day), and water (daily intake less than 1600 ml for 30% of the vegetarians) need special attention, considering the relatively high prevalence of a marginal status of these nutrients. In conclusion, a lacto-(ovo-)vegetarian diet can be adequate at old age, provided that it is carefully planned, especially with respect to the supply of iron, zinc, and vitamin B12.     

Aluminum in renal disease.

To assess the adequacy of a vegetarian diet at old age, the dietary intake (assessed through dietary history with cross-check) of 44 apparently healthy lacto-(ovo-)vegetarians, aged 65-97 years, was evaluated. Adequacy was assessed by a comparison of nutrient intake with (Dutch) recommendations and by evaluating data on nutritional status. The results were also compared with data of elderly omnivores. In contrast to elderly omnivores, percentages of energy from protein (13%), fat (37%), and carbohydrates (50%) as well as P/S ratio (0.63) were close to or within the range of Dutch guidelines regarding a healthy diet (percentages of energy from protein, fat, and carbohydrates 10-15, 30-35, and 55%, respectively: P/S ratio 0.5-1.0). For most of the micronutrients studied intake was adequate, and nutrient density of the vegetarian diet was higher than of the omnivorous diet. However, the supply of zinc (average daily intake 8.5 and 7.6 mg for men and women, respectively), iron (because of lower bioavailability of nonheme iron), vitamin B12 (women only: intake 2.3 micrograms/day), and water (daily intake less than 1600 ml for 30% of the vegetarians) need special attention, considering the relatively high prevalence of a marginal status of these nutrients. In conclusion, a lacto-(ovo-)vegetarian diet can be adequate at old age, provided that it is carefully planned, especially with respect to the supply of iron, zinc, and vitamin B12.     

Deficient dietary iron intakes among women and children in Russia: evidence from the Russian Longitudinal Monitoring Survey.

OBJECTIVES: This study evaluated the iron sufficiency of the Russian diet. METHODS: Data were obtained from 24-hour dietary recalls conducted in 4 rounds (1992 through 1994) of a nationally representative longitudinal survey of 10,548 women and children. Iron bioavailability was estimated via algorithms adjusting for enhancers (heme, vitamin C) and inhibitors (tannins in tea, phytates in grains) consumed at the same meal. RESULTS: Dietary iron intakes were deficient in the most vulnerable groups: young children and women of reproductive age. Poverty status was strongly associated with deficiency. After adjustment for enhancers and inhibitors, estimated bioavailable iron intakes at 3% to 4% of total iron were inadequate in all women and children. CONCLUSIONS: These dietary data suggest that Russian women and children are at high risk of iron deficiency. Grain products rich in phytates, which inhibit absorption, were the major food source of iron in Russia. High intakes of tea and low consumption of vitamin C also inhibited iron bioavailability. Since changes in eating behavior could potentially double iron bioavailability, educational programs should be explored as a strategy for improving iron nutriture.