@article {714626,
	title = {Estimated effect of age of marriage on utilization of India{\textquoteright}s Integrated Child Development Service programme},
	journal = {Journal of Epidemiology and Community Health},
	year = {2023},
	pages = {1-7},
	abstract = {
	Background: Age of marriage among women is considered an important indicator of their readiness for familial integration and parenting. This study estimated the effect of age of marriage of young mothers (aged 15{\textendash}24 years) on utilisation of various services for their children, provided under the Integrated Child Development Service (ICDS) programme in India.



	\&nbsp;



	Methods: Data from the nationally representative 2019{\textendash}2021 National Family Health Survey of India were analysed. Mothers{\textquoteright} age of menarche was used as an instrumental variable to isolate the effect of age of marriage on whether their children received (1) food, (2) health check-up, (3) immunisation, (4) early childhood care or preschooling or (5) weight measurement services from ICDS.



	\&nbsp;



	Results: Nationally, 67.9\% (95\% CI 67.6\%, 68.3\%) of children received food (sample: 60 578), 61.8\% (95\% CI 61.4\%, 62.1\%) received a health check-up (sample: 60 316), 60.0\% (95\% CI 59.6\%, 60.4\%) received immunisation services (sample: 60 537), 52.0\% (95\% CI 51.6\%, 52.4\%) received early childhood care or preschooling (sample: 60 458) and 62.9\% (95\% CI 62.5\%, 63.3\%) received weight measurement services (sample: 60 278). Findings from instrumental variable analysis suggest that a 1-year increase in age of marriage could yield a 9 percentage point increase (95\% CI 4\%{\textendash}13\%; p\&lt;0.001) in utilisation of immunisation services. Although postponement of marriage positively affected utilisation of each of the other four ICDS components, these effects were not statistically significant.



	\&nbsp;



	Conclusion: Postponing age of marriage among young women is an effective intervention for promoting uptake of child immunisation services. Our findings support the Government of India{\textquoteright}s 2021 Bill to raise legal age of marriage of women.

},
	url = {https://jech.bmj.com/content/early/2023/12/11/jech-2023-221325},
	author = {Rai, Rajesh Kumar and Sabri Bromage}
}
@article {712931,
	title = {Women{\textquoteright}s input and decision-making in agriculture are associated with diet quality in rural Tanzania},
	journal = {Frontiers in Public Health Nutrition},
	volume = {11},
	year = {2023},
	abstract = {
	Background: Women{\textquoteright}s empowerment is one critical pathway through which agriculture can impact women{\textquoteright}s nutrition; however, empirical evidence is still\&nbsp;limited. We evaluated the association of women{\textquoteright}s participation, input, and\&nbsp;decision-making in key agricultural and household activities with women{\textquoteright}s diet quality.



	Methods: We analyzed data from a cross-sectional study of 870 women engaged in homestead agriculture. We used food frequency questionnaires to\&nbsp;assess women{\textquoteright}s diets and computed women{\textquoteright}s diet quality using the Prime Diet Quality Score (PDQS) (range 0{\textendash}42), which captures healthy and unhealthy\&nbsp;foods. We evaluated women{\textquoteright}s decision-making in 8 activities, food crop farming,\&nbsp;cash crop farming, livestock raising, non-farm economic activities, wage/salary\&nbsp;employment, fishing, major household expenditures, and minor household\&nbsp;expenditures. Generalized estimating equations (GEE) linear models were used to evaluate associations between (a) women{\textquoteright}s participation, (b) decision-making,\&nbsp;(c) adequate input, (d) adequate extent of independence in decision-making in agriculture, and (e) adequate input in use of agricultural income with their PDQS.\&nbsp;Adequate input was defined as input into some, most or all decisions compared to input into few decisions or none. Adequate extent of independence was defined as input to a medium or high extent compared to input to a small extent or none.



	Findings: Median PDQS was 19 (IQR: 17{\textendash}21). Women{\textquoteright}s adequate input\&nbsp;in decision-making on wage and salary employment (estimate: 4.19, 95\%\&nbsp;CI: 2.80, 5.57) and minor expenditures were associated with higher PDQS\&nbsp;vs. inadequate input. Women with independence in decision-making on\&nbsp;livestock production (estimate: 0.97, 95\% CI: 0.05, 1.90) and minor household expenditures, and women with adequate decision-making in the use of income from wages/salaries (estimate: 3.16, 95\% CI: 2.44, 3.87) had higher PDQS.\&nbsp;Participation in agricultural activities was positively associated with PDQS.



	\&nbsp;



	Conclusions: Women{\textquoteright}s participation and input in decision-making in wage and\&nbsp;salary employment, livestock production, and minor household expenditures\&nbsp;were strongly associated with the consumption of better-quality diets. Women\&nbsp;participating in multiple farm activities were also likely to have better diet quality.\&nbsp;This study adds to the growing evidence on the pathways through which women{\textquoteright}s\&nbsp;empowerment may influence women{\textquoteright}s nutrition in rural Tanzania.

},
	url = {https://www.frontiersin.org/articles/10.3389/fpubh.2023.1215462/full},
	author = {Isabel Madzorera and Bliznashka, Lilia and Mia M. Blakstad and Alexandra L. Bellows and Chelsey R. Canavan and Dominic Mosha and Sabri Bromage and Ramadhani A. Noor and Patrick Webb and Shibani Ghosh and Joyce Kinabo and Honorati Masanja and Wafaie W. Fawzi}
}
@article {709381,
	title = {Performance of the Global Diet Quality Score (GDQS) app in predicting nutrient adequacy and metabolic risk factors among Thai adults},
	journal = {Journal of Nutrition},
	year = {2023},
	abstract = {
	Background



	The Global Diet Quality Score (GDQS) was developed for monitoring nutrient adequacy and diet-related non-communicable disease risk in diverse populations. A software application (GDQS app) was developed for standardized collection of GDQS data. The app involves a simplified 24-hour dietary recall (24HR) where foods are matched to GDQS food groups using an onboard database, portion sizes are estimated at the food group level using cubic models, and the GDQS is computed.



	Objective



	To estimate associations between GDQS scores, collected using the GDQS app, and nutrient adequacy and metabolic risks.



	Design



	In this cross-sectional study of 600 Thai men and non-pregnant/non-lactating women (40-60 years) we collected 2 days of GDQS app and paper-based 24HR, food-frequency questionnaires (FFQs), anthropometry, body composition, blood pressure, and biomarkers. Associations between app scores and outcomes were estimated using multiple regression, and app performance was compared with that of metrics scored using 24HR and FFQ data: GDQS, Minimum Dietary Diversity{\textendash}Women, Alternative Healthy Eating Index{\textendash}2010, Global Dietary Recommendations score.



	Results



	In covariate-adjusted models, app scores were significantly (p\&lt;0.05) associated with higher energy-adjusted mean micronutrient adequacy computed using 24HR (range in estimated mean adequacy between score quintiles 1 and 5: 36.3-44.5\%) and FFQ (Q1-Q5: 40.6-44.2\%), and probability of protein adequacy from 24HR (Q1-Q5: 63.-72.5\%). App scores were inversely associated with BMI (Q1-Q5: 26.3-24.9 kg/m2), body fat percentage (Q1-Q5: 31.7-29.1\%), diastolic blood pressure (Q1-Q5: 84-81 mmHg), and a locally-developed sodium intake score (Q1-Q5: 27.5-24.0 points out of 100); positively associated with HDL-C (Q1-Q5: 49-53 mg/dL) and 24-hour urinary potassium (Q1-Q5: 1385-1646 mg); and inversely associated with high mid-upper arm circumference (Q5/Q1 OR: 0.52) and abdominal obesity (Q5/Q1 OR: 0.51). Significant associations for the app outnumbered those for metrics computed using 24HR or FFQ.



	Conclusion



	The GDQS app is effective for assessing nutrient adequacy and metabolic risk in population surveys.

},
	url = {https://www.sciencedirect.com/science/article/pii/S0022316623726618?casa_token=LtB76QDRwoAAAAAA:73WV6xSPRj9RrvRMxH2-E_i6TKO1nXkY3DAClRxrRwi4xOvkfAbEUxdWPjyuxYmCQvGYmOEISx7H$\#$bib4},
	author = {Sabri Bromage and Tippawan Pongcharoen and Aree Prachansuwan and Pornpan Sukboon and Weerachat Srichan and Sasiumphai Purttiponthanee and Megan Deitchler and Moursi, Mourad and Joanne Arsenault and Nazia Binte Ali and Batis, Carolina and Fawzi, Wafaie W and Pattanee Winichagoon and Willett, Walter C and Wantanee Kriengsinyos}
}
@article {704206,
	title = {Food product quality, environmental and personal characteristics affecting consumer perception toward food},
	journal = {Frontiers in Sustainable Food Systems},
	volume = {7},
	year = {2023},
	pages = {1-12},
	abstract = {
	Food industries are developing new processing technologies, resulting in the emergence of new product categories, including ready-to-eat meals, functional foods and beverages, and plant-based foods, etc. Rapid globalization, changes in lifestyle, consumer awareness, and perception toward food drive further technical advancements. However, consumer perception remains the prime factor for food marketing and technological development. Consumer perception is a trifecta of sensory properties, personal and environmental factors. Sensory and personal factors include consumer age, attitude, health condition, nutrition awareness, and religion which directly influence consumer choice. Whereas environmental factors consist of regional variation in the food process, national economic status, and consumer purchasing power. All these factors affect consumers{\textquoteright} decisions to accept or reject foods. Additionally, consumers are more willing to taste innovative food products that assure the safety and quality of the product.

},
	url = {https://www.frontiersin.org/articles/10.3389/fsufs.2023.1222760/full},
	author = {Sampurna Rai and Phu Pwint Wai and Pankaj Koirala and Sabri Bromage and Nilesh Prakash Nirmal and Ravi Pandiselvam and Mahmud Ab Rashid Nor Khaizura and Naresh Kumar Mehta}
}
@article {704201,
	title = {Vitamin D and zinc supplementation to improve treatment outcomes among COVID-19 patients in India results from a double-blind randomized placebo-controlled trial},
	journal = {Current Developments in Nutrition},
	volume = {7},
	number = {8},
	year = {2023},
	pages = {101971},
	abstract = {
	Background



	There remains a need to identify low-cost interventions to improve COVID-19 outcomes. Vitamin D and zinc play a role in respiratory infections, and could hold value as part of therapeutic regimens.



	Objective



	To determine the effect of vitamin D or zinc supplementation on recovery from COVID-19.



	Methods



	We conducted a double-blind randomized 2x2 factorial placebo-controlled trial with 1:1:1:1 allocation ratio, enrolling non-pregnant adults with COVID-19 from hospitals in Mumbai and Pune, India (NCT04641195). Participants (N=181) were randomized to vitamin D3 (180,000IU bolus, then 2000IU daily), zinc (40mg daily), vitamin D3 and zinc, or placebo, for 8 weeks. Participants were followed until 8 weeks. The primary outcome was time to resolution of fever, cough, and shortness of breath. Secondary outcomes were duration of individual symptoms; need for assisted ventilation; duration of hospital stay; all-cause mortality; and blood biomarkers including nutritional, inflammatory and immunological markers.



	Results



	We observed no effect of vitamin D or zinc supplementation on time to resolution of all three symptoms (vitamin D hazard ratio [HR]: 0.92, 95\% confidence interval [95\% CI]: 0.66-1.30,\&nbsp;P=0.650; zinc HR: 0.94, 95\% CI: 0.67-1.33,\&nbsp;P=0.745). Neither vitamin D nor zinc supplementation was associated with secondary outcomes, except for increased endline serum vitamin D with vitamin D supplementation (median [interquartile range] difference between endline and baseline for vitamin D: 5.3ng/mL [-2.3-13.7]; for no vitamin D: -1.4ng/mL [-5.6-3.9];\&nbsp;P=0.003). We observed non-significant increases in serum zinc at endline following zinc supplementation. There was no evidence of interaction between vitamin D and zinc supplementation; no effect of either on hypercalcemia; and no adverse events.



	Conclusions



	Results suggest that neither vitamin D nor zinc supplementation improve COVID-19 treatment outcomes in this population. However, much larger-scale evidence, particularly from populations with vitamin D or zinc deficiency and severe infection, is required to corroborate our findings.

},
	url = {https://www.sciencedirect.com/science/article/pii/S2475299123247940},
	author = {Uttara Partap and Kamal Kant Sharma and Yogesh Marathe and Molin Wang and Sanaa Shaikh and Pradeep D{\textquoteright}Costa and Gaurav Gupta and Sabri Bromage and Elena C. Hemler and Nerges Mistry and Kevin C. Kain and Yatin Dholakia and Wafaie W. Fawzi}
}
@report {699986,
	title = {Climate Change, Nutrition and Mongolia: A Risk Profile},
	year = {2023},
	institution = {UNICEF Mongolia, FAO Mongolia, IFPRI, Government of Mongolia},
	abstract = {
	Mongolia is severely affected by adverse climate change impacts, including substantially higher temperatures that have contributed to increased evapotranspiration and the drying up of the country{\textquoteright}s water resources. Moreover, the number and intensity of extreme events--especially droughts--is growing, with largest impacts on the poorer population employed in agriculture. At the same time, nutrition security remains out of reach with the co-existence of multiple forms of malnutrition, including obesity. The Mongolian pastoral culture is important to consider in balancing nutritional requirements, health risks, economics, sustainability of food production, including greenhouse gas emissions. While linkages between climate change and food security are increasingly understood, in particular the direct impacts of climate change on crop yields, associated higher food prices, and increased costs of healthy diets resulting in higher levels of malnutrition, other linkages between climate change and nutrition have been barely studied. Mongolia thus suffers from the syndemic of climate change, obesity and undernutrition, which are three co-occurring and interlinked epidemics.



	A better and more comprehensive understanding of the linkages between climate change and nutrition is key to developing effective interventions to ensure that Mongolia{\textquoteright}s population has access to sufficient, safe and nutritious food despite adverse climate outcomes. Importantly, climate change does not only affect food production but can exacerbate malnutrition by removing food and nutrients in all stages of the food value chain. Finally, given the important contribution of food systems to climate change, nutrition policy in Mongolia should more\&nbsp;proactively consider environmental impacts.

},
	url = {https://www.unicef.org/mongolia/media/4921/file/English.pdf},
	author = {Claudia Ringler and Kristen Bellisario and Fanzo, Jessica and Sabri Bromage and Jorick Bater and .A Bakey and D. Kadirbyek and B, Chimed-Ochir and D. Ganbat and Soninkhishig Tsolmon and Tim Thomas}
}
@article {699981,
	title = {Dietary intake and quality for young adolescents in sub-Saharan Africa: Status and influencing factors},
	journal = {Maternal and Child Nutrition},
	volume = {e13463},
	year = {2023},
	pages = {1-15},
	abstract = {
	
		
			Adolescents face the risk of the triple burden of malnutrition{\textemdash}the co-existence of micronutrient deficiencies, underweight and overweight and obesity\&nbsp;and related noncommunicable diseases. Poor-quality diets are a modifiable risk factor for all forms of malnutrition in adolescents. However, there is limited knowledge about diet quality for African adolescents. We analyzed data from 4609 school-going adolescents aged 10{\textendash}15 years in Burkina Faso, Ethiopia, Sudan\&nbsp;and Tanzania. Dietary intake was assessed using food frequency questionnaires, and diet quality computed using the Global Diet Quality Score (GDQS). Generalized estimating equations linear regression models were used to evaluate factors associated with adolescent diet quality. Mean adolescent age was 12.4 ({\textpm}1.4) years and 54\% of adolescents were female. Adolescents reported physical activity on 1.5 ({\textpm}1.7) days/week. The mean GDQS ({\textpm}SD) was 20.6 ({\textpm}4.0) (maximum 40). Adolescent consumption of vegetables, fruit, nuts and seeds, eggs, fish and poultry was low, and refined grain consumption was relatively high. Boys consumed unhealthy foods less frequently but consumed fewer cruciferous vegetables and deep orange tubers. Older adolescents had higher fish and lower red meat consumption. Having an unemployed mother versus farmer (estimate -2.60, 95\%\&nbsp;confidence interval [CI]: -4.81, -0.39), and having 3{\textendash}4 days of physical activity per week versus none (estimate 0.64, 95\%\&nbsp;CI: 0.11, 1.17) were associated with GDQS. We found evidence of poor-quality adolescent diets and gender and age differences in the consumption of healthy diets. Programs to address poor-quality diets should consider tailoring interventions for adolescent girls and boys of different ages and also consider the role of physical activity in these contexts.
		
	

},
	url = {https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13463},
	author = {Isabel Madzorera and Sabri Bromage and Mwanyika-Sando, Mary and Alain Vandormael and Huda Sherfi and Amare Worku and Sachin Shinde and Ramadhani Abdallah Noor and Till Baernighausen and Deepika Sharma and Wafaie W. Fawzi}
}
@article {695524,
	title = {A video repository for innovative methods of dietary assessment and analysis},
	journal = {Journal of Visualized Experiments},
	year = {2023},
	abstract = {
	In the context of clinical and epidemiologic research, dietary intake is a particularly complex exposure to measure given the vast diversity of foods consumed globally, with variation in consumption patterns across eating occasions, days, seasons, and the life cycle. Assessing intake is challenged by measurement error arising from various sources, including imperfect recall of foods consumed in retrospective assessments, such as 24-hour diet recalls and food-frequency questionnaires, and reactivity associated with real-time recording in the case of food records. In analysis and interpretation, further complexity is introduced by the diversity of dietary components often of interest in a given study, related to the growing recognition of the need to account for the multidimensionality of intake to holistically characterize and translate the effects of dietary patterns on health and disease risk. These challenges, resulting gaps in the quantity and quality of dietary intake data available for populations globally, and resulting deficits in time-relevant and evidence-based strategies for improving dietary patterns continue to inspire innovative approaches that attempt to surmount challenges faced by conventional dietary assessment methods. As of October 2022, this methods collection includes seven video articles describing the development, evaluation, and/or application of innovative dietary assessment and analysis methods and tools that researchers may consider applying in their own work. Three of the articles describe the protocol for developing the method to assist interested researchers in creating similar methods tailored to specific settings or populations. The methods incorporate aspects of nutritional, behavioral, and computer science and mechanical, electrical, and software engineering, highlighting the importance of broad interdisciplinary and integrative perspectives to innovation in this field.

},
	url = {https://www.jove.com/v/64958/a-video-repository-for-innovative-methods-of-dietary-assessment-and-analysis},
	author = {Sabri Bromage and Teresa T. Fung and Sharon I. Kirkpatrick and Willett, Walter C.}
}
@article {699976,
	title = {Influence of Vitamin D Supplementation on Growth, Body Composition, and Pubertal Development Among School-aged Children in an Area With a High Prevalence of Vitamin D Deficiency},
	journal = {JAMA Pediatrics},
	volume = {177},
	number = {1},
	year = {2023},
	pages = {32-41},
	abstract = {
	Importance\&nbsp;\&nbsp;Vitamin D deficiency (defined as 25-hydroxyvitamin D [25(OH)D] \&lt;20 ng/mL) is prevalent among children living in temperate climates and has been reported to associate independently with stunting, obesity, and early activation of the hypothalamic-pituitary-gonadal axis. Phase 3 randomized clinical trials to investigate the influence of long-term vitamin D replacement on growth, body composition, and pubertal development of school-aged children with vitamin D deficiency are lacking.



	Objective\&nbsp;\&nbsp;To determine whether weekly oral vitamin D supplementation influences linear growth, body composition, or pubertal development in school-aged children living in a setting where vitamin D deficiency is highly prevalent.



	Design, Setting, and Participants\&nbsp;\&nbsp;This secondary analysis of a double-blind, placebo-controlled randomized clinical trial was conducted from June 2016 to June 2019 at 18 grade schools in Ulaanbaatar, Mongolia. School-aged children (6 to 13 years at baseline) attending participating schools were included. Exclusion criteria included a positive QuantiFERON-TB Gold in-tube assay result, conditions or medications associated with altered vitamin D metabolism, use of vitamin D supplements, signs of rickets, or intention to move from Ulaanbaatar within 4 years. Of 11 475 children invited to participate in the study, 9814 underwent QFT testing, and 8851 with negative results were included in the study. All but 1 participant in the placebo group completed follow-up and were included in the present analysis. Data were analyzed from November 2021 to February 2022.



	Interventions\&nbsp;\&nbsp;Weekly oral doses of vitamin D3, 14 000 IU, (n = 4418), or placebo (n = 4433) for 3 years.



	Main Outcomes and Measures\&nbsp;\&nbsp;Mean\&nbsp;z\&nbsp;scores for height for age, body mass index for age, and waist-to-height ratio; mean percentage body fat, fat mass, and fat-free mass; and mean Tanner scores for pubertal development.



	Results\&nbsp;\&nbsp;Of 8851 participants, 4366 (49.3\%) were female, and 8165 (92.2\%) were of Khalkh ethnicity; the mean (SD) age was 9.4 (1.6) years. A total of 8453 participants (95.5\%) were vitamin D deficient at baseline, and mean end-of-study 25(OH)D concentrations among participants randomized to vitamin D vs placebo were 31.0 vs 10.7 ng/mL (mean difference, 20.3; 95\% CI; 19.9-20.6). However, vitamin D supplementation did not influence mean height for age, body mass index for age, waist-to-height ratio, percentage body fat, fat mass, fat-free mass, or Tanner scores, either overall or within subgroups defined by baseline 25(OH)D concentration less than 10 ng/mL vs 10 ng/mL or greater, estimated calcium intake less than 500 mg/d vs 500 mg/d or greater, or male vs female sex.



	Conclusions and Relevance\&nbsp;\&nbsp;In school-aged children in this study with low baseline vitamin D status, oral vitamin D3\&nbsp;supplementation at a dose of 14 000 IU per week for 3 years was effective in elevating 25(OH)D concentrations but did not influence growth, body composition, or pubertal development.



	Trial Registration\&nbsp;\&nbsp;ClinicalTrials.gov Identifier:\&nbsp;NCT02276755

},
	url = {https://jamanetwork.com/journals/jamapediatrics/article-abstract/2798998},
	author = {Davaasambuu Ganmaa and Sabri Bromage and Polyna Khudyakov and Sumiya Erdenebaatar and Baigal Delgerekh and Adrian R. Martineau}
}
@article {695523,
	title = {Integrated Spreadsheets for Nutritional Analysis of Population Diet Surveys},
	journal = {Journal of Visualized Experiments},
	number = {188},
	year = {2022},
	pages = {e64327},
	abstract = {It can be challenging to calculate nutrient intakes in population diet surveys because existing nutritional analysis software is generally oriented toward analyzing intakes of individuals and may not allow users to input or easily modify the food composition data used in the analysis. These are drawbacks that are more problematic in low- and middle-income country settings. While there are numerous software-assisted dietary assessment platforms that conduct onboard nutritional analysis and are appropriate for use in large surveys, they are often similarly limited, and further restrict users\&nbsp;to specific assessment modalities. This paper presents a multifunctional system of\&nbsp;integrated spreadsheets for nutritional analysis of population diet surveys (ISNAPDS)\&nbsp;that provides a solution for situations in which data have been collected but cannot be adequately analyzed with existing software. The protocol involves supplying the system with fully customizable data on food composition, food group classifications, and food intake (food intake in g/day may be entered directly or calculated based on user-supplied intake frequencies and either standard or variable serving sizes). Following data entry, the user modifies a set of simple pre-populated formulas to\&nbsp;match them to the structure of the input data and the system applies these formulas to calculate nutrient and food group intakes, and the contributions of food groups\&nbsp;to nutrient intakes for all members of the survey population. The flexibility of the ISNAPDS system allows it to accommodate the global diversity of foods consumed\&nbsp;and analyze quantitative, semiquantitative, and nonquantitative food consumption\&nbsp;data collected using prospective and retrospective assessment methods employing\&nbsp;different reference periods and portion size estimation methods. To date, the system\&nbsp;has been applied in published and ongoing analyses of 24 h recall, diet record, food frequency, and disaggregated household consumption data from population surveys in China, Ethiopia, India, Mongolia, Thailand, and a multi-country analysis of 10 sub-Saharan African countries.},
	url = {https://www.jove.com/t/64327/integrated-spreadsheets-for-nutritional-analysis-of-population-diet-surveys},
	author = {Sabri Bromage}
}
@article {689769,
	title = {Case-control study of vitamin D status and adult multidrug-resistant pulmonary tuberculosis in Mumbai, India},
	journal = {International Journal of Tuberculosis and Lung Disease},
	volume = {26},
	number = {9},
	year = {2022},
	month = {1 Sep, 2022},
	pages = {826-834},
	abstract = {
	BACKGROUND:\&nbsp;India has the highest prevalence of multidrug-resistant TB (MDR-TB) globally. Vitamin D deficiency is potentially an important risk factor for MDR-TB.\&nbsp;METHODS:\&nbsp;We conducted a case-control study of 90 newly diagnosed adult MDR-TB cases, 180 household controls and 82 non-household controls in Mumbai, India. Serum 25-hydroxyvitamin D (25(OH)D), anthropometry, clinical status and history, dietary data and sociodemographic data were collected from each participant. Interferon-gamma release assay (IGRA) was also performed in controls to assess latent TB. Multivariable regression was performed to estimate associations between 25(OH)D vs. case status and IGRA positivity.\&nbsp;RESULTS:\&nbsp;Mean participant age was 33.8 {\textpm} 12.0 years; 72.8\% had 25(OH)D \&lt;20 ng/ml. Mean 25(OH)D was significantly (P\&nbsp;\&lt; 0.05) lower in cases (12.5 {\textpm} 7.9) than both household (17.5 {\textpm} 11.2) and non-household controls (16.4 {\textpm} 9.1). In multivariable models, 25(OH)D concentration was inversely associated with MDR-TB case status among cases and household controls (OR 0.95 per 1 ng/ml, 95\% CI 0.92-0.99;\&nbsp;P\&nbsp;= 0.015), and among cases and non-household controls (OR 0.94 per 1 ng/ml, 95\% CI 0.89-1.00;\&nbsp;P\&nbsp;= 0.033); 53.6\% of controls were IGRA-positive. 25(OH)D status was not associated with IGRA positivity.\&nbsp;CONCLUSION:\&nbsp;Vitamin D status was independently associated with MDR-TB case status. Research should evaluate the effectiveness of vitamin D supplementation in prevention and adjunctive treatment of MDR-TB.

},
	url = {https://www.ingentaconnect.com/contentone/iuatld/ijtld/2022/00000026/00000009/art00005},
	author = {Anupam Shukla and Sabri Bromage and Yatin Dholakia and Elena C. Hemler and Prachi Dev and Laxmi Govekar and Pranita Tipre and Daksha Shah and Salmaan A. Keshavjee and Molin Wang and Nerges Mistry and Wafaie W. Fawzi}
}
@article {692683,
	title = {A randomized trial to determine the effect of vitamin D and zinc supplementation for improving treatment outcomes among COVID-19 patients in India: trial protocol},
	journal = {BMJ Open},
	volume = {12},
	number = {8},
	year = {2022},
	pages = {e061301},
	abstract = {
	Introduction:\&nbsp;Presently, there are few population-level strategies to address SARS-CoV-2 infection except preventive measures such as vaccination. Micronutrient deficiency, particularly vitamin D and zinc deficiency, has been associated with dysregulated host responses, and may play an important role in COVID-19.



	Methods and analysis:\&nbsp;We have designed a 2{\texttimes}2 factorial, randomised, double-blind, multi-centre placebo-controlled trial to evaluate the effect of vitamin D and zinc on COVID-19 outcomes in Maharashtra, India. COVID-19 positive individuals are recruited from hospitals in Mumbai and Pune. Participants are provided (1) vitamin D3 bolus (180 000 IU) maintained by daily dose of 2000 IU and/or (2) zinc gluconate (40 mg daily), versus placebo for 8 weeks. Participants undergo a detailed assessment at baseline and at 8 weeks, and are monitored daily in hospital or every 3 days after leaving the hospital to assess symptoms and other clinical measures. A final follow-up telephone call occurs 12 weeks post-enrolment to assess long-term outcomes. The primary outcome of the study is to time to recovery, defined as time to resolution of all of fever, cough and shortness of breath. Secondary outcomes include: duration of hospital stay, all-cause mortality, necessity of assisted ventilation, change in blood biomarker levels and individual symptoms duration. Participant recruitment commenced on April 2021.



	Ethics and dissemination:\&nbsp;Ethical approval was obtained from institutional ethical committees of all participating institutions. The study findings will be presented in peer-reviewed medical journals.



	Trial registration numbers:\&nbsp;NCT04641195, CTRI/2021/04/032593, HMSC (GOI)-2021-0060.



	Keywords:\&nbsp;COVID-19; clinical trials; nutrition.

},
	url = {https://bmjopen.bmj.com/content/12/8/e061301},
	author = {Kamal Kant Sharma and Uttara Partap and Nerges Mistry and Yogesh Marathe and Molin Wang and Sanaa Shaikh and Pradeep D{\textquoteright}Costa and Gaurav Gupta and Sabri Bromage and Elena Hemler and Kevin Kain and Yatin Dholakia and Fawzi, Wafaie}
}
@article {690814,
	title = {Estimating national and subnational nutrient intake distributions of global diets},
	journal = {Am J Clin Nutr},
	year = {2022},
	month = {2022 Jun 10},
	abstract = {BACKGROUND: Access to high-quality dietary intake data is central to many nutrition, epidemiology, economic, environmental, and policy applications. When data on individual nutrient intakes are available, they have not been consistently disaggregated by sex and age groups, and their parameters and full distributions are often not publicly available. OBJECTIVES: We sought to derive usual intake distributions for as many nutrients and population subgroups as possible, use these distributions to estimate nutrient intake inadequacy, compare these distributions and evaluate the implications of their shapes on the estimation of inadequacy, and make these distributions publicly available. METHODS: We compiled dietary data sets from 31 geographically diverse countries, modeled usual intake distributions for 32 micronutrients and 21 macronutrients, and disaggregated these distributions by sex and age groups. We compared the variability and skewness of the distributions and evaluated their similarity across countries, sex, and age groups. We estimated intake inadequacy for 16 nutrients based on a harmonized set of nutrient requirements and bioavailability estimates. Last, we created an R package-nutriR-to make these distributions freely available for users to apply in their own analyses. RESULTS: Usual intake distributions were rarely symmetric and differed widely in variability and skewness across nutrients and countries. Vitamin intake distributions were more variable and skewed and exhibited less similarity among countries than other nutrients. Inadequate intakes were high and geographically concentrated, as well as generally higher for females than males. We found that the shape of usual intake distributions strongly affects estimates of the prevalence of inadequate intakes. CONCLUSIONS: The shape of nutrient intake distributions differs based on nutrient and subgroup and strongly influences estimates of nutrient intake inadequacy. This research represents an important contribution to the availability and application of dietary intake data for diverse subpopulations around the world.},
	issn = {1938-3207},
	doi = {10.1093/ajcn/nqac108},
	url = {https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqac108/6605334},
	author = {Simone Passarelli and Free, Christopher M and Allen, Lindsay H and Batis, Carolina and Beal, Ty and Biltoft-Jensen, Anja Pia and Sabri Bromage and Ling Cao and Castellanos-Guti{\'e}rrez, Anal{\'\i} and Christensen, Tue and Crispim, Sandra P and Dekkers, Arnold and De Ridder, Karin and Kronsteiner-Gicevic, Selma and Lee, Christopher and Li, Yanping and Moursi, Mourad and Moyersoen, Isabelle and Schmidhuber, Josef and Alon Shepon and Viana, Daniel F and Golden, Christopher D}
}
@article {689770,
	title = {Associations of percent energy intake from total, animal and plant protein with overweight and underweight among adults in Addis Ababa, Ethiopia},
	journal = {Public Health Nutrition},
	year = {2022},
	pages = {1-34},
	url = {https://www.cambridge.org/core/journals/public-health-nutrition/article/associations-of-percent-energy-intake-from-total-animal-and-plant-protein-with-overweightobesity-and-underweight-among-adults-in-addis-ababa-ethiopia/419BF010CDB7F526CDD77B952DB0D92F},
	author = {Elena C. Hemler and Sabri Bromage and Tadesse, Amare Worku and Rachel Zack and Berhane, Yemane and Chelsey R. Canavan and Wafaie W. Fawzi and Willett, Walter C.}
}
@inbook {682938,
	title = {Developing and Validating a Food-Based Global Diet Quality Score},
	booktitle = {Nutrient Profiling: Designing a Healthier Future for Global Benefit},
	year = {2021},
	pages = {58-61},
	publisher = {Sight and Life},
	organization = {Sight and Life},
	address = {Basel, Switzerland},
	abstract = {In contrast to nutrient pro!ling models that evaluate the overall\&nbsp;nutritional value of individual foods, food-based diet quality metrics\&nbsp;attempt to characterize the collective contribution of foods to health. The two approaches are complementary means of providing a quantitative basis upon which to develop programmatic\&nbsp;guidance for improving population diets. In this article, we describe a novel food-based metric of diet quality for global use, and key takeaways of our research to develop and evaluate this metric.},
	url = {https://sightandlife.org/wp-content/uploads/2021/10/Sight-and-Life-Special-Report_Nutrient-Profiling_2021_FULL-EDITION_compressed.pdf},
	author = {Sabri Bromage and Willett, Walter C. and Megan Deitchler}
}
@article {681444,
	title = {Aquatic foods to nourish nations},
	journal = {Nature},
	year = {2021},
	abstract = {Despite contributing to healthy diets for billions of people, aquatic foods are often undervalued as a nutritional solution because their diversity is often reduced to the protein and energy value of a single food type ({\textquoteleft}seafood{\textquoteright} or {\textquoteleft}fish{\textquoteright}). Here we create a cohesive model that unites terrestrial foods with nearly 3,000 taxa of aquatic foods to understand the future impact of aquatic foods on human nutrition. We project two plausible futures to 2030: a baseline scenario with moderate growth in aquatic animal-source food (AASF) production, and a high-production scenario with a 15-million-tonne increased supply of AASFs over the business-as-usual scenario in 2030, driven largely by investment and innovation in aquaculture production. By comparing changes in AASF consumption between the scenarios, we elucidate geographic and demographic vulnerabilities and estimate health impacts from diet-related causes. Globally, we find that a high-production scenario will decrease AASF prices by 26\% and increase their consumption, thereby reducing the consumption of red and processed meats that can lead to diet-related non-communicable diseases\&nbsp;while also preventing approximately 166 million cases of inadequate micronutrient intake. This finding provides a broad evidentiary basis for policy makers and development stakeholders to capitalize on the potential of aquatic foods to reduce food and nutrition insecurity and tackle malnutrition in all its forms.},
	url = {https://www.nature.com/articles/s41586-021-03917-1},
	author = {Golden, Christopher D. and J. Zachary Koehn and Alon Shepon and Simone Passarelli and Christopher M. Free and Daniel F. Viana and Holger Matthey and Jacob G. Eurich and Jessica A. Gephart and Etienne Fluet-Chouinard and Elizabeth A. Nyboer and Abigail J. Lynch and Marian Kjellevold and Sabri Bromage and Pierre Charlebois and Manuel Barange and Stefania Vannuccini and Ling Cao and Kristin M. Kleisner and Rimm, Eric B. and Danaei, Goodarz and Camille DeSisto and Heather Kelahan and Kathryn J. Fiorella and David C. Little and Edward H. Allison and Fanzo, Jessica and Shakuntala H. Thilsted}
}
@article {672372,
	title = {Food systems as drivers of optimal nutrition and health {\textendash} Complexities and opportunities for research and implementation},
	journal = {Current Developments in Nutrition},
	volume = {24},
	number = {5 (Suppl 3)},
	year = {2021},
	pages = {nzab062},
	abstract = {
	
		The Sustainable Development Goals (SDGs) are intricately linked to food systems. Addressing challenges in food systems is key to meeting the SDGs in Africa and South Asia, where undernutrition and micronutrient deficiencies persist, alongside increased nutrition transition, overweight and obesity, and related chronic diseases. Suboptimal diets are a key risk factor for mortality and 3 billion people cannot afford a healthy diet; in addition, food systems are not prioritizing environmental sustainability. Optimizing food systems and increasing agricultural productivity beyond calories, to nutrient-rich vegetables and fruits, legumes, and livestock, and sustainable fishing, are required. Strengthening of research around food systems{\textemdash}on pathways, value chains, and development and validation of metrics of diet quality{\textemdash}is required. The development of new technology in crop management and pest control and addressing natural resource degradation is key. Engaging with the public and private sectors, outreach to donors and policymakers, and strengthening cross-disciplinary collaborations are imperative to improving food systems.
	

},
	url = {https://academic.oup.com/cdn/article/5/Supplement_3/nzab062/6283739},
	author = {Isabel Madzorera and Lindsay Jaacks and Robert Paarlberg and Anna Herforth and Sabri Bromage and Shibani Ghosh and Myers, Samuel and William Masters and Wafaie W. Fawzi}
}
@article {671769,
	title = {Receipt of Weekly Iron Supplementation among Indian Children, 2005-2016},
	journal = {Current Developments in Nutrition},
	year = {2021},
	month = {March 3},
	pages = {nzab020},
	abstract = {
	Background: In response to India{\textquoteright}s unacceptably high burden of anemia among children aged 6{\textendash}59 mo, the central government introduced the National Iron Plus Initiative program which recommends an intervention of iron supplementation to mitigate anemia, especially iron deficiency anemia. Objective: The objective of this study was to examine the trend (between 2005{\textendash}2006 and 2015{\textendash}2016) in receiving weekly iron supplementation (WIS) among children aged 6{\textendash}59 mo, and factors associated with receiving WIS during 2015{\textendash}2016.



	Methods: Two waves of the nationally representative cross-sectional National Family Health Survey (NFHS) data collected during 2005{\textendash}2006 (NFHS-3) and 2015{\textendash}2016 (NFHS-4) were used. The trend was measured using both rounds of datasets, whereas factors associated with WIS receipt were assessed from NFHS-4. The trend was assessed using a sample of 35,650 children from NFHS-3 and 202,227 children from NFHS-4. After exclusion of 8978 cases, a total of 199,110 children were included to analyze the factors associated with receiving WIS. Using appropriate sample weighting, unadjusted and adjusted (multivariate) logistic regression analyses were deployed. Application of the chi-squared test and checking for multicollinearity were also part of the analysis. The possibility of sample selection bias was tested.



	Results: An increase of WIS receipt (from 4.6\% in 2005{\textendash}2006 to 26\% in 2015{\textendash}2016) was observed. Older children, children living in rural areas, children belonging to Scheduled Tribes, children of mothers with secondary education or higher, and children whose mothers had some mass media exposure had higher odds of receiving WIS. Children of fifth or higher birth order, children who were followers of Islam and Christianity, children from the richest economic group, noninstitutional birth of children, and children from high-focus group states were negatively associated with WIS receipt.



	Conclusions: Despite improvement (between 2005{\textendash}2006 and 2015{\textendash}2016) in receiving WIS, coverage remains unacceptably low (in absolute terms). The suboptimum performance of WIS intervention demands further investigation.



	
		\&nbsp;
	

},
	url = {https://academic.oup.com/cdn/advance-article/doi/10.1093/cdn/nzab020/6157759},
	author = {Rai, Rajesh Kumar and Sabri Bromage and Wafaie W. Fawzi}
}
@article {671514,
	title = {Diet quality and all-cause mortality among U.S. adults, estimated from NHANES, 2003-2008},
	journal = {Public Health Nutrition},
	year = {2021},
	pages = {1-25},
	abstract = {
	Objective:\&nbsp;We assessed the ability of the Prime Diet Quality Score (PDQS) to predict mortality in a United States (U.S.) population and compared its predictiveness with that of the Healthy Eating Index-2015 (HEI-2015).



	Design:\&nbsp;PDQS and HEI-2015 scores were derived using two 24-hour recalls and converted to quintiles. Mortality data were obtained from the 2015 Public-Use Linked Mortality File. Associations between diet quality and all-cause mortality were evaluated using multivariable Cox proportional hazards models, and predictive performance of the two metrics were compared using a Wald test of equality of coefficients with both scores in a single model. Finally, we evaluated associations between individual metric components and mortality.



	Setting:\&nbsp;A prospective analysis of the U.S. National Health and Nutrition Examination Survey (NHANES) data.



	Participants:\&nbsp;5,525 participants from three survey cycles (2003-2008) in the NHANES aged 40 years and over.



	Results:\&nbsp;Over the 51,248 person-years of follow-up (mean: 9.2 years), 767 deaths were recorded. In multivariable models, hazard ratios between the highest and lowest quintiles of diet quality scores were 0.70 (95\%CI: 0.51, 0.96, p-trend=0.03) for the PDQS, and 0.77 (95\%CI: 0.57, 1.03, p-trend=0.20) for the HEI-2015. The PDQS and HEI-2015 were similarly good predictors of total mortality (p-difference=0.88).



	Conclusion:\&nbsp;Among U.S. adults, better diet quality measured by the PDQS was associated with reduced risk of all-cause mortality. Given that the PDQS is simpler to calculate than the HEI-2015, it should be evaluated further for use as a diet quality metric globally.



	Keywords:\&nbsp;Healthy Eating Index-2015; NHANES; Prime Diet Quality Score; all-cause mortality; diet quality metrics.

},
	url = {https://www.cambridge.org/core/journals/public-health-nutrition/article/diet-quality-and-allcause-mortality-among-us-adults-estimated-from-nhanes-20032008/CA804AF363A4ABFF56522F2FF7F1FC3D},
	author = {Gicevic, Selma and Emin Tahirovic and Sabri Bromage and Walter Willett}
}
@article {668030,
	title = {Development and evaluation of a novel diet quality screener for global use: evaluation in a sample of U.S. women},
	journal = {Journal of the Academy of Nutrition and Dietetics},
	year = {2021},
	abstract = {
	Background



	Valid and efficient tools for measuring and tracking diet quality globally are lacking.



	Objective



	The objective of the study was to develop and evaluate a new tool for rapid and cost-efficient diet quality assessment.



	Design



	Two screener versions were designed using Prime Diet Quality Score (PDQS), one in a 24-hour recall (PDQS-24HR) and another in a 30-day (PDQS-30D) food frequency format. Participants completed two 24-hour diet recalls using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) and 2 web-based diet quality questionnaires 7 to 30 days apart in April and May 2019. Both dichotomous/trichotomous and granular scoring versions were tried for each screener.



	Participants/setting



	The study included 290 nonpregnant, nonlactating US women (mean age {\textpm} standard deviation 41 {\textpm} 11 years) recruited via Amazon Mechanical Turk.



	Main outcome measures



	The main outcome measures were Spearman rank correlation coefficients and linear regression beta-coefficients between ASA24 nutrient intakes from foods and beverages and PDQS values.



	Statistical analyses performed



	The Spearman rank correlation and linear regression were used to evaluate associations of the PDQS values with ASA24 nutrient intakes from food, both crude and energy-adjusted. Correlations were de-attenuated for within-person variation in 24-hour recalls. Wolfe{\textquoteright}s test was used to compare correlations of the 2 screening instruments (PDQS-24HR and PDQS-30D) with the ASA24. Associations between the ASA24 Healthy Eating Index 2015 and the PDQS values were also evaluated.



	Results



	Positive, statistically significant rank correlations between the PDQS-24HR values and energy-adjusted nutrients from ASA24 for fiber (r\&nbsp;= 0.53), magnesium (r\&nbsp;= 0.51), potassium (r\&nbsp;= 0.48), vitamin E (r\&nbsp;= 0.40), folate (r\&nbsp;= 0.37), vitamin C (r\&nbsp;= 0.36), vitamin A (r\&nbsp;= 0.33), vitamin B6 (r\&nbsp;= 0.31), zinc (r\&nbsp;= 0.25), and iron (r\&nbsp;= 0.21); and inverse correlations for saturated fatty acids (r\&nbsp;= {\textendash}0.19), carbohydrates (r\&nbsp;= {\textendash}0.22), and added sugar (r\&nbsp;= {\textendash}0.34) were observed. Correlations of nutrient intakes assessed by ASA24 with the PDQS-30D were not significantly different from those with the PDQS-24HR. Positive, statistically significant correlations between the ASA24 Healthy Eating Index 2015 and the PDQS-24HR (r\&nbsp;= 0.61) and the PDQS-30D (r\&nbsp;= 0.60) were also found.



	Conclusions



	The results of an initial evaluation of the PDQS-based diet quality screeners are promising. Correlations and associations between the PDQS values and nutrient intakes were of acceptable strength and in the expected directions, and the PDQS values had moderately strong correlations with the total Healthy Eating Index 2015 score. Future work should include evaluating the screeners in other population groups, including men, and piloting it across low- and middle-income countries.

},
	url = {https://www.sciencedirect.com/science/article/pii/S221226722031577X},
	author = {Gicevic, Selma and Yuchan Mou and Sabri Bromage and Fung, Teresa T and Willett, Walter C}
}
@article {667550,
	title = {Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: A systematic review and meta-analysis},
	journal = {BMJ Global Health},
	volume = {6},
	year = {2021},
	month = {2020},
	pages = {e003176},
	abstract = {
	Acute respiratory tract infections (ARIs) are a leading cause of ill-health and death globally. Individual or multiple micronutrients have been shown to modulate immune function and affect the risk and severity of a number of infectious diseases. We systematically reviewed the evidence on the impact of micronutrient supplements to reduce the occurrence of ARIs and shorten the duration of ARI symptoms among adults. Random effects meta-analyses were conducted to estimate the pooled effects of vitamin D, vitamin C, zinc and multiple micronutrient supplementation (MMS) on the occurrence of ARIs and the duration of ARI symptoms. Vitamin D supplementation reduced the risk of ARI (risk ratio (RR)=0.97; 95\% CI 0.94 to 1.00; p=0.028) and shortened the duration of symptoms (per cent difference: -6\% (95\% CI -9\% to -2\%; p=0.003)). The RR of vitamin D to prevent ARI was farther from the null when diagnosis was based on clinical diagnosis or laboratory testing, compared with self-report and when the loading dose was \&lt;60 000 IU. Vitamin C supplementation reduced the risk of ARIs (RR=0.96; 95\% CI 0.93 to 0.99; p=0.01) and shortened the duration of symptoms (per cent difference: -9\% (95\% CI -16\% to -2\%; p=0.014)). The effect of vitamin C on preventing ARI was stronger among men and in middle-income countries, compared with women and high-income countries, respectively. Zinc supplementation did not reduce the risk of ARIs but shortened the duration of symptoms substantially (per cent difference: -47\% (95\% CI -73\% to -21\%;\&nbsp;p=0.0004)). Our synthesis of global evidence from randomised controlled trials indicates that micronutrient supplements including zinc, vitamins C and D, and multiple micronutrient supplements may be modestly effective in preventing ARIs and improving their clinical course. Further research is warranted to better understand the effectiveness that individual or multiple micronutrients have on SARS-CoV-2 infection and treatment outcomes.

},
	url = {https://gh.bmj.com/content/6/1/e003176},
	author = {Ajibola I. Abioye and Sabri Bromage and Wafaie W. Fawzi}
}
@article {683423,
	title = {Anemia Etiology in Ethiopia: Assessment of Nutritional, Infectious Disease, and Other Risk Factors in a Population-based Cross-sectional Survey of Women, Men, and Children},
	journal = {J Nutr},
	year = {2021},
	month = {2021 Oct 14},
	abstract = {BACKGROUND: While the causes of anemia at an individual level (such as certain nutritional deficiencies, infections, and genetic disorders) are well defined, there is limited understanding of the relative burden of anemia attributable to each cause within populations. OBJECTIVE: To estimate the proportion of anemia cases attributable to nutritional, infectious disease, and other risk factors among women, men, and children in six regions of Ethiopia. METHODS: A population-based cross-sectional study was conducted. Data were obtained from 2520 women of reproductive age (15-49 years), 1,044 adult men (15-49 years), and 1,528 children (6-59 months). Participants provided venous blood samples for assessment of hemoglobin concentration, ferritin, folate, vitamin B12, C-reactive protein, and malaria infection. Stool samples were collected to ascertain helminth infection status. Sociodemographic questionnaires and a 24-hour diet recall were administered. Population-weighted prevalences of anemia and risk factors were calculated. Multivariable-adjusted associations of risk factors with anemia and partial population attributable risk percentages (pPAR\%) were estimated using generalized linear models. RESULTS: Anemia prevalence was 17\% (95\% CI: 13\%, 21\%) among women, 8\% (6\%, 12\%) among men, and 22\% (19\%, 26\%) among children. Low serum ferritin contributed to 11\% (-1\%, 23\%) of anemia cases among women, 9\% (0\%, 17\%) among men, and 21\% (4\%, 34\%) among children. The proportion of anemia attributable to low serum folate was estimated at 25\% (5\%, 41\%) among women and 29\% (11\%, 43\%) among men. Dietary iron intake was adequate for nearly all participants, while inadequacy was common for folate and vitamin B12. Inflammation and malaria were responsible for less than one in ten anemia cases. CONCLUSIONS: Folate deficiency, iron deficiency, and inflammation appear to be important contributors to anemia in Ethiopia. Folic acid food fortification, targeted iron interventions, and strategies to reduce infections may be considered as potential public health interventions to reduce anemia in Ethiopia.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab366},
	url = {https://academic-oup-com.ezp-prod1.hul.harvard.edu/jn/advance-article/doi/10.1093/jn/nxab366/6396756},
	author = {Andersen, Christopher T and Tadesse, Amare Worku and Sabri Bromage and Fekadu, Habtamu and Hemler, Elena C and Simone Passarelli and Spiegelman, Donna and Sudfeld, Christopher R and Worku, Alemayehu and Berhane, Yemane and Fawzi, Wafaie W}
}
@article {683419,
	title = {Application of the Global Diet Quality Score in Chinese Adults to Evaluate the Double Burden of Nutrient Inadequacy and Metabolic Syndrome},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {93S-100S},
	abstract = {BACKGROUND: The double burdens of under- and overnutrition are changing the health of individuals and the economic and disease burdens in China. Poor diet plays an important role; however, a valid and easily operationalized metric that could capture the full range of characteristics of the diet that are relevant to both under- and overnutrition is lacking in China. OBJECTIVES: We aimed to examine the application of the Global Diet Quality Score (GDQS) to evaluate nutrient inadequacy and metabolic syndrome in different demographic groups of Chinese adults. METHODS: A total of 35,146 individuals (men 14,978, women 20,168) aged \&gt;18 y from the 2010-2012 China National Nutrition and Health Survey were included. We scored the GDQS using average intakes of 25 food groups from 3 d of 24-h dietary recalls. Double burden was defined as coexisting metabolic syndrome and nutrient inadequacy. RESULTS: Diet quality assessed by GDQS was significantly higher in urban than in rural residents (20.8 compared with 18.7), and increased with both educational level and household income (P-trends\&nbsp;\&lt; 0.0001). A higher GDQS score was inversely associated with metabolic syndrome and nutrient inadequacy, or both (P-trends\&nbsp;\&lt; 0.0001): multivariate adjusted ORs comparing extreme quintiles of GDQS were 0.79 (95\% CI: 0.69, 0.91) for metabolic syndrome, 0.17 (95\% CI: 0.14, 0.20) for nutrient inadequacy, and 0.59 (95\% CI: 0.50, 0.69) for the double burden. These associations were consistent across different household income levels (P-interaction\&nbsp;=\&nbsp;0.26), suggestively stronger in younger (\&lt;50 y), females, urban residents, and the more highly educated (P-interaction\&nbsp;\&lt; 0.05) compared with their counterparts. CONCLUSIONS: A higher GDQS was inversely associated with a double burden of nutrient inadequacy and metabolic syndrome across various subgroups of Chinese adults. The finding supports the use of the GDQS in different demographic groups of Chinese adults to assess diet quality and nutritional status.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab162},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/93S/6409545},
	author = {He, Yuna and Fang, Yuehui and Sabri Bromage and Fung, Teresa T and Bhupathiraju, Shilpa N and Batis, Carolina and Megan Deitchler and Fawzi, Wafaie and Stampfer, Meir J and Hu, Frank B and Willett, Walter C and Li, Yanping}
}
@article {683414,
	title = {Changes in the Global Diet Quality Score, Weight, and Waist Circumference in Mexican Women},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {152S-161S},
	abstract = {BACKGROUND: Evidence on concurrent changes in overall diet quality and weight and waist circumference in women of reproductive age from low- and middle-income countries is limited. OBJECTIVES: We examined the associations of changes in the Global Diet Quality Score (GDQS) and each GDQS food group with concurrent weight and waist circumference change in Mexican women. METHODS: We followed prospectively 8967 nonpregnant nonlactating women aged 25-49 y in the Mexican Teachers{\textquoteright} Cohort between 2006 and 2008. We assessed diet using an FFQ of the previous year and anthropometric measures were self-reported. Regression models were used to examine 2-y changes in the GDQS and each food group (servings/d) with weight and waist circumference changes within the same period, adjusting for demographic and lifestyle factors. RESULTS: Compared with those with little change in the GDQS (-2 to 2 points), women with the largest increase in the GDQS (\&gt;5 points) had less weight (β: -0.81\&nbsp;kg/2\&nbsp;y; 95\% CI: -1.11, -0.51\&nbsp;kg/2\&nbsp;y) and waist circumference gain (β: -1.05\&nbsp;cm/2\&nbsp;y; 95\% CI: -1.62, -0.48\&nbsp;cm/2\&nbsp;y); likewise, women with the largest decrease in the GDQS (\&lt;-5 points) had more weight (β: 0.36\&nbsp;kg/2\&nbsp;y; 95\% CI: 0.06, 0.66\&nbsp;kg/2\&nbsp;y) and waist circumference gain (β: 0.71\&nbsp;cm/2\&nbsp;y; 95\% CI: 0.09, 1.32\&nbsp;cm/2\&nbsp;y). Increased intake of dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, citrus fruits, and fish and shellfish was associated with less weight gain. In addition, deep orange vegetables, low fat and high fat dairy, whole grains, and fish were associated with less waist circumference gain within the 2-y period. CONCLUSIONS: Improvements in diet quality over a 2-y period reflected by an increase in the GDQS and changes in consumption of specific components of the GDQS were associated with less weight and waist circumference gain in Mexican women.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab171},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/152S/6409540},
	author = {Angulo, Erick and Stern, Dalia and Castellanos-Guti{\'e}rrez, Anal{\'\i} and Adriana Monge and Mart{\'\i}n Lajous and Sabri Bromage and Fung, Teresa T and Li, Yanping and Bhupathiraju, Shilpa N and Megan Deitchler and Willett, Walter C and Batis, Carolina}
}
@article {683422,
	title = {Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS)},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {75S-92S},
	abstract = {BACKGROUND: Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22\% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. OBJECTIVES: We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. METHODS: Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. RESULTS: We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). CONCLUSIONS: The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab244},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/75S/6409546?login=true},
	author = {Sabri Bromage and Batis, Carolina and Bhupathiraju, Shilpa N and Fawzi, Wafaie W and Fung, Teresa T and Li, Yanping and Megan Deitchler and Angulo, Erick and Birk, Nick and Castellanos-Guti{\'e}rrez, Anal{\'\i} and He, Yuna and Fang, Yuehui and Matsuzaki, Mika and Yiwen Zhang and Moursi, Mourad and Gicevic, Selma and Michelle D Holmes and Isanaka, Sheila and Kinra, Sanjay and Sachs, Sonia E and Stampfer, Meir J and Stern, Dalia and Willett, Walter C}
}
@article {683420,
	title = {Exploration of Machine Learning and Statistical Techniques in Development of a Low-Cost Screening Method Featuring the Global Diet Quality Score for Detecting Prediabetes in Rural India},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {110S-118S},
	abstract = {BACKGROUND: The prevalence of type 2 diabetes has increased substantially in India over the past 3 decades. Undiagnosed diabetes presents a public health challenge, especially in rural areas, where access to laboratory testing for diagnosis may not be readily available. OBJECTIVES: The present work explores the use of several machine learning and statistical methods in the development of a predictive tool to screen for prediabetes using survey data from an FFQ to compute the Global Diet Quality Score (GDQS). METHODS: The outcome variable prediabetes status (yes/no) used throughout this study was determined based upon a fasting blood glucose measurement >=100\&nbsp;mg/dL. The algorithms utilized included the generalized linear model (GLM), random forest, least absolute shrinkage and selection operator (LASSO), elastic net (EN), and generalized linear mixed model (GLMM) with family unit as a (cluster) random (intercept) effect to account for intrafamily correlation. Model performance was assessed on held-out test data, and comparisons made with respect to area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. RESULTS: The GLMM, GLM, LASSO, and random forest modeling techniques each performed quite well (AUCs \&gt;0.70) and included the GDQS food groups and age, among other predictors. The fully adjusted GLMM, which included a random intercept for family unit, achieved slightly superior results (AUC of 0.72) in classifying the prediabetes outcome in these cluster-correlated data. CONCLUSIONS: The models presented in the current work show promise in identifying individuals at risk of developing diabetes, although further studies are necessary to assess other potentially impactful predictors, as well as the consistency and generalizability of model performance. In addition, future studies to examine the utility of the GDQS in screening for other noncommunicable diseases are recommended.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab281},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/110S/6409536},
	author = {Birk, Nick and Matsuzaki, Mika and Fung, Teresa T and Li, Yanping and Batis, Carolina and Stampfer, Meir J and Megan Deitchler and Willett, Walter C and Fawzi, Wafaie W and Sabri Bromage and Kinra, Sanjay and Bhupathiraju, Shilpa N and Lake, Erin}
}
@article {683418,
	title = {The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {130S-142S},
	abstract = {BACKGROUND: Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. OBJECTIVES: To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. METHODS: We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15-49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models. RESULTS: In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95\% CI: 0.31-0.79); inversely associated with underweight (OR, 0.63; 95\% CI: 0.44-0.90), low midupper arm circumference (OR, 0.61; 95\% CI: 0.45-0.84), and anemia (OR, 0.59; 95\% CI: 0.38-0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95\% CI: 1.12-2.80). For comparison, the Minimum Dietary Diversity-Women (MDD-W) was associated more positively (P\&nbsp;\&lt;\&nbsp;0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P\&nbsp;\&lt;\&nbsp;0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia. CONCLUSIONS: The GDQS performed capably in capturing nutrient adequacy-related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS{\textquoteright} performance in capturing NCD outcomes in sub-Saharan Africa.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab264},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/130S/6409544},
	author = {Sabri Bromage and Andersen, Christopher T and Tadesse, Amare W and Simone Passarelli and Hemler, Elena C and Fekadu, Habtamu and Sudfeld, Christopher R and Worku, Alemayehu and Berhane, Hanna and Batis, Carolina and Bhupathiraju, Shilpa N and Fung, Teresa T and Li, Yanping and Stampfer, Meir J and Megan Deitchler and Willett, Walter C and Fawzi, Wafaie W}
}
@article {683416,
	title = {The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {119S-129S},
	abstract = {BACKGROUND: Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. OBJECTIVES: We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. METHODS: We scored the GDQS, Minimum Dietary Diversity-Women (MDD-W), and Alternative Healthy Eating Index-2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. RESULTS: Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95\% CI: 0.30, 0.38) in men and 0.37 (95\% CI: 0.32, 0.41) in women. The GDQS was associated (P\&nbsp;\&lt;\&nbsp;0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95\% CI: 0.22, 0.85; women: 0.57, 95\% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95\% CI: 0.32, 0.98; women: 0.60, 95\% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P\&nbsp;=\&nbsp;0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P\&nbsp;=\&nbsp;0.06) and anemia (P\&nbsp;=\&nbsp;0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive. CONCLUSIONS: The GDQS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab161},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/119S/6409543},
	author = {Sabri Bromage and Yiwen Zhang and Michelle D Holmes and Sachs, Sonia E and Fanzo, Jessica and Remans, Roseline and Sachs, Jeffrey D and Batis, Carolina and Bhupathiraju, Shilpa N and Fung, Teresa T and Li, Yanping and Stampfer, Meir J and Megan Deitchler and Willett, Walter C and Fawzi, Wafaie W}
}
@article {683415,
	title = {Higher Global Diet Quality Score Is Associated with Less 4-Year Weight Gain in US Women},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {162S-167S},
	abstract = {BACKGROUND: We have developed a simple and globally applicable tool, the Global Diet Quality Score (GDQS), to measure diet quality. OBJECTIVES: To test the utility of the GDQS, we examined the associations of the GDQS with weight change and risk of obesity in US women. METHODS: Health, lifestyle, and diet information were collected from women (n\&nbsp;=\&nbsp;68,336) in the Nurses{\textquoteright} Health Study II (aged 27-44 y in 1991) through repeated questionnaires (1991-2015). The GDQS has 25 food groups (maximum\&nbsp;=\&nbsp;49 points) and scoring higher points reflects a healthier diet. The association between GDQS change in 4-y intervals and concurrent weight change was computed with linear models adjusted for confounders. RESULTS: Mean\&nbsp;{\textpm}\&nbsp;SD weight gain across 4-y periods was 1.68\&nbsp;{\textpm}\&nbsp;6.26\&nbsp;kg. A \&gt;5-point improvement in GDQS was associated with -1.13\&nbsp;kg (95\% CI: -1.19, -0.77\&nbsp;kg) weight gain compared with a score change of \&lt;{\textpm}2 points. For each 5-point increase, weight gain was 0.83\&nbsp;kg less for age\&nbsp;\&lt;50\&nbsp;y compared with 0.71\&nbsp;kg less for age\&nbsp;>=50\&nbsp;y (P-interaction\&nbsp;\&lt;\&nbsp;0.05). A \&gt;5-point score decrease was associated with 1.13\&nbsp;kg (95\% CI: 1.04, 1.22\&nbsp;kg) more weight gain in women aged \&lt;50\&nbsp;y and 0.81\&nbsp;kg more (95\% CI: 0.63, 0.98\&nbsp;kg) in women aged\&nbsp;>=50 y. Compared with little change in score, obesity RR was 0.77 (95\% CI: 0.74, 0.81) for a \&gt;5-point increase and 1.32 (95\% CI: 1.26, 1.37) for a \&gt;5-point decrease. Risk of obesity did not differ by age. Compared with other diet quality scores, the Alternate Healthy Eating Index-2010 had somewhat stronger associations than the GDQS (P\&nbsp;\&lt;\&nbsp;0.05) but the GDQS had stronger associations than the Minimum Dietary Diversity for Women score (P\&nbsp;\&lt;\&nbsp;0.05). CONCLUSIONS: Improvement of diet quality as measured by the GDQS was associated with less weight gain and risk of obesity in US women. The association was stronger for women aged \&lt;50\&nbsp;y. Associations similar in direction and magnitude were observed between the GDQS and obesity across age groups.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab170},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/162S/6409538},
	author = {Fung, Teresa T and Li, Yanping and Sabri Bromage and Bhupathiraju, Shilpa N and Batis, Carolina and Fawzi, Wafaie and Michelle D Holmes and Stampfer, Meir and Hu, Frank B and Megan Deitchler and Willett, Walter C}
}
@article {683417,
	title = {Higher Global Diet Quality Score Is Inversely Associated with Risk of Type 2 Diabetes in US Women},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {168S-175S},
	abstract = {BACKGROUND: We have developed a diet quality metric intended for global use. To assess its utility in high-income settings, an evaluation of its ability to predict chronic disease is needed. OBJECTIVES: We aimed to prospectively examine the ability of the Global Diet Quality Score (GDQS) to predict the risk of type 2 diabetes in the United States, examine potential differences of association by age, and compare the GDQS with other diet quality scores. METHODS: Health, lifestyle, and diet information was collected from women (n\&nbsp;=\&nbsp;88,520) in the Nurses{\textquoteright} Health Study II aged 27-44 y at baseline through repeated questionnaires between 1991 and 2017. The overall GDQS consists of 25 food groups. Points are awarded for higher intake of healthy groups and lower intake of unhealthy groups (maximum of 49 points). Multivariable HRs were computed for confirmed type 2 diabetes using proportional hazards models. We also compared the GDQS with the Minimum Diet Diversity score for Women (MDD-W) and the Alternate Healthy Eating Index-2010 (AHEI-2010). RESULTS: We ascertained 6305 incident cases of type 2 diabetes during follow-up. We observed a lower risk of diabetes with higher GDQS; the multivariable HR comparing extreme quintiles of the GDQS was 0.83 (95\% CI: 0.76, 0.91; P-trend\&nbsp;\&lt;\&nbsp;0.001). The magnitude of association was similar between women aged \&lt;50 y and those aged >=50 y. An inverse association was observed with lower intake of unhealthy components (HR comparing extreme quintiles of the unhealthy submetric: 0.76; 95\% CI: 0.69, 0.84; P-trend\&nbsp;\&lt;\&nbsp;0.001) but was not with the healthy submetric. The inverse association for each 1-SD increase in the GDQS (HR: 0.93; 95\% CI: 0.91, 0.96) was stronger (P\&nbsp;\&lt;\&nbsp;0.001) than for the MDD-W (HR: 1.00; 95\% CI: 0.94, 1.04) but was slightly weaker (P\&nbsp;=\&nbsp;0.03) than for the AHEI-2010 (HR: 0.91; 95\% CI: 0.88, 0.94). CONCLUSIONS: A higher GDQS was inversely associated with type 2 diabetes risk in US women of reproductive age or older, mainly from lower intake of unhealthy foods. The GDQS performed nearly as well as the AHEI-2010.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab195},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/168S/6409542},
	author = {Fung, Teresa T and Li, Yanping and Bhupathiraju, Shilpa N and Sabri Bromage and Batis, Carolina and Michelle D Holmes and Stampfer, Meir and Hu, Frank B and Megan Deitchler and Willett, Walter C}
}
@article {683421,
	title = {Performance of the Global Diet Quality Score with Nutrition and Health Outcomes in Mexico with 24-h Recall and FFQ Data},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {143S-151S},
	abstract = {BACKGROUND: The Global Diet Quality Score (GDQS) is intended as a simple global diet quality metric feasible in low- and middle-income countries facing the double burden of malnutrition. OBJECTIVE: The aim of this study was to evaluate the performance of the GDQS with markers of nutrient adequacy and chronic disease in nonpregnant nonlactating (NPNL) Mexican women of reproductive age and to compare it with the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Minimum Dietary Diversity for Women (MDD-W). METHODS: We included NPNL women aged 15 to 49 y from the Mexican National Health and Nutrition Surveys (2012 and 2016) with 24-h recall (n\&nbsp;=\&nbsp;2542) or a FFQ (n\&nbsp;=\&nbsp;4975) (separate samples). We evaluated the correlation of the GDQS with the energy-adjusted intake of several nutrients and evaluated its association with health parameters using covariate-adjusted linear regression models. RESULTS: The GDQS was positively correlated with the intake of calcium, folate, iron, vitamin A, vitamin B-12, zinc, fiber, protein, and total fat (rho\&nbsp;=\&nbsp;0.09 to 0.38, P\&nbsp;\&lt; 0.05) and was inversely correlated with the intake of added sugar (rho = -0.37 and -0.38, P\&nbsp;\&lt; 0.05) using both instruments, and with total fat, SFA, and MUFA only with 24-h recall data (rho = -0.06 to -0.16, P\&nbsp;\&lt; 0.05). The GDQS was inversely associated with serum ferritin, BMI, waist circumference, and serum total and LDL cholesterol using FFQ data (P\&nbsp;\&lt;\&nbsp;0.05), and was positively associated with serum folate using 24-h recall data (P\&nbsp;\&lt; 0.05). Similar correlations and associations were observed with the MDD-W (only with micronutrients) and the AHEI-2010 (only with chronic disease-related nutrients and health markers). CONCLUSIONS: In comparison to other diet metrics, the GDQS can capture both dimensions of nutrient adequacy and health markers related to the risk of chronic disease. The performance of the GDQS was satisfactory with either 24-h recall or FFQ.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab202},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/143S/6409541},
	author = {Castellanos-Guti{\'e}rrez, Anal{\'\i} and Rodr{\'\i}guez-Ram{\'\i}rez, Sonia and Sabri Bromage and Fung, Teresa T and Li, Yanping and Bhupathiraju, Shilpa N and Megan Deitchler and Walter Willett and Batis, Carolina}
}
@article {nu13114175,
	title = {Prevalence and Determinants of Vitamin D Deficiency in 9595 Mongolian Schoolchildren: A Cross-Sectional Study},
	journal = {Nutrients},
	volume = {13},
	number = {11},
	year = {2021},
	abstract = {Population-based data relating to vitamin D status of children in Northeast Asia are lacking. We conducted a cross-sectional study to determine the prevalence and determinants of vitamin D deficiency in 9595 schoolchildren aged 6{\textendash}13 years in Ulaanbaatar (UB), the capital city of Mongolia. Risk factors for vitamin D deficiency were collected by questionnaire, and serum 25-hydroxyvitamin D (25[OH]D) concentrations were measured using an enzyme-linked fluorescent assay, standardized and categorized as deficient (25[OH]D \&lt;10 ng/mL) or not. Odds ratios for associations between independent variables and risk of vitamin D deficiency were calculated using multivariate analysis with adjustment for potential confounders. The prevalence of vitamins D deficiency was 40.6\% (95\% CI 39.7\% to 41.6\%). It was independently associated with female gender (adjusted odds ratio [aOR] for girls vs. boys 1.23, 95\% CI 1.11{\textendash}1.35), month of sampling (aORs for December{\textendash}February vs. June{\textendash}November 5.28 [4.53{\textendash}6.15], March{\textendash}May vs. June{\textendash}November 14.85 [12.46{\textendash}17.74]), lower levels of parental education (P for trend \&lt;0.001), lower frequency of egg consumption (P for trend \&lt;0.001), active tuberculosis (aOR 1.40 [1.03{\textendash}1.94]), household smoking (aOR 1.13 [1.02 to1.25]), and shorter time outdoors (P for trend \&lt;0.001). We report a very high prevalence of vitamin D deficiency among Mongolian schoolchildren, which requires addressing as a public health priority.},
	issn = {2072-6643},
	doi = {10.3390/nu13114175},
	url = {https://www.mdpi.com/2072-6643/13/11/4175},
	author = {Jorick Bater and Sabri Bromage and Jambal, Tuyatsetseg and Tsendjav, Enkhjargal and Enkhsaikhan Lkhagvasuren and Jutmann, Yanjmaa and Adrian R. Martineau and Davaasambuu Ganmaa}
}
@article {683412,
	title = {There{\textquoteright}s an App for That: Development of an Application to Operationalize the Global Diet Quality Score},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {176S-184S},
	abstract = {BACKGROUND: The global diet quality score (GDQS) is a simple, standardized metric appropriate for population-based measurement of diet quality globally. OBJECTIVES: We aimed to operationalize data collection by modifying the quantity of consumption cutoffs originally developed for the GDQS food groups and to statistically evaluate the performance of the operationalized GDQS relative to the original GDQS against nutrient adequacy and noncommunicable disease (NCD)-related outcomes. METHODS: The GDQS application uses a 24-h open-recall to collect a full list of all foods consumed during the previous day or night, and automatically classifies them into corresponding GDQS food group. Respondents use a set of 10 cubes in a range of predetermined sizes to determine if the quantity consumed per GDQS food group was below, or equal to or above food group-specific cutoffs established in grams. Because there is only a total of 10 cubes but as many as 54 cutoffs for the GDQS food groups, the operationalized cutoffs differ slightly from the original GDQS cutoffs. RESULTS: A secondary analysis using 5 cross-sectional datasets comparing the GDQS with the original and operationalized cutoffs showed that the operationalized GDQS remained strongly correlated with nutrient adequacy and was equally sensitive to anthropometric and other clinical measures of NCD risk. In a secondary analysis of a longitudinal cohort study of Mexican teachers, there were no differences between the 2 modalities with the beta coefficients per 1 SD change in the original and operationalized GDQS scores being nearly identical for weight gain (-0.37 and -0.36, respectively, P\&nbsp;\&lt;\&nbsp;0.001 for linear trend for both models) and of the same clinical order of magnitude for waist circumference (-0.52 and -0.44, respectively, P\&nbsp;\&lt;\&nbsp;0.001 for linear trend for both models). CONCLUSION: The operationalized GDQS cutoffs did not change the performance of the GDQS and therefore are recommended for use to collect GDQS data in the future.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab196},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/176S/6409539},
	author = {Moursi, Mourad and Sabri Bromage and Fung, Teresa T and Isanaka, Sheila and Matsuzaki, Mika and Batis, Carolina and Castellanos-Guti{\'e}rrez, Anal{\'\i} and Angulo, Erick and Birk, Nick and Bhupathiraju, Shilpa N and He, Yuna and Li, Yanping and Fawzi, Wafaie and Danielyan, Armen and Thapa, Sachit and Ndiyoi, Liseteli and Vossenaar, Marieke and Alexandra Bellows and Arsenault, Joanne E and Willett, Walter C and Megan Deitchler}
}
@article {683413,
	title = {Validation of Global Diet Quality Score Among Nonpregnant Women of Reproductive Age in India: Findings from the Andhra Pradesh Children and Parents Study (APCAPS) and the Indian Migration Study (IMS)},
	journal = {J Nutr},
	volume = {151},
	number = {Supplement_2},
	year = {2021},
	month = {2021 Oct 23},
	pages = {101S-109S},
	abstract = {BACKGROUND: In India, there is a need to monitor population-level trends in changes in diet quality in relation to both undernutrition and noncommunicable diseases. OBJECTIVES: We conducted a study to validate a novel diet quality score in southern India. METHODS: We included data from 3041 nonpregnant women of reproductive age (15-49 years) from 2 studies in India. Diet was assessed using a validated food frequency questionnaire (FFQ). The Global Diet Quality Score (GDQS) was calculated from 25 food groups (16 healthy; 9 unhealthy), with points for each group based on the frequency and quantity of items consumed in each group. We used Spearman correlations to examine correlations between the GDQS and several nutrient intakes of concern. We examined associations between the GDQS [overall, healthy (GDQS+), and unhealthy (GDQS-) submetrics] and overall nutrient adequacy, micro- and macronutrients, body mass index (BMI), midupper arm circumference, hemoglobin, blood pressure, high density lipoprotein (HDL), and total cholesterol (TC). RESULTS: The mean GDQS was 23 points (SD, 3.6; maximum, 46.5). In energy-adjusted models, positive associations were found between the overall GDQS and GDQS+ and intakes of calcium, fiber, folate, iron, monounsaturated fatty acid (MUFA), protein, polyunsaturated fatty acid (PUFA), saturated fatty acid (SFA), total fat, and zinc (ρ = 0.12-0.39; P \&lt;\&nbsp;0.001). Quintile analyses showed that the GDQS was associated with better nutrient adequacy. At the same time, the GDQS was associated with higher TC, lower HDL, and higher BMI. We found no associations between the GDQS and hypertension. CONCLUSIONS: The GDQS was a useful tool for reflecting overall nutrient adequacy and some lipid measures. Future studies are needed to refine the GDQS for populations who consume large amounts of unhealthy foods, like refined grains, along with healthy foods included in the GDQS.},
	issn = {1541-6100},
	doi = {10.1093/jn/nxab217},
	url = {https://academic.oup.com/jn/article/151/Supplement_2/101S/6409537?login=true},
	author = {Matsuzaki, Mika and Birk, Nick and Sabri Bromage and Bowen, Liza and Batis, Carolina and Fung, Teresa T and Li, Yanping and Stampfer, Meir J and Megan Deitchler and Willett, Walter C and Fawzi, Wafaie W and Kinra, Sanjay and Bhupathiraju, Shilpa N}
}
@article {664915,
	title = {Food crop diversity, women{\textquoteright}s income-earning activities and distance to markets in relation to maternal dietary quality in Tanzania},
	journal = {Journal of Nutrition},
	year = {2020},
	abstract = {
	Background:\&nbsp;Women{\textquoteright}s dietary diversity and quality are limited in low- and middle-income countries (LMICs). Nutrition-sensitive interventions that promote food crop diversity and women{\textquoteright}s access to income could improve diets and address the double burden of malnutrition in LMICs.



	Objectives:\&nbsp;We examined the associations among food crop diversity and women{\textquoteright}s income-earning activities with women{\textquoteright}s diet quality, as well as effect modification by access to markets, in the context of small-holder food production in rural Tanzania.



	Methods:\&nbsp;Data from a cross-sectional study of 880 women from Rufiji, Tanzania, were analyzed. Women{\textquoteright}s dietary intake was assessed using a food frequency questionnaire. The prime diet quality score (PDQS; 21 food groups; range, 0-42), a unique diet-quality metric for women that captures the healthy and unhealthy aspects of diet, was computed. Generalized estimating equation linear models were used to evaluate the associations of food crop diversity and women{\textquoteright}s income-earning activities with PDQS, while controlling for socio-economic factors.



	Results:\&nbsp;Maternal overweight (24.3\%) and obesity (13.1\%) were high. The median PDQS was 19 (IQR, 17-21). Households produced 2.0 food crops (SD {\textpm} 1.0) yearly. Food crop diversity was positively associated with PDQS (P \&lt; 0.001), but the association was strengthened by proximity to markets (P for interaction = 0.02). For women living close (\&lt;1.1 km) to markets, producing 1 additional food crop was associated with a 0.67 (95\% CI, 0.22-1.12) increase in PDQS, versus a 0.40 (95\% CI, 0.24-0.57) increase for women living farther away. The PDQS increased with women{\textquoteright}s salaried employment (estimate, 0.96; 95\% CI, 0.26-1.67).



	Conclusions:\&nbsp;Household food production may interact with access to markets for sales and purchases, while nonfarm income also improves women{\textquoteright}s diet quality in rural Tanzania. Programs to improve women{\textquoteright}s diet quality should consider improving market access and women{\textquoteright}s access to income (source of empowerment), in addition to diversifying production.



	Keywords:\&nbsp;PDQS; Tanzania; distance to market; food crop diversity; food systems; market food diversity; maternal diet quality; prime diet quality score; production diversity; women{\textquoteright}s access to income.

},
	url = {https://academic.oup.com/jn/advance-article-abstract/doi/10.1093/jn/nxaa329/6007024?redirectedFrom=fulltext},
	author = {Isabel Madzorera and Mia M. Blakstad and Alexandra L. Bellows and Chelsey R. Canavan and Dominic Mosha and Sabri Bromage and Ramadhani A. Noor and Patrick Webb and Shibani Ghosh and Joyce Kinabo and Honorati Masanja and Wafaie W. Fawzi}
}
@article {665252,
	title = {Protocol for a case-control study of vitamin D status, adult multidrug-resistant tuberculosis disease and tuberculosis infection in Mumbai, India},
	journal = {BMJ Open},
	volume = {10},
	number = {11},
	year = {2020},
	pages = {e039935},
	abstract = {
	\&nbsp;



	Introduction:\&nbsp;Vitamin D status may be an important determinant of multidrug-resistant tuberculosis (MDR-TB) infection, progression to disease and treatment outcomes. Novel and potentially cost-effective therapies such as vitamin D supplementation are needed to stem the tide of TB and MDR-TB globally, particularly in India, a country that accounts for the largest fraction of the world{\textquoteright}s TB incidence and MDR-TB incidence, and where vitamin D deficiency is endemic. While vitamin D has shown some promise in the treatment of MDR-TB, its role in the context of MDR-TB infection and progression to disease is largely unknown.



	Methods and analysis:\&nbsp;Through a case-control study in Mumbai, India, we aim to examine associations between vitamin D status and active MDR-TB and to investigate vitamin D status and TB infection among controls. Cases are adult outpatient pulmonary patients with MDR-TB recruited from two public TB clinics. Controls are recruited from the cases{\textquoteright} household contacts and from non-respiratory departments of the facilities where cases were recruited. Cases and controls are assessed for serum 25-hydroxyvitamin D concentration, nutrient intake, diet quality, anthropometry and other relevant clinical and sociodemographic parameters. Controls undergo additional clinical assessments to rule out active TB and laboratory assessments to determine presence of TB infection. Statistical analysis investigates associations between vitamin D status and active MDR-TB and between vitamin D status and TB infection among controls, accounting for potential confounding effects of diet, anthropometry and other covariates.



	Ethics and dissemination:\&nbsp;This study has been approved by Harvard T.H. Chan School of Public Health Institutional Review Board; Foundation for Medical Research Institutional Research Ethics Committee and Health Ministry{\textquoteright}s Screening Committee of the Indian Council for Medical Research. Permission was granted by the Municipal Corporation of Greater Mumbai, India, a collaborating partner on this research. Outcomes will be disseminated through publication and scientific presentation.



	Trial registration number:\&nbsp;NCT04342598.



	Keywords:\&nbsp;epidemiology; nutrition \&amp; dietetics; public health; tuberculosis.



	\&nbsp;

},
	url = {https://bmjopen.bmj.com/content/10/11/e039935.long},
	author = {Nerges Mistry and Elena C. Hemler and Yatin Dholakia and Sabri Bromage and Anupam Shukla and Prachi Dev and Laxmi Govekar and Pranita Tipre and Daksha Shah and Salmaan A. Keshavjee and Wafaie W. Fawzi}
}
@webarticle {664913,
	title = {Recent study finds key nutrient inadequacies and overweight to be widespread among Mongolian adults nationwide},
	journal = {IKON},
	year = {2020},
	url = {https://ikon.mn/n/20b9},
	author = {Sabri Bromage and Davaasambuu Ganmaa}
}
@article {653735,
	title = {Diet and Nutrition Status of Mongolian Adults},
	journal = {Nutrients},
	volume = {12},
	number = {5},
	year = {2020},
	pages = {1514},
	abstract = {
	(1) Background: Aspects of the Mongolian food supply, including high availability of animal-source foods and few plant foods, are plausibly associated with disease in the population. Data on Mongolian diets are lacking, and these risks are poorly quantified. The purpose of this study was to provide a multifaceted nutritional analysis of the modern Mongolian diet. (2) Methods: The study population consisted of 167 male and 167 female healthy non-pregnant urban and nomadic adults (22{\textendash}55 years) randomly selected from lists of residents in 8 regions. From 2011{\textendash}2016, 3-day weighed diet records and serum were collected twice from each participant in summer and winter; anthropometry was collected once from each participant. Serum was analyzed for biomarkers, and nutrient intake computed using purpose-built food composition data and adjusted for within-person variation. Exploratory dietary patterns were derived and analyzed for associations with diet and nutrition measurements. (3) Results: We collected 1838 of an expected 1986 diet records (92.5\%), 610/658 serum samples (92.7\%), and 315/334 height and weight measurements (94.3\%). Sixty-one percent of men and 51\% of women were overweight or obese. Consumption of red meat, refined grains, and whole-fat dairy was high, while that of fruits, non-tuberous vegetables, eggs, nuts and seeds, fish and poultry, and whole grains was low. Dairy and red meat were more consumed in summer and winter, respectively. Dietary inadequacy of 10 of 21 assessed nutrients, including fiber, folate, and vitamin D were \&gt;50\% prevalent, while protein, zinc, and vitamin B12 inadequacy were low. Biochemical evidence of iron and vitamin A deficiency was also low. Three dietary patterns (Urban, Transitional, Nomadic) explained 41\% of variation in food consumption. The Urban pattern was positively associated with BMI in multivariate analysis. (4) Conclusions: Results indicate a high prevalence of key dietary inadequacies and overweight among Mongolian adults. Prior studies by our group have suggested that expanded supplementation and food fortification would be effective in addressing micronutrient inadequacies; these strategies should be coupled with measures to mitigate the growing burden of chronic disease.

},
	url = {https://www.mdpi.com/2072-6643/12/5/1514},
	author = {Sabri Bromage and Tselmen Daria and Rebecca L. Lander and Soninkhishig Tsolmon and Lisa A. Houghton and Enkhjargal Tserennadmid and Nyamjargal Gombo and Rosalind S. Gibson and Davaasambuu Ganmaa}
}
@article {645240,
	title = {Aflatoxin exposure in utero and birth and growth outcomes in Tanzania},
	journal = {Maternal \& Child Nutrition},
	year = {2019},
	pages = {e12917},
	abstract = {
	
		Some evidence suggests that aflatoxin may contribute to the high prevalence of stunting observed in low-income countries. Whereas several studies have been conducted in West Africa, fewer exist in East Africa and even fewer in nonagricultural contexts. We analyzed serum samples from 400 iron-replete, nonanemic pregnant women from a cohort in Dar es Salaam, Tanzania to determine the extent and magnitude of exposure to aflatoxin and to study the relationship between levels of aflatoxin exposure in utero and infant birth and growth outcomes. Ninety-nine percent of women had detectable concentrations of aflatoxin B1-lysine (AFB1-lysine), with a median level of 1.4-pg/mg albumin, indicating a much lower level compared to studies of rural populations in sub-Saharan Africa. Our results do not show a statistically significant relationship between AFB1-lysine levels and birth weight, small for gestational age, or prematurity. We observe a small statistically significant reduction in gestational age at delivery (0.47 weeks; 95\% CI: -0.86, -0.07) as the natural log of AFB1-lysine levels increases by 1 unit of pg/mg of albumin, after controlling for potential confounders. Among a nonrandom set of infants who had measurements for placental weight, haemoglobin at delivery, and follow-up z-score measurements, we find no association between aflatoxin plasma concentrations and these variables. These findings suggest a high prevalence of chronic low-level exposure to aflatoxin, though its effect on birth outcomes in this population remains unclear. Our research adds to a growing body of literature finding mixed associations between aflatoxins on pregnancy outcomes and child growth.
	

},
	url = {https://onlinelibrary.wiley.com/doi/10.1111/mcn.12917},
	author = {Simone Passarelli and Sabri Bromage and Anne Marie Darling and Jia-Sheng Wang and Said Aboud and Ferdinand Mugusi and Jeffrey K. Griffiths and Fawzi, Wafaie}
}
@article {643189,
	title = {Effects of Vitamin D Supplementation and Seasonality on Circulating Cytokines in Adolescents: Analysis of Data From a Feasibility Trial in Mongolia},
	journal = {Frontiers in Nutrition},
	volume = {6},
	number = {166},
	year = {2019},
	pages = {1-6},
	abstract = {
	Vitamin D deficiency is prevalent in human populations and has been linked to immune dysfunction. Here we explored the effects of cholecalciferol supplementation on circulating cytokines in severely vitamin D deficient [blood 25(OH)D \&lt;\&lt; 30 nmol/L] adolescents aged 12{\textendash}15 from Mongolia. The study included 28 children receiving 800 IU daily cholecalciferol for 6 months spanning winter and spring, and 30 children receiving placebo during the same period. The levels of 25(OH)D were assessed at baseline, 3 and 6 months. Twenty-one cytokines were measured in serum at baseline and at 6 months. Changes in 25(OH)D and cytokines were assessed using paired parametric tests. The median blood 25(OH)D concentration at baseline was 13.7 nmol/L (IQR = 10.0{\textendash}21.7). Supplementation tripled blood 25(OH)D levels (p\&nbsp;\&lt; 0.001) and was associated with elevated interleukin (IL)-6 (p\&nbsp;= 0.043). The placebo group had reduced macrophage inflammatory protein (MIP)-1α (p\&nbsp;= 0.007) and IL-8 (p\&nbsp;= 0.034) at 6 months. Although limited by a small sample size, these findings suggest that cholecalciferol supplementation and seasonality may impact systemic immunity in adolescents, identifying chemokines as potentially important biomarkers of vitamin D status in this Northeast Asian population. Larger clinical trials are warranted to validate these results.

},
	url = {https://www.frontiersin.org/articles/10.3389/fnut.2019.00166/full},
	author = {Sergey Yegorov and Sabri Bromage and Ninjin Boldbaatar and Davaasambuu Ganmaa}
}
@article {638287,
	title = {Home Fortification of Rice With Lime, A Novel Potential Way to Reduce Calcium Deficiency in Bangladesh},
	journal = {Food and Nutrition Bulletin},
	year = {2019},
	abstract = {Background:In order to improve the calcium status, fortified rice should have acceptable organoleptic properties of that food.Objective:We aimed to assess whether home fortification of rice with slaked lime can increase calcium content of the rice and whether this fortified rice is well tolerated in a nutritionally at-risk population.Methods:This experimental study measured the calcium content of rice cooked with different concentration of lime and assessed the acceptability of fortified rice among 400 women and children. Each participant received fortified rice with one of five concentrations of lime (0, 2.5, 5, 7.5 or 10 gm per 500 gm of rice), with or without additional foods (lentil soup or fried green papaya). All participants were asked to score the organoleptic qualities in hedonic scale.Results:Analysis showed, rice calcium content increased in dose response manner with increased lime amount during cooking (76.03, 205.58, 427.55, 614.29 and 811.23 mg/kg for given lime concentrations). Acceptability of meal was greater when additional foods were served with rice at all lime concentrations. In both groups, 7.5M arm reported highest overall acceptability (children, 6.25; women 6.10). This study found significant association between overall acceptability (different concentrations of lime mixed rice; with/without additional foods) and between groups (women vs. children) (p\&nbsp;value = \&lt; 0.001) where as no association was found within groups.Conclusions:Lime-fortified-rice can be feasible considering the calcium uptake of rice and organoleptic character. Further research on bioavailability can establish a solid foundation which will support designing of an effective intervention to reduce calcium deficiency in this population.},
	url = {https://journals.sagepub.com/doi/abs/10.1177/0379572119845573?rfr_dat=cr_pub\%3Dpubmed\&url_ver=Z39.88-2003\&rfr_id=ori\%3Arid\%3Acrossref.org\&journalCode=fnba},
	author = {Nurun Nahar Naila and Prasenjit Mondal and Sabri Bromage and M. Munirul Islam and M. Mamun Huda and Mohammad Sohel Shomik and Dinesh Mondal and Fawzi, Wafaie and Tahmeed Ahmed}
}
@article {638286,
	title = {Comparison of seasonal serum 25-hydroxyvitamin D concentrations among pregnant women in Mongolia and Boston},
	journal = {Journal of Steroid Biochemistry and Molecular Biology},
	volume = {193},
	year = {2019},
	pages = {105427},
	abstract = {
	Adequate vitamin D status during pregnancy is important for developing fetal bone strength and density and may play a role in preventing a range of skeletal and non-skeletal diseases in both mothers and children. We previously identified Mongolian women of reproductive age to have the lowest vitamin D levels yet observed in any population globally, which renders this population uniquely important in vitamin D research. In this study, we measured the seasonal distribution of 25-hydroxyvitamin D (25(OH)D) concentration in 390 healthy third trimester pregnant women living in urban and rural Mongolia using DiaSorin LIAISON and compared this distribution to that of 206 third trimester women living in Boston, USA. Also, we analyzed seasonally-independent associations between (25(OH)D) levels and selected predictors in both groups using quantile regression. Mean 25(OH)D levels were significantly higher and less seasonal in Boston (seasonal range: 27.1 {\textpm} 7.0{\textendash}31.5 {\textpm} 7.7 ng/ml) than in Mongolia (seasonal range: 11.2 {\textpm} 3.9{\textendash}19.2 {\textpm} 6.7 ng/ml). Adjusting for month of blood draw, higher 25(OH)D levels were significantly associated with older age, lower gravidity, lower BMI, and lack of a college or university degree among Boston participants, however, only gravidity was robust to multivariable adjustment. No assessed characteristics were independently predictive in Mongolia, likely due to universally low 25(OH)D levels and a resulting lack of between-person variation. In conclusion, vitamin D status among pregnant Mongolians is severely depressed throughout the year and should be addressed through fortification and supplementation, while in the U.S., deficiency is associated with specific characteristics targetable through supplementation.




},
	url = {https://www.sciencedirect.com/science/article/pii/S0960076019300858},
	author = {Sabri Bromage and Davaasambuu Enkhmaa and Tsedmaa Baatar and Gantsetseg Garmaa and Gary Bradwin and Buyandelger Yondonsambuu and Tuul Sengee and Enkhtuya Jamts and Narmandakh Suldsuren and McElrath, Thomas F. and David E. Cantonwine and Robert N. Hoover and Rebecca Troisi and Davaasambuu Ganmaa}
}
@article {631154,
	title = {Mediating role of arsenic in the relationship between diet and pregnancy outcomes: prospective birth cohort in Bangladesh},
	journal = {Environmental Health},
	volume = {18},
	number = {10},
	year = {2019},
	pages = {1-13},
	abstract = {
	Background



	Epidemiological evidence suggests that arsenic (As) exposure during pregnancy may reduce infant birth weight. One significant source of As exposure is diet; thus, As may indirectly affect infant growth by mediating the effect of maternal diet on birth weight (BW). This study evaluated the potential mediating effect of As in the relationship between maternal diet and BW, gestational age (GA), and gestational weight gain (GWG).



	Method



	The study used a prospective birth cohort in Bangladesh that captured the dietary habits of 1057 pregnant women through validated semi-quantitative food frequency questionnaires. We applied a causal mediation model with counterfactual approach and performed analyses with and without adjustment for total energy intake. Other potential confounders captured by self-report questionnaire were exposure to secondhand tobacco smoke, betel nut chewing, maternal age, education level, household income level, physical activity level during pregnancy, and daily hours spent cooking over open fire.



	Result



	No association was found between maternal toenail As and BW. Higher absolute and energy-adjusted protein, fat and fiber intakes were associated with higher toenail As and lower GA and GWG, while higher absolute and energy-adjusted carbohydrate intake was associated with lower toenail As and greater GA and GWG. Mediation analysis showed significant natural indirect effects by toenail As in the relationships between absolute fat, carbohydrate and fiber intake with GA. Specifically, 3\% (95\% CI: 1{\textendash}6\%) of the association between carbohydrate intake and GA was mediated by change in toenail As, 6\% (95\% CI: 1{\textendash}9\%) for absolute fat intake and 10\% (95\% CI: 4{\textendash}13\%) for absolute fiber intake. After adjusting for total energy, no significant mediating effect was observed, suggesting the mediating effect might be due to measurement error or that absolute amount of As exposure rather than the amount in relationship to total energy intake was a more important factor to consider when understanding the negative implication of As on fetal growth.



	Conclusion



	The mediating effect of As in the relationship between maternal diet and birth outcome was small and might be due to measurement error.

},
	url = {https://ehjournal.biomedcentral.com/articles/10.1186/s12940-019-0450-1},
	author = {Pi-I D. Lin and Sabri Bromage and Md. Golam Mostofa and Mohammad Rahman and Joseph Allen and Oken, Emily and Molly L. Kile and David C. Christiani}
}
@article {641783,
	title = {Vitamin D deficiency is associated with tuberculosis infection among household contacts in Ulaanbaatar, Mongolia},
	journal = {International Journal of Tuberculosis and Lung Disease},
	volume = {23},
	number = {8},
	year = {2019},
	pages = {919{\textendash}923},
	abstract = {
	BACKGROUND: Vitamin D deficiency (VDD) is a known risk factor for tuberculous infection. We investigated if VDD is a risk factor for tuberculous infection among the household contacts (HHCs) of patients with tuberculosis (TB) in Mongolia.



	MATERIALS AND METHOD: All HHCs of TB patients diagnosed in Khan-Uul District, Mongolia, were enrolled. The serum level of 25-hydroxyvitamin D [25(OH)D] was detected and TB infection determined using QuantiFERON-TB Gold Plus (QFT-Plus). A tuberculin skin test (TST) reading .10 mm was considered to be positive. Epidemiological and bacteriological data were collected from routine surveillance of the National Tuberculosis Programme.



	RESULTS: Among study participants, 48.2\% (135/285) were QFT-Plus-positive. Of QFT-positive HHCs, 77.0\% (104/135) were TST-positive and the overall concordance of tests was low (j 0.374, P , 0.001). A low serum level of 25(OH)D was an independent predictor for QFT-Plus positivity (P , 0.001). CD8{\th} T-cell stimulation measured by QFT-Plus had borderline association with the serum level of 25(OH)D (P {\textonequarter} 0.089).



	CONCLUSION: We showed a high rate of TB infection among HHCs in Mongolia. QFT-Plus could decrease the number of people requiring TB preventive treatment, in addition to aiding detection of new TB infection. A low serum level of vitamin D was an independent predictor of TB infection, but not a predictor of stimulation of CD8{\th} T cells.



	KEY WORDS: VDD; latent tuberculous infection; CD8{\th} T-cell stimulation; tuberculin skin test

},
	url = {https://www.ingentaconnect.com/contentone/iuatld/ijtld/2019/00000023/00000008/art00008},
	author = {Ulziijargal Gurjav and Munkhzaya Ankhbat and Gantungalag Ganbaatar and Khulan Batjargal and Batbayar Ochirbat and Delgerekh Baigal and Badamtsetseg Jargalsaikhan and Oyunsuren Munkhjargal and Sunjidmaa Bolormaa and Narankhuu Yansanjav and Narangerel Luvsanyandan and Gantserseg Dorj and Naranzul Dambaa and Sabri Bromage and Davaasambuu Ganmaa}
}
@article {630367,
	title = {Awareness and Attitudes Regarding Industrial Food Fortification in Mongolia and Harbin},
	journal = {Nutrients},
	number = {11},
	year = {2019},
	pages = {201},
	abstract = {
	This study assessed awareness and attitudes regarding industrial food fortification among adults in urban and rural Mongolia, and the city of Harbin, China. Between 2014 and 2017, surveys were collected from healthy men and women aged 18 years (182 Harbin residents and 129 urban and rural Mongolians participating in a nationwide nutrition survey in Mongolia). Survey reproducibility was assessed among 69 Mongolian participants to whom it was administered twice (summer and winter). Findings revealed that only 19\% of rural and 30\% of urban Mongolians, and 48\% of Harbin residents were aware that industrial fortification is practiced in their countries. For most food groups evaluated, at least half of Mongolians and less than half of Harbin residents thought fortification was government-mandated (only the addition of iodine with salt is actually mandated in both countries). Fifty-five percent of rural and urban Mongolians favored mandatory fortification of foods, 14\% disapproved of it, and 31\% were uncertain (compared with 25\%, 38\%, and 37\% respectively in Harbin). Upon learning that the primary purpose of adding vitamin D to milk is to prevent rickets, 75\% of Mongolians but only 18\% of Harbin residents favored mandatory fortification, while 42\% of Harbin residents favored voluntary fortification (compared with \&lt;10\% of Mongolians). In conclusion, in Mongolia and Harbin, awareness and understanding of food fortification is low, as is receptivity toward mandatory fortification. Health promotion and social marketing should be designed to create an enabling environment for increasing supply and demand of fortified foods, in support of upcoming program implementation in Mongolia and potential future legislation in northeern China.

},
	url = {https://www.mdpi.com/2072-6643/11/1/201},
	author = {Sabri Bromage and Enkhmaa Gonchigsumlaa and Margaret Traeger and Bayarbat Magsar and Qifan Wang and Jorick Bater and Hewei Li and Davaasambuu Ganmaa}
}
@article {626485,
	title = {Prevalence and determinants of QuantiFERON-diagnosed tuberculosis infection in 9,810 Mongolian schoolchildren},
	journal = {Clinical Infectious Disease},
	year = {2018},
	abstract = {
	BACKGROUND:



	There is controversy regarding the potential influence of vitamin D deficiency, exposure to environmental tobacco smoke, BCG vaccination, season and body habitus on susceptibility to Mycobacterium tuberculosis (MTB) infection.



	METHODS:



	We conducted a cross-sectional analysis to identify determinants of a positive QuantiFERON{\textregistered}-TB Gold (QFT) assay result in children aged 6-13 years attending 18 schools in Ulaanbaatar, Mongolia. Data relating to potential risk factors for MTB infection were collected by questionnaire, physical examination and determination of serum 25-hydroxyvitamin D (25[OH]D) concentrations. Risk ratios were calculated using generalized estimating equations with adjustment for potential confounders, and population attributable fractions (PAFs) were calculated for modifiable risk factors identified.



	RESULTS:



	946/9,810 (9.6\%) participants had a positive QFT result. QFT-positivity was independently associated with household exposure to pulmonary TB (adjusted risk ratio [aRR] 4.75, 95\% CI 4.13-5.46, P\&lt;0.001; PAF 13.1\%, 95\% CI 11.1\%-15.0\%), vitamin D deficiency (aRR 1.23, 95\% CI 1.08-1.40, P=0.002; PAF 5.7\%, 1.9\%-9.3\%), exposure to environmental tobacco smoke (one indoor smoker, aRR 1.19, 95\% CI 1.04-1.35; two or more indoor smokers, aRR 1.30, 95\% CI 1.02-1.64; P for trend, 0.006; PAF 7.2\%, 95\% CI 2.2\%-12.0\%) and increasing age (aRR per additional year 1.14, 95\% CI 1.10-1.19, P\&lt;0.001). No statistically significant independent association was seen for presence of a BCG scar, season of sampling or body mass index.



	CONCLUSIONS:



	Our findings underline the importance of contact tracing in TB-exposed households as a strategy to identify MTB-infected children. Vitamin D deficiency and exposure to environmental tobacco smoke may be modifiable risk factors for MTB infection.

},
	url = {https://academic-oup-com.ezp-prod1.hul.harvard.edu/cid/advance-article/doi/10.1093/cid/ciy975/5210883},
	author = {Davaasambuu Ganmaa and Polyna Khudyakov and Uyanga Buyanjargal and Badamtsetseg Jargalsaikhan and Delgerekh Baigal and Oyunsuren Munkhjargal and Narankhuu Yansan and Sunjidmaa Bolormaa and Enkhsaikhan Lkhagvasuren and Christopher T Sempos and Sabri Bromage and Zhenqiang Wu and Batbayar Ochirbat and Batbaatar Gunchin and Adrian R Martineau}
}
@article {625670,
	title = {Bronze Age population dynamics and the rise of dairy pastoralism on the eastern Eurasian steppe},
	journal = {PNAS},
	year = {2018},
	abstract = {
	Recent paleogenomic studies have shown that migrations of Western steppe herders (WSH) beginning in the Eneolithic (ca. 3300{\textendash}2700 BCE) profoundly transformed the genes and cultures of Europe and central Asia. Compared with Europe, however, the eastern extent of this WSH expansion is not well defined. Here we present genomic and proteomic data from 22 directly dated Late Bronze Age burials putatively associated with early pastoralism in northern Mongolia (ca. 1380{\textendash}975 BCE). Genome-wide analysis reveals that they are largely descended from a population represented by Early Bronze Age hunter-gatherers in the Baikal region, with only a limited contribution (\~{}7\%) of WSH ancestry. At the same time, however, mass spectrometry analysis of dental calculus provides direct protein evidence of bovine, sheep, and goat milk consumption in seven of nine individuals. No individuals showed molecular evidence of lactase persistence, and only one individual exhibited evidence of \&gt;10\% WSH ancestry, despite the presence of WSH populations in the nearby Altai-Sayan region for more than a millennium. Unlike the spread of Neolithic farming in Europe and the expansion of Bronze Age pastoralism on the Western steppe, our results indicate that ruminant dairy pastoralism was adopted on the Eastern steppe by local hunter-gatherers through a process of cultural transmission and minimal genetic exchange with outside groups.

},
	url = {http://www.pnas.org/content/early/2018/10/31/1813608115},
	author = {Choongwon Jeong and Shevan Wilkin and Tsend Amgalantugs and Abigail S. Bouwman and William Timothy Treal Taylor and Richard W. Hagan and Sabri Bromage and Soninkhishig Tsolmon and Christian Trachsel and Jonas Grossmann and Judith Littleton and Cheryl A. Makarewicz and John Krigbaum and Marta Burri and Ashley Scott and Ganmaa Davaasambuu and Joshua Wright and Franziska Irmer and Erdene Myagmar and Boivin, Nicole and Martine Robbeets and Frank J. R{\"u}hli and Krause, Johannes and Bruno Frohlich and Jessica Hendy and Christina Warinner}
}
@article {621747,
	title = {Risk Tradeoffs Associated with Traditional Food Advisories for Labrador Inuit},
	journal = {Environmental Research},
	year = {2018},
	abstract = {
	The traditional Inuit diet includes wild birds, fish and marine mammals, which can contain high concentrations of the neurotoxicant methylmercury (MeHg). Hydroelectric development may increase MeHg concentrations in traditional foods. Consumption advisories are often used to mitigate such risks and can result in reduced intake of traditional foods. Data from a dietary survey, MeHg exposure assessment and risk analysis for individuals in three Inuit communities in Labrador, Canada (n\&nbsp;= 1,145) in 2014 indicate reducing traditional food intake is likely to exacerbate deficiencies in n-3 polyunsaturated fatty acids and vitamins B12 and B2. Traditional foods accounted for \&lt; 5\% of per-capita calories but up to 70\% of nutrients consumed. Although consumption advisories could lower neurodevelopmental risks associated with an increase in MeHg exposure (90th-percentile ∆IQ = -0.12 vs. -0.34), they may lead to greater risks of cardiovascular mortality (90th-percentile increase: +58\% to +116\% vs. +25\%) and cancer mortality (90th-percentile increase +2\% to +4\% vs. no increase). Conversely, greater consumption of locally caught salmon mostly unaffected by hydroelectric flooding would lower all these risks (90th-percentile ∆IQ = +0.4; cardiovascular risk: {\textendash}45\%; cancer risk: {\textendash}1.4\%). We thus conclude that continued consumption of traditional foods is essential for Inuit health in these communities.

},
	url = {https://www.sciencedirect.com/science/article/pii/S0013935118304912},
	author = {Ryan S.D. Calder and Sabri Bromage and Elsie M. Sunderland}
}
@article {621748,
	title = {Prospective cohort study of overweight and obesity among rural Indian adults: sociodemographic predictors of prevalence, incidence and remission},
	journal = {BMJ Open},
	volume = {8},
	number = {8},
	year = {2018},
	pages = {e021363},
	abstract = {
	OBJECTIVES:



	To assess sociodemographic predictors of prevalence, incidence and remission of overweight including obesity among adults (aged >=18 years) in rural Eastern India.



	DESIGN:



	Prospective cohort study.



	SETTING:



	Birbhum Health and Demographic Surveillance System, West Bengal, India.



	PARTICIPANTS:



	Self-weighted sample of 24 115 adults (men: 10915, women: 13200) enrolled in 2008 were followed up for body mass index (BMI) reassessment in 2017.



	PRIMARY AND SECONDARY OUTCOME MEASURES:



	Measured BMI was categorised as: underweight (\&lt;18.5 kg/m2), normal weight (18.5-22.9 kg/m2) and overweight including obesity (>=23 kg/m2; hereinafter overweight). Incident overweight was defined as transition from normal weight in 2008 to overweight in 2017, whereas if overweight individuals in 2008 measured normal BMI in 2017, it was classified as remission from overweight.



	RESULTS:



	In 2008, 10.1\% of men and 14.6\% of women were overweight, whereas 17.3\% of men and 24.7\% of women were overweight in 2017. At the same time, in 2017, 35.6\% of men and 33.3\% of women were underweight. Incident overweight was 19.0\% among men and 27.2\% among women, whereas remission among men was higher (15.4\%) than women (11.5\%). Women were more likely to be overweight in 2008 and to experience incident overweight than men. For men and women, education level and wealth were positively associated with prevalence and incidence of overweight. Remission from overweight was less likely in Sainthia, a business hub in the district, as compared with Mohammad Bazar, a more rural area.



	CONCLUSION:



	A nutrition transition to higher risk of overweight is evident in this rural setting in India, especially among women and individuals with high socioeconomic status. At the same time, a high prevalence of underweight persists, resulting in a significant double burden. Culturally sensitive interventions that address both ends of the malnutrition spectrum should be prioritised.

},
	url = {https://bmjopen.bmj.com/content/8/8/e021363.long},
	author = {Rajesh K. Rai and Lindsay M. Jaacks and Sabri Bromage and Anamitra Barik and Wafaie W. Fawzi and Abhijit Chowdhury}
}
@article {621749,
	title = {Projected effectiveness of mandatory industrial fortification of wheat flour, milk, and edible oil with multiple micronutrients among Mongolian adults.},
	journal = {PLoS One},
	volume = {13},
	number = {8},
	year = {2018},
	pages = {e0201230},
	abstract = {
	Industrial fortification of wheat flour is a potentially effective strategy for addressing micronutrient deficiencies in Mongolia, given its ubiquitous consumption and centralized production. However, Mongolia has not mandated fortification of any foods except for salt with iodine. This study modeled the effectiveness and safety of mandatory industrial fortification of wheat flour alone and in combination with edible oil and milk in reducing the prevalence of multiple micronutrient intake deficiencies among healthy non-pregnant adults in Mongolia. Six days of diet records (3 summer, 3 winter) were collected from 320 urban and rural adults across the country and analyzed for food and nutrient consumption using a purpose-built food composition table, and the Intake Monitoring and Planning Program (IMAPP) was used to project the effects of fortification on summer and winter bioavailable micronutrient intake and intake deficiency under different fortification guidelines within population subgroups defined by urban or rural locality and sex. Projections showed that flour fortification would be effective in reducing intake deficiencies of thiamin and folate, while marginal benefits of fortification with iron and riboflavin would be smaller given these nutrients{\textquoteright} higher baseline consumption, and fortification with zinc, niacin, and vitamin B12 may be unnecessary. Fortification of flour, oil, and milk with vitamins A, D, and E at levels suggested by international guidelines would substantially reduce vitamin A intake deficiency and would increase vitamin D intake considerably, with the greatest benefits elicited by flour fortification and smaller benefits by additionally fortifying oil and milk. These results support mandatory industrial fortification of wheat flour, edible oil, and milk with iron, thiamin, riboflavin, folate, and vitamins A, D, and E in Mongolia. Considerations will be necessary to ensure the fortification of these nutrients is also effective for children, for whom the potential benefit of zinc, niacin, and vitamin B12 fortification should be assessed.

},
	url = {https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201230},
	author = {Sabri Bromage and Davaasambuu Ganmaa and Janet W. Rich-Edwards and Rosner, Bernard and Jorick Bater and Wafaie W. Fawzi}
}
@article {621750,
	title = {Comparison of Methods for Estimating Dietary Food and Nutrient Intakes and Intake Densities from Household Consumption and Expenditure Data in Mongolia.},
	journal = {Nutrients},
	volume = {10},
	number = {6},
	year = {2018},
	pages = {E703},
	abstract = {
	Household consumption and expenditure surveys are frequently conducted around the world and they usually include data on household food consumption, but their applicability to nutrition research is limited by their collection at the household level. Using data from Mongolia, this study evaluated four approaches for estimating diet from household surveys: direct inference from per-capita household consumption; disaggregation of household consumption using a statistical method and the "adult male equivalent" method, and direct prediction of dietary intake. Per-capita household consumption overestimated dietary energy in single- and multi-person households by factors of 2.63 and 1.89, respectively. Performance of disaggregation methods was variable across two household surveys analyzed, while the statistical method exhibited less bias in estimating intake densities (per 100 kcal) of most dietary components in both of the surveys. Increasingly complex prediction models explained 54\% to 72\% of in-sample variation in dietary energy, with consistent benefits incurred by inclusion of basic dietary measurements. In conclusion, in Mongolia and elsewhere, differences in how household and dietary measurements are recorded make their comparison challenging. Validity of disaggregation methods depends on household survey characteristics and the dietary components that are considered. Relatively precise prediction models of dietary intake can be achieved by integrating basic dietary assessment into household surveys.

},
	url = {http://www.mdpi.com/2072-6643/10/6/703},
	author = {Sabri Bromage and Rosner, Bernard and Janet W. Rich-Edwards and Davaasambuu Ganmaa and Soninkhishig Tsolmon and Zuunnast Tserendejid and Tseye-Oidov Odbayar and Margaret Traeger and Wafaie W. Fawzi}
}
@mastersthesis {664914,
	title = {Epidemiology of Dietary and Micronutrient Deficiencies in Mongolia},
	year = {2018},
	type = {ScD Dissertation},
	url = {http://nrs.harvard.edu/urn-3:HUL.InstRepos:37945604},
	author = {Sabri Bromage}
}
@article {621751,
	title = {Underweight among rural Indian adults: burden, and predictors of incidence and recovery.},
	journal = {Public Health Nutrition},
	volume = {21},
	number = {4},
	year = {2018},
	pages = {669-678},
	abstract = {
	OBJECTIVE:



	To study the magnitude and predictors of underweight, incident underweight and recovery from underweight among rural Indian adults.



	DESIGN:



	Prospective cohort study. Each participant{\textquoteright}s BMI was measured in 2008 and 2012 and categorized as underweight (BMI\&lt;18{\textperiodcentered}5 kg/m2), normal (BMI=18{\textperiodcentered}5-22{\textperiodcentered}9 kg/m2) or overweight/obese (BMI >=23{\textperiodcentered}0 kg/m2). Incident underweight was defined as a transition from normal weight or overweight/obese in 2008 to underweight in 2012, and recovery from underweight as a transition from underweight in 2008 to normal weight in 2012. Bivariate and multivariable logistic regression analyses were employed.



	SETTING:



	The Birbhum Health and Demographic Surveillance System, West Bengal, India.



	SUBJECTS:



	Predominantly rural individuals (n 6732) aged >=18 years enrolled in 2008 were followed up in 2012.



	RESULTS:



	In 2008, the prevalence of underweight was 46{\textperiodcentered}5 \%. From 2008 to 2012, 25{\textperiodcentered}8 \% of underweight persons transitioned to normal BMI, 12{\textperiodcentered}9 \% of normal-weight persons became underweight and 0{\textperiodcentered}1 \% of overweight/obese persons became underweight. Multivariable models reveal that people aged 25-49 years, educated and wealthier people, and non-smokers had lower odds of underweight in 2008 and lower odds of incident underweight. Odds of recovery from underweight were lower among people aged >=36 years and higher among educated (Grade 6 or higher) individuals.



	CONCLUSIONS:



	The current study highlights a high incidence of underweight and important risk factors and modifiable predictors of underweight in rural India, which may inform the design of local nutrition interventions.

},
	url = {https://www.cambridge.org/core/journals/public-health-nutrition/article/underweight-among-rural-indian-adults-burden-and-predictors-of-incidence-and-recovery/1988B84C71586B1A68E9FCDE8C3D4708},
	author = {Rajesh K. Rai and Wafaie W. Fawzi and Sabri Bromage and Anamitra Barik and Abhijit Chowdhury}
}
@article {621754,
	title = {High-Dose Vitamin D3 during Tuberculosis Treatment in Mongolia. A Randomized Controlled Trial.},
	journal = {American Journal of Respiratory and Critical Care Medicine},
	volume = {196},
	number = {5},
	year = {2017},
	pages = {628-637},
	abstract = {
	RATIONALE:



	Existing trials of adjunctive vitamin D in the treatment of pulmonary tuberculosis (PTB) are variously limited by small sample sizes, inadequate dosing regimens, and high baseline vitamin D status among participants. Comprehensive analyses of the effects of genetic variation in the vitamin D pathway on response to vitamin D supplementation are lacking.



	OBJECTIVES:



	To determine the effect of high-dose vitamin D3\&nbsp;on response to antimicrobial therapy for PTB and to evaluate the influence of single-nucleotide polymorphisms (SNPs) in vitamin D pathway genes on response to adjunctive vitamin D3.



	METHODS:



	We conducted a clinical trial in 390 adults with PTB in Ulaanbaatar, Mongolia, who were randomized to receive four biweekly doses of 3.5 mg (140,000 IU) vitamin D3\&nbsp;(n = 190) or placebo (n = 200) during intensive-phase antituberculosis treatment.



	MEASUREMENTS AND MAIN RESULTS:



	The intervention elevated 8-week serum 25-hydroxyvitamin D concentrations (154.5 nmol/L vs. 15.2 nmol/L in active vs. placebo arms, respectively; 95\% confidence interval for difference, 125.9-154.7 nmol/L; P \&lt; 0.001) but did not influence time to sputum culture conversion overall (adjusted hazard ratio, 1.09; 95\% confidence interval, 0.86-1.36; P = 0.48). Adjunctive vitamin D3\&nbsp;accelerated sputum culture conversion in patients with one or more minor alleles for SNPs in genes encoding the vitamin D receptor (rs4334089, rs11568820) and 25-hydroxyvitamin D 1α-hydroxylase (CYP27B1: rs4646536) (adjusted hazard ratio >= 1.47; P for interaction <= 0.02).



	CONCLUSIONS:



	Vitamin D3\&nbsp;did not influence time to sputum culture conversion in the study population overall. Effects of the intervention were modified by SNPs in VDR and CYP27B1. Clinical trial registered with www.clinicaltrials.gov (NCT01657656).

},
	url = {https://www.atsjournals.org/doi/full/10.1164/rccm.201705-0936OC},
	author = {Davaasambuu Ganmaa and Baatar Munkhzul and Wafaie W. Fawzi and Spiegelman, Donna and Willett, Walter C. and Purev Bayasgalan and Erkhembayar Baasansuren and Burneebaatar Buyankhishig and Sereeter Oyun-Erdene and David A. Jolliffe and Theodoros Xenakis and Sabri Bromage and Barry R. Bloom and Adrian R. Martineau}
}
@article {621753,
	title = {Validation of summer and winter ELISA measurements of serum 25-hydroxyvitamin D concentrations in Mongolia.},
	journal = {Asia Pacific Journal of Clinical Nutrition},
	volume = {26},
	number = {6},
	year = {2017},
	pages = {987-993},
	abstract = {
	BACKGROUND AND OBJECTIVES:



	Assay cost, quality, and availability pose challenges for vitamin D surveys in limited resource settings. This study aimed to validate an inexpensive vitamin D assay (ELISA) under real-world conditions in Mongolia, the northernmost developing country, to characterize the assay{\textquoteright}s usefulness and inform the design of epidemiologic studies in similar regions.



	METHODS AND STUDY DESIGN:



	We collected paired summer and winter serum samples from 120 men and women (aged 20-57 years) in urban and rural Mongolia, analyzed each sample for 25(OH)D concentration using both Immunodiagnostic Systems ELISA and DiaSorin LIAISON 25(OH)D TOTAL, and compared the assays using multiple statistics. LIAISON was itself validated by participation in the DEQAS program.



	RESULTS:



	Correlation and agreement between assays were higher in summer (Pearson{\textquoteright}s correlation=0.60, Spearman{\textquoteright}s rank correlation=0.67, Lin{\textquoteright}s concordance correlation=0.56) than winter (rP=0.37, rS=0.43, rC=0.33), although ELISA less accurately assigned subjects to sufficiency categories in summer (percent agreement=44\%) than winter (58\%), during the latter of which most subjects were deficient ([25(OH)D] categories used: \&gt;75 nmol/L (optimal), 50-75 nmol/L (adequate), 25-50 nmol/L (inadequate), \&lt;25 nmol/L (deficient)). Compared with LIAISON, ELISA tended to indicate higher vitamin D status in both seasons (mean paired difference: 7.0 nmol/L (95\% CI: 3.5-10.5) in summer, 5.2 nmol/L (95\% CI: 2.9-7.5) in winter).



	CONCLUSIONS:



	ELISA proved useful for measuring and ranking subjects{\textquoteright} vitamin D status in Mongolia during summer, but levels were too low in winter to sensitively discriminate between subjects, and ELISA overestimated status in both seasons. These findings have implications for the timing and interpretation, respectively, of vitamin D surveys in highly deficient populations.

},
	url = {http://apjcn.nhri.org.tw/server/APJCN/26/6/987.pdf},
	author = {Sabri Bromage and Tselmen Daria and Gary Bradwin and Michael F. Holick and Davaasambuu Ganmaa}
}
@article {621755,
	title = {Associations between Diet and Toenail Arsenic Concentration among Pregnant Women in Bangladesh: A Prospective Study.},
	journal = {Nutrients},
	volume = {9},
	number = {4},
	year = {2017},
	pages = {420},
	abstract = {
	This prospective study evaluated the relationship between long-term dietary habits and total arsenic (As) concentration in toenail clippings in a cohort of 1616 pregnant women in the Bangladeshi administrative regions of Sirajdikhan and Pabna Sadar. Diet was assessed at Gestation Week 28 and at Postpartum Month 1, using a locally-validated dish-based semi-quantitative food-frequency questionnaire. Toenail As concentration was analyzed by microwave-assisted acid digestion and inductively coupled plasma mass spectrometry. Associations between natural log-transformed consumption of individual food items and temporally matched natural log-transformed toenail As concentration were quantified using general linear models that accounted for As concentration in the primary drinking water source and other potential confounders. The analysis was stratified by As in drinking water (<=50 μg/L versus \&gt;50 μg/L) and the time of dietary assessment (Gestation Week 28 versus Postpartum Week 1). Interestingly, toenail As was not significantly associated with consumption of plain rice as hypothesized. However, toenail As was positively associated with consumption of several vegetable, fish and meat items and was negatively associated with consumption of rice, cereal, fruits, and milk based food items. Further studies in pregnant women are needed to compare As metabolism at different levels of As exposure and the interaction between dietary composition and As absorption.

},
	url = {http://www.mdpi.com/2072-6643/9/4/420},
	author = {Pi-I D. Lin and Sabri Bromage and Md. Golam Mostofa and Joseph Allen and Oken, Emily and Molly L. Kile and David C. Christiani}
}
@article {621757,
	title = {Trained Cohorts of University Students are a Useful Resource for Conducting Dietary Surveys in Mongolia},
	journal = {Food and Nutrition Bulletin},
	volume = {38},
	number = {2},
	year = {2017},
	pages = {267-272},
	abstract = {
	BACKGROUND:



	Population-based dietary assessment is important for informing national nutrition policy. The developing country setting presents challenges for robust implementation of dietary surveys, yet effective nutrition interventions are often urgently required.



	OBJECTIVE:



	To develop and evaluate a low-cost approach to epidemiologic dietary assessment in Mongolia, involving the use of large cohorts of local public health and medical students as research assistants for collecting diet records.



	METHODS:



	From 2011 to 2016, over 200 Mongolian medical and public health university students were trained to collect paired summer and winter 3-day weighed diet records from urban and rural study populations across the geographic expanse of Mongolia. Students were supervised during data collection, and their performance and experience during training and data collection were qualitatively evaluated from their own perspectives as well as those of the investigators.



	RESULTS:



	Students collected detailed and thorough diet records and generally reported positive feedback regarding training and data collection. Frequent supervision of students during data collection proved to be extremely worthwhile. While rural participants were amenable to having students follow them, students faced several challenges in assessing the diets of urban participants. These challenges may best be addressed by separately training these participants beforehand.



	CONCLUSIONS:



	With adequate training and supervision, university students may be a useful and cost-effective resource for large-scale dietary surveys in regions where their use would be practical and culturally appropriate. Further research is warranted to study how well this approach may be adapted outside Mongolia and to other dietary assessment methods and technologies.

},
	url = {http://journals.sagepub.com/doi/full/10.1177/0379572117700749},
	author = {Sabri Bromage and Holly Y.F. Chung and Hannah Bonville and Jeannie C. Sprenger and Rebecca Lander and Davaasambuu Ganmaa}
}
@article {621758,
	title = {Validation of a Dish-Based Semiquantitative Food Questionnaire in Rural Bangladesh.},
	journal = {Nutrients},
	volume = {9},
	number = {1},
	year = {2017},
	pages = {E49},
	abstract = {
	A locally validated tool was needed to evaluate long-term dietary intake in rural Bangladesh. We assessed the validity of a 42-item dish-based semi-quantitative food frequency questionnaire (FFQ) using two 3-day food diaries (FDs). We selected a random subset of 47 families (190 participants) from a longitudinal arsenic biomonitoring study in Bangladesh to administer the FFQ. Two 3-day FDs were completed by the female head of the households and we used an adult male equivalent method to estimate the FD for the other participants. Food and nutrient intakes measured by FFQ and FD were compared using Pearson{\textquoteright}s and Spearman{\textquoteright}s correlation, paired\&nbsp;t-test, percent difference, cross-classification, weighted Kappa, and Bland{\textendash}Altman analysis. Results showed good validity for total energy intake (paired\&nbsp;t-test,\&nbsp;p\&nbsp;\&lt; 0.05; percent difference \&lt;10\%), with no presence of proportional bias (Bland{\textendash}Altman correlation,\&nbsp;p\&nbsp;\&gt; 0.05). After energy-adjustment and de-attenuation for within-person variation, macronutrient intakes had excellent correlations ranging from 0.55 to 0.70. Validity for micronutrients was mixed. High intraclass correlation coefficients (ICCs) were found for most nutrients between the two seasons, except vitamin A. This dish-based FFQ provided adequate validity to assess and rank long-term dietary intake in rural Bangladesh for most food groups and nutrients, and should be useful for studying dietary-disease relationships.

},
	url = {http://www.mdpi.com/2072-6643/9/1/49},
	author = {Pi-I D. Lin and Sabri Bromage and Md. Golam Mostofa and Joseph Allen and Oken, Emily and Molly L. Kile and David C. Christiani}
}
@article {621761,
	title = {Calcium Deficiency in Bangladesh: Burden and Proposed Solutions for the First 1000 Days.},
	journal = {Food and Nutrition Bulletin},
	volume = {37},
	number = {4},
	year = {2016},
	pages = {475-493},
	abstract = {
	BACKGROUND:



	Bangladesh incurs among the highest prevalence of stunting and micronutrient deficiencies in the world, despite efforts against diarrheal disease, respiratory infections, and protein-energy malnutrition which have led to substantial and continuous reductions in child mortality over the past 35 years. Although programs have generally paid more attention to other micronutrients, the local importance of calcium to health has been less recognized.



	OBJECTIVE:



	To synthesize available information on calcium deficiency in Bangladesh in order to inform the design of an effective national calcium program.



	METHODS:



	We searched 3 online databases and a multitude of survey reports to conduct a narrative review of calcium epidemiology in Bangladesh, including population intake, determinants and consequences of deficiency, and tested interventions, with particular reference to young children and women of childbearing age. This was supplemented with secondary analysis of a national household survey in order to map the relative extent of calcium adequacy among different demographics.



	RESULTS:



	Intake of calcium is low in the general population of Bangladesh, with potentially serious and persistent effects on public health. These effects are especially pertinent to young children and reproductive-age women, by virtue of increased physiologic needs, disproportionately poor access to dietary calcium sources, and a confluence of other local determinants of calcium status in these groups.



	CONCLUSION:



	A tablet supplementation program for pregnant women is an appealing approach for the reduction in preeclampsia and preterm birth. Further research is warranted to address the comparative benefit of different promising approaches in children for the prevention of rickets.

},
	url = {http://journals.sagepub.com/doi/full/10.1177/0379572116652748},
	author = {Sabri Bromage and Tahmeed Ahmed and Wafaie W. Fawzi}
}
@article {621760,
	title = {Intervention study shows suboptimal growth among children receiving a food supplement for five months in a slum in Bangladesh.},
	journal = {Acta Paediatrica},
	volume = {105},
	number = {10},
	year = {2016},
	pages = {e464-73},
	abstract = {
	AIM:



	This study assessed weight and height changes among underweight children who received a locally produced, cereal-based, ready-to-use supplementary food.



	METHODS:



	We recruited 500 underweight Bangladeshi children aged 6-23 months from a Dhaka slum and individually matched them by sex and neighbourhood with 480 well-nourished controls. The intervention group received the daily food supplement for five months, and both groups received daily micronutrient supplements. Their weight, height, mid-upper-arm circumference and head circumference were measured monthly.



	RESULTS:



	The children{\textquoteright}s mean daily weight gain decreased from 1.27 to 0.66 grams per kilogram per day (g/kg/day) in the intervention group and 0.77 to 0.49 g/kg/day in the controls after adjusting for age differences between the two groups from baseline to five months of follow-up. The mean monthly height gain decreased from 1.13 to 1.03 millimetres per metre per month in the intervention children and 1.26 to 1.01 in the controls. The weight gain was highest in the intervention children who were most wasted at baseline and the controls who were least stunted.



	CONCLUSION:



	The children showed suboptimal growth despite food supplements, highlighting the need for ongoing research to develop inexpensive, locally sourced food supplements to improve the nutrition of underweight children in Bangladesh.

},
	url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/apa.13528},
	author = {Nuzhat Choudhury and Sabri Bromage and Md. Ashraful Alam and A.M. Shamsir Ahmed and Md. Munirul Islam and Md. Iqbal Hossain and Mustafa Mahfuz and Dinesh Mondal and Rashidul Haque and Tahmeed Ahmed}
}
@article {621759,
	title = {Seasonal Epidemiology of Serum 25-Hydroxyvitamin D Concentrations among Healthy Adults Living in Rural and Urban Areas in Mongolia.},
	journal = {Nutrients},
	volume = {8},
	number = {10},
	year = {2016},
	pages = {E592},
	abstract = {
	Many factors put Mongolians at risk of vitamin D deficiency. Despite low levels observed in Mongolian children and pregnant women, there are few data published on the vitamin D status of non-pregnant adults. Between summer 2011 and winter 2013, paired summer and winter blood samples were collected from 320 healthy men and women (20-58 years) living in eight Mongolian provinces. Mean serum 25(OH)D concentrations were 22.5 ng/mL (95\% CI: 14.5, 32.5) in summer and 7.7 ng/mL (95\% CI: 4.6, 10.8) in winter, with a distribution (\&lt;10/10-20/20-30/>=30 ng/mL) of 3.1\%/39.3\%/39.6\%/17.9\% in summer and 80.1\%/19.5\%/0.3\%/0.0\% in winter. Residents of the capital, Ulaanbaatar, had lower levels in both seasons than any other region, whereas residents of the Gobi desert had the highest. In summer, indoor workers had significantly lower levels than outdoor workers (-2.3 ng/mL; 95\% CI: -4.1, -5.7) while levels in males exceeded those in females (4.0 ng/mL; 95\% CI: 2.3, 5.7). Effects of region, occupation, and sex were also significant in multivariable regression. In conclusion, Mongolian adults had extremely low serum 25(OH)D, particularly in winter, when 80.1\% had concentrations below 10 ng/mL. These results indicate a need for effective vitamin D interventions for the Mongolian adult population, particularly among women and residents of Ulaanbaatar.

},
	url = {http://www.mdpi.com/2072-6643/8/10/592},
	author = {Sabri Bromage and Janet W. Rich-Edwards and Daria Tselmen and Baylin, Ana and Lisa A. Houghton and Nachin Baasanjav and Davaasambuu Ganmaa}
}
@magazinearticle {660881,
	title = {Opinion: Diet is the number one killer in Mongolia},
	journal = {Forbes Mongolia},
	year = {2016},
	pages = {42-44},
	abstract = {
	Though nutrition has its biological and medical aspects, what a people eats is also central to its culture and history. Friends and families bond as they eat together. Recipes are handed down from generation to generation. The tastes and smells of mother{\textquoteright}s cooking evoke memories of childhood, and deep feelings of safety. Mongolia{\textquoteright}s culture is thousands of years old, and while eating a diet quite similar to the one people in the countryside eat today, Mongolians developed the largest contiguous land empire in human history. The Mongol empire was built upon meat and milk. So, what is wrong with the Mongolian diet?



	\&nbsp;



	Хоол хүнс, шим тэжээл нь биологийн болон анагаах ухааны үүднээс олон талын ач холбогдолтой бөгөөд хүн юу идэх вэ гэдэг нь тухайн орны соёл, түүхийн онцлогоос ихээхэн хамаардаг. Мөн гэр бүл, анд найзуудын хоорондын харилцааг ч хоол, хүнс дулаан уур амьсгалтай болгох нь бий. Хоолны жор үеэс үед уламжлагдан ирдэг билээ. Ээжийн хийсэн хоолны үнэр болон амт хүүхэд насны дурсамжийг сэргээж, тайван аюулгүй мэдрэмжийг бид бүхэнд төрүүлдэг. Түүхэн дэх хамгийн том газар нутгийг эзэлж явсан, хэдэн мянган жилийн түүхтэй Монгол орны хоолны соёлд ч өнөөдрийн бидний хэрэглээнд буй мах, сүү дийлэнх хувийг эзэлдэг байсан. Тэгвэл өнөөдрийн Монголчуудын хоол хүнсний хэрэглээнд үүсээд буй асуудал юу вэ?



	\&nbsp;

},
	author = {Sabri Bromage}
}
