Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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    Natuurbeleid betwist : Visies op legitimiteit en natuurbeleid
    Buijs, A.E. ; Boonstra, F.G. - \ 2020
    Zeist : KNNV uitgeverij - ISBN 9789050117456 - 220 p.
    Wat is legitimiteit?
    Buijs, A.E. ; Mattijssen, T.J.M. ; Boonstra, F.G. - \ 2020
    In: Natuurbeleid betwist / Buijs, Arjen, Boonstra, Froukje, Zeist : KNNV uitgeverij - ISBN 9789050117456 - p. 19 - 28.
    Buijs, A.E. ; Boonstra, F.G. ; Mattijssen, T.J.M. - \ 2020
    In: Natuurbeleid betwist / Buijs, Arjen, Boonstra, Froukje, Zeist : KNNV uitgeverij - ISBN 9789050117456 - p. 9 - 18.
    Tot slot: Meervoudige legitimiteit en het belang van een mens-inclusief natuurverhaal
    Buijs, A.E. ; Boonstra, F.G. - \ 2020
    In: Natuurbeleid betwist / Buijs, A., Boonstra, F., Zeist : KNNV uitgeverij - ISBN 9789050117456 - p. 182 - 198.
    Een museum in de wildernis
    Behagel, J.H. ; Turnhout, E. - \ 2020
    In: Natuurbeleid betwist / Buijs, A., Boonstra, F., Zeist : KNNV uitgeverij - ISBN 9789050117456 - p. 135 - 144.
    De meervoudige legitimiteit van sturing op biodiversiteitsherstel in het agrarisch landschap: spanningen en synergiën
    Runhaar, Hens - \ 2020
    In: Natuurbeleid betwist / Buijs, A., Boonstra, F., Zeist : KNNV uitgeverij - ISBN 9789050117456 - p. 158 - 169.
    Two novel porcine teschovirus strains as the causative agents of encephalomyelitis in the Netherlands
    Vreman, Sandra ; Caliskan, Nermin ; Harders, Frank ; Boonstra, Jan ; Peperkamp, Klaas ; Ho, Cynthia K.Y. ; Kuller, Wikke ; Kortekaas, Jeroen - \ 2020
    BMC Veterinary Research 16 (2020)1. - ISSN 1746-6148
    Non-suppurative encephalomyelitis - Porcine teschovirus - Weanling pigs

    Background: Porcine teschovirus (PTV) circulates among wild and domesticated pig populations without causing clinical disease, however neuroinvasive strains have caused high morbidity and mortality in the past. In recent years, several reports appeared with viral agents as a cause for neurologic signs in weanling and growing pigs among which PTV and new strains of PTV were described. Case presentation: On two unrelated pig farms in the Netherlands the weanling pig population showed a staggering gate, which developed progressively to paresis or paralysis of the hind legs with a morbidity up to 5%. After necropsy we diagnosed a non-suppurative encephalomyelitis on both farms, which was most consistent with a viral infection. PTV was detected within the central nervous system by qPCR. From both farms PTV full-length genomes were sequenced, which clustered closely with PTV-3 (98%) or PTV-11 (85%). Other common swine viruses were excluded by qPCR and sequencing of the virus. Conclusion: Our results show that new neuroinvasive PTV strains still emerge in pigs in the Netherlands. Further research is needed to investigate the impact of PTV and other viral agents causing encephalomyelitis within wild and domestic pig populations supported by the awareness of veterinarians.

    Protein intake adequacy among Nigerian infants, children, adolescents and women and protein quality of commonly consumed foods
    Vries-Ten Have, Judith De; Owolabi, Adedotun ; Steijns, Jan ; Kudla, Urszula ; Melse-Boonstra, Alida - \ 2020
    Nutrition Research Reviews 33 (2020)1. - ISSN 0954-4224 - p. 102 - 120.
    Diet - Digestible indispensable amino acid score (DIAAS) - Essential amino acids - Nigeria - Protein intake

    Protein is important for growth, maintenance and protection of the body. Both adequacy of protein quantity and protein quality in the diet are important to guarantee obtaining all the essential amino acids. Protein-energy malnutrition is widely present in developing countries such as Nigeria and might result in stunting and wasting. Needs for protein differ depending on age and physiological status and are higher during growth, pregnancy and lactation. The present review assessed protein quantity and quality in diets of Nigerian infants, children, adolescents, and pregnant and lactating women. Literature reviews and calculations were performed to assess adequacy of Nigerian protein intake and to examine the Nigerian diet. The digestible indispensable amino acid score was used to calculate protein quality of nine Nigerian staple foods and of a mixture of foods. The Nigerian population had mostly adequate protein intake when compared with the most recent protein recommendations by the FAO (2013) and WHO/FAO/UNU (2007). An important exception was the protein intake of adolescent girls and pregnant and lactating women. Most of the assessed Nigerian plant-based staple foods were of low protein quality and predominantly lacked the amino acid lysine. The addition of animal-source foods can bridge the protein quality gap created by predominance of plant-based foods in the Nigerian diet. The methodology of this review can be applied to other low- and middle-income countries where diets are often plant-based and lack variety, which might influence protein intake adequacy.

    Gene interactions observed with the HDL-c blood lipid, intakes of protein, sugar and biotin in relation to circulating homocysteine concentrations in a group of black South Africans
    Plessis, Jacomina P. du; Melse-Boonstra, Alida ; Zandberg, Lizelle ; Nienaber-Rousseau, Cornelie - \ 2020
    Molecular Genetics and Metabolism Reports 22 (2020). - ISSN 2214-4269
    Biotin - Blood lipid–gene interactions - Gene–diet interactions - Hyperhomocysteinemia - Nutrient–gene interactions - Nutrigenetics - Precision nutrition - Protein - Sugar - Total homocysteine

    Background: Elevated homocysteine (Hcy) is associated with several pathologies. Gene–diet interactions related to Hcy might be used to customize dietary advice to reduce disease incidence. To explore this possibility, we investigated interactions between anthropometry, biochemical markers and diet and single-nucleotide polymorphisms (SNPs) in relation to Hcy concentrations. Five SNPs of Hcy-metabolizing enzymes were analyzed in 2010 black South Africans. Results: Hcy was higher with each additional methylenetetrahydrofolate reductase (MTHFR) C677T minor allele copy, but was lower in methionine synthase (MTR) 2756AA homozygotes than heterozygotes. Individuals harboring cystathionine β synthase (CBS) 833 T/844ins68 had lower Hcy concentrations than others. No interactive effects were observed with any of the anthropometrical markers. MTHFR C677T and CBS T833C/844ins68 homozygote minor allele carriers presented with lower Hcy as high density lipoprotein cholesterol (HDL-c) increased. Hcy concentrations were negatively associated with dietary protein and animal protein intake in the TT and TC genotypes, but positively in the CC genotype of CBS T833C/844ins68. Hcy was markedly higher in TT homozygotes of MTHFR C677T as added sugar intake increased. In CBS T833C/844ins68 major allele carriers, biotin intake was negatively associated with Hcy; but positively in those harboring the homozygous minor allele. Conclusions: The Hcy–SNP associations are modulated by diet and open up the possibility of invoking dietary interventions to treat hyperhomocysteinemia. Future intervention trials should further explore the observed gene–diet and gene–blood lipid interactions.

    Herstel & benutten van biodiversiteit in de kringlooplandbouw : programmeringsstudie voor de kennis en innovatie agenda
    Doorn, Anne van; Schutt, Jeroen ; Erisman, Jan Willem ; Kleijn, David ; Melman, Dick ; Sukkel, Wijnand ; Migchels, Gerard ; Lotz, Bert ; Westerik, Judith ; Schmidt, Anne ; Roessink, Ivo ; Groot, Arjen de; Boonstra, Froukje ; Blijdorp, Janneke ; Hilgen, Peter - \ 2019
    Wageningen : Wageningen University & Research - 40
    Meer met mate: co-creatie en leren
    Schönfeld, Kim von; Tan, W.G.Z. - \ 2019
    In: Meer met meer: Bijdragen aan de Plandag 2019. - Groningen : Stichting Planologische Discussiedagen - ISBN 9789081921763 - p. 154 - 161.
    citizen participation - urban planning - Social learning
    In the context of 'more-with-more', citizens are often asked to do more: they have to participate more, do more themselves and take on more responsibility. At the same time, this also requires more administration and flexible working from the government.
    This can result in a more involved attitude from both sides, and in building better-tuned results and knowledge. But this does not happen automatically, and we still too often start from the ideal of participation and co-creation, as a result of which we do not look sufficiently at which forms of this lead to which outcomes and consequences. Social learning is an analytical concept that can help with this: by looking better at how we gain knowledge and skills through interaction with others, we can get a better grip on which factors respond to each other in which way. This article introduces two cases from Groningen, the Netherlands, and discusses three main lessons that flow from this, regarding "desired" results; speed and efficiency; and personal backgrounds and timing of collaboration. The conclusion reflects on five concrete consequences that this has for planning practice.
    Het stedelijk laboratorium als lege huls? Het gevaar van het verzuimen van wetsnormen in een ‘experiment’
    Karnenbeek, Lilian van; Tan, W.G.Z. - \ 2019
    In: Meer met meer. - Groningen : Stichting Planologische Discussiedagen - ISBN 9789081921763 - p. 182 - 190.
    citizen participation - urban planning - experiments
    Wat is er gebeurd met Planners’ Paradise? Een analyse van Nederlands gemeentelijk grondbeleid
    Nieland, Elin ; Meijer, R. ; Jonkman, Arend ; Hartmann, Thomas - \ 2019
    In: Meer met meer. - Groningen : Stichting Planologische Discussiedagen - ISBN 9789081921763 - p. 30 - 37.
    citizen participation - urban planning - Social learning
    Fractional Absorption of Iron from Crickets Consumed with Refined or Whole Meal Maize Porridge in Young Adult Women (OR07-06-19)
    Melse-Boonstra, A. ; Mwangi, M.N. ; Oonincx, D.G.A.B. ; Loon, J.J.A. van; Cercamondi, C.I. ; Utami, Dessy Aryanti ; Gunawan, Lidyawati ; Veenenbos, M.E. ; Zeder, Christophe ; Zimmermann, M.B. ; Dicke, M. - \ 2019
    Current Developments in Nutrition 3 (2019)Supplement_1. - ISSN 2475-2991 - p. 728 - 728.
    Edible insects are considered as an alternative source of proteins, but in addition are also rich sources of minerals. However, no studies have investigated the bioavailability of minerals from edible insects in humans. House cricket (Acheta domesticus) is an edible insect species that is commonly consumed in low and middle income countries where the prevalence of iron deficiency and anaemia is relatively high. We aimed to assess the fractional iron absorption of iron from house crickets in humans after addition to either a refined (low-phytate) or a whole meal (high-phytate) maize porridge meal. A second objective was to assess the fractional iron absorption from maize porridge meals when crickets were added.
    Vooronderstellingen maatschappelijke betrokkenheid en legitimiteit natuurbeleid. : Tussenrapportage WOT-04-010-037.08
    Buijs, A.E. ; Boonstra, F.G. - \ 2019
    Dietary patterns and the double burden of malnutrition in mexican adolescents : Results from ENSANUT-2006
    Zárate-Ortiz, Arli Guadalupe ; Melse-Boonstra, Alida ; Rodríguez-Ramírez, Sonia ; Hernández-Cordero, Sonia ; Feskens, Edith J.M. - \ 2019
    Nutrients 11 (2019)11. - ISSN 2072-6643
    Adolescence - Anemia - Dietary patterns - Double burden - Malnutrition - Overweight and obesity - Stunting

    Mexico is facing the double burden of malnutrition, and adolescents are not an exception. Diet plays an important role, both in causing overweight and undernutrition. This study aimed to describe the dietary patterns (DPs) of Mexican adolescents and to examine its association with nutritional status using data from adolescents aged 12–19 years (n = 7380) from the National Survey of Health and Nutrition (ENSANUT-2006). Principal component analysis was used to derivate the DPs. Associations between DP and nutritional status were determined by prevalence ratio (PR). Four DPs were identified: nontraditional and breakfast-type, Western, plant-based, and protein-rich. The prevalence of overweight and obesity was higher in adolescents who scored high on the Western pattern (PR: 1.15, 95% CI: 1.08–1.21) or on the plant-based pattern (PR: 1.09, 95% CI: 1.03–1.17). The Western pattern was positively associated with anemia in girls (PR: 1.18, 95% CI: 1.03–1.35), while the nontraditional and breakfast-type pattern was inversely associated with anemia in adolescents aged 12–15 years (PR: 0.87, 95% CI: 0.76–0.99) and in girls (PR: 0.84, 95% CI: 0.75–0.97). The Western and plant-based patterns were simultaneously associated with overweight–obesity and at least one indicator of undernutrition. In the context of the double burden of malnutrition, dietary advice must consider malnutrition in all its forms.

    Comparing saliva and urine samples for measuring breastmilk intake with the deuterium oxide dose-to-mother technique among children 2-4 months old
    Matsiko, Eric ; Hulshof, Paul J.M. ; Velde, Laura Van Der; Kenkhuis, Marlou Floor ; Tuyisenge, Lisine ; Melse-Boonstra, Alida - \ 2019
    The British journal of nutrition (2019). - ISSN 0007-1145
    Breastmilk intake - Deuterium oxide dose-to-mother technique - Doubly labelled water - Maternal energy expenditure - Saliva and urine samples

    Saliva and urine are the two main body fluids sampled when breastmilk intake is measured with the deuterium oxide dose-to-mother technique. However, these two body fluids may generate different estimates of breastmilk intake due to differences in isotope enrichment. Therefore, we aimed to assess how the estimated amount of breastmilk intake differs when based on saliva and urine samples and to explore whether the total energy expenditure of the mothers is related to breastmilk output. We used a convenience sample of 13 pairs of mothers and babies aged 2 to 4 months, who were exclusively breastfed and apparently healthy. To assess breastmilk intake, we administered doubly labelled water to the mothers, and collected saliva samples from them, while simultaneously collecting both saliva and urine from their babies over a 14-day period. IRMS was used to analyze the samples for deuterium and oxygen-18 enrichments. Mean breastmilk intake based on saliva samples was significantly higher than that based on urine samples (854.5g/day vs. 812.8g/day, p=0.029). This can be attributed to slightly higher isotope enrichments in saliva and to a poorer model fit for urine samples as indicated by a higher square root of the mean square error (14.6 vs. 10.4 mg/kg, p=0.001). Maternal energy expenditure was not correlated with breastmilk output. Our study suggests that saliva sampling generates slightly higher estimates of breastmilk intake and is more precise as compared to urine and that maternal energy expenditure does not influence breastmilk output.

    Challenges to Quantify Total Vitamin Activity: How to Combine the Contribution of Diverse Vitamers?
    Jakobsen, Jette ; Melse-Boonstra, Alida ; Rychlik, Michael - \ 2019
    Current Developments in Nutrition 3 (2019)10. - ISSN 2475-2991
    folate - foods - total vitamin activity - vitamer - Vitamin A - Vitamin D

    This state-of-the-art review aims to highlight the challenges in quantifying vitamin activity in foods that contain several vitamers of a group, using as examples the fat-soluble vitamins A and D as well as the water-soluble folate. The absorption, metabolism, and physiology of these examples are described along with the current analytical methodology, with an emphasis on approaches to standardization. Moreover, the major food sources for the vitamins are numerated. The article focuses particularly on outlining the so-called SLAMENGHI factors influencing a vitamer's' ability to act as a vitamin, that is, molecular species, linkage, amount, matrix, effectors of absorption, nutrition status, genetics, host-related factors, and the interaction of these. After summarizing the current approaches to estimating the total content of each vitamin group, the review concludes by outlining the research gaps and future perspectives in vitamin analysis. There are no standardized methods for the quantification of the vitamers of vitamin A, vitamin D, and folate in foods. For folate and β-carotene, a difference in vitamer activity between foods and supplements has been confirmed, whereas no difference has been observed for vitamin D. For differences in vitamer activity between provitamin A carotenoids and retinol, and between 25-hydroxyvitamin D and vitamin D, international consensus is lacking. The challenges facing each of the specific vitamin communities are the gaps in knowledge about bioaccessibility and bioavailability for each of the various vitamers. The differences between the vitamins make it difficult to formulate a common strategy for assessing the quantitative differences between the vitamers. In the future, optimized stationary digestive models and the more advanced dynamic digestive models combined with in vitro models for bioavailability could more closely resemble in vivo results. New knowledge will enable us to transfer nutrient recommendations into improved dietary advice to increase public health throughout the human life cycle.

    Vector competence is strongly affected by a small deletion or point mutations in bluetongue virus
    Gennip, René G.P. van; Drolet, Barbara S. ; Rozo Lopez, Paula ; Roost, Ashley J.C. ; Boonstra, Jan ; Rijn, Piet A. van - \ 2019
    Parasites & Vectors 12 (2019). - ISSN 1756-3305
    Arbovirus - Bluetongue virus - Culicoides - Feeding model - Midge - Vector competence - Virus propagation

    BACKGROUND: Transmission of vector-borne virus by insects is a complex mechanism consisting of many different processes; viremia in the host, uptake, infection and dissemination in the vector, and delivery of virus during blood-feeding leading to infection of the susceptible host. Bluetongue virus (BTV) is the prototype vector-borne orbivirus (family Reoviridae). BTV serotypes 1-24 (typical BTVs) are transmitted by competent biting Culicoides midges and replicate in mammalian (BSR) and midge (KC) cells. Previously, we showed that genome segment 10 (S10) encoding NS3/NS3a protein is required for virus propagation in midges. BTV serotypes 25-27 (atypical BTVs) do not replicate in KC cells. Several distinct BTV26 genome segments cause this so-called 'differential virus replication' in vitro. METHODS: Virus strains were generated using reverse genetics and their growth was examined in vitro. The midge feeding model has been developed to study infection, replication and disseminations of virus in vivo. A laboratory colony of C. sonorensis, a known competent BTV vector, was fed or injected with BTV variants and propagation in the midge was examined using PCR testing. Crossing of the midgut infection barrier was examined by separate testing of midge heads and bodies. RESULTS: A 100 nl blood meal containing ±105.3 TCID50/ml of BTV11 which corresponds to ±20 TCID50 infected 50% of fully engorged midges, and is named one Midge Alimentary Infective Dose (MAID50). BTV11 with a small in-frame deletion in S10 infected blood-fed midge midguts but virus release from the midgut into the haemolymph was blocked. BTV11 with S1[VP1] of BTV26 could be adapted to virus growth in KC cells, and contained mutations subdivided into 'corrections' of the chimeric genome constellation and mutations associated with adaptation to KC cells. In particular one amino acid mutation in outer shell protein VP2 overcomes differential virus replication in vitro and in vivo. CONCLUSION: Small changes in NS3/NS3a or in the outer shell protein VP2 strongly affect virus propagation in midges and thus vector competence. Therefore, spread of disease by competent Culicoides midges can strongly differ for very closely related viruses.

    Exploring linear growth retardation in Rwandan children: Ecological and biological factors
    Matsiko, Eric - \ 2019
    Wageningen University. Promotor(en): E.J.M. Feskens, co-promotor(en): A. Melse-Boonstra. - Wageningen : Wageningen University - ISBN 9789463950213 - 194

    Background: Stunted linear growth and anaemia are major public health concerns in low-income countries, with a disproportionate global burden affecting Sub-Saharan Africa. In Rwanda, stunting among children under five years of age is still high (38%) and it affects more boys compared to girls (43% vs. 33%). However, no studies have tried to explain the causes of this sex disparity so far. Furthermore, anaemia prevalence hits its peak at infancy, with 72% and 61% of children being anaemic at 6-8 and 9-11 months of age, respectively. Little is known about the causes of anaemia including the contribution of iron deficiency. Therefore, understanding the context-specific factors of poor linear growth and anaemia is key to targeting evidence-based interventions for accelerating the reduction in the magnitude of these two forms of undernutrition. Our research aimed to explore the aetiology of stunted linear growth and anaemia in the Rwandan context.

    Methods: We analysed cross-sectional data of 1228 children aged 6-23 months from eight districts with a high burden of malnutrition in Rwanda collected in 2014-2015 as the baseline survey of a nutrition program. Then we conducted a longitudinal study on 192 mother-child pairs living in a rural area of one district of these eight districts. From birth to 1 year of age, anthropometric measures, morbidity, and feeding data were collected monthly. The child’s length and its potential predictors were analysed using a linear mixed model. We stratified the analysis by age ranges of 0-5, 6-12, and 0-12 months to consider the differences in the start of feeding practices. In the longitudinal study, we, further, measured haemoglobin concentration and collected blood samples from the mother-child pairs at birth and at 4 and 12 months post-partum. Ferritin, sTfR, CRP, and AGP concentrations were measured using a sandwich ELISA technique. Haemoglobin and ferritin values were adjusted for altitude and inflammation, respectively. Finally, in a methodological study, we used a convenience sample of 13 pairs of mothers and babies aged 2 to 4 months who were exclusively breastfed and healthy to assess breastmilk intake using the deuterium dose-to-mother technique.

    Results: The findings from the analysis of the cross-sectional data confirmed that stunting significantly affected more boys than girls, with a prevalence of 43.3% vs. 28.0%, respectively. Being fed porridge as first weaning food as opposed to cow’s milk was a significant factor for stunting in boys solely (PR=1.44, 95% CI=1.07-1.94, p-interaction=0.048) while discontinued breastfeeding was a significant factor in girls only (PR=1.49, 95% CI=1.05-2.11, p-interaction=0.017). The results from the longitudinal study showed that children were already born with length deficits of -1.4 cm, which gradually deteriorated to -2.7 cm at 12 months of age. Significant predictors of decelerated linear growth were late initiation of breastfeeding (-0.73 cm, 95% CI: -1.45, -0.01) in the age range of 6-12 months, high breastfeeding frequency (-0.01 cm per additional feed, 95% CI: -0.02, -0.00) from 0-5 and 0-12 months, and early introduction of complementary feeding (-0.69 cm, 95% CI: -0.90, -0.49) from 0-12 months. Moreover, the duration (days) of diarrhoea or malaria illnesses significantly predicted decreased linear growth depending on the age range. Meal frequency, dietary diversity, and acceptable diet did not significantly predict linear growth. Conversely, the study confirmed a strong positive effect of birth weight and birth length on postnatal linear growth. We saw that at 4 months of age, anaemia, iron deficiency (ID), and iron deficiency anaemia (IDA) occurred in 73%, 10%, and 8%, respectively while at 12 months of age, anaemia reduced to 48% and both ID and IDA increased to 28% and 18%, respectively. At 4 and 12 months of age, ID contributed 10% and 36.5% to anaemia cases, respectively. Dietary iron intake tended to significantly predict iron deficiency (PR=0.79, 95% CI: 0.62, 1.03), but not anaemia or iron-deficiency anaemia at 12 months of age. However, the duration of being ill with malaria was significantly associated with anaemia (PR=1.05, 95% CI: 1.00-1.10), ID (PR=1.09, 95% CI: 1.04-1.15), as well as with IDA (PR=1.15, 95% CI: 1.06-1.25). In addition, the presence of inflammation predicted anaemia (PR=1.01, 95% CI: 1.01-1.10). Iron deficiency at 12 months of age occurred less often when children had higher body iron reserves at 4 months of age (PR=0.73, 95% CI: 0.59, 0.89). Lastly, the findings from a small methodological study showed that the mean breastmilk intake based on saliva samples was significantly higher than that based on urine samples (854.5 g/day vs. 812.8 g/day, p=0.029).

    Conclusions: Stunted linear growth among boys is higher than among girls in Rwanda and this seems to be most strongly related to the nutritional quality of foods during the complementary feeding period. However, children in Rwanda are already born with a length deficit, which gradually deteriorates with the child’s age without any signs of catch-up growth during infancy. Late initiation of breastfeeding, high breastfeeding frequency, early introduction to complementary feeding, and the duration of diarrhoea and malaria illnesses are significant correlates of decelerated linear growth. However, none of the indicators of complementary feeding practices is significantly related to linear growth, anaemia, ID, and IDA. However, dietary iron intake is weakly associated with iron deficiency, but not with anaemia or iron deficiency anaemia. The duration of malaria infection significantly predicts anaemia, iron deficiency, and iron deficiency anaemia at 12 months of age.

    Considering these findings, prenatal interventions seem to be crucial to ensure that children are born with adequate body dimensions and iron reserves, which should give a strong foundation to sustain postnatal growth and iron status. Moreover, improving the quality of complementary foods is central to prevent any deterioration of their nutritional status from 6 months of age onwards. However, to make dietary interventions effective, infectious diseases must be controlled.

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