BMC Nutrition最新文献

Background: The World Health Organization has recommended intermittent weekly iron-folic acid (IFA) supplementation as the most cost-effective intervention to reduce the burden of anemia among adolescents and women in child bearing age. Given the documented benefits of iron-folic acid supplementation, it goes with jurisdictional hurdles and motivators for uptake yet little is known in this regard in our study's settings. This study aimed to assess the challenges, motivators, and coping strategies for IFA tablets intake among beneficiaries in the Girls Iron-Folic Acid Tablet Supplementation (GIFTS) program of the Upper West region-Ghana.

Materials and methods: A convergent parallel mixed-methods design (n = 355; three focus group discussions) was used in this study. Semi-structured questionnaire was used to gather data on socio-demographic characteristics, motivators for IFA tablets intake, while focus group discussion was used to collect data on challenges, motivators and coping strategies for IFA tablets intake.

Results: Challenges to IFA tablets intake were reported under personal level (pharmacophobia, inadequate knowledge, experienced side effects, and forgetfulness), product level (negative sensory attributes), and school/distribution level (distribution failures and shortages). IFA tablets intake was motivated by perceived personal level benefits (nutritional and health benefits, appetite enhancement, menstrual benefits) derived from the IFA up-take. Participants adopted various coping strategies for personal and product level challenges, (Water therapy, massage therapy, medication, rest/reduced mobility, changed dressing style, avoiding tablets intake, and masking of tablets). The study also showed that participants had no specific coping mechanism for school/distribution level challenges (distribution failures and shortages).

Conclusion: Varied challenges, motivators, and coping strategies for IFA intake were identified. Beneficiaries experienced shortages of IFA tablets distribution. It is thus recommended that implementers of the GIFTS program make the tablets readily available to schools to avoid shortages.

Background: Protein-energy wasting and frailty are highly prevalent among maintenance dialysis patients, particularly in low- and middle-income countries where nutrition care is often limited to brief, one-time counselling. We evaluated whether a home-based, supervised, personalised diet with structured follow-up could improve nutritional and functional outcomes compared with conventional dietary advice.

Methods: In this randomised controlled trial, 93 adults on maintenance dialysis were assigned to conventional diet (CD, n = 46) or supervised personalised diet (SPD, n = 47) for six months. Both groups received identical guideline-aligned dietary targets (25-35 kcal/kg/day energy; 1.0-1.2 g/kg/day protein) and portion-control tools. CD participants received one-time counselling; SPD participants received individualised meal planning based on 4-day dietary records analysed with DietCal™, fortnightly telephonic reinforcement and adjustments at 3 month intervals. The primary outcome was the Malnutrition-Inflammation Score (MIS); secondary outcomes included frailty (simplified Fried criteria) and dietary intake. Analyses followed the intention-to-treat principle using multiple imputation, with per-protocol sensitivity analyses.

Results: Baseline intake was markedly inadequate (23 kcal/kg/day energy; 0.68 g/kg/day protein), with 98% of participants malnourished (MIS ≥ 3), 52% severely malnourished, and 77% frail. At six months, MIS worsened in CD (8.9 to 10.6) but improved in SPD (8.6 to 6.4), yielding a significant between-group difference (p < 0.001). Severe malnutrition prevalence was 76% in CD versus 13% in SPD (RR 0.17, 95% CI 0.08-0.36), and frailty prevalence was 91% in CD and 36% in SPD (RR 0.40, 95% CI 0.27-0.59). Energy and protein intake rose to 27.2 kcal/kg/day and 0.97 g/kg/day in SPD compared with 24.7 kcal/kg/day energy and 0.84 g/kg/day protein in CD respectively (both p < 0.001). Per-protocol findings (n = 70) showed consistent results.

Conclusions: A home-based, supervised, personalised diet with structured remote follow-up significantly improved nutritional status, dietary intake, and frailty over six months in maintenance dialysis patients. This food-first, tele-counselling model demonstrates that systematic dietary assessment and personalised nutrition support can effectively address protein-energy wasting in dialysis populations. Future research should assess long-term sustainability, cost-effectiveness, and scalability through technology-enabled and task-sharing approaches adaptable to resource-limited settings.

Trial registration: CTRI/2021/07/034790.