Maternal and Child Nutrition最新文献

Poor intrauterine growth has long-term implications for child growth and nutritional status. Fetal malnutrition (FM) is a type of poor intrauterine growth defined by the presence of soft tissue wasting at birth and is identified using the Clinical Assessment of Nutritional Status Score (CANSCORE) tool, independent of gestational age. There is limited evidence evaluating FM as a predictor of longitudinal growth and nutritional status in young children. In this longitudinal birth cohort in Leyte, the Philippines, mother-infant dyads were enroled, and infants were followed for 24 months after delivery. Infants were evaluated using CANSCORE within 48 h of birth by a trained midwife, and FM was defined as CANSCORE < 25. Weight and length were measured at birth, 1-, 6-, 12-, 18- and 24-month visits. Weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) z scores were determined using WHO Anthro. Associations between FM and anthropometric z scores were assessed using multivariable linear regression, adjusting for maternal body mass index (BMI), family socioeconomic status (SES) and child's sex. Among N = 246 infants included for analysis, 8 (3%) were classified with FM at birth. Despite limited power, FM was significantly associated with reduced WAZ, LAZ and WLZ at nearly all timepoints in the fully adjusted models. CANSCORE is a user-friendly tool for assessing FM in areas with limited equipment and predicted that newborns with FM were at continued risk for undernutrition and growth stunting until age 24 months. Identification of FM at birth provides opportunities for targeted early nutrition interventions for high-risk infants.

Relapse to acute malnutrition after recovery from severe acute malnutrition (SAM) is common. However, most programmatic resources are devoted to the acute phase of recovery, and fewer interventions are available for children recently discharged from outpatient nutritional programs. We evaluated the feasibility of training caregivers to screen for relapse using mid-upper arm circumference (MUAC) tapes for reducing time to detection of relapse among children recently recovered from SAM in Burkina Faso. Caregiver-child dyads were enrolled and randomized in a 1:1 fashion to either caregiver MUAC screening or local standard of care (SOC), which consists of monthly clinic-based follow-up visits for 3 months following discharge. In the MUAC screening group, caregivers were trained on how to use a standard MUAC tape and asked to screen their child weekly with a provided MUAC tape for the 6-month duration of the study. The primary outcome was time to relapse detection, defined as MUAC < 12.5 cm and/or weight-for-height Z-score < −2. Secondary outcomes included hospitalization and/or death over the 6-month study period. Of 200 caregiver-child dyads enrolled in the trial, 99 were randomized to the MUAC screening group and 101 to the SOC group. By 6 months after enrollment, the hazard of relapse detection was lower in the MUAC screening group compared to the SOC group (hazard ratio, HR, 0.65, 95% confidence interval, CI, 0.38–1.12). Fewer hospitalizations and/or deaths occurred in the MUAC screening group compared to the SOC group (MUAC: 3%; SOC: 14%, risk ratio 0.23, 95% CI, 0.07–0.79). Training caregivers to screen for relapse after recovery from SAM was feasible and may lead to modestly reduced time to detection of relapse, suggesting a full-scale trial is warranted.

Trial Registration: This study was prospectively registered on clinicaltrials.gov (NCT05932992, registered June 27, 2023).

Choi S, Walsh C, Omer S, Patro-Golab B, Lawrence W, Havemann-Nel L, et al. Evaluation of ImpENSA technology-enabled behaviour change module delivered to healthcare professionals in South Africa to improve micronutrient nutrition during the first 1000 days. Matern Child Nutr. 2024;20:e13678.

In the published article, four members of the ImpENSA Study Group were inadvertently omitted. This correction serves to update the study group list with the complete information.

The currently published list under the ImpENSA Study Group is as follows:

Members of the ImpENSA Study Group are Berthold Koletzko, Shweta Vandana Feher, Rungrawee Loipimai, Marina Sanchez Garcia, Brigitte Brands, Germany; Keith Godfrey, Sunhea Choi, Wendy Lawrence, Selma Omer, Daniella Watson, United Kingdom; Hania Szajewska, Bernadeta Patro-Golab, Maciej Kolodziej, Jan Lukasik, Poland; Lize Havemann-Nel, Jeannine Baumgartner, Estelle Venter, Tertia Van-Zyl, Edelweiss Wentzel-Viljoen, Welma Lubbe, Marius Smuts, Etienne Nel, Renee Blaauw, Liz Goddard, Michael Hendricks, Hilary Goeiman, Gregory Doyle, Ronalda de Lecy, Kerry Sexton, South Africa.

The corrected list is as follows:

Members of the ImpENSA Study Group are Berthold Koletzko, Shweta Vandana Feher, Rungrawee Loipimai, Marina Sanchez Garcia, Brigitte Brands, Germany; Keith Godfrey, Sunhea Choi, Wendy Lawrence, Selma Omer, Daniella Watson, United Kingdom; Hania Szajewska, Bernadeta Patro-Golab, Maciej Kolodziej, Jan Lukasik, Poland; Lize Havemann-Nel, Jeannine Baumgartner, Estelle Venter, Tertia Van-Zyl, Edelweiss Wentzel-Viljoen, Welma Lubbe, Marius Smuts, Etienne Nel, Renee Blaauw, Liz Goddard, Michael Hendricks, Hilary Goeiman, Gregory Doyle, Ronalda de Lecy, Kerry Sexton, Ali Dhansay, Corinna Walsh, Elize Symington, Christine Taljaard-Krugell, South Africa.

We apologise for this error.

Suboptimal diets, including low fruit and vegetable (F&V) intake, are major contributors to malnutrition and non-communicable diseases (NCDs) in Sri Lanka. Understanding dietary patterns is essential for addressing these challenges. This scoping review synthesizes the literature on diet, F&V intake, and nutritional status across different population groups in Sri Lanka. Searches were conducted in PubMed in October 2023. In total, 30 publications on diet, 13 on F&V intake, and 26 on nutritional status met the inclusion criteria. Sri Lankan diets were found to be rice-dominant with limited variety of nutrient-dense foods such as animal-source foods (ASF) and F&V. Trends in nutritional status varied across life stages. Among children < 5, undernutrition was prevalent, with stunting affecting 14%–21%, wasting 10%–15%, and underweight 17%–21%. Anemia was found in 8%–15% of children < 5 and 25%–30% of pregnant women. Micronutrient deficiencies, particularly vitamin D, iron, and zinc, affected more than one-third of pregnant women. In adults, over one-third were overweight/obese, 8%–12% had diabetes, and 20%–25% had hypertension. Diet, F&V intake and nutrition outcomes also differed by socioeconomic, demographic, and geographic characteristics, with estate sector residents, Indian Tamil populations, and low-income groups disproportionately affected by poor diet quality, low F&V intake, insufficient nutrient intake and malnutrition, while women (vs. men) and urban (vs. rural/estate) residents exhibited higher prevalence of overweight/obesity and NCDs. This review revealed evidence gaps such as the lack of recent dietary intake data based on individual quantitative dietary assessments that limit understanding of current diet adequacy. Additionally, only one impact evaluation designed to improve diet was identified. More research is needed to understand how to effectively improve diet including increasing intake of F&V and ASF in Sri Lanka.

Edible crickets are commonly farmed insects containing high-quality protein and micronutrients. They can potentially replace common animal source protein in complementary food (CF). We evaluated the effect of edible cricket-enriched CF on linear growth in a 2 × 2 factorial randomized control trial based on Cricket treatment (+/−CR) and Nutrition Education treatment (+/−ED). We enrolled 284 eligible mother–infant dyads with infants from 6 months having a middle upper arm circumference (MUAC) > 11.5 cm at Rwambwa Sub-County Hospital, Siaya County, Kenya. Participants were randomized to treatment arms with intervention foods issued monthly as a take-home food ration adjusted for age, were offered +ED sessions monthly as personalized audio–visual sessions where education messages and reminders were sent to the mother's mobile phones. Monthly infant anthropometry, feeding practices and child health data were collected. A significant contrast (Z = −0.28 (95% CI: 0.03, 0.53) [p = 0.03]) in length-for-age Z-score (LAZ) between −CR and +CR was observed. By MUAC, girls were significantly 1.98 (1.15, 3.41) (p = 0.01) times likely to be undernourished. Increased illness episodes significantly increased the child's risk to undernutrition, with those experiencing three episodes being 4.30 (95% CI: 1.21, 15.37) times likely to suffer undernutrition, while those with above five episodes were almost six times as likely to be malnourished. Consuming either of the intervention foods resulted in a similar growth rate irrespective of nutrition education treatment offered. Nutrition education improved weight-for-length, irrespective of CF consumed. The similarity in growth rate across study arms signifies the potential of edible cricket protein in growth of infants' comparative to the super cereal.

Trial registration: https://clinicaltrials.gov NCT06002620

Protein and fat concentrations in donor human milk (DHM) can vary twofold to threefold and are influenced by the number of unique donors per pool. The aim of this study was to broadly characterize how the number of donors (2–10) randomly combined into a pool during milk bank processing influenced the variability of macronutrients, vitamins, minerals, and bioactive factors in DHM. The minimum number of donors required for 80% of the pools to meet pre-defined targets for true protein, fat, and disialyllacto-N-tetraose (DSLNT) was also evaluated. Monte Carlo simulation was used to create models that accounted for donor lifetime donation volume and milk bank production constraints. Variability in nutrients was quantified as a Nutrient Inequality Index (NII) which was computed as the ratio of the 90th percentile to the 10th percentile for each simulation. Random multi-donor pooling of 2–10 donors produced lower variability in DHM macronutrients than most vitamins and minerals. A priori targets of 0.9 g/dL of true protein, 3.5 g/dL of fat, and 210 µg/L of DSLNT could not be achieved with any random pooling scenario. The NII for lactose stabilized at less than 1.1 when there were 3+ donors per pool, while the NII for fat and true protein stabilized at less than 1.3 when there were 5+ donors per pool. The NII exceeded 1.5, even at 10 donors per pool, for several micronutrients including zinc, copper, sodium, iron, biotin, riboflavin, B6, B12, and pantothenic acid.

Parental feeding practices play a crucial role in preventing childhood obesity and promoting healthy eating habits. However, few interventions are specifically designed to improve these practices. We aimed to assess the feasibility and preliminary effects of a novel psychoeducational intervention, Empower Parents to Optimise Feeding Practices (EPO-Feeding), tailored to enhance parental feeding practices in China. A parallel-arm feasibility randomised controlled trial (RCT) was conducted in two public kindergartens in Yangzhou, China. Participants were randomly assigned to the intervention group (EPO-Feeding programme plus usual care) or control group (usual care). Data were collected at baseline, post-intervention, and 1 month after intervention. Descriptive statistics assessed feasibility and acceptability, while analysis of variance for repeated measures and generalised estimating equations analysed continuous and categorical outcomes across time points, respectively. Within 2 weeks, 131 parents expressed interest, and 84 eligible participants were randomly assigned. Module attendance and retention rates were high, with 83.3% (n = 35) completing all sessions and 97.6% (n = 82) completing all measurements. Satisfaction surveys indicated high acceptability. Statistically significant improvements were observed in the intervention group, including increased encouragement of healthy eating and monitoring, reduced pressure to eat and food as rewards, improved weight accurate perception, and enhanced parenting efficacy (p < 0.05). However, no significant effects were found in long-term outcomes, including children's eating behaviours and weight status. This study demonstrates high feasibility and acceptability of the EPO-Feeding programme and suggests its potential to support Chinese parents' feeding strategies. A full-scale RCT is recommended.

Trial registration. It was registered with ClinicalTrials.gov (NCT06181773), 20/11/2023.

Suboptimal complementary feeding practices remain a significant challenge in LMICs. Peer support shows promise in improving these practices; however, their long-term success hinges on sustained engagement and integration into existing support systems, aspects that remain poorly understood. This theory-led systematic review aimed to understand why people participate, support, and continue using peer support for complementary feeding practices. The literature search covered studies conducted between January 1990 and February 2025. This pragmatic, Normalisation Process Theory-led review employs an integrative mixed-methods synthesis. We conducted a theory-informed systematic review guided by the four subconstructs of cognitive participation, presenting the findings narratively into barriers and facilitators. While peer-led complementary feeding promotion involves multiple actors at different levels, few studies directly included family members and caregivers beyond mothers, thereby limiting their cognitive participation. Most studies were donor-driven. Financial, structural, sociocultural, training, and capacity-related factors strongly influence peer-led complementary feeding support. Their influences were not fixed; what served as facilitators in the initial stages of studies became barriers later, and vice versa. Household and local leaders and gatekeepers constrained peer support early in the interventions, but this later reversed with their involvement. Incentives boosted interest and increased enrolment. However, this also led to volunteers being less motivated and to attrition when resources were limited. Weak supportive supervision diminished the legitimacy of peer support, causing a loss of confidence in volunteers' skills. Keeping the momentum of early implementation stages requires a predictable funding model, primarily from domestic sources, and sustained engagement in the intervention. This can address multifaceted operational problems, ranging from recruitment to embedding the intervention in the health system. Political commitment, especially when translated into operational support, can strengthen the financial sustainability of peer support programmes.

In 2021, participants in the United States Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) received an unprecedented increase in a cash-value benefit for fruits and vegetables (CVB) as a part of their monthly food package. Responses to this increase among WIC staff and American Indian populations are poorly understood. The objective of this study was to assess perceptions and diet-related behaviors of both WIC staff and participants within an Indian Tribal Organization state agency following the CVB increase. To accomplish these objectives, we conducted interviews with WIC local agency staff members (n = 15) and distributed a survey to WIC participants (n = 1,587) at the Inter Tribal Council of Arizona WIC. Thematic analysis of interviews showed that the CVB increase enabled WIC staff to provide more actionable nutrition education regarding fruits and vegetables and that staff and participants highly valued higher CVB amounts. Participant survey results showed improved fruit and vegetable consumption and high satisfaction following the increase, especially among households receiving larger amounts of CVBs. Interview and survey findings both suggested that limited access to fresh produce on rural tribal lands may limit benefits of the CVB increase. Taken together, findings indicate that both WIC staff and participants have very positive perceptions of the CVB increase. However, systemic barriers to redemption on rural tribal lands highlight the need for additional strategies to improve benefit use.