Maternal and Child Nutrition最新文献

In the first 6 months, breastfeeding is the optimal nutrition for newborns, but the breastfeeding prevalence in Austria is still below the official WHO Guidelines (64% breastfeeding and 1.9% exclusive breastfeeding after 6 months). Exclusive breastfeeding rates in the first 6 months are low in the European Region but higher globally at 48%. Breastfeeding behaviour and the decision to breastfeed can be influenced by many factors, such as social norms, the social environment, health, commercial milk formula (CMF) marketing, and media reports. Therefore, it is important to understand how breastfeeding and CMF are presented in Austrian media and the possible impact these portrayals have on mothers and the broader community. The aim of this study was to analyze print and online newspaper coverage in Austrian newspapers related to breastfeeding between 2002 and 2022 with a special focus on the valence of reporting on breastfeeding and CMF in different genres of online and print newspapers. For this analysis, more than 2500 unique articles were identified, coded, and analysed (e.g., main topic, valence towards breastfeeding, and valence towards CMF). The results showed that media coverage of breastfeeding has decreased slightly over the last 20 years, particularly with the start of the COVID-19 pandemic. Print and online newspaper coverage of breastfeeding was mostly neutral, with a focus on breastfeeding and its association with disease, health benefits of breastfeeding, and event announcements related to breastfeeding. The valence on breastfeeding was more positive than on CMF. Middle-market newspapers appear to report more about breastfeeding than tabloids and broadsheets. To normalise breastfeeding, informative, unbiased, and extensive media coverage is important. Collaboration between breastfeeding advocates and journalists could be beneficial in increasing positive coverage of breastfeeding in the long term.

Vitamin A deficiency remains a major public health problem worldwide, particularly among young children. Capillary blood has the potential for application in vitamin A assessment. The aim of this study is to validate the accuracy of capillary blood for assessing vitamin A nutritional status among young children. Venous and capillary blood samples were simultaneously collected from 1366 healthy children under 7 years of age across 12 regions in China. Retinol was measured using high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS). The agreement was assessed with Bland-Altman plot, Kappa, and prevalence-adjusted and bias-adjusted kappa (PABAK) values. The sensitivity and specificity were evaluated using the ROC curve method. Venous and capillary retinol levels showed significant differences but were highly correlated with r of 0.93. Ordinary least squares regression was used to characterize (β = 0.913) and correct the systematic bias in capillary data (compared to paired venous). Thereafter, Bland-Altman analysis demonstrated that the mean bias of corrected capillary retinol compared to venous retinol was 0.01 (95%CI: -0.24, 0.25) μmol/L with no significant difference (p ＞ 0.05). Corrected capillary retinol showed excellent performance for estimating vitamin A status when compared to venous retinol, with Kappa of 0.77-0.83, PABAK of 0.80-0.96, sensitivity of 0.86-0.91 and specificity of 0.87-0.98. Capillary HPLC-MS/MS method is therefore adequate for assessing vitamin A status of young children after correction for systematic bias.

Undernutrition in women and young children in Burkina Faso is a critical problem. Egg consumption is low despite many households raising poultry. The Soutenir l'Exploitation Familiale pour Lancer l'Élevage des Volailles et Valoriser l'Économie Rurale (SELEVER) project, an integrated agriculture-nutrition intervention, promoted egg consumption and sales to investigate the impact of poultry production on child nutrition. Multisectoral nutrition-sensitive agriculture programs address nutrition deficits but lack comparable cost information. This study estimates the costs of the SELEVER program, an integrated poultry and nutrition intervention. The study estimates the program's economic costs using a standardized methodology from the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) consortium, which aligns financial and economic costs along program impact pathways, allocating costs by activities and inputs. We conducted qualitative interviews and focus groups on time allocation and beneficiary out-of-pocket costs. Incremental economic costs were calculated by combining expenditures and economic costs. The total incremental program cost was USD$18,084,727.68 over 5 years, with annual incremental costs of USD$209.20 per direct beneficiary and $796.26 per household. Major cost drivers included overhead (18%), poultry extension (17%), training (16%), household counseling (7%), technical assistance (7%) and microcredit (6%). Total input costs were dominated by personnel (51%), supplies (13%), agricultural inputs (10%) and overhead (9%). We present the total incremental costs of a multisectoral nutrition intervention to generate revenue with poultry. The costs per beneficiary were higher than similar interventions, underscoring the need for cost-effectiveness evaluations of multisectoral nutrition programs. A standardized cost methodology facilitates comparisons with multisectoral nutrition interventions and builds the evidence base.

Introducing commercial milk formula (CMF) as prelacteal feeds can disturb exclusive breastfeeding and shorten breastfeeding duration. However, the prelacteal feeding of CMF has been growing alongside its increasing sales in Indonesia. This study examined predictors of the CMF feeding in the Malang and Sidoarjo districts of Indonesia. This analysis used post-delivery data collected from 676 mothers in a cohort evaluation of a cluster randomised controlled trial (Baduta study). Multivariate random effects logistic models were employed to assess factors associated with the CMF feeding. A total of 467 (69.1%) respondents reported giving CMF to their infants during the first 3 days after delivery. Mothers with low breastfeeding self-efficacy (BFSE) were at a higher risk of providing CMF within 3 days of birth compared to those with medium or high BFSE (adjusted odds ratio (aOR) 8.12; 95% confidence interval (CI) (4.26-15.48). Receiving explanations to solve breastfeeding problems from health professionals (aOR: 1.87; 97% CI: 1.12-3.11) and primipara parity (aOR: 1.71; 95% CI: 1.12-3.04) were positively associated with the CMF feeding. Early initiation of breastfeeding (EIBF) was protective against CMF feeding (aOR: 0.40; 95% CI: 0.22-0.58). There was an interaction between EIBF and BFSE. EIBF was protective among mothers with high or medium BFSE, but had no effect among those with low BFSE. CMF feeding was prevalent in Indonesia. Future strategies should focus on improving health-staff capacity to strengthen BFSE during pregnancy and provide adequate counselling for mothers with breastfeeding problems.

Infant undernutrition, defined by length- and weight-based indices, is common in low- and middle-income countries (LMICs), but corresponding deficits in head size have received less attention. In a cohort of term newborns in Dhaka, Bangladesh, we compared the severity of deficits (vs. World Health Organization Growth Standards) in head circumference (HC), length and weight at birth and every 3 months until 2 years of age (n range across timepoints: 843-920). We estimated the mean and 25th, 50th and 75th percentiles of HC-, length- and weight-for-age z-scores (HCZ, LAZ and WAZ, respectively). Differences between HCZ and LAZ (or WAZ) were analyzed using paired t tests and quantile regression. We also derived HCZ using height-age instead of chronological age at 3-24 months. Mean HCZ was significantly higher than mean LAZ and WAZ at birth, but HCZ was significantly lower than LAZ at 6, 9 and 12 months and the HCZ and LAZ deficits were similar from 15 to 24 months. Mean HCZ was lower than WAZ at all ages beyond birth. Patterns were broadly consistent at the 25th, 50th and 75th percentiles. The HCZ deficit remained evident when HC was standardized using height-age at all ages beyond birth, indicating HC was reduced relative to body size. In conclusion, among term-born children in Dhaka, HCs were smaller than international standards at all ages up to 2 years, and there was no evidence of postnatal head sparing. Consideration should be given to routine measurement of HC in population health surveys in LMICs.

The relationship between the famine and metabolic syndrome has been reported, but there is a lack of more detailed changes in metabolic profiles. It is unclear how famine affects body composition. This study included 21,142 participants from the China National Health Survey. The body mass index (BMI), fat mass index (FMI), and fat-free mass index (FFMI) were calculated. Systolic blood pressure (SBP), diastolic blood pressure (DBP), blood lipids, and fasting blood glucose (FBG) were measured. Multivariate adjusted linear regression models were used to assess the association between famine and outcome. Our results shown that fetal-exposed group had higher BMI and FMI (β > 0). Childhood-exposed group showed an average decrease of 0.08 standard deviation (SD) in FFMI, and adolescence-exposed group had lower BMI and FFMI than non-exposed group. SBP were 0.38 SD higher in fetal-exposed group, 0.58 SD higher in childhood-exposed group and 0.85 SD higher in adolescence-exposed group than non-exposed group. Famine-exposed groups had higher total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), and FBG levels (β > 0). For females with famine exposure, they had a higher BMI, FMI, LDL-C, TG, and TC than males. Overall, early famine exposure is associated with increased blood pressure, LDL-C, TC, and FBG. Muscle mass loss in adulthood associated with childhood and adolescence famine exposure. Famine-exposed females appear to have higher levels of body fat and blood lipids.

Nutrition and the home environment contribute to the development of the autonomic nervous system (ANS). However, no study has examined the long-term effects of prenatal and postnatal small-quantity lipid-based nutrient supplements (SQ-LNS) and home environment on ANS regulation. We investigated the effect of early-life SQ-LNS and home environment on ANS regulation at 9-11 years. Participants were children born to women who participated in a randomized controlled trial in Ghana from 2009 to 2014. Women were randomized to receive daily, from pregnancy until delivery, either SQ-LNS, multiple micronutrients (MMN) or iron and folic acid (IFA) followed by SQ-LNS, MMN or placebo, respectively, until 6 months postpartum. Infants in the SQ-LNS group received SQ-LNS from 6 to 18 months. Quality of home environment was observed at 4-6 and 9-11 years. At 9-11 years, 965 children had their respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) measured at baseline and during two inhibitory control tasks, the RACER Simon and Emotion Go/No-Go (EGNG) tasks. PEP reactivity to the RACER Simon task was greater in the MMN (-2.54 ± 4.45, p = 0.016) and SQ-LNS (-2.31 ± 4.94, p = 0.093) groups than in the IFA group (-1.57 ± 3.51). A better home environment at 4-6 predicted longer baseline PEP (β = 0.13, 95% CI: 0.02, 0.23, p = 0.016) and more PEP reactivity during the EGNG task (β = -0.06, 95% CI: -0.00, -0.02, p = 0.001). Prenatal micronutrient supplementation appears to increase SNS reactivity. Children raised in disadvantaged early home environments had more tonic SNS activation and less SNS reactivity, suggesting a predisposition for stronger fight-or-flight activation and less likelihood to modulate arousal in response to acute situations. Trial Registration: ClinicalTrials.gov identifier: NCT00970866.

Breast milk substitute (BMS) marketing significantly influences global infant feeding practices. Ecuador, like many countries, seeks to regulate these promotions under the WHO's International Code of Marketing of Breast-Milk Substitutes. This cross-sectional analysis assessed BMS marketing compliance with WHO's Code in Ecuador. Surveys were conducted with mothers (n = 330) and healthcare professionals (n = 66), complemented by observations at health facilities (n = 33) and retail outlets (n = 44). Media monitoring and product labelling evaluations were also conducted. The study revealed widespread exposure to BMS marketing outside health facilities (91.21% of mothers). Promotional activities targeted healthcare professionals, with significant interactions involving free supplies (26.09%) and gifts (21.74%). Retail outlets prominently displayed BMS promotions, often featuring discounts (95%). Compliance with labelling criteria was notably low, particularly concerning nutrition and health claims (39%). TV emerged as the dominant platform for BMS advertising, with 2884 ads aired over 16 h and 24 min, totalling $1,876,915.50 in expenditures. Digital platforms also featured BMS ads, with significant engagement on social media (533,845 interactions). This study reveals widespread violations of the WHO Code in Ecuador, emphasizing the need for stronger regulations and targeted education for healthcare professionals and the public to protect infant health and promote breastfeeding. Despite existing regulations, the pervasive advertising and substantial investment in BMS marketing across various media underscore significant enforcement gaps. To effectively safeguard maternal and child health, Ecuador must fully incorporate and rigorously enforce all Code recommendations within its national legislation.

Suboptimal diets contribute to the risk of malnutrition and non-communicable diseases across the life course. Globally, intakes of fruit and vegetables (F&V) fall below recommendations, including in the Philippines. To promote F&V intakes, understanding the extent of inadequate intakes across population groups and key drivers of dietary patterns is needed. This narrative scoping review was conducted to map the diet, F&V intakes and nutritional status in the Philippines. PubMed was searched using keywords specific to diet, F&V intake, and nutritional status, with 50, 24 and 22 articles meeting the inclusion criteria for diet, F&V intake, and nutritional status, respectively. Available evidence indicates that across all population and sociodemographic groups, diets lacked diversity, with high intakes of energy-dense, nutrient-poor foods, such as refined rice and sugar-based foods and beverages, contributing to inadequate micronutrient intakes. Intakes of F&V were especially low across all population groups. Stunting/short height, wasting and underweight were prevalent among children and adolescents, and micronutrient deficiencies (iron, zinc, vitamin A) were common among children < 5 years of age. More than one-quarter of adults were overweight or obese and demonstrated poor cardiometabolic health. A lack of published evidence identified through this search reported on pregnant and lactating women and women of reproductive age. Published evaluations assessing the impact of interventions or programmes to improve diets or F&V intake were limited. Additional research to fill these gaps will help design interventions and target entry points to improve diet diversity and F&V intakes across all population groups.

Recommendations on Early Childhood Allergy Prevention (ECAP) are found in Clinical Practice Guidelines (CPG) and Food-Based Dietary Guidelines (FBDG). This synthesis of guidelines aims to compare the methodological quality and content of recommendations in CPGs and FBDGs for ECAP. We searched MEDLINE, the FAO directory of FBDGs and other guideline databases, including the Association of the Scientific Medical Societies in Germany (AWMF), the WHO and the Guideline International Networks database on clinical guidelines (GIN) for CPGs and FBDGs about ECAP and child nutrition. Guidelines had to be published from 2010 onwards, target infants or pregnant/breastfeeding women and contain recommendations on primary preventative interventions to decrease the onset of IgE-mediated allergies, including atopic eczema or asthma. We retrieved a sample of 36 guidelines (23 CPGs, 13 FBDGs) and assessed their methodological quality with the Appraisal of Guidelines for Research and Evaluation tool (AGREE) II. On a subset of recommendations, we performed an in-depth analysis by the type of intervention for direction and strength of recommendation and level of evidence. Descriptive analysis was conducted with SPSS 27. CPGs score higher than FBDGs in most AGREE domains (3, 4, 5 and 6). The 36 guidelines contain 287 recommendations on ECAP, with 70 addressing the introduction of complementary foods and common allergens. We found only slight differences between those recommendations in CPGs and FBDGs. FBDGs on ECAP are of lower quality than CPGs. This does not affect their recommendations on the introduction of complementary foods and common allergens but may compromise their trustworthiness.