Maternal and Child Nutrition最新文献

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.

Childhood obesity is an increasing public health problem with heterogeneous metabolic health outcomes. In children, distinguishing differences in body composition between individuals with metabolically healthy obesity (MHO) and those with metabolic syndrome (MS) may be useful for understanding the impact of body composition on metabolic health. This cross-sectional study included 193 children aged 6-10 years with obesity (BMI > 95th percentile). Fat and lean mass distributions were measured by dual-energy X-ray absorptiometry to assess body composition. Among the study population, 45.1% were classified as MHO, while 25% presented MS. Compared with children with MHO, those with MS had significantly greater fat mass and lean mass. Body composition was strongly correlated with metabolic dysfunction, including insulin resistance, hypoalphalipoproteinaemia, and hypertriglyceridaemia. These findings reveal a definitive association between body composition indices and metabolic syndrome status in children with obesity. However, not all children with obesity develop metabolic abnormalities, highlighting the importance of detailed body composition analysis in assessing metabolic health risk.

Childhood stunting remains a public health challenge in Thailand. While national surveys provide prevalence estimates, there is limited understanding of the multilevel influences shaping child feeding practices. This qualitative study aimed to explore individual, familial, and socioenvironmental determinants of child feeding practices among Thai female caregivers of young children with stunting. In-depth interviews, guided by Social Cognitive Theory, were conducted with 40 female caregivers (primarily mothers) of children under 5 years old with stunting. Participants were purposively selected from nutrition clinics in four hospitals across four regions of Thailand (Chiang Mai, Bangkok, Satun, and Ubon Ratchathani). Trained local dietitians and nutritionists conducted interviews within the clinics. Transcripts were thematically analysed by two independent researchers, triangulated by input from local interviewers. Children's age ranged from 1.0 to 4.9 years old (mean 3.0 ± 1.1 years). Results showed that caregivers understood the importance of healthful feeding but faced barriers such as financial constraints, low self-efficacy, limited food acceptance, and misconceptions about nutrition. Permissive feeding practices were common due to concerns over picky eating. Family dynamics, food access and availability, and limited engagement with government nutrition programmes further shaped child feeding practices. This study highlights the complex interplay of multilevel factors that influence child feeding practices among Thai caregivers of young children with stunting. Addressing these challenges effectively requires a multifaceted approach for caregivers, including nutrition education, behavioural support, and policies to improve food access and affordability.

Serving children larger portion sizes is associated with higher energy intake and can contribute to childhood obesity. Parents of young children report being open to receiving portion guidance. However, the perspective of parents who have received a portion guide is not well understood. The current study aimed to (i) understand how parents provided with an age-appropriate portion guide use it to guide feeding behaviour and (ii) assess the value of making age-appropriate portion guidance more widely available. In-depth, semi-structured interviews were conducted with 15 parents of young children (1–4 years) who had received an age-appropriate portion guide. Interviews were analysed using reflexive thematic analysis and four themes were developed: (i) guidance is appreciated but has a limited impact on portion sizes, (ii) portions are usually determined by other factors, (iii) the guide is still useful, just not as intended and (iv) when and how guides are delivered influences acceptability. Parents were receptive to feeding guidance from trusted sources. The portion guide was seen as a useful resource for maintaining balance in children's diets along with limiting less healthy foods, but was not used directly to guide the portions parents served. Several aspects of the guide were seen as impractical and unrealistic, and portions served were mainly determined using parent- and child-led strategies. Results suggest that portion guides might be less useful for parents' portioning practices than previously assumed. However, portion guides are still appreciated by parents and positively influence other aspects of feeding behaviour.

Despite lactation being a natural occurrence in mammals, many structural barriers and individual factors can impact the ability of a woman to breastfeed her newborn. At the individual level, evidence has widely documented several risk factors and societal barriers for impaired lactation, many of which have been steeply increasing in human societies in the past few decades (e.g., psychosocial stress, metabolic disorders, births interventions, etc.). Yet the healthcare system worldwide does not seem to be prepared to support women facing such breastfeeding difficulties. Pregnant women are often provided with unrealistic expectations of how the breastfeeding experience should unfold, which can then translate into negative feelings when they encounter difficulties. In this context, the development of objective diagnostic tools able to help healthcare professionals and women identify breastfeeding difficulties that could then be treated accordingly would seem an ideal solution. Previous studies have tried to provide evidence for the use of milk compositional variations during early lactation as a tool to identify delayed secretory activation of the mammary gland, which often results in impaired lactation. However, despite portable technology for this purpose being successfully developed and/or validated, a consistent research gap remains around the true diagnostic power of such biomarkers in relation to clinically significant outcomes. This obstructs the development of effective diagnostic tools that could be employed in clinical practice to improve breastfeeding outcomes and breastfeeding rates.

The World Health Organization's 2023 recommendations for managing moderate wasting provide criteria for prioritizing children to receive specially formulated foods (SFF) rather than counseling alone. However, the practical programmatic impact of such prioritization is unclear. This secondary analysis aimed to describe the caseload and treatment outcomes among moderately wasted 6- to 59-month-old Malian children, categorized into higher-priority (HP) and lower-priority (LP) groups. All children admitted with a MUAC ≥ 115 to < 125 mm without nutritional edema received SFF (500 kcal/day) until they achieved a MUAC ≥ 125 mm for 2 consecutive visits. HP criteria were < 2 years old, WAZ < −3 SD, or MUAC 115–119 mm; LP criteria were ≥ 2 years, WAZ ≥ −3 SD, or MUAC ≥ 120 mm. We reported the caseload per priority criterion and compared treatment outcomes, including recovery and anthropometric changes, between LP and HP children. Of the 35 685 children included in the analysis, 95% met at least one priority criterion. The proportion of children recovered was similar between LP and HP children, regardless of the criterion used. MUAC-for-age z-score and WAZ weekly changes showed similar trajectories. Furthermore, although classified as LP, children > 2 years exhibited lower WAZ throughout treatment compared to children < 2 years. Most moderately wasted children (MUAC < 125 mm) met at least one priority criterion, raising concerns about the feasibility and rationale of the prioritization approach. The similar recovery rates in higher- and lower-priority groups after both received SFF highlight the need for research to assess the impact of different interventions.

Children's early years food environment can influence dietary habits. We evaluated Yes to Veg! a 4-week nursery-based programme on pre-school children's vegetable exposure, consumption and agency. A quasi-experimental study in 11 nurseries (6 intervention/5 controls) located in socio-economically deprived areas of Glasgow, Scotland. Yes to Veg! delivered locally grown fresh vegetables once-per-week for children's daily nursery activities. Control nurseries received standard healthy eating recommendations. Parental pre- and post-questionnaires measured child vegetable exposure (vegetables tried from a 27-item list), consumption frequency (1 = once-per-week to 5 = everyday) and variety consumed (0 = none/1 = 1-4/2 = 5-9/3 = 10+ kinds). Qualitative comments reported by parents, nursery staff and from researcher observations were extracted for qualitative themes. From 257 parent-child dyads recruited, 57 (n = 34 intervention/n = 23 control, child mean age 51 months) completed both questionnaires. Vegetables tried [Mean(SD)] did not change between intervention [total score pre 16.7(4.5) vs 16.8(5.6) post, difference 0.19(0.6), p = 0.765] and control group [total score pre 16.4(5.3) vs 16.0(5.6) post, difference −0.39(0.57), p = 0.503]. Median pre- and post-consumption frequency in both groups was 4 (most days); the variety of vegetables consumed was higher in intervention (5-9 items) vs control (1-4 items) and these measurements didn't change between pre- and post. Vegetable agency increased in the intervention; parents said children talked more about vegetables at home (91% vs 65% control) and were willing to try vegetables at home (41% vs 34% control); emerging qualitative themes included children's engagement with vegetables, sensory interaction and programme acceptance. Yes to Veg! facilitated exposure, engagement and familiarisation to vegetables, was well implemented and received, but did not change consumption.

The 2025 call of the World Alliance for Breastfeeding Action (WABA) is to prioritise breastfeeding through creating sustainable support systems. This is based on the strong foundations of breastfeeding and the unique properties of human milk to nourish, protect and provide optimal physical, emotional and cognitive growth for the infant. Empowering women to establish and maintain lactation is critical for the short- and long-term health of mothers and infants; reducing infant and maternal morbidity; reducing healthcare costs; and building healthy societies. Studies have demonstrated this can be done effectively and sustainably using peer educators to provide support, knowledge and self-efficacy to establish and maintain breastfeeding. However, rates of breastfeeding remain far below global targets. Safe and sustainable support options are needed for mothers who struggle with an insufficient milk supply, despite lactation support. These options include wet nursing and safe human milk sharing. When these are not possible/feasible, donor milk from human milk banks should be considered. Creating support systems requires investing in financial and human resources to protect, promote and support breastfeeding through revisiting these sustainable approaches.