Maternal and Child Nutrition最新文献

Household food insecurity (HFI) remains a challenge globally and is recognized as a risk factor for poor child nutritional outcomes for infants and young children. However, few studies have evaluated the associations of HFI with the growth and development of preschool children. This study assessed the association of HFI with growth and development outcomes among preschool-aged children in rural Pakistan and explored potential differences in the magnitude of the associations by child gender and early childhood care and education (ECCE) intervention. Anthropometric and child development data from 2795 children aged 4.5–5.5 years enroled in a cluster-randomized stepped-wedge trial of the Youth Leaders for Early Childhood Assuring Children are Prepared for School intervention were collected across four districts in rural Sindh. HFI was assessed using the Household Food Insecurity Access Scale, and child development was measured by the International Development and Early Learning Assessment (IDELA) and a battery of executive functions tasks. Multilevel mixed-effects models were utilized to investigate the associations between HFI and height-for-age (HAZ), weight-for-age (WAZ), BMI-for-age z scores and child development scores. Increasing levels of HFI were associated with lower child WAZ, lower total IDELA scores and lower emergent literacy scores (p values for trend < 0.05). No significant association was observed between HFI and executive functioning. Gender and ECCE intervention status did not modify the relationship between HFI and child growth and development outcomes (p > 0.05). Future research should investigate the synergistic potential of nutrition and ECCE programmes to improve outcomes for children and families in rural Pakistan and similar resource-scarce settings. The trial is registered with ClinicalTrials.gov (NCT03764436).

A growing body of research on commercial baby foods (CBFs) has reported nutritional composition, marketing, and labelling concerns. We aimed to review and consolidate the evidence on CBFs marketed for children 0–36 months in the UK, Europe, Australia, and New Zealand to inform UK policy by highlighting key issues with the current retail offer. A systematic search conducted on PubMed and Web of Science on three topics: (1) Nutritional Composition, Flavour Profile and Texture, (2) Marketing and Labelling, and (3) Parental Choice and Preferences. Studies on CBFs were included if conducted in English in specified countries, age, and published between 2019 and 2024. Out of 3143 studies screened, 31 full papers were separated into three topics and reviewed. Topic 1: Out of all products sampled, 56% were puréed and 18% were snacks. The median sugar content per 100 g (IQR) were 10.4 g (1.0) in purées, 20.3 g (9.9) in snacks, and 14.7 g (14.4) in cereals. Nearly half of all products contained added or free sugars (n = 13 studies), and 62% when looking at snacks alone (n = 6 studies). Topic 2: Six out of 9 studies had ‘no added sugar’ claims, and eight studies reported finding claims related to health or nutrition. Topic 3: All studies reported that health/development/nutrition were motivations to purchase CBFs, and 75% mentioned ‘baby's enjoyment’, ‘convenience/time’, and ‘safety’. Purées and snacks dominate the CBF market and are often high in sugars. Marketing claims are misleading and exploit parents' fears to motivate use.

Adolescent food insecurity (FI) is associated with negative health and development outcomes, but parents may be unaware of these experiences. In Ghana, adolescents without access to school meals may be at risk of FI and poor diet. We described adolescent FI at home/school, assessed parents' abilities to report on them, and determined how FI relates to diet quality. We randomly selected 187 adolescent (11–17 years)/parent pairs from 8 schools in Cape Coast. Adolescents and their parents responded to the Child Food Insecurity Experiences Scale and parents reported household FI. The Diet Quality Questionnaire was used to create 4 diet quality scores for adolescents only. We assessed differences in FI scores using t-tests and agreement using Cochrane's Q and Cohen's kappa. We used linear/logistic regression to assess the relationship between FI and diet quality. Half of adolescents reported several/many FI experiences at school (56.7%) and at home (53.5%). Parent and adolescent reports of FI at home did not differ, while reports at school did (30.5% vs. 56.7% p = 0.002). 40.2% of parents responded ‘I don't know’ about their child's FI at school and 11.2% of parents reported better FI than their child. Parental report of household FI was significantly worse than adolescents' self-reports (82.4% vs. 56.7%). Adolescent, but not parental, reports of FI at home and school were negatively associated with diet quality. Food insecurity is common and strongly related to adolescent diet quality, but parents are often not aware. Interventions are needed to address adolescent FI in this context, especially at school.

Breastfeeding rates are lower for women with disabilities than for women without disabilities, and women with visual impairment may be discouraged from breastfeeding by health professionals or their families. Little is known about how women with visual impairments learn to breastfeed and their breastfeeding experiences. The aim of this scoping review was to identify and map available evidence regarding the experiences and needs of mothers with visual impairment in initiating, establishing and maintaining lactation and breastfeeding, as well as to examine the extent of existing knowledge regarding supports and services currently available to meet those needs. We searched the following: MEDLINE, CINAHL, Embase, Scopus, the Cochrane Database and JBI Evidence Synthesis, Directory of Open Access Journals (DOAJ) and ProQuest Dissertations and Theses. Grey literature sources were searched via Google Scholar. Initial searches, after removal of duplicates, title and abstract screening, resulted in 39 articles for full text screening, of which, 17 met the inclusion criteria. Data were analysed using thematic synthesis. Studies came from seven countries and were mostly qualitative. Two analytical themes were generated: Visual impairment increases women's difficulty in learning to breastfeed, and Peer support is essential for visually impaired mothers, as HCPs provide poor support for breastfeeding. Visual impairment adds an extra layer of difficulty when women are learning to breastfeed. Barriers are created when systems and structures did not accommodate a woman's inability to see. Lack of access to information in nonvisual formats, limited transport to attend appointments and unsupportive attitudes from healthcare workers were common.

Investigating the association between gestational weight gain (GWG) on low birth weight (LBW, birth weight < 2500 g) across pre-pregnancy body mass index (BMI) categories (underweight: < 18.5, normal: 18.5–24.9 and overweight/obese: ≥ 25 kg/m²) is crucial for clinical practice. While the Institute of Medicine's (IOM) 2009 GWG guidelines are widely used, evidence-based data from diverse populations is scarce, creating a global research gap. We explored how total GWG and adherence to IOM recommendations affected the odds of LBW across BMI categories in the Sri Lankan context. This nationwide prospective study evaluated 1499 maternal and singleton-newborn pairs between August 2022 and April 2024. Unadjusted and adjusted logistic regression analyses were performed. An increase in total GWG z-score was associated with decreased odds of LBW among women with underweight pre-pregnancy BMI (aOR: 0.56, 95% CI: 0.35‒0.89), but no significant association was observed among women with normal or ≥ 25 kg/m² BMI. Women with underweight BMI whose GWG was below the IOM recommended range showed higher odds of LBW than those with GWG within the recommended range (aOR 3.05, 95% CI: 1.08‒8.61). However, among women with normal or higher BMI, GWG below the recommended range was not significantly associated with LBW. These findings suggest that the association between GWG and odds of LBW varies across pre-pregnancy BMI categories. Among Sri Lankan women with underweight pre-pregnancy BMI, gaining pregnancy weight within the IOM GWG recommendations was associated with significantly lower odds of delivering an LBW newborn. This association was not observed among women with normal or higher BMI.

Breastfeeding is the optimal method of infant and young child feeding. In Nigeria, breastfeeding rates have struggled to markedly improve over past decades. Prior efforts to understand the determinants of breastfeeding have heavily focused on women themselves, with lesser attention on the complex interplay of cultural, economic and health system factors affecting breastfeeding. Given the struggle to sustain improvements in optimal feeding practices, a deeper, updated understanding of the supportive environment for breastfeeding in Nigeria is needed. This subset analysis stems from a formative study that conducted semi-structured interviews and focus group discussions in urban and rural communities in Nigeria's six geo-political zones. The analysis explored barriers and facilitators to breastfeeding at different levels of a socioecological model (SEM). Discussions with pregnant women and mothers of young children focused on the supportive environment for breastfeeding beyond the individual level, exploring facilitators and barriers in women's nuclear and multi-generational families, their communities, and institutions that provide health and nutrition services. At the household level, participants highlighted the influence of family elders. In their communities, widespread traditional practices and beliefs helped and hindered breastfeeding, along with varying sources of community-level support and influence. At the service level, women elaborated on the effect of healthcare service access, service availability, and the quality of health and nutrition services. This formative analysis deepens understanding of factors crucial for developing multilevel and multicomponent interventions across the SEM in Nigeria that can simultaneously support mothers and improve infant health outcomes nationwide.

Research on early childhood development has focused on child health, nutrition and stimulation. However, less attention has been given to the role of caregiver nutrition in shaping caregiving behaviours. Suboptimal caregiver nutrition may impair the ability to provide responsive and nurturing care. This scoping review aimed to summarise the existing evidence on the link between caregiver nutrition and nurturing care, specifically responsive caregiving and early learning opportunities. Database (Medline) and citation searches yielded 23 articles meeting inclusion criteria (n = 17 observational; n = 6 randomised controlled trials [RCTs]). The majority (n = 15) were conducted in low- and middle-income countries. Observational studies measured caregiver anthropometry (n = 8), dietary intakes/diversity/quality (n = 6), anaemia (n = 6) and vitamin B6 status (n = 1). RCTs supplemented pregnant and/or postpartum women with iron (n = 2), multiple micronutrients (n = 2), fish oil (n = 1) and food-based snacks (n = 1). Most articles (n = 18) measured caregiving through live or videotaped observations of caregiver–child interactions; the remaining used caregiver self-reported measures of stimulation or caregiver–child bonding/relationship. Overall, suboptimal diets, food insecurity, caregiver under- and overnutrition, anaemia and low vitamin B6 status were associated with less responsive caregiving and fewer opportunities for early learning. Providing anaemic or food-insecure caregivers with iron or food-based supplements positively altered caregiver–child interactions. Supplementation trials that did not specifically target undernourished caregivers found no effects on caregiving behaviours. More research specifically targeting undernourished caregivers is needed to understand how nutritional interventions might benefit caregiving. Interventions aimed at enhancing nurturing care should consider both caregiver and child nutrition as potential targets to improve outcomes for both children and their caregivers.

Infants born with a very low birth weight (VLBW, < = 1.500 g) have an increased risk for medical complications and long-term impairments. Feeding these infants with their mother's own milk (MOM) reduces the risk for adverse outcomes, but many VLBW infants are not fed with MOM for the recommended duration of at least 6 months postpartum. This study examines factors associated with early cessation during the VLBW infants' neonatal intensive care unit (NICU) stay and after discharge. Data were collected from an anonymous, nationwide survey as part of the Neo-MILK study. Logistic regressions and Cox proportional hazard models were used to identify factors associated with early cessation of MOM feeding. Among the 304 mothers analysed, 19.4% of all mothers ceased MOM feeding during the infants' NICU stay. The total cessation rate before 6 months was 53.9%. An early milk volume of over 500 mL/day compared to less or equal to 500 mL/day was negatively associated with MOM feeding cessation during the infants' NICU stay (Adjusted OR: 0.14). Exclusive pumping was associated with a higher cessation rate after discharge (Adjusted HR: 2.01). Early sufficient milk volume and mixed feeding (pumping and breastfeeding) inform longer MOM feeding duration. Interventions targeting early lactation practices and promoting direct breastfeeding while helping with the transition from pumping to breastfeeding are essential for improving MOM feeding outcomes in VLBW infants.

Trial Registration: German Register of Clinical Trials, ID: DRKS00024799, https://drks.de/search/en/trial/DRKS00024799.