Maternal and Child Nutrition最新文献

There is a high incidence of neural tube defects (NTDs) in Ethiopia and folate insufficiency, a primary risk factor for NTDs, is common among Ethiopian women of reproductive age (WRA). Folic acid fortification of salt has been proposed as a strategy to control these problems. In preparation for an intervention trial to assess the nutritional effects of folic acid-fortified salt, we measured discretionary salt intakes among nonpregnant WRA using observed weighed food records, and we assessed household salt disappearance rates. We estimated the distribution of usual discretionary salt intake by adjusting for intra-individual variability using the National Cancer Institute (NCI) method, and we simulated the potential effects of two levels of folic acid fortification (30 and 90 ppm folic acid) on folic acid intakes. Mean ± SD of usual discretionary salt intake was 6.8 ± 1.9 g/day. At the 95th percentile of usual discretionary salt intake, the higher fortification level would provide 918 µg folic acid/day, which is less than the tolerable upper intake level of 1000 µg/day. At the 5th percentile of usual discretionary salt intake, the lower fortification level would provide 124 µg folic acid/day, which should produce a statistically significant increase in red blood cell folate concentration. Estimated household salt utilization was 8.8 ± 6.1 g/person/day. These findings inform plans for a randomized, dose-response intervention trial of folic acid-fortified salt and a possible future national program to mandate folic acid fortification of refined, edible salt in Ethiopia.

This study examined relations between caregiver feeding behaviours, child dietary diversity and anthropometry at 24 months of age in rural Bangladesh. Twenty-four hours dietary recall, weight and length data were collected on 4733 children. Factor analysis was applied to an 11-item caregiver feeding behaviours scale administered at 24 months, revealing two constructs: responsive/involved (five items) and forceful (six items); each dichotomised to reflect low and high use. Stunting (length-for-age Z-score < -2), wasting (weight-for-length Z-score < -2) and underweight (weight-for-age Z-score < -2) were defined using international growth reference standards. Associations between feeding behaviours, dietary diversity score (DDS, food groups consumed; range 0-7) and anthropometric indicators were examined using multivariable linear or logistic regression models, adjusting for study design, confounders and intervention arm. Mean (SD) age of children in the study was 24.1 (0.3) months. Mean (SD) DDS was 3.7 (1.4), with 55% of children meeting minimum dietary diversity (MDD, DDS ≥ 4). Stunting, wasting and underweight were 40%, 19% and 42%, respectively. Use of high responsive/involved feeding behaviours (reported in 71% of mothers) was associated with higher DDS (0.09, 95% confidence interval [CI]: 0.001, 0.17) and higher odds of achieving MDD (OR: 1.17; 95% CI: 1.02, 1.33) but not with anthropometric outcomes. Use of high forceful feeding behaviours (reported in 34% of mothers) was associated with lower DDS (-0.12, 95% CI: -0.21 to 0.04), lower odds of achieving MDD (OR: 0.82, 95% CI: 0.72, 0.93), and higher odds of underweight (OR: 1.38, 95% CI: 1.22, 1.56) and wasting (OR: 1.55, 95% CI: 1.33, 1.81). In Bangladesh, responsive/involved feeding was associated with higher child dietary diversity whereas forceful feeding was associated with lower dietary diversity and undernutrition. Future research is needed to understand causality and test the effect of responsive feeding interventions on the promotion of child growth.

Globally, the intake of fruit and vegetables (F&V) is far below the recommended levels, contributing to various health challenges including micronutrient deficiencies and non-communicable diseases. In Tanzania, where the triple burden of malnutrition persists, there is a need to identify gaps in evidence, better understand diets and F&V intake and identify promising interventions for improved intake. We conducted a scoping review to summarize the evidence on dietary intake, F&V intake and nutritional status in Tanzania. This included three separate literature searches in PubMed covering the years 2012-2023. A total of 62, 37 and 15 articles met predefined eligibility criteria for the review of overall diet, dietary intake of F&V and nutritional status, respectively. Identified studies suggest that overall dietary practices among all population groups were primarily based on carbohydrate-rich foods, complementary feeding practices were suboptimal among young children and a low proportion of women of reproductive age (WRA) and pregnant and lactating women achieved minimum dietary diversity for women (MDD-W). Across all population groups, F&V intake was below the recommended 400 g per day. Analysis of nutritional status in Tanzania in population representative surveys showed high stunting prevalence in children below 5 years of age, and a high prevalence of overweight and obesity among WRA, particularly in urban areas. Additional research is needed to understand better the complex interactions between diet and nutrition and health outcomes, and to identify efficient and cost-effective strategies to improve overall dietary quality, including increasing F&V intake.

Maternity protection policies are designed to preserve the health of working women and their infants, support optimal infant and young child nutrition through breastfeeding and prevent workplace discrimination against women. The aim of this study was to identify how advocates may be able to effectively advance maternal leave and workplace lactation policies, two key maternity protection policies, and does so through an exploration of advocacy efforts in Indonesia, Nigeria, the Philippines and Vietnam. A desk review of programme and policy documents and 20 key informant interviews with diverse stakeholders explored advocacy efforts in each of the four countries. Thematic analyses of documents and interviews identified key considerations, challenges and success factors within each country context. These lessons can inform maternity protection policy reform efforts more broadly. Study findings show that effective, context-specific advocacy rests on strong partnerships with traditional and nontraditional stakeholders informed by opinion leader research and strengthened through various avenues of consensus-building. Contextual considerations are essential for identifying attainable policy asks and developing an advocacy strategy, with attention to a country's governance structure and availability of funding for social protections. Lastly, advocacy efforts may be most successful by presenting expanded paid maternity leave and breastfeeding-friendly workplaces as parts of a set of social protections with synergistic benefits. These lessons are intended to help inform how policy advocates can better design and implement advocacy approaches for maternity protection and entitlement policies.

Unhealthy diets, including low fruit and vegetables (F&V) intake, contribute to morbidity and mortality related to non-communicable diseases. Designing culturally appropriate interventions to improve diets and F&V intake requires an in-depth understanding of individual-level dietary patterns, household consumption patterns, and nutritional status resulting from inadequate F&V intake. In this scoping review, we summarised the literature on diets, F&V intake, and nutritional status in Benin. We searched PubMed from 2012 to August 2024 to identify articles on diets and nutritional status, and from 2002 to August 2024 to identify articles on F&V intake. We included 36 articles on diets, 27 on F&V intake, and 16 on nutritional status. Existing literature demonstrated that Beninese diets are cereal-based and monotonous, characterised by low diversity and low F&V intake across all population groups. Available evidence indicated a high burden of undernutrition in children <5 years of age, a rising prevalence of overnutrition in women of reproductive age, and a high prevalence of overnutrition in adults. Evidence on how diets and F&V intake vary by urban/rural location, season, and socioeconomic characteristics was limited and inconsistent. Two evaluations of garden irrigation programmes assessed impacts on women's dietary diversity and F&V consumption. Additional research is needed to improve our understanding of diets, F&V intake, and diet-related nutritional challenges and how they evolve over time and across different population groups. Understanding these gaps can help identify entry points and targets for interventions to improve diet quality and F&V intake in Benin.

Despite the persistence of breastfeeding racial and ethnic disparities in the United States, little is known about Black fathers' perceptions of breastfeeding and breastfeeding support services (e.g., maternity hospital-based care and lactation management care). This qualitative, community-based participatory research study reports Black fathers' perceptions of barriers and facilitators to breastfeeding, including the provision of breastfeeding support services in Connecticut. A focus group guide was co-developed with community partners and adapted from the Barrier Analysis Tool to identify breastfeeding facilitators, barriers, and service improvement areas. Four focus groups were conducted with 30 Black fathers who were Connecticut residents with a child under 3 years old. Qualitative data were analyzed using rapid template analysis involving deductive and inductive coding. We identified factors influencing breastfeeding and fathers' ability to support breastfeeding across all levels of the Socio-Ecological Model. Facilitators included high paternal breastfeeding knowledge, paternal breastfeeding involvement, parents' shared decision-making, extensive maternity hospital discharge support, ongoing breastfeeding support into the postnatal period, availability of community breastfeeding resources, and designated spaces for public breastfeeding. Barriers included low paternal breastfeeding knowledge, familial discouragement, insufficient prenatal breastfeeding education, exclusion of the father from breastfeeding support services, and stigma against breastfeeding in public. Understanding breastfeeding perceptions among members of a mother's support network, including their partners, is key for developing effective person- and family-centered breastfeeding education and counseling services that are well coordinated from the prenatal to postnatal periods with strong direct engagement from fathers.

This secondary analysis of the Eggcel-growth study investigated the effect of daily egg intake for 6 months in infants aged 6-9 months on environmental enteric dysfunction (EED) biomarkers and the association of EED markers with growth faltering. A randomised controlled trial was conducted in Jouberton, South Africa, among 500 infants randomly assigned equally to either an intervention group receiving a daily chicken egg or a control group. Both groups were followed up for 6 months. Data on infant and maternal sociodemographic information and anthropometric status of infants were collected. EED and inflammatory markers were analysed using Q-Plex Human EED (11-Plex) assay. There was a significant reduction in fibroblast growth factor 21 (FGF21) concentration in the intervention group (B = -0.132; 95% CI -0.255, -0.010; p = 0.035). Baseline, insulin-like growth factor 1 (IGF-1) was positively associated with endpoint length-for-age z-score (LAZ), weight-for-age z-score (WAZ) and weight-for-length z-score (WLZ) and there was an inverse relationship between baseline FGF21 and intestinal fatty acid-binding protein (I-FABP) with endpoint growth indicators. Baseline IGF-1 was positively associated with reduced odds of wasting, stunting and being underweight (p < 0.001) and baseline FGF21 was associated with increased odds of stunting (p = 0.002), wasting (p = 0.031) and being underweight (p = 0.035). There was a 20% increased odds of stunting with baseline I-FABP (p = 0.045) and a 30% increased odds of being underweight with baseline soluble CD14 (p = 0.039). Complementary feeding with eggs decreased growth hormone resistance (reduced FGF21 levels); however, FGF21 and I-FABP levels were linked to increased growth faltering. Trial Registration: ClinicalTrials.gov: NCT05168085.

Diet quality is influenced by multiple individual factors, but their relative strength and importance remain unclear. We investigate the associations between five domains of individual factors (economic, cognitive, aspirational, situational and consumer behaviour) and diet intake of adolescents in Accra, Ghana. A cross-sectional survey among Junior High School (JHS) students (n = 409, mean age 14.3 years ± 1.28 (SD)) in Accra, Ghana, was conducted. Data on diet intake, knowledge, attitude and practices (KAP) and socioeconomic background characteristics were collected. Adjusting for other factors, students' total budget was positively associated with food group diversity (β = 0.12, 95% confidence interval [CI] 0.09-0.15) but inversely associated with diet quality (β = -0.07, 95% CI -0.11 to -0.03). Positive attitude towards nutrition and healthy eating was inversely associated with unfavourable diversity (β = -0.17, 95% CI -0.31 to -0.03). Differences between negative deviants relative to positive deviants were determined by attitude towards healthy eating (odds ratio [OR] = 0.41; 95% CI 0.17-0.99) and family practices (OR = 0.48; 95% CI 0.23-1.00). We provide evidence that higher food budgets were associated with higher diet diversity, but not with improved diet quality. Attitude, but not knowledge, was linked to better diet quality. Future studies should focus on the specific contribution of aspirational, situational and behavioural factors in directing increased diversity towards favourable eating habits.

Though child anthropometric failure (CAF) is a persistent problem in India, previous studies have often neglected state-level variance and aggregated moderate and severe CAF categories. This study addresses this gap by examining moderate and severe malnutrition across India's states and union territories (UTs) from 1993 to 2021. Data of children under 2 years old from five waves of National Family Health Surveys, a representative cross-sectional survey of Indian households, were analysed. Outcomes included prevalence of moderate and severe stunting, underweight and wasting, as per the 2006 World Health Organization growth standards. Percentage prevalence and standardized absolute change (SAC) were calculated nationally and by region for each wave. From 1993 to 2021, there was a notable reduction in the nationwide prevalence of moderate stunting, underweight and wasting, with rates dropping from 20% to 16%, 23% to 18%, and 15% to 12%, respectively. Severe stunting and underweight declined considerably from 23% to 16% and 18% to 11%, respectively; severe wasting marginally increased from 8% to 9%. From 2016 to 2021 moderate underweight was noted to have the highest SAC across all regions, although 15 regions saw an increase in the prevalence of moderate underweight. In the 2016-2021 period, severe wasting has increased in 13 of the 36 regions. While there has been a nationwide reduction in most indicators of CAF since 1993, the rate and direction of change vary widely among states and UTs and between moderate and severe categories within each of the states and UTs. Understanding these patterns of change can direct context-specific interventions for improving child nutrition and health. A greater focus on reducing severe wasting, which has increased since 1993, is also crucial.

Adolescence is a period of tremendous physical and neurophysiological change, and today's rapidly changing food system has implications for adolescent nutritional and health outcomes. Ensuring nutritious diets during adolescence requires evidence on what is being consumed by adolescent boys and girls, however, little is known about the dietary patterns among this age group. This study assessed the prevalence of food group consumption and indicators of diet quality among adolescents in the Southeast Asia region and compared these results to the adult population. Secondary analysis of the Gallup World Poll, a population-based survey, was performed using datasets from Cambodia, Indonesia, Laos PDR, the Philippines and Vietnam. Pooled analysis of nine diet quality indicators was conducted among all adolescents 15-19 years of age (n = 479), with comparison to the adult population (n = 4589). Various unhealthy food groups were consumed by one-quarter to one-half of adolescents, with a greater proportion of adolescents consuming instant noodles, sweets, processed meats and salty snacks, as compared to adults. Just over one-third of adolescents (37.4%) consumed all five recommended food groups to meet dietary guidelines, almost two-thirds (62.6%) consumed sweet beverages and over three-quarters consumed unhealthy/ultra-processed foods (76.8%). Overall indicators of diet quality showed that Southeast Asian adolescents' diets were less healthy than adults. This is one of the first studies to explore the healthy and unhealthy aspects of diets among both adolescent boys and girls across the Southeast Asia region, with results indicating that diets are not nutritionally adequate.