Maternal and Child Nutrition最新文献

A simplified, combined protocol treats children with moderate acute malnutrition (MAM), defined by mid-upper arm circumference (MUAC) of < 125 and ≥ 115 mm and no oedema, with 1 daily sachet of ready-to-use therapeutic food (RUTF) and those with severe acute malnutrition (SAM), defined by MUAC < 115 mm and/or oedema, with two daily sachets of RUTF. This protocol was previously shown to result in non-inferior recovery compared to standard treatment that used higher, weight-based RUTF dosing among children with SAM and ready-to-use supplementary food (RUSF) for MAM in a cluster-based randomised controlled trial in Kenya and South Sudan. We conducted a secondary analysis of this trial to compare linear growth among children admitted with MUAC < 115 mm. Linear and ponderal growth were calculated from admission to discharge and visualised using aggregate growth curves. HAZ change adjusted for admission characteristics was negative across the course of treatment but similar across arms [-0.21 ± 0.18 SE in the standard arm, -0.24 ± 0.18 SE in simplified; difference (95% confidence interval) 0.03 (-0.12, 0.18)]. The unadjusted mean ± SE linear growth velocity from admission to discharge was 1.8 ± 0.7 mm/week in the standard arm compared to 1.7 ± 0.7 mm/week in the simplified arm [difference = 0.09 (-0.36, 0.53)] and similar in adjusted analysis. MUAC and weight gain velocities were not significantly different by treatment arm. Reducing the RUTF dose prescribed to children during SAM treatment does not appear to affect linear growth or other growth velocities during treatment.

The first 1000 days of life lay the foundations for subsequent growth. This ambidirectional study, including prenatal, perinatal and postnatal factors, aimed to identify exposure variables affecting body size and composition and corresponding Z-score outcomes at age 18 months in infants born to women at low risk of adverse pregnancy outcomes in a peri-urban area of South Africa. Prenatal factors (maternal age, HIV status, anthropometry, parity, food insecurity and umbilical artery resistance index Z-score (UmA-RIAZ) as a measure of placental function, with higher UmA-RIAZ indicating poorer placental function); perinatal factors (infant sex, gestational age and birth anthropometry) and postnatal factors (infant feeding) were included as exposure variables, with infant anthropometry and body composition at 18 months as outcomes. Simple linear regression analysis was used to investigate associations between exposure variables and infant outcomes, and variables with p < 0.10 were included in the subsequent multiple regression analyses. Multiple regression analysis showed that higher UmA-RIAZ predicted lower birthweight [-0.11 kg (95% CI: -0.17, -0.04 kg)], birthweight-for-age Z-score [-0.24 (95% CI: -0.39, -0.09)] and 18-month infant length [-0.9 cm (95% CI: -1.4, -0.4 cm)] and length-for-age Z-score [-0.28 (95% CI: -0.45, -0.11)]. Maternal HIV infection predicted reduced 18-month infant length-for-age Z-score [-0.46 (95% CI: -0.83, -0.09)]. Household food insecurity predicted reduced fat-free mass-for-age Z-score at 18 months [-0.27 (95% CI: -0.51, -0.03)]. Infant anthropometry and body composition outcomes, therefore, are greatly affected by pre- and postnatal nutrition-related factors, such as placental insufficiency in utero and household food insecurity, with long-term consequences including stunting, which impact the individual, future generations and society.

Long-chain n-3 polyunsaturated fatty acid (PUFA) consumption in maternal and infants has been positively associated with cognitive and visual development. Tails even meta-analysis showed mixed results. To evaluate the effects of maternal and infant n-3 PUFA supplementation on childhood psychomotor and cognitive development, PubMed, Embase, the Cochrane Library, PsycINFO and clinicaltrials.gov were searched. Randomized controlled trials were included to evaluate the effect on child cognitive and psychomotor outcomes of n-3 PUFA supplementation in mothers or infants (age ≤ 2 years). Findings were pooled with mean differences (MD) with 95% confidence intervals (95% CIs). Heterogeneity was explored using I² and subgroup analyses, stratified for maternal (pregnancy and/or lactation) and infant (preterm infant and term infant). We identified 47 articles, with 14 trials on mothers and 33 on infants. Pooled results showed that infants' mental development index (MDI) increased with n-3 PUFA supplementation (MD = 2.91, 95% CI: 1.32-4.51, I² = 65.1%). Subgroup analysis of MDI also demonstrated a benefit in preterm infants (MD = 4.16, 95% CI: 1.40-6.93, I² = 49.5%) and term infants (MD = 2.28, 95% CI: 0.27-4.29, I² = 70.1%). No significant association was found in subgroup analyses of supplementation to mothers during pregnancy or lactation period. Supplementation did not increase the psychomotor development index (PDI) in the mother or infant group. Language composite score increased for infants whose mothers accepted supplementation in pregnancy or breastfeeding (MD = 8.57, 95% CI: 5.09-12.04, I² = 70.2%). The cognitive composite score did not improve in any subgroup. Intelligence Quotient (IQ) increased in the infants' group with n-3 PUFA supplementation (MD = 2.54, 95% CI: 0.45-4.63, I² = 66.0%). Furthermore, IQ in term infants also improved (MD = 2.91, 95% CI: 0.24-5.57, I² = 69.2%). The funnel plot and Egger's test confirmed no publication bias in any endpoints. Supplementation with n-3 PUFA during pregnancy or breastfeeding in mothers has increased language abilities. Furthermore, direct supplementation in term infants can improve intelligence in later childhood. However, insufficient evidence supports the claim that supplementation improves cognitive abilities.

Inadequate physical growth and poor development are significant global challenges affecting millions of children. Globally, 149.2 million children under five experience stunted growth and 45.4 million suffer from wasting. Growth monitoring and promotion (GMP) programmes aim to identify growth faltering in children before they develop malnutrition. However, understanding the factors influencing GMP service utilization is crucial for improving its effectiveness in the study area. This community-based cross-sectional study in the Sude district of southeastern Ethiopia investigated GMP service utilization among mothers of children aged 0-23 months. The study included 874 participants selected through systematic random sampling. Data collected through a structured questionnaire revealed a GMP service utilization rate of 40.2%. The study identified several factors significantly associated with GMP service utilization. This includes maternal education, husband involvement, institutional delivery, maternal autonomy and birth interval, which are the most significant factors identified to influence GMP service utilization. Mothers with higher levels of education were more likely to utilize GMP services [AOR = 3.70 (95% CI: 2.09, 6.54)]. Discussions about child growth with husbands were linked to increased GMP utilization [AOR = 2.22 (95% CI: 1.24, 3.968)]. Moreover, mothers who delivered at health facilities and with greater autonomy in decision-making showed higher GMP utilization with [AOR = 1.83 (95% CI: 1.23, 2.72)] and [AOR = 3.79 (95% CI: 2.41, 5.96), respectively. Mothers with longer birth intervals were also more likely to utilize GMP services [AOR = 1.947 (95% CI: 1.39, 2.73)]. The study highlights the importance of addressing these factors to increase GMP service utilization and improve child health outcomes in the study area. Behavioural change communication programmes targeting fathers can promote their engagement in child growth discussions. Moreover, empowering women to make decisions about their children's health and access to healthcare services and promoting open communication within families about child growth and development can raise awareness and support for GMP services. Addressing these factors through targeted interventions will promote GMP utilization and improve child growth and development.

Responsive feeding practices are crucial for developing healthy eating behaviours in children. However, chaotic households and financial stress may disrupt these practices. This cross-sectional study aimed to characterise feeding practices among Australian parents experiencing financial hardship. Parents of children aged 5-35 months, who identified as experiencing financial hardship, completed an online questionnaire from October 2021 to June 2022. Validated tools gathered data on feeding practices, mealtime structure and environment, household chaos (HC), household food insecurity (HFI) and sociodemographic characteristics. Bivariate correlations and hierarchical regression assessed relationships between these variables, adjusted for parent age, education and number of children. Data from 213 parent-child dyads were analysed (97% mothers, median age = 31 years, IQR 28-36; 50% boys, median age = 12 months, IQR 8-17). Median HC score was 4 (IQR 2-7). Seventy-six percent of families reported experiencing HFI (median = 6, IQR 3-9). Over 80% of parents often or always ate meals as a family and never or rarely engaged in 'parent-led' feeding (median = 1.75, IQR 1.00-2.50), or used '(non)-food as reward' (median = 1.33, IQR 1.00-2.00). '(Non)-food as reward' was positively correlated with HC (p = 0.016), and 'food to calm' was positively associated with HC (p = 0.004). 'Feeding on demand' was negatively associated with HC and HFI (p = 0.002). 'Persuasive feeding' was not associated with either. Findings suggest that HC had more influence than HFI on some nonresponsive feeding practices. Increasing levels of HC and HFI may result in less structured mealtimes. Interventions must consider how financial hardship, HFI and HC can impact parents' ability to engage in responsive feeding practices. This cross-sectional study examined feeding practices among Australian parents facing financial hardship. Over 75% were food insecure. While the meal environment supported responsive feeding, increasing household chaos and food insecurity led to fewer structured mealtimes and household chaos increased coercive practices such as using (non)-food rewards and food to calm.

A large body of research investigates the determinants of stunting in young children, but few studies have considered which factors are the most important predictors of stunting. We examined the relative importance of predictors of height-for-age z-scores (HAZ) and stunting among children under 5 years of age in seven of the most food-insecure districts in South Africa using data from the Grow Great Community Stunting Survey of 2022. We used dominance analysis and variable importance measures from conditional random forest models to assess the relative importance of predictors. We found that intergenerational and socioeconomic factors-specifically maternal height (HAZ: Coef. 0.02, 95% CI 0.01-0.03; stunting: OR 0.96, 95% CI 0.94-0.98), birth weight (HAZ: Coef. 0.3, 95% CI 0.16-0.43; stunting: OR 0.5, 95% CI 0.35-0.72) and asset-based measures of socioeconomic status (HAZ: Coef. 0.17, 95% CI 0.10-0.24; stunting: OR 0.77, 95% CI 0.67-0.89)-were the most important predictors of HAZ and stunting in these districts. We explored whether any other factors moderated (weakened) the relationship between these intergenerational factors and child height using conditional inference trees and moderation analysis. We found that being on track for vitamin A and deworming, adequate sanitation, a diverse diet and good maternal mental health moderated the effect of birth weight or mother's height. Though impacts are likely to be small relative to the impact of intergenerational risk factors, these moderating factors may provide promising avenues for helping to mitigate the intergenerational transmission of stunting risk in South Africa.

A male partner or husband is the most influential person in the family, especially in Ethiopia. The role of a male partner or husband in promoting and supporting breastfeeding has hardly been investigated in low- and middle-income countries, including Ethiopia. Therefore, the objective of this study was to evaluate the effect of breastfeeding education and support interventions that focus on male partners, with the goal of promoting optimal breastfeeding practices in central Ethiopia. A two-arm parallel design cluster randomized controlled trial was carried out among couples in a community setting in the Hadiya Zone, Central Ethiopia. Fathers and mothers in the intervention group received breastfeeding education and support via social events, home visits and using printed materials, while those in the control group received existing routine care. A total of 408 couples from 16 clusters were randomly assigned to either the intervention group (n = 204) or the control group (n = 204). A Generalized Estimating Equation (GEE) model was used to evaluate the effectiveness of the interventions. At the end of the interventions, the proportion of optimal breastfeeding practice increased by 19.5% in the intervention group and by 2% in the control group. The differences-in-difference in optimal breastfeeding practice between the intervention and control groups was 17.5% [95% CI: 13.8%-21.2%; p = 0.001]. In the GEE model, babies born to mothers in the mother-father pair group had a 38% higher likelihood [RR = 1.38, 95% CI (1.106, 1.723)] of being optimally breastfed at the sixth month compared with babies born to mothers who received standard care. Breastfeeding education and support interventions targeting male partners in low-resource settings improve optimal breastfeeding practices, highlighting the need to give due emphasis to integrating breastfeeding promotion and counselling for male partners into existing maternal and child health services. Trial Registration: ClinicalTrials.gov identifier (NCT number): NCT05173454, First registered on 30/12/2021.

This study aimed to examine the directionality of the relationship between children's satiety responsiveness and parental pressure to eat and to explore how children's temperament moderates this relationship. Parents of preschoolers (n = 482, M_age = 3.66, SD = 0.29, 51.2% boys) were surveyed at two-time points spaced 2 years in China, and 76.6% of those were mothers. Cross-lagged analyses indicated that children's satiety responsiveness positively predicted parental pressure to eat over time. Moderation analyses revealed that children's high anger/frustration intensified the predictive relationship above. These findings suggest that parents should accurately understand their children's satiety responsiveness and tailor their responses based on children's temperament, thereby fostering a virtuous cycle of parent-child interaction.

The Ethiopia Food and Nutrition Strategy (FNS 2021-2030) aims to provide evidence-based, nutrition-specific, and sensitive interventions to address malnutrition. A costing exercise was done to estimate the minimum financing needed to implement nutrition interventions for the ten-year FNS, and further analysis was made to estimate the investment required to implement the prioritised recommended Lancet series interventions for 10 years. Activity-based costing methodology was used to carry out the FNS costing for nutrition interventions prioritised by the different line ministries, and then estimated costs to implement the 2021 recommended Lancets interventions were examined from the FNS. The minimum cost of implementing the National FNS was estimated to be US$ 2.55bn with an average annual cost of US$ 250 million over 10 years (2021-2030). The cost of nutrition-sensitive approaches represents US$ 1.8 billion (72%) and nutrition-specific US$ 704 million (28%) of the total cost of the FNS. The Lancet series intervention costs accounted for US$ 1.7 billion (66%) of the total cost of the strategy. In this costing, half of the strong/moderate evidence (7 out of 13) Lancet interventions are costed. Therefore, the strategy's costing should be revised every 3 years to integrate new evidence and consider lessons from real expenditure. Furthermore, the need to establish a nutrition expenditure tracking system is urgent.

Emerging research suggests that a more infant-led approach to complementary feeding may confer benefits for child language, but these findings are based on parent report studies. Using an observational approach this study examines whether different complementary feeding experiences relate to infant language exposure and language use. Fifty-eight parents recorded a typical infant mealtime in the home (mean infant age = 14 months, SD = 4.15). Observations were coded to measure the prevalence of infant-led and parent-led feeding using the Family Mealtime Coding Scheme. Caregiver language use (word types and token directed at the child, mean length of utterances in child-directed speech, responsiveness and initiations) and the number of infant vocalisations were coded in ELAN using CHAT conventions and parents completed the MacArthur Communicative Development Inventory short form as a measure of child language. Greater observed infant self-feeding was significantly associated with greater observed exposure to language from caregivers (r = 0.312 percentage of infant self-feeding correlated with caregiver word types directed at the child) and a greater number of infant vocalisations (r = 0.320 percentage of infant self-feeding correlated with number of child vocalisations produced). Structural Equation Modelling showed the relationship between infant self-feeding and infant vocalisations to be significantly mediated by enhanced quality and quantity of caregiver child-directed speech (model fit: χ² [5] = 5.01, p = 0.415, CFI = 1.00 [NF = 0.98], RMSEA = 0.006). Differences in the approach to complementary feeding may shape infant's experiences in ways that support language exposure and use. Autonomy associated with infant self-feeding may enhance opportunities for social interaction.