Maternal and Child Nutrition最新文献

This study investigated adherence to Indonesia's Dietary Guidelines (IDG) among lactating women, examining related factors and association with nutrient intake adequacy, maternal and infant biomarkers, body mass index, and growth. Participants were lactating women (n = 220) from urban and rural West Java, Indonesia. Dietary intake (via 3-day weighed food records), anthropometry and blood samples were assessed. Adherence was evaluated using a scoring system tailored for IDG and adapted from the Healthy Eating Index to assess intake of food groups, sugar, salt, fat, water, coffee, and breakfast habits. Starchy staples intake exceeded recommendations by nearly double (median 7.1 vs. recommended 3–4 servings/day), while vegetable (0.5 servings/day), fruit (1.0), and water (1300 mL/day) intake fell notably short. Protein-rich food intake (3.5 servings/day) was closer to target. Only 1% of participants met three out of four food group targets. Adherence to the meal-based MyPlate framework showed similar imbalances, with 68% of the plate occupied by starchy staples versus the recommended 33%. Sociodemographic factors, including education, wealth, and family size, were associated with adherence to IDG components. For instance, women in the highest wealth quintile had higher adherence scores for starchy staple moderation (mean 4.3) than those in the lowest (mean 2.9). Adherence to IDG components correlated positively with nutrient intake adequacy (e.g. protein-rich food and overall adequacy: r = 0.19, 95% CI: 0.06–0.32) but not consistently with maternal or infant biomarkers. These findings highlight the need to refine dietary guidelines with clearer portion guidance and consideration of factors beyond intake adequacy during lactation.

Child undernutrition remains a global challenge, intricately linked to systemic inequities in access to maternal and child health and nutrition (MCHN) services. While SMS-based behaviour change communication (BCC) offers a scalable strategy to address this challenge, its effectiveness is often undermined by low and inconsistent user engagement. This study extends the impact evaluation of the mNutrition programme in Tanzania—a nationwide SMS-based BCC programme aimed at improving maternal and child nutrition (MCN)—to investigate what drives sustained, long-term engagement—an important but underexplored gap. The objective is to explore the mechanisms driving sustained engagement among mothers in rural Tanzania and how these are triggered by specific contextual factors and inequities. A realist approach was used, combining realist interviews with 40 sustained engagers (conducted across three sites between February and April 2019) and quantitative endline survey data. Retroductive analysis iteratively tested initial programme theories (IPTs) and derived Context-Mechanism-Outcome (CMO) configurations explaining sustained engagement. Findings showed sustained engagement resulted from the interplay between programme elements—such as content, SMS delivery (regularity, convenience, privacy), message tone (non-judgmental, supportive), and perceptions of the sender—and inequity-laden contextual realities, including time poverty, social isolation, undervaluation of women, gendered power dynamics within households and healthcare settings. The study concludes that digital BCC programmes must be context-sensitive and equity-oriented to achieve sustained engagement. Designing messages and delivery systems that reflect users' lived experiences and address structural vulnerabilities can enhance engagement and support more equitable nutrition outcomes.

Gestational diabetes mellitus (GDM) is characterised by glucose intolerance identified during pregnancy, typically resolving postpartum. Globally, the standardised prevalence is 14%. Dietary management is essential in mitigating adverse maternal and infant outcomes, with guidelines recommending low- or no-carbohydrate snacks to stabilise blood glucose concentrations. However, the influence of snacking patterns on glycaemic outcomes in women with GDM has yet to be assessed by systematic review. Following PRISMA guidelines, this review examines the association between snacking patterns, specifically timing, frequency, and composition, and glycaemia in this population. Electronic searches were conducted in MEDLINE, Embase, Maternity and Infant Care (MIDIRS), and CINAHL in April 2024, with an updated search performed in June 2025. Reference lists and citations were also screened. Studies examining the impact of snacking on glycaemia in women with GDM were included. Of the 7405 articles identified, five studies met the inclusion criteria: four 1–8-week intervention studies and one 7-day observational study. The included studies showed considerable heterogeneity in their designs. Evidence for a relationship between snacking and glycaemia in GDM was mixed, with some studies suggesting glycaemic benefits from snacking, including bedtime snacking, while others found that bedtime snacks adversely influenced glycaemia. Any association between snacking and glycaemia in individuals with GDM remains inconclusive due to limited available data, study heterogeneity, and conflicting results. The lack of high-quality studies underscores the need for further research to define the role of snacking in glycaemia among this population.

In Malawi, 38% of children under five are stunted, and only 36% are developmentally on track. An ethnographic study using the Reality Check Approach was conducted in four villages in Ntcheu and Balaka districts in Malawi to understand caregiving-related drivers of malnutrition and poor child development. Researchers immersed themselves in 12 rural households with a pregnant woman or a child under 2 years for 4 days and nights, and gathered information through informal conversations, participation in daily activities, observations, and group sessions. They assessed current behaviours and the factors driving these behaviours in five recommended nurturing care domains essential for a child to both survive and thrive. The study revealed that children were not receiving the nurturing care they needed. Caregiving-related issues identified included poor maternal, child, and family diets; inadequate infant and young child feeding; poor hygiene environment and practices; low use of health and nutrition services; limited responsive care, stimulation and learning opportunities, and early pregnancies. Caregiving determinants included chronic poverty and food insecurity, climate and economic shocks, low access to quality health, nutrition and early childhood development services, poor maternal wellbeing, gender inequality and harmful social norms. The research underscores the need for a multi-sector approach to improve maternal and child nutrition and development. It also stresses the importance of understanding the contextual determinants of caregiving behaviours to inform multi-sector programmes and policies and meet Malawi's Sustainable Development Goals and World Health Assembly targets for maternal and child health, nutrition, and development.

Acute malnutrition (AM) in children under five is a significant global health concern. Community-based management of AM (CMAM) with provision of specially formulated foods (SFFs) is recommended for treating moderate (MAM) and uncomplicated severe (SAM) cases in outpatient settings. Integrating nutrition counseling and cooking demonstrations (NC&CD) into CMAM programs can improve caregiver knowledge and practices. In our parent trial, we evaluated the effectiveness of enhanced NC&CD without SFFs on MAM management. This study examines perceptions and understanding of CMAM among parents, healthcare providers (HCPs), and policymakers in both CMAM and no-CMAM areas. A purposive sampling technique was used to recruit participants who were reflective and willing to share their experiences with the research team. Data collection involved 30 focus group discussions (FGDs), 34 in-depth interviews (IDIs) with parents, 28 key informant interviews (KIIs) with HCPs in Cox's Bazar, and 16 KIIs with policymakers in Dhaka. Data were analyzed thematically using NVivo, guided by the concepts of the theoretical framework. Parents and HCPs generally valued CMAM for its SFFs, while parents in the MAM trial's intervention arm preferred NC&CD with incentives. Policymakers largely supported combining SFFs with NC&CD, though some advocated for NC&CD alone as a feasible approach. Challenges identified included workforce shortages, policy gaps, and insufficient prioritization. One-third of HCPs in CMAM areas and most HCPs and parents in no-CMAM areas favored NC&CD. The study highlights the need to continue NC&CD-based CMAM programs with incentives and recommends integrating NC&CD into CMAM guidelines to enhance caregiver awareness. Additionally, increased manpower, policy advocacy, strong government leadership, and preventive nutrition initiatives are warranted to ensure the sustainable effect of CMAM in Bangladesh.

Breastfeeding (BF) is a crucial step in the path to improving a child's health. Exclusive breastfeeding (EBF) is recognized as the best practice to improve a child's physical growth and cognitive development in the first months of life. The World Health Organization (WHO) recommends EBF for 6 months. Family support is an important element to help mothers' adhere to breastfeeding recommendations in Ghana. This study aimed to: (a) understand, at the interpersonal level, the relational influences of fathers, grandmothers, and other family members on the adherence of the mother-child dyad to recommended EBF practices and (b) document community and societal influences on EBF. This study took place in the Central Region of Ghana. We used a qualitative design to analyze semi-structured in-depth interviews with mothers (n = 24; 12 adults and 12 teens), fathers (n = 16; 12 adults and 4 teens), and other caregivers (n = 12) of children younger than 1-year-old. Findings showed that family relational influences on a mother's EBF practices did not occur in isolation, given that the family members' EBF knowledge and behaviors were influenced mainly by nurses, community and church peers, and societal and environmental characteristics. Fathers' presence had a protective effect on the mother-child dyad. Fathers built their knowledge on nurses' recommendations. Grandmothers were vital in sharing household and child-caring chores. Cultural and social norms and community peers influenced family member beliefs about EBF. Fathers' and grandmothers' support was essential to mothers' adherence to the practice of EBF; thus, including these family members in prenatal and postnatal care should be encouraged.

The specific food parenting practices used by parents, along with the broader parenting style that reflects the general characteristics of their approach to parenting, may influence children's vegetable consumption. We examined cross-sectional associations of parenting style constructs (nurturance, structure, behavioural control, inappropriate control, and overprotection) and vegetable-related parenting practices (VPP) (‘encouragement and modelling’, ‘child involvement’, ‘enhanced availability and autonomy support’) with 3–6-year-old children's vegetable consumption. Additionally, we explored if parenting style moderated the associations between the VPPs and children's vegetable consumption. The sample included 767 Finnish children and their parents. Parents reported parenting style using an item-reduced Comprehensive General Parenting Questionnaire and the use of VPPs. Three-day food records were used to assess children's vegetable consumption. Data was analysed using linear mixed-effects models. If parents scored higher on ‘enhanced availability and autonomy support’, their children consumed more vegetables (B = 0.249, 95% CI = 0.128; 0.371). Regarding parenting style, if parents scored higher on overprotection, their children consumed less vegetables (B = −0.223, 95% CI = −0.384; −0.062). Additionally, two exploratory moderation effects by parenting style were found: parents' higher score on ‘child involvement’ was associated with children consuming more vegetables only when parents were lower on overprotection or nurturance. Although further research is needed to understand the details of the role of parenting style in children's vegetable consumption, our results suggest that overprotection might be an important factor, and parenting style as a context should be considered when targeting parenting practices to promote children's vegetable consumption.

The Lebanese National Dietary and Lifestyle Guidelines for Pregnancy (DLGP) were developed to foster maternal and child health. The study aims to examine adherence to the DLGP and investigate its association with postpartum weight retention at 6 months (PPWR6). This study is based on the Mother and Infant Nutrition Assessment prospective cohort study conducted among pregnant women in Lebanon (n = 152). Pregnant women were recruited during their first trimester and were followed up until 6 months after delivery. Data on the socio-economic, anthropometric and lifestyle characteristics of participants were collected. A validated FFQ was used to examine dietary intake during the second trimester. A composite score was calculated for the adherence to the DLGP, with high adherence defined as belonging to the third tertile of the score. PPWR6 was calculated as the difference between pre-pregnancy weight and weight at 6 months postpartum, and high PPWR6 was defined as belonging to the third tertile of PPWR6 (≥ 5.4 kg). Multiple logistic regression was used to examine associations between adherence to guidelines and PPWR6. The proportion of participants adhering was lowest for guidelines regarding saturated fats (1.3%), sugar (13.8%), hydration (21.7%), adequate gestational weight gain (37.5%), omega-3 supplementation (38.8%) and salt (44.1%). Average PPWR6 was 3.9 kg, with 34.2% of participants retaining ≥ 5 kg. While no association was observed between any of the individual guidelines with PPWR6, participants with high adherence to the DLGP had 77% lower odds of a PPWR6 more than 5.4 kg, compared to those in the first and second tertiles (adjusted OR: 0.23, 95% CI: 0.09, 0.58). The findings of this study highlighted important gaps in adherence to the DLGP, along with a direct association between higher DLGP adherence and lower PPWR. These findings underscore the need for comprehensive strategies to promote healthier practices during pregnancy and mitigate long-term risks of obesity and related chronic diseases.

Micronutrient deficiencies are a significant public health problem, particularly affecting children under five, caused by inadequate intake of micronutrient-rich foods or environmental factors like aflatoxin exposure. Three hundred sixty-nine children aged 6–24 months from Tanzania's Babati and Hanang districts participated in this study. Serum aflatoxin albumin adduct (AF-alb) levels were assessed as measures of aflatoxin exposure. Haemoglobin levels, serum ferritin, C-reactive protein, zinc and vitamins A, B9, and B12 were assessed to determine anaemia and deficiencies in iron, zinc and vitamins A, B9 and B12 based on WHO cut-off points. Seventy per cent of the children had detectable levels of AF-alb. The AF-alb geometric mean was 5.99 (95% CI: 5.99, 6.87) pg/mg. Of those with measured micronutrient markers, 37% were anaemic, and 33%, 75%, 4%, 4% and 73% were deficient in iron, zinc, vitamins A, B9 and B12, respectively. The child's age, gender and stunting were all significantly associated (p < 0.05) with anaemia and deficiencies in zinc, vitamin A and B12. Moreover, AF-alb was associated with iron deficiency even after adjusting for confounders; children with high AF-alb levels ( > 6.07 pg/mg) were 1.40 times more likely to be iron deficient (AOR = 1.40, 95% CI: 1.11, 1.74). The high prevalence of micronutrient deficiencies and its association with aflatoxin exposure among young children highlights the urgent need for comprehensive intervention strategies, such as improving dietary diversity and enhancing food safety to reduce aflatoxin exposure. Importantly, longitudinal research is needed to understand the causal effect relationship between aflatoxin exposure and micronutrient deficiencies.

Research into the sugar content of commercial complementary foods (CCFs) for infants and young children (IYC) has been extensive, but little attention has been given to flavourings in these products. This study aimed to create a profile of the prevalence and type of flavourings in CCFs for IYC in South Africa (SA). Data were collected on CCFs indicated as suitable for introduction from ages 6 to 23 months at 26 physical stores in the Western Cape, and the online stores of nine major SA retailers between June 2022 and February 2023. Data were collected by photographing product labels and contacting the manufacturers for further information. The results showed that 36.2% of CCFs contained flavourings, with 75.9% of these containing one and the remainder up to three flavourings. More than half (52.4%) of the flavouring-containing products were marketed as suitable for introduction from 6+ months, and almost half (48.6%) of the baby drinks, all indicated as suitable for introduction from 6+ months, contained flavourings. Flavourings were present in 84.2% of dry baby foods (cereals/porridges). The flavourings in CCFs were primarily of sweet flavours (> 80%) with vanilla being the most prevalent flavour. Moreover, only 51% of CCFs complied with all SA labelling regulations relating to flavourings and 78.3% violated regulations relating to non-addition claims. The prevalence of sweet CCFs with added flavourings raises concerns about its potential negative impact on children's taste preferences, dietary habits, and consequent long-term health outcomes. Re-evaluating the use of flavourings in CCFs and strengthening the enforcement of labelling regulations in SA is imperative.