Showing papers in "Maternal and Child Nutrition in 2014"

Maternal obesity and breastfeeding intention, initiation, intensity and duration: a systematic review

Abstract: This systematic review investigates the relationship between maternal obesity and breastfeeding intention, initiation, intensity, duration and milk supply. A comprehensive search was performed through three major databases, including Medline, Cochrane Library and Cumulative Index For Nursing and Allied Health Literature, and by screening reference lists of the relevant publications. Selection criteria were: report of original research, studies on low-risk obese mothers and the comparison with normal weight mothers which met at least two of the following primary outcomes: breastfeeding intention; initiation; intensity; duration and/or milk supply. Furthermore, the included reports had to contain a clear definition of pre-pregnant obesity, use compensation mechanisms for potential confounding factors, have a prospective cohort design and had to have been published between 1997 and 2011 and in English, French or Dutch. Effects of obesity on breastfeeding intention, initiation, intensity, duration and milk supply were analysed, tabulated and summarised in this review. Studies have found that obese women are less likely to intend to breastfeed and that maternal obesity seems to be associated with a decreased initiation of breastfeeding, a shortened duration of breastfeeding, a less adequate milk supply and delayed onset of lactogenesis II, compared with their normal weight counterparts. This systematic review indicates therefore that maternal obesity is an adverse determinant for breastfeeding success.

World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings

Abstract: As the World Health Organization (WHO) infant and young child feeding (IYCF) indicators are increasingly adopted, a comparison of country-specific analyses of the indicators' associations with child growth is needed to examine the consistency of these relationships across contexts and to assess the strengths and potential limitations of the indicators. This study aims to determine cross-country patterns of associations of each of these indicators with child stunting, wasting, height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). Eight studies using recent Demographic and Health Surveys data from a total of nine countries in sub-Saharan Africa (nine), Asia (three) and the Caribbean (one) were identified. The WHO indicators showed mixed associations with child anthropometric indicators across countries. Breastfeeding indicators demonstrated negative associations with HAZ, while indicators of diet diversity and overall diet quality were positively associated with HAZ in Bangladesh, Ethiopia, India and Zambia (P < 0.05). These same complementary feeding indicators did not show consistent relationships with child stunting. Exclusive breastfeeding under 6 months of age was associated with greater WHZ in Bangladesh and Zambia (P < 0.05), although CF indicators did not show strong associations with WHZ or wasting. The lack of sensitivity and specificity of many of the IYCF indicators may contribute to the inconsistent associations observed. The WHO indicators are clearly valuable tools for broadly assessing the quality of child diets and for monitoring population trends in IYCF practices over time. However, additional measures of dietary quality and quantity may be necessary to understand how specific IYCF behaviours relate to child growth faltering.

Immediate or early skin-to-skin contact after a caesarean section: a review of the literature

Abstract: The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress.

Fathers' experiences of supporting breastfeeding: challenges for breastfeeding promotion and education

Abstract: Increasing breastfeeding rates is a strategic priority in the UK and understanding the factors that promote and encourage breastfeeding is critical to achieving this. It is established that women who have strong social support from their partner are more likely to initiate and continue breastfeeding. However, little research has explored the fathers' role in breastfeeding support and more importantly, the information and guidance he may need. In the current study, 117 men whose partner had given birth in the previous 2 years and initiated breastfeeding at birth completed an open-ended questionnaire exploring their experiences of breastfeeding, the information and support they received and their ideas for future breastfeeding education and promotion aimed at fathers and families. Overall, the findings showed that fathers were encouraging of breastfeeding and wanted to be able to support their partner. However, they often felt left out of the breastfeeding relationships and helpless to support their partner at this time. Many reported being excluded from antenatal breastfeeding education or being considered unimportant in post-natal support. Men wanted more information about breastfeeding to be directed towards them alongside ideas about how they could practically support their partner. The importance of support mechanisms for themselves during this time was also raised. The results highlight the need for health professionals to direct support and information towards fathers as well as the mother–infant dyad and to recognise their importance in promoting and enabling breastfeeding.

The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods

Abstract: The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration.

Factors associated with inappropriate complementary feeding practices among children aged 6–23 months in Tanzania

Abstract: Inappropriate complementary feeding is one of the major causes of undernutrition among young children in Tanzania. Prevalence of newly developed World Health Organization complementary feeding indicators and their associated factors were determined among 2402 children aged 6-23 months in Tanzania using data from the 2010 Tanzania Demographic and Health Survey. The survey used a multistage cluster sample of 10 300 households from the eight geographical zones in the country. The prevalence of the introduction of soft semi-solid or solid foods among infants aged 6-8 months was 92.3%. Of all the children aged 6-23 months the prevalence of minimum dietary diversity meal frequency and acceptable diet were 38.2% 38.6% and 15.9% respectively. Results from multivariate analyses indicated that the main risk factors for inappropriate complementary feeding practices in Tanzania include young childs age (6-11 months) lower level of paternal/maternal education limited access to mass media lack of post-natal check-ups and poor economic status. Overall complementary feeding practices in Tanzania as measured by dietary diversity meal frequency and acceptable diet are not adequately met and there is a need for interventions to improve the nutritional status of young children in Tanzania. (c) 2012 John Wiley & Sons Ltd.

Babies, soft drinks and snacks: a concern in low- and middle-income countries?

Abstract: Undernutrition in infants and young children is a global health priority while overweight is an emerging issue. Small-scale studies in low- and middle-income countries have demonstrated consumption of sugary and savoury snack foods and soft drinks by young children. We assessed the proportion of children 6–23 months of age consuming sugary snack foods in 18 countries in Asia and Africa using data from selected Demographic and Health Surveys and household expenditures on soft drinks and biscuits using data from four Living Standards Measurement Studies (LSMS). Consumption of sugary snack foods increased with the child's age and household wealth, and was generally higher in urban vs. rural areas. In one-third of countries, >20% of infants 6–8 months consumed sugary snacks. Up to 75% of Asian children and 46% of African children consumed these foods in the second year of life. The proportion of children consuming sugary snack foods was generally higher than the proportion consuming fortified infant cereals, eggs or fruit. Household per capita daily expenditures on soft drinks ranged from $0.03 to $0.11 in three countries for which LSMS data were available, and from $0.01 to $0.04 on biscuits in two LSMS. Future surveys should include quantitative data on the purchase and consumption of snack foods by infants and young children, using consistent definitions and methods for identifying and categorising snack foods across surveys. Researchers should assess associations between snack food consumption and stunting and overweight, and characterise household, maternal and child characteristics associated with snack food consumption.

Maternal correlates of maternal child feeding practices: a systematic review

Abstract: Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 and June 2012. Only studies with mothers of normally developing children between the ages of 2 and 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or socioeconomic status (SES). Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and SES and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross-sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation.

Identifying determinants of effective complementary feeding behaviour change interventions in developing countries.

Abstract: As stunting moves to the forefront of the global agenda, there is substantial evidence that behaviour change interventions (BCI) can improve infant feeding practices and growth. However, this evidence has not been translated into improved outcomes on a national level because we do not know enough about what makes these interventions work, for whom, when, why, at what cost and for how long. Our objective was to examine the design and implementation of complementary feeding BCI, from the peer-reviewed literature, to identify generalisable key determinants. We identified 29 studies that evaluated BCI efficacy or effectiveness, were conducted in developing countries, and reported outcomes on infant and young children aged 6–24 months. Two potential determinants emerged: (1) effective studies used formative research to identify cultural barriers and enablers to optimal feeding practices, to shape the intervention strategy, and to formulate appropriate messages and mediums for delivery; (2) effective studies delineated the programme impact pathway to the target behaviour change and assessed intermediary behaviour changes to learn what worked. We found that BCI that used these developmental and implementation processes could be effective despite heterogeneous approaches and design components. Our analysis was constrained, however, by the limited published data on how design and implementation were carried out, perhaps because of publishing space limits. Information on cost-effectiveness, sustainability and scalability was also very limited. We suggest a more comprehensive reporting process and a more strategic research agenda to enable generalisable evidence to accumulate.

Women's exposure to intimate partner violence and child malnutrition: findings from demographic and health surveys in Bangladesh.

Abstract: Domestic violence, in particular intimate partner violence (IPV), has been recognized as a leading cause of mortality and morbidity among women of reproductive age. The effects of IPV against women on their children's health, especially their nutritional status has received less attention but needs to be evaluated to understand the comprehensive public health implications of IPV. The aim of current study was to investigate the association between women's exposure to IPV and their children's nutritional status, using data from the 2007 Bangladesh Demographic and Health Survey (BDHS). Logistic regression models were used to estimate association between ever-married women's lifetime exposure to physical and sexual violence by their spouses and nutritional status of their children under 5 years. Of 2042 women in the BDHS survey with at least one child under 5 years of age, 49.4% reported lifetime experience of physical partner violence while 18.4% reported experience of sexual partner violence. The prevalence of stunting, wasting and underweight in their children under 5 years was 44.3%, 18.4% and 42.0%, respectively. Women were more likely to have a stunted child if they had lifetime experience of physical IPV [odds ratio n = 2027 (OR)adj, 1.48; 95% confidence interval (CI), 1.23-1.79] or had been exposed to sexual IPV (n = 2027 OR(adj), 1.28; 95% CI, 1.02-1.61). The present findings contribute to growing body of evidence showing that IPV can also compromise children's growth, supporting the need to incorporate efforts to address IPV in child health and nutrition programmes and policies.

Maternal selenium, copper and zinc concentrations in pregnancy associated with small-for-gestational-age infants.

Abstract: Pregnancy during adolescence increases the risk of adverse pregnancy outcome, especially risk of small-for gestational-age (SGA) birth, which has been linked to micronutrient deficiencies. Likewise, smoking has been shown to be related with lower micronutrient concentrations. Different ethnicities have not previously been examined. We used a subset from a prospective observational study, the About Teenage Eating (ATE) study consisting of 126 pregnant adolescents (14-18 years old) between 28-32 weeks' gestation. Micronutrient status was assessed by inductively-coupled mass spectrometry. Smoking was assessed by self-report and plasma cotinine, and SGA was defined as infants born < 10th corrected birthweight centile. The main outcome measures were: 1) Maternal plasma selenium, copper and zinc concentrations in adolescent mothers giving birth to SGA versus appropriate-for-gestational-age (AGA) infants. 2) Comparison of micronutrient concentrations between women of different ethnicities and smoking habits. The plasma selenium (mean ± SD [95% CI]) concentration was lower in the SGA (n = 19: 49.4 ± 7.3 [CI: 45.9, 52.9] μg/L) compared to the AGA (n = 107: 65.1 ± 12.5 [CI: 62.7, 67.5] μg/L; P < 0.0001) group. Smoking mothers had a lower selenium concentration compared to non-smokers (P = 0.01) and Afro-Caribbean women had higher selenium concentrations compared to White Europeans (P = 0.02). Neither copper nor zinc concentrations varied between groups, but selenium and copper were moderately correlated (P < 0.05). Selenium is an essential trace element which exerts its biological effects through the expression of a variety of important selenoproteins. Low plasma selenium concentration in adolescent mothers could contribute to the risk of delivering an SGA infant, possibly through lowering the placental antioxidant defence, thus direclty affecting fetal growth. The differences in plasma selenium between different ethnicities may relate to variation in nutritional intake, which requires further investigation.

Development of the Parental Modelling of Eating Behaviours Scale (PARM): links with food intake among children and their mothers

Abstract: This study aimed to develop a self-report questionnaire to explore parental modelling of eating behaviours and then to use the newly developed measure to investigate associations between parental modelling with healthy and unhealthy food intake in both mothers and their children. Mothers (n = 484) with a child aged between 18 months and 8 years completed the Parental Modelling of Eating Behaviours Scale (PARM), a new, self-report measure of modelling, as well as a food frequency questionnaire. Principal components analysis of the PARM identified 15 items grouped into three subscales: verbal modelling (modelling through verbal communication); unintentional modelling (UM) (children adopting eating behaviours that parents had not actively modelled); and behavioural consequences (children's eating behaviours directly associated with parental modelling). The PARM subscales were found to be differentially related to food intake. Maternally perceived consequences of behavioural modelling were related to increased fruit and vegetable intake in both mothers and children. UM was related to higher levels of savoury snack intake in both mothers and their children. This study has highlighted three distinct aspects of parental modelling of eating behaviours. The findings suggest that mothers may intentionally model healthy food intake while unintentionally acting as role models for their children's less healthy, snack food intake.

An online survey of knowledge of the weaning guidelines, advice from health visitors and other factors that influence weaning timing in UK mothers.

Abstract: The UK weaning guidelines recommend the introduction of solid food at or around 6 months. The evidence suggests that knowledge of the guidelines is high, although only a small minority of parents wait until 6 months to wean. The aim of this study was to assess understanding of the UK weaning guidelines in a sample of UK parents and investigate the associations of this understanding with weaning timing, and in comparison to other influencing factors. This study conducted an online survey of UK parents. Eligible participants had weaned a child since the introduction of the current guidelines. Of 3607 participants, 86% accurately understood the guidelines. Eighty-seven per cent of health visitors were reported to have advised weaning at or around 6 months. Knowledge of the guidelines was associated with later weaning (independently of demographic factors) (P < 0.001) but did not ensure compliance: 80% of mothers who weaned before 24 weeks and 65% who weaned before 17 weeks were aware of the guidelines. Younger mothers (P < 0.001), those receiving benefits (P < 0.001), those educated only to 16 (P < 0.001) and minority ethnic groups (P < 0.001) had lower levels of awareness. Poor understanding of the guidelines was the most reliable predictor of early weaning (P = 0.021) together with young maternal age (P = 0.014). Following the baby-led weaning approach was the most reliable predictor of those weaning at 26 weeks, together with the Internet being the most influential source of advice. Understanding of the current weaning guidelines is high and is a key independent predictor of weaning age in this population.

The relationship of serum vitamin D with pre-eclampsia in the Iranian women.

Abstract: Vitamin D deficiency may be a risk factor for negative outcome in pregnancy such as pre-term labor low birth weight intrauterine growth retardation and gestational diabetes. This study aimed to evaluate the relationship between vitamin D and pre-eclampsia. This was a case-control study of 59 pre-eclamptic women and 59 healthy pregnant women selected in two hospitals in Ahvaz Iran. Women with term singleton pregnancy nulliparous and of reproductive age were selected. Venous blood samples (2 mL) were taken and the level of 25-dihydroxy vitamin D (25-OH-D) was measured. If the levels of 25-OH-D were less than 10 ng mL¹ between 10 ng mL-¹ and 29 ng mL-¹ and more than 30 ng mL-¹ they were considered as indicating deficient insufficient and normal 25-OH-D concentrations respectively. The independent t-test Mann-Whitney U-test chi-square and logistic regression were used for analyzing the data. Vitamin D deficiency was significantly higher in the pre-eclampsia group [odds ratio (OR) = 24.04 confidence interval (CI) = 2.10-274.8 P = 0.01]. Older women (30-35 years) were more likely to develop pre-eclampsia compared with the control group (OR = 10.36 CI = 2.18-49.09 P = 0.003). The results showed that women with body mass index (BMI) <20 were more likely to develop pre-eclampsia.The ages between 20 years and 30 years and normal BMI were not the risk factors for pre-eclampsia. Vitamin D deficiency has a statistically significant relationship with pre-eclampsia. It seems that the serum vitamin D levels are low in Iranian women because of their particular lifestyle and they may need more than 400 IU day-¹ vitamin D supplement during pregnancy.

Diet patterns are associated with demographic factors and nutritional status in South Indian children.

Abstract: The burden of non-communicable chronic disease (NCD) in India is increasing. Diet and body composition ‘track’ from childhood into adult life and contribute to the development of risk factors for NCD. Little is known about the diet patterns of Indian children. We aimed to identify diet patterns and study associations with body composition and socio-demographic factors in the Mysore Parthenon Study cohort. We collected anthropometric and demographic data from children aged 9.5 years (n = 538). We also administered a food frequency questionnaire and measured fasting blood concentrations of folate and vitamin B12. Using principal component analysis, we identified two diet patterns. The ‘snack and fruit’ pattern was characterised by frequent intakes of snacks, fruit, sweetened drinks, rice and meat dishes and leavened breads. The ‘lacto-vegetarian’ pattern was characterised by frequent intakes of finger millet, vegetarian rice dishes, yoghurt, vegetable dishes and infrequent meat consumption. Adherence to the ‘snack and fruit’ pattern was associated with season, being Muslim and urban dwelling. Adherence to the lacto-vegetarian pattern was associated with being Hindu, rural dwelling and a lower maternal body mass index. The ‘snack and fruit’ pattern was negatively associated with the child's adiposity. The lacto-vegetarian pattern was positively associated with blood folate concentration and negatively with vitamin B12 concentration. This study provides new information on correlates of diet patterns in Indian children and how diet relates to nutritional status. Follow-up of these children will be important to determine the role of these differences in diet in the development of risk factors for NCD including body composition.

Predictors of post-partum weight retention in a prospective longitudinal study.

Abstract: Post-partum weight retention (WR) occurs in 60-80% of women with some retaining ≥10 kg with contributing factors reported as pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and breastfeeding A longitudinal study of pregnancy, with 12-month post-partum follow-up was conducted to determine factors associated with WR Pregnant women (n = 152) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia Pre-pregnancy weight was self-reported; weight was measured four times during pregnancy (for GWG) and in the first 12 months post-partum Infant feeding data were obtained via questionnaires Breastfeeding was categorised as exclusive, predominant, complementary or not breastfeeding Linear mixed models tested the predictors of WR, with and without adjustment for potential confounders Compared with pre-pregnancy weight, 68% of women retained weight at 12 months, median (interquartile range) [45 kg (21-89)] After adjustment, GWG was positively associated with WR (P < 001), but pre-pregnancy weight did not predict WR For each additional week of any breastfeeding, 004 kg less weight was retained Compared with women who retained weight, those women who did retain had higher rates of exclusive breastfeeding at three months (P < 005), but the number of weeks of exclusive breastfeeding failed to predict WR for all women WR following childbirth is common and associated with GWG, while the number of weeks of 'any' breastfeeding contributed to post-partum weight loss Whether these factors are modifiable strategies to optimise the weight status of women at this life stage requires further research

Overweight increases risk of first trimester hypothyroxinaemia in iodine-deficient pregnant women.

Abstract: Hypothyroxinaemia early in pregnancy may impair fetal brain development. Increased body weight has been associated with low thyroxine concentrations in non-pregnant women. In pregnant women, morbid maternal obesity is a risk factor for thyroid dysfunction. But whether lesser degrees of overweight that are much more common could be a risk factor for hypothyroxinaemia in pregnancy is unclear. The objective of this study was to investigate if overweight increases risk for thyroid dysfunction, and specifically hypothyroxinaemia, in iodine-deficient pregnant women. We performed a cross-sectional study at first hospital visit among healthy Thai pregnant women. We measured weight and height, urinary iodine concentration (UIC), serum thyroid hormones and thyroglobulin. Pre-pregnancy weight and relevant dietary factors were determined by questionnaire, and body mass index (BMI) was used to classify weight status. Among 514 women (mean gestational age, 11 weeks) with a median UIC of 111 μg dL–1, indicating mild iodine deficiency, 12% had low free thyroxine (fT4) concentrations: 3% had overt hypothyroidism; 7% had subclinical hypothyroidism; and 8% had isolated hypothyroxinaemia. Based on pre-pregnancy BMI, 26% of women were overweight or obese. In a multiple regression model, BMI was a negative predictor of fT4 (β = −0.20, P < 0.001). Compared to normal weight women, the prevalence ratio (95% CI) of a low fT4 in overweight women was 3.64 (2.08–6.37) (P < 0.01). Iodine-deficient pregnant Thai women who are overweight have a 3.6-fold higher risk of hypothyroxinaemia in the first trimester compared to normal weight women. Targeted screening should consider overweight a potential risk factor for thyroid dysfunction in pregnant women in iodine-deficient areas.

Goals, dilemmas and assumptions in infant feeding education and support. Applying theory of constraints thinking tools to develop new priorities for action

Abstract: Three important infant feeding support problems are addressed: (1) mothers who use formula milk can feel undersupported and judged; (2) mothers can feel underprepared for problems with breastfeeding; and (3) many mothers who might benefit from breastfeeding support do not access help. Theory of constraints (TOC) is used to examine these problems in relation to ante-natal education and post-natal support. TOC suggests that long-standing unresolved problems or ‘undesirable effects’ in any system (in this case a system to provide education and support) are caused by conflicts, or dilemmas, within the system, which might not be explicitly acknowledged. Potential solutions are missed by failure to question assumptions which, when interrogated, often turn out to be invalid. Three core dilemmas relating to the three problems are identified, articulated and explored using TOC methodology. These are whether to: (1) promote feeding choice or to promote breastfeeding; (2) present breastfeeding positively, as straightforward and rewarding, or focus on preparing mothers for problems; and (3) offer support proactively or ensure that mothers themselves initiate requests for support. Assumptions are identified and interrogated, leading to clarified priorities for action relating to each problem. These are (1) shift the focus from initial decision-making towards support for mothers throughout their feeding journeys, enabling and protecting decisions to breastfeed as one aspect of ongoing support; (2) to promote the concept of an early-weeks investment and adjustment period during which breastfeeding is established; and (3) to develop more proactive mother-centred models of support for all forms of infant feeding.

Heightened attention to supplementation is needed to improve the vitamin D status of breastfeeding mothers and infants when sunshine exposure is restricted.

Abstract: Although exclusively breastfed infants are at increased risk of vitamin D (vit D) deficiency if vit D supplementation is lacking and sun exposure is limited, assessment of both risk factors in the first year of life is lacking. We evaluated the contribution of vit D intake and sunlight exposure to vit D status in 120 healthy, breastfeeding mother-infant dyads, who were followed up for 1 year. Vitamin D intake and skin sunlight exposure were evaluated using questionnaires. Serum 25-hydroxyvitamin D, parathyroid hormone (PTH) and alkaline phosphatase levels were determined post-natally in mothers at 4 weeks and in infants at 4, 26 and 52 weeks. Vitamin D supplementation was low (<20%) and sunlight exposure was common (93%) in study infants. At 4 weeks, 17% of mothers were vit D deficient (<50 nmol L(-1)) and 49% were insufficient (50-<75 nmol L(-1)), while 18% of infants were severely vit D deficient (<25 nmol L(-1)) and 77% were deficient (<50 nmol L(-1)). At 26 weeks, winter/spring birth season and shorter duration of months of exclusive breastfeeding were protective of vit D deficiency in infants. Vitamin D deficiency in infants decreased to 12% at 52 weeks with sunlight exposure. Serum PTH levels were significantly higher in severely vit D deficient than sufficient infants. Vitamin D deficiency was widespread in early post-partum breastfeeding mothers and infants, and declined to one in eight infants at 52 weeks due mostly to sunshine exposure. When sunlight exposure is limited or restricted, intensified vit D supplementation of breastfeeding mothers and infants is needed to improve vit D status.

Effectiveness of milk whey protein-based ready-to-use therapeutic food in treatment of severe acute malnutrition in Malawian under-5 children: A randomised, double-blind, controlled non-inferiority clinical trial

Abstract: The cost of ready-to-use therapeutic food (RUTF) used in community-based management of acute malnutrition has been a major obstacle to the scale up of this important child survival strategy The current standard recipe for RUTF [peanut-based RUTF (P-RUTF)] is made from peanut paste, milk powder, oil, sugar, and minerals and vitamins Milk powder forms about 30% of the ingredients and may represent over half the cost of the final product The quality of whey protein concentrates 34% (WPC34) is similar to that of dried skimmed milk (DSM) used in the standard recipe and can be 25-33% cheaper This blinded, parallel group, randomised, controlled non-inferiority clinical trial tested the effectiveness in treating severe acute malnutrition (SAM) of a new RUTF formulation WPC-RUTF in which WPC34 was used to replace DSM Average weight gain (non-inferiority margin Δ=-12gkg-1day-1) and recovery rate (Δ=-10%) were the primary outcomes, and length of stay (LOS) was the secondary outcome (Δ=+14days) Both per-protocol (PP) and intention-to-treat (ITT) analyses showed that WPC-RUTF was not inferior to P-RUTF for recovery rate [difference and its 95% confidence interval (CI) of 05% (95% CI -27, 37) in PP analysis and 06% (95% CI -52, 63) in ITT analysis] for average weight gain [02 (-05; 09) for both analyses] and LOS [-16days (95% CI, -46, 14days) in PP analysis and -19days (95% CI, -46, 08days) for ITT analysis] In conclusion, whey protein-based RUTF is an effective cheaper alternative to the standard milk-based RUTF for the treatment of SAM © 2014 John Wiley & Sons Ltd

Social circumstances that drive early introduction of formula milk: an exploratory qualitative study in a peri‐urban South African community

Abstract: Breastfeeding is widely endorsed as the optimal strategy for feeding newborns and young infants, as well as improving child survival and achieving Millennium Development Goal 4. Exclusive breastfeeding (EBF) for the first 6 months of life is rarely practised in South Africa. Following the 2010 World Health Organization (WHO) infant feeding recommendations (EBF for HIV-positive mothers with maternal or infant antiretroviral treatment), South Africa adopted breastfeeding promotion as a National Infant Feeding Strategy and removed free formula milk from the Prevention of Mother-to-Child Transmission of HIV programme. This study aimed to explore the perceptions of mothers and household members at community level regarding the value they placed on formula feeding and circumstances that drive the practice in a peri-urban community. We conducted in-depth interviews with HIV-positive and HIV-negative mothers in a community-randomised trial (Good Start III). Focus group discussions were held with grandmothers, fathers and teenage mothers. Data were analysed using thematic analysis. The following themes were identified; inadequate involvement of teenage mothers; grandmothers who become replacement mothers; fear of failing to practise EBF for 6 months; partners as formula providers and costly formula milk leading to risky feeding practices. The new South African Infant Feeding Strategy needs to address the gaps in key health messages and develop community-orientated programmes with a focus on teenage mothers. These should encourage the involvement of grandmothers and fathers in decision-making about infant feeding so that they can support EBF for optimal child survival.

The burden and consequences of inherited blood disorders among young children in western Kenya

Abstract: Although inherited blood disorders are common among children in many parts of Africa, limited data are available about their prevalence or contribution to childhood anaemia. We conducted a cross-sectional survey of 858 children aged 6–35 months who were randomly selected from 60 villages in western Kenya. Haemoglobin (Hb), ferritin, malaria, C-reactive protein (CRP) and retinol binding protein (RBP) were measured from capillary blood. Using polymerase chain reaction (PCR), Hb type, −3.7 kb alpha-globin chain deletion, glucose-6-phosphate dehydrogenase (G6PD) genotype and haptoglobin (Hp) genotype were determined. More than 2 out of 3 children had at least one measured blood disorder. Sickle cell trait (HbAS) and disease (HbSS) were found in 17.1% and 1.6% of children, respectively; 38.5% were heterozygotes and 9.6% were homozygotes for α+-thalassaemia. The Hp 2-2 genotype was found in 20.4% of children, whereas 8.2% of males and 6.8% of children overall had G6PD deficiency. There were no significant differences in the distribution of malaria by the measured blood disorders, except among males with G6PD deficiency who had a lower prevalence of clinical malaria than males of normal G6PD genotype (P = 0.005). After excluding children with malaria parasitaemia, inflammation (CRP > 5 mg L−1), iron deficiency (ferritin < 12 μg L−1) or vitamin A deficiency (RBP < 0.7 μg L−1), the prevalence of anaemia among those without α+-thalassaemia (43.0%) remained significantly lower than that among children who were either heterozygotes (53.5%) or homozygotes (67.7%, P = 0.03). Inherited blood disorders are common among pre-school children in western Kenya and are important contributors to anaemia.

The reliability of weight-for-length/height Z scores in children.

Abstract: The World Health Organisation (WHO) recommends weight-for-length/height (WFL/H), represented as a Z score for diagnosing acute malnutrition among children aged 0 to 60 months. Under controlled conditions, weight, height and length measurements have high degree of reliability. However, the reliability when combined into a WFL/H Z score, in all settings is unclear. We conducted a systematic review of published studies assessing the reliability of WFL/Hz on PubMed and Google scholar. Studies were included if they presented reliability scores for the derived index of WFL/Hz, for children under 5 years. Meta-analysis was conducted for a pooled estimate of reliability overall, and for children above and below 24 months old. Twenty six studies on reliability of anthropometry were identified but only three, all community-based studies, reported reliability scores for WFL/Hz. The overall pooled intra-class correlation coefficient (ICC) estimate for WFL/Hz among children aged 0 to 60 months was 0.81 (95% CI 0.64 to 0.99). Among children aged less than 24 months the pooled ICC estimate from two studies was 0.72 (95% CI 0.67 to 0.77) while the estimate reported for children above 24 months from one study was 0.97 (95% CI 0.97 to 0.99). Although WFL/Hz is recommended for diagnosis of acute under nutrition among children below 5 years, information on its reliability in all settings is sparse. In community settings, reliability of WFL/Hz is considerably lower than for absolute measures of weight and length/height, especially in younger children. The reliability of WFL/Hz needs further evaluation.

'I know it's wrong, but...': A qualitative investigation of low-income parents' feelings of guilt about their child-feeding practices

Abstract: In the developed world, child overweight and obesity rates are highest among the disadvantaged. This has resulted in calls for more research with low socio-economic families to better understand their experiences with disadvantage and how they might lead to poorer weight outcomes. The present study, conducted in Australia, adopted a qualitative approach to investigate the factors affecting low socio-economic parents' child-feeding practices. Methods used to collect data were introspections, interviews and focus groups. In total, 37 parents of overweight or obese children aged between 5 and 9 years took part in the 6-month study. Guilt emerged as an emotion that parents regularly experienced when allowing their children to consume too much food or foods high in fat, salt and/or sugar. Parents attributed their guilt-inducing child-feeding practices to both external and internal factors. Time scarcity and cost were factors that were primarily characterized by an external locus of control. The factors characterized by an internal locus of control were fear of their children experiencing hunger, the perceived need to secure their children's affection through the provision of treat foods, perceptions of their ability to balance their children's diets across eating situations and perceived laziness. Recommendations are provided for addressing guilt-inducing child-feeding practices.

Comparison of mid-infrared transmission spectroscopy with biochemical methods for the determination of macronutrients in human milk

Abstract: The variability of human milk (HM) composition renders analysis of its components essential for optimal nutrition of preterm fed either with donor's or own mother's milk. To fulfil this requirement, various analytical instruments have been subjected to scientific and clinical evaluation. The objective of this study was to evaluate the suitability of a rapid method for the analysis of macronutrients in HM as compared with the analytical methods applied by cow's milk industry. Mature milk from 39 donors was analysed using an infrared human milk analyser (HMA) and compared with biochemical reference laboratory methods. The statistical analysis was based on the use of paired data tests. The use of an infrared HMA for the analysis of lipids, proteins and lactose in HM proved satisfactory as regards the rapidity, simplicity and the required sample volume. The instrument afforded good linearity and precision in application to all three nutrients. However, accuracy was not acceptable when compared with the reference methods, with overestimation of the lipid content and underestimation of the amount of proteins and lactose contents. The use of mid-infrared HMA might become the standard for rapid analysis of HM once standardisation and rigorous and systematic calibration is provided.

Dietary patterns in infancy and their associations with maternal socio‐economic and lifestyle factors among 758 Japanese mother–child pairs: the Osaka Maternal and Child Health Study

Abstract: Dietary habits established in early childhood contribute to lifelong dietary pattern and the development of early risk factors for disease in adulthood. Although a large body of epidemiologic data from Western countries show that the dietary pattern of children is influenced by maternal socio-economic and lifestyle characteristics, information on this topic in non-Western countries is absolutely lacking. The present study identified dietary patterns among infants aged 16-24 months, and then examined the influence of maternal socio-economic and lifestyle characteristics on identified dietary patterns. Subjects were 758 Japanese mother-child pairs. Dietary data of infants were collected from the mothers using a questionnaire. Dietary patterns were extracted from the consumption of 15 foods (times week(-1)) by cluster analysis. The following two dietary patterns were identified: 'fruits, vegetables and high-protein foods' (n = 483) and 'confectionaries and sweetened beverages' (n = 275) patterns. After adjustment for all other predictors, maternal educational level, number of infants' siblings and maternal dietary patterns were independently associated with dietary patterns of infants. Infants whose mothers had a higher educational level and the 'rice, fish and vegetables' dietary pattern were less likely to belong to the 'confectionaries and sweetened beverages' pattern, whereas infants whose mothers had a higher number of children and the 'wheat product' dietary pattern were more likely to belong to the 'confectionaries and sweetened beverages' than the 'fruits, vegetables and high-protein foods' pattern. In conclusion, the mother's socio-economic position and dietary patterns were associated with the dietary patterns of infants in the Japanese pairs as observed in the Western populations.

Breastfeeding and educational achievement at age 5.

Abstract: Our aim was to investigate whether the duration of breastfeeding, at all or exclusively, is associated with educational achievement at age 5. We used data from a prospective, population-based UK cohort study, the Millennium Cohort Study (MCS). 5489 children from White ethnic background born at term in 2000-2001, attending school in England in 2006, were included in our analyses. Educational achievement was measured using the Foundation Stage Profile (FSP), a statutory assessment undertaken by teachers at the end of the child's first school year. Breastfeeding duration was ascertained from interviews with the mother when the child was 9 months old. We used modified Poisson's regression to model the association of breastfeeding duration with having reached a good level of achievement overall (≥78 overall points and ≥6 in 'personal, social and emotional development' and 'communication, language and literacy' points) and in specific areas (≥6 points) of development. Children who had been breastfed for up to 2 months were more likely to have reached a good level of overall achievement [adjusted rate ratio (RR): 1.09, 95% confidence interval (CI): 1.01, 1.19] than never breastfed children. This association was more marked in children breastfed for 2-4 months (adjusted RR: 1.17, 95% CI: 1.07, 1.29) and in those breastfed for longer than 4 months (adjusted RR: 1.16, 95% CI: 1.07, 1.26). The associations of exclusive breastfeeding with the educational achievement were similar. Our findings suggest that longer duration of breastfeeding, at all or exclusively, is associated with better educational achievement at age 5.

Effects of dietary counselling on food habits and dietary intake of Finnish pregnant women at increased risk for gestational diabetes - a secondary analysis of a cluster-randomized controlled trial.

Abstract: The incidence of gestational diabetes mellitus (GDM) is increasing and GDM might be prevented by improving diet. Few interventions have assessed the effects of dietary counselling on dietary intake of pregnant women. This study examined the effects of dietary counselling on food habits and dietary intake of Finnish pregnant women as secondary outcomes of a trial primarily aiming at preventing GDM. A cluster-randomized controlled trial was conducted in 14 municipalities in Finland, including 399 pregnant women at increased risk for developing GDM. The intervention consisted of dietary counselling focusing on dietary fat, fibre and saccharose intake at four routine maternity clinic visits. Usual counselling practices were continued in the usual care municipalities. A validated 181-item food frequency questionnaire was used to assess changes in diet from baseline to 26-28 and 36-37 weeks gestation. The data were analysed using multilevel mixed-effects linear regression models. By 36-37 weeks gestation, the intervention had beneficial effects on total intake of vegetables, fruits and berries (coefficient for between-group difference in change 61.6 g day(-1), 95% confidence interval 25.7-97.6), the proportions of high-fibre bread of all bread (7.2% units, 2.5-11.9), low-fat cheeses of all cheeses (10.7% units, 2.6-18.9) and vegetable fats of all dietary fats (6.1% -units, 2.0-10.3), and the intake of saturated fatty acids (-0.67 energy-%-units, -1.16 to -0.19), polyunsaturated fatty acids (0.38 energy-%-units, 0.18-0.58), linoleic acid (764 mg day(-1), 173-1354) and fibre (2.07 g day(-1) , 0.39-3.75). The intervention improved diet towards the recommendations in pregnant women at increased risk for GDM suggesting the counselling methods could be implemented in maternity care.

Development and acceptability of a novel milk-free soybean-maize-sorghum ready-to-use therapeutic food (SMS-RUTF) based on industrial extrusion cooking process.

Abstract: Peanut milk-based ready-to-use therapeutic food (P-RUTF) primarily used to treat severe acute malnutrition at community setting is expensive. We developed an alternative milk-free soybean-maize-sorghum-based RUTF (SMS-RUTF) using locally grown ingredients that have the potential to support local economy and reduce the cost of RUTF. We describe the production process and results of acceptability of the new product. Acceptability and tolerance of SMS-RUTF was compared with P-RUTF among 45 children aged 4-11 years old based on a cross-over design. Each child consumed 250 g RUTF for 10 days followed by a five-day washout period and a subsequent 10-day period on the second RUTF. The SMS-RUTF was as acceptable as the P-RUTF among normal children aged 4-11 years of age with no associated adverse effects. SMS-RUTF was stable for at least 12 months without detectable microbiological or chemical deterioration. The major challenge encountered in SMS-RUTF development was the difficulty to accurately determine key nutrient composition due to its high oil content. Use of diversified locally available ingredients to produce RUTF is feasible. The SMS-RUTF meets expected standards and is acceptable to children aged 4-11 months old. Effectiveness and cost-effectiveness of SMS-RUTF is required.