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Hollinrake G, Komninou S, Brown A. Use of baby food products during the complementary feeding period: What factors drive parents' choice of products? MATERNAL & CHILD NUTRITION 2024:e13689. [PMID: 38898599 DOI: 10.1111/mcn.13689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
It is recommended that infants are introduced to complementary foods from 6 months old, moving from a solely milk diet to eating a family diet by 12 months old. Although home cooking of family foods is recommended, a rapidly growing market producing baby food products (BFP) such as jars, pouches and snacks has developed. These are often accompanied by marketing claims around nutritional, health and developmental impacts despite research highlighting high sugar content. Although numerous studies have explored drivers of infant formula choice and use, little research has examined the drivers of BFP use. This study used an online survey for United Kingdom parents of infants aged 4-12 months to explore use of BFP alongside perceptions and drivers to purchase products. Overall, 271 parents participated (173 used BFP and 98 did not), with a descriptive analysis of closed items and a thematic analysis for open ended text conducted. The top motivators for using BFP were convenience, time saving, and baby's perceived enjoyment of products. The most purchased puree was fruit based and the most purchased baby snacks were vegetable puffs/sticks, with snack purchases being more common than purees in this sample. Aspects such as perceived healthiness drove choice, with snack foods being seen to enhance self-feeding skills, appetite regulation and motor development. Those who did not use BFP did not trust them and preferred to feed their baby home cooked foods. The findings are important for professionals working with parents, to support them through the transition to solid foods, particularly around raising awareness of marketing techniques and how to check content of foods to make a more informed choice.
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Affiliation(s)
- Grace Hollinrake
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, Swansea, UK
- Faculty Medicine, Health and Life Sciences, Swansea University, Swansea, UK
| | - Sophia Komninou
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, Swansea, UK
- Faculty Medicine, Health and Life Sciences, Swansea University, Swansea, UK
| | - Amy Brown
- Centre for Lactation, Infant Feeding and Translation (LIFT), Swansea University, Swansea, UK
- Faculty Medicine, Health and Life Sciences, Swansea University, Swansea, UK
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Semanew Y, Tesfaye E, Tesgera D. Inadequate weight gain and factors influencing it among preterm neonates in neonatal intensive care units in the Amhara region, Ethiopia, in 2022. Front Pediatr 2024; 12:1381010. [PMID: 38774296 PMCID: PMC11106434 DOI: 10.3389/fped.2024.1381010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Background Adequate weight gain is crucial for the health and development of preterm neonates admitted to neonatal intensive care units (NICUs). Understanding the factors influencing weight gain in this vulnerable population is essential for improving outcomes. This study aimed to assess the weight gain status and associated factors among preterm neonates admitted to NICUs in specialized hospitals in the Amhara region of Ethiopia. Methods A cross-sectional study design involving 363 preterm neonates admitted to NICUs in specialized hospitals within the Amhara region was used. Data were collected using structured questionnaires and the Kobo Tool Box. Daily weight measurements were recorded for three consecutive days. Descriptive statistics, logistic regression analysis, and graphical presentations were utilized for data analysis and presentation. Results The study revealed that a significant proportion (80.8%) of preterm neonates experienced poor weight gain during their NICU stay. The factors significantly associated with poor weight gain were older maternal age, delayed initiation of enteral feeding, lack of kangaroo mother care (KMC), and inadequate antenatal care visits. Conclusion Addressing the identified factors, such as providing adequate support during the antenatal period, promoting a timely initiation of enteral feeding, and encouraging KMC practices, is crucial for improving weight gain outcomes in preterm neonates. The findings highlight the importance of a comprehensive approach to neonatal care targeting both maternal and neonatal factors. Policymakers and healthcare providers should prioritize interventions aimed at optimizing weight gain in preterm neonates to improve these neonates' overall well-being and long-term outcomes.
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Affiliation(s)
- Yaregal Semanew
- Paediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Eleny Tesfaye
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Debrework Tesgera
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Silva-Neto LGR, Grotti Clemente AP, Bueno NB, Dos Santos TLF, Dos Santos Neto JE, de Menezes Toledo Florêncio TM. The Double Burden of Malnutrition is Associated with Continued Breastfeeding and Early Consumption of Ultra-Processed Drinks in Socially Vulnerable Brazilian Children. Ecol Food Nutr 2024; 63:160-173. [PMID: 38414231 DOI: 10.1080/03670244.2024.2322732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
This study aimed to assess the association between the double burden of malnutrition (DBM) with continued breastfeeding and the early introduction of ultra-processed drinks in children living in situations of social vulnerability. This cross-sectional population-based study was carried out in a capital city in the Northeast of Brazil, which included 561 children. It was observed that introducing soft drinks into the child's diet during the first year of life was directly associated with DBM but indirectly with continuous breastfeeding for 12 or more months. These results indicate paths that can be followed to reverse the current scenario.
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Affiliation(s)
- Luiz Gonzaga Ribeiro Silva-Neto
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil
| | - Ana Paula Grotti Clemente
- Programa de Pós-Graduação em Nutrição, Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, Brasil
| | - Nassib Bezerra Bueno
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil
- Programa de Pós-Graduação em Nutrição, Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, Brasil
| | | | - João Eudes Dos Santos Neto
- Hospital Universitário Alcides Carneiro, Empresa Brasileira de Serviços Hospitalares, Campina Grande, Paraíba, Brasil
| | - Telma Maria de Menezes Toledo Florêncio
- Programa de Pós-Graduação em Nutrição, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil
- Programa de Pós-Graduação em Nutrição, Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, Brasil
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Heltbech MS, Jensen CL, Girma T, Abera M, Admassu B, Kæstel P, Wells JCK, Michaelsen KF, Friis H, Andersen GS, Wibæk R. The Associations of Breastfeeding Status at 6 Months with Anthropometry, Body Composition, and Cardiometabolic Markers at 5 Years in the Ethiopian Infant Anthropometry and Body Composition Birth Cohort. Nutrients 2023; 15:4595. [PMID: 37960248 PMCID: PMC10647349 DOI: 10.3390/nu15214595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Breastfeeding (BF) has been shown to lower the risk of overweight and cardiometabolic disease later in life. However, evidence from low-income settings remains sparse. We examined the associations of BF status at 6 months with anthropometry, body composition (BC), and cardiometabolic markers at 5 years in Ethiopian children. (2) Methods: Mother-child pairs from the iABC birth cohort were categorised into four BF groups at 6 months: 1. "Exclusive", 2. "Almost exclusive", 3. "Predominantly" and 4. "Partial or none". The associations of BF status with anthropometry, BC, and cardiometabolic markers at 5 years were examined using multiple linear regression analyses in three adjustment models. (3) Results: A total of 306 mother-child pairs were included. Compared with "Exclusive", the nonexclusive BF practices were associated with a lower BMI, blood pressure, and HDL-cholesterol at 5 years. Compared with "Exclusive", "Predominantly" and "Almost exclusive" had shorter stature of -1.7 cm (-3.3, -0.2) and -1.2 cm (-2.9, 0.5) and a lower fat-free mass index of -0.36 kg/m2 (-0.71, -0.005) and -0.38 kg/m2 (-0.76, 0.007), respectively, but a similar fat mass index. Compared with "Exclusive", "Predominantly" had higher insulin of 53% (2.01, 130.49), "Almost exclusive" had lower total and LDL-cholesterol, and "Partial or none" had a lower fat mass index. (5) Conclusions: Our data suggest that children exclusively breastfed at 6 months of age are overall larger at 5 years, with greater stature, higher fat-free mass but similar fat mass, higher HDL-cholesterol and blood pressure, and lower insulin concentrations compared with predominantly breastfed children. Long-term studies of the associations between BF and metabolic health are needed to inform policies.
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Affiliation(s)
- Mathilde S. Heltbech
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Cecilie L. Jensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Bitiya Admassu
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Jonathan C. K. Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
| | - Kim F. Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Gregers S. Andersen
- Clinical Research, Copenhagen University Hospital–Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Rasmus Wibæk
- Clinical Research, Copenhagen University Hospital–Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
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Fujita M, Wander K, Tran T, Brindle E. Characterizing the extent human milk folate is buffered against maternal malnutrition and infection in drought‐stricken northern Kenya. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 179:171-183. [PMCID: PMC9805107 DOI: 10.1002/ajpa.24603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/09/2022] [Accepted: 07/20/2022] [Indexed: 09/29/2023]
Abstract
Objectives Folate is an essential nutrient fundamental to human growth and development. Human milk maintains high folate content across the maternal folate status range, suggesting buffering of milk folate with prioritized delivery to milk at the expense of maternal depletion. We investigated whether and how the extent of this buffering may diminish under prolonged nutritional and/or disease stress, while taking into consideration infants' varying vulnerability to malnutrition‐related morbidity/mortality. Methods A cross‐sectional study analyzed milk specimens from northern Kenyan mothers (n = 203), surveyed during a historic drought and ensuing food shortage. Multiple regression models for folate receptor‐α (FOLR1) in milk were constructed. Predictors included maternal underweight (BMI < 18.5), iron‐deficiency anemia (hemoglobin <12 g/dl and dried‐blood‐spot transferrin receptor >5 mg/L), folate deficiency (hyperhomocysteinemia, homocysteine >12 or 14 μmol/L), inflammation (serum C‐reactive protein >5 mg/L), infant age and sex, and mother‐infant interactions. Results In adjusted models, milk FOLR1 was unassociated with maternal underweight, iron‐deficiency anemia and inflammation. FOLR1 was positively associated with maternal folate deficiency, and inversely associated with infant age. There was interaction between infant age and maternal underweight, and between infant sex and maternal folate deficiency, predicting complex changes in FOLR1. Conclusions Our results suggest that mothers buffer milk folate against their own nutritional stress even during a prolonged drought; however, the extent of this buffering may vary with infant age, and, among folate‐deficient mothers, with infant sex. Future research is needed to better understand this variability in maternal buffering of milk folate and how it relates to folate status in nursing infants. Human mothers might have the capacity to buffer milk nutrient content against undue fluctuations under nutritional or disease stress. In the case of the micronutrient folate, this buffering is most apparent for younger infants.
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Affiliation(s)
- Masako Fujita
- Department of AnthropologyMichigan State UniversityEast LansingMichiganUSA
- Biomarker Laboratory for Anthropological ResearchMichigan State UniversityEast LansingMichiganUSA
| | - Katherine Wander
- Department of AnthropologyBinghamton University (SUNY)BinghamtonNew YorkUSA
- Laboratory for Anthropometry and BiomarkersBinghamton UniversityBinghamtonNew YorkUSA
| | - Tin Tran
- Biomarker Laboratory for Anthropological ResearchMichigan State UniversityEast LansingMichiganUSA
- College of PharmacyUniversity of IowaIowa CityIowaUSA
| | - Eleanor Brindle
- Maternal, Newborn and Child Health & NutritionPATHSeattleWashingtonUSA
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Kittisakmontri K, Lanigan J, Wells JCK, Manowong S, Kaewarree S, Fewtrell M. Quantity and Source of Protein during Complementary Feeding and Infant Growth: Evidence from a Population Facing Double Burden of Malnutrition. Nutrients 2022; 14:3948. [PMID: 36235599 PMCID: PMC9572535 DOI: 10.3390/nu14193948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While high protein intake during infancy may increase obesity risk, low qualities and quantities of protein contribute to undernutrition. This study aimed to investigate the impact of the amount and source of protein on infant growth during complementary feeding (CF) in a country where under- and overnutrition co-exist as the so-called the double burden of malnutrition. METHODS A multicenter, prospective cohort was conducted. Healthy term infants were enrolled with dietary and anthropometric assessments at 6, 9 and 12 months (M). Blood samples were collected at 12M for IGF-1, IGFBP-3 and insulin analyses. RESULTS A total of 145 infants were enrolled (49.7% female). Animal source foods (ASFs) were the main protein source and showed a positive, dose-response relationship with weight-for-age, weight-for-length and BMI z-scores after adjusting for potential confounders. However, dairy protein had a greater impact on those parameters than non-dairy ASFs, while plant-based protein had no effect. These findings were supported by higher levels of IGF-1, IGFBP-3 and insulin following a higher intake of dairy protein. None of the protein sources were associated with linear growth. CONCLUSIONS This study showed the distinctive impact of different protein sources during CF on infant growth. A high intake of dairy protein, mainly from infant formula, had a greater impact on weight gain and growth-related hormones.
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Affiliation(s)
- Kulnipa Kittisakmontri
- Childhood Nutrition Research Centre, Department of Population, Policy and Practice, Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Julie Lanigan
- Childhood Nutrition Research Centre, Department of Population, Policy and Practice, Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Jonathan C. K. Wells
- Childhood Nutrition Research Centre, Department of Population, Policy and Practice, Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Suphara Manowong
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sujitra Kaewarree
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, Department of Population, Policy and Practice, Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
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Vidal L, Brunet G, Bove I, Girona A, Fuletti D, Ares G. Parents’ mental associations with ultra-processed products for their infant children: Insights to improve complementary feeding practices. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nurrizka RH, Wenny DM, Amalia R. Complementary Feeding Practices and Influencing Factors Among Children Under 2 Years of Age: A Cross-Sectional Study in Indonesia. Pediatr Gastroenterol Hepatol Nutr 2021; 24:535-545. [PMID: 34796098 PMCID: PMC8593361 DOI: 10.5223/pghn.2021.24.6.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study aimed to analyze the practice of complementary feeding and its influencing factors in children under 2 years of age in Indonesia. METHODS This cross-sectional study used data obtained from the 2017 National Socioeconomic Survey. The sample totaled 1,751 households with children under 2 years of age, who received complementary feeding in urban and rural communities. Furthermore, the practice of complementary feeding was evaluated on the basis of the variations in provided food grouped into two categories: complete and incomplete. This study applied bivariate and multivariate analytical methods. Multivariate analysis was performed using binary logistic regression. RESULTS The proportion of children under 2 years of age who received complementary feeding with complete variant food was 15.9%, while that with incomplete variant food was 84.1%. Furthermore, the factor influencing the practice of complementary feeding among the children was the mother's educational level (odds ratio: 1.481, 95% confidence interval: 0.245-0.943). CONCLUSION Complete complementary feeding, which involves a variety of food sources, is the best approach to improve the nutritional status of infants. Therefore, the source of food for complementary feeding must be accessible to all communities.
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Affiliation(s)
- Rahmah Hida Nurrizka
- Department of Public Health, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia
| | - Dwi Muthia Wenny
- Department of Public Health, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, Indonesia
| | - Rizki Amalia
- Department of Public Health, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, Indonesia
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Yu L, Ke HJ, Che D, Guo Y, Wu JL. Large retrospective cohort study of the association between maternal 25-hydroxyvitamin D status and birth weight of neonate. J Matern Fetal Neonatal Med 2021; 35:7231-7237. [PMID: 34225543 DOI: 10.1080/14767058.2021.1946781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The effect of maternal vitamin D levels on the birth weight of the offspring remains controversial, as the results are inconsistent between different populations. This large retrospective cohort study aimed to assess the relationship between maternal vitamin D levels and birth weight of neonates in southern China. METHODS Serum samples were collected from 10,586 Chinese women at 13-27 weeks of pregnancy, and the 25-hydroxyvitamin D (25(OH)D) level of the participants was assessed. Using the INTERGROWTH-21st standards, the offspring were classified into three groups based on their gestational age and birth weight, which were small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). The differences in vitamin D levels among the different groups were compared, and their correlation with newborn birth weight was analyzed. RESULTS The average maternal vitamin D concentration was 61.1 nmol/L. The 25(OH)D concentrations were 50-75 nmol/L, 25-50 nmol/L and below 25 nmol/L in 45.5%, 29.5%, and 1.6% of the participants, respectively. No significant differences were observed in the vitamin D levels between the three groups. With the increase in 25(OH)D levels, the risk of SGA and LGA tended to increase and decrease, respectively. AGA was not affected by the 25(OH)D levels. The results of the curve fitting and threshold effect analyses did not support the correlation between vitamin D levels and SGA or LGA. Based on the univariate prediction model and the model adjusted for risk factors, the area under the curve was extremely small. Thus, 25(OH)D levels are not an effective predictor of SGA and LGA. CONCLUSIONS Low maternal vitamin D levels were not associated with SGA or LGA.
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Affiliation(s)
- Li Yu
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hai-Jin Ke
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Di Che
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yong Guo
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jie-Ling Wu
- Department of Children's Health Care, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
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The Impact of Stress Within and Across Generations: Neuroscientific and Epigenetic Considerations. Harv Rev Psychiatry 2021; 29:303-317. [PMID: 34049337 DOI: 10.1097/hrp.0000000000000300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The impact of stress and trauma on biological systems in humans can be substantial. They can result in epigenetic changes, accelerated brain development and sexual maturation, and predisposition to psychopathology. Such modifications may be accompanied by behavioral, emotional, and cognitive overtones during one's lifetime. Exposure during sensitive periods of neural development may lead to long-lasting effects that may not be affected by subsequent environmental interventions. The cumulative effects of life stressors in an individual may affect offspring's methylome makeup and epigenetic clocks, neurohormonal modulation and stress reactivity, and physiological and reproductive development. While offspring may suffer deleterious effects from parental stress and their own early-life adversity, these factors may also confer traits that prove beneficial and enhance fitness to their own environment. This article synthesizes the data on how stress shapes biological and behavioral dimensions, drawing from preclinical and human models. Advances in this field of knowledge should potentially allow for an improved understanding of how interventions may be increasingly tailored according to individual biomarkers and developmental history.
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Mapping Geographical Differences and Examining the Determinants of Childhood Stunting in Ethiopia: A Bayesian Geostatistical Analysis. Nutrients 2021; 13:nu13062104. [PMID: 34205375 PMCID: PMC8234472 DOI: 10.3390/nu13062104] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/06/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
Understanding the specific geographical distribution of stunting is essential for planning and implementing targeted public health interventions in high-burdened countries. This study investigated geographical variations in the prevalence of stunting sub-nationally, and the determinants of stunting among children under 5 years of age in Ethiopia. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) dataset for children aged 0–59 months with valid anthropometric measurements and geographic coordinates (n = 9089). We modelled the prevalence of stunting and its determinants using Bayesian geospatially explicit regression models. The prevalence of stunting among children under five years was 36.3% (95% credible interval (CrI); 22.6%, 51.4%) in Ethiopia, with wide variations sub-nationally and by age group. The prevalence of childhood stunting ranged from 56.6% (37.4–74.6%) in the Mekelle Special zone of the Tigray region to 25.5% (10.5–48.9%) in the Sheka zone of the Southern Nations, Nationalities and Peoples region. Factors associated with a reduced likelihood of stunting in Ethiopia included non-receipt of breastmilk, mother’s BMI (overweight/obese), employment status (employed), and higher household wealth, while the enablers were residence in the “arid” geographic areas, small birth size of the child, and mother’s BMI (underweight). The prevalence and determinants of stunting varied across Ethiopia. Efforts to reduce the burden of childhood stunting should consider geographical heterogeneity and modifiable risk factors.
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Academy of Nutrition and Dietetics Nutrition Research Network: The Saqmolo' Project Rationale and Study Protocol for a Randomized Controlled Trial Examining the Influence of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala. J Acad Nutr Diet 2021; 122:432-444. [PMID: 33962902 DOI: 10.1016/j.jand.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Adequate nutrition during the complementary feeding period is critical for optimal child growth and development and for promoting long-term educational attainment and economic potential. To prioritize limited public health resources, there is a need for studies that rigorously assess the influence of multicomponent integrated nutrition interventions in children younger than age 2 years in different contexts. This study aimed to describe the rationale and protocol for the Saqmolo' Project using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The Saqmolo' (ie, "egg" in the Mayan language, Kaqchiquel) Project is an individually randomized, partially blinded, controlled comparative effectiveness trial to evaluate the influence of adding delivery of a single whole egg per day to local standard nutrition care (ie, growth monitoring, medical care, deworming medication, multiple micronutrient powders for point-of-use food fortification [chispitas], and individualized complementary and responsive feeding education for caregivers) for 6 months, compared with the local standard nutrition care package alone, on child development, growth, and diet quality measures in rural indigenous Mayan infants aged 6 to 9 months at baseline (N = 1,200). The study is being executed in partnership with the Wuqu' Kawoq/Maya Health Alliance, a primary health care organization located in central Guatemala. Primary outcomes for this study are changes in global development scores, assessed using the Guide for Monitoring Global Development and the Caregiver Reported Child Development Instruments. Secondary outcomes include changes in infant hemoglobin, anthropometric measures (including z scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality as measured using the World Health Organization's infant and young child feeding indicators. The results of the Saqmolo' Project may help to inform public health decision making regarding resource allocation for effective nutrition interventions during the complementary feeding period.
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Alao ME, Perin J, Brooks WA, Hossain L, Goswami D, Zaman K, Yunus M, Khan MA, Jahan Y, Ahmed D, Slavkovich V, Graziano J, Prosperi C, Higdon M, Deloria-Knoll M, O' Brien KL, George CM. Urinary arsenic is associated with wasting and underweight status in young children in rural Bangladesh. ENVIRONMENTAL RESEARCH 2021; 195:110025. [PMID: 32791251 DOI: 10.1016/j.envres.2020.110025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Deficits in child growth are associated with poor cognitive outcomes and an increased risk for infection and mortality globally. One hundred forty million people are chronically exposed to arsenic from contaminated drinking water worldwide. While arsenic exposure has been associated with cognitive developmental delays in children, there is limited research on the association between arsenic exposure and growth deficits in young children. PURPOSE The objective of this study was to assess the association between chronic arsenic exposure and deficits in growth among children under 5 years in a rural setting in Bangladesh. METHODS Urinary arsenic measurements were collected from 465 children between the ages of 28 days-59 months in rural Matlab, Bangladesh, and analyzed by graphite furnace atomic absorption. Height and weight measurements were collected from children according to World Health Organization child growth standards. A z-score cutoff2 standard deviations below the mean was used to define stunting (height-for-age z-score), underweight (weight-for-age z-score), and wasting (weight-for-height z-score). RESULTS Children under 5 years with urinary arsenic concentrations in the third tertile (greater than 31 μg per liter (μg/L)) had a two times higher odds of being underweight after adjustment for age, creatinine, paternal education, breastfeeding, number of individuals using the same sleeping room, and physician-diagnosed pneumonia (Odds Ratio (OR): 2.29 (95% Confidence Interval (CI): 1.16, 4.52)). Children under 2 years of age had a two times higher odds of being wasted after adjustment for age, creatinine, paternal education, breastfeeding, number of individuals using the same sleeping room, and physician-diagnosed pneumonia (OR: 2.85 (95% CI: 1.18, 6.89)). CONCLUSIONS These findings suggest that arsenic exposure is associated with an increased odds of being wasted and underweight among young children in rural Bangladesh.
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Affiliation(s)
- Mary E Alao
- Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - W Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lokman Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Khalequzzaman Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Alfazal Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Vesna Slavkovich
- Department of Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Joseph Graziano
- Department of Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria Deloria-Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine L O' Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Marie George
- Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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14
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Littlejohn P, Finlay BB. When a pandemic and an epidemic collide: COVID-19, gut microbiota, and the double burden of malnutrition. BMC Med 2021; 19:31. [PMID: 33504332 PMCID: PMC7840385 DOI: 10.1186/s12916-021-01910-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is estimated that the COVID-19 pandemic will drastically increase all forms of malnutrition. Of particular concern, yet understated, is the potential to increase the double burden of malnutrition (DBM) epidemic. This coexistence of undernutrition together with overweight and obesity, or diet-related non-communicable disease (NCD), within low- to middle-income countries (LMICs) is increasing rapidly. Although multiple factors contribute to the DBM, food insecurity (FI) and gut microbiota dysbiosis play a crucial role. Both under- and overnutrition have been shown to be a consequence of food insecurity. The gut microbiota has also been recently implicated in playing a role in under- and overnutrition, with altered community structure and function common to both. The pandemic has already caused significant shifts in food availability which has immediate effects on the gut microbiome. In this opinion paper, we discuss how COVID-19 may indirectly exacerbate the DBM through food insecurity and the gut microbiome. MAIN TEXT The World Food Programme (WFP) estimates that 265 million people in LMICs will experience acute hunger in 2020 due to the pandemic, nearly doubling the original projection of 135 million. Global border closures to food trade, loss of food production, and stark decline in household income will exacerbate starvation while simultaneously necessitating that families resort to calorie-dense, nutrient-poor foods, thereby increasing obesity. While food insecurity, which is the persistent lack of consistent access to adequate and nutrient-rich foods, will primarily drive nutrition behavior, the gut microbiome is perhaps a key biological mechanism. Numerous human and animal studies describe low diversity and an increase in inflammatory species as characteristic features of the undernourished and overnourished gut microbiota. Indeed, fecal transplant studies show that microbiota transfer from undernourished and overnourished humans to germ-free mice lacking a microbiome transfers the physical and metabolic phenotype, suggesting a causal role for the microbiota in under- and overnutrition. The observed microbiome dysbiosis within severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coupled with the DBM presents a viscous cycle. CONCLUSION Low- to mid-income countries will likely see an increase in the DBM epidemic. Providing access to nutritious foods and protecting individuals' gut microbiome to "flatten the curve" of the DBM trajectory should be prioritized.
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Affiliation(s)
- Paula Littlejohn
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, V6T 1Z3, Canada
- Michael Smith Laboratories, University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - B Brett Finlay
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, V6T 1Z3, Canada.
- Michael Smith Laboratories, University of British Columbia, Vancouver, V6T 1Z4, Canada.
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, V6T 1Z3, Canada.
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15
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Vidal L, Bove I, Brunet G, Girona A, Alcaire F, Antúnez L, Ares G. Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay? Public Health Nutr 2021; 24:1-10. [PMID: 33413708 DOI: 10.1017/s1368980020005352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore Uruguayan paediatricians' personal recommendations about complementary feeding and to assess if they are aligned with current guidelines and scientific evidence. DESIGN A questionnaire composed of open-ended questions was used to explore foods recommended to start complementary feeding, foods regarded as the most important during the first meals, recommendations for delayed introduction of foods and foods that should be avoided. Reasons underlying the recommendations were also explored. SETTING Montevideo, the capital city of Uruguay (Latin America). PARTICIPANTS A total of 212 paediatricians were recruited during a National Pediatrics Conference, organised by the Uruguayan Society of Pediatrics. RESULTS The recommendations about complementary feeding provided by paediatricians to parents and caregivers in Uruguay seemed not to be fully aligned with the guidelines provided by the Ministry of Health. Paediatricians recommend a rigid food introduction sequence, characterised by the early introduction of soft pureed vegetables and fruits, followed by meat and the delayed introduction of allergenic foods. Food diversity and the concept of ultra-processed were not frequently identified in the responses. CONCLUSIONS Results stress the importance of developing educational and communication approaches targeted at paediatricians to contribute to the uptake of updated recommendations regarding complementary feeding.
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Affiliation(s)
- Leticia Vidal
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000Pando, Canelones, Uruguay
| | | | - Gerónimo Brunet
- Espacio Interdisciplinario, Universidad de la República, Montevideo, Uruguay
| | - Alejandra Girona
- Departamento de Nutrición Básica, Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Florencia Alcaire
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000Pando, Canelones, Uruguay
| | - Lucía Antúnez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000Pando, Canelones, Uruguay
| | - Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000Pando, Canelones, Uruguay
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