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Hernández-Aguilar MT, Bartick M, Schreck P, Harrel C, Noble L, Calhoun S, Dodd S, Elliott-Rudder M, Lappin S, Larson I, Lawrence RA, Marinelli KA, Marshall N, Mitchell K, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Seo T, Wonodi A. ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding. Breastfeed Med 2018; 13:559-574. [PMID: 30457366 DOI: 10.1089/bfm.2018.29110.mha] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Maria-Teresa Hernández-Aguilar
- 1 Breastfeeding Clinical Unit Dr. Peset, University Hospital Dr. Peset, National Health Service, Valencia, Spain .,2 National Coordinator of Spain Baby-Friendly Initiative (IHAN-España Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia), Madrid, Spain
| | - Melissa Bartick
- 3 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,4 Harvard Medical School, Boston, Massachusetts
| | - Paula Schreck
- 5 Department of Pediatrics, Ascension St. John , Detroit, Michigan
| | - Cadey Harrel
- 6 Department of Family Medicine, University of Arizona , Tucson, Arizona
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Kløvgaard M, Nielsen NO, Sørensen TL, Bjerregaard P, Olsen B, Júlíusson PB, Roelants M, Christesen HT. Growth of children in Greenland exceeds the World Health Organization growth charts. Acta Paediatr 2018; 107:1953-1965. [PMID: 29693738 PMCID: PMC6221127 DOI: 10.1111/apa.14369] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/10/2018] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
AIM Previous studies have found high rates of stunted linear growth in Greenlandic children. We measured growth patterns in Greenland and compared them with international growth charts. METHODS The study cohort comprised 279 healthy children aged 6-10 years in 2012. They participated in two pregnancy and birth cohorts in Greenland and longitudinal growth data as birth was extracted from their medical records. Growth reference ranges were estimated with the lambda-mu-sigma (LMS) method and compared with growth charts from Denmark and the World Health Organization (WHO). RESULTS The children's mean length, weight and head circumference were significantly larger than the WHO growth charts (p < 0.001). We found that 21-28% of the children aged zero to one years exceeded the WHO growth chart for length by more than two standard deviations. For weight and head circumference, 9-16% of the children aged 0-10 years and 9-11% of the children from zero to two years exceeded the WHO charts by more than two standard deviations. The Danish references were exceeded to a lesser degree. CONCLUSION This study showed that the growth of Greenlandic children up to 10 years was no longer stunted. Major determining factors suggested are genetic admixture, maternal overweight, changes in nutrition and improved health.
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Affiliation(s)
- Marius Kløvgaard
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
- Department of Clinical Research; Faculty of Health Sciences; University of Southern Denmark; Odense Denmark
- Ilulissat Healthcare Center; Avannaa Greenland
| | - Nina Odgaard Nielsen
- Center for Health Research in Greenland; National Institute of Public Health; Copenhagen Denmark
| | | | - Peter Bjerregaard
- Center for Health Research in Greenland; National Institute of Public Health; Copenhagen Denmark
| | - Britta Olsen
- Pediatric Department; Queen Ingrid's Hospital; Nuuk Greenland
| | - Pétur Benedikt Júlíusson
- Department of Paediatrics; Haukeland University Hospital; Bergen Norway
- Department of Clinical Science; University of Bergen; Bergen Norway
| | - Mathieu Roelants
- Environment and Health/Youth Health Care; Department of Public Health and Primary Care; KU Leuven; University of Leuven; Leuven Belgium
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
- Department of Clinical Research; Faculty of Health Sciences; University of Southern Denmark; Odense Denmark
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Chai Y, Nandi A, Heymann J. Does extending the duration of legislated paid maternity leave improve breastfeeding practices? Evidence from 38 low-income and middle-income countries. BMJ Glob Health 2018; 3:e001032. [PMID: 30364395 PMCID: PMC6195155 DOI: 10.1136/bmjgh-2018-001032] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction Among all barriers to breastfeeding, the need to work has been cited as one of the top reasons for not breastfeeding overall and for early weaning among mothers who seek to breastfeed. We aimed to examine whether extending the duration of paid maternity leave available to new mothers affected early initiation of breastfeeding, exclusive breastfeeding under 6 months and breastfeeding duration in low-income and middle-income countries (LMICs). Methods We merged longitudinal data measuring national maternity leave policies with information on breastfeeding related to 992 419 live births occurring between 1996 and 2014 in 38 LMICs that participated in the Demographic and Health Surveys. We used a difference-in-differences approach to compare changes in the prevalence of early initiation and exclusive breastfeeding, as well as the duration of breastfeeding, among treated countries that lengthened their paid maternity leave policy between 1995 and 2013 versus control countries that did not. Regression models included country and year fixed effects, as well as measured individual-level, household-level and country-level covariates. All models incorporated robust SEs and respondent-level sampling weights. Results A 1-month increase in the legislated duration of paid maternity leave was associated with a 7.4 percentage point increase (95% CI 3.2 to 11.7) in the prevalence of early initiation of breastfeeding, a 5.9 percentage point increase (95% CI 2.0 to 9.8) in the prevalence of exclusive breastfeeding and a 2.2- month increase (95% CI 1.1 to 3.4) in breastfeeding duration. Conclusion Extending the duration of legislated paid maternity leave appears to promote breastfeeding practices in LMICs. Our findings suggest a potential mechanism to reduce barriers to breastfeeding for working mothers.
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Affiliation(s)
- Yan Chai
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health and Institute for Health and Social Policy, MGill University, Montreal, Quebec, Canada
| | - Jody Heymann
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA
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Kim SS, Nguyen PH, Tran LM, Sanghvi T, Mahmud Z, Haque MR, Afsana K, Frongillo EA, Ruel MT, Menon P. Large-Scale Social and Behavior Change Communication Interventions Have Sustained Impacts on Infant and Young Child Feeding Knowledge and Practices: Results of a 2-Year Follow-Up Study in Bangladesh. J Nutr 2018; 148:1605-1614. [PMID: 30169665 PMCID: PMC6168701 DOI: 10.1093/jn/nxy147] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/24/2018] [Accepted: 06/22/2018] [Indexed: 11/26/2022] Open
Abstract
Background Sustained improvements in infant and young child feeding (IYCF) require continued implementation of effective interventions. From 2010-2014, Alive & Thrive (A&T) provided intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM) in Bangladesh, demonstrating impact on IYCF practices. Since 2014, implementation has been continued and scaled up by national partners with support from other donors and with modifications such as added focus on maternal nutrition and reduced program intensity. Objective We assessed changes in intervention exposure and IYCF knowledge and practices in the intensive (IPC + CM + MM) compared with nonintensive areas (standard nutrition counseling + less intensive CM and MM) 2 y after termination of initial external donor support. Methods We used a cluster-randomized design with repeated cross-sectional surveys at baseline (2010, n = 2188), endline (2014, n = 2001), and follow-up (2016, n = 2400) in the same communities, among households with children 0-23.9 mo of age. Within-group differences over time and differences between groups in changes were tested. Results In intensive areas, exposure to IPC decreased slightly between endline and follow-up (88.9% to 77.2%); exposure to CM activities decreased significantly (29.3% to 3.6%); and MM exposure was mostly unchanged (28.1-69.1% across 7 TV spots). Exposure to interventions did not expand in nonintensive areas. Most IYCF indicators in intensive areas declined from endline to follow-up, but remained higher than at baseline. Large differential improvements of 12-17 percentage points in intensive, compared with nonintensive areas, between baseline and follow-up remained for early initiation of and exclusive breastfeeding, timely introduction of foods, and consumption of iron-rich foods. Differential impact in breastfeeding knowledge remained between baseline and follow-up; complementary feeding knowledge increased similarly in both groups. Conclusions Continued IPC exposure and sustained impacts on IYCF knowledge and practices in intensive areas indicated lasting benefits from A&T's interventions as they underwent major scale-up with reduced intensity. This trial was registered at clinicaltrials.gov as NCT02740842.
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Affiliation(s)
- Sunny S Kim
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC
| | - Phuong Hong Nguyen
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC
| | | | | | | | | | - Kaosar Afsana
- Health, Nutrition and Population Programme, BRAC, Dhaka, Bangladesh
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Marie T Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC
| | - Purnima Menon
- Poverty, Health, and Nutrition Division, IFPRI, New Delhi, India
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Early-life origins of disparities in chronic diseases among Indigenous youth: pathways to recovering health disparities from intergenerational trauma. J Dev Orig Health Dis 2018; 10:115-122. [PMID: 30223914 DOI: 10.1017/s2040174418000661] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Indigenous women and children experience some of the most profound health disparities globally. These disparities are grounded in historical and contemporary trauma secondary to colonial atrocities perpetuated by settler society. The health disparities that exist for chronic diseases may have their origins in early-life exposures that Indigenous women and children face. Mechanistically, there is evidence that these adverse exposures epigenetically modify genes associated with cardiometabolic disease risk. Interventions designed to support a resilient pregnancy and first 1000 days of life should abrogate disparities in early-life socioeconomic status. Breastfeeding, prenatal care and early child education are key targets for governments and health care providers to start addressing current health disparities in cardiometabolic diseases among Indigenous youth. Programmes grounded in cultural safety and co-developed with communities have successfully reduced health disparities. More works of this kind are needed to reduce inequities in cardiometabolic diseases among Indigenous women and children worldwide.
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Influence of Maternal Fish Intake on the Anthropometric Indices of Children in the Western Amazon. Nutrients 2018; 10:nu10091146. [PMID: 30142890 PMCID: PMC6164537 DOI: 10.3390/nu10091146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 12/19/2022] Open
Abstract
We studied trends in fish intake among pregnant women living in the Madeira River Basin in Rondônia State, Brazil, to investigate the influence of maternal fish intake on anthropometric indices of children followed up to 5 years. Maternal fish intake was assessed using hair mercury concentrations of mothers and children at delivery and 6, 24, and 59 months. Data analysis was performed using a linear mixed-effect model. Mothers were predominantly young, had low incomes and limited schooling, and breastfed for >6 months. Only 1.9% of children had low birth weight. Anthropometric indices in approximately 80% of the study population showed Z-score values ranging from ≥-2 to ≤1. The influence of maternal fish intake on anthropometric indices, including height-to-age (H/A), weight-to-age (W/A), and weight-to-height (W/H) were not statistically significant after model adjustments. However, higher income and larger birth weight had a positive influence on H/A and W/A, whereas W/H gain was favored by higher maternal educational status and breastfeeding duration. Other variables (hemoglobin concentration and maternal age) had a positive significant influence on anthropometric indices. Maternal fish intake (or its attendant MeHg exposure) did not affect children growth. Nevertheless, it is advisable to avoid mercury-contaminated fish during pregnancy and childhood.
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Chanani S, Waingankar A, Shah More N, Pantvaidya S, Fernandez A, Jayaraman A. Participation of pregnant women in a community-based nutrition program in Mumbai's informal settlements: Effect on exclusive breastfeeding practices. PLoS One 2018; 13:e0195619. [PMID: 29621355 PMCID: PMC5886586 DOI: 10.1371/journal.pone.0195619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/25/2018] [Indexed: 12/03/2022] Open
Abstract
Background In urban Maharashtra, India, approximately half of mothers exclusively breastfeed. For children residing in informal settlements of Mumbai, this study examines factors associated with exclusive breastfeeding, and whether exclusive breastfeeding, in a community-based nutrition program to prevent and treat wasting among children under age three, is associated with enrolment during the mother’s pregnancy. Methods The nutrition program conducted a cross-sectional endline survey (October-December 2015) of caregivers in intervention areas. Factors associated with exclusive breastfeeding for infants under six months of age were explored using multi-level logistic regressions. Additionally, program surveillance data collected during home-based counselling visits documented breastfeeding practices for children under six months of age. Using the surveillance data (January 2014-March 2016), exclusive breastfeeding status was regressed adjusting for child, maternal and socioeconomic characteristics, and whether the child was enrolled in the program in utero or after birth. Results The community-based endline survey included 888 mothers of infants. Mothers who received the nutrition program home visits or attended group counselling sessions were more likely to exclusively breastfeed (adjusted odds ratio 1.67, 95% CI 1.16, 2.41). Having a normal weight-for-height z-score (adjusted odds ratio 1.57, 95% CI 1.00, 2.45) was associated positively with exclusive breastfeeding. As expected, being an older infant aged three to five months (adjusted odds ratio 0.34, 95% CI 0.25, 0.48) and receiving a prelacteal feed after birth (adjusted odds ratio 0.57, 95% CI 0.41, 0.80) were associated with lower odds of exclusively breastfeeding. Surveillance data (N = 3420) indicate that infants enrolled in utero have significantly higher odds of being exclusively breastfed (adjusted odds ratio 1.55, 95% CI 1.30, 1.84) than infants enrolled after birth. Conclusions Prenatal enrolment in community-based programs working on child nutrition in urban informal settlements of India can improve exclusive breastfeeding practices.
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Affiliation(s)
- Sheila Chanani
- Society for Nutrition, Education and Health Action, Mumbai, India
- * E-mail:
| | | | - Neena Shah More
- Society for Nutrition, Education and Health Action, Mumbai, India
| | | | - Armida Fernandez
- Society for Nutrition, Education and Health Action, Mumbai, India
| | - Anuja Jayaraman
- Society for Nutrition, Education and Health Action, Mumbai, India
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Alexandre-Gouabau MC, Moyon T, Cariou V, Antignac JP, Qannari EM, Croyal M, Soumah M, Guitton Y, David-Sochard A, Billard H, Legrand A, Boscher C, Darmaun D, Rozé JC, Boquien CY. Breast Milk Lipidome Is Associated with Early Growth Trajectory in Preterm Infants. Nutrients 2018; 10:E164. [PMID: 29385065 PMCID: PMC5852740 DOI: 10.3390/nu10020164] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/30/2022] Open
Abstract
Human milk is recommended for feeding preterm infants. The current pilot study aims to determine whether breast-milk lipidome had any impact on the early growth-pattern of preterm infants fed their own mother's milk. A prospective-monocentric-observational birth-cohort was established, enrolling 138 preterm infants, who received their own mother's breast-milk throughout hospital stay. All infants were ranked according to the change in weight Z-score between birth and hospital discharge. Then, we selected infants who experienced "slower" (n = 15, -1.54 ± 0.42 Z-score) or "faster" (n = 11, -0.48 ± 0.19 Z-score) growth; as expected, although groups did not differ regarding gestational age, birth weight Z-score was lower in the "faster-growth" group (0.56 ± 0.72 vs. -1.59 ± 0.96). Liquid chromatography-mass spectrometry lipidomic signatures combined with multivariate analyses made it possible to identify breast-milk lipid species that allowed clear-cut discrimination between groups. Validation of the selected biomarkers was performed using multidimensional statistical, false-discovery-rate and ROC (Receiver Operating Characteristic) tools. Breast-milk associated with faster growth contained more medium-chain saturated fatty acid and sphingomyelin, dihomo-γ-linolenic acid (DGLA)-containing phosphethanolamine, and less oleic acid-containing triglyceride and DGLA-oxylipin. The ability of such biomarkers to predict early-growth was validated in presence of confounding clinical factors but remains to be ascertained in larger cohort studies.
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Affiliation(s)
- Marie-Cécile Alexandre-Gouabau
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Thomas Moyon
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Véronique Cariou
- Statistique, Sensométrie et Chimiométrie (StatSC), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Institut National de la Recherche Agronomique (INRA), 44322 Nantes, France.
| | - Jean-Philippe Antignac
- L'Université Nantes Angers Le Mans (LUNAM Université), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, 44200 Nantes, France.
| | - El Mostafa Qannari
- Statistique, Sensométrie et Chimiométrie (StatSC), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Institut National de la Recherche Agronomique (INRA), 44322 Nantes, France.
| | - Mikaël Croyal
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Mohamed Soumah
- Statistique, Sensométrie et Chimiométrie (StatSC), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Institut National de la Recherche Agronomique (INRA), 44322 Nantes, France.
| | - Yann Guitton
- L'Université Nantes Angers Le Mans (LUNAM Université), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, 44200 Nantes, France.
| | - Agnès David-Sochard
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Hélène Billard
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Arnaud Legrand
- Faculté de Médicine de Nantes, Centre Hospitalo-Universitaire Hôtel-Dieu (CHU), 44093 Nantes, France.
| | - Cécile Boscher
- Faculté de Médicine de Nantes, Centre Hospitalo-Universitaire Hôtel-Dieu (CHU), 44093 Nantes, France.
| | - Dominique Darmaun
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
- Faculté de Médicine de Nantes, Centre Hospitalo-Universitaire Hôtel-Dieu (CHU), 44093 Nantes, France.
| | - Jean-Christophe Rozé
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
- Faculté de Médicine de Nantes, Centre Hospitalo-Universitaire Hôtel-Dieu (CHU), 44093 Nantes, France.
| | - Clair-Yves Boquien
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
- European Milk Bank Association (EMBA), 20126 Milan, Italy.
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Kumwenda C, Hemsworth J, Phuka J, Ashorn U, Arimond M, Maleta K, Prado EL, Haskell MJ, Dewey KG, Ashorn P. Association between breast milk intake at 9-10 months of age and growth and development among Malawian young children. MATERNAL AND CHILD NUTRITION 2018; 14:e12582. [PMID: 29349922 DOI: 10.1111/mcn.12582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 10/30/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022]
Abstract
World Health Organization recommends exclusive breastfeeding for infants for the first 6 months of life, followed by introduction of nutritious complementary foods alongside breastfeeding. Breast milk remains a significant source of nourishment in the second half of infancy and beyond; however, it is not clear whether more breast milk is always better. The present study was designed to determine the association between amount of breast milk intake at 9-10 months of age and infant growth and development by 12-18 months of age. The study was nested in a randomized controlled trial conducted in Malawi. Regression analysis was used to determine associations between breast milk intake and growth and development. Mean (SD) breast milk intake at 9-10 months of age was 752 (244) g/day. Mean (SD) length-for-age z-score at 12 months and change in length-for-age z-score between 12 and 18 months were -1.69 (1.0) and -0.17 (0.6), respectively. At 18 months, mean (SD) expressive vocabulary score was 32 (24) words and median (interquartile range) skills successfully performed for fine, gross, and overall motor skills were 21 (19-22), 18 (16-19), and 38 (26-40), respectively. Breast milk intake (g/day) was not associated with either growth or development. Proportion of total energy intake from breast milk was negatively associated with fine motor (β = -0.18, p = .015) but not other developmental scores in models adjusted for potential confounders. Among Malawian infants, neither breast milk intake nor percent of total energy intake from breast milk at 9-10 months was positively associated with subsequent growth between 12 and 18 months, or development at 18 months.
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Affiliation(s)
- Chiza Kumwenda
- Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.,Department of Nutrition and Health, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.,School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Jaimie Hemsworth
- Department of Population Health, Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
| | - John Phuka
- School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Ulla Ashorn
- Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Mary Arimond
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Elizabeth L Prado
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | - Marjorie J Haskell
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | - Per Ashorn
- Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.,Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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Prudhon C, Benelli P, Maclaine A, Harrigan P, Frize J. Informing infant and young child feeding programming in humanitarian emergencies: An evidence map of reviews including low and middle income countries. MATERNAL & CHILD NUTRITION 2018; 14:e12457. [PMID: 28670790 PMCID: PMC6865874 DOI: 10.1111/mcn.12457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 03/07/2017] [Accepted: 03/19/2017] [Indexed: 01/08/2023]
Abstract
Around 200 million people were affected by conflict and natural disasters in 2015. Whereas those populations are at a particular high risk of death, optimal breastfeeding and complementary feeding practices could prevent almost 20% of deaths amongst children less than 5 years old. Yet, coverage of interventions for improving infant and young child feeding (IYCF) practices in emergencies is low, partly due to lack of evidence. Considering the paucity of data generated in emergencies to inform programming, we conducted an evidence map from reviews that included low- and middle-income countries and looked at several interventions: (a) social and behavioural change interpersonal and mass communication for promoting breastfeeding and adequate complementary feeding; (b) provision of donated complementary food; (c) home-based fortification with multiple micronutrient powder; (d) capacity building; (e) cash transfers; (f) agricultural or fresh food supply interventions; and (g) psychological support to caretakers. We looked for availability of evidence of these interventions to improve IYCF practices and nutritional status of infants and young children. We identified 1,376 records and included 28 reviews meeting the inclusion criteria. The highest number of reviews identified was for behavioural change interpersonal communication for promoting breastfeeding, whereas no review was identified for psychological support to caretakers. We conclude that any further research should focus on the mechanisms and delivery models through which effectiveness of interventions can be achieved and on the influence of contextual factors. Efforts should be renewed to generate evidence of effectiveness of IYCF interventions during humanitarian emergencies despite the challenges.
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61
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Pecoraro L, Agostoni C, Pepaj O, Pietrobelli A. Behind human milk and breastfeeding: not only food. Int J Food Sci Nutr 2017; 69:641-646. [DOI: 10.1080/09637486.2017.1416459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Luca Pecoraro
- Pediatric Unit, Verona University Medical School, Verona, Italy
| | - Carlo Agostoni
- Intermediate Pediatric Care Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Orsiol Pepaj
- Pediatric Unit, Verona University Medical School, Verona, Italy
| | - Angelo Pietrobelli
- Pediatric Unit, Verona University Medical School, Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Cheng ER, Taveras EM, Hawkins SS. Paternal Acculturation and Maternal Health Behaviors: Influence of Father's Ethnicity and Place of Birth. J Womens Health (Larchmt) 2017; 27:724-732. [PMID: 29087779 DOI: 10.1089/jwh.2017.6439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Studies show disparities in maternal health behaviors according to acculturation, but whether paternal factors influence these patterns is unknown. We assessed the relationships between fathers' ethnicity and place of birth with maternal smoking during pregnancy and breastfeeding initiation overall and for 30 major ethnic groups. MATERIALS AND METHODS Data were from the Standard Certificate of Live Births on 1,053,096 births in Massachusetts between 1996 through 2010. We examined the concordance of maternal and paternal ethnicity and place of birth across three categories (United States-born white, United States-born Other ethnicity, and foreign-born), and then in relation to maternal smoking during pregnancy and breastfeeding initiation. Multivariable models adjusted for maternal age, marital status, education, plurality, parity, prenatal care, delivery source of payment, and year of birth. RESULTS United States-born white mothers were less likely to smoke during pregnancy (adjusted odds ratio [AOR] 0.66; 95% confidence interval [CI]: 0.60, 0.73) and more likely to initiate breastfeeding (AOR 1.56; 95% CI: 1.46, 1.66) if their partners were foreign-born. In contrast, foreign-born mothers whose partners were United States-born of Other ethnicity or United States-born white had a 1.65-5.12 higher odds of smoking during pregnancy and were 26%-41% less likely (AORs 0.59-0.74) to initiate breastfeeding than if their partners were also foreign-born. Results were consistent across most racial/ethnic groups. CONCLUSIONS Our findings offer new insight into the social pathways by which acculturation impacts maternal health behaviors and add to growing evidence that fathers are valuable to maternal health. Future efforts to understand how acculturation results in poorer maternal health behaviors should account for paternal influences.
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Affiliation(s)
- Erika R Cheng
- 1 Section of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine , Indianapolis, Indiana
| | - Elsie M Taveras
- 2 Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children , Boston, Massachusetts.,3 Department of Nutrition, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
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63
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Himes KP, Donovan H, Wang S, Weaver C, Grove JR, Facco FL. Healthy Beyond Pregnancy, a Web-Based Intervention to Improve Adherence to Postpartum Care: Randomized Controlled Feasibility Trial. JMIR Hum Factors 2017; 4:e26. [PMID: 29017990 PMCID: PMC5654734 DOI: 10.2196/humanfactors.7964] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/10/2017] [Accepted: 08/28/2017] [Indexed: 12/26/2022] Open
Abstract
Background During the postpartum visit, health care providers address issues with short- and long-term implications for maternal and child health. Women with Medicaid insurance are less likely to return for a postpartum visit compared with women with private insurance. Behavioral economics acknowledges that people do not make exclusively rational choices, rather immediate gratification, cognitive and psychological biases, and social norms influence decision making. Drawing on insights from decision science, behavioral economists have examined how these biases can be modulated through carefully designed interventions. We have developed a Web-based tool, Healthy Beyond Pregnancy, that incorporates empirically derived concepts of behavioral economics to improve adherence rates to the postpartum visit. Objectives The primary objectives of this pilot study were to (1) refine and assess the usability of Healthy Beyond Pregnancy and (2) assess the feasibility of a randomized controlled trial (RCT) of the intervention. Methods We used a multistep process and multidisciplinary team of maternal-fetal medicine physicians, a behavioral economist, and researchers with expertise in behavioral interventions to design Healthy Beyond Pregnancy. We assessed the usability of the program with the Post-Study System Usability Questionnaire (PSSUQ), a validated 7-point scale, and semistructured interviews with postpartum women. We then conducted a feasibility trial to determine the proportion of eligible women who were willing to participate in an RCT of Healthy Beyond Pregnancy and the proportion of women willing to complete the Web-based program. Exploratory outcomes of the pilot trial included attendance at the postpartum visit, uptake of long-acting reversible contraception, and uptake of any contraception. Results The median PSSUQ score for Healthy Beyond Pregnancy was 6.5 (interquartile range: 6.1-7) demonstrating high usability. Semistructured interviews (n=10) provided in-depth comments about users’ experience and further improved the program. A total of 34 postpartum women with Medicaid insurance were approached for the pilot trial, and 30 (88%) were consented and randomized. All women randomized to Healthy Beyond Pregnancy completed the Web-based program, had text-enabled cell phones, and were willing to receive text messages from the study team. Women in the Healthy Beyond Pregnancy arm were more likely to return for a postpartum visit compared with women in the control arm with 85% of women in Healthy Beyond Pregnancy returning versus 53% in the control arm (odds ratio in the Healthy Beyond Pregnancy group: 5.3; 95% CI 0.9-32.0; P=.06). Conclusions We have developed a highly usable and acceptable Web-based program designed to increase attendance at the postpartum visit. Our pilot trial demonstrates that women are willing and able to participate in a randomized trial of a Web-based program and text messaging system. Trial Registration Clinicaltrials.gov NCT03296774; https://clinicaltrials.gov/ct2/show/NCT03296774 (Archived by WebCite at http://www.webcitation.org/6tpgXFzyk)
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Affiliation(s)
- Katherine Park Himes
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Heidi Donovan
- School of Nursing, Health and Community Systems, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephanie Wang
- Department of Economics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Carrie Weaver
- University of Pittsburgh Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA, United States
| | - Jillian Rae Grove
- University of Pittsburgh Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA, United States
| | - Francesca Lucia Facco
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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64
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Nair N, Tripathy P, Sachdev HS, Pradhan H, Bhattacharyya S, Gope R, Gagrai S, Rath S, Rath S, Sinha R, Roy SS, Shewale S, Singh V, Srivastava A, Costello A, Copas A, Skordis-Worrall J, Haghparast-Bidgoli H, Saville N, Prost A. Effect of participatory women's groups and counselling through home visits on children's linear growth in rural eastern India (CARING trial): a cluster-randomised controlled trial. Lancet Glob Health 2017; 5:e1004-e1016. [PMID: 28911749 PMCID: PMC5640793 DOI: 10.1016/s2214-109x(17)30339-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/14/2017] [Accepted: 08/09/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Around 30% of the world's stunted children live in India. The Government of India has proposed a new cadre of community-based workers to improve nutrition in 200 districts. We aimed to find out the effect of such a worker carrying out home visits and participatory group meetings on children's linear growth. METHODS We did a cluster-randomised controlled trial in two adjoining districts of Jharkhand and Odisha, India. 120 clusters (around 1000 people each) were randomly allocated to intervention or control using a lottery. Randomisation took place in July, 2013, and was stratified by district and number of hamlets per cluster (0, 1-2, or ≥3), resulting in six strata. In each intervention cluster, a worker carried out one home visit in the third trimester of pregnancy, monthly visits to children younger than 2 years to support feeding, hygiene, care, and stimulation, as well as monthly women's group meetings to promote individual and community action for nutrition. Participants were pregnant women identified and recruited in the study clusters and their children. We excluded stillbirths and neonatal deaths, infants whose mothers died, those with congenital abnormalities, multiple births, and mother and infant pairs who migrated out of the study area permanently during the trial period. Data collectors visited each woman in pregnancy, within 72 h of her baby's birth, and at 3, 6, 9, 12, and 18 months after birth. The primary outcome was children's length-for-age Z score at 18 months of age. Analyses were by intention to treat. Due to the nature of the intervention, participants and the intervention team were not masked to allocation. Data collectors and the data manager were masked to allocation. The trial is registered as ISCRTN (51505201) and with the Clinical Trials Registry of India (number 2014/06/004664). RESULTS Between Oct 1, 2013, and Dec 31, 2015, we recruited 5781 pregnant women. 3001 infants were born to pregnant women recruited between Oct 1, 2013, and Feb 10, 2015, and were therefore eligible for follow-up (1460 assigned to intervention; 1541 assigned to control). Three groups of children could not be included in the final analysis: 147 migrated out of the study area (67 in intervention clusters; 80 in control clusters), 77 died after the neonatal period and before 18 months (31 in intervention clusters; 46 in control clusters), and seven had implausible length-for-age Z scores (<-5 SD; one in intervention cluster; six in control clusters). We measured 1253 (92%) of 1362 eligible children at 18 months in intervention clusters, and 1308 (92%) of 1415 eligible children in control clusters. Mean length-for-age Z score at 18 months was -2·31 (SD 1·12) in intervention clusters and -2·40 (SD 1·10) in control clusters (adjusted difference 0·107, 95% CI -0·011 to 0·226, p=0·08). The intervention did not significantly affect exclusive breastfeeding, timely introduction of complementary foods, morbidity, appropriate home care or care-seeking during childhood illnesses. In intervention clusters, more pregnant women and children attained minimum dietary diversity (adjusted odds ratio [aOR] for women 1·39, 95% CI 1·03-1·90; for children 1·47, 1·07-2·02), more mothers washed their hands before feeding children (5·23, 2·61-10·5), fewer children were underweight at 18 months (0·81, 0·66-0·99), and fewer infants died (0·63, 0·39-1·00). INTERPRETATION Introduction of a new worker in areas with a high burden of undernutrition in rural eastern India did not significantly increase children's length. However, certain secondary outcomes such as self-reported dietary diversity and handwashing, as well as infant survival were improved. The interventions tested in this trial can be further optimised for use at scale, but substantial improvements in growth will require investment in nutrition-sensitive interventions, including clean water, sanitation, family planning, girls' education, and social safety nets. FUNDING UK Medical Research Council, Wellcome Trust, UK Department for International Development (DFID).
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Affiliation(s)
| | | | - H S Sachdev
- Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | | | | | | | | | | | | | | | | | | | | | | | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | | | - Naomi Saville
- Institute for Global Health, University College London, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK.
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65
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Nutrition (Micronutrients) in Child Growth and Development: A Systematic Review on Current Evidence, Recommendations and Opportunities for Further Research. J Dev Behav Pediatr 2017; 38:665-679. [PMID: 28746059 DOI: 10.1097/dbp.0000000000000482] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE An important aspect of malnutrition is deficiency of different micronutrients during pregnancy or early childhood. We systematically reviewed the role of nutrition in child growth (weight or height gain) and development. METHODS A comprehensive literature search was done on PubMed/Cochrane Library browsing through 38,795 abstracts until December 31, 2016 to select systematic reviews/meta-analyses and individual randomized controlled trials (RCTs) of micronutrient supplementation. RESULTS Micronutrients studied included iron, iodine, folate, zinc, calcium, magnesium, selenium, vitamin D, vitamin A, vitamin B complex, and multiple micronutrients. We summarize evidence with details and results of RCTs, highlight strengths/weaknesses, and critically interpret findings. Effects of breastfeeding-promotion, food-supplementation (complementary and school feeding), conditional-cash-transfers, and integrated nutrition/psychosocial interventions are discussed. CONCLUSION Based on this evidence we make policy and programmatic recommendations for supplementation to mothers and children at high-risk of deficiency.
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66
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Sinha B, Taneja S, Chowdhury R, Mazumder S, Rongsen-Chandola T, Upadhyay RP, Martines J, Bhandari N, Bhan MK. Low-birthweight infants born to short-stature mothers are at additional risk of stunting and poor growth velocity: Evidence from secondary data analyses. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28840655 PMCID: PMC5763338 DOI: 10.1111/mcn.12504] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/05/2017] [Accepted: 07/12/2017] [Indexed: 01/20/2023]
Abstract
Low‐birthweight (LBW) infants are at an increased risk of stunting and poor linear growth. The risk might be additionally higher in these infants when born to short mothers. However, this hypothesis has been less explored. The objective of this secondary data analysis was to determine the risk of linear growth faltering and difference in linear growth velocity in LBW infants born to short mothers (<150 cm) compared to those born to mothers with height ≥150 cm during the first year of life. This analysis uses data from a community‐based randomized controlled trial of 2,052 hospital‐born term infants with birthweight ≤2,500g from urban low–middle socioeconomic neighbourhoods in Delhi, India. Data on maternal height and infant birth length were available from 1,858 (90.5%) of the infants. Infant anthropometry outcomes were measured at birth, 3, 6, 9, and 12 months of age. We found that infants born to short mothers had around twofold higher odds of stunting and lower attained length‐for‐age Z scores compared to infants of mothers with height ≥150 cm, at all ages of assessment. Linear growth velocity was significantly lower in infants of short mothers particularly in the first 6 months of life. We conclude that LBW infants born to short mothers are at a higher risk of stunting and have slower postnatal growth velocity resulting in lower attained length‐for‐age Z scores in infancy. Evidence‐based strategies need to be tested to optimize growth velocity in LBW infants especially those born to short mothers.
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Affiliation(s)
- Bireshwar Sinha
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Ravi Prakash Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Jose Martines
- Independent Consultant, 181, Rue Du Parc Jean Monnet 01630, St Genis Pouilly, France
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Maharaj Kishan Bhan
- Indian Institute of Technology, New Delhi, India.,Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC), New Delhi, India
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67
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Affiliation(s)
- S. M. Robinson
- MRC Lifecourse Epidemiology Unit; University of Southampton; Southampton UK
- NIHR Southampton Biomedical Research Centre; Southampton UK
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68
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Betoko A, Lioret S, Heude B, Hankard R, Carles S, Forhan A, Regnault N, Botton J, Charles MA, de Lauzon-Guillain B. Influence of infant feeding patterns over the first year of life on growth from birth to 5 years. Pediatr Obes 2017; 12 Suppl 1:94-101. [PMID: 28299906 DOI: 10.1111/ijpo.12213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/25/2016] [Accepted: 01/05/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES As early-life feeding experiences may influence later health, we aimed to examine relations between feeding patterns over the first year of life and child's growth in the first 5 years of life. METHODS Our analysis included 1022 children from the EDEN mother-child cohort. Three feeding patterns were previously identified, i.e. 'Later dairy products introduction and use of ready-prepared baby foods' (pattern-1), 'Long breastfeeding, later main meal food introduction and use of home-made foods' (pattern-2) and 'Use of ready-prepared adult foods' (pattern-3). Associations between the feeding patterns and growth [weight, height and body mass index {BMI}] were analysed by multivariable linear regressions. Anthropometric changes were assessed by the final value adjusted for the initial value. RESULTS Even though infant feeding patterns were not related to anthropometric measurements at 1, 3 and 5 years, high scores on pattern-1 were associated with higher 1-3 years weight and height changes. High scores on pattern-2 were related to lower 0-1 year weight and height changes, higher 1-5 years weight and height changes but not to BMI changes, after controlling for a wide range of potential confounding variables including parental BMI. Scores on pattern-3 were not significantly related to growth. Additional adjustment for breastfeeding duration reduced the strength of the associations between pattern-2 and growth but not those between pattern-1 and height growth. CONCLUSION Our findings emphasize the relevance of considering infant feeding patterns including breastfeeding duration, age of complementary foods introduction as well as type of foods used when examining effects of early infant feeding practices on later health. © 2017 World Obesity Federation.
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Affiliation(s)
- A Betoko
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France.,Paris Descartes University, Paris, France
| | - S Lioret
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France.,Paris Descartes University, Paris, France
| | - B Heude
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France.,Paris Descartes University, Paris, France
| | - R Hankard
- Inserm, UMR 1069, Tours, France.,CHU Tours, Tours, France.,Université François Rabelais, Tours, France
| | - S Carles
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France.,Paris Descartes University, Paris, France
| | - A Forhan
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France.,Paris Descartes University, Paris, France
| | - N Regnault
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France.,Paris Descartes University, Paris, France
| | - J Botton
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France.,Université Paris Sud, Faculty of Pharmacy, Châtenay-Malabry, France
| | - M A Charles
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France.,Paris Descartes University, Paris, France
| | - B de Lauzon-Guillain
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France.,Paris Descartes University, Paris, France
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69
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Hvatum I, Glavin K. Mothers’ experience of not breastfeeding in a breastfeeding culture. J Clin Nurs 2017; 26:3144-3155. [DOI: 10.1111/jocn.13663] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
| | - Kari Glavin
- Department of Nursing; Diakonova University College; Oslo Norway
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70
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Abstract
The prevalence of stunting remains high in low- and middle-income countries despite adoption of comprehensive nutrition interventions, particularly in low-income countries. In the present paper, we review current evidence on the acceptability and efficacy of small-quantity lipid-based nutrient supplements (SQ-LNS) on preventing stunting in children under 2 years, discuss the factors that affect their efficacy, highlight the implications of the current findings at pragmatic level and identify research priorities. Although the present paper is not a generic systematic review, we used a systematic approach to select relevant literature. The review showed that there is growing interest in the potential benefits of using SQ-LNS to prevent growth faltering. Acceptability studies showed that SQ-LNS are generally well accepted. However, results on the efficacy of SQ-LNS on improving linear growth or preventing growth faltering in infants and young children are still inconclusive. Factors that may affect efficacy include the duration of the trial, composition and dosage of SQ-LNS given, and baseline demographics and nutritional status of research participants. Future research should focus on controlled and long-term follow-up trials to obtain more conclusive results. In the long term, there will be need for studies to investigate how provision of SQ-LNS can be integrated with existing strategies to prevent stunting in low- and middle-income settings.
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71
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Norman M. Breastfeeding and outcome. Acta Paediatr 2017; 106:516. [PMID: 28102555 DOI: 10.1111/apa.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mikael Norman
- Department of Neonatal Medicine, Karolinska Institutet & University Hospital, Stockholm, Sweden
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72
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Eriksen KG, Johnson W, Sonko B, Prentice AM, Darboe MK, Moore SE. Following the World Health Organization's Recommendation of Exclusive Breastfeeding to 6 Months of Age Does Not Impact the Growth of Rural Gambian Infants. J Nutr 2017; 147:248-255. [PMID: 28003540 PMCID: PMC5265696 DOI: 10.3945/jn.116.241737] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/23/2016] [Accepted: 11/29/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The WHO recommends exclusive breastfeeding (EBF) for the first 6 mo of life. OBJECTIVE The objective of this study was to assess the benefit of EBF to age 6 mo on growth in a large sample of rural Gambian infants at high risk of undernutrition. METHODS Infants with growth monitoring from birth to 2 y of age (n = 756) from the ENID (Early Nutrition and Immune Development) trial were categorized as exclusively breastfed if only breast milk and no other liquids or foods were given. EBF status was entered into confounder-adjusted multilevel models to test associations with growth trajectories by using >11,000 weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) z score observations. RESULTS Thirty-two percent of infants were exclusively breastfed to age 6 mo. The mean age of discontinuation of EBF was 5.2 mo, and growth faltering started at ∼3.5 mo of age. Some evidence for a difference in WAZ and WHZ was found between infants who were exclusively breastfed to age 6 mo (EBF-6) and those who were not (nEBF-6), at 6 and 12 mo of age, with EBF-6 children having a higher mean z score. The differences in z scores between the 2 groups were small in magnitude (at 6 mo of age: 0.147 WAZ; 95% CI: -0.001, 0.293 WAZ; 0.189 WHZ; 95% CI: 0.038, 0.341 WHZ). No evidence for a difference between EBF-6 and nEBF-6 infants was observed for LAZ at any time point (6, 12, and 24 mo of age). Furthermore, a higher mean WLZ at 3 mo of age was associated with a subsequent higher mean age at discontinuation of EBF, which implied reverse causality in this setting (coefficient: 0.060; 95% CI: 0.008, 0.120). CONCLUSION This study suggests that EBF to age 6 mo has limited benefit to the growth of rural Gambian infants. This trial was registered at http://www.isrctn.com as ISRCTN49285450.
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Affiliation(s)
- Kamilla G Eriksen
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom;
| | - William Johnson
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | | | - Andrew M Prentice
- MRC Unit The Gambia, Banjul, The Gambia;,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | | | - Sophie E Moore
- MRC Unit The Gambia, Banjul, The Gambia;,Division of Women’s Health, King’s College London, London, United Kingdom
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73
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Aakre I, Lilleengen AM, Lerseth Aarsand M, Strand TA, Barikmo I, Henjum S. Infant feeding practices in the Saharawi refugee camps Algeria, a cross-sectional study among children from birth to six months of age. Int Breastfeed J 2017; 12:8. [PMID: 28149322 PMCID: PMC5273854 DOI: 10.1186/s13006-016-0098-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/26/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Appropriate breastfeeding and infant feeding practices are crucial to a child's growth and development. The objective of this paper is to describe breastfeeding and general feeding practices and the nutrition status among children from birth to 6 months of age, in the Saharawi refugee camps located in Algeria. METHODS A cross-sectional study was carried out among 111 lactating mothers with infants from birth to 6 months of age. Data regarding breastfeeding practices and a 24 h dietary recall for the infants were collected to assess the World Health Organization's (WHO) indicators for infant and young child feeding. For exclusive and predominant breastfeeding, age disaggregation for each month was applied to the data. Background characteristics from the mothers and infants were collected, together with anthropometrical measures. We explored predictors for breastfeeding and nutrition status in multiple regression models. RESULTS In total 13.8%, 8.2% and 16.5% of the infants were stunted, wasted and underweight, respectively. Approximately 65% initiated breastfeeding within 1 h after birth and 11.7 and 21.6% were exclusively or predominantly breastfed less than 6 months. The most commonly given solid foods were dates (27.0%) and bread (10.8%). In multiple regression models, initiation of breastfeeding within 1 h after birth gave increased probability of exclusive or predominant breastfeeding. Giving birth at home as opposed to in a hospital and increasing number of children gave increased probability of initiating breastfeeding early. Exclusive or predominant breastfeeding seemed to protect against underweight and wasting. CONCLUSIONS Exclusively or predominant breastfeeding was low among Saharawi refugee infants. Wasting and underweight was common and more likely to occur if the infants were not exclusively or predominantly breastfed. These findings support the current international breastfeeding recommendations, and suggest that there is an urgent need for promoting infant feeding practices in the Sahara refugee camps.
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Affiliation(s)
- Inger Aakre
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College, PB 4 St. Olavs plass, 0130 Oslo, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, PB 7804, N-5018 Bergen, Norway
| | - Anne Marie Lilleengen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College, PB 4 St. Olavs plass, 0130 Oslo, Norway
| | - Marie Lerseth Aarsand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College, PB 4 St. Olavs plass, 0130 Oslo, Norway
| | - Tor A. Strand
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, PB 7804, N-5018 Bergen, Norway
- Medical Microbiology, Department of Laboratory Medicine, Medical Services Division, Innlandet Hospital Trust, Anders Sandvigs gate 17, 2609 Lillehammer, Norway
| | - Ingrid Barikmo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College, PB 4 St. Olavs plass, 0130 Oslo, Norway
| | - Sigrun Henjum
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College, PB 4 St. Olavs plass, 0130 Oslo, Norway
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Early rapid weight gain and subsequent overweight and obesity in middle childhood in Peru. BMC OBESITY 2016; 3:55. [PMID: 27999679 PMCID: PMC5155392 DOI: 10.1186/s40608-016-0135-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 12/02/2016] [Indexed: 12/17/2022]
Abstract
Background Rapid postnatal weight gain is associated with risk of overweight and obesity, but it’s unclear whether this holds in populations exposed to concurrent obesogenic risk factors and for children who have been extensively breastfed. This study investigates whether an increase in weight for age from birth to 1 year (infancy) and from 1 to 5 years (early childhood) predicts overweight and obesity, and waist circumference at 8 years, using data from a longitudinal cohort study in Peru. Methods Generalized estimating equations (GEE) models were constructed for overweight and obesity, obesity alone and waist circumference at 8 years versus rapid weight gain in infancy, and early childhood including adjusted models to account for confounders. Results Rapid weight gain in both periods was associated with double the risk of overweight and obesity, obesity alone at 8 years and increased waist circumference even after controlling for maternal BMI and education level, sex of child, height-for-age at 8 years, consumption of “fast food” and number of days of active exercise. The association was significant, with some differences, for children in both rural and urban environments. Conclusions Rapid weight gain in infancy and in early childhood in Peru is associated with overweight and obesity at age 8 years even when considering other determinants of childhood obesity. Electronic supplementary material The online version of this article (doi:10.1186/s40608-016-0135-z) contains supplementary material, which is available to authorized users.
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Beake S, Bick D, Narracott C, Chang YS. Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27882659 DOI: 10.1111/mcn.12390] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/05/2016] [Accepted: 09/05/2016] [Indexed: 01/23/2023]
Abstract
Rates of breastfeeding uptake are lower after a caesarean birth than vaginal birth, despite caesarean rates increasing globally over the past 30 years, and many high-income countries reporting overall caesarean rates of above 25%. A number of factors are likely to be associated with women's infant feeding decisions following a caesarean birth such as limited postoperative mobility, postoperative pain, and ongoing management of medical complications that may have triggered the need for a caesarean birth. The aim of this systematic review was to evaluate evidence of interventions on the initiation and duration of any and exclusive breastfeeding among women who had a planned or unplanned caesarean birth. Seven studies, presenting quantitative and qualitative evidence, published in the English language from January 1994 to February 2016 were included. A limited number of interventions were identified relevant to women who had had a caesarean birth. These included immediate or early skin-to-skin contact, parent education, the provision of sidecar bassinets when rooming-in, and use of breast pumps. Only one study, an intervention that included parent education and targeted breastfeeding support, increased initiation and continuation of breastfeeding, but due to methodological limitations, findings should be considered with caution. There is a need to better understand the impact of caesarean birth on maternal physiological, psychological, and physical recovery, the physiology of lactation and breastfeeding and infant feeding behaviors if effective interventions are to be implemented.
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Affiliation(s)
- Sarah Beake
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Debra Bick
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Cath Narracott
- King's College Hospital NHS Foundation Trust, London, UK
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Christian P, Kim J, Mehra S, Shaikh S, Ali H, Shamim AA, Wu L, Klemm R, Labrique AB, West KP. Effects of prenatal multiple micronutrient supplementation on growth and cognition through 2 y of age in rural Bangladesh: the JiVitA-3 Trial. Am J Clin Nutr 2016; 104:1175-1182. [PMID: 27604769 DOI: 10.3945/ajcn.116.135178] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 08/04/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Childhood undernutrition may have prenatal origins, and the impact of prenatal interventions on postnatal growth is not well known. OBJECTIVE We assessed the effects of prenatal multiple micronutrient (MM) supplementation on child growth and cognitive development. DESIGN In a cluster-randomized controlled trial in rural Bangladesh, prenatal MM supplementation compared with iron-folic acid (IFA) supplementation was examined for its impact on growth assessed longitudinally from birth up to 24 mo of age (n = 8529) and, in a subsample (n = 734), on cognitive function at 24 mo of age by use of the Bayley scales of infant and toddler development-third edition test. RESULTS Prevalence of stunting at birth [length for age z score (LAZ): <-2] was 31.9% in the MM and 35.7% in the IFA groups (P < 0.001); however, LAZ increased during the first 3-4 mo in both groups. With the use of a linear random-effects model, prenatal MM-exposed children sustained a higher mean predicted LAZ of ∼0.10 at 1 and 3 mo and 0.06 at 6 mo of age compared with children in the IFA group. Supplementation reduced the prevalence of stunting at 1 (RR: 0.95; 95% CI: 0.92, 0.98) and 3 (RR: 0.91; 95% CI: 0.88, 0.94) mo of age. Differences between groups were absent by 6, 12, and 24 mo of age, when nearly 50% of children had stunted growth. Ponderal and linear growth velocities were somewhat slower from 3 to 12 mo of age in the MM group than in the IFA group, but not from 12 to 24 mo of age. There was no difference between groups on composite scores of cognition, language, and motor performance at 24 mo of age. CONCLUSIONS In this Bangladeshi trial, maternal pre- and postnatal MM supplementation resulted in improvements in LAZ and reduction in stunting through 3 mo of age, but not thereafter and had no impact on cognitive and motor function at 2 y. This trial was registered at clinicaltrials.gov as NCT000860470.
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Affiliation(s)
- Parul Christian
- Departments of International Health and Bill & Melinda Gates Foundation, Seattle, WA
| | - Jeongyong Kim
- Biostatistics, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | | | - Saijuddin Shaikh
- Departments of International Health and JiVitA Maternal and Child Health & Nutrition Research Project, Gaibandha, Bangladesh; and
| | - Hasmot Ali
- Departments of International Health and JiVitA Maternal and Child Health & Nutrition Research Project, Gaibandha, Bangladesh; and
| | - Abu Ahmed Shamim
- Departments of International Health and Biostatistics, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Lee Wu
- Departments of International Health and
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Abstract
OBJECTIVE To characterize the epidemiology of wasting and identify the main predictors of wasting, severe wasting and poor weight-for-height in children. DESIGN We analysed a nationally representative sample of 2028 children (Multiple Indicator Survey, 2010). SETTING Royal Kingdom of Bhutan. SUBJECTS Children aged 0-23 months. RESULTS Wasting prevalence was significantly higher among infants aged 0-11 months than among children aged 12-23 months (12·0 v. 6·7 %; P=0·004) and among boys than girls (11·0 v. 7·5 %; P=0·04). Children from the Western region had 63 % higher odds of being wasted than children from the Central/Eastern regions (adjusted OR (AOR)=1·63; 95 % CI 1·14, 2·34). Poor feeding practices were among the most significant predictors of wasting and severe wasting. Children who were given prelacteal feeds in the first days of life had 2·5 times higher odds of being severely wasted than those who were not (AOR=2·49; 95 % CI 1·19, 5·19); inadequate complementary feeding in children aged 0-23 months was associated with 58 % higher odds of being wasted (AOR=1·58; 95 % CI 1·02, 2·47) and 2·3 times higher odds of being severely wasted (AOR=2·28; 95 % CI 1·13, 4·58). The association of poor infant feeding practices with wasting and severe wasting was particularly significant in infants (0-11 months). CONCLUSIONS Programmes for the detection and treatment of severely wasted children need to prioritize very young children (0-11 months), particularly in the Western region. Programmes for the prevention of wasting need to prioritize the improvement of complementary foods and feeding practices in children aged 6-23 months.
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Caffarelli C, Santamaria F, Di Mauro D, Mastrorilli C, Mirra V, Bernasconi S. Progress in pediatrics in 2015: choices in allergy, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, nephrology, neurology, nutrition, oncology and pulmonology. Ital J Pediatr 2016; 42:75. [PMID: 27566421 PMCID: PMC5002164 DOI: 10.1186/s13052-016-0288-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/10/2016] [Indexed: 12/29/2022] Open
Abstract
This review focuses key advances in different pediatric fields that were published in Italian Journal of Pediatrics and in international journals in 2015. Weaning studies continue to show promise for preventing food allergy. New diagnostic tools are available for identifying the allergic origin of allergic-like symptoms. Advances have been reported in obesity, short stature and autoimmune endocrine disorders. New molecules are offered to reduce weight gain and insulin-resistance in obese children. Regional investigations may provide suggestions for preventing short stature. Epidemiological studies have evidenced the high incidence of Graves' disease and Hashimoto's thyroiditis in patients with Down syndrome. Documentation of novel risk factors for celiac disease are of use to develop strategies for prevention in the population at-risk. Diagnostic criteria for non-celiac gluten sensitivity have been reported. Negative effect on nervous system development of the supernumerary X chromosome in Klinefelter syndrome has emerged. Improvements have been made in understanding rare diseases such as Rubinstein-Taybi syndrome. Eltrombopag is an effective therapy for immune trombocytopenia. Children with sickle-cell anemia are at risk for nocturnal enuresis. Invasive diseases caused by Streptococcus pyogenes are still common despite of vaccination. No difference in frequency of antibiotic prescriptions for acute otitis media between before the publication of the national guideline and after has been found. The importance of timing of iron administration in low birth weight infants, the effect of probiotics for preventing necrotising enterocolitis and perspectives for managing jaundice and cholestasis in neonates have been highlighted. New strategies have been developed to reduce the risk for relapse in nephrotic syndrome including prednisolone during upper respiratory infection. Insights into the pathophysiology of cerebral palsy, arterial ischemic stroke and acute encephalitis may drive advances in treatment. Recommendations on breastfeeding and complementary feeding have been updated. Novel treatments for rhabdomyosarcoma should be considered for paediatric patients. Control of risk factors for bronchiolitis and administration of pavilizumab for preventing respiratory syncytial virus infection may reduce hospitalization. Identification of risk factors for hospitalization in children with wheezing can improve the management of this disease. Deletions or mutations in genes encoding proteins for surfactant function may cause diffuse lung disease.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Dora Di Mauro
- Clinica Pediatrica, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Carla Mastrorilli
- Clinica Pediatrica, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Virginia Mirra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Sergio Bernasconi
- Pediatrics Honorary Member University Faculty, G D’Annunzio University of Chieti-Pescara, Chieti, Italy
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Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387:475-90. [PMID: 26869575 DOI: 10.1016/s0140-6736(15)01024-7] [Citation(s) in RCA: 3713] [Impact Index Per Article: 464.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.
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Affiliation(s)
- Cesar G Victora
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), WHO, Geneva, Switzerland
| | - Aluísio J D Barros
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Giovanny V A França
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Susan Horton
- Department of Economics, University of Waterloo, ON, Canada
| | - Julia Krasevec
- Data and Analytics Section, Division of Data, Research, and Policy, UNICEF, New York, NY, USA
| | - Simon Murch
- University Hospital Coventry and Warwickshire, Coventry, UK
| | - Mari Jeeva Sankar
- WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neff Walker
- Institute for International Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nigel C Rollins
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), WHO, Geneva, Switzerland
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