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McDonald CM, Wessells KR, Stewart CP, Dewey KG, de Pee S, Rana R, Hafeez-Ur-Rehman H, Mwangi MN, Hess SY. Perinatal intervention strategies providing food with micronutrients to pregnant and breastfeeding women in low- and middle-income countries: A scoping review. MATERNAL & CHILD NUTRITION 2024:e13681. [PMID: 38949186 DOI: 10.1111/mcn.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/03/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
In resource-constrained settings, pregnant and breastfeeding women and girls (PBW/G) are particularly vulnerable to undernutrition. Micronutrient-fortified balanced energy protein (BEP) supplementation may be provided to boost maternal nutritional status and improve birth and infant outcomes. We conducted a scoping review of the published literature to determine the impact of BEP and other related nutrition interventions that provided fortified food or cash along with a minimum of 3 micronutrients on maternal, birth, and infant/child outcomes in low- and middle-income countries. We conducted a PubMed search using pre-defined keywords and controlled vocabulary search terms. All titles and abstracts were reviewed for eligibility by two independent reviewers, and data were extracted according to outcome type. We identified 149 eligible research articles that reported on a total of 21 trials and/or programme evaluations which assessed the health impact of one or more products (fortified lipid-based nutrient supplement [LNS, n = 12], fortified blended flours [n = 5], milk-based beverages [n = 2], and local food/snacks [n = 3]) that provided 118-750 kcal/day and varying levels of protein and micronutrients. Only one of these programme evaluations assessed the impact of the provision of cash and fortified food. Effects on maternal outcomes such as gestational weight gain and duration of gestation were promising but inconsistent. Birth outcomes were reported in 15 studies, and the effects on birthweight and birth length were generally positive. Seven studies demonstrated sustained benefits on infant and child growth out of the 15 studies that reported at least one of these outcomes, although data were sparse. Additional research is needed to investigate issues of dose, cost-effectiveness, and incorporation into multi-component interventions.
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Affiliation(s)
- Christine M McDonald
- Departments of Pediatrics, and Epidemiology & Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Saskia de Pee
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | - Ritu Rana
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | | | | | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
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Castro-Barquero S, Crovetto F, Estruch R, Ruiz-León AM, Larroya M, Sacanella E, Casanovas-Garriga F, Casas I, Nakaki A, Youssef L, Trejo-Domínguez A, Benitez L, Genero M, Vieta E, Gratacós E, Crispi F, Casas R. Validation of a pregnancy-adapted Mediterranean Diet Adherence Screener (preg-MEDAS): a validation study nested in the Improving Mothers for a better PrenAtal Care Trial BarCeloNa (IMPACT BCN) trial. Am J Clin Nutr 2024:S0002-9165(24)00519-7. [PMID: 38830408 DOI: 10.1016/j.ajcnut.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 05/04/2024] [Accepted: 05/30/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Non-time-consuming and easy-to-administer dietary assessment tools specific for pregnancy are needed. OBJECTIVES The aim of this validation study nested in the IMPACT BCN (Improving Mothers for a better PrenAtal Care Trial BarCeloNa) trial is to determine the concurrent validity of the 17-item pregnancy-adapted Mediterranean diet score (preg-MEDAS) and to analyze whether changes in the preg-MEDAS score were associated with maternal favorable dietary and cardiometabolic changes after 3 mo of intervention in pregnant women. METHODS Dietary data was collected in 812 participants using the preg-MEDAS and a 151-item validated food frequency questionnaire (FFQ) at baseline (19-23 wk gestation) and final visit (31-34 wk gestation). Concurrent preg-MEDAS validity was evaluated by Pearson and intraclass correlation coefficients, κ statistic, and Bland-Altman methods. RESULTS The preg-MEDAS had a good correlation with the FFQ (r = 0.76 and intraclass correlation coefficient 0.75). The agreement of each of the preg-MEDAS items ranged from 40.9% to 93.8% with a substantial agreement mean concordance (κ = 0.61). A 2-point increase in preg-MEDAS was associated with a decrease in maternal mean and systolic blood pressure (β: -0.51 mmHg; 95% confidence interval [CI]: -0.97, -0.04 mmHg and -0.87 mmHg; 95% CI: -1.48, -0.26 mmHg, respectively). CONCLUSIONS The preg-MEDAS displays good validity for assessing adherence to the Mediterranean diet, allowing detection of dietary changes over time. In addition, changes observed in preg-MEDAS are significantly associated with a decrease in maternal blood pressure. Therefore, we propose preg-MEDAS as a rapid and simple dietary assessment tool during pregnancy. This trial was registered at clinicaltrials.gov as NCT03166332.
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Affiliation(s)
- Sara Castro-Barquero
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain; Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain
| | - Francesca Crovetto
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin, RD21/0012/0001, Instituto de Salud Carlos III, Barcelona, Spain
| | - Ramon Estruch
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain; Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain; Department of Internal Medicine Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain.
| | - Ana María Ruiz-León
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain; Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain; Department of Internal Medicine Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Larroya
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Emilio Sacanella
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain; Department of Internal Medicine Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Casanovas-Garriga
- Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain; Department of Internal Medicine Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Irene Casas
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Ayako Nakaki
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Lina Youssef
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain; Josep Carreras Leukemia Research Institute, Hospital Clinic/University of Barcelona Campus, Barcelona, Spain
| | - Alejandra Trejo-Domínguez
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
| | - Leticia Benitez
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariona Genero
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Eduard Vieta
- Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain; Department of Psychiatry and Psychology, Hospital Clinic, Neuroscience Institute, University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Fàtima Crispi
- BCNatal | Barcelona Center for Maternal and Fetal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Rosa Casas
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain; Institut de Recerca en Nutrició i Seguretat Alimentaria (INSA-UB), University of Barcelona, Barcelona, Spain; Department of Internal Medicine Hospital Clinic, University of Barcelona, Barcelona, Spain; Institut de Recerca August Pi Sunyer (IDIBAPS), Barcelona, Spain.
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Zewude SB, Beshah MH, Ahunie MA, Arega DT, Addisu D. Undernutrition and associated factors among pregnant women in Ethiopia. A systematic review and meta-analysis. Front Nutr 2024; 11:1347851. [PMID: 38769991 PMCID: PMC11103006 DOI: 10.3389/fnut.2024.1347851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Background Maternal undernutrition is a major public health concern due to its association with mortality and overall disease burden for mothers and their children. Maternal nutrition determines pregnancy outcomes since reduced intake of nutrients influences gestational age length, placental function, and fetal growth during pregnancy. The complexity of the intergenerational aspects of maternal nutrition may also confound the design of interventions. Therefore, this research aimed to assess the prevalence of undernutrition and associated factors among pregnant women in Ethiopia. Methods We identified the literature from PubMed, EMBASE, Scopus, and CINAHL databases. Data were entered into Microsoft Excel and then exported to Stata version 17 statistical software for analysis. The I2 and Q-statistic values detect the level of heterogeneity, and meta regression was performed to investigate between-study heterogeneity using more than one moderator. JBI quality assessment tools were used to include relevant articles. Evidence of publication bias was indicated using the funnel plot and Egger's linear regression test. The effect size was expressed in the form of point estimates and an odds ratio of 95% CI in the fixed-effect model. Result In total, 19 studies fulfill the inclusion criteria. The pooled prevalence of undernutrition among pregnant women was 32% (95% CI 31.3-33.2 I2 = 97.5%, P < 0.0). Illiteracy (AOR = 3.6 95% CI; 2.3-5.6), rural residence (AOR = 2.6 95% CI; 1.2-3.5), a lack of prenatal dietary advice (AOR = 2.6 95% CI; 1.8-3.7), household food insecurity (AOR = 2.5 95% CI; 1.9-3.2), and low dietary diversity score (AOR = 3.7 95% CI; 2.2-5.9) appear to be significantly associated with undernutrition among pregnant women. Conclusion The review showed that the prevalence of undernutrition is still high among pregnant women. Illiteracy, rural residence, a lack of prenatal dietary advice, household food insecurity, and low dietary diversity score were significantly associated with undernutrition during pregnancy. Interventions should focus on educating the public and helping families access food or supplements they need through local markets, health systems, and community-based support, as undernutrition is caused by numerous interconnected causes. Systematic review registration https://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42023417028.
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Affiliation(s)
- Shimeles Biru Zewude
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mekonen Haile Beshah
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mengesha Assefa Ahunie
- Department of Social and Public Health, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dawit Tiruneh Arega
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dagne Addisu
- Department of Midwifery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Medise BE, Julia M, Devaera Y, Sitaresmi MN, Asmarinah, Widjaja NA, Kalalo RT, Soesanti F, Friska D, Sirait WR, Azzopardi P, Sawyer S. Understanding the pubertal, psychosocial, and cognitive developmental trajectories of stunted and non-stunted adolescents: protocol of a multi-site Indonesian cohort study. Front Pediatr 2024; 12:1296128. [PMID: 38690523 PMCID: PMC11059053 DOI: 10.3389/fped.2024.1296128] [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: 09/18/2023] [Accepted: 03/06/2024] [Indexed: 05/02/2024] Open
Abstract
Background The prevalence of stunting among Indonesian children aged 5-12 years decreased from 30.7% in 2013 to 23.6% in 2018 but has remained among the highest rates worldwide. Furthermore, Indonesian children were shorter than the standard reported by the World Health Organization and experienced obesity. The Indonesian government has created many programs to reduce stunting in children under the age of 5 years. An early preventive strategy is necessary because stunting can manifest within the initial 1,000 days of life, including during pregnancy. Therefore, a newer perspective, such as that achieved by addressing stunting in adolescents, has been deemed useful, given that adolescents are in their pubertal stage and are undergoing lifestyle changes. This cohort study was designed to measure these factors comprehensively in stunted and non-stunted children as they pass through adolescence. Methods For the prospective cohort, 560 individuals will be recruited from DKI Jakarta, DI Yogyakarta, and East Java. The participants will be categorized into stunted and non-stunted groups, then undergo annual examinations in which key objectives, such as weight, height, and body mass index ,will be assessed for the growth profile; waist circumference, middle-upper arm circumference, hand-grip strength, body fat percentage, and food intake will be evaluated in a nutritional assessment; psychosocial and mental issues will be evaluated according to behavioral problems, symptoms of depression, quality of life, sleep patterns, anxiety disorders, and parenting style through the use of specific questionnaires; and pubertal stage will be assessed using a self-report questionnaire. Some cross-sectional data, such as cognitive performance, hair zinc levels, vitamin D levels, bone mineral density, and bone age, will also be included. All the outcomes will be analyzed in accordance with the variable types. Discussion This study provides a thorough dataset of Indonesian adolescents encompassing several elements, such as growth, nutrition, psychosocial wellbeing, mental health, and pubertal development, for both stunted and non-stunted individuals. The data acquired from this study can be used to formulate policies to prevent stunting through targeted interventions for adolescents. Finally, a better understanding of adolescent health could lead to improved strategies to decrease the number of stunted individuals in the next Indonesian generation.
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Affiliation(s)
- Bernie Endyarni Medise
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Madarina Julia
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Yoga Devaera
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mei Neni Sitaresmi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Asmarinah
- Department of Medical Biology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nur Aisiyah Widjaja
- Department of Child Health, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
| | - Royke Tony Kalalo
- Department of Psychiatry, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
| | - Frida Soesanti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dewi Friska
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Peter Azzopardi
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch's Children Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Susan Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch's Children Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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Ezeama NN, Okunna N, Ezeama CO. Multi-Level Correlates of the Nutritional Status of Nigerian Women of Reproductive Age. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 44:109-121. [PMID: 37724033 DOI: 10.1177/2752535x221126071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Poor nutrition compromises the capacity of women to perform their vital roles as mothers and productive workers in their families, communities and society. Using a conceptual framework developed by the United Nations Children's Fund, this study determines individual-, household- and community-level factors associated with the nutritional status of Nigerian women of reproductive age. A secondary analysis of pooled data from the Nigeria Demographic and Health Survey (NDHS) for 2003, 2008, 2013 and 2018 was conducted involving 82,734 non-pregnant women aged 15-49 years. Multinomial logistic regression was used to determine predictors of nutritional status. Study results show that a significant proportion of the women had poor nutritional status; the prevalence of underweight, overweight and obesity were 12.1%, 16.8% and 7.2% respectively. Statistically significant factors associated with poor nutritional status were found at all three levels, highlighting the need for effective multidimensional, multisectoral policy interventions to address the double burden of malnutrition among women in Nigeria.
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Affiliation(s)
- Nkiru N Ezeama
- Department of Community Medicine and Primary Health Care, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Nene Okunna
- Department of Health, West Chester University, West Chester, PA, USA
| | - Chukwuemeka O Ezeama
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
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Young MF, Faerber EC, Mehta RV, Ranjan S, Shetty SA, Ramakrishnan U, Rangiah K, Bose B, Devi S, Dwarkanath P, Kurpad AV, Taneja S, Martorell R. Maternal nutritional status and milk volume and composition in India: an observational study. Am J Clin Nutr 2023; 117:830-837. [PMID: 36773786 DOI: 10.1016/j.ajcnut.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Human milk provides essential nutrition for infants, and its benefits are well established. We lack data on the influence of maternal nutritional status on milk volume and composition in low-middle income countries. OBJECTIVE We aimed to 1) assess lactation performance (human milk volume, macronutrient composition, and infant energy intake) in Indian females and 2) examine the associations between maternal anthropometry (BMI, percentage body fat) and lactation performance. METHODS We conducted an observational study among 232 mother-infant dyads, 2 to 4 mo postpartum in Haryana, India. We used deuterium oxide dose-to-mother technique to measure milk volume and maternal percentage body fat and collected human milk samples to determine macronutrient and energy concentrations. Adjusted multiple linear regression models were used to examine the associations between maternal anthropometry and lactation performance. RESULTS The mean BMI and percentage body fat of mothers were 21.7 ± 3.6 kg/m2 and 29.5 ± 7.7, respectively. Milk volume and macronutrient composition were similar to the reference values (means ± standard deviations: milk volume, 724 ± 184 mL/d; median (25th, 75th percentile); protein, 9.9 (8.3, 11.7) g/L; fat, 41.0 ± 15.2 g/L; energy density, 0.71 ± 0.14 kcal/g; lactose, 65.5 (55.3, 71.3) g/L). Maternal BMI and percentage body fat were not significantly associated with macronutrient composition. Both maternal BMI and percentage body fat were negatively associated with milk volume (-7.0, 95% CI: -12.4, -1.6 mL/d; -3.5, 95% CI: -6.0, -1.1mL/d, respectively) but there were no effects on the total energy intake of infants after adjusting for covariates. CONCLUSION Most mothers had a normal BMI and milk of similar composition and volume to reference values. Future work in populations with a greater burden of underweight and/or obesity are needed to examine the underlying mechanisms between maternal body composition and milk volume. This trial was registered at The Clinical Trials Registry- India as CTRI/2017/01/007636.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, United States
| | - Emily C Faerber
- Hubert Department of Global Health, Emory University, Atlanta, United States
| | - Rukshan V Mehta
- Hubert Department of Global Health, Emory University, Atlanta, United States; Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Samriddhi Ranjan
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sweekruthi A Shetty
- Food Safety and Analytical Quality Control Laboratory, CSIR-CFTRI, Karnataka, India
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, United States
| | - Kannan Rangiah
- Food Safety and Analytical Quality Control Laboratory, CSIR-CFTRI, Karnataka, India; Institute of Bioinformatics, Bangalore, India and Manipal Academy of Higher Education, Manipal
| | - Beena Bose
- Division of Nutrition, St. John's Research Institute, Bangalore, Karnataka, India
| | - Sarita Devi
- Department of Physiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Pratibha Dwarkanath
- Division of Nutrition, St. John's Research Institute, Bangalore, Karnataka, India
| | - Anura V Kurpad
- Department of Physiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
| | - Reynaldo Martorell
- Hubert Department of Global Health, Emory University, Atlanta, United States
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Mesfin BA, Argaw AT, Getahun Negash F, Emiru DA, Aserese AD, Matebe GY. Minimum Dietary Diversity and Associated Factors Among Pregnant Women Living in Arba Minch Health and Demographic Surveillance Sites, Southern Ethiopia, 2022. Health Serv Res Manag Epidemiol 2023; 10:23333928231166671. [PMID: 37122558 PMCID: PMC10134103 DOI: 10.1177/23333928231166671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 05/02/2023] Open
Abstract
Background Worldwide 1.2 billion women suffer from micronutrient deficiency. Feeding diversified foods during pregnancy prevents pregnancy complications such as severe anemia, low birth weight, and birth defects. However, the status of minimum dietary diversity and associated factors among pregnant women were not explored in the study area; therefore, this study was conducted at the Arba Minch Health and Demographic Surveillance Sites (AMHDSS). Method A community-based cross-sectional study was conducted from December 19, 2021, to October 30, 2022, on randomly selected 635 pregnant women. The data were collected through face-to-face interviews, and measurements of mid-upper arm circumference using a tablet; then exported to Statistical Package for Social Sciences version 25. Descriptive statistics were used to describe the characteristics of the study participants and presented by text, figures, and tables. Binary logistic regression was used to determine factors associated with pregnant women MDD-W. Independent variables with a P-value < .05 were considered as associated factors. Findings 98.2% of the pregnant women responded to this survey, more than half, (53.3%) of them achieved MDD-W, and 24.2% of the pregnant women were undernourished. The MDD-W was associated with household food security (AOR = 0.55, CI: .36, .83), meal frequency, (AOR = 1.62, CI: 1.1, 2.5), house ownership (AOR = 0.52, CI: .29, .9), ownership of banana farms (AOR = 1.7, CI: 1.02, 2.8), antenatal follow-up (ANC) (AOR = 1.9, CI: 1.1, 3.3), and occupational status (AOR = 6, CI: 2.1, 17.6). Conclusion The MDD-W outcome in this study was higher than that in other studies. The MDD-W is associated with, ANC follow-up, meal frequency, living in a food-secured household, ownership of a house, and pregnant women's merchant occupation. For optimal pregnancy outcomes; the AMHDSS and stakeholders might need to work in collaboration to increase ANC coverage and meal frequency for pregnant women. In addition, micronutrient supplementation, and increasing the availability/production capacity of food-insecure households are expected.
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Affiliation(s)
- Bezawit Afework Mesfin
- Department of Midwifery, Arba Minch University College of Medicine and Health Sciences, Arba Minch, Ethiopia
- Bezawit Afework Mesfin, Department of Midwifery, Arba Minch University College of Medicine and Health Sciences, Arba Minch, P.O. Box 21, Ethiopia.
| | - Abinet Teshome Argaw
- Department of Biomedical Sciences, Arba Minch University College of Medicine and Health Sciences, Arba Minch, Ethiopia
| | - Firdawek Getahun Negash
- Department of Epidemiology, Arba Minch University College of Medicine and Health Sciences School of Public Health, Arba Minch, Ethiopia
| | - Dagninet Alelign Emiru
- Department of Medical Laboratory Science, Arba Minch University College of Medicine and Health Sciences, Arba Minch, Ethiopia
| | - Adisalem Damtei Aserese
- School of Public Health Department of Human Nutrition, Arba Minch University College of Medicine and Health Sciences School of Public Health, Arba Minch, Ethiopia
| | - Girum Yihun Matebe
- Department of Health Economics, Addis Ababa University College of Health Sciences, School of Public Health, Arba Minch, Ethiopia
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Tramontt CR, Jesus JGLD, Santos TSS, Rauber F, Louzada MLDC, Couto VDC, Hochberg JRB, Jaime PC. Development and Validation of a Protocol for Pregnant Women Based on the Brazilian Dietary Guidelines. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1021-1031. [PMID: 36580947 PMCID: PMC9886497 DOI: 10.1055/s-0042-1756213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To develop and validate a protocol for the use of the Dietary Guidelines for the Brazilian Population (DGBP) in the individual dietary advice for pregnant women assisted in primary healthcare (PHC). METHODS Methodological study that involved the elaboration of a protocol in six steps: definition of the format, definition of the instrument to evaluate food consumption, systematization of evidence on food and nutrition needs of pregnant women, extraction of DGBP recommendations, development of messages of dietary guidelines and content, and face validity. The analyses of the validation steps were carried out by calculating the Content Validity Index (CVI) and thematic content analysis. RESULTS As products of the steps, the protocol structure was defined and the dietary advice for pregnant women were elaborated, considering physiological changes, food consumption, nutritional and health needs, and socioeconomic conditions of this population. The protocol was well evaluated by experts and health professionals in terms of clarity, relevance (CVI > 0.8), and applicability. In addition, the participants made some suggestions to improve the clarity of the messages and to expand the applicability of the instrument with Brazilian pregnant women. CONCLUSION The instrument developed fills a gap in clinical protocols on dietary advice for pregnant women focused on promoting a healthy diet, contributing to a healthy pregnancy. In addition, it demonstrates potential to contribute to the qualification of PHC professionals and to the implementation of the DGBP recommendations.
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Affiliation(s)
- Cláudia Raulino Tramontt
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde da Universidade de São Paulo, São Paulo, SP, Brazil,Address for correspondence Cláudia Raulino Tramontt, PhD Dr. Arnaldo715, São Paulo, SP, 01246-904Brazil
| | | | - Thanise Sabrina Souza Santos
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde da Universidade de São Paulo, São Paulo, SP, Brazil,Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Fernanda Rauber
- Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | - Vanessa Del Castillo Couto
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Patrícia Constante Jaime
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde da Universidade de São Paulo, São Paulo, SP, Brazil
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9
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Marume A, Archary M, Mahomed S. Dietary patterns and childhood stunting in Zimbabwe. BMC Nutr 2022; 8:111. [PMID: 36224638 PMCID: PMC9555084 DOI: 10.1186/s40795-022-00607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 09/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background Diet is one important predictor of children’s growth, and often dietary interventions can assist with reversing adverse nutrition outcomes. Traditionally research has focused on individual food items or food classes to generate an understanding of disease risk. Dietary patterns provide a holistic approach to understanding the relationship between exposure and outcome. Method A matched case-control study was conducted. Caregivers of 450 children (225 cases, 225 controls) aged 6–59 months were asked to describe the diet their children had consumed in the previous 7 days using a Food Frequency Questionnaire. Dietary patterns were developed using factor analysis and regression analysis was conducted to assess which dietary pattern was associated with childhood stunting. Results Three dietary patterns were identified: modern (n = 181), low animal-source (n = 158), and traditional (n = 111). Children with the low animal source dietary pattern had increased odds of being stunted (AOR 1.03, p < 0.05). Three demographic factors (Child’s age, father’s age and having a sibling < 24 months apart) were identified as significant predictors of consumption of any of the traditional and low animal source diet (P < 0.001). Conclusion Nutrition intervention such as health education, counselling and supplementary feeding should include a holistic approach to dietary education not only focusing on promoting a balanced diet but improvement strengthening the upgrading of child’s dietary pattern taking into cognisant both quantity, and quality of nutrients provided to the child. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00607-7.
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Affiliation(s)
- Anesu Marume
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Ministry of Health and Child Care, Harare, Zimbabwe
| | - Moherndran Archary
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,King Edward VIII Hospital, Durban, South Africa
| | - Saajida Mahomed
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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10
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Rahman M, Tariqujjaman M, Islam MR, Sheikh SP, Sultana N, Ahmed T, Ahmed S, Sarma H. Socioeconomic Inequalities in Women's Undernutrition: Evidence from Nationally Representative Cross-Sectional Bangladesh Demographic and Health Survey 2017-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084698. [PMID: 35457563 PMCID: PMC9031436 DOI: 10.3390/ijerph19084698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/30/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
The objective of this study was to explore the socioeconomic inequalities in undernutrition among ever-married women of reproductive age. We used nationally representative cross-sectional data from the Bangladesh Demographic and Health Survey, 2017−2018. Undernutrition was defined as a body mass index (BMI) of <18.5 kg/m2. The concentration index (C) was used to measure the socioeconomic inequality in the prevalence of women’s undernutrition. A multiple binary logistic regression model was carried out to find out the factors associated with women’s undernutrition. The prevalence of undernutrition among women of 15−49 years was 12%. Among them, 8.5% of women were from urban and 12.7% of women were from rural areas. The prevalence of undernutrition was highest (21.9%) among women who belonged to the adolescent age group (15−19 years). The C showed that undernutrition was more prevalent among the socioeconomically worst-off (poorest) group in Bangladesh (C = −0.26). An adjusted multiple logistic regression model indicated that women less than 19 years of age had higher odds (adjusted odds ratio, AOR: 2.81; 95% confidence interval, CI: 2.23, 3.55) of being undernourished. Women from the poorest wealth quintile (AOR: 3.93, 95% CI: 3.21, 4.81) had higher odds of being undernourished. On the other hand, women who had completed secondary or higher education (AOR: 0.55; 95% CI: 0.49, 0.61), married women who were living with their husbands (AOR: 0.72, 95% CI: 0.61, 0.86), and women exposed to mass media (AOR: 0.87, 95% CI: 0.79, 0.97) were less likely to be undernourished. Intervention strategies should be developed targeting the poorest to combat undernutrition in women of reproductive age in Bangladesh.
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Affiliation(s)
- Mahfuzur Rahman
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh; (M.R.); (N.S.); (T.A.)
| | - Md. Tariqujjaman
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh; (M.R.); (N.S.); (T.A.)
- Correspondence:
| | - Md. Rayhanul Islam
- Health Systems and Population Studies Division, icddr,b, Dhaka 1212, Bangladesh; (M.R.I.); (S.P.S.)
| | - Sifat Parveen Sheikh
- Health Systems and Population Studies Division, icddr,b, Dhaka 1212, Bangladesh; (M.R.I.); (S.P.S.)
- Centre for Injury Prevention and Research, Dhaka 1212, Bangladesh
| | - Nadia Sultana
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh; (M.R.); (N.S.); (T.A.)
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh; (M.R.); (N.S.); (T.A.)
| | - Sayem Ahmed
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow G1 28RZ, UK;
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Haribondhu Sarma
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia;
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11
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Saleh A, Syahrul S, Hadju V, Andriani I, Restika I. Role of Maternal in Preventing Stunting: a Systematic Review. GACETA SANITARIA 2021; 35 Suppl 2:S576-S582. [PMID: 34929905 DOI: 10.1016/j.gaceta.2021.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Currently, stunting is seen as a serious public health problem. Although its prevalence has decreased, the stunting rate is a large number of cases in the world. METHODS A literature search was conducted on electronic databases such as ProQuest, PubMed, ScienceDirect, and Google Scholar to identify relevant published articles from January 1, 2010, to July 1, 2020. Additional articles were identified from the reference lists and grey literature. RESULT Three main phases require the optimal mother roles to prevent stunting in children during the golden phase. These phases include the preconception phase, the prenatal phase, and the infant-toddlerhood phase. Various mother roles include fulfilling maternal, fetal, infant, and child nutrition, carrying out early breastfeeding initiation, exclusive breastfeeding, and appropriate complementary feeding, optimizing the environment for child development, optimizing family support, and avoiding various psychosocial factors that can be detrimental during growth, and child development. CONCLUSION The mother roles in the golden phase are crucial to preventing stunting in children. Although the conception period does not have a fetus, early strengthening of maternal nutrition must be done so that the mother's body is ready to undergo the prenatal phase for fetal development, which then continues in the infant phase - toddlerhood to adolescence.
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Affiliation(s)
- Ariyanti Saleh
- Faculty of Nursing, Hasanuddin University, Makassar, 90245, Indonesia.
| | - Syahrul Syahrul
- Faculty of Nursing, Hasanuddin University, Makassar, 90245, Indonesia
| | - Veni Hadju
- Faculty of Public Health, Hasanuddin University, Makassar, 90245, Indonesia
| | - Irma Andriani
- Faculty of Mathematics and Natural Sciences, Hasanuddin University, Makassar, 90245, Indonesia
| | - Indah Restika
- Faculty of Nursing, Hasanuddin University, Makassar, 90245, Indonesia
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12
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Dearden KA, Bishwakarma R, Crookston BT, Masau BT, Mulokozi GI. Health facility-based counselling and community outreach are associated with maternal dietary practices in a cross-sectional study from Tanzania. BMC Nutr 2021; 7:45. [PMID: 34412681 PMCID: PMC8377836 DOI: 10.1186/s40795-021-00447-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022] Open
Abstract
Background Anemia and underweight among women are major public health challenges. Access to health services can improve dietary behaviors and women’s nutritional status. We examined whether exposure to health services is associated with women’s dietary practices in Tanzania. Methods Data come from a cross-sectional baseline survey among 5000 female primary caregivers who were randomly selected via two-stage sampling, prior to implementing a maternal and child nutrition program. We ran frequencies on women’s exposure to existing health facility-based counselling, community health worker visits, and attendance at women’s support groups. We examined associations between exposure to these interventions and maternal diets and adjusted for sociodemographic covariates using ordinary least squares regression and ordered logistic regression. Results A third of the sample (34.1%) had received any antenatal care (ANC) during their most recent pregnancy or had been advised by anyone about nutrition (37.0%). 68.0% had never had a community health worker (CHW) speak to them about their children’s health and 9.4% had participated in a women’s group. Only 8.0% of mothers ate more than usual during pregnancy and 7.1% ate more types of foods. After adjusting for mother’s age, education and household assets, women who received nutrition advice were 1.3 times (95% CI: 1.1, 1.7) more likely than mothers who did not to eat more during pregnancy. Receiving antenatal care (ANC) and advice on nutrition before, during, and after pregnancy and delivery were highly associated with the mother eating more types of foods. Hearing from a CHW about children’s health but not support group attendance was often associated with various dietary practices. Almost all measures of access to health services were significantly associated with mothers’ frequency of eating in the previous 24 h. Receiving advice on nutrition during pregnancy and after giving birth and CHW contact were associated with mothers’ dietary diversity in the previous 24 h. Conclusions Several program exposure variables—especially being counselled about nutrition—were associated with improved dietary practices. Improving service delivery at scale may contribute to improved dietary behaviors in larger populations, given the associations we describe, along with findings from the existing literature.
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Affiliation(s)
- Kirk A Dearden
- IMA World Health/Corus International, Washington DC, USA.
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13
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A scoping review of research on policies to address child undernutrition in the Millennium Development Goals era. Public Health Nutr 2021; 24:4346-4357. [PMID: 33926609 DOI: 10.1017/s1368980021001890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The breadth of research on the impact of nutrition-specific policies to address child undernutrition is not well documented. This review maps the evidence base and identifies gaps on such policies. DESIGN We systematically searched Medline, Embase, PAIS Index for public policy, Scopus and Web of Science databases to identify eligible studies. Key study characteristics, including research design, type of policy, time span of policy before impact assessment, child age at outcome assessment and types of outcomes assessed, were abstracted in duplicate. SETTING Low-, middle- and high-income countries. PARTICIPANTS Studies were eligible for inclusion if they aimed to assess the impact of population-level nutrition-specific policies on undernutrition among children under 10 years of age. RESULTS Of the 5646 abstracts screened, eighty-three studies were included. A range of policies to address child undernutrition were evaluated; the majority were related to micronutrient fortification. Most studies were observational, reported on mandatory regional or sub-national polices, were conducted in high-income countries and evaluated policies within 1 year of implementation. A narrow set of health outcomes were evaluated, most commonly iodine deficiency disorders and neural tube defects. CONCLUSIONS Nutrition policies were commonly associated with improved child nutritional status and health. However, this evidence is primarily based on limited settings and on a limited number of outcomes. Further research is needed to assess the longer-term impact of a broader range of nutrition policies on child health, particularly in low- and middle-income countries.
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14
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Kinshella MLW, Omar S, Scherbinsky K, Vidler M, Magee LA, von Dadelszen P, Moore SE, Elango R. Effects of Maternal Nutritional Supplements and Dietary Interventions on Placental Complications: An Umbrella Review, Meta-Analysis and Evidence Map. Nutrients 2021; 13:472. [PMID: 33573262 PMCID: PMC7912620 DOI: 10.3390/nu13020472] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/26/2021] [Indexed: 01/08/2023] Open
Abstract
The placenta is a vital, multi-functional organ that acts as an interface between maternal and fetal circulation during pregnancy. Nutritional deficiencies during pregnancy alter placental development and function, leading to adverse pregnancy outcomes, such as pre-eclampsia, infants with small for gestational age and low birthweight, preterm birth, stillbirths and maternal mortality. Maternal nutritional supplementation may help to mitigate the risks, but the evidence base is difficult to navigate. The primary purpose of this umbrella review is to map the evidence on the effects of maternal nutritional supplements and dietary interventions on pregnancy outcomes related to placental disorders and maternal mortality. A systematic search was performed on seven electronic databases, the PROSPERO register and references lists of identified papers. The results were screened in a three-stage process based on title, abstract and full-text by two independent reviewers. Randomized controlled trial meta-analyses on the efficacy of maternal nutritional supplements or dietary interventions were included. There were 91 meta-analyses included, covering 23 types of supplements and three types of dietary interventions. We found evidence that supports supplementary vitamin D and/or calcium, omega-3, multiple micronutrients, lipid-based nutrients, and balanced protein energy in reducing the risks of adverse maternal and fetal health outcomes. However, these findings are limited by poor quality of evidence. Nutrient combinations show promise and support a paradigm shift to maternal dietary balance, rather than single micronutrient deficiencies, to improve maternal and fetal health. The review is registered at PROSPERO (CRD42020160887).
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Affiliation(s)
- Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
| | - Shazmeen Omar
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
| | - Kerri Scherbinsky
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
| | - Laura A. Magee
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
- Department of Women & Children’s Health, King’s College London, London WC2R 2LS, UK;
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
- Department of Women & Children’s Health, King’s College London, London WC2R 2LS, UK;
| | - Sophie E. Moore
- Department of Women & Children’s Health, King’s College London, London WC2R 2LS, UK;
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, P.O. Box 273 Banjul, The Gambia
| | - Rajavel Elango
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Division of Neonatology, BC Women’s Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada
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15
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Kinshella MLW, Moore SE, Elango R. Beyond Reproduction: The "First 1,000 Days" Approach to Nutrition through a Gendered Rights-Based Lens. Health Hum Rights 2020; 22:113-123. [PMID: 33390701 PMCID: PMC7762907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The First 1,000 Days approach highlights the importance of adequate nutrition in early life-from conception to a child's second birthday-for good development and growth throughout the child's life and potentially onto their own offspring. The approach has been highly influential in mobilizing policy attention and resources to improve maternal and infant nutrition in global health and development. This paper undertakes a critical review of this approach from a gendered human rights lens, finding that the theoretical underpinnings implicitly reflect and reproduce gender biases by conceptualizing women within a limited scope of reproduction and child care. We explore the processes of systemic neglect through Pierre Bourdieu's theories on how social structures are reproduced. Understanding theory is important to the governance of global health, how we frame priorities, and how we act on them. Revisiting influential theories is a means of accountability to ensure inclusiveness and to reduce gender and health inequities in research. We argue that a greater focus on women could increase the potential impact of nutrition interventions.
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Affiliation(s)
- Mai-Lei Woo Kinshella
- PhD student at the Department of Obstetrics and Gynecology, BC Children’s and Women’s Hospital and University of British Columbia, and Global Health Research Coordinator at the University of British Columbia’s PRE-EMPT, Vancouver, Canada
| | - Sophie E. Moore
- Reader in Global Women and Children’s Health at King’s College London and an Honorary Senior Research Fellow at the MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, UK
| | - Rajavel Elango
- Associate Professor at the School of Population and Public Health, Department of Pediatrics, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
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16
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Offspring Birth Weight Is Associated with Specific Preconception Maternal Food Group Intake: Data from a Linked Population-Based Birth Cohort. Nutrients 2020; 12:nu12103172. [PMID: 33081304 PMCID: PMC7602981 DOI: 10.3390/nu12103172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022] Open
Abstract
The preconception period has been recognized as one of the earliest sensitive windows for human development. Maternal dietary intake during this period may influence the oocyte quality, as well as placenta and early embryonic development during the first trimester of pregnancy. Previous studies have found associations between macronutrient intake during preconception and pregnancy outcomes. However, as food products consist of multiple macro- and micronutrients, it is difficult to relate this to dietary intake behavior. Therefore, the aim of this study was to investigate the association between intake of specific food groups during the preconception period with birth weight, using data from the Perined-Lifelines linked birth cohort. The Perined-Lifelines birth cohort consists of women who delivered a live-born infant at term after being enrolled in a large population-based cohort study (The Lifelines Cohort). Information on birth outcome was obtained by linkage to the Dutch perinatal registry (Perined). In total, we included 1698 women with data available on birth weight of the offspring and reliable detailed information on dietary intake using a semi-quantitative food frequency questionnaire obtained before pregnancy. Based on the 2015 Dutch Dietary Guidelines and recent literature 22 food groups were formulated. Birth weight was converted into gestational age-adjusted z-scores. Multivariable linear regression was performed, adjusted for intake of other food groups and covariates (maternal BMI, maternal age, smoking, alcohol, education level, urbanization level, parity, sex of newborn, ethnicity). Linear regression analysis, adjusted for covariates and intake of energy (in kcal) (adjusted z score [95% CI], P) showed that intake of food groups “artificially sweetened products” and “vegetables” was associated with increased birth weight (resp. (β = 0.001 [95% CI 0.000 to 0.001, p = 0.002]), (β = 0.002 [95% CI 0.000 to 0.003, p = 0.03])). Intake of food group “eggs” was associated with decreased birth weight (β = −0.093 [95% CI −0.174 to −0.013, p = 0.02]). Intake in food groups was expressed in 10 g per 1000 kcal to be able to draw conclusions on clinical relevance given the bigger portion size of the food groups. In particular, preconception intake of “artificially sweetened products” was shown to be associated with increased birth weight. Artificial sweeteners were introduced into our diets with the intention to reduce caloric intake and normalize blood glucose levels, without compromising on the preference for sweet food products. Our findings highlight the need to better understand how artificial sweeteners may affect the metabolism of the mother and her offspring already from preconception onwards.
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Abstract
The First 1,000 Days approach highlights the time between conception and a child’s second birthday as a critical period where adequate nutrition is essential for adequate development and growth throughout the child’s life and potentially onto their own offspring. Based on a review of relevant literature, this commentary explores the First 1,000 Days approach with a maternal lens. While the primary objective of the First 1,000 Days approach to nutrition is to reduce child malnutrition rates, particularly chronic undernutrition in the form of stunting, interventions are facilitated through mothers in terms of promoting healthy behaviours such as exclusive breast-feeding and attention to her nutritional status during pregnancy and lactation. Though these interventions were facilitated through women, women’s health indicators are rarely tracked and measured, which we argue represents a missed opportunity to strengthen the evidence base for associations between maternal nutrition and women’s health outcomes. Limited evidence on the effects of dietary interventions with pregnant and lactating mothers on women’s health outcomes hinders advocacy efforts, which then contributes to lower prioritisation and less research.
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18
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Grammatikopoulou MG, Theodoridis X, Gkiouras K, Lampropoulou M, Petalidou A, Patelida M, Tsirou E, Papoutsakis C, Goulis DG. Methodological quality of clinical practice guidelines for nutrition and weight gain during pregnancy: a systematic review. Nutr Rev 2020; 78:546-562. [PMID: 31755916 DOI: 10.1093/nutrit/nuz065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Ensuring a healthy pregnancy and achieving optimal gestational weight gain (GWG) are important for maternal and child health. Nevertheless, the nutritional advice provided during pregnancy is often conflicting, suggesting limited adherence to clinical practice guidelines (CPGs). OBJECTIVE The aim of this review was to identify all CPGs on maternal nutrition and GWG and to critically appraise their methodological quality. DATA SOURCES The MEDLINE/PubMed, Cochrane, Guidelines International Network, and BMJ Best Practice databases, along with gray literature, were searched from inception until February 2019 for CPGs and consensus, position, and practice papers. STUDY SELECTION Clinical practice guidelines published in English and containing advice on maternal nutrition or GWG were eligible. DATA EXTRACTION Two authors independently extracted data on items pertaining to maternal nutrition or GWG, and CPGs were appraised using the AGREE II instrument. RESULTS Twenty-two CPGs were included. All scored adequately in the "scope" domain, but most were considered inadequate with regard to stakeholder involvement, rigor of development, applicability, and editorial independence. Many CPGs lacked patient or dietician involvement, and more than half did not disclose funding sources or conflicts of interest. Guidance on GWG was based mostly on Institute of Medicine thresholds, while nutrition recommendations appeared scattered and heterogeneous. CONCLUSION Despite the importance of maternal nutrition and the plethora of advising bodies publishing relevant guidance, there is room for substantial improvement in terms of development standards and content of nutritional recommendations. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019120898.
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Affiliation(s)
- Maria G Grammatikopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xenophon Theodoridis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Lampropoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Fourth Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Arianna Petalidou
- Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Patelida
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Efrosini Tsirou
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ravaoarisoa L, Razafimahatratra MJJ, Rakotondratsara MA, Pourette D, Rakotonirina J, Rakotomanga JDDM. Appréciation des interventions de lutte contre la malnutrition maternelle par la population à Madagascar. SANTE PUBLIQUE 2020; Vol. 32:113-122. [PMID: 32706221 DOI: 10.3917/spub.201.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Madagascar has adopted strategies to fight against maternal malnutrition, but the evaluation of their implementation is not effective.Purpose of research: The present study aims to describe beneficiary appreciation of interventions to fight maternal malnutrition and to identify their expectations. METHOD A qualitative study was conducted in the Amoron’i Mania region, Madagascar. The study included mothers of children under 5, pregnant women, and other family members and community members (fathers, grandmothers, matrons and community workers). Six focus groups and 16 individual interviews were conducted to collect the data. The thematic analysis was used. RESULTS Food supplementation, improved production of agriculture and livestock, and nutrition education, operated by NGOs, are the best-known interventions. The health centers were not mentioned as interveners and their interventions were ignored. The effectiveness of the intervention is generally judged on the benefits perceived by the beneficiaries. Interveners working on a project basis were assessed as unsustainable. Two main problems were mentioned: first, the insufficiency of agricultural production resulting in the inaccessibility of the ingredients required for the nutrition education, and second the low coverage of the interventions. The improvement of agricultural production is the main suggestion mentioned to fight against maternal undernutrition. CONCLUSIONS Beneficiaries thought that existing interventions in the region are insufficient to address the problem of malnutrition among mothers.
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Charles Shapu R, Ismail S, Ahmad N, Ying LP, Abubakar Njodi I. Knowledge, Attitude, and Practice of Adolescent Girls towards Reducing Malnutrition in Maiduguri Metropolitan Council, Borno State, Nigeria: Cross-Sectional Study. Nutrients 2020; 12:E1681. [PMID: 32512907 PMCID: PMC7353014 DOI: 10.3390/nu12061681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 12/31/2022] Open
Abstract
Addressing the gap in knowledge, attitude, and practice among adolescent girls are important as malnutrition has a negative effect on their future generation. This study aimed to determine the knowledge, attitude, and practice of adolescent girls towards reducing malnutrition in Maiduguri Metropolitan Council, Borno State, Nigeria. This was a school-based cross-sectional study conducted among 612 adolescent girls (10 to 19 years old). KoBo collect toolbox was used for the data collection between 3 June and 31 July 2019. Multivariable logistic regression was used to identify predictors of knowledge, attitude, and practice towards reducing malnutrition. The majority of respondents (451, 80.2%; 322, 57.3%) had poor knowledge and attitude towards reducing malnutrition respectively, 278 (49.5%) had poor practice towards reducing malnutrition. Schooling (GGSS; p = 0.022; Shehu Garbai; p = 0.003) was a significant predictor of knowledge. Religion (p = 0.023), information (p < 0.001) and motivation (p < 0.001) were significant predictors of attitude. School (GGSS; p < 0.001; GGC; p < 0.001; Shehu garbai; p < 0.001; Bulabulin; p = 0.030; Zajeri day; p = 0.049), education of father (p = 0.001), information (p = 0.026) and behavioral skill (p = 0.019) were significant predictors of practice. There is a need to focus on both school-based and community-based health education intervention to address the poor knowledge, attitude, and practice among adolescent girls for a healthier future.
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Affiliation(s)
- Ruth Charles Shapu
- Department of Community Health, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang 43400, Selangor, Malaysia; (R.C.S.); (N.A.); (L.P.Y.)
- College of Nursing and Midwifery, Damboa Road, Maiduguri 600252, Borno State, Nigeria
| | - Suriani Ismail
- Department of Community Health, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang 43400, Selangor, Malaysia; (R.C.S.); (N.A.); (L.P.Y.)
| | - Norliza Ahmad
- Department of Community Health, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang 43400, Selangor, Malaysia; (R.C.S.); (N.A.); (L.P.Y.)
| | - Lim Poh Ying
- Department of Community Health, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang 43400, Selangor, Malaysia; (R.C.S.); (N.A.); (L.P.Y.)
| | - Ibrahim Abubakar Njodi
- Department of Physical and Health Education, University of Maiduguri, Maiduguri 600230, Borno State, Nigeria;
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Djossinou DRA, Savy M, Fanou‐Fogny N, Landais E, Accrombessi M, Briand V, Yovo E, Hounhouigan DJ, Gartner A, Martin‐Prevel Y. Changes in women's dietary diversity before and during pregnancy in Southern Benin. MATERNAL & CHILD NUTRITION 2020; 16:e12906. [PMID: 31833230 PMCID: PMC7083447 DOI: 10.1111/mcn.12906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/12/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
Dietary diversity before and during pregnancy is crucial to ensure optimal foetal health and development. We carried out a cohort study of women of reproductive age living in the Sô-Ava and Abomey-Calavi districts (Southern Benin) to investigate women's changes in dietary diversity and identify their determinants both before and during pregnancy. Nonpregnant women were enrolled (n = 1214) and followed up monthly until they became pregnant (n = 316), then every 3 months during pregnancy. One 24-hr dietary recall was administered before conception and during each trimester of pregnancy. Women's dietary diversity scores (WDDS) were computed, defined as the number of food groups out of a list of 10 consumed by the women during the past 24 hr. The analysis included 234 women who had complete data. Mixed-effects linear regression models were used to examine changes in the WDDS over the entire follow-up, while controlling for the season, subdistrict, socio-demographic, and economic factors. At preconception, the mean WDDS was low (4.3 ± 1.1 food groups), and the diet was mainly composed of cereals, oils, vegetables, and fish. The mean WDDS did not change during pregnancy and was equally low at all trimesters. Parity and household wealth index were positively associated with the WDDS before and during pregnancy in the multivariate analysis. Additional research is needed to better understand perceptions of food consumption among populations, and more importantly, efforts must be made to encourage women and communities in Benin to improve the diversity of their diets before and during pregnancy.
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Affiliation(s)
- Diane R. A. Djossinou
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
| | - Mathilde Savy
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Nadia Fanou‐Fogny
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
| | - Edwige Landais
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Manfred Accrombessi
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
- UMR 216‐MERIT, Institut de Recherche pour le Développement (IRD)Université Paris DescartesParisFrance
| | - Valérie Briand
- UMR 216‐MERIT, Institut de Recherche pour le Développement (IRD)Université Paris DescartesParisFrance
| | - Emmanuel Yovo
- Faculté des Sciences Agronomiques de l'Université d'Abomey‐Calavi (FSA/UAC), Campus d'Abomey‐Calavi, CotonouBénin
| | - D. Joseph Hounhouigan
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Agnès Gartner
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
| | - Yves Martin‐Prevel
- Nutripass, Institut de Recherche pour le Développement (IRD)Université de MontpellierMontpellierFrance
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Laporte ASDCM, Zangirolani LTO, Medeiros MATD. Prenatal and puerperium nutritional care from an integrality perspective in a city of Baixada Santista, São Paulo, Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to perform a comparative assessment of the nutritional care process in the prenatal and puerperium periods at a primary care unit in the city of Santos, SP, Brazil before and after the implantation of the Prenatal and Puerperium Nutritional Care Strategy. Methods: a cross-sectional study was composed of 58 pairs of women and their children, of whom, 30 underwent prenatal care before and 28 of them after the implantation by collecting data from perinatal registrations and children's charts. The care was evaluated by the official National guidelines. The chi-square test was used to compare variables between the pre and post intervention groups. Results: there was a significant improvement after the nutritional intervention, regarding to height (p=0.001), registration on pre-pregnancy weight (p=0.032), follow up on Body Mass Index/gestational week (p=0.001), registration on newborn’s weight at discharge (p=0.011) and daily weight gain at the first pediatric consultation (p=0.019). Conclusions: the Prenatal and Puerperal Nutritional Care Strategy contributed to improve maternal-child nutritional care and the data registration on patients’ charts, demonstrating the necessity to establish processes/flows and an integral care for this population.
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Jones RE, Haardörfer R, Ramakrishnan U, Yount KM, Miedema SS, Roach TD, Girard AW. Intrinsic and instrumental agency associated with nutritional status of East African women. Soc Sci Med 2020; 247:112803. [PMID: 31978705 DOI: 10.1016/j.socscimed.2020.112803] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/05/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
Abstract
The 2030 Agenda for Sustainable Development prioritizes women's empowerment in Sustainable Development Goal (SDG) #5: to achieve gender equality and empowerment among all women and girls. Research on the relationships of women's empowerment and nutrition has focused on the child's nutrition. Less is known about how women's empowerment influences their own nutritional status. We examined the pathways by which three domains of women's empowerment (WE)-assets, intrinsic agency, and instrumental agency-may influence women's nutritional status (WNS) in East Africa. We used data from 42,721 married non-pregnant women, 15-49 years old interviewed in Demographic and Health Surveys (DHS) from five east Africa countries (2011-2016). WNS was operationalized through body mass index (BMI) and altitude-adjusted blood-hemoglobin level (Hb). A latent factor for women's human/social assets (assets) measured women's enabling resources. Two additional latent factors measured women's intrinsic agency (power within; women's non-justification of intimate partner violence (IPV) against wives) and instrumental agency (power to; influence in household decision-making). We used structural equation models with latent variables to estimate the strength of the hypothesized pathways from women's assets to WNS through measures of intrinsic and instrumental agency. All three domains of WE had direct, positive associations with women's BMI [(estimate (95% CI) (Assets: [0.17 (0.14,0.20)]; Intrinsic Agency: [0.25 (0.22,0.27)]; Instrumental Agency [0.08 (0.03,0.10)])]. Women's instrumental agency was positively associated with women's Hb [0.12 (0.09,0.14)]. Total associations, including direct and indirect effects, with women's BMI were positive through intrinsic agency & instrumental agency. Total associations with women's Hb were positive through instrumental agency. Direct and indirect effects from assets through both components of agency to BMI were higher in magnitude by household wealth category. Domains of WE were positively associated with WNS. Findings indicate that the process of women's empowerment may be an important driver of their nutritional status.
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Affiliation(s)
- Rebecca E Jones
- Nutrition and Health Sciences, Laney Graduate School, Emory University, USA.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University, USA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences, Laney Graduate School, Emory University, USA; Hubert Department of Global Health, Emory University, USA
| | - Kathryn M Yount
- Hubert Department of Global Health, Emory University, USA; Department of Sociology, Emory University, USA
| | | | - Timmie D Roach
- Hubert Department of Global Health, Emory University, USA
| | - Amy Webb Girard
- Nutrition and Health Sciences, Laney Graduate School, Emory University, USA; Hubert Department of Global Health, Emory University, USA
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24
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Jones R, Haardörfer R, Ramakrishnan U, Yount KM, Miedema S, Girard AW. Women's empowerment and child nutrition: The role of intrinsic agency. SSM Popul Health 2019; 9:100475. [PMID: 31993480 PMCID: PMC6978483 DOI: 10.1016/j.ssmph.2019.100475] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/08/2019] [Accepted: 08/22/2019] [Indexed: 11/29/2022] Open
Abstract
Women's empowerment is associated with improved child nutrition, and both underpin the achievement of multiple Sustainable Development Goals (SDGs). We examined pathways by which women's empowerment influences child nutritional status. We pooled nationally representative data from Demographic and Health Surveys (2011-2016) collected from married women with children aged 6-24 months in Ethiopia, Kenya, Rwanda, Tanzania, and Uganda (n = 13,780). We operationalized child nutritional status using anemia, height-for-age z-score (HAZ), and weight-for-age z-score (WHZ). We operationalized women's empowerment using a validated measure comprised of three latent domains: social/human assets ("assets"), intrinsic agency (attitudes about intimate partner violence), and instrumental agency (influence in household decision making). We used structural equation models with latent constructs to estimate hypothesized pathways from women's empowerment to child nutritional status with further mediation by maternal body mass index (BMI) and stratification by wealth. Women's empowerment domains were directly and positively associated with maternal BMI (estimate±SE: assets, 0.17 ± 0.03; intrinsic agency, 0.23 ± 0.03; instrumental agency, 0.03 ± 0.01). Maternal BMI was directly and positively associated with child HAZ (0.08 ± 0.04) and child WHZ (0.35 ± 0.03). Assets were indirectly associated with child HAZ and WHZ through intrinsic agency and maternal BMI. In the lowest wealth category, the direct effects from women's empowerment to child nutritional status were significant (assets and instrumental agency were associated with anemia; intrinsic agency associated with HAZ). In the highest wealth category, direct effects from women's empowerment on child nutritional status were significant (intrinsic and instrumental agency associated with WHZ). Improving women's empowerment, especially intrinsic agency, in East Africa could improve child nutrition directly and via improved maternal nutrition. These findings suggest that efforts to realize SDG 5 may have spillover effects on other SDGs. However, strategies to improve nutrition through empowerment approaches may need to also address household resource constraints.
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Affiliation(s)
- Rebecca Jones
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University, USA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, USA
- Hubert Department of Global Health, Emory University, USA
| | - Kathryn M. Yount
- Hubert Department of Global Health, Emory University, USA
- Department of Sociology, Emory University, USA
| | | | - Amy Webb Girard
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, USA
- Hubert Department of Global Health, Emory University, USA
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25
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Hashmi AH, Nyein PB, Pilaseng K, Paw MK, Darakamon MC, Min AM, Charunwatthana P, Nosten F, McGready R, Carrara VI. Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study. BMC Public Health 2019; 19:1586. [PMID: 31779599 PMCID: PMC6883662 DOI: 10.1186/s12889-019-7825-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/21/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study aims to provide a comprehensive understanding of maternal risk factors, infant risk factors and maternal infant feeding practices among refugees and migrants along the Thailand-Myanmar border. METHODS This study employed a mixed-methods approach with two components: (1) cross-sectional survey (n = 390) and (2) focus group discussions (n = 63). Participants were chosen from one of three clinics providing antenatal and delivery services for Karen and Burman refugees and migrants along the border. Participants were pregnant women and mother-infant dyads. RESULTS Refugee and migrant mothers demonstrated high rates of suboptimal breastfeeding and low rates of minimum dietary diversity and acceptable diet. Multivariable regression models showed infant stunting (AOR: 2.08, 95% CI: 1.12, 3.84, p = 0.020) and underweight (AOR: 2.26, 95% CI: 1.17, 4.36, p = 0.015) to have increased odds among migrants, while each 5 cm increase in maternal height had decreased odds of stunting (AOR: 0.50, 95% CI: 0.38, 0.66, p < 0.001) and underweight (AOR: 0.64, 95% CI: 0.48, 0.85, p = 0.002). In addition, small-for-gestational-age adjusted for length of gestation, infant age and gender increased odds of infant's stunting (AOR: 3.42, 95% CI: 1.88, 6.22, p < 0.001) and underweight (AOR: 4.44, 95% CI: 2.36, 8.34, p < 0.001). Using the Integrated Behavioural Model, focus group discussions explained the cross-sectional findings in characterising attitudes, perceived norms, and personal agency as they relate to maternal nutrition, infant malnutrition, and infant feeding practices. CONCLUSIONS Inadequate infant feeding practices are widespread in refugee and migrant communities along the Thailand-Myanmar border. Risk factors particular to maternal nutrition and infant birth should be considered for future programming to reduce the burden of chronic malnutrition in infants.
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Affiliation(s)
- A H Hashmi
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand. .,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - P B Nyein
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - K Pilaseng
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - M K Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - M C Darakamon
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - A M Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - P Charunwatthana
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - F Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX37FZ, UK
| | - R McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX37FZ, UK
| | - V I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051, Basel, Switzerland
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Chadare FJ, Idohou R, Nago E, Affonfere M, Agossadou J, Fassinou TK, Kénou C, Honfo S, Azokpota P, Linnemann AR, Hounhouigan DJ. Conventional and food-to-food fortification: An appraisal of past practices and lessons learned. Food Sci Nutr 2019; 7:2781-2795. [PMID: 31576203 PMCID: PMC6766603 DOI: 10.1002/fsn3.1133] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/17/2019] [Accepted: 05/31/2019] [Indexed: 01/15/2023] Open
Abstract
Food fortification is an important nutrition intervention to fight micronutrient deficiencies and to reduce their incidence in many low- and middle-income countries. Food fortification approaches experienced a significant rise in the recent years and have generated a lot of criticism. The present review aimed to shed light on the actual effect of food fortification approaches on the reduction of malnutrition. A set of 100 articles and reports, which have dealt with the impact of food fortification on malnutrition, were included in this review. This review identified a broad selection of local raw materials suitable for a food-to-food fortification approach.
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Affiliation(s)
- Flora Josiane Chadare
- Faculty of Agronomic Sciences, Laboratory of Food ScienceUniversity of Abomey‐Calavi (LSA/FSA/UAC)Abomey‐CalaviBenin
- Ecole des Sciences et Techniques de Conservation et de Transformation des Produits AgricolesUniversité Nationale d'Agriculture (ESTCTPA/UNA)SaketeBenin
| | - Rodrigue Idohou
- Faculté des Sciences Agronomiques, Laboratoire de Biomathématiques et d'Estimations ForestièresUniversité d'Abomey‐Calavi (LABEF/FSA/UAC)Abomey‐CalaviBenin
- Ecole de Gestion et de Production Végétale et SemencièreUniversité Nationale d'Agriculture (EGPVS/UNA)KetouBenin
| | - Eunice Nago
- Ecole de Nutrition et des Sciences et Technologies Alimentaires, Faculté des Sciences AgronomiquesUniversité d'Abomey‐Calavi (ENSTA/FSA/UAC)Abomey‐CalaviBenin
| | - Marius Affonfere
- Faculty of Agronomic Sciences, Laboratory of Food ScienceUniversity of Abomey‐Calavi (LSA/FSA/UAC)Abomey‐CalaviBenin
| | - Julienne Agossadou
- Faculty of Agronomic Sciences, Laboratory of Food ScienceUniversity of Abomey‐Calavi (LSA/FSA/UAC)Abomey‐CalaviBenin
| | - Toyi Kévin Fassinou
- Faculty of Agronomic Sciences, Laboratory of Food ScienceUniversity of Abomey‐Calavi (LSA/FSA/UAC)Abomey‐CalaviBenin
| | - Christel Kénou
- Faculté des Sciences Agronomiques, Laboratoire de Biomathématiques et d'Estimations ForestièresUniversité d'Abomey‐Calavi (LABEF/FSA/UAC)Abomey‐CalaviBenin
| | - Sewanou Honfo
- Faculté des Sciences Agronomiques, Laboratoire de Biomathématiques et d'Estimations ForestièresUniversité d'Abomey‐Calavi (LABEF/FSA/UAC)Abomey‐CalaviBenin
| | - Paulin Azokpota
- Faculty of Agronomic Sciences, Laboratory of Food ScienceUniversity of Abomey‐Calavi (LSA/FSA/UAC)Abomey‐CalaviBenin
| | - Anita R. Linnemann
- Food Quality and Design(FQD/WUR)Wageningen University and ResearchWageningenThe Netherlands
| | - Djidjoho J. Hounhouigan
- Faculty of Agronomic Sciences, Laboratory of Food ScienceUniversity of Abomey‐Calavi (LSA/FSA/UAC)Abomey‐CalaviBenin
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Caspersen IH, Thomsen C, Haug LS, Knutsen HK, Brantsæter AL, Papadopoulou E, Erlund I, Lundh T, Alexander J, Meltzer HM. Patterns and dietary determinants of essential and toxic elements in blood measured in mid-pregnancy: The Norwegian Environmental Biobank. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 671:299-308. [PMID: 30928759 DOI: 10.1016/j.scitotenv.2019.03.291] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Inadequate stores or intakes of essential minerals in pregnancy, or too high exposure to both toxic and essential elements, can have adverse effects on mother and child. The main aims of this study were to 1) describe the concentrations and patterns of essential and toxic elements measured in maternal whole blood during pregnancy; 2) identify dietary, lifestyle and sociodemographic determinants of element status; and 3) explore the impact of iron deficiency on blood element concentrations. METHODS This study is based on blood samples collected from 2982 women in gestational week 18 in The Norwegian Mother and Child Cohort study (MoBa) which were analyzed as part of the Norwegian Environmental Biobank. We derived blood element patterns by exploratory factor analysis, and associations between blood element patterns and diet were explored using sparse partial least squares (sPLS) regression. RESULTS Blood concentrations were determined for the essential elements (in the order of most abundant) Zn > Cu > Se > Mn > Mo > Co, and the toxic metals Pb > As > Hg > Cd > Tl. The concentrations were in ranges that were similar to or sometimes more favorable than in other pregnant and non-pregnant European women. We identified two blood element patterns; one including Zn, Se and Mn and another including Hg and As. For the Zn-Se-Mn pattern, use of multimineral supplements was the most important dietary determinant, while a high score in the Hg-As pattern was mainly determined by seafood consumption. Concentrations of Mn, Cd and Co were significantly higher in women with iron deficiency (plasma ferritin < 12 μg/L) than in women with plasma ferritin ≥ 12 μg/L. CONCLUSION Our study illustrates complex relationships and coexistence of essential and toxic elements. Their potential interplay adds to the challenges of studies investigating health effects related to either diet or toxicants.
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Affiliation(s)
- Ida Henriette Caspersen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Cathrine Thomsen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Line Småstuen Haug
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle K Knutsen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eleni Papadopoulou
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Iris Erlund
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Institution of Laboratory Medicine, Lund University, Lund, Sweden
| | - Jan Alexander
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Margrete Meltzer
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Hashmi A, Carrara VI, Nyein PB, Darakamon MC, Charunwatthana P, McGready R. The Healthy Baby Flipbook: piloting home-based counseling for refugee mothers to improve infant feeding and water, sanitation, and hygiene (WASH) practices. Glob Health Action 2019; 12:1560115. [PMID: 31154995 PMCID: PMC6338267 DOI: 10.1080/16549716.2018.1560115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Problems in growth and undernutrition manifest in early infancy, with suboptimal breastfeeding and inadequate complementary feeding remaining strong risk factors for chronic undernutrition in infants. No published studies exist on educational interventions to improve infant feeding practices among refugees or displaced persons in low and middle-income (LMIC) settings. The objective of this study was to create and pilot educational materials for home-based counseling of refugee mothers along the Thailand–Myanmar border to improve appropriate infant feeding and water, sanitation, and hygiene (WASH) behaviors. Mothers of infants received counseling on appropriate infant feeding and WASH practices on a monthly basis for a total of six months from infant age three months until nine months. Educational materials were designed to feature a basic script for health workers and photos of locally available, appropriate foods. Of the 20 mothers participating in this pilot, infant feeding and WASH behaviors improved within 1 to 2 months of the first visit, including exclusive breastfeeding, minimum acceptable diet, and safe disposal of infant stool. This pilot demonstrates improvement in maternal infant feeding and WASH practices in a small set of refugee mothers, providing evidence for counseling measures to improve infant health in vulnerable populations.
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Affiliation(s)
- Ahmar Hashmi
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand.,b Department of Family Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Verena I Carrara
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand.,c Department of Medicine , Swiss Tropical and Public Health Institute , Basel , Switzerland
| | - Paw Bay Nyein
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand
| | - Mu Chae Darakamon
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand
| | - Prakaykaew Charunwatthana
- d Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Bangkok , Thailand
| | - Rose McGready
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand.,e Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford , UK
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Madan EM, Haas JD, Menon P, Gillespie S. Seasonal variation in the proximal determinants of undernutrition during the first 1000 days of life in rural South Asia: A comprehensive review. GLOBAL FOOD SECURITY 2018. [DOI: 10.1016/j.gfs.2018.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Fox EL, Davis C, Downs SM, Schultink W, Fanzo J. Who is the Woman in Women's Nutrition? A Narrative Review of Evidence and Actions to Support Women's Nutrition throughout Life. Curr Dev Nutr 2018. [PMCID: PMC6349991 DOI: 10.1093/cdn/nzy076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Nutrition interventions that target mothers alone inadequately address women's needs across their lives: during adolescence, preconception, and in later years of life. They also fail to capture nulliparous women. The extent to which nutrition interventions effectively reach women throughout the life course is not well documented. In this comprehensive narrative review, we summarized the impact and delivery platforms of nutrition-specific and nutrition-sensitive interventions targeting adolescent girls, women of reproductive age (nonpregnant, nonlactating), pregnant and lactating women, women with young children <5 y, and older women, with a focus on nutrition interventions delivered in low- and middle-income countries. We found that although there were many effective interventions that targeted women's nutrition, they largely targeted women who were pregnant and lactating or with young children. There were major gaps in the targeting of interventions to older women. For the delivery platforms, community-based settings, compared with facility-based settings, more equitably reached women across the life course, including adolescents, women of reproductive age, and older women. Nutrition-sensitive approaches were more often delivered in community-based settings; however, the evidence of their impact on women's nutritional outcomes was less clear. We also found major research and programming gaps relative to targeting overweight, obesity, and noncommunicable disease. We conclude that focused efforts on women during pregnancy and in the first couple of years postpartum fail to address the interrelation and compounding nature of nutritional disadvantages that are perpetuated across many women's lives. In order for policies and interventions to more effectively address inequities faced by women, and not only women as mothers, it is essential that they reflect on how, when, and where to engage with women across the life course.
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Affiliation(s)
- Elizabeth L Fox
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Claire Davis
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Shauna M Downs
- Department of Health Systems and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | | | - Jessica Fanzo
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC
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31
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Lemos LF, Albuquerque LM, Larocca LM, Mazza VDA. Menores de dos años y la disfunción nutricional: la visión del enfermero de la atención básica. AVANCES EN ENFERMERÍA 2018. [DOI: 10.15446/av.enferm.v36n3.69163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: describir los elementos de vulnerabilidad del niño menor de dos años relacionados con disfuncionesnutricionales, identificados por los enfermeros de atención primaria. Materiales y métodos: estudio cualitativo-descriptivo realizado en una ciudad al sur de Brasil, con seis enfermeras de servicio de unidad de salud básica y también del modelo Estrategia Salud de la Familia. La recolección de datos fue por grupos focales, de enero a febrero del 2015. Se adoptó el análisis de contenido de categorías temáticas de Bardin y para la organización y procesamiento de datos se utilizó el programa informático Iramuteq®.Resultados: el análisis de datos textuales empleados fue la clasificación jerárquica descendente, este software procesó y organizó los datos en seis textos, distribuidos en 106segmentos, de los cuales 81 (76,4 %) fueron aprovechados. El análisis de los datos expresó las siguientes categorías:Ambiente desfavorable para la alimentación infantil sana y Prácticas y responsabilidades compartidas en el manejo de la lactancia. Mostraron que el ambiente abarca déficitssocioeconómicos familiares, cognitivos y de la salud materna, mala red social y familiar como también fuerte impacto del marketing y débil supervisión de las políticas públicas.Conclusión: la comprensión de los elementos de vulnerabilidad puede permitir un diálogo estrecho entre losdistintos segmentos intersectoriales y profesionales, cuyo objetivo común es el entendimiento de que la enfermedady la discapacidad están influenciadas por aspectos políticos, sociales y económicos.
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32
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Young MF, Nguyen PH, Gonzalez Casanova I, Addo OY, Tran LM, Nguyen S, Martorell R, Ramakrishnan U. Role of maternal preconception nutrition on offspring growth and risk of stunting across the first 1000 days in Vietnam: A prospective cohort study. PLoS One 2018; 13:e0203201. [PMID: 30161206 PMCID: PMC6117029 DOI: 10.1371/journal.pone.0203201] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/10/2018] [Indexed: 12/20/2022] Open
Abstract
Growing evidence supports the role of preconception maternal nutritional status (PMNS) on birth outcomes; however, evidence of relationships with child growth are limited. We examined associations between PMNS (height, weight and body mass index- BMI) and offspring growth during the first 1000 days. We used prospective cohort data from a randomized-controlled trial of preconception micronutrient supplementation in Vietnam, PRECONCEPT (n = 1409). Poisson regression models were used to examine associations between PMNS and risk of offspring stunting (<-2 HAZ) at 2 years. We used path analytic models to examine associations with PMNS on fetal growth (ultrasound measurements) and offspring HAZ at birth and 2 years. All models were adjusted for child age, sex, gestational weight gain, education, socioeconomic status and treatment group. A third of women had a preconception height < 150cm or weight < 43 kg. Women with preconception height < 150 cm or a weight < 43 kg were at increased risk of having a stunted child at 2 years (incident risk ratio IRR: 1.85, 95% CI 1.51–2.28; IRR 1.35, 95% CI 1.10–1.65, respectively). While the traditional low BMI cut-off (< 18.5 kg/m2) was not significant, lower BMI cut-offs (< 17.5 kg/m2 or < 18.0 kg/m2) were significantly associated with 1.3 times increased risk of child stunting. In path models, PMNS were positively associated with fetal growth (ultrasound measurements) and offspring HAZ at birth and 2 years. For each 1 standard deviation (SD) increase in maternal height and weight, offspring HAZ at 2 years increased by 0.30 SD and 0.23 SD, respectively. In conclusion, PMNS influences both offspring linear growth and risk of stunting across the first 1000 days. These findings underscore the importance of expanding the scope of current policies and strategies to include the preconception period in order to reduce child stunting.
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Affiliation(s)
- Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Phuong Hong Nguyen
- International Food Policy Research Institute, Washington, District of Columbia, United States of America
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Ines Gonzalez Casanova
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - O. Yaw Addo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Lan Mai Tran
- International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Son Nguyen
- International Food Policy Research Institute, Washington, District of Columbia, United States of America
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Socioeconomic determinants of malnutrition among mothers in the Amoron'i Mania region of Madagascar: a cross-sectional study. BMC Nutr 2018; 4:6. [PMID: 32153870 PMCID: PMC7050867 DOI: 10.1186/s40795-018-0212-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 02/05/2018] [Indexed: 12/13/2022] Open
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Hon KL, Leung AK, Cheung E, Lee B, Tsang MM, Torres AR. An overview of exposure to ethanol-containing substances and ethanol intoxication in children based on three illustrated cases. Drugs Context 2018; 7:212512. [PMID: 29344053 PMCID: PMC5764489 DOI: 10.7573/dic.212512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 11/21/2022] Open
Abstract
Alcohol addiction and intoxication are major health problems worldwide. Acute alcohol intoxication is well reported in adults and adolescents but less frequently reported in children of younger ages. We report three anonymized cases of pediatric ethanol exposure and illustrate the different mechanisms of intoxication. In all cases, a focused history is the key to prompt diagnosis and timely management. Physicians should be aware of this potential poison in children presented with acute confusional or encephalopathic state. In contrast, neonates with ethanol intoxication may present with nonspecific gastrointestinal symptomatology. Urgent exclusion of sepsis, electrolyte imbalance, drug intoxication, and surgical abdominal condition is critical. Using these illustrated cases, we performed a narrative literature review on issues of exposure to ethanol-containing substances and ethanol intoxication in children. In conclusion, a high level of suspicion and interrogation on ethanol or substance use are essential particularly in the lactating mother for an accurate and timely diagnosis of ethanol intoxication to be made.
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Affiliation(s)
- Kam Lun Hon
- Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Alexander Kc Leung
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Bryan Lee
- Department of Anaesthesia, Princess Margaret Hospital, Hong Kong
| | - Michelle Mc Tsang
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong
| | - Alcy R Torres
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Kavle JA, Landry M. Addressing barriers to maternal nutrition in low- and middle-income countries: A review of the evidence and programme implications. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28836343 PMCID: PMC5763330 DOI: 10.1111/mcn.12508] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/04/2017] [Accepted: 07/21/2017] [Indexed: 01/22/2023]
Abstract
Adequate maternal nutrition during the "first 1,000 days" window is critical from conception through the first 6 months of life to improve nutritional status and reduce the risk of poor birth outcomes, such as low birthweight and preterm birth. Unfortunately, many programmes have targeted implementation and monitoring of nutrition interventions to infants and young children, rather than to women during pregnancy or post-partum. A literature review was conducted to identify barriers to food choice and consumption during pregnancy and lactation and to examine how low- and middle-income countries have addressed maternal nutrition in programmes. A literature review of peer-reviewed and grey literature was conducted, and titles and abstracts reviewed by authors. Twenty-three studies were included in this review. Barriers to adequate nutrition during pregnancy included cultural beliefs related to knowledge of quantity of food to eat during pregnancy, amount of weight to gain during pregnancy, and "eating down" during pregnancy for fear of delivering a large baby. Foods considered inappropriate for consumption during pregnancy or lactation contributed to food restriction. Drivers of food choice were influenced by food aversions, economic constraints, and household food availability. Counselling on maternal diet and weight gain during pregnancy was seldom carried out. Programming to support healthy maternal diet and gestational weight gain during pregnancy is scant. Tailored, culturally resonant nutrition education and counselling on diet during pregnancy and lactation and weight gain during pregnancy, as well as monitoring of progress in maternal nutrition, are areas of needed attention.
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Affiliation(s)
- Justine A Kavle
- Maternal and Child Survival Program (MCSP), Washington, District of Columbia, USA.,PATH, Maternal, Newborn, Child Health, and Nutrition, Washington, District of Columbia, USA.,The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Megan Landry
- The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA.,Independent Consultant, USA
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36
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Abstract
Early life nutrition and feeding practices are important modifiable determinants of subsequent obesity, yet little is known about the circadian feeding pattern of 12-month-old infants. We aimed to describe the 24-h feeding patterns of 12-month-old infants and examine their associations with maternal and infant characteristics. Mothers from a prospective birth cohort study (n 431) reported dietary intakes of their 12-month-old infants and respective feeding times using 24-h dietary recall. Based on their feeding times, infants were classified into post-midnight (00.00-05.59 hours) and pre-midnight (06.00-23.59 hours) feeders. Mean daily energy intake was 3234 (sd 950) kJ (773 (sd 227) kcal), comprising 51·8 (sd 7·8) % carbohydrate, 33·9 (sd 7·2) % fat and 14·4 (sd 3·2) % protein. Mean hourly energy intake and proportion of infants fed were lower during post-midnight than pre-midnight hours. There were 251 (58·2 %) pre-midnight and 180 (41·8 %) post-midnight feeders. Post-midnight feeders consumed higher daily energy, carbohydrate, fat and protein intakes than pre-midnight feeders (all P<0·001). The difference in energy intake originated from energy content consumed during the post-midnight period. Majority (n 173) of post-midnight feeders consumed formula milk during the post-midnight period. Using multivariate logistic regression with confounder adjustment, exclusively breast-feeding during the first 6 months of life was negatively associated with post-midnight feeding at 12 months (adjusted OR 0·31; 95 % CI 0·11, 0·82). This study provides new insights into the circadian pattern of energy intake during infancy. Our findings indicated that the timing of feeding at 12 months was associated with daily energy and macronutrient intakes, and feeding mode during early infancy.
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37
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Krebs N, Bagby S, Bhutta ZA, Dewey K, Fall C, Gregory F, Hay W, Rhuman L, Caldwell CW, Thornburg KL. International summit on the nutrition of adolescent girls and young women: consensus statement. Ann N Y Acad Sci 2017; 1400:3-7. [PMID: 28722768 PMCID: PMC5601188 DOI: 10.1111/nyas.13417] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/27/2022]
Abstract
An international summit focusing on the difficult challenge of providing adequate nutrition for adolescent girls and young women in low- and middle-income countries was held in Portland, Oregon in 2015. Sixty-seven delegates from 17 countries agreed on a series of recommendations that would make progress toward improving the nutritional status of girls and young women in countries where their access to nutrition is compromised. Delegate recommendations include: (1) elevate the urgency of nutrition for girls and young women to a high international priority, (2) raise the social status of girls and young women in all regions of the world, (3) identify major knowledge gaps in the biology of adolescence that could be filled by robust research efforts, (4) and improve access to nutrient-rich foods for girls and young women. Attention to these recommendations would improve the health of young women in all nations of the world.
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Affiliation(s)
- Nancy Krebs
- Department of Food Science & Human Nutrition, University of Colorado School of Medicine, Aurora, Colorado
| | - Susan Bagby
- Division of Nephrology and Hypertension, Department of Medicine, Oregon Health & Science University, Portland, Oregon.,Bob and Charlee Moore Institute for Nutrition & Wellness, Oregon Health & Science University, Portland, Oregon
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Kathryn Dewey
- Department of Nutrition, Program in International and Community Nutrition, University of California Davis, Davis, California
| | - Caroline Fall
- Department of International Pediatric Epidemiology, University of Southampton, Southampton, United Kingdom
| | - Fred Gregory
- Bob and Charlee Moore Institute for Nutrition & Wellness, Oregon Health & Science University, Portland, Oregon
| | - William Hay
- Department of Pediatrics, Perinatal Research Center, University of Colorado School of Medicine, Aurora, Colorado
| | - Lisa Rhuman
- Department of Medicine, Knight Cardiovascular Institute, Center for Developmental Health, Moore Institute for Nutrition & Wellness, Oregon Health & Science University, Portland, Oregon
| | | | - Kent L Thornburg
- Department of Medicine, Knight Cardiovascular Institute, Center for Developmental Health, Moore Institute for Nutrition & Wellness, Oregon Health & Science University, Portland, Oregon
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38
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Gough EK, Moodie EE, Prendergast AJ, Ntozini R, Moulton LH, Humphrey JH, Manges AR. Linear growth trajectories in Zimbabwean infants. Am J Clin Nutr 2016; 104:1616-1627. [PMID: 27806980 PMCID: PMC5118730 DOI: 10.3945/ajcn.116.133538] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/14/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Undernutrition in early life underlies 45% of child deaths globally. Stunting malnutrition (suboptimal linear growth) also has long-term negative effects on childhood development. Linear growth deficits accrue in the first 1000 d of life. Understanding the patterns and timing of linear growth faltering or recovery during this period is critical to inform interventions to improve infant nutritional status. OBJECTIVE We aimed to identify the pattern and determinants of linear growth trajectories from birth through 24 mo of age in a cohort of Zimbabwean infants. DESIGN We performed a secondary analysis of longitudinal data from a subset of 3338 HIV-unexposed infants in the Zimbabwe Vitamin A for Mothers and Babies trial. We used k-means clustering for longitudinal data to identify linear growth trajectories and multinomial logistic regression to identify covariates that were associated with each trajectory group. RESULTS For the entire population, the mean length-for-age z score declined from -0.6 to -1.4 between birth and 24 mo of age. Within the population, 4 growth patterns were identified that were each characterized by worsening linear growth restriction but varied in the timing and severity of growth declines. In our multivariable model, 1-U increments in maternal height and education and infant birth weight and length were associated with greater relative odds of membership in the least-growth restricted groups (A and B) and reduced odds of membership in the more-growth restricted groups (C and D). Male infant sex was associated with reduced odds of membership in groups A and B but with increased odds of membership in groups C and D. CONCLUSION In this population, all children were experiencing growth restriction but differences in magnitude were influenced by maternal height and education and infant sex, birth weight, and birth length, which suggest that key determinants of linear growth may already be established by the time of birth. This trial was registered at clinicaltrials.gov as NCT00198718.
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Affiliation(s)
- Ethan K Gough
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Erica Em Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Robert Ntozini
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
| | - Lawrence H Moulton
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Jean H Humphrey
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Amee R Manges
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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39
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Valente A, Silva D, Neves E, Almeida F, Cruz JL, Dias CC, da Costa-Pereira A, Caldas-Afonso A, Guerra A. Acute and chronic malnutrition and their predictors in children aged 0-5 years in São Tomé: a cross-sectional, population-based study. Public Health 2016; 140:91-101. [PMID: 27576113 DOI: 10.1016/j.puhe.2016.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 07/11/2016] [Accepted: 07/26/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Undernutrition is an important cause of morbidity and mortality in infants and children worldwide. The aim of this study was to evaluate the nutritional status and their predictors in children from 0 to 5 years of age in São Tomé. STUDY DESIGN A cross-sectional study was conducted in São Tomé Island. METHODS A total of 1285 individuals were enrolled between January and May 2011. Children were measured, and height for age (HAZ), weight for height (WHZ) and body mass index (BAZ) Z-score were computed. Global acute undernutrition is defined as weight for height <-1 Z-score (wasting < -2 Z-scores) and global chronic undernutrition as length/height for age <-1 Z-score (stunting < -2 Z-scores). Relevant information was collected from individual health bulletins, namely gestational age and birth weight, as well as weight at 6, 12, 18 and 24 months for all individual above these ages. Mothers were invited to answer a specific questionnaire. RESULTS A high percentage of global acute undernutrition (30.9% in <24 months and 21.9% in ≥24 months) and global chronic undernutrition (32.5% in <24 months and 41.1% in ≥24 months) was observed. Appropriate birth weight for gestational age (AGA) is significantly associated with lower odds for both acute (OR 0.485 [95% CI 0.299-0.785]) and chronic undernutrition (OR 0.427 [95% CI 0.270-0.675]) in children >12 months. Weight gain above 0.67 Z-score in the first semester of life was strongly related to lower odds for both acute (OR 0.109 [95% CI 0.040-0.291]) and chronic undernutrition (OR 0.379 [95% CI 0.187-0.770]) in children >12 months of age. Similarly, mother's education seems to protect against acute (>12 months: OR 0.448 [95% CI 0.244-0.825]; >24 months: OR 0.186 [95% CI 0.064-0.540]) and chronic undernutrition (>12 months: OR 0.389 [95% CI 0.232-0.653]; >24 months: OR 0.324 [95% CI 0.171-0.625]). All logistic regressions were adjusted for all children (gender, age, gestational age, birth weight, breastfeeding, begin consumption alcohol), mothers (age, height, body mass index, educational level, number of previous pregnancies, smoking during pregnancy, alcohol consumption during pregnancy) and household (number of siblings and persons at home) variables included in the protocol. CONCLUSIONS Birth weight, nutritional status, and the mother's education and weight gain particularly in the first year of life were important factors protecting against undernutrition during infancy and childhood. These results emphasize the importance of women's nutrition and of adequate birth weight and particularly weight gain during the first year of life in order to prevent wasting and stunting in childhood.
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Affiliation(s)
- A Valente
- Division of Pediatric Nutrition, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal.
| | - D Silva
- Division of Pediatric Nutrition, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal; Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Portugal
| | - E Neves
- Instituto Marquês de Valle Flôr, Sao Tome and Principe
| | - F Almeida
- Hospital Ayres de Menezes, São Tomé, Sao Tome and Principe
| | - J L Cruz
- Hospital Ayres de Menezes, São Tomé, Sao Tome and Principe
| | - C C Dias
- CINTESIS - Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Portugal
| | - A da Costa-Pereira
- CINTESIS - Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Portugal
| | - A Caldas-Afonso
- Department of Pediatrics, Faculty of Medicine, University of Porto, Portugal
| | - A Guerra
- Division of Pediatric Nutrition, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal; Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; CINTESIS - Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Portugal; Department of Pediatrics, Faculty of Medicine, University of Porto, Portugal
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40
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Pérez-Lu JE, Cárcamo C, Nandi A, Kaufman JS. Health effects of 'Juntos', a conditional cash transfer programme in Peru. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27549365 DOI: 10.1111/mcn.12348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 05/19/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
Abstract
In some countries, conditional cash transfer (CCT) programmes show an impact on maternal and child health. Juntos, the CCT programme in Peru, has been evaluated several times operationally, but seldom for maternal and child health outcomes. The objective of this study is to evaluate the impact of Juntos on children under 6 years, pregnant women and mothers of children under 17 years. Outcomes evaluated included (1) anaemia in women and children; (2) acute malnutrition in children; (3) post-partum complications in mothers; and (4) underweight and overweight in mothers. We identified Juntos eligible respondents from the Demographic and Health Surveys of Peru for years 2007 to 2013. Propensity score matching was used to identify comparable treatment and control groups, including eligible respondents enrolled in Juntos vs. those not enrolled in Juntos (individual-level analysis), as well as eligible respondents living in Juntos districts vs. those not residing in Juntos districts (district-level analysis). We then used generalized linear models to estimate prevalence ratios. Individual level analysis showed that Juntos reduced underweight in women (PR:0.39, 95%CI:0.18 - 0.85) and anaemia in children (PR:0.93, 95%CI:0.86 - 1.00). In the district level analysis, the programme was associated with a reduction of overweight in women (PR:0.94, 95%CI:0.90 - 0.98) and acute malnutrition in children (PR:0.49, 95%CI:0.32 - 0.73), but an increase in the prevalence of anaemia in children (PR:1.09, 95%CI:1.01 - 1.17). We found that Juntos had an effect on maternal and child health indicators, but further studies are required to overcome some limitations encountered here.
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Affiliation(s)
- José E Pérez-Lu
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Cárcamo
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.,Institute for Health and Social Policy, McGill University, Montreal, Québec, Canada
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.,Institute for Health and Social Policy, McGill University, Montreal, Québec, Canada
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De-Regil LM, Harding KB, Roche ML. Preconceptional Nutrition Interventions for Adolescent Girls and Adult Women: Global Guidelines and Gaps in Evidence and Policy with Emphasis on Micronutrients. J Nutr 2016; 146:1461S-70S. [PMID: 27281812 DOI: 10.3945/jn.115.223487] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 04/19/2016] [Indexed: 12/15/2022] Open
Abstract
Much of the global nutrition efforts in recent years have been focused on improving the nutritional status of children during the window of the first 1000 d of life, from conception to 2 y of age. However, as the world transitions from the Millennium Development Goals to the Sustainable Development Goals, women's and adolescent girls' overall health and well-being are being placed at the center of the global agenda. It is also increasingly recognized that a woman's nutritional status before pregnancy affects maternal and child outcomes and thus needs to be improved to ensure optimal outcomes. This article reviews the global picture of preconception nutrition in women and girls, including some of the key factors that influence women's outcomes, as well as their children's outcomes, if they do become pregnant. This article describes the current global guidelines on preconceptional nutrition interventions for girls and women; highlights related gaps in evidence, guidelines, and policy; and discusses research to forward the agenda of improving women's and girls' preconceptional nutrition.
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Affiliation(s)
- Luz M De-Regil
- Research and Evaluation, Micronutrient Initiative, Ottawa, Canada
| | | | - Marion L Roche
- Research and Evaluation, Micronutrient Initiative, Ottawa, Canada
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Devakumar D, Hallal PC, Horta BL, Barros FC, Wells JCK. Association between Birth Interval and Cardiovascular Outcomes at 30 Years of Age: A Prospective Cohort Study from Brazil. PLoS One 2016; 11:e0149054. [PMID: 26890250 PMCID: PMC4758625 DOI: 10.1371/journal.pone.0149054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 01/25/2016] [Indexed: 11/19/2022] Open
Abstract
Background Birth interval is an important and potentially modifiable factor that is associated with child health. Whether an association exists with longer-term outcomes in adults is less well known. Methods Using the 1982 Pelotas (Brazil) Birth Cohort Study, the association of birth interval with markers of cardiovascular health at 30 years of age was examined. Multivariable linear regression was used with birth interval as a continuous variable and categorical variable, and effect modification by gender was explored. Results Birth interval and cardiovascular data were present for 2,239 individuals. With birth interval as a continuous variable, no association was found but stratification by gender tended to show stronger associations for girls. When compared to birth intervals of <18 months, as binary variable, longer intervals were associated with increases in height (1.6 cm; 95% CI: 0.5, 2.8) and lean mass (1.7 kg; 95% CI: 0.2, 3.2). No difference was seen with other cardiovascular outcomes. Conclusions An association was generally not found between birth interval and cardiovascular outcomes at 30 years of age, though some evidence existed for differences between males and females and for an association with height and lean mass for birth intervals of 18 months and longer.
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Affiliation(s)
- D. Devakumar
- Institute for Global Health, University College London, London, United Kingdom
- * E-mail:
| | - P. C. Hallal
- Federal University of Pelotas, Post-Graduate Programme in Epidemiology, Pelotas, Brazil
| | - B. L. Horta
- Federal University of Pelotas, Post-Graduate Programme in Epidemiology, Pelotas, Brazil
| | - F. C. Barros
- Federal University of Pelotas, Post-Graduate Programme in Epidemiology, Pelotas, Brazil
| | - J. C. K. Wells
- Institute of Child Health, University College London, London, United Kingdom
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Characterisation of anaemia and associated factors among infants and pre-schoolers from rural India. Public Health Nutr 2015; 19:861-71. [DOI: 10.1017/s1368980015002050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractObjectiveIn India, national databases indicate anaemia prevalence of 80 % among 6–35-month-old children and 58 % among 36–59-month-old children. The present study aimed to characterise anaemia and the associated factors among infants and pre-schoolers living in rural India.DesignMultivariate logistic regression analysis of data collected prior to an intervention trial. Fe-deficiency with anaemia (IDA), Fe deficiency with no anaemia (IDNA) and anaemia without Fe deficiency were defined. Serum ferritin, soluble transferrin receptor (sTfR) and sTfR/log ferritin index were used to indicate Fe status.SettingTwenty-six villages of Nalgonda district, Telangana, India. Data were collected in community sites.ParticipantsFour hundred and seventy-six infants (aged 6–12 months), 316 pre-schoolers (aged 29–56 months) and their mothers.ResultsPrevalence of anaemia among infants and pre-schoolers was 66·4 and 47·8 %, prevalence of IDA was 52·2 and 42·1 %, prevalence of IDNA was 22·2 and 29·8 %, prevalence of anaemia without Fe deficiency was 14·2 and 5·7 %. Among infants, anaemia was positively associated with maternal anaemia (OR=3·31; 95 % CI 2·10, 5·23;P<0·001), and sTfR/log ferritin index (OR=2·21; 95 % CI 1·39, 3·54;P=0·001). Among pre-schoolers, anaemia was positively associated with maternal anaemia (OR=3·77; 95 % CI 1·94, 7·30;P<0·001), sTfR/log ferritin index (OR=5·29; 95 % CI 2·67, 10·50;P<0·001), high C-reactive protein (OR=4·39; 95 % CI 1·91, 10·06,P<0·001) and young age (29–35 months: OR=1·92; 05 % CI 1·18, 3·13,P=0·009).ConclusionsAnaemia prevalence continues to be high among infants and pre-schoolers in rural India. Based on sTfR/ferritin index, Fe deficiency is a major factor associated with anaemia. Anaemia is also associated with inflammation among pre-schoolers and with maternal anaemia among infants and pre-schoolers, illustrating the importance of understanding the aetiology of anaemia in designing effective control strategies.
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Abstract
PURPOSE OF REVIEW This article reviews the maternal and child nutrition situation in Asia in transition and its public health implications. RECENT FINDINGS Countries in Asia are facing a double burden of malnutrition. Accessibility to high energy, less nutrient-dense foods or processed foods affects current dietary patterns, whereas industrialization is leading to more sedentary lifestyles both in rural and urban areas. Stunting and wasting among young children persist but have declined in severity, whereas overweight and obesity have risen rapidly. Growth faltering in height during the first 2 years of life has affected muscle mass accretion, but rapid weight gain after 2 years of age has led to more fat accretion, imposing risks of childhood obesity and consequent metabolic disorders. The number of women entering pregnancy with low BMI has decreased, but increasing BMI is noticeable. Prepregnancy BMI and gestational weight gain are important determinants of maternal nutrition during pregnancy, the risk of gestational diabetes and postpartum weight retention, as well as obesity and diet-related noncommunicable diseases in later adulthood. SUMMARY Asia in transition is faced with persistent undernutrition and increasing trends of obesity and metabolic disorders among children and women. The first 1000 days from conception is a critical period, but it is also a window of opportunity for preventing double burden of malnutrition in Asian countries characterized by a nutrition transition.
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Haddad L, Achadi E, Bendech MA, Ahuja A, Bhatia K, Bhutta Z, Blössner M, Borghi E, Colecraft E, de Onis M, Eriksen K, Fanzo J, Flores-Ayala R, Fracassi P, Kimani-Murage E, Koukoubou EN, Krasevec J, Newby H, Nugent R, Oenema S, Martin-Prével Y, Randel J, Requejo J, Shyam T, Udomkesmalee E, Reddy KS. The Global Nutrition Report 2014: actions and accountability to accelerate the world's progress on nutrition. J Nutr 2015; 145:663-71. [PMID: 25740908 PMCID: PMC5129664 DOI: 10.3945/jn.114.206078] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/02/2015] [Indexed: 11/14/2022] Open
Abstract
In 2013, the Nutrition for Growth Summit called for a Global Nutrition Report (GNR) to strengthen accountability in nutrition so that progress in reducing malnutrition could be accelerated. This article summarizes the results of the first GNR. By focusing on undernutrition and overweight, the GNR puts malnutrition in a new light. Nearly every country in the world is affected by malnutrition, and multiple malnutrition burdens are the "new normal." Unfortunately, the world is off track to meet the 2025 World Health Assembly (WHA) targets for nutrition. Many countries are, however, making good progress on WHA indicators, providing inspiration and guidance for others. Beyond the WHA goals, nutrition needs to be more strongly represented in the Sustainable Development Goal (SDG) framework. At present, it is only explicitly mentioned in 1 of 169 SDG targets despite the many contributions improved nutritional status will make to their attainment. To achieve improvements in nutrition status, it is vital to scale up nutrition programs. We identify bottlenecks in the scale-up of nutrition-specific and nutrition-sensitive approaches and highlight actions to accelerate coverage and reach. Holding stakeholders to account for delivery on nutrition actions requires a well-functioning accountability infrastructure, which is lacking in nutrition. New accountability mechanisms need piloting and evaluation, financial resource flows to nutrition need to be made explicit, nutrition spending targets should be established, and some key data gaps need to be filled. For example, many UN member states cannot report on their WHA progress and those that can often rely on data >5 y old. The world can accelerate malnutrition reduction substantially, but this will require stronger accountability mechanisms to hold all stakeholders to account.
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Affiliation(s)
- Lawrence Haddad
- International Food Policy Research Institute, Washington, DC;
| | | | | | - Arti Ahuja
- Women and Child Development, Odisha, India
| | - Komal Bhatia
- Institute of Development Studies, Brighton, United Kingdom
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada,Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Stineke Oenema
- Interchurch Organization for Development Cooperation (ICCO) Alliance, Utrecht, The Netherlands
| | | | | | - Jennifer Requejo
- Partnership for Maternal, Newborn and Child Health, WHO, Geneva, Switzerland
| | - Tara Shyam
- Institute of Development Studies, Brighton, United Kingdom
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Öhman A, Eriksson M, Goicolea I. Gender and health - aspects of importance for understanding health and illness in the world. Glob Health Action 2015; 8:26908. [PMID: 25623614 PMCID: PMC4306753 DOI: 10.3402/gha.v8.26908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ann Öhman
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden, Umeå Centre for Gender Studies, Umeå University, Umeå, Sweden;
| | - Malin Eriksson
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Isabel Goicolea
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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Cardoso MA, Hure AJ. Nutrition in the first 500 days of life. Public Health Nutr 2014; 17:1907-8. [PMID: 25265981 PMCID: PMC11112425 DOI: 10.1017/s1368980014001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Linear growth failure is the most common form of undernutrition globally. With an estimated 165 million children below 5 years of age affected, stunting has been identified as a major public health priority, and there are ambitious targets to reduce the prevalence of stunting by 40% between 2010 and 2025. We view this condition as a 'stunting syndrome' in which multiple pathological changes marked by linear growth retardation in early life are associated with increased morbidity and mortality, reduced physical, neurodevelopmental and economic capacity and an elevated risk of metabolic disease into adulthood. Stunting is a cyclical process because women who were themselves stunted in childhood tend to have stunted offspring, creating an intergenerational cycle of poverty and reduced human capital that is difficult to break. In this review, the mechanisms underlying linear growth failure at different ages are described, the short-, medium- and long-term consequences of stunting are discussed, and the evidence for windows of opportunity during the life cycle to target interventions at the stunting syndrome are evaluated.
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Affiliation(s)
- Andrew J Prendergast
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, UK,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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