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Pasqualino MM, Shaikh S, Hossain MI, Islam MT, Ali H, Haque R, Ayesha K, Wu LSF, Dyer B, Hasan K, Alland K, Schulze KJ, Johura FT, Alam M, West KP, Ahmed T, Labrique AB, Palmer AC. An Egg Intervention Improves Ponderal But Not Linear Growth Among Infants 6-12 mo of Age in Rural Bangladesh. J Nutr 2024; 154:2290-2299. [PMID: 38759886 DOI: 10.1016/j.tjnut.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Animal source foods are rich in multiple nutrients. Regular egg consumption may improve infant growth in low- and middle-income countries. OBJECTIVES To assess the impact of daily egg consumption on linear growth among 6-12-mo olds in rural Bangladesh. METHODS We conducted a 2 × 4 factorial cluster-randomized controlled trial allocating clusters (n = 566) to treatment for enteric pathogens or placebo and a daily egg, protein supplement, isocaloric supplement, or control. All arms received nutrition education. Here, we compare the effect of the egg intervention versus control on linear growth, a prespecified aim of the trial. Infants were enrolled at 3 mo. We measured length and weight at 6 and 12 mo and visited households weekly to distribute eggs and monitor compliance. We used linear regression models to compare 12-mo mean length, weight, and z-scores for length-for-age (LAZ), weight-for-length, and weight-for-age (WAZ), and log-binomial or robust Poisson regression to compare prevalence of stunting, wasting, and underweight between arms. We used generalized estimating equations to account for clustering and adjusted models for baseline measures of outcomes. RESULTS We enrolled 3051 infants (n = 283 clusters) across arms, with complete 6 and 12 mo anthropometry data from 1228 infants (n = 142 clusters) in the egg arm and 1109 infants (n = 141 clusters) in the control. At baseline, 18.5%, 6.0%, and 16.4% were stunted, wasted, and underweight, respectively. The intervention did not have a statistically significant effect on mean LAZ (β: 0.05, 95% confidence interval [CI]: -0.01, 0.10) or stunting prevalence (β: 0.98, 95% CI: 0.89, 1.13) at 12 mo. Mean weight (β: 0.07 kg, 95% CI: 0.02, 0.11) and WAZ (β: 0.06, 95% CI: 0.02, 0.11) were significantly higher in the egg compared with control arms. CONCLUSIONS Provision of a daily egg for 6 mo to infants in rural Bangladesh improved ponderal but not linear growth. TRIAL REGISTRATION NUMBER NCT03683667, https://clinicaltrials.gov/ct2/show/NCT03683667.
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Affiliation(s)
- Monica M Pasqualino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | | | | | | | - Hasmot Ali
- The JiVitA Project, Gaibandha, Bangladesh
| | | | | | - Lee S-F Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Brian Dyer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Khaled Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kelsey Alland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kerry J Schulze
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | - Keith P West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amanda C Palmer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Choudhary N, Brewis A, Schuster RC, Wutich A. Beyond WASH: Testing Additional Connections Between Household Water Insecurity and Child Nutrition Outcomes in Multi-Country Contexts. Ecol Food Nutr 2024; 63:435-468. [PMID: 38889358 DOI: 10.1080/03670244.2024.2366913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
This study identifies multiple pathways connecting household water insecurity with child nutrition. Using nationally representative samples for 18 countries, we examine the mediating role of child's dietary diversity as a function of household water status, while also accounting for sanitation. We construct a latent household water insecurity score (HWI) and use Structural Equation approach to model underlying pathways. HWI affected child's HAZ score and hemoglobin both directly and indirectly, with a mediation from child feeding alongside effects from sanitation. Broadening the conception of household water insecurity and accommodating the indirect effects of water could improve explanations of child under-nutrition.
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Affiliation(s)
- Neetu Choudhary
- School of Human Evolution and Social Change, Arizona State University, Tempe
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe
| | - Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe
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Chiwila MK, Krebs NF, Manasyan A, Chomba E, Mwenechanya M, Mazariegos M, Sami N, Pasha O, Tshefu A, Lokangaka A, Goldenberg RL, Bose CL, Koso-Thomas M, Goco N, Do BT, McClure EM, Hambidge KM, Westcott JE, Carlo WA. Junk food use and neurodevelopmental and growth outcomes in infants in low-resource settings. Front Public Health 2024; 12:1308685. [PMID: 38686037 PMCID: PMC11057493 DOI: 10.3389/fpubh.2024.1308685] [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: 10/18/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Feeding infants a sub-optimal diet deprives them of critical nutrients for their physical and cognitive development. The objective of this study is to describe the intake of foods of low nutritional value (junk foods) and identify the association with growth and developmental outcomes in infants up to 18 months in low-resource settings. Methods This is a secondary analysis of data from an iron-rich complementary foods (meat versus fortified cereal) randomized clinical trial on nutrition conducted in low-resource settings in four low- and middle-income countries (Democratic Republic of the Congo, Guatemala, Pakistan, and Zambia). Mothers in both study arms received nutritional messages on the importance of exclusive breastfeeding up to 6 months with continued breastfeeding up to at least 12 months. This study was designed to identify the socio-demographic predictors of feeding infants' complementary foods of low nutritional value (junk foods) and to assess the associations between prevalence of junk food use with neurodevelopment (assessed with the Bayley Scales of Infant Development II) and growth at 18 months. Results 1,231 infants were enrolled, and 1,062 (86%) completed the study. Junk food feeding was more common in Guatemala, Pakistan, and Zambia than in the Democratic Republic of Congo. 7% of the infants were fed junk foods at 6 months which increased to 70% at 12 months. Non-exclusive breastfeeding at 6 months, higher maternal body mass index, more years of maternal and paternal education, and higher socioeconomic status were associated with feeding junk food. Prevalence of junk foods use was not associated with adverse neurodevelopmental or growth outcomes. Conclusion The frequency of consumption of junk food was high in these low-resource settings but was not associated with adverse neurodevelopment or growth over the study period.
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Affiliation(s)
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Albert Manasyan
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Elwyn Chomba
- Global Network, University Teaching Hospital, Lusaka, Zambia
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Manolo Mazariegos
- Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala
| | - Neelofar Sami
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Antoinette Tshefu
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Adrien Lokangaka
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, United States
| | - Carl L. Bose
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shiver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Norman Goco
- Research Triangle Institute International, Durham, NC, United States
| | - Barbara T. Do
- Research Triangle Institute International, Durham, NC, United States
| | | | | | - Jamie E. Westcott
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
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Chagwena DT, Fernando S, Tavengwa NV, Sithole S, Nyachowe C, Njovo H, Datta K, Brown T, Humphrey JH, Prendergast AJ, Smith LE. Formulation and acceptability of local nutrient-dense foods for young children: A formative study for the Child Health, Agriculture and Integrated Nutrition (CHAIN) Trial in rural Zimbabwe. MATERNAL & CHILD NUTRITION 2024; 20:e13605. [PMID: 38093409 PMCID: PMC10981484 DOI: 10.1111/mcn.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 04/01/2024]
Abstract
Stunting affects almost one-quarter of children globally, leading to reduced human capacity and increased long-term risk of chronic disease. Despite intensive infant and young child feeding (IYCF) interventions, many children do not meet their requirements for essential nutrients. This study aimed to assess the feasibility of implementing an IYCF intervention utilizing nutrient-dense powders from egg, biofortified sugar beans and Moringa oleifera leaf in rural Zimbabwe. A mixed-methods formative study was conducted comprising the following: (i) a recipe formulation trial, (ii) trials of improved practices to assess acceptability of the intervention, and (iii) a participatory message formulation process to develop counselling modules for the IYCF-plus intervention. Twenty-seven mother-baby pairs were recruited between November 2019 and April 2020. Key domains affecting IYCF practices that emerged were time, emotional and physical space, cultural and religious beliefs, indigenous knowledge systems and gender dynamics. Household observations and sensory evaluation indicated high acceptability of the new ingredients. Recipe formulation and participatory message formulation by participants instilled community ownership and served to demystify existing misconceptions about the new food products. Families noted the potential for intervention sustainability because the foods could be grown locally. Supplementing complementary foods with nutrient-dense local food ingredients as powders has the potential to sustainably address nutrient-gaps in the diets of young children living in rural lower- and middle-income countries. Comprehensive IYCF counselling utilizing a gender-lens approach, family support and indigenous knowledge systems or resources are key elements to support positive behaviour change in complementary feeding interventions.
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Affiliation(s)
- Dexter T. Chagwena
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Ministry of Health and Child CareHarareZimbabwe
- School of GeographyQueen Mary University of LondonLondonUK
| | - Shamiso Fernando
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | - Naume V. Tavengwa
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | | | | | | | - Kavita Datta
- School of GeographyQueen Mary University of LondonLondonUK
| | - Tim Brown
- School of GeographyQueen Mary University of LondonLondonUK
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- School of GeographyQueen Mary University of LondonLondonUK
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Laura E. Smith
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Department of Public and Ecosystem HealthCornell UniversityIthacaNew YorkUSA
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Alotaibi AF, Khdary SN, Alzarzor Alajami MA, Sambas EA, Aldakhil NA, Naibulharam DY, Alsulmi AA, Alosaimi FD. Pattern of dietary supplement use and its psychosocial predictors among females visiting fitness centers in Saudi Arabia: Findings from a cross-sectional study. Saudi Pharm J 2024; 32:101966. [PMID: 38322147 PMCID: PMC10845057 DOI: 10.1016/j.jsps.2024.101966] [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: 05/31/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
Background Establishing a balanced diet is necessary for obtaining the required daily micronutrients and macronutrients. However, the importance of using dietary supplements to complement one's diet is a significant aspect to consider. While studies have reported the prevalence and patterns of dietary supplements in Saudi Arabia, most focused on university students, women in their reproductive life-particularly during pregnancy-or male athletes. Hence, the objective of this study is to estimate the prevalence and patterns of dietary supplement usage, along with the associated sociodemographic and psychiatric predictors among women attending fitness centers in Saudi Arabia. Methods A cross-sectional design was utilized using a structured questionnaire to collect data on dietary intakes such as consumption, nutrition supplements, type of nutrition supplements, and reason for consuming dietary supplements. Data collection occurred in female fitness centers, with participants accessing the questionnaires through QR codes linked to online Google forms. The dietary usage was assessed using a structured questionnaire developed by the study authors, and depressive and anxiety symptoms were assessed using the PHQ-9 and the GAD-7 scales, respectively. SPSS 23.0 was utilized to analyze the data, and a multivariable logistic regression analysis was performed to determine the association between sociodemographic and psychiatric predictors and patterns of dietary supplement usage. The results were presented by reporting an unadjusted and adjusted odds ratio (AOR) with 95 % Confidence Intervals (CIs). Results The total number of participants in this study was 453 women. Half of the 453 women (46.1 %) consumed dietary supplements, and (84.0 %) reported taking proteins, caffeine, creatinine, mineral salts, fish oil, and/or amino acids or a combination of these dietary supplements. A considerable number of women (41.0 %) reported that a doctor, dietitian, or trainer motivated them to take the dietary supplement, and (38.0 %) of women self-prescribed dietary supplements. More than half (51 %) of the women consumed dietary supplements to compensate for nutrient deficiency, and 48 % used them to improve their health. Women who did not work to earn were 53 % less likely to consume dietary supplements (AOR = 0.47; [95 % CI: 0.30-0.72]) than women who reported working to earn either in the private or government sector. Depressed women were (42 %) less likely to consume dietary supplements than non-depressed women (AOR = 0.58; [95 % CI: 0.33-0.99]) after adjusting for sociodemographic variables and other medical conditions. Conclusion It has been evident that a large proportion of women enrolled in the fitness center report consuming dietary supplements, mostly to compensate for energy and to improve overall health. The findings highlight that non-working and depressed women were less likely to use dietary supplements than their counterparts. By understanding these patterns, the community can tailor health interventions and policies to ensure equitable access to proper dietary support, especially for those facing challenges like depression and unemployment. Future research on a larger sample of women outside fitness centers is encouraged to explore further dietary supplement consumption and patterns among diverse population groups, and to ultimately develop health guidelines for the appropriate use of supplements.
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Affiliation(s)
| | - Shuaa N. Khdary
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | | | - Esraa A. Sambas
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Norah A. Aldakhil
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | | | - Alaa A. Alsulmi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Fahad D. Alosaimi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
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Mario E, Belay A, Amare E. Evaluation of the quality and safety of commercial complementary foods: Implications for nutrient adequacy and conformance with national and international standards. PLoS One 2024; 19:e0294068. [PMID: 38381727 PMCID: PMC10880965 DOI: 10.1371/journal.pone.0294068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/17/2023] [Indexed: 02/23/2024] Open
Abstract
Optimal nutrition in early childhood increases growth and development while preventing morbidity and mortality in later life. This study focused on the quality and safety of 32 commercially produced complementary foods collected from supermarkets in Addis Ababa, Ethiopia. The proximate composition (moisture, protein, fat, crude fibre, and ash); and the mineral profile (calcium, iron, zinc, manganese, and magnesium) were determined using the AOAC method. The determination of antinutritional factors (Condensed tannin and oxalate) was done using a UV spectrophotometer. A rapid visco analyzer was used to measure the rheological property. The microbial load of commercially produced complimentary foods was identified using aerobic colony counts for mold and yeast. Labeling practice was evaluated using the WHO and Ethiopian standard tools. The results of proximate compositions were: protein (0.92-18.16 g/100g), fat (0.63-6.44 g/100g), crude fiber (1.04-13.2 g/100g), energy (410-337 kcal/100g), moisture (0.03-17 g/100g), and ash (0.60-4.67 g/100g). The protein and fat content of all the products is below international standards. Only three products met the standards for energy. Moisture and ash contents partially met the requirement, while all of the carbohydrate contents of the products fell under the specified standard. The lowest and highest mineral contents of the products were: Fe (1.38 to 15.10 mg/100g), Zn (0.64 to 6.78 mg/100g), Ca (30.55 to 364.45 mg/100g), Mg (1.2 to 34.2 mg/100g), and Mn (0.80 to 32 mg/100g). Based on these, 21.5% of the foods met the Fe standard, and 31.5% didn't meet the Zn standard. The Ca and Mg of all the products met the requirement. Except for one product, all met standards. The highest and lowest results for the tannin and oxalate content of the products were 49.20 to 90.09 mg/100g and 0.47 to 30.10 mg/100g, respectively and this shows that the products are below the permissible range for tannin and oxalate. The counts of yeast and mold were 0.00-2.95 log10 cfu/g and 0.00-2.91 log10 cfu/g, respectively. Only one product fell below the standard for yeast count, and none of the products showed a mold count that exceeded the standard. The final viscosity was 63.5-3476 RVU, and only 31.25% of the samples fell under the permissible peak viscosity range, of 83-250 RVU. Thus, regular monitoring of the raw material and processing trends and the inclusion of animal sources in the raw material are suggested for having well-enriched complementary foods. Regulatory bodies should also conduct frequent market surveillance to safeguard the health of the consumer.
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Affiliation(s)
- Elroe Mario
- Department of Food Science and Applied Nutrition, and Bioprocessing and Biotechnology Center of Excellence, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Abera Belay
- Department of Food Science and Applied Nutrition, and Bioprocessing and Biotechnology Center of Excellence, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Endale Amare
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Kamudoni P, Kiige L, Ortenzi F, Beal T, Nordhagen S, Kirogo V, Arimi C, Zvandaziva C, Garg A, Codjia P, Rudert C. Identifying and understanding barriers to optimal complementary feeding in Kenya. MATERNAL & CHILD NUTRITION 2024; 20 Suppl 3:e13617. [PMID: 38180165 PMCID: PMC10782142 DOI: 10.1111/mcn.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 01/06/2024]
Abstract
Optimal complementary feeding between the ages of 6 and 23 months provides children with the required range of nutritious and safe foods while continuing to be breastfed to meet their needs for essential nutrients and develop their full physical and cognitive potential. The rates of exclusive breastfeeding in the first 6 months of life have increased from 32% in 2008 to 60% in 2022 in Kenya. However, the proportion of children between 6 and 23 months receiving a minimum acceptable diet remains low and has declined from 39% in 2008 to 31% in 2023. The Kenyan Ministry of Health, GAIN and UNICEF collaborated to understand the drivers of complementary feeding practices, particularly proximal determinants, which can be directly addressed and acted upon. A secondary analysis of household surveys and food composition data was conducted to outline children's dietary patterns within the different regions of Kenya and the extent to which the affordability of animal-source foods could be improved. Ethnographic data were analyzed to identify socio-cultural barriers to optimal complementary feeding. Furthermore, we outlined the critical steps for developing user-friendly and low-cost complementary feeding recipes. The results of all the analyses are presented in five of the six papers of this Special Issue with this additional paper introducing the Kenyan context and some of the critical findings. The Special Issue has highlighted multidimensional barriers surrounding the use and availability of animal-source foods. Furthermore, it emphasizes the need for a multi-sectoral approach in enacting policies and programmes that address these barriers.
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Affiliation(s)
| | | | | | - Ty Beal
- Global Alliance for Improved Nutrition (GAIN)WashingtonDCUSA
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Martins FA, Ramalho AA, de Andrade AM, Opitz SP, Koifman RJ, de Aguiar DM, da Silva IF. Minimum acceptable diet in a cohort of children aged between 6 and 15 months: Complementary feeding assessment and associated factors in the Brazilian western Amazon. Nutrition 2024; 117:112231. [PMID: 37976617 DOI: 10.1016/j.nut.2023.112231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/17/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The goal of the article was to assess complementary feeding patterns, and associated factors, of children between 6 and 15-month old in Rio Branco-Acre, Brazil, based on the minimum acceptable diet indicator. METHODS This study was cross-sectional, including 857 children between ages 6 and 15 mo, from a 2015 birth cohort of Rio Branco, Brazil. The prevalence of complementary feeding indicators, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet was estimated based on the recommendations of the World Health Organization. Sociodemographic characteristics, infant and maternal habits, prenatal information, birth characteristics, breastfeeding, and complementary feeding were evaluated. Differences between the proportions were evaluated by the χ2 test and univariate and multiple logistic regression analyses, to determine associated factors with child minimum acceptable diet. RESULTS The minimum frequencies of meals and dietary diversity were observed in 81.0% and 51.8% of the children, respectively. The minimum acceptable diet prevalence was 47.1%. Also, minimum acceptable diet was inversely associated with C, D, and E social classes (adjusted odds ratio = 0.49; 95% CI, 0.33-0.72), number of living siblings (adjusted odds ratio for two or three children = 0.69; 95% CI, 0.48-0.98, and adjusted odds ratio for ≥ 4 children = 0.56; 95% CI, 0.37-0.84). Maternal regular consumption of fruits, vegetables, and legumes (adjusted odds ratio = 2.62; 95% CI, 1.69-4.05), child age from 12 to 15 mo (adjusted odds ratio = 2.05; 95% CI, 1.32-3.18), and receiving guidance regarding complementary feeding during postnatal consultations (adjusted odds ratio = 1.38; 95% CI, 1.03-1.86) were directly associated with minimum acceptable diet. CONCLUSIONS Fewer than 50% of the children received adequate food with adequate frequency and diversity. Low socioeconomic status and having ≥ 2 living siblings reduced the chance of minimum acceptable diet, whereas maternal healthy diet, child age (12-15 mo), and complementary feeding counseling during postnatal appointments increased the chance of minimum acceptable diet.
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Affiliation(s)
| | | | | | - Simone Perufo Opitz
- Graduate Program of Community Health, Federal University of Acre, Rio Branco, Brazil
| | - Rosalina Jorge Koifman
- Department of Epidemiology and Quantitative Methods of Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Debora Melo de Aguiar
- Graduate Program of Community Health, Federal University of Acre, Rio Branco, Brazil
| | - Ilce Ferreira da Silva
- Department of Epidemiology and Quantitative Methods of Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Mohammed KAA, Salih EMM, Alamr F, Alzahrani MMM, Khallufah ASA, Alghamdi KAK, Alzahrani YFY, Alzahrani YMS. Complementary Feeding for Children Aged 6-24 Months: Impact and Maternal Awareness in Al Baha City, Saudi Arabia. Cureus 2024; 16:e53086. [PMID: 38414687 PMCID: PMC10897635 DOI: 10.7759/cureus.53086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/29/2024] Open
Abstract
Background Breastfeeding and complementary feeding are essential for baby health and nutrition. Concerning these feeding habits, there is a dearth of information on mother awareness and behaviors in Saudi Arabia. This study intends to evaluate maternal knowledge of breastfeeding and complementary feeding in Al Baha City, Saudi Arabia. Methodology This cross-sectional prospective study was conducted among mothers in Al Baha City, Saudi Arabia. Data were collected using a structured electronic questionnaire and analyzed using descriptive statistics and a chi-square test. Results We received 524 responses. The majority of participants (358, 68.2%) were found to have sufficient understanding of breastfeeding and complementary feeding. Four hundred and forty participants (84%) were aware that breastfeeding should begin immediately after birth, but only 250 (47.7%) participants knew the proper time to start complementary feeding. Three hundred and ninety-six (75.6%) participants were aware of the proper duration of exclusive breastfeeding, whereas 128 (24.4%) of them did not know. The study showed that factors such as occupation, family economic status, and educational level influence maternal knowledge of complementary feeding. Conclusions The study revealed that the majority of participants had good knowledge about breastfeeding and complementary feeding. The study highlights effective training and public awareness initiatives aimed at improving mothers' knowledge and practices regarding feeding. Additionally, it sheds light on the healthcare providers' exemplary knowledge and attitudes toward appropriate feeding practices among mothers in Al Baha City.
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Affiliation(s)
| | - Elfatih Mirghani M Salih
- Department of Pediatrics, Dongola University, Dongola, SDN
- Department of Pediatrics, Al Baha University, Al Baha, SAU
| | - Fahad Alamr
- Faculty of Medicine, Al Baha Univeristy, Al Baha, SAU
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Bassetti E, Blankenship J, White JM, Mulder A, Threapleton D, Pries AM. Benchmarking the nutrient composition and labelling practices of commercially produced ready-to-eat purées and meals for older infants and young children across seven Southeast Asian countries. MATERNAL & CHILD NUTRITION 2023; 19 Suppl 2:e13585. [PMID: 38092377 PMCID: PMC10719058 DOI: 10.1111/mcn.13585] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 12/17/2023]
Abstract
Commercially produced complementary foods (CPCF), including ready-to-eat CPCF purées and meals, are gaining popularity among caregivers of older infants and young children (IYC) as a convenient alternative to home-prepared foods in low and middle-income countries. However, there is growing concern regarding the suitability of these products for older IYC, as they can contain high levels of sugar and/or sodium. Given the rapidly evolving market in Southeast Asia, it is crucial to monitor the appropriate composition and promotion of CPCF in the region. This study examined the nutrient composition and labelling practices of CPCF purées and meals sold in 2021 in the capital cities of seven Southeast Asian countries: Phnom Penh (Cambodia), Jakarta (Indonesia), Manila (Philippines), Bangkok (Thailand), Vientiane (Lao PDR), Hanoi (Viet Nam), Kuala Lumpur (Malaysia). The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older IYC. The proportion of CPCF purées and meals that would require a high sugar front-of-pack warning based on the percentage energy from total sugar was also determined. Of the 459 CPCF purées/meals assessed, only 37.7% of the products met all nutrient composition requirements and none met all labelling requirements. In addition, most CPCF purées and meals were identified as having high total sugar content. To ensure that older IYC consume appropriate CPCF products, Southeast Asian countries need to implement and enforce regulations concerning the nutrient composition and labelling practices of CPCF purées and meals.
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Blankenship J, Nguyen T, White JM, Badham J, Zambrano P, Vu D, Nguyen H, Cashin J, Kupka R. Overpromoted and underregulated: National binding legal measures related to commercially produced complementary foods in seven Southeast Asian countries are not fully aligned with available guidance. MATERNAL & CHILD NUTRITION 2023; 19 Suppl 2:e13588. [PMID: 38092379 PMCID: PMC10719056 DOI: 10.1111/mcn.13588] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/11/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023]
Abstract
The market for commercially produced complementary foods (CPCF) is rapidly expanding in Southeast Asia; however, the existence and content of mandatory national policies, standards and legislation (binding legal measures) for CPCF in the region is unclear. To assess the status of national binding legal measures for CPCF in Southeast Asia, a legal and policy desk review was conducted in seven countries (Cambodia, Laos People's Democratic Republic, Indonesia, Malaysia, Philippines, Thailand and Viet Nam). The alignment of the national binding legal measures relevant to CPCF was assessed against guidance on CPCF nutrient composition and labelling requirements provided by Codex Alimentarius and the World Health Organization (WHO). Each of the seven countries had at least two national binding legal measures related to the nutrient composition or labelling of CPCF; however, there was limited alignment with the guidance from Codex and WHO. No country was fully aligned with the three CPCF-specific Codex standards/guidelines and only one country was in full alignment with the recommendations related to the protection of breastfeeding from the 'WHO Guidance on ending the inappropriate promotion of foods for infants and young children'. The findings of the review indicate that the existing national binding legal measures are insufficient to ensure that the CPCF sold as suitable for older infants and young children are nutritionally adequate and labelled in a responsible manner that does not mislead caregivers. Improved and enforced national binding legal measures for CPCF, in alignment with global guidance, are required to ensure that countries protect, promote and support optimal nutrition for children 6-36 months of age.
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Affiliation(s)
| | - Tuan Nguyen
- Alive and Thrive East Asia Pacific, FHI 360/FHI SolutionsHanoiVietnam
| | | | | | - Paul Zambrano
- Alive and Thrive East Asia Pacific, FHI 360/FHI SolutionsHanoiVietnam
| | - Duong Vu
- Alive and Thrive East Asia Pacific, FHI 360/FHI SolutionsHanoiVietnam
| | | | - Jennifer Cashin
- Alive and Thrive East Asia Pacific, FHI 360/FHI SolutionsHanoiVietnam
| | - Roland Kupka
- UNICEF East Asia Pacific Regional OfficeBangkokThailand
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White JM, Drummond E, Bijalwan V, Singhkumarwong A, Betigeri A, Blankenship J. Micronutrient gaps during the complementary feeding period in seven countries in Southeast Asia: A Comprehensive Nutrient Gap Assessment. MATERNAL & CHILD NUTRITION 2023; 19 Suppl 2:e13577. [PMID: 38092378 PMCID: PMC10719053 DOI: 10.1111/mcn.13577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 12/17/2023]
Abstract
The complementary feeding period is a critical stage of child development when micronutrient needs are high and challenging to meet. Understanding if specific micronutrient gaps exist during this period is critical for effective programming. A Comprehensive Nutrient Gap Assessment (CONGA) was conducted in seven countries in Southeast Asia to estimate gaps in micronutrients commonly lacking in the diets of children aged 6-23 months and to establish the certainty of available evidence for each identified gap. Sixty-eight evidence sources were identified during this analysis, and 310 micronutrient-specific data points were identified across all seven countries. Data points varied in recency, representativeness and evidence type. The CONGA methodology enabled the estimation of a gap burden rating for each micronutrient in each country, as well as a rating of their evidence certainty. Micronutrient gaps were identified in vitamin D, zinc and iron and a potential gap was identified in calcium during the complementary feeding period in the region. Evidence relevant to intake and deficiency of folate, vitamin B12 , thiamine, niacin, vitamin C and vitamin B6 was limited across the region. Proven strategies to address these gaps include increasing the availability and consumption of nutrient-dense foods, micronutrient supplementation, large-scale fortification of staple foods and condiments and point-of-use fortification through multiple micronutrient powders and fortified speciality foods. More recent data on micronutrient availability, intake and deficiency is urgently needed in Southeast Asia.
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Affiliation(s)
| | | | | | | | - Arvind Betigeri
- World Food Programme Asia and the Pacific Regional OfficeBangkokThailand
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13
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Bassetti E, Blankenship J, White JM, Sweet L, Threapleton D, Pries AM. Benchmarking the nutrient composition and labelling practices of dry or instant cereals for older infants and young children across seven Southeast Asian countries. MATERNAL & CHILD NUTRITION 2023; 19 Suppl 2:e13603. [PMID: 38092376 PMCID: PMC10719057 DOI: 10.1111/mcn.13603] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/17/2023]
Abstract
In Southeast Asia, the increasing availability of commercially produced complementary foods (CPCF), including dry or instant cereals (CPCF cereals), has been noted, however, concerns exist around their nutrient profile and labelling practices. This 2021 study assessed the nutrient composition, labelling practices, and micronutrient content of CPCF cereals sold in the capital cities of seven Southeast Asian countries: Phnom Penh (Cambodia), Jakarta (Indonesia), Manila (Philippines), Bangkok (Thailand), Vientiane (Lao PDR), Hanoi (Vietnam), and Kuala Lumpur (Malaysia). The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older infants and young children. Micronutrient content of fortified CPCF cereals was assessed against fortification levels specified in the Codex Alimentarius guideline for formulated complementary foods. Of the 484 products assessed, 184 (38.0%) met all nutrient composition requirements. Around one-third of CPCF cereals contained added sugars and/or sweeteners (37.2%) and high levels of sodium (28.9%). None of the CPCF cereals met all labelling requirements, primarily due to the presence of inappropriate claims on the labels. Most fortified CPCF cereals contained adequate amounts of critical micronutrients, such as calcium, iron, zinc, vitamin A, and vitamin D. However, rates of fortification varied across the seven countries, and almost a third (30.8%) of CPCF cereals were not fortified with any micronutrients. To support the appropriate promotion of CPCF in the region, Southeast Asian countries need to strengthen and enforce national binding legal measures, including national standards for the composition, labelling, and fortification of CPCF cereals.
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Upadhyay RP, Taneja S, Strand TA, Hysing M, Koshy B, Bhandari N, Bahl R. Milk-cereal mix supplementation during infancy and impact on neurodevelopmental outcomes at 12 and 24 months of age: a randomised controlled trial in India. Br J Nutr 2023; 130:868-877. [PMID: 36539339 PMCID: PMC10404480 DOI: 10.1017/s0007114522003944] [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: 09/30/2022] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
Inadequate protein intake and lack of micronutrients may affect neurodevelopment in infants. This randomised controlled trial was conducted to measure the effect of two milk-cereal mixes with modest and high amounts of protein and enriched with multiple micronutrients, given between 6 and 12 months, on cognitive, language, motor and behavioural scores at 12 and 24 months of age, compared with no-supplementation. The two supplements were also compared with each other. The study was conducted in urban Delhi, India, and the infants were randomised in a 1:1:1 ratio to the three study groups. At 12 and 24 months of age, 1134 and 1214 children were available, respectively. At 12 months of age, compared with no-supplement group, an increase in the motor scores (mean difference, MD 1·52, 95 % CI: 0·28, 2·75) and a decrease in the infant temperament scores (MD - 2·76, 95 % CI: -4·23, -1·29) in the modest-protein group was observed. Those in the high-protein group had lower socio-emotional scores (MD - 1·40, 95 % CI: -2·43, -0·37) and higher scores on Infant Temperament Scale (MD 2·05, 95 % CI: 0·62, 3·48) when compared with modest-protein group. At 24 months, no significant differences in any of the neurodevelopment scores between the three study groups was found. In conclusion, supplementation with modest amount of protein and multiple micronutrients may lead to short-term small improvements in motor function and infant temperament. There appears no advantage of supplementing with high protein, rather negative effects on infant behaviour were observed.
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Affiliation(s)
- Ravi Prakash Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tor Arne Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Beena Koshy
- Department of Developmental Pediatrics, Christian Medical College, Vellore, India
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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15
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Theophilus RJ, Taft DH. Antimicrobial Resistance Genes (ARGs), the Gut Microbiome, and Infant Nutrition. Nutrients 2023; 15:3177. [PMID: 37513595 PMCID: PMC10383493 DOI: 10.3390/nu15143177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The spread of antimicrobial resistance genes (ARGs) is a major public health crisis, with the ongoing spread of ARGs leading to reduced efficacy of antibiotic treatments. The gut microbiome is a key reservoir for ARGs, and because diet shapes the gut microbiome, diet also has the potential to shape the resistome. This diet-gut microbiome-resistome relationship may also be important in infants and young children. This narrative review examines what is known about the interaction between the infant gut microbiome, the infant resistome, and infant nutrition, including exploring the potential of diet to mitigate infant ARG carriage. While more research is needed, diet has the potential to reduce infant and toddler carriage of ARGs, an important goal as part of maintaining the efficacy of available antibiotics and preserving infant and toddler health.
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Affiliation(s)
- Rufus J Theophilus
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - Diana Hazard Taft
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
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Akseer N, Tasic H, Adeyemi O, Heidkamp R. Concordance and determinants of mothers' and children's diets in Nigeria: an in-depth study of the 2018 Demographic and Health Survey. BMJ Open 2023; 13:e070876. [PMID: 37433728 DOI: 10.1136/bmjopen-2022-070876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES Improving the diversity of the diets in young children 6-23 months is a policy priority in Nigeria and globally. Studying the relationship between maternal and child food group intake can provide valuable insights for stakeholders designing nutrition programmes in low-income and middle-income countries. DESIGN We examined the relationship between maternal and child dietary diversity among 8975 mother-child pairs using the Nigeria 2018 Demographic and Health Survey (DHS). We assessed concordance and discordance between maternal and child food group intake using the McNemar's χ2 test, and the determinants of child minimum dietary diversity (MDD-C) including women MDD (MDD-W) using hierarchical multivariable probit regression modelling. SETTING Nigeria. PARTICIPANTS 8975 mother-child pairs from the Nigeria DHS. PRIMARY AND SECONDARY OUTCOME MEASURES MDD-C, MDD-W, concordance and discordance in the food groups consumed by mothers and their children. RESULTS MDD increased with age for both children and mothers. Grains, roots and tubers had high concordance in mother-child dyads (90%); discordance was highest for legumes and nuts (36%), flesh foods (26%), and fruits and vegetables (39% for vitamin-A rich and 57% for other). Consumption of animal source food (dairy, flesh foods, eggs) was higher for dyads with older mothers, educated mothers and more wealthy mothers. Maternal MDD-W was the strongest predictor of MDD-C in multivariable analyses (coef 0.27; 95% CI 0.25 to 0.29, p<0.000); socioeconomic indicators including wealth (p<0.000), mother's education (p<0.000) were also statistically significant in multivariable analyses and rural residence (p<0.000) was statistically significant in bivariate analysis. CONCLUSION Programming to address child nutrition should be aimed at the mother-child dyad as their food consumption patterns are related and some food groups appear to be withheld from children. Stakeholders including governments, development partners, non-governmental organizations, donors and civil society can act on these findings in their efforts to address undernutrition in the global child population.
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Affiliation(s)
- Nadia Akseer
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hana Tasic
- Modern Scientist Global, St Catharines, Ontario, Canada
| | - Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Nigeria
| | - Rebecca Heidkamp
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Champeny M, Yuen-Esco K, Juniza E, Sy NY, Kane R, Badham J, Mulder A, Pries AM. Accuracy of declared nutrient content on labels of commercial complementary food products in Cambodia, Indonesia and Senegal. MATERNAL & CHILD NUTRITION 2023; 19:e13504. [PMID: 36961253 DOI: 10.1111/mcn.13504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 06/14/2023]
Abstract
Commercially produced complementary foods (CPCF) have the potential to fill nutritional gaps in the diets of older infants and young children. This study evaluated the accuracy of nutrient declarations on labels of 43 commonly available CPCF in three peri-urban/urban locations: Khsach Kandal district, Cambodia (n = 11); Bandung, Indonesia (n = 11) and Guédiawaye and Dakar departments, Senegal (n = 21). Label values (LV) from product nutrient declarations were compared to analytical values (AV) derived from laboratory nutrient analysis for macronutrients (carbohydrate, protein and total fat), nutrients of public health concern (saturated fat, total sugar and sodium), and micronutrients of interest (calcium, iron and zinc). European Union guidance for nutrition label accuracy was used to set tolerance ranges for each nutrient LV relative to AV. LV were missing for one or more nutrients in 88.4% (n = 38) of the CPCF products and no CPCF met EU tolerance thresholds for all nine nutrients assessed. Over half of products with LV for key micronutrients (55.6%, n = 10/18) and macronutrients (54.8%, n = 23/42) met tolerances for LV accuracy. Eighty-five percent (n = 11/13) of products with LV for nutrients of public health concern were determined to be accurate. Nutrient content claims for iron appeared on 19 (44.2%) of the 43 products. Of the products which made an iron content claim, 26.3% had inaccurate LV with the majority of these containing less iron than declared. Regulatory action is needed to ensure that CPCF labelling communicates complete and accurate nutrient content information that enables caregivers to make informed decisions for feeding older infants and young children.
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Affiliation(s)
| | | | - Eva Juniza
- Helen Keller International, New York, New York, USA
| | - Ndeye Y Sy
- Helen Keller International, New York, New York, USA
| | | | - Jane Badham
- JB Consultancy, Johannesburg, Gauteng, South Africa
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18
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Vanderkooy A, Ferguson EL, Sy NY, Kane R, Diagne M, Mbodji A, Pries AM. High unhealthy food and beverage consumption is associated with poor diet quality among 12-35-month-olds in Guédiawaye Department, Senegal. Front Nutr 2023; 10:1125827. [PMID: 37404859 PMCID: PMC10315617 DOI: 10.3389/fnut.2023.1125827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/19/2023] [Indexed: 07/06/2023] Open
Abstract
Background High consumption of unhealthy foods and beverages (UFB) during early childhood is cause for concern, with growing evidence from low- and middle-income countries finding associations with poor diet quality and malnutrition. Research from sub-Saharan Africa remains limited, with no studies quantifying the contribution of UFB to total energy intakes among young children or exploring the relationship between such intakes and diet quality or anthropometric outcomes. Objectives Assess UFB consumption patterns and their contribution to total energy intake from non-breastmilk foods/beverages (TEI-NBF), assess the association between high UFB consumption and dietary/nutrition outcomes, and explore drivers of unhealthy food choice among young children in Guédiawaye Department, Senegal. Methods We conducted a cross-sectional study of a representative sample of 724 primary caregivers and their 12-35.9-month-old children. The study included a questionnaire, a quantitative four-pass 24-h dietary recall, and anthropometric measurements. The contribution of UFB to TEI-NBF was calculated and terciles generated. Logistic and linear models were used to compare outcomes of high versus low UFB consumption terciles. Results UFB contributed on average 22.2% of TEI-NBF, averaging 5.9% for the lowest tercile and 39.9% for the highest. Diets of high UFB consumers, as compared to low, were significantly less dense in protein, fiber, and seven of the 11 micronutrients assessed and significantly denser in total fat, saturated fat, and total sugar. No associations were found with anthropometric outcomes. High UFB consumers were older and more likely to be living in food insecurity. The most common drivers of commercial UFB consumption were related to child preference, the use of these products as behavior management tools, treats, or gifts, and the sharing of these products by someone else eating them. Conclusion High UFB consumption is associated with poor diet quality among 12-35-month-olds in Guédiawaye Department, Senegal. Addressing high UFB consumption during this critical developmental period should be prioritized in young child nutrition research, programming, and policy development.
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Affiliation(s)
| | - Elaine L. Ferguson
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Maty Diagne
- Direction de la Santé de la Mère et de l’Enfant, Division Alimentaire et Nutrition, Ministère de la Santé et de l’Action Sociale, Dakar, Senegal
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19
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Gsoellpointner M, Eibensteiner F, Thanhaeuser M, Ristl R, Jilma B, Berger A, Haiden N. Effects of early introduction of solid foods on nutrient intake in preterm infants during their 1st year of life: a secondary outcome analysis of a prospective, randomized intervention study. Front Nutr 2023; 10:1124544. [PMID: 37275631 PMCID: PMC10232899 DOI: 10.3389/fnut.2023.1124544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/21/2023] [Indexed: 06/07/2023] Open
Abstract
Very low birth weight (VLBW) infants have higher nutritional needs even after hospital discharge. However, data concerning current nutrient intakes at different time points after the introduction of solid foods and whether dietary reference values are being met are scarce. To adress this issue, this secondary analysis of a prospective, two-arm interventional study in 177 VLBW infants 21 investigates dietary intake comparing early and late (early: 10-12 weeks corrected for gestational age, late: 16-18 weeks corrected for gestational age) introduction of standardized complementary food during the first year of life. Nutritional intake was assessed using self-reported monthly 3-day dietary records from 3 until 12 months, corrected for gestational age. The time point of the introduction of solid foods did not influence nutrient intake, but the early introduction of solids tended toward a higher proportional intake of protein and carbohydrates and a lower intake of fat as a percentage of total energy) during the 1st year of life, corrected for gestational age. The results of this study indicate that this standardized feeding concept was sufficient for zinc, calcium, and phosphorus intake. However, dietary iron and vitamin D intakes did not meet the recommendations. Thus, prolonged iron supplementation should be considered beyond the introduction of meat and vitamin D supplementation at least until 12 months, corrected for gestational age. Trial registration number ClinicalTrials.gov: NCT01809548.
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Affiliation(s)
| | - Fabian Eibensteiner
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Margarita Thanhaeuser
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Nadja Haiden
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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20
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Kalam MA, Asif CAA, Stormer A, Bishop T, Jackson‐deGraffenried M, Talukder A. Use of designing for behaviour change framework in identifying and addressing barriers to and enablers of animal source feeding to children ages 8-23 months in Bandarban Hill District in Bangladesh: Implications for a nutrition-sensitive agriculture programme. MATERNAL & CHILD NUTRITION 2023; 19:e13472. [PMID: 36606599 PMCID: PMC10019048 DOI: 10.1111/mcn.13472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
Inadequate diet quality is a cause of undernutrition among children 6-23 months of age in Bangladesh, particularly in remote and isolated areas such as Bandarban District. Feeding animal source foods can help to combat stunting and wasting problems among children, but it may not be accessible or acceptable. A barrier analysis using the Designing for Behavior Change Framework was conducted in Bandarban district with participants from 4 ethnic groups, to explore potential barriers and key motivators by examining 12 behavioural determinants of consumption of animal-source food in complementary feeding for children 8-23 months. Data were collected from 45 mothers of children 8-23 months, who provided animal-source foods to their children (doers), and from 45 mothers who did not (non-doers), for a total of 90 interviews. Nine determinants were statistically significantly different between doers and non-doers as follows: self-efficacy, positive consequences, negative consequences, social norms, access, reminders, perceived risk, perceived severity and perceived action efficacy. Nearby access to purchase animal-source foods, rearing poultry or livestock at home and the support of household and community members are enablers to feeding animal-source food. In contrast, these same factors are barriers for non-doers. The lack of money to spend on animal-source foods is also a barrier. An integrated nutrition-sensitive and gender-transformative animal-based food production, and inclusive market programme could increase access to meat and eggs at the household level, increase opportunities to earn income and support gender-equitable household workloads and decision-making for optimal child feeding.
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Affiliation(s)
- Md Abul Kalam
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Helen Keller InternationalDhakaBangladesh
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21
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Kang Y, Heidkamp RA, Mako-Mushaninga K, Garg A, Matji JN, Nyawo M, Craig HC, Thorne-Lyman AL. Factors associated with diet diversity among infants and young children in the Eastern and Southern Africa region. MATERNAL & CHILD NUTRITION 2023:e13487. [PMID: 36924028 DOI: 10.1111/mcn.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/18/2023]
Abstract
This study explores common factors associated with not meeting minimum dietary diversity (MDD) among 27,072 children aged 6-23 months in Eastern and Southern Africa using data from nine Demographic and Health Surveys from 2013 to 2016. MDD was defined as consumption of more than or equals to five of eight food groups including breast milk in the past 24 h. Equity gaps were calculated as the difference in MDD prevalence between the top and bottom wealth quintiles. Logistic regression was conducted to identify common factors for not meeting MDD at the household, maternal and child levels across two or more countries to inform regional policies to improve children's diets. Kenya had the highest MDD wealth equity gap (40.4 pts), and South Africa had the smallest (14.4 pts). Equity gaps for flesh foods or eggs (up to 39.8 pp) were larger than for grain or legumes (up to 20 pp). Common risk factors for not reaching MDD included younger child age (6-11 months) (n = 9 countries), no formal maternal occupation (n = 6), not receiving vitamin-A supplementation (n = 3), younger maternal age (n = 3), lower maternal education (n = 3), no media (n = 3) or newspaper (n = 3) exposure, lower household wealth quintile (n = 3), use of nonefficient cooking fuel (n = 2), longer time to get to the water source (n = 2), not listening to the radio (n = 2) and higher birth order (n = 2). Priorities for improving MDD in the region include introducing diverse foods at a young age from 6 months with early nutrition counselling, promoting higher maternal education, increasing food purchasing power and ensuring the support of younger mothers.
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Affiliation(s)
- Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca A Heidkamp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Aashima Garg
- UNICEF Program Division, New York City, New York, USA
| | - Joan N Matji
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Mara Nyawo
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Hope C Craig
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew L Thorne-Lyman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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22
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Pasqualino MM, Shaikh S, McGready J, Islam MT, Ali H, Ahmed T, West KP, Alam M, Hossain MI, Labrique AB, Palmer AC. An Egg Intervention Improves Dietary Intakes but Does Not Fill Intake Gaps for Multiple Micronutrients among Infants in Rural Bangladesh. J Nutr 2023; 153:1199-1210. [PMID: 36806554 DOI: 10.1016/j.tjnut.2023.02.004] [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: 10/01/2022] [Revised: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Eggs are nutrient-rich. Strengthening evidence of the impact of egg consumption on dietary quality can inform complementary feeding guidance. OBJECTIVES We aimed to assess the effect of an egg intervention on dietary intakes among infants aged 6-12 mo in rural Bangladesh. METHODS We conducted a cluster-randomized controlled trial allocating clusters (n = 566) to enteric pathogen control or placebo treatment, with daily provision of a protein-rich meal, isocaloric meal, egg, or control. Nutrition education was provided to all arms. Our focus here is on the egg and control arms. Infants were enrolled at 3 mo. From 6 mo, we visited households weekly to distribute eggs and measure compliance. A semistructured feeding questionnaire assessed 24-h intake at 6, 9, and 12 mo. Assessments were repeated in ∼10% of subjects 2-29 d later. Using NCI SAS macros, we estimated usual intake distributions for energy, protein, fat, and 18 micronutrients and the proportion meeting intake recommendations. We compared the outcomes between the arms using clustered bootstrapping. RESULTS Data were available from 757 infants (137 clusters) and 943 infants (141 clusters) in the egg and control arms, respectively. In the egg arm compared with the control arm, the mean usual intakes were higher for energy (610 compared with 602 kcal/d, 9 mo; 669 compared with 658 kcal/d, 12 mo), crude protein (2.2 compared with 1.7 g/(kg·d), 9 mo; 2.4 compared with 1.9 g/(kg·d), 12 mo), available protein (2.0 compared with 1.6 g/(kg·d), 9 mo; 2.1 compared with 1.8 g/(kg·d), 12 mo), and for 13 and 14 micronutrients at 9 and 12 mo, respectively. The proportion meeting intake recommendations for most micronutrients was higher in the egg arm but remained <50% for 15 and 13 micronutrients at 9 and 12 mo, respectively. CONCLUSIONS Daily egg consumption improved dietary intakes among Bangladeshi infants, but was insufficient to meet multiple micronutrient intake recommendations, demonstrating the need to be coupled with other strategies.
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Affiliation(s)
- Monica M Pasqualino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Hasmot Ali
- The JiVitA Project, Gaibandha, Bangladesh
| | | | - Keith P West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Alain B Labrique
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda C Palmer
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Moramarco S, Roster Mwaba I, Chafula Muyaba L, Palombi L, Buonomo E. Improvement in dietary diversity and feeding habits of malnourished under-five children attending supplementary feeding programmmes: a community-based cross-sectional study in Zambia. Int J Food Sci Nutr 2023; 74:82-94. [PMID: 36356200 DOI: 10.1080/09637486.2022.2144148] [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: 11/12/2022]
Abstract
A community-based cross-sectional study was conducted on 390 under-five malnourished children enrolled in the Rainbow Project supplementary feeding programmmes-SFPs. Dietary diversity, feeding habits and nutritional status at admission (T1) and at discharge (T2) were compared. At T1 the diet was monotonous and unbalanced, with a progressive decline in dietary diversity and anthropometric values noted with children's age growth (p < 0.001). Significant improvements were registered at T2: DDS 5.1 ± 1.1 SD vs. 8.3 ± 1.0 SD; meal frequency 3.0 ± 0.6 SD vs. 4.9 ± 0.2 SD; animal-protein consumed 62.8% vs. 90.5%; drinking water treated 41.0% vs. 97.2%. At T1, the risk of having ZMUAC < 2.5SD increased when teenage motherhood (AOR: 5.3; CI: 1.8-15.2; p = 0.002), followed by children's age >2 years (AOR: 1.9; CI: 1.1-3.5; p = 0.020). Children's age was associated with an increased risk of WAZ < 2.5 SD (AOR: 4.9; CI: 2.4-10.4; p < 0.001). When considering inadequate DDS, the variable associated was breastfeeding cessation (AOR: 12.0; CI: 4.6-31.4; p < 0.001). Rainbow's SFPs have proved effective in treating under-five malnourished children, irrespective of the severity of malnutrition.
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Affiliation(s)
- Stefania Moramarco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Rainbow Project, Association Pope John the 23rd, Ndola, Zambia
| | | | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Anemia among Syrian Refugee Children Aged 6 to 23 Months Living in Greater Beirut, Lebanon, including the Voices of Mothers' and Local Healthcare Staff: A Mixed-Methods Study. Nutrients 2023; 15:nu15030700. [PMID: 36771406 PMCID: PMC9920708 DOI: 10.3390/nu15030700] [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: 12/03/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow's milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.
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Ribeiro C, Severo M, Oliveira A, Barros H, Ramos E. Are problematic eating behaviors from 4- to 7-year-old explained by genetic, shared factors or individual characteristics? A longitudinal twin study. Eur J Clin Nutr 2023; 77:82-89. [PMID: 35945260 DOI: 10.1038/s41430-022-01192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 01/28/2023]
Abstract
Studies based on twins are ideal to disentangle the relative contribution of different factors in the development of eating behaviors. This study aims to evaluate if changes in problematic eating behaviors from 4 to 7 years old are more influenced by the genetics, the shared environment of twins, or by individual characteristics of each twin. A total of 86 caregivers (mostly mothers) of twins from the Generation XXI birth cohort provided information on eating behaviors at 4 and 7 years of age. A score of problematic eating behaviors was developed. The Common fate model and the ACE model were used to estimate the effect of shared, individual, and genetic characteristics on changes in eating behaviors. At the dyadic level (shared), the eating behavior score at 4 years old was significantly and positively associated with the eating behavior at 7 years of age (β = 0.402, 95% CI 0.063;0.657). At the individual level, no significant association was observed (β = 0.020, 95% CI -0.078;0.125). The ACE model also showed the shared environment as the major responsible for the changes in eating behaviors from 4 to 7 years old. It also showed that genetic characteristics decreased their relevance overtime. This study supports that changes in eating behaviors from 4 to 7 years of age are mostly associated with the shared environment rather than individual characteristics of each twin. These results are important to improve future strategies to promote healthy environments.
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Affiliation(s)
- Cláudia Ribeiro
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319, Porto, Portugal.
| | - Milton Severo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, 4050-313, Porto, Portugal
| | - Andreia Oliveira
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319, Porto, Portugal
| | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319, Porto, Portugal
| | - Elisabete Ramos
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319, Porto, Portugal
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Bhati D, Tripathy A, Mishra PS, Srivastava S. Contribution of socio-economic and demographic factors to the trend of adequate dietary diversity intake among children (6-23 months): evidence from a cross-sectional survey in India. BMC Nutr 2022; 8:153. [PMID: 36575545 PMCID: PMC9793661 DOI: 10.1186/s40795-022-00655-z] [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: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The present study aims to estimate the factors contributing to the change adequate diversified dietary intake (ADDI) from 2005-06 to 2015-16 among children aged 6-23 months in India. METHODS A cross-sectional study was conducted using a large representative survey data. Data from the National Family Health Survey 2005-06 and 2015-16 was used. The effective sample size for the present study was 14,422 and 74,132 children aged 6-23 months in 2005-06 and 2015-16, respectively. The outcome variable was minimum adequate dietary diversity intake. Binary logistic regression was used to evaluate the factors associated with ADDI. Additionally, the Fairlie method of decomposition was used, which allows quantifying the total contribution of factors explaining the decadal change in the probability of ADDI among children aged 6-23 months in India. RESULTS There was a significant increase in ADDI from 2005-06 to 2015-16 (6.2%; p < 0.001). Additionally, compared to the 2005-06 years, children were more likely to have ADDI [AOR; 1.29, CI: 1.22-1.35] in 2015-16. Mother's education explained nearly one-fourth of the ADDI change among children. Further, the regional level contribution of 62.3% showed that the gap was widening across regions between the year 2005-06 and 2015-16 in ADDI among children. The child's age explained 5.2% with a positive sign that means it widened the gaps. Whereas the household wealth quintile negatively contributed and explained by -5.2%, that means between the years the gaps has reduced in ADDI among children aged 6-23 months. CONCLUSION Our findings indicate that increasing awareness of the use of mass media and improving the education levels of mothers would be beneficial for adequate dietary diversity intake among children aged 6-23 months. Investments should support interventions to improve overall infant and young children feeding practices in India.
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Affiliation(s)
| | - Abhipsa Tripathy
- grid.412779.e0000 0001 2334 6133PG Department of Statistics, Utkal University, Vani Vihar, Odisha Bhubaneswar, 751004 India
| | - Prem Shankar Mishra
- grid.464840.a0000 0004 0500 9573Population Research Centre, Institute for Social and Economic Change, Bengaluru, 560072 Karnataka India
| | - Shobhit Srivastava
- grid.419349.20000 0001 0613 2600 Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, 400088 Maharashtra India
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Mukwevho T, Smuts CM, Asare H, Faber M. Energy and nutrient contribution of different food groups to the dietary intake of 6- to <9-month-old infants in a low socioeconomic community in North West Province, South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2022.2141051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tshiphiri Mukwevho
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Hannah Asare
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Mieke Faber
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa
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McKune SL, Mechlowitz K, Miller LC. Dietary animal source food across the lifespan in LMIC. GLOBAL FOOD SECURITY 2022. [DOI: 10.1016/j.gfs.2022.100656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pikosky MA, Ragalie-Carr J, Miller GD. Recognizing the importance of protein quality in an era of food systems transformation. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.1012813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A transformation of current food systems is needed to nourish the growing global population in more sustainable ways. To support this, some are advocating for a shift to plant-based or -exclusive diets. These recommendations – typically borne out of concerns for the environment – often fail to account for unintended nutritional consequences, which could be particularly pronounced for protein intake. While there is enough protein to meet current global needs, the issue of protein quality is often overlooked and oversimplified. High-quality protein, including from animal source foods (ASF), is needed to meet nutritional demands in low- and middle-income countries (LMIC), particularly among vulnerable population groups. In high-income countries (HIC), protein quality is important for at-risk populations who have higher protein requirements and lower energy and/or protein intakes. Further, as the global population increases, driven primarily by population growth in LMIC, it is possible that protein production will need to increase in HIC to support exports to help feed the global population. The global dialogue and resulting dietary recommendations must therefore become more nuanced to consider the interaction between nutritional value and environmental impact to help better reflect trade-offs across multiple domains of sustainability. Nutritional life cycle assessments are one way to help accomplish this nuance and evaluate how all types of food production systems should be refocused to improve their environmental efficiency and nutritional impact.
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Dietary diversity and its determinants among children aged 6-23 months in Ethiopia: evidence from the 2016 Demographic and Health Survey. J Nutr Sci 2022; 11:e88. [PMID: 36304826 PMCID: PMC9554528 DOI: 10.1017/jns.2022.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6-23 months in Ethiopia. We included 2960 children aged 6-23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6-23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6-23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9-11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12-17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18-23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.
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Anato A, Baye K, Stoecker BJ. Suboptimal feeding practices and impaired growth among children in largely food insecure areas of north Wollo, Ethiopia. J Nutr Sci 2022; 11:e81. [PMID: 36304818 PMCID: PMC9554422 DOI: 10.1017/jns.2022.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/01/2021] [Accepted: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
In Ethiopia, information is limited about energy and micronutrient intakes from complementary foods consumed by children in Productive Safety Net Program districts. Therefore, we assessed feeding practices and intakes of energy and selected micronutrients from complementary foods of children aged 6-23 months in a food insecure rural area of Ethiopia. Energy and micronutrient intakes were estimated from multiple-pass 24 h recall. Data were collected using a structured questionnaire. Only 1⋅9 % of children in the age range 6-8 months met recommended minimum dietary diversity of ≥5 food groups; this value slightly increased to 4 and 10⋅1 % in the older age groups (9-11 months and 12-23 months, respectively). Overwhelmingly, none of the children (9-11 months) did get the minimum acceptable diet (Children receiving minimum acceptable diet were 4 and 2⋅6 % in 6-8 months and 12-23 months, respectively). The overall prevalence of stunting was 34 % in younger children (6-8 months) and 51 % in older children aged 12-23 months. Median energy and selected micronutrient intakes from complementary foods were below corresponding WHO recommendations assuming average breast-milk amount and composition. The worst shortfalls were for vitamins A and C and for Ca. In contrast, median iron, protein and niacin intakes and densities were above the WHO recommendation. Caretakers and community leaders in the study setting need nutrition education on IYCF-related practices and on the importance of men's involvement in IYCF. Ensuring the accessibility and affordability of animal source foods (ASFs), fruits and vegetables, and feasible complementary foods is critical to address the quality of complementary feedings. This can be achieved through promoting nutrition-sensitive agriculture such as poultry and home gardening in this setting.
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Affiliation(s)
- Anchamo Anato
- School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Barbara J. Stoecker
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
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Appropriate Complementary Feeding Practice and Its Associated Factors among Mothers Who Have Children Aged between 6 and 24 Months in Ethiopia: Systematic Review and Meta-Analysis. J Nutr Metab 2022; 2022:1548390. [PMID: 36245817 PMCID: PMC9553750 DOI: 10.1155/2022/1548390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/08/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background Appropriate complementary feeding practices prevent malnutrition among children. The proportion and determinant factors of appropriate complementary feeding practices identified by different studies were inconsistent in Ethiopia. Therefore, this systematic review and meta-analysis aimed to assess the pooled proportion and determinants of appropriate complementary feeding practices among mothers. Methods Databases (PubMed, HINARI, Google Scholar, Cochrane Library, and Web of Science) and university repositories were used to search for important articles. A critical appraisal of the studies was conducted. Data analysis was conducted using STATA version 11. Cochran (Q test) and I2 test were used to test the heterogeneity of the studies. Publication bias was checked using the funnel plot for asymmetry and Egger's regression test. Results Seventeen primary studies with a total sample size of 9166 mothers were involved in this study. The pooled proportion of appropriate complementary feeding practices among mothers who had infants and young children aged between 6 and 24 months was 21.77 (with a 95% CI: 14.07–29.48). Mothers' educational status of secondary school and above (OR = 3.36 with a 95% CI: 3.03–3.69), having repeated antenatal care visits (OR = 4.77 with a 95% CI: 3.49–6.05), child's age between 12 and 24 months (OR = 3.7 with a 95% CI: 2.75–4.65), having repeated postnatal care visits (OR = 3.17 with a 95% CI: 1.96–4.38), health education (OR = 4.88 with a 95% CI: 3.86–5.9), knowledge of mothers (OR = 4.85 with a 95% CI: 3.77–5.93), maternal age between 18 and 35 years (AOR = 2.67 with a 95% CI: 1.64–3.72), institutional delivery (OR = 2.23 with a 95% CI: 1.79–2.68), and higher household wealth (OR = 2.65 with a 95% CI: 1.46–3.84) were found to be statistically significant associated factors of appropriate complementary feeding practices among mothers. Conclusions The pooled proportion of appropriate complementary feeding practices was low in Ethiopia. Knowledge of mothers and maternal health service uptake such as antenatal care, postnatal care, and institutional delivery increase appropriate complementary feeding practices. More focus is required for mothers who have children aged less than 12 months, mothers aged above 35 years and less than 18 years, lower mothers' educational status, and lower household wealth. Therefore, integrated interventions are still required to improve appropriate complementary feeding practices.
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Commercial Complementary Food in Germany: A 2020 Market Survey. Nutrients 2022; 14:nu14183762. [PMID: 36145138 PMCID: PMC9502210 DOI: 10.3390/nu14183762] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
As consumption of commercial complementary food (CCF) during infancy and toddlerhood is common, the aim of the present study was to describe the current (2020) German market of CCF products targeted at infants and toddlers with a special focus on ingredients, macronutrients, and the practice of nutrient fortification. Information on age declarations, ingredients, energy and nutrient contents, and nutrient fortification was obtained in a market survey by contacting the producers and searching manufacturers’ websites. Each product was assigned to 1 of 13 product categories (menus, milk−cereal−meal, fruit−cereal−meal, oil, vegetables, meat, fish, fruits, cereals, snack foods, pouches, desserts, beverages). Descriptive statistics were used. We identified 1057 CF products on the German market (infants’ CCF (<12 months): n = 829; toddlers’ CCF (>12 months): n = 228)). The highest protein content (% of energy content, %E) was found in meat products. In pouches, beverages, cereal fruit meals, and fruits, more than 50% of energy came from total sugar. The highest median salt content was found in toddlers’ menus and desserts. Around one-third of infants’ CCF products and one quarter of toddlers’ products were fortified with nutrients. Vitamin B1 (thiamin) was the most frequently fortified nutrient, followed by vitamin C, iron, calcium, and vitamin D. Apple was the type of fruit listed most often in products with fruits, whereas carrot was the most frequent vegetable among CCF with vegetables. In particular, the high total sugar content of most CCFs currently available on the German market may promote unhealthy dietary habits. Parents need to be advised about the optimal selection of products.
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Bocquet A, Brancato S, Turck D, Chalumeau M, Darmaun D, De Luca A, Feillet F, Frelut ML, Guimber D, Lapillonne A, Linglart A, Peretti N, Rozé JC, Simeoni U, Briend A, Dupont C, Chouraqui JP. "Baby-led weaning" - Progress in infant feeding or risky trend? Arch Pediatr 2022; 29:516-525. [PMID: 36109286 DOI: 10.1016/j.arcped.2022.08.012] [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: 01/19/2022] [Revised: 04/12/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
Baby-led weaning (BLW), proposed as a new form of complementary feeding, has emerged as a real trend phenomenon in the media. Infants are seated at the family table from the age of 6 months, facing the foods they grab and bring to their mouth: they decide which foods they want to eat and what amount. The consumption of mashed foods and the use of a spoon are totally discouraged. BLW is increasingly used in nurseries and centers of young children. A bibliographic search carried out between 2000 and 2021 found 423 articles, of which 38 were selected. The clinical studies selected are 11 cross-sectional observational studies and two randomized controlled studies. BLW promotes breastfeeding, the early introduction of morsels, the respect of the child's appetite, the use of unprocessed foods, and the choice of "homemade" and friendliness. These benefits can nonetheless be reached with usual complementary feeding (SCF), according to current recommendations. Other benefits are claimed without scientific evidence such as easier achievement of dietary complementary feeding and an optimal growth with prevention of excess weight gain. BLW has some obvious downsides. The infant may not get enough energy, iron, zinc, vitamins, and other nutrients, or too much protein, saturated fat, salt, or sugar. The risk of choking, which must be distinguished from the physiological gagging reflex, has not been ruled out by scientific studies. Currently, the Nutrition Committee of the French Pediatric Society considers that the data published to date in terms of benefits and risks of BLW do not lend themselves to advice for this practice in preference over SCF carried out according to current recommendations.
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Affiliation(s)
- A Bocquet
- Université de Franche-Comté, 25000 Besançon, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France.
| | - S Brancato
- Cabinet de pédiatrie, 4, rue du puits Descarsses, 30190 Brignon, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France
| | - D Turck
- Université de Lille, INFINITE-Inserm U1286, 59000 Lille, France
| | - M Chalumeau
- Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker - Enfants malades, AP HP, France; Centre of Research in Epidemiology and Statistics (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team, INSERM; Université de Paris, Paris, France
| | - D Darmaun
- Inra UMR1280, Université Nantes-Atlantique, 44300 Nantes, France
| | - A De Luca
- Université de Tours, 37000 Tours, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M-L Frelut
- Cabinet de pédiatrie, 16, rue Septfonds, 81000 Albi, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France
| | - D Guimber
- Université de Lille, 59000 Lille, France
| | - A Lapillonne
- Université de Paris,EA7328,AP-HP, hôpital Necker-Enfants-Malades, 75015 Paris, France
| | - A Linglart
- AP-HP, Université Paris Saclay, endocrinologie et diabète de l'enfant, Hôpital Bicêtre, le Kremlin Bicêtre, France
| | - N Peretti
- Université de Lyon, Hospices Civils de Lyon, CaRMEN, 69000 Lyon, France
| | - J-C Rozé
- Inra UMR1280, Université Nantes-Atlantique, 44300 Nantes, France
| | - U Simeoni
- Université of Lausanne, CHUV, 1011 Lausanne, Switzerland
| | - A Briend
- Institut de Recherche Pour le Développement, 13002 Marseille, France
| | - C Dupont
- Université de Paris 75015 Paris, France; Clinique Marcel-Sembat, 92100 Boulogne-Billancourt, France
| | - J-P Chouraqui
- Gastro-entérologie et nutrition pédiatriques DMCP, CHUV, rue du Bugnon, 46, 1011 Lausanne, Switzerland
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- Hôpital Necker - Enfants-Malades (NEM), 149, rue de Sèvres, 75015 Paris, France
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Faber M, Malan L, Kruger HS, Asare H, Visser M, Mukwevho T, Ricci C, Smuts CM. Potential of Egg as Complementary Food to Improve Nutrient Intake and Dietary Diversity. Nutrients 2022; 14:nu14163396. [PMID: 36014905 PMCID: PMC9416406 DOI: 10.3390/nu14163396] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
The original aim was to determine the effect of egg consumption on infant growth in a low socioeconomic community in South Africa in a randomized controlled trial. Enrolment was, however, prematurely stopped due to COVID-19 lockdown regulations. The resultant small sample (egg group n = 70; control group n = 85) was followed up to assess the feasibility of egg consumption for eight months in terms of dietary intake, egg usage and perceived effects of lockdown on child feeding. Egg consumption remained low in the control group, <10% consumed egg ≥4 days/week at the follow-up points. In the egg group, egg was frequently consumed at midpoint (daily 87.1%, 4−6 days 8.1%) and endpoint (daily 53.1%, 4−6 days 21.9%). At endpoint, dietary intake of cholesterol and vitamin D was higher, and intake of niacin and vitamin B6 lower in the egg group compared to the control group. Dietary diversity was low, 36.2% of the egg group and 18.9% of the control group (p < 0.05) achieved minimum dietary diversity at endpoint. No babies developed egg allergy or sensitization, and adjusted regression analysis showed that frequency of egg intake was not related with the incidence or duration of allergy-related symptoms. This study showed that frequent egg consumption can contribute safely to complementary food for babies, especially in low- and middle-income countries.
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Affiliation(s)
- Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2530, South Africa
- Correspondence:
| | - Linda Malan
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2530, South Africa
| | - Herculina S. Kruger
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2530, South Africa
| | - Hannah Asare
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2530, South Africa
| | - Marina Visser
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2530, South Africa
| | - Tshiphiri Mukwevho
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2530, South Africa
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom 2530, South Africa
| | - Cornelius M. Smuts
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom 2530, South Africa
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Retail Cost and Energy Adjusted Cost Are Associated with Dietary Diversity and Nutrient Adequacy for Diets of 6–24 Months Children. Nutrients 2022; 14:nu14163376. [PMID: 36014881 PMCID: PMC9415705 DOI: 10.3390/nu14163376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Poor nutrition during the first two years of life has long term consequences, but resource-poor households often do not have the means to access nutrient-dense and diverse diets. Pooled data of 24-h dietary recalls (n = 3336) and 2019 retail food prices were analyzed to determine associations of retail cost and energy cost (per 100 kcal) with diet quality indicators for diets of 6–24-month-old South African children who were breastfed (BF-diet) and not breastfed (NBF-diet) during the 24-h recall period. Compared to the BF-diet, retail cost for the NBF-diet was three times higher for age 6–11 months, and double for age 12–17 months. Higher retail cost and energy cost were both associated with higher mean adequacy ratios and dietary diversity scores for BF and NBF diets, except energy cost for the NBF-diet for age 6–11 months. Overall, inclusion of flesh foods, vitamin A-rich fruits and vegetables, and other fruit and vegetables increased from the lowest to the highest retail cost tertile. The higher cost of more nutritious diets highlights the importance of the affordability of diets in interventions aimed at improving diet quality. Possible strategies include: identifying the most-affordable foods within each food group, focusing on foods that provide multiple key micronutrients, and the inclusion of locally available indigenous foods.
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Iannotti LL, Gyimah EA, Reid M, Chapnick M, Cartmill MK, Lutter CK, Hilton C, Gildner TE, Quinn EA. Child dietary patterns in Homo sapiens evolution: A systematic review. Evol Med Public Health 2022; 10:371-390. [PMID: 36042843 PMCID: PMC9415195 DOI: 10.1093/emph/eoac027] [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: 12/30/2021] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Dietary patterns spanning millennia could inform contemporary public health nutrition. Children are largely absent from evidence describing diets throughout human evolution, despite prevalent malnutrition today signaling a potential genome-environment divergence. This systematic review aimed to identify dietary patterns of children ages 6 months to 10 years consumed before the widespread adoption of agriculture. Metrics of mention frequency (counts of food types reported) and food groups (globally standardized categories) were applied to: compare diets across subsistence modes [gatherer-hunter-fisher (GHF), early agriculture (EA) groups]; examine diet quality and diversity; and characterize differences by life course phase and environmental context defined using Köppen-Geiger climate zones. The review yielded child diet information from 95 cultural groups (52 from GHF; 43 from EA/mixed subsistence groups). Animal foods (terrestrial and aquatic) were the most frequently mentioned food groups in dietary patterns across subsistence modes, though at higher frequencies in GHF than in EA. A broad range of fruits, vegetables, roots and tubers were more common in GHF, while children from EA groups consumed more cereals than GHF, associated with poor health consequences as reported in some studies. Forty-eight studies compared diets across life course phases: 28 showed differences and 20 demonstrated similarities in child versus adult diets. Climate zone was a driver of food patterns provisioned from local ecosystems. Evidence from Homo sapiens evolution points to the need for nutrient-dense foods with high quality proteins and greater variety within and across food groups. Public health solutions could integrate these findings into food-based dietary guidelines for children.
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Affiliation(s)
- Lora L Iannotti
- Brown School, Institute for Public Health, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Emmanuel A Gyimah
- Brown School, Institute for Public Health, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Miranda Reid
- Brown School, Institute for Public Health, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Melissa Chapnick
- Brown School, Institute for Public Health, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Mary Kate Cartmill
- Brown School, Institute for Public Health, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Chessa K Lutter
- RTI International, 701 13th St NW #750, Washington, DC 20005, USA
| | - Charles Hilton
- Department of Anthropology, University of North Carolina-Chapel Hill, CB#3115, 301 Alumni Hall, 207 E. Cameron Avenue, Chapel Hill, NC 27599, USA
| | - Theresa E Gildner
- Department of Anthropology, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1114, St. Louis, MO 63130, USA
| | - Elizabeth A Quinn
- Department of Anthropology, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1114, St. Louis, MO 63130, USA
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Bassetti E, Zehner E, Mayhew SH, Nasser N, Mulder A, Badham J, Sweet L, Crossley R, Pries AM. Nutrient profiles of commercially produced complementary foods available in Cambodia, Indonesia and the Philippines. Public Health Nutr 2022; 25:1-11. [PMID: 35786427 PMCID: PMC9991791 DOI: 10.1017/s1368980022001483] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/06/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the nutritional suitability of commercially produced complementary foods (CPCF) marketed in three South-East Asian contexts. DESIGN Based on label information declared on the products, nutrient composition and content of CPCF were assessed against the WHO Europe nutrient profile model (NPM). The proportion of CPCF that would require a 'high sugar' warning was also determined. SETTING Khsach Kandal district, Cambodia; Bandung City, Indonesia; and National Capital Region, Philippines. PARTICIPANTS CPCF products purchased in Cambodia (n 68) and Philippines (n 211) in 2020, and Indonesia (n 211) in 2017. RESULTS Only 4·4 % of products in Cambodia, 10·0 % of products in Indonesia and 37·0 % of products in the Philippines fully complied with relevant WHO Europe NPM nutrient composition requirements. Sixteen per cent of CPCF in Cambodia, 27·0 % in Indonesia and 58·8 % in the Philippines contained total sugar content levels that would require a 'high sugar' warning. CONCLUSIONS Most of the analysed CPCF were not nutritionally suitable to be promoted for older infants and young children based on their nutrient profiles, with many containing high levels of sugar and sodium. Therefore, it is crucial to introduce new policies, regulations and standards to limit the promotion of inappropriate CPCF in the South-East Asia region.
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Affiliation(s)
- Eleonora Bassetti
- Helen Keller International, New York, NY, USA
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nadine Nasser
- Access to Nutrition Initiative, Utrecht, Netherlands
| | | | | | - Lara Sweet
- JB Consultancy, Johannesburg, South Africa
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Daher S, Ziade F, Nasreddine L, Baroudi M, Naja F. Breastfeeding and complementary feeding in fragile settings: the case of Syrian refugees and their host communities in North Lebanon. Int Breastfeed J 2022; 17:37. [PMID: 35568877 PMCID: PMC9107246 DOI: 10.1186/s13006-022-00480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate breastfeeding and complementary feeding practices are paramount in fragile situations where access to food and healthcare is limited. The objectives of this study are to examine breastfeeding and complementary feeding practices among Syrian refugees and their Lebanese host communities and to investigate the correlates of exclusive breastfeeding (EBF) at four and 6 months in these communities. METHODS Using two-stage stratified sampling, a cross-sectional survey was conducted in Akkar, a region with a high density of Syrian refugees in Lebanon, between April and November 2019. In one-to-one interviews, mothers of children (6-24 months) completed a questionnaire including specific questions about breastfeeding and complementary feeding practices, a 24-h recall, and socio-demographic characteristics for 189 Syrian refugees and 182 Lebanese host community households. Descriptive statistics, simple and multiple logistic regression were used in data analysis. RESULTS Among breastfeeding practices, ever-breastfeeding was most prevalent (90%), followed by early initiation of breastfeeding (64.8%), EBF at four (49.6%), and six (36%) months. One in four children was introduced to solids before 6 months of age, and less than a third was given iron-fortified baby cereals as the first complementary foods. Only 24.4% and 9.2% of children met the minimum dietary diversity and minimum acceptable diet requirements, respectively. Compared to children of the Lebanese host communities, those of Syrian refugees had higher rates of EBF at four and 6 months as well as continued breastfeeding at 1 year, whereas only 17.9% of Syrian refugees' children met minimum dietary diversity compared to 30.9% of Lebanese host community children (p < 0.05). Among refugees, education and spouse's employment status were associated with higher odds of EBF at 4 months. As for Lebanese households, female children were less likely to be exclusively breastfed at 4 months and 6 months, while a natural delivery increased the odds of EBF at 6 months. CONCLUSION Breastfeeding and complementary feeding practices are suboptimal among children of Syrian refugees and their Lebanese host communities in North Lebanon. There is a need for intervention strategies to tackle gaps in services and assistance delivery programs to enhance infant and young child feeding practices among both communities.
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Affiliation(s)
- Sara Daher
- Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Ziade
- Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Riad El Solh, 1107 2020, Lebanon
| | - Moomen Baroudi
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Riad El Solh, 1107 2020, Lebanon
| | - Farah Naja
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, 27272, UAE. .,Faculty of Agriculture and Food Sciences, American University of Beirut, Riad El Solh, 1107 2020, Lebanon.
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Maiyo NC, Khamis FM, Okoth MW, Abong GO, Subramanian S, Egonyu JP, Xavier C, Ekesi S, Omuse ER, Nakimbugwe D, Ssepuuya G, Ghemoh CJ, Tanga CM. Nutritional Quality of Four Novel Porridge Products Blended with Edible Cricket (Scapsipedus icipe) Meal for Food. Foods 2022; 11:foods11071047. [PMID: 35407134 PMCID: PMC8998076 DOI: 10.3390/foods11071047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/13/2022] Open
Abstract
Currently, no data exist on the utilization of the newly described cricket species (Scapsipedus icipe) meal as additive in food products, though they have high protein (57%) with 88% total digestibility as well as a variety of essential amino acids. This article presents the first report on the effects of processing techniques and the inclusion of cricket meal (CM) on the nutrient and antinutrient properties of four porridge products compared to a popularly consumed commercial porridge flour (CPF). Porridge enriched with CM had significantly higher protein (2-folds), crude fat (3.4–4-folds), and energy (1.1–1.2-folds) levels than the CPF. Fermented cereal porridge fortified with CM had all three types of omega-3 fatty acids compared to the others. The vitamin content across the different porridge products varied considerably. Germinated cereal porridge with CM had significantly higher iron content (19.5 mg/100 g). Zinc levels ranged from 3.1–3.7 mg/100 g across the various treatments. Total flavonoid content varied significantly in the different porridge products. The phytic acid degradation in germinated and fermented porridge products with CM was 67% and 33%, respectively. Thus, the fortification of porridge products with cricket and indigenous vegetable grain powder could be considered an appropriate preventive approach against malnutrition and to reduce incidences in many low-and middle-income countries.
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Affiliation(s)
- Nelly C. Maiyo
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772, Nairobi 00100, Kenya; (N.C.M.); (F.M.K.); (S.S.); (J.P.E.); (C.X.); (S.E.); (E.R.O.)
- Department of Food Science, Nutrition and Technology, University of Nairobi, P.O. Box 30197, Nairobi 00100, Kenya; (M.W.O.); (G.O.A.)
| | - Fathiya M. Khamis
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772, Nairobi 00100, Kenya; (N.C.M.); (F.M.K.); (S.S.); (J.P.E.); (C.X.); (S.E.); (E.R.O.)
| | - Michael W. Okoth
- Department of Food Science, Nutrition and Technology, University of Nairobi, P.O. Box 30197, Nairobi 00100, Kenya; (M.W.O.); (G.O.A.)
| | - George O. Abong
- Department of Food Science, Nutrition and Technology, University of Nairobi, P.O. Box 30197, Nairobi 00100, Kenya; (M.W.O.); (G.O.A.)
| | - Sevgan Subramanian
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772, Nairobi 00100, Kenya; (N.C.M.); (F.M.K.); (S.S.); (J.P.E.); (C.X.); (S.E.); (E.R.O.)
| | - James P. Egonyu
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772, Nairobi 00100, Kenya; (N.C.M.); (F.M.K.); (S.S.); (J.P.E.); (C.X.); (S.E.); (E.R.O.)
| | - Cheseto Xavier
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772, Nairobi 00100, Kenya; (N.C.M.); (F.M.K.); (S.S.); (J.P.E.); (C.X.); (S.E.); (E.R.O.)
| | - Sunday Ekesi
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772, Nairobi 00100, Kenya; (N.C.M.); (F.M.K.); (S.S.); (J.P.E.); (C.X.); (S.E.); (E.R.O.)
| | - Evanson R. Omuse
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772, Nairobi 00100, Kenya; (N.C.M.); (F.M.K.); (S.S.); (J.P.E.); (C.X.); (S.E.); (E.R.O.)
| | - Dorothy Nakimbugwe
- Department of Food Technology and Nutrition, School of Food Technology, Nutrition and Bioengineering, Makerere University, Kampala P.O. Box 7062, Uganda; (D.N.); (G.S.)
| | - Geoffrey Ssepuuya
- Department of Food Technology and Nutrition, School of Food Technology, Nutrition and Bioengineering, Makerere University, Kampala P.O. Box 7062, Uganda; (D.N.); (G.S.)
| | - Changeh J. Ghemoh
- Centre for African Bio-Entrepreneurship (CABE), P.O. Box 25535, Nairobi 00603, Kenya;
| | - Chrysantus M. Tanga
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772, Nairobi 00100, Kenya; (N.C.M.); (F.M.K.); (S.S.); (J.P.E.); (C.X.); (S.E.); (E.R.O.)
- Correspondence: ; Tel.: +254-702-729-931
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Kimere NC, Nambooze J, Lim H, Bulungu AL, Wellard K, Ferguson EL. A food‐based approach could improve dietary adequacy for 12–23‐month‐old Eastern Ugandan children. MATERNAL & CHILD NUTRITION 2022; 18:e13311. [PMID: 34981664 PMCID: PMC8932727 DOI: 10.1111/mcn.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/12/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
Little is known about dietary adequacy, for young Ugandan children, or context‐specific food choices to improve it. This study estimated the percentage of breastfed 12–23‐month‐old rural Eastern Ugandan children (n = 114) at risk of inadequate intakes of 12 nutrients; and identified realistic food choices for improving it. In this cross‐sectional survey, dietary (weighed food records), anthropometric and socioeconomic data were collected. The percentages of children at risk of inadequate nutrient intakes were estimated, assuming 541 g/day of breast milk was consumed. The median nutrient densities of their complementary feeding diets were also compared with desired levels. Linear programming analyses were used to identify ‘problem nutrients’ (where requirements will be difficult to meet given dietary practices) and model food choices to improve dietary adequacy. Overall, 21.2% of children were stunted and 3.8% were wasted. A high percentage (>45%) of children were at risk of inadequate intakes, for nine of the 12 nutrients assessed, and dietary nutrient densities were below desired levels for seven of the 12 nutrients. Iron, calcium, thiamine and niacin were ‘problem nutrients’. Through careful selection of foods, modelling indicates that population level dietary adequacy can be achieved for eight of the 12 nutrients modelled. These choices include cows' milk, legumes, green leafy vegetables, sweet potatoes and fruits. Overall results suggest these high percentages of children at risk of inadequate nutrient intakes can be reduced through behaviour change interventions, although additional interventions may be required to ensure population‐level dietary adequacy for iron, thiamine and niacin. Dietary adequacy, for breastfed 12–23‐month‐old rural Eastern Ugandan children, is poor with over 45% of children at risk of inadequate intakes of nine micronutrients. Inadequate intakes of micronutrients likely contribute to growth faltering in this population where 21% of children are stunted but less than 4% are wasted. Dietary adequacy can be improved through careful selection of nutrient‐dense foods, including cows' milk, legumes, green leafy vegetables, sweet potatoes, and fruits. A food‐based approach alone, however, will not reduce the percentage of children at risk of inadequate intakes to low levels, for iron, thiamine and perhaps niacin, indicating alternative interventions are required.
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Affiliation(s)
- Njeri C. Kimere
- Department of Population Health London School of Hygiene and Tropical Medicine London UK
| | - Joweria Nambooze
- Department of Food Systems and Nutrition Africa Innovations Institute Kampala Uganda
| | - Haeun Lim
- Department of Population Health London School of Hygiene and Tropical Medicine London UK
| | - Andrea L.S. Bulungu
- Department of Population Health London School of Hygiene and Tropical Medicine London UK
| | - Kate Wellard
- Livelihoods and Institutions Department, Natural Resources Institute University of Greenwich, Medway Campus Chatham UK
| | - Elaine. L. Ferguson
- Department of Population Health London School of Hygiene and Tropical Medicine London UK
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Cartmill MK, Blackmore I, Sarange C, Mbeyu R, Cheupe C, Cheupe J, Kamau-Mbuthia E, Iannotti L, Wamukota A, Humphries A, Lesorogol C. Fish and complementary feeding practices for young children: Qualitative research findings from coastal Kenya. PLoS One 2022; 17:e0265310. [PMID: 35286341 PMCID: PMC8920237 DOI: 10.1371/journal.pone.0265310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
This study examines barriers to fish consumption during the complementary feeding period in two coastal counties of Kenya with high rates of child malnutrition. Study findings indicate that young child fish consumption is impacted by factors related to accessibility, food preferences, and caregiver's knowledge and beliefs about fish during the complementary feeding period. These factors are influenced by prominent community figures such as elder women and health workers, whose own beliefs and understandings are impacted by underlying cultural norms, potentially limiting fish consumption. To our knowledge, this is the first study conducted in the coastal region of Kenya to focus on understanding fish consumption attitudes and beliefs during the complementary feeding phase. Our findings represent a critical first step towards the creation of more effective policies and interventions to address the significant nutritional disparities that exist in the study population.
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Affiliation(s)
- Mary Kate Cartmill
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Ivy Blackmore
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | | | - Ruth Mbeyu
- Department of Human Nutrition, Egerton University, Nakuru, Kenya
| | | | - Joaquim Cheupe
- Department of Environmental Sciences, Pwani University, Kilifi, Kenya
| | | | - Lora Iannotti
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Andrew Wamukota
- Department of Environmental Sciences, Pwani University, Kilifi, Kenya
| | - Austin Humphries
- Department of Fisheries, Animal and Veterinary Sciences, University of Rhode Island, Kingston, Rhode Island, United States of America
- Graduate School of Oceanography, University of Rhode Island, Narragansett, Rhode Island, United States of America
| | - Carolyn Lesorogol
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
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Chittchang U, Rojroongwasiukul N, Winnichagoon P, Watson L, Ferguson E. Mathematical modeling to inform the development of national guidelines on infant feeding in Thailand. Ann N Y Acad Sci 2022; 1511:142-153. [PMID: 35061914 PMCID: PMC9303245 DOI: 10.1111/nyas.14738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
The development of national dietary guidelines promoting healthy food choices is a public health priority in Thailand. In developing the recent national complementary feeding guidelines (CFGs) for 6‐ to 12‐month‐old children, mathematical modeling was used to inform decisions. Model parameters were derived from nationally representative dietary data and analyzed for 11 micronutrients by age group, using linear programming analysis in Optifood. Models were run to identify micronutrients whose nutrient reference values could not be met using local foods as consumed (problem nutrients), evaluate the original 2012 Thai CFGs, and predict the nutritional benefits of a specific fortified complementary food. The results identified three problem nutrients (iron, calcium, and zinc), which, for 9‐ to 11‐month‐olds, were reduced to one when the fortified food was modeled. The number of servings/week of vegetables and meat, fish or eggs were higher, and of oil and fruit were lower, in the modeled nutritionally best rather than observed diets (medians). When modeled, the original Thai CFGs were not feasible because the energy constraint was exceeded; hence, in revising them, the recommended number of servings/week of oil and fruit were reduced. This study demonstrates the advantages of using mathematical modeling, when revising national CFGs, to evaluate and improve them.
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Affiliation(s)
| | | | | | - Louise Watson
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | - Elaine Ferguson
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
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Molani Gol R, Kheirouri S, Alizadeh M. Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:65-83. [PMID: 35000681 DOI: 10.1016/j.jneb.2021.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to present an overview of the association between dietary diversity (DDiv) and growth outcomes (stunting, wasting, and underweight) in children aged < 5 years. DESIGN This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. SETTING AND PARTICIPANTS PubMed, Scopus, Embase, Cochrane library, and Google Scholar databases were searched up to February, 2021, using relevant keywords as follows: "Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety," "under-nutrition or stunting or wasting or underweight or nutritional status," and "children or infants." Original articles published in English were eligible for this review. Newcastle-Ottawa scales and the Cochrane Collaboration's tool were used to assess the quality and risk of bias of the articles. MAIN OUTCOME MEASURES, ANALYSIS, AND RESULTS Totally, 81 articles (70 cross-sectional, 4 longitudinal cohort, 5 case-control, and 2 randomized controlled trials) were included in this review. Of the studies, 45 focused on infants and 36 on children aged < 5 years. The reviewed articles had good quality and low risk of bias (scores > 6). In infants, low DDiv was associated with stunting, wasting, and being underweight (79%, 57%, and 68% of the studies, respectively). Among children aged < 5 years, the association was observed in 75%, 56%, and 57% of the studies, respectively, for stunting, wasting, and underweight. CONCLUSIONS AND IMPLICATIONS The findings indicate a possible association between low DDiv of infants and children aged < 5 years with stunting. However, this association remained uncertain with wasting and being underweight.
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Affiliation(s)
- Roghayeh Molani Gol
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sorayya Kheirouri
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Alizadeh
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Gassmann F, de Groot R, Dietrich S, Timar E, Jaccoud F, Giuberti L, Bordon G, Fautsch-Macías Y, Veliz P, Garg A, Arts M. Determinants and drivers of young children's diets in Latin America and the Caribbean: Findings from a regional analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000260. [PMID: 36962164 PMCID: PMC10021987 DOI: 10.1371/journal.pgph.0000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
The Latin America and Caribbean region exhibit some of the lowest undernutrition rates globally. Yet, disparities exist between and within countries and countries in the region increasingly face other pressing nutritional concerns, including overweight, micronutrient deficiencies and inadequate child feeding practices. This paper reports findings from a regional analysis to identify the determinants and drivers of children's diets, with a focus on the complementary feeding window between the age of 6-23 months. The analysis consists of a narrative review and descriptive data analysis, complemented with qualitative interviews with key informants in four countries: Guatemala, Paraguay, Peru and Uruguay. Findings indicate that poverty and inequality (disparities within countries by wealth and residence), unequal access to services, inadequate coverage of social programmes and lack of awareness on appropriate feeding practices are important drivers for inadequate diets. We conclude that countries in the region need to invest in policies to tackle overweight and micronutrient deficiencies in young children, considering inequalities between and within countries, enhance coverage of social protection programmes, improve coordination between sectors to improve children's diets and expand the coverage and intensity of awareness campaigns on feeding practices, using iterative programme designs.
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Affiliation(s)
| | | | | | - Eszter Timar
- UNU-MERIT, Maastricht University, Maastricht, Netherlands
| | | | | | - Giulio Bordon
- UNU-MERIT, Maastricht University, Maastricht, Netherlands
| | - Yvette Fautsch-Macías
- UNICEF Latin America and Caribbean Regional Office, New York, New York, United States of America
| | - Paula Veliz
- UNICEF Latin America and Caribbean Regional Office, New York, New York, United States of America
| | - Aashima Garg
- UNICEF, New York, New York, United States of America
| | - Maaike Arts
- UNICEF Latin America and Caribbean Regional Office, New York, New York, United States of America
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Maulu S, Nawanzi K, Abdel-Tawwab M, Khalil HS. Fish Nutritional Value as an Approach to Children's Nutrition. Front Nutr 2021; 8:780844. [PMID: 34977125 PMCID: PMC8715098 DOI: 10.3389/fnut.2021.780844] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022] Open
Abstract
Fish is a relatively cheap and accessible source of animal protein for human consumption even in rural communities. It is critical for global food and nutrition security, and its consumption continues to increase. As a highly nutritious food, fish consumption is highly recommended for children and expectant mothers for normal growth and development. The present paper explores the nutritional value of fish as approach to nutrition in children and its benefits. The findings reveal that fish is a valuable source of essential amino acids (EAA) and polyunsaturated fatty acids (PUFAs) that play important physiological functions for maintenance and development of fetuses, neonates, and infant brains. Therefore, it could be a valuable tool in the fight against food insecurity and malnutrition. However, fish and fish products are also highly susceptible to contamination by various organic and inorganic compounds that threaten public health. Particularly, heavy metals and biogenic amines (BAs) have shown adverse effects when contaminated fish is consumed, and the effects in children have been worse. Hence, while fish consumption is highly recommended for children's nutrition, the safety and quality of the product should always be checked to safeguard public health.
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Affiliation(s)
- Sahya Maulu
- Centre for Innovative Approach Zambia (CIAZ), Lusaka, Zambia
| | - Kundananji Nawanzi
- Department of Agriculture and Aquatic Sciences, Kapasa Makasa University, Chinsali, Zambia
| | - Mohsen Abdel-Tawwab
- Department of Fish Biology and Ecology, Central Laboratory for Aquaculture Research, Agriculture Research Center, Abbassa, Sharqia, Egypt
| | - Hala Saber Khalil
- Aquaculture and Fisheries Group, Wageningen Institute of Animal Sciences, Wageningen University and Research, Wageningen, Netherlands
- WorldFish, Africa Aquaculture Research and Training Center, Abbassa, Egypt
- Aquaculture Division, National Institute of Oceanography and Fisheries (NIOF), Cairo, Egypt
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Dewey KG, Wessells KR, Arnold CD, Prado EL, Abbeddou S, Adu-Afarwuah S, Ali H, Arnold BF, Ashorn P, Ashorn U, Ashraf S, Becquey E, Bendabenda J, Brown KH, Christian P, Colford JM, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Humphrey JH, Huybregts L, Iannotti LL, Jannat K, Lartey A, Le Port A, Leroy JL, Luby SP, Maleta K, Matias SL, Mbuya MNN, Mridha MK, Nkhoma M, Null C, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Prendergast AJ, Ruel M, Shaikh S, Weber AM, Wolff P, Zongrone A, Stewart CP. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2021; 114:15S-42S. [PMID: 34590672 PMCID: PMC8560308 DOI: 10.1093/ajcn/nqab278] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design. OBJECTIVES We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes. METHODS We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. RESULTS SQ-LNS provision decreased stunting (length-for-age z score < -2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < -2] by 14%, low midupper arm circumference (MUAC) (<125 mm or MUAC-for-age z score < -2) by 18%, acute malnutrition (WLZ < -2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z score < -2) by 13%, and small head size (head circumference-for-age z score < -2) by 9%. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS. Effects of SQ-LNSs on stunting, wasting, low MUAC, and small head size were greater among girls than among boys; effects on stunting, underweight, and low MUAC were greater among later-born (than among firstborn) children; and effects on wasting and acute malnutrition were greater among children in households with improved (as opposed to unimproved) sanitation. CONCLUSIONS The positive impact of SQ-LNSs on growth is apparent across a variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNSs in packages of interventions to prevent both stunting and wasting.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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Affiliation(s)
- Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Bangladesh
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sania Ashraf
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA, USA
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Jaden Bendabenda
- Department of Nutrition and Food Safety, WHO, Geneva, Switzerland
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
- Helen Keller International, New York, NY, USA
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jean H Humphrey
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Kaniz Jannat
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Minyanga Nkhoma
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Harriet Okronipa
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Bangladesh
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | | | | | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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Prado EL, Arnold CD, Wessells KR, Stewart CP, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn U, Ashorn P, Becquey E, Brown KH, Chandna J, Christian P, Dentz HN, Dulience SJL, Fernald LC, Galasso E, Hallamaa L, Hess SY, Huybregts L, Iannotti LL, Jimenez EY, Kohl P, Lartey A, Le Port A, Luby SP, Maleta K, Matchado A, Matias SL, Mridha MK, Ntozini R, Null C, Ocansey ME, Parvez SM, Phuka J, Pickering AJ, Prendergast AJ, Shamim AA, Siddiqui Z, Tofail F, Weber AM, Wu L, Dewey KG. Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers. Am J Clin Nutr 2021; 114:43S-67S. [PMID: 34590116 PMCID: PMC8560311 DOI: 10.1093/ajcn/nqab277] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development. OBJECTIVES We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects. METHODS We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024). RESULTS In 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11). CONCLUSIONS Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.
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Affiliation(s)
- Elizabeth L Prado
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Christine P Stewart
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Kenneth H Brown
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
- Helen Keller International, New York, NY, USA
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly N Dentz
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonja Y Hess
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Elizabeth Y Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Patricia Kohl
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Matchado
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | - Sarker M Parvez
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - John Phuka
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Abu A Shamim
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Zakia Siddiqui
- Healthy Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | - Lee S F Wu
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
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Taneja S, Upadhyay RP, Chowdhury R, Kurpad AV, Bhardwaj H, Kumar T, Dwarkanath P, Bose B, Devi S, Kumar G, Kaur B, Bahl R, Bhandari N. Impact of supplementation with milk-cereal mix during 6-12 months of age on growth at 12 months: a 3-arm randomized controlled trial in Delhi, India. Am J Clin Nutr 2021; 115:83-93. [PMID: 34637505 PMCID: PMC8754995 DOI: 10.1093/ajcn/nqab304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/31/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A large proportion of infants in low- and middle-income countries are stunted. These infants are often fed complementary foods that are low-quality, primarily in terms of protein and micronutrients. OBJECTIVES We aimed to test 2 milk-cereal mixes supplemented with modest and high amounts of protein during 6-12 mo of age, compared with no supplementation, for their effect on length-for-age z score (LAZ) at 12 mo of age. METHODS Eligible infants (6 mo plus ≤29 d) were randomly assigned to either of the 2 interventions (modest- and high-protein) or a no supplement group. The milk-cereal mixes provided ∼125 kcal, 30%-45% energy from fats, and 80%-100% RDA of multiple micronutrients (MMN). The modest-protein group received 2.5 g protein [protein energy ratio (PER): 8%; 0.75 g from milk source] and the high-protein group received 5.6 g protein (PER: 18%, 1.68 g from milk source). One packet was given daily for 180 d. Counseling on continued breastfeeding and optimal infant-care practices was provided to all. RESULTS We enrolled 1548 infants (high-protein: n = 512; modest-protein: n = 519; and no supplement: n = 517). Compared with the no supplement group, there was an improvement in LAZ [adjusted mean difference (MD): 0.08; 95% CI: 0.01, 0.15], weight-for-age z score (MD: 0.12; 95% CI: 0.06, 0.19), weight-for-length z score (MD: 0.11; 95% CI: 0.02, 0.19), and midupper arm circumference z score (MD: 0.10; 95% CI: 0.02, 0.18) in the high-protein group at 12 mo of age. No significant differences for these anthropometric indicators were noted between the modest-protein and no supplement groups or between the high- and modest-protein groups. CONCLUSIONS Cereal mixes with higher amounts of milk-based protein and MMN may lead to improvement in linear growth and other anthropometric indexes in infants, compared with no supplementation.This trial was registered at ctri.nic.in as CTRI/2018/04/012932.
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Affiliation(s)
- Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ravi P Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, India
| | - Himani Bhardwaj
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tivendra Kumar
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Beena Bose
- Department of Physiology, St John's Medical College, Bengaluru, India
| | - Sarita Devi
- Department of Physiology, St John's Medical College, Bengaluru, India
| | - Gunjan Kumar
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Baljeet Kaur
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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50
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Nikièma V, Fogny NF, Kangas ST, Lachat C, Salpéteur C. Availability, use, and consumption practices of ready-to-use therapeutic foods prescribed to children with uncomplicated severe acute malnutrition aged 6-59 months during outpatient treatment in Burkina Faso. Appetite 2021; 168:105751. [PMID: 34648913 DOI: 10.1016/j.appet.2021.105751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/25/2021] [Accepted: 10/09/2021] [Indexed: 11/02/2022]
Abstract
Ready-to-use-therapeutic-foods (RUTF) was designed for the nutritional management of children with uncomplicated severe acute malnutrition (SAM) treated as outpatients. However, to our knowledge, no study has evaluated the availability, use and consumption of RUTF within the beneficiary household in programs and in the context of a reduction in the dose of RUTF. This study, assessed the effect of a reduction in RUTF dose on the availability, use, consumption, and perceptions of caregivers on RUTF prescribed to 516 children treated for SAM, aged 6-59 months in Burkina Faso. Children received a weekly dose of RUTF according to their treatment arm until recovery. Data were collected by structured individual in-depth interviews, with caregivers one month and two months post-admission. Differences between children receiving reduced RUTF (intervention arm) and those receiving standard RUTF (control arm) were assessed by Poisson, logistic, and ordered logistic regression model. RUTF was available for the whole week in 95% in intervention arm compared to about 98% in control arm (p > 0.05). Starting from week 3 onwards, children in intervention arm consumed an average of 9 sachets of RUTF per week compared to 15 sachets in control arm (p < 0.001) and 5% of children in intervention arm reported leftover compared to 11% in control arm (p < 0.05). About 40% of children in intervention arm consumed RUTF at least 3-times per day compared to 82% in control arm (p < 0.001). The amount of RUTF prescribed was perceived as sufficient in 93% by caregivers in intervention arm against 97% in control arm (p > 0.05). In conclusion, reducing the dose of RUTF did not affect the availability of RUTF during treatment but did reduce leftover and the frequency of consumption of RUTF.
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Affiliation(s)
- Victor Nikièma
- Nutrition and Health Department, Action Contre la Faim, mission in Burkina Faso, France; School of Nutrition and Food Sciences and Technologies, Faculty of Agronomic Sciences, University of Abomey-Calavi, Benin.
| | - Nadia F Fogny
- School of Nutrition and Food Sciences and Technologies, Faculty of Agronomic Sciences, University of Abomey-Calavi, Benin
| | - Suvi T Kangas
- Expertise and Advocacy Department, Action contre la Faim, Paris, France
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Belgium
| | - Cécile Salpéteur
- Expertise and Advocacy Department, Action contre la Faim, Paris, France
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