Research

13 pages, 606 KiB

Open AccessArticle

Nutrition, Hygiene and Stimulation Education for Impoverished Mothers in Rural Uganda: Effect on Maternal Depression Symptoms and Their Associations to Child Development Outcomes

by Prudence Atukunda, Grace K. M. Muhoozi, Ane C. Westerberg and Per O. Iversen

Nutrients 2019, 11(7), 1561; https://doi.org/10.3390/nu11071561 - 11 Jul 2019

Cited by 16 | Viewed by 6572

Abstract

Optimal nutrition improves child development, and impaired development is associated with maternal depression symptoms, in particular in low resource settings. In this follow-up of an open cluster-randomized education trial, we examined its effects among mothers in rural Uganda on their depression symptoms and [...] Read more.

Optimal nutrition improves child development, and impaired development is associated with maternal depression symptoms, in particular in low resource settings. In this follow-up of an open cluster-randomized education trial, we examined its effects among mothers in rural Uganda on their depression symptoms and the association of these symptoms to child development. The education comprised complementary feeding, stimulation, and hygiene. We assessed 77 intervention mothers and 78 controls using Beck Depression Inventory-II (BDI-II) and Center for Epidemiologic Studies Depression Scale (CES-D) scores. Child development was assessed with Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores for cognitive, language and motor development. Compared to controls, the intervention reduced depression symptoms’ scores with mean (95% CI) differences: −8.26 (−11.49 to −1.13, p = 0.0001) and −6.54; (−8.69 to −2.99, p = 0.004) for BDI II at 20–24 and 36 months, respectively. Similar results were obtained with CES-D. There was a negative association of BDI-II scores and BSID-III cognitive and language scores at 20–24 (p = 0.01 and 0.008, respectively) and 36 months (p = 0.017 and 0.001, respectively). CES-D associations with BSID-III cognitive and language scores showed similar trends. BSID-III motor scores were associated with depression scores at 36 months for both BDI-II and CES-D (p = 0.043 and 0.028, respectively). In conclusion, the group education was associated with reduced maternal depression scores. Moreover, the depression scores were inversely associated with child cognitive and language development outcomes. Full article

(This article belongs to the Special Issue Complementary Feeding in Infants)

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16 pages, 592 KiB

Open AccessArticle

Identifying Dietary Strategies to Improve Nutrient Adequacy among Ethiopian Infants and Young Children Using Linear Modelling

by Aregash Samuel, Saskia J. M. Osendarp, Elaine Ferguson, Karin Borgonjen, Brenda M. Alvarado, Lynnette M. Neufeld, Abdulaziz Adish, Amha Kebede and Inge D. Brouwer

Nutrients 2019, 11(6), 1416; https://doi.org/10.3390/nu11061416 - 24 Jun 2019

Cited by 10 | Viewed by 4567

Abstract

Nutrient adequacy of young children’s diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6–8, 9–11 and [...] Read more.

Nutrient adequacy of young children’s diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6–8, 9–11 and 12–23 months), and to formulate feasible Food-Based Dietary Recommendations (FBDRs) in four regions which differ in culture and food practices. Alternative interventions including a local complementary food, micronutrient powders (MNPs), Small quantity Lipid-based Nutrient Supplement (Sq-LNS) and combinations of these were modelled in combination with the formulated FBDRs to compare their relative contributions. Risk of inadequate and excess nutrient intakes was simulated using the Estimated Average Requirement cut-point method and the full probability approach. Optimized local diets did not provide adequate zinc in all regions and age groups, iron for infants <12 months of age in all regions, and calcium, niacin, thiamine, folate, vitamin B12 and B6 in some regions and age-groups. The set of regional FBDRs, considerably different for four regions, increased nutrient adequacy but some nutrients remained sub-optimal. Combination of regional FBDRs with daily MNP supplementation for 6–12 months of age and every other day for 12–23 months of age, closed the identified nutrient gaps without leading to a substantial increase in the risk of excess intakes. Full article

(This article belongs to the Special Issue Complementary Feeding in Infants)

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10 pages, 228 KiB

Open AccessFeature PaperArticle

The Early Introduction of Complementary (Solid) Foods: A Prospective Cohort Study of Infants in Chengdu, China

by Chuan Yu, Colin W. Binns and Andy H. Lee

Nutrients 2019, 11(4), 760; https://doi.org/10.3390/nu11040760 - 01 Apr 2019

Cited by 10 | Viewed by 3888

Abstract

The objective of this study was to document the types of foods introduced to infants before six months of age and identify factors associated with their early introduction. A prospective cohort study of infant feeding for the first six months after birth was [...] Read more.

The objective of this study was to document the types of foods introduced to infants before six months of age and identify factors associated with their early introduction. A prospective cohort study of infant feeding for the first six months after birth was undertaken in the city of Chengdu, PR China. The participants were 845 mothers who delivered their infants in hospitals in Chengdu. Mothers were interviewed within 15 days of giving birth and were followed up with for six months. The outcome measures were the introduction of complementary foods to infants within four and six months postpartum. Complementary foods are defined as any food, whether manufactured or locally prepared, used as a complement to breast milk or infant formula. In this study the emphasis was on solids and not liquid foods. More than 94% of the infants were given complementary foods (semi-solid or solid foods) before the age of six months and 10% by four months. The most commonly introduced food was infant cereal, which was given to three quarters of the infants by six months. Multivariate analysis showed that maternal education level was a significant factor affecting the introduction of complementary foods before four months, adjusted odds ratio 2.983 (1.232–7.219), with the more educated mothers introducing complementary foods earlier. More antenatal and postnatal health promotion efforts are required to highlight the benefits of introducing solid foods later than is the current practice in Chengdu, at or close to six months of age. Further education is also required for training health professionals including pediatricians, midwives, and community health staff. Full article

(This article belongs to the Special Issue Complementary Feeding in Infants)

17 pages, 258 KiB

Open AccessArticle

“The One Time You Have Control over What They Eat”: A Qualitative Exploration of Mothers’ Practices to Establish Healthy Eating Behaviours during Weaning

by Eleni Spyreli, Michelle C. McKinley, Virginia Allen-Walker, Louise Tully, Jayne V. Woodside, Colette Kelly and Moira Dean

Nutrients 2019, 11(3), 562; https://doi.org/10.3390/nu11030562 - 06 Mar 2019

Cited by 15 | Viewed by 4983

Abstract

Background: Weaning marks the transition from a milk-only diet to the consumption of solid foods. It is a time period where nutrition holds an undeniable importance and taste experiences have a long-lasting effect on food preferences. The factors and conditions that form parental [...] Read more.

Background: Weaning marks the transition from a milk-only diet to the consumption of solid foods. It is a time period where nutrition holds an undeniable importance and taste experiences have a long-lasting effect on food preferences. The factors and conditions that form parental feeding practices are yet to be fully understood; doing so can help target problematic behaviours and develop interventions aiming to modify them. Objective: This study used a qualitative methodology to gain a better understanding of parental experiences of weaning a child. Particular emphasis was placed on exploring the factors and conditions that favour the establishment of a healthy relationship with food in infancy and those that impede it. Methods: Thirty-seven mothers of healthy infants 3–14 months with no previous history of allergies or food-related disorders were recruited. Eight semi-structured focus group discussions were conducted, transcribed and analysed thematically. Results: Discussions revealed a number of opportunities to establish healthy eating habits during weaning, as well as relevant challenges. Important opportunities included: acting as a role model for healthy foods; giving multiple opportunities to try a food; food variety “so you don’t have a fussy eater”; and without food variety “things aren’t going to work properly”. Additionally, some of the challenges identified were: misconceptions about the definition of food variety; and distractions occurring during feeding. Conclusions: Mothers were mindful of the need to provide their children with appropriate nutritional stimuli during weaning. They were aware of their role in influencing their infants’ likes and used strategies such as modelling and repeated food exposure. The importance of a diverse diet in infancy was acknowledged, although knowledge gaps exist in relation to its definition. Distractions were tactfully employed by mothers to assist feeding. Findings of this study have applications in developing interventions for nutritional education in the complementary feeding period. Full article

(This article belongs to the Special Issue Complementary Feeding in Infants)

14 pages, 992 KiB

Open AccessArticle

Soil Zinc Is Associated with Serum Zinc But Not with Linear Growth of Children in Ethiopia

by Masresha Tessema, Hugo De Groote, Inge D. Brouwer, Edith J.M. Feskens, Tefera Belachew, Dilnesaw Zerfu, Adamu Belay, Yoseph Demelash and Nilupa S. Gunaratna

Nutrients 2019, 11(2), 221; https://doi.org/10.3390/nu11020221 - 22 Jan 2019

Cited by 22 | Viewed by 5254

Abstract

To our knowledge, the relationships among soil zinc, serum zinc and children’s linear growth have not been studied geographically or at a national level in any country. We use data from the cross-sectional, nationally representative Ethiopian National Micronutrient Survey (ENMS) (n = [...] Read more.

To our knowledge, the relationships among soil zinc, serum zinc and children’s linear growth have not been studied geographically or at a national level in any country. We use data from the cross-sectional, nationally representative Ethiopian National Micronutrient Survey (ENMS) (n = 1776), which provided anthropometric and serum zinc (n = 1171) data on children aged 6–59 months. Soil zinc levels were extracted for each child from the digital soil map of Ethiopia, developed by the Africa Soil Information Service. Children’s linear growth was computed using length/height and age converted into Z-scores for height-for-age. Multi-level mixed linear regression models were used for the analysis. Nationally, 28% of children aged 6–59 months were zinc deficient (24% when adjusted for inflammation) and 38% were stunted. Twenty percent of households in the ENMS were located on zinc-deficient soils. Soil zinc (in mg/kg) was positively associated with serum zinc (in µg/dL) (b = 0.9, p = 0.020) and weight-for-height-Z-score (b = 0.05, p = 0.045) but linear growth was not associated with soil zinc (p = 0.604) or serum zinc (p = 0.506) among Ethiopian preschool children. Intervention studies are needed to determine whether there are causal links between soil and human zinc status. Full article

(This article belongs to the Special Issue Complementary Feeding in Infants)

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15 pages, 790 KiB

Open AccessArticle

Biofortified Maize Can Improve Quality Protein Intakes among Young Children in Southern Ethiopia

by Nilupa S. Gunaratna, Debebe Moges and Hugo De Groote

Nutrients 2019, 11(1), 192; https://doi.org/10.3390/nu11010192 - 18 Jan 2019

Cited by 15 | Viewed by 5090

Abstract

Quality protein maize (QPM) varieties are biofortified, or nutritionally improved, to have higher lysine and tryptophan levels to increase quality protein intakes particularly among young children. This study assesses adequacy of children’s protein intakes in Ethiopia, where QPM is being promoted, accounting for [...] Read more.

Quality protein maize (QPM) varieties are biofortified, or nutritionally improved, to have higher lysine and tryptophan levels to increase quality protein intakes particularly among young children. This study assesses adequacy of children’s protein intakes in Ethiopia, where QPM is being promoted, accounting for protein quality and seasonal dietary changes, and estimates potential increases in intakes if QPM replaced conventional maize in diets. Diets of randomly sampled children aged 12–36 months in rural southern Ethiopia (n = 218) were assessed after harvest during relative food security and 3–4 months later during relative food insecurity using 24-h weighed food records. Diets were analyzed for protein adequacy, accounting for protein quality using the protein digestibility corrected amino acid score (PDCAAS) method, and potential improvements from QPM substitution were estimated. Stunting was prevalent (38%) at the first assessment. Across seasons, 95–96% of children consumed maize, which provided 59–61% of energy and 51–55% of total protein in 24 h. Dietary intakes decreased in the food insecure season, though children were older. Among children no longer breastfeeding, QPM was estimated to reduce inadequacy of utilizable protein intakes from 17% to 13% in the food secure season and from 34% to 19% in the food insecure season. However, breastfed children had only 4–6% inadequate intakes of utilizable protein, limiting QPM’s potential impact. Due to small farm sizes, maize stores from home production lasted a median of three months. Young Ethiopian children are at risk of inadequate quality protein intakes, particularly after breastfeeding has ceased and during food insecurity. QPM could reduce this risk; however, reliance on access through home production may result in only short-term benefits given the limited quantities of maize produced and stored. Full article

(This article belongs to the Special Issue Complementary Feeding in Infants)

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17 pages, 881 KiB

Open AccessArticle

Associations among High-Quality Protein and Energy Intake, Serum Transthyretin, Serum Amino Acids and Linear Growth of Children in Ethiopia

by Masresha Tessema, Nilupa S. Gunaratna, Inge D. Brouwer, Katherine Donato, Jessica L. Cohen, Margaret McConnell, Tefera Belachew, Demissie Belayneh and Hugo De Groote

Nutrients 2018, 10(11), 1776; https://doi.org/10.3390/nu10111776 - 16 Nov 2018

Cited by 32 | Viewed by 7800

Abstract

Limited evidence is available on the associations of high-quality protein and energy intake, serum transthyretin (TTR), serum amino acids and serum insulin-like growth factor-1 (IGF-1) with linear growth of young children. Data collected during the baseline of a randomized control trial involving rural [...] Read more.

Limited evidence is available on the associations of high-quality protein and energy intake, serum transthyretin (TTR), serum amino acids and serum insulin-like growth factor-1 (IGF-1) with linear growth of young children. Data collected during the baseline of a randomized control trial involving rural Ethiopian children aged 6–35 months (n = 873) were analyzed to evaluate the associations among height/length-for-age z-scores, dietary intakes, and these biomarkers (i.e., serum level of TTR, IGF-1, tryptophan and lysine, and inflammation). The prevalence of stunting was higher for children >23 months (38%) than ≤23 months (25%). The prevalence of inflammation was 35% and of intestinal parasites 48%. Three-quarters of the children were energy deficient, and stunted children had lower daily energy intake that non-stunted children (p < 0.05). Intakes of tryptophan, protein, and energy, and serum levels of tryptophan and IGF-1 were positively correlated with the linear growth of children. Controlling for inflammation, intestinal parasites, and sociodemographic characteristics, daily tryptophan (b = 0.01, p = 0.001), protein (b = 0.01, p = 0.01) and energy (b = 0.0003, p = 0.04) intakes and serum TTR (b = 2.58, p = 0.04) and IGF-1 (b = 0.01, p = 0.003) were positively associated with linear growth of children. Linear growth failure in Ethiopian children is likely associated with low quality protein intake and inadequate energy intake. Nutrition programs that emphasize improved protein quantity and quality and energy intake may enhance the linear growth of young children and need to be further investigated in longitudinal and interventional studies. Full article

(This article belongs to the Special Issue Complementary Feeding in Infants)

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16 pages, 993 KiB

Open AccessArticle

Effectiveness of a Program Intervention with Reduced-Iron Multiple Micronutrient Powders on Iron Status, Morbidity and Growth in Young Children in Ethiopia

by Aregash Samuel, Inge D. Brouwer, Edith J. M. Feskens, Abdulaziz Adish, Amha Kebede, Luz Maria De-Regil and Saskia J. M. Osendarp

Nutrients 2018, 10(10), 1508; https://doi.org/10.3390/nu10101508 - 15 Oct 2018

Cited by 16 | Viewed by 7901

Abstract

Despite the potential for improving iron status and child growth in low- and middle-income settings, concerns on the safety of high iron dosages of Micronutrient Powders (MNP currently limit their applicability in programs. We examined the effectiveness and risks of an integrated complementary [...] Read more.

Despite the potential for improving iron status and child growth in low- and middle-income settings, concerns on the safety of high iron dosages of Micronutrient Powders (MNP currently limit their applicability in programs. We examined the effectiveness and risks of an integrated complementary feeding program with low iron dose (6 mg/serving) MNP among 6–23-month-old Ethiopian children using a quasi-experimental study design comparing children from five intervention districts (n = 1172) to those from four matched non-intervention districts (n = 1137). Haemoglobin concentrations increased in intervention and decreased in non-intervention children (group-difference +3.17 g/L), but without improvement in iron stores. Intervention children were 2.31 times more likely to have diarrhoea and 2.08 times more likely to have common cold and flu, but these differences decreased towards the end of the intervention. At end line, intervention children had higher mean Height-for-Age Zscore (HAZ) and a 51% reduced odds of being stunted compared to non-intervention children. MNP with low iron dose, when provided combined with other Infant and Young Child Feeding (IYCF) interventions, marginally improved haemoglobin status and resulted in a remarkable improvement in linear growth in 6–23-month-old children. These benefits likely outweigh the relatively small increase in the risk of diarrhoea. Full article

(This article belongs to the Special Issue Complementary Feeding in Infants)

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