Application of the infant and young child feeding index and the evaluation of its relationship with nutritional status in 6-24 months children / Aplicação do índice de alimentação de lactentes e crianças pequenas e avaliação de sua relação com o estado nutricional de crianças de 6 a 24 meses

ABSTRACT Objective To evaluate the complementary feeding practices of mothers in infant and child nutrition using Infant and Young Child Feeding Indicator and Infant and Child Feeding Index and to determine their relationship with nutritional status. Methods Study data were collected through an online questionnaire administered to 141 parents on healthy 6-24 month infants/children. Complementary feeding practices for infants/children were evaluated in line with the Infant and Child Feeding Index and Infant and Young Child Feeding Indicator. In the evaluation of growth, weight for age z-scores, length for age z-scores, and weight for length z-scores of infants/children were calculated with the World Health Organization Anthro program. Results 74.5% of 141 infants and children (71 boys, 70 girls) evaluated in the study are breastfed. The prevalence of stunting, wasted, and underweight was determined as 6.4%, 0.7%, and 4.3%, respectively. When evaluated using Infant and Young Child Feeding Indicator, it was determined that 82.3% of children met the minimum meal frequency, 80.9% met the minimum dietary diversity, and 67.4% met the minimum acceptable diet. Regarding Infant and Child Feeding Index evaluations of the children, while there was no difference between 9-11 and 12-24 month age groups, the mean Infant and Child Feeding Index score in the 6-8 month group was significantly lower than the other age groups (p=0.000). The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were found to be high in most infants/children. No clear relationship was found between stunting and minimum acceptable diet, minimum dietary diversity or minimum meal frequency, which are indicators of both Infant and Child Feeding Index scores and World Health Organization, Infant and Young Child Feeding Indicator. Conclusion The Infant and Child Feeding Index scores used to evaluate complementary feeding practices in our study were high in most infants/children. In addition, the high rates of MMF, minimum dietary diversity, and minimum acceptable diet coverage in evaluating infants/children in terms of World Health Organization indicators show that they have appropriate complementary feeding practices. However, study found no clear relationship between stunting and minimum acceptable diet, minimum dietary diversity or MMF, which are indicators of both Infant and Child Feeding Index I scores and WHO Infant and Young Child Feeding Indicator. It was concluded that World Health Organization Infant and Young Child Feeding Indicator indicators may be better than length for age z-scores in the weight for length z-scores explanation.

RESUMO Objetivo Avaliar as práticas de alimentação complementar das mães na nutrição de lactentes e crianças utilizando o Indicador de Alimentação de Lactentes e Crianças Pequenas e o Índice de Alimentação de Lactentes e Crianças e determinar sua relação com o estado nutricional. Métodos Os dados do estudo foram coletados por meio de um questionário online administrado a 141 pais de bebês/crianças saudáveis de 6 a 24 meses. As práticas de alimentação complementar de lactentes/crianças foram avaliadas de acordo com o Índice de Alimentação de Lactentes e Crianças e o Indicador de Alimentação de Lactentes e Crianças Pequenas. Na avaliação do crescimento, os escores z de peso para idade, escores z de comprimento para idade e escores z de peso para comprimento de bebês/crianças foram calculados com o programa Organização Mundial da Saúde Anthro. Resultados Quando avaliadas por meio do Indicador de Alimentação de Lactentes e Crianças Pequenas, constatou-se que 82,3% das crianças atendiam à frequência mínima de refeições, 80,9% atingiam a diversidade alimentar mínima e 67,4% atingiam a dieta mínima aceitável. Em relação às avaliações do Índice de Alimentação de Lactentes e Crianças das crianças, embora não tenha havido diferença entre as faixas etárias de 9 a 11 e 12 a 24 meses, a pontuação média do Índice de Alimentação de Lactentes e Crianças no grupo de 6 a 8 meses foi significativamente menor do que nas outras faixas etárias (p=0,000). Os escores do Índice de Alimentação de Lactentes e Crianças utilizados para avaliar as práticas de alimentação complementar em nosso estudo foram elevados na maioria dos bebês/crianças. Não foi encontrada nenhuma relação clara entre o atraso no crescimento e a dieta mínima aceitável, diversidade alimentar mínima ou frequência mínima de refeição ,que são indicadores tanto das pontuações do Índice de Alimentação de Lactentes e Crianças como do Indicador de Alimentação de Lactentes e Crianças Pequenas da Organização Mundial da Saúde. Conclusão Escores altos do Índice de Alimentação de Lactentes e Crianças na maioria dos bebês/crianças são um bom indicador de Indicador de Alimentação de Lactentes e Crianças Pequenas nessa população. No entanto, nenhuma relação clara foi encontrada entre o déficit de estatura e os escores do Índice de Alimentação de Lactentes e Crianças e do Indicador de Alimentação de Lactentes e Crianças Pequenas neste estudo.

Academy of Nutrition and Dietetics Nutrition Research Network: The Saqmolo' Project Rationale and Study Protocol for a Randomized Controlled Trial Examining the Influence of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala.

Adequate nutrition during the complementary feeding period is critical for optimal child growth and development and for promoting long-term educational attainment and economic potential. To prioritize limited public health resources, there is a need for studies that rigorously assess the influence of multicomponent integrated nutrition interventions in children younger than age 2 years in different contexts. This study aimed to describe the rationale and protocol for the Saqmolo' Project using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The Saqmolo' (ie, "egg" in the Mayan language, Kaqchiquel) Project is an individually randomized, partially blinded, controlled comparative effectiveness trial to evaluate the influence of adding delivery of a single whole egg per day to local standard nutrition care (ie, growth monitoring, medical care, deworming medication, multiple micronutrient powders for point-of-use food fortification [chispitas], and individualized complementary and responsive feeding education for caregivers) for 6 months, compared with the local standard nutrition care package alone, on child development, growth, and diet quality measures in rural indigenous Mayan infants aged 6 to 9 months at baseline (N = 1,200). The study is being executed in partnership with the Wuqu' Kawoq/Maya Health Alliance, a primary health care organization located in central Guatemala. Primary outcomes for this study are changes in global development scores, assessed using the Guide for Monitoring Global Development and the Caregiver Reported Child Development Instruments. Secondary outcomes include changes in infant hemoglobin, anthropometric measures (including z scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality as measured using the World Health Organization's infant and young child feeding indicators. The results of the Saqmolo' Project may help to inform public health decision making regarding resource allocation for effective nutrition interventions during the complementary feeding period.

Attitudes and practice of Turkish mothers with babies between 0-24 months regarding infant nutrition: the Iowa Infant Feeding Attitude Scale / Atitudes e aplicações de mães turcas sobre a nutrição do bebê entre 0-24 meses: Iowa Nutrição do Bebê Atitude

ABSTRACT Objective This study aims to evaluate the behaviors and attitudes of mothers with 0-24-month-old babies towards infant feeding, depending on their sociodemographic characteristics. Methods This is a cross-sectional study, which was carried out with 300 mothers. Demographic characteristics of the mothers, breastfeeding and complementary feeding practices, and the Iowa Infant Feeding Attitude Scale were collected. As for the statistical evaluation, Statistical Package for the Social Sciences version 22 statistical package program was used. For the statistical analysis; percentages, mean values, Independent T-Test, One-Way ANOVA, Chi-Square test, and multinomial regression models analysis were used. Results 79.7% of the mothers gave human milk to their infants as the first food after delivery, 36.9% gave only human milk for the first 6 months, 52.0% started complementary feeding at 4-6 months. Of the mothers with a mean The Iowa Infant Feeding Attitude Scale score of 64.38±8.43, 54.0% were positive towards breastfeeding. A significant relationship was found between education and income levels and Iowa Infant Feeding Attitude Scale scores level of the mothers, respectively (χ2=10.001, χ2=10.421, p<0.05). The mothers with a postgraduate degree as educational status (AOR=1.27, 95%CI:1.06-1.53) and mothers who had more income than expenditures (AOR=1.19, 95%CI:1.03-1.63) were associated with a higher positive towards of breastfeeding. Conclusion Although most of the mothers say that they have a positive attitude towards breastfeeding, the rate of those who only breastfeed for the first 6 months is low. As the education and income level of mothers increase, their positive attitude towards breastfeeding increases. Mothers should be informed to initiate and maintain successful breastfeeding.

RESUMO Objetivo Este estudo tem como objetivo avaliar os comportamentos e atitudes de mães com bebês de 0 a 24 meses em relação à alimentação infantil, em função de suas características sociodemográficas. Métodos Este estudo é um estudo transversal, realizado com 300 mães. Foram coletadas características demográficas das mães, práticas de amamentação e alimentação complementar e a Iowa Infant Feeding Attitude Scale. Quanto à avaliação estatística, foi utilizado o programa de pacote estatístico Statistical Package for the Social Sciences versão 22. Para a análise estatística; percentagens, valores médios, Teste T independente, Anova de uma via, teste do qui-quadrado e análise de modelos de regressão multinominal. Resultados 79,7% das mães deram leite materno como primeiro alimento após o parto, 36,9% deram apenas leite materno durante os primeiros 6 meses, 52,0% iniciaram a alimentação complementar aos 4-6 meses. Das mães com escore médio Iowa Infant Feeding Attitude Scale de 64,38±8,43, 54,0% eram positivas para amamentação. Encontrou-se relação significativa entre os níveis de escolaridade e renda e o nível dos Iowa Infant Feeding Attitude Scale escores das mães, respectivamente (χ2=10,001, χ2=10,421, p<0,05). Mães com pós-graduação (AOR=1,27, IC 95%: 1,06-1,53) e mães que tinham mais renda do que despesas (AOR=1,19, IC 95%: 1,03 -1,63) foram associadas a maior positividade para amamentação. Conclusão Embora a maioria das mães diga que têm uma atitude positiva em relação à amamentação, a taxa das que amamentam apenas nos primeiros 6 meses é baixa. À medida que aumenta a escolaridade e o nível de renda das mães, sua atitude positiva em relação à amamentação aumenta. As mães devem ser informadas para iniciar e manter a amamentação com sucesso.

Infant Feeding and Ethnic Differences in Body Mass Index during Childhood: A Prospective Study.

This study investigated ethnic differences in childhood body mass index (BMI) in children from Dutch and Turkish descent and the role of infant feeding factors (breastfeeding duration, milk feeding frequency, as well as the timing, frequency and variety of complementary feeding (CF)). We used data from 244 children (116 Dutch and 128 Turkish) participating in a prospective study in the Netherlands. BMI was measured at 2, 3 and 5 years and standard deviation scores (sds) were derived using WHO references. Using linear mixed regression analyses, we examined ethnic differences in BMI-sds between 2 and 5 years, and the role of infant feeding in separate models including milk or CF factors, or both (full model). Relative to Dutch children, Turkish children had higher BMI-sds at age 3 (mean difference: 0.26; 95%CI: 0.04, 0.48) and 5 (0.63; 0.39, 0.88), but not at 2 years (0.08; -0.16, 0.31). Ethnic differences in BMI-sds were somewhat attenuated by CF factors at age 3 (0.16; -0.07, 0.40) and 5 years (0.50; 0.24, 0.77), whereas milk feeding had a minor impact. Of all factors, only CF variety was associated with BMI-sds in the full model. CF factors, particularly CF variety, explain a small fraction of the BMI-sds differences between Dutch and Turkish children. The role of CF variety on childhood BMI requires further investigation.

Timely Initiation of Complementary Feeding Practices in Gondar Town Northwest Ethiopia: A Cross-sectional Study.

BACKGROUND: The time of introduction and nutritionally adequate, safe, age-appropriate complementary feeding is extremely important for the child's optimal growth, development, and health within the first 2 years of life. Despite a number of interventions to improve infant and young child feeding practices and nutritional status, appropriate feeding practices are far away from the recommendation. Therefore, the study aimed to assess timely initiation of complementary feeding practices and associated factors among children aged 6-23 months in Gondar town, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted in December 2017. A multistage sampling technique was employed to select 632 mother-child pairs. Pretested structured and interviewer-administered questionnaire was used to collect data. Data were entered into Epi-info version 7 and transferred to SPSS version 20.0 for analysis. Both bivariable and multivariable logistic regression analysis were used to identify factors associated with timely initiation of complementary feeding. Finally, variables with a P-value of <0.05 were considered as statistically significant. RESULTS: The prevalence of timely initiation of complementary feeding was 47.3% (95%CI: 43.0, 51.3). Being housewife in maternal occupation (AOR = 2.03, 95%CI: 1.21, 3.43), good mother's knowledge about complementary feeding (AOR = 1.80, 95% CI: 1.28, 2.53) and attending post-natal care checkup (AOR = 3.90, 95%CI: 1.26, 12.04) were significantly associated with timely initiation of complementary feeding. CONCLUSION: This study revealed that timely initiation of complementary feeding was low within the study area. Around half of the children started complementary feeding at their 6 months of age. Therefore, special emphasis should be given to mothers who have poor knowledge about complementary feeding and encourage all mothers to have postnatal follow-up is crucial.

Complementary feeding practices and nutrient intakes of children aged 6-24 months from Bangladeshi background living in Tower Hamlets, East London: a feasibility study.

BACKGROUND: The aim of this study was to assess dietary intakes and complementary feeding practices of children aged 6-24 months who are from Bangladeshi ancestry and living in Tower Hamlets, London, and determine the feasibility of a larger, population-representative study. METHODS: Questionnaires for demographic variables and feeding practices, and 24-h dietary recalls were administered to 25 mothers to determine whether it would be feasible to conduct a similar study on a representative sample size of the same population. Data from both tools were used to determine adequacy of complementary feeding practices through the WHO indicators and an infant and child feeding index score as well as overall macronutrient and micronutrient intake. RESULTS: Four children had varying suboptimal complementary feeding practices: two children failed to achieve the minimum dietary diversity, one child was being fed cow's milk before the age of 1 year, and one scored 'poor' on the infant and child feeding index. Most notably, the mean protein intake (39.7 g/day, SD 18.2) was higher than RNIs for all age groups (P = 0.001). Vitamin D intake was below recommendations (P = 0.006) for the 12-24-month age group. For the 10-12-month age group, zinc intake fell below recommendations (P = 0.028). For the 6-9-month combined age group, iron and zinc intakes were below recommendations (P = 0.021 and P = 0.002, respectively). CONCLUSIONS: Given the feasibility of this study, the results obtained require a large-scale study to be conducted to confirm findings. Our initial results indicated that children from Bangladeshi heritage may not be meeting nutritional requirements; thus, a future intervention tailored to the needs of the Bangladeshi population may be required to improve aspects of complementary feeding practices and nutrient intakes of those children.

Prelacteal feeding and associated factors among mothers having children less than 24 months of age, in Mettu district, Southwest Ethiopia: a community based cross-sectional study.

OBJECTIVE: Despite prelacteal feeding contravenes with exclusive breastfeeding, it is a prevailing problem in Ethiopia. However, its burden and factors were not investigated in Mettu district. Therefore, the objective of our study was to conduct the burden of prelacteal feeding and its associated factors. Community-based cross-sectional study was conducted among 730 mother-child pairs. Stratified cluster sampling was used. Data were collected by face- to- face interview. Logistic regression model was fitted. RESULTS: A total of 719 mother-child pairs with a response rate of 98.5% were participated. The overall proportion of prelacteal feeding among mothers was 14.2% [95% CI (12.0, 17.0)]. No maternal education [AOR: 3.54 (95% CI 1.7, 6.98)], single ANC visits [AOR: 6.87 (95% CI 3.21, 14.73)], didn't know risks of prelacteal feeding [AOR: 2.73 (95% CI 1.47, 5.05)], colostrums avoidance [AOR: 6.030 (95% CI 3.48, 10.46)], home delivery [AOR: 3.04 (95% Cl 1.60, 5.75] and cesarean delivery [AOR: 4.27 (95% CI 2.28, 7.99)] were significantly associated factors. Prelacteal feeding among mother-child pairs was high. Hence, increasing maternal education and institutional delivery are vital for prompt infant feeding.

Is there a "complementary feeding cultural core" in rural Kenya? Results from ethnographic research in five counties.

This investigation used data from focused ethnographic studies in five rural counties in Kenya to determine whether the concept of "special foods for infants and young children" exists in the different ethnic groups in these areas as an identifiable component of cultural beliefs and knowledge, as well as in practice, and whether they can be characterized as a "complementary feeding cultural core." The concept of "cultural core foods" refers to the set of foods that have a central role in diets of a population and, as a consequence, also have significant social and emotional components. We used the ethnographic cognitive mapping technique of "free listing" and a qualitative 24-hr recall of infants and young children (IYC) intake, with probing, to obtain data on caregivers' beliefs and behaviours. The results show that an IYC cultural food core can be identified in all of the counties. A related finding that supports the argument for an "IYC cultural core" with respect to appropriate foods for IYC is the clear cognitive consensus within sites about its content, although in practice, food insecurity and food shortage constrain household abilities to put their beliefs into practice. We conclude that interventions to improve IYC feeding in rural Kenya that build on the concept of "IYC cultural core foods" will be congruent with basic cultural ideas about managing IYC feeding and could take advantage of this cultural feature.

Complementary Feeding Practices for South Asian Young Children Living in High-Income Countries: A Systematic Review.

Sub-optimal nutrition among South Asian (SA) children living in high-income countries is a significant problem. High rates of obesity have been observed in this population, and differential complementary feeding practices (CFP) have been highlighted as a key influence. Our aim was to undertake a systematic review of studies assessing CFP in children under two years of age from SA communities living in high-income countries, including dietary diversity, timing, frequency and promotors/barriers. Searches covered January 1990⁻July 2018 using MEDLINE, EMBASE, Global Health, Web of Science, BanglaJOL, OVID Maternity and Infant Care, CINAHL, Cochrane Library, POPLINE and World Health Organisation (WHO) Global Health Library. Eligible studies were primary research on CFP in SA children aged 0⁻2 years. Search terms were "children", "feeding" and "South Asian", and derivatives. Quality appraisal used the Evidence for Policy and Practice Information (EPPI) Weight of Evidence scoring. From 50,713 studies, 13 were extracted with ten from the UK, and one each from the USA, Canada and Singapore. Sub-optimal CFP were found in all studies. All ten studies investigating timing reported complementary feeding (CF) being commenced before six months. Promoters/barriers influencing CFP included income, lack of knowledge, and incorrect advice. This is the first systematic review to evaluate CFP in SA children living in high-income countries and these findings should inform the development of effective interventions for SA infants in these settings.

The Pattern of Complementary Foods in American Infants and Children Aged 0⁻5 Years Old-A Cross-Sectional Analysis of Data from the NHANES 2011⁻2014.

Proper nutrition early in life can influence children’s present and future health. While several authoritative sources provide eating/food recommendations, only a few studies have assessed whether these recommendations are followed. The goal of this paper was to examine food and nutrient intakes on any given day during infancy and early childhood among various ethnicities. Twenty-four-hour dietary recall data of 0⁻5 years-old children (n = 2431) from the National Health and Nutrition Examination Survey (NHANES) 2011⁻2014 was used to estimate intakes of nutrients and food groups and prevalence of inadequate intake. Data was analyzed separately for various age groups and ethnicities, and differences in means by age and or race/ethnicity were determined by t-tests with p < 0.05 as significant. The results indicate that intakes of all food groups were expectedly low at 0⁻11 months, increased with age, and were influenced by race/ethnicity. Mixed dish consumption, which also increased with age, made substantial contributions to children’s food group intakes. However, there was a substantial percentage of the population among all age and race/ethnic groups who did not consume the recommended amounts for each food group and had inadequate intakes of key nutrients, such as calcium, vitamin D, and vitamin E. Non-Hispanic black children consumed less dairy and more protein foods, and a significantly greater proportion of these children had inadequate intakes of calcium and vitamin D compared to their peers. In conclusion, the results from this study suggest that a substantial population of American infants and children from 0 to five years of age did not meet food group recommendations and had inadequate intakes of key nutrients such as calcium, vitamin D, and vitamin E from foods.

Factors Associated with Undernutrition in Children under the Age of Two Years: Secondary Data Analysis Based on the Pakistan Demographic and Health Survey 2012⁻2013.

In Pakistan, 96% of the children under the age of two years do not receive an adequate diet. The main aim of this paper is to identify the sociodemographic, nutritional, and health-related factors associated with stunting, wasting, and underweight in children under the age of two years in Pakistan. Secondary data analysis was performed based on the Pakistan Demographic and Health Survey, 2012⁻2013. The analysis was limited to children under the age of two years (n = 984). Analysis was done using bivariate and multivariable binary logistic regression. The incidence of stunting, wasting, and underweight in children was 28.3%, 12.1%, and 27.9%, respectively. The odds of stunting, wasting, and underweight increased with the child's age. The odds of stunting and underweight increased with the mother's low body mass index, low access to information, high birth order of child, consanguineous marriages, father's low education, rural settlement, poor toilet facilities, and low vitamin A consumption. The odds of wasting increased in children who were not being breastfed, but no significant relation was seen with stunting and underweight. There is a need to improve child nutritional status in Pakistan by addressing issues such as poverty, low parental education, low micronutrient intake, and targeting provinces where undernutrition was found to be higher.

Randomised Controlled Trial Comparing Daily Versus Depot Vitamin D3 Therapy in 0-16-Year-Old Newly Settled Refugees in Western Australia Over a Period of 40 Weeks.

Vitamin D deficiency is highly prevalent in newly settled refugees in Western Australia (WA). If adherence to daily vitamin D therapy is problematic, depot therapy is a therapeutic alternative. The aim of this study was to compare daily versus depot treatment and factors influencing the therapeutic outcome. Newly settled refugees (n = 151) with 25(OH)D levels less than 78 nmol/L were randomised to receive daily or depot vitamin D therapy with eight weekly interval follow up to 40 weeks. Biochemical and clinical parameters were collected at each visit. Generalized Linear Mixed Models (GLMM) examined the longitudinal changes over time controlling for confounders including age, gender, treatment arm, season, country of refuge/origin and sun exposure score. Participants were aged 5.5 months to 16.0 years (75 males, 83 females). Both treatment groups achieved vitamin D sufficiency. The daily treatment group had significantly higher 25(OH)D levels at each visit post baseline and a higher proportion of participants with levels above 50 nmol/L at all time points. Time, treatment group, calcium and sun exposure score were significant predictors of 25(OH)D serum levels. Depot vitamin D therapy is an alternative to daily treatment in this at-risk group of children and adolescents in whom treatment adherence is problematic.

Complementary feeding patterns among ethnic groups in rural western China.

OBJECTIVE: This study investigated complementary feeding practices among four ethnic groups (Han, Uygur, Tibetan, and Zhuang) based on a cross-sectional survey in rural western China. METHODS: In 2005, a stratified multistage cluster random sampling method was used to recruit 9712 children (7411 Han, 1032 Uygur, 678 Tibetan, and 591 Zhuang) between 6 and 35 months of age and their mothers from 45 counties in 10 provinces (autonomous regions, municipalities) in western China. RESULTS: The rates of early introduction (before 6 months) of complementary foods in four ethnic groups (Han, Uygur, Tibetan, and Zhuang) were 71.30%, 95.95%, 82.40%, and 72.30%, respectively. The Infant and Child Feeding Index (ICFI) for Uygur and Tibetan children was lower than that for Han children at all age groups. Uygur children were more likely to have unqualified ICFI compared with Han children in a multivariate logistic regression (odds ratio (OR)=5.138, 95% confidence interval (CI): 4.340-6.084). A higher level of maternal education, greater family wealth, and the availability of complementary feeding educational materials decreased the likelihood of an unqualified ICFI. The nutritional status of children (Han, Tibetan, and Zhuang) with qualified ICFI was better than that for children with unqualified ICFI. CONCLUSIONS: Appropriate interventions are required to improve complementary feeding practices in rural western China.

Patterns of cultural consensus and intracultural diversity in Ghanaian complementary feeding practices.

Designing effective interventions to improve infant and young child (IYC) feeding requires knowledge about determinants of current practices, including cultural factors. Current approaches to obtaining and using research on culture tend to assume cultural homogeneity within a population. The purpose of this study was to examine the extent of cultural consensus (homogeneity) in communities where interventions to improve IYC feeding practices are needed to address undernutrition during the period of complementary feeding. A second, related objective was to identify the nature of intracultural variation, if such variation was evident. Selected protocols from the Focused Ethnographic Study for Infant and Young Child Feeding Manual were administered to samples of key informants and caregivers in a peri-urban and a rural area in Brong-Ahafo, Ghana. Cultural domain analysis techniques (free listing, caregiver assessment of culturally significant dimensions, and food ratings on these dimensions), as well as open-ended questions with exploratory probing, were used to obtain data on beliefs and related practices. Results reveal generally high cultural consensus on the 5 dimensions that were assessed (healthiness, appeal, child acceptance, convenience, and modernity) for caregiver decisions and on their ratings of individual foods. However, thematic analysis of caregiver narratives indicates that the meanings and content of the constructs connoted by the dimensions differed widely among individual mothers. These findings suggest that research on cultural factors that affect IYC practices, particularly cultural beliefs, should consider the nature and extent of cultural consensus and intracultural diversity, rather than assuming cultural homogeneity.

Socioeconomic determinants of growth in a longitudinal study in Nepal.

Socioeconomic status (SES) is associated with childhood anthropometry, but little is known about how it is associated with tissue growth and body composition. To investigate this, we looked at components of SES at birth with growth in early and mid-childhood, and body composition in a longitudinal study in Nepal. The exposure variables (material assets, land ownership, and maternal education) were quantified from questionnaire data before birth. Anthropometry data at birth, 2.5 and 8.5 years, were normalized using WHO reference ranges and conditional growth calculated. Associations with child growth and body composition were explored using multiple regression analysis. Complete anthropometry data were available for 793 children. There was a positive association between SES and height-for-age and weight-for-age, and a reduction in odds of stunting and underweight for each increase in rank of SES variable. Associations tended to be significant when moving from the lower to the upper asset score, from none to secondary education, and no land to >30 dhur (~500 m2 ). The strongest associations were for maternal secondary education, showing an increase of 0.6-0.7 z scores in height-for-age and weight-for-age at 2.5 and 8.5 years and 0.3 kg/m2 in fat and lean mass compared to no education. There was a positive association with conditional growth in the highest asset score group and secondary maternal education, and generally no association with land ownership. Our results show that SES at birth is important for the growth of children, with a greater association with fat mass. The greatest influence was maternal secondary education.

"Those who care much, understand much." Maternal perceptions of children's appetite: Perspectives from urban and rural caregivers of diverse parenting experience in Bangladesh.

Appetite in children is an important determinant of nutritional intake and growth. The information used by caregivers to understand children's appetite can help inform infant and young child feeding promotion and appetite assessment. We conducted a qualitative study to (a) explore maternal perceptions and responses to children's appetite and (b) to identify how these factors differ by type of caregiver, level of maternal experience, and urban versus rural context. We used purposive sampling to recruit mothers and alternate caregivers into 14 total focus group discussions (six to eight participants in each group; N = 95) in both urban and rural settings in Bangladesh. To understand children's appetite, caregivers monitor children's dietary patterns, emotional signs, and physical and verbal cues. Healthy appetite was observed by willingness to eat diverse foods, finish offered portions, and by acceptance of foods without excessive prompting. Child illness was cited for a cause of low appetite, which was manifested through fussiness, and avoiding commonly consumed foods. Mothers described a limited set of feeding practices (offering diverse foods, playing, and cheering children with videos) to encourage consumption when children lacked appetite. Mothers' stress related to work was noted as a barrier to identifying appetite cues. Urban mothers described a lower access to instrumental social support for child feeding but informational support than mothers in the rural setting. Understanding caregivers' perceptions of children's appetite may inform strategies to improve responsive feeding and tool development to assess changes in appetite as early indicators of change in health or nutrition status among high-risk children.

Caregiver-infant's feeding behaviours are associated with energy intake of 9-11 month-old infants in rural Ethiopia.

Inappropriate complementary feeding, both in quantity and quality, is a major determinant of undernutrition. However, little is known about how infant-caregiver's feeding behaviours affect infants' energy intake. Therefore, the objective of this study was to characterize infant-caregiver feeding behaviours and investigate their association with infants' energy intake. The study involved 106 mother-child pairs recruited from seven randomly selected kebeles of Mecha district, West Gojam, Ethiopia. The feeding styles were assessed through observations of 1-day, in-home, feeding episodes that were videotaped and coded into self-feeding, responsive, active, distracting, and social feeding behaviours. Infants' haemoglobin and anthropometric measurements were taken. The association between feeding behaviour scores and energy intake per meal was investigated. The mean food intake of the infants was very low (11.4 ± 7.0 g/kg body weight per meal) compared to the minimum theoretical gastric capacity (30 g/kg body weight per meal). Infants' haemoglobin concentration was negatively associated with energy intake (ρ = 0.178, p = .03). Infants' responsive and active positive feeding styles were positively associated with energy intakes (ρ = 0.258 and 0.432, p = .004 and p < .001, respectively) as well as caregivers' responsive positive feeding styles (ρ = 0.237, p = .007). Both haemoglobin concentrations and feeding styles were associated with infant's energy intake. Anaemia prevention and control measures should be reinforced. Current nutrition education programmes should give emphasis on ways to effectively incorporate culturally adapted responsive feeding messages in this and similar settings.

Associations between social support, psychological well-being, decision making, empowerment, infant and young child feeding, and nutritional status in Ugandan children ages 0 to 24 months.

Maternal capabilities-qualities of mothers that enable them to leverage skills and resources into child health-hold potential influence over mother's adoption of child caring practices, including infant and young child feeding. We developed a survey (n = 195) that assessed the associations of 4 dimensions of maternal capabilities (social support, psychological health, decision making, and empowerment) with mothers' infant and young child feeding practices and children's nutritional status in Uganda. Maternal responses were converted to categorical subscales and an overall index. Scale reliability coefficients were moderate to strong (α range = 0.49 to 0.80). Mothers with higher social support scores were more likely to feed children according to the minimum meal frequency (odds ratio [OR] [95% confidence interval (CI)] = 1.38 [1.10, 1.73]), dietary diversity (OR [95% CI] = 1.56 [1.15, 2.11]), iron rich foods, (OR [95% CI] = 1.47 [1.14, 1.89]), and minimally acceptable diet (OR [95% CI] = 1.55 [1.10, 2.21]) indicators. Empowerment was associated with a greater likelihood of feeding a minimally diverse and acceptable diet. The maternal capabilities index was significantly associated with feeding the minimum number of times per day (OR [95% CI] = 1.29 [1.03, 1.63]), dietary diversity (OR [95% CI] = 1.44 [1.06, 1.94]), and minimally acceptable diet (OR [95% CI] = 1.43 [1.01, 2.01]). Mothers with higher psychological satisfaction were more likely to have a stunted child (OR [95% CI] = 1.31 [1.06, 1.63]). No other associations between the capabilities scales and child growth were significant. Strengthening social support for mothers and expanding overall maternal capabilities hold potential for addressing important underlying determinants of child feeding in the Ugandan context.

Parental history of moderate to severe infantile malnutrition is associated with cognitive deficits in their adult offspring.

OBJECTIVES: We compared the IQ and academic achievement of the young adult offspring of parents malnourished in infancy and those of a healthy control group in order to test the hypothesis that the offspring of previously malnourished individuals would show IQ and academic deficits that could be related to reduced parental socioeconomic status. METHODS: We conducted a group comparison study based on a community sample in Barbados (Barbados Nutrition Study). Participants were adult children ≥16 years of age whose parents had been malnourished during the first year of life (n = 64; Mean age 19.3 years; 42% male) or whose parents were healthy community controls (n = 50; Mean age 19.7 years; 48% male). The primary outcome was estimated IQ (Wechsler Abbreviated Scale of Intelligence); a secondary outcome was academic achievement (Wide Range Achievement Test - Third Edition). Data were analyzed using PROC MIXED with and without adjusting for parental socioeconomic status (Hollingshead Index of Social Position). RESULTS: IQ was reduced in the offspring of previously malnourished parents relative to the offspring of controls (9.8 point deficit; P < 0.01), but this difference was not explained by parental socioeconomic status or parental IQ. The magnitude of the group difference was smaller for basic academic skills and did not meet criteria for statistical significance. DISCUSSION: The deleterious impact of infant malnutrition on cognitive function may be transmitted to the next generation; however, this intergenerational effect does not appear to be explained by the reduced socioeconomic status or IQ of the parent generation.

Concurrent iron and zinc deficiencies in lactating mothers and their children 6-23 months of age in two agro-ecological zones of rural Ethiopia.

PURPOSE: The aim of this study is to examine the co-occurrences of low serum ferritin and zinc and anaemia among mothers and their children in two agro-ecological zones of rural Ethiopia. METHODS: Data were collected from 162 lactating mothers and their breast fed children aged 6-23 months. The data were collected via a structured interview, anthropometric measurements, and blood tests for zinc, ferritin and anaemia. Correlation, Chi-square and multivariable analysis were used to determine the association between nutritional status of mothers and children, and agro-ecological zones. RESULTS: Low serum levels of iron and zinc, anaemia and iron deficiency anaemia were found in 44.4, 72.2, 52.5 and 29.6% of children and 19.8, 67.3, 21.8, 10.5% of mothers, respectively. There was a strong correlation between the micronutrient status of the mothers and the children for ferritin, zinc and anaemia (p < 0.005). Deficiency in both zinc and ferritin and one of the two was observed in 19.1, and 53.7% of the mothers and 32.7 and 46.3%, of their children, respectively. In the 24 h before the survey, 82.1% of mothers and 91.9% of their infants consumed foods that can decrease zinc bioavailability while only 2.5% of mothers and 3.7% of their infants consumed flesh foods. CONCLUSION: This study shows that micronutrient deficiencies were prevalent among lactating mothers and their children, with variation in prevalence across the agro-ecological zones. This finding calls for a need to design effective preventive public health nutrition programs to address both the mothers' and their children's needs.