Impact of home food production on nutritional blindness, stunting, wasting, underweight and mortality in children: a systematic review and meta-analysis of controlled trials.

Vitamin A deficiency is highly prevalent and remains the major cause of nutritional blindness in children in low-and middle-income countries, despite supplementation programmes. Xeropthalmia (severe drying and thickening of the conjunctiva) is caused by vitamin A deficiency and leads to irreversible blindness. Vitamin A supplementation programmes effectively reduce vitamin A deficiency but many rural children are not reached. Home food production may help prevent rural children's vitamin A deficiency. We aimed to systematically review trials assessing effects of home food production (also called homestead food production and agricultural interventions) on xeropthalmia, nightblindness, stunting, wasting, underweight and mortality (primary outcomes). We searched Medline, Embase, Scopus, Cochrane CENTRAL and trials registers to February 2019. Inclusion of studies, data extraction and risk of bias were assessed independently in duplicate. Random-effects meta-analysis, sensitivity analyses, subgrouping and GRADE were used. We included 16 trials randomizing 2498 children, none reported xerophthalmia, night-blindness or mortality. Home food production may slightly reduce stunting (mean difference (MD) 0.13 (z-score), 95% CI 0.01 to 0.24), wasting (MD 0.05 (z-score), 95% CI -0.04 to 0.14) and underweight (MD 0.07 (z-score), 95% CI -0.01 to 0.15) in young children (all GRADE low-consistency evidence), and increase dietary diversity (standardized mean difference (SMD) 0.24, 95% CI 0.15 to 0.34). Home food production may usefully complement vitamin A supplementation for rural children. Large, long-duration trials with good randomization, allocation concealment and correct adjustment for clustering are needed to assess effectiveness of home food production on nutritional blindness in young children.

Malnutrition and its associated factors: a cross-sectional study with children under 2 years in a suburban area in Angola.

BACKGROUND: The prevalence of child malnutrition in Angola is still very high, and little is known about its associated factors. The aim of this study was to identify these factors in children under 2 years in a suburban area of the country's capital city. METHODS: We used data from a cross-sectional population-based study conducted in 2010. The outcomes studied were stunting and underweight. Multivariable analysis was conducted; prevalence ratios were estimated by Poisson regression with robust variance using a hierarchical model. RESULTS: Of the children studied (N = 749), 232 [32.0% (95% CI: 28.7-35.5%)] were stunted and 109 [15.1% (95% CI: 12.6-17.9%)] were underweight. In multivariable analysis, occurrence of diarrhea (PR 1.39 [95% CI: 1.07-1.87]) and the death of other children in the household (PR 1.52 [95% CI: 1.01-2,29]) were associated with stunting and underweight, respectively. In the model composed only of distal and intermediate factors, the primary caregiver not being the mother increased the prevalence of stunting by 42% (PR 1.42 [95% CI: 1.10-1.84], and a mother's working outside the house while not being self-employed was associated with its reduced prevalence (PR 0.55 [95% CI: 0.34-0.89]). In the intermediate model, each additional month of delay in the onset of prenatal care increased the relative prevalence of underweight by 20% (PR 1.20 [95% CI: 1.03-1.40]). CONCLUSIONS: Despite the high prevalence rates of stunting and underweight, relatively few risk factors were identified for these conditions, suggesting that collective exposures are likely to play a major role in causing malnutrition in Angola. The individual factors identified can be useful for the development of strategies to deal with this public health problem.

Evaluation of breastfeeding behaviors and complementary feeding practices of Turkish and Syrian refugee mothers. / Evaluación de las conductas de lactancia materna y las prácticas de alimentación complementaria de las madres turcas y las madres refugiadas sirias.

Objectives: The purpose of this study was to compare breastfeeding and related factors (age, level of education, age at first pregnancy, etc.), and complementary feeding practices between Syrian refugee and native Turkish mothers. Material and methods: This descriptive-comparative study examined the nutritional characteristics of infants aged 9 to 60 months whose mothers were Turkish or Syrian refugees who attended Kiziltepe State Hospital between January 2022 and July 2022. Results: 204 mothers (126 Turkish and 78 Syrian) who had a child aged 9-60 months were included. The average age of the mothers was 27.60 ± 5.17 years for Turkish citizens and 28.91 ± 5.62 for Syrian refugees, without significant difference between the two groups (p: 0.091). Postpartum breastfeeding was 91.3% and breastfeeding duration was 12 (0-24) months in Turkish citizens; in Syrian refugees, breastfeeding was 84.6% and average breastfeeding time was 9 (0- 24) months (respectively, breast milk intake p: 0.144, uptake time p: 0.161; no statistical difference). Breastfeeding training was received by 23.8% of Turkish citizens and 5.1% of Syrian refugees; there was a significant difference between the two groups (p: 0.001). Conclusion: In refugee groups, infant and maternal nutrition practices are disrupted. Working in conjunction with local and international organizations and state agencies that give help to refugee groups, the appropriate interventions, initiatives, supports, and awareness-raising activities would strive to improve practices in mother and baby nutrition and narrow gaps.

Objetivos: el objetivo de este estudio fue comparar la lactancia y los factores relacionados (edad, nivel educativo, edad al momento del primer embarazo, etc.) y las prácticas de alimentación complementaria de las madres refugiadas sirias y las madres turcas. Materiales y métodos: este estudio descriptivo y comparativo analizó las características nutricionales de los bebés de 9 a 60 meses de edad cuyas madres fueran turcas o refugiadas sirias que asistieron al Hospital Público de Kiziltepe entre enero y julio de 2022. Resultados: se incluyó a 204 madres (126 turcas y 78 sirias). La edad promedio de las madres turcas era 27,60 ± 5,17 años y la de las refugiadas sirias, 28,91 ± 5,62 años, sin una diferencia significativa entre ambos grupos (p: 0,091). La lactancia materna posparto fue del 91,3 % y la duración de la lactancia fue de 12 meses (0-24) en las ciudadanas turcas, mientras que, en las refugiadas sirias, fue del 84,6 % y 9 meses (0-24), respectivamente (consumo de leche materna, p: 0,144; tiempo de consumo, p: 0,161; sin diferencias estadísticas). El 23,8 % de las ciudadanas turcas y el 5,1 % de las refugiadas sirias recibieron capacitación sobre la lactancia, con una diferencia significativa entre ambos grupos (p: 0,001). Conclusión: en los grupos de refugiadas, las prácticas de nutrición infantil y materna se ven alteradas. En colaboración con las organizaciones locales e internacionales y los organismos estatales que ayudan a los grupos de refugiados se podrían mejorar las prácticas de nutrición maternoinfantil y reducir las brechas.

Customized versus population-based birth weight charts for the detection of neonatal growth and perinatal morbidity in a cross-sectional study of term neonates.

Customized birth weight charts that incorporate maternal characteristics are now being adopted into clinical practice. However, there is controversy surrounding the value of these charts in the prediction of growth and perinatal outcomes. The objective of this study was to assess the use of customized charts in predicting growth, defined by body fat percentage, and perinatal morbidity. A total of 581 term (≥37 weeks' gestation) neonates born in Sydney, Australia, in 2010 were included. Body fat percentage measurements were taken by using air displacement plethysmography. Objective composite measurements of perinatal morbidity were used to identify neonates who had poor outcomes; these data were extracted from medical records. The value of customized charts was assessed by calculating positive predictive values, negative predictive values, and odds ratios with 95% confidence intervals. Customized versus population-based charts did not improve the prediction of either low body fat percentage (59% vs. 66% positive predictive value and 87% vs. 89% negative predictive value, respectively) or high body fat percentage (48% vs. 53% positive predictive value and 90% vs. 89% negative predictive value, respectively). Customized charts were not better than population-based charts at predicting perinatal morbidity (for customized charts, odds ratio = 1.02, 95% confidence interval: 1.01, 1.04; for population-based charts, odds ratio = 1.03, 95% confidence interval: 1.01, 1.05) per percentile decrease in birth weight. Customized birth weight charts do not provide significant improvements over population-based charts in predicting neonatal growth and morbidity.

Oro-Motor Intervention Protocol to Improve Sucking Behavior among Neonates with Immature Sucking: An Experimental Protocol.

BACKGROUND: Oro-motor intervention methods were previously adopted to improve the sucking pattern but there is still a lag in the structured protocol for improving sucking behavior in infants with immature sucking. Thus, this study is aimed to develop a structured protocol for the Oro-motor intervention to improve sucking behavior. METHOD: Using the prospective observational study design, neonates with poor suck (producing less than 10 sucks per minute), under NG tube feeding, and maintaining oxygen saturation at room air were included. A total of 6 subjects were enrolled in this study and they were treated with Oro-motor intervention protocol. The Sucking rate and LATCH score were taken as the outcome measures and measured at beginning of intervention and after 2 weeks of intervention. RESULT: The mean pre-test and post-test values for sucking rate were is (8.66), (32.5) and LATCH were (4.66), (8.16) respectively. The data collected showed that the protocol framed for Oro-motor intervention was significantly effective in improving quality of feeding among infants with immature sucking behavior. CONCLUSION: The structured Oro-motor intervention protocol improves the feeding performance in infants with poor sucking behavior and improves the LATCH score. All the infants included in this study where under nasogastric tube feeding, thus the structured protocol can be considered to be helpful in weaning from NG tube feeding.

Biometric, nutritional, biochemical, and cardiovascular outcomes in male rats submitted to an experimental model of early weaning that mimics mother abandoning.

Literature describes breast milk as the best food for the newborn, recommending exclusive breastfeeding for up to 6 months of age. However, it is not available for more than 40% of children worldwide. Pharmacological and non-pharmacological models of 3-day early weaning were developed in rodents to investigate later outcomes related solely to this nutritional insult. Thus, the present work aimed to describe biometric, nutritional, biochemical, and cardiovascular outcomes in adult male rats submitted to 3-day early weaning achieved by maternal deprivation. This experimental model comprises not only nutritional insult but also emotional stress, simulating mother abandoning. Male offspring were physically separated from their mothers at 21st (control) or 18th (early weaning) postnatal day, receiving water/food ad libitum. Analysis performed at postnatal days 30, 90, 150, and 365 encompassed body mass and food intake monitoring and serum biochemistry determination. Further assessments included hemodynamic, echocardiographic, and cardiorespiratory evaluation. Early-weaned males presented higher body weight when compared to control as well as dyslipidemia, higher blood pressure, diastolic dysfunction, and cardiac hypertrophy in adult life. Animals early deprived of their mothers have also presented a worse performance on the maximal effort ergometer test. This work shows that 3-day early maternal deprivation favors the development of cardiovascular disease in male rats.

[Infant feeding, how to choose an infant milk?] / Alimentation du nourrisson : comment choisir un lait infantile ?

Infant feeding, how to choose an infant milk? The infant's nutrition is of particular concern, not only to assume a good nutritional status, an adequate growth and development, but also, to some extent, for his future health. Breast feeding remains the best choice but needs to be counseled in practice and in order to avoid deficiencies as well as chemical or in¬fectious contaminations. As a substitute to breast milk, none non modified mammalian milk fits the infant's nutritional needs. Similarly, no non-modified vegetal juice fits these needs, being able to provoke severe nutritional deficiencies. Out of the numerous available formulas, a choice criterion should be the presence of arachidonic acid in infant and follow-up formulae. No other ingredient can yet be counseled as inescapable for every healthy infant. Anti-reflux substitutes are useful for the spitting infants. The lac¬tose-free formulas should be used only in protracted or severe acute diarrheas. Extended hydrolysates of cow's milk proteins, or hydrolyzed rice formulas are prescribed in cow's milk allergy. In rare cases of allergy to these formulas, an amino-acid mixture-based formula is an alternative.

Alimentation du nourrisson : comment choisir un lait infantile ? L'alimentation du nourrisson revêt une importance cruciale non seulement pour assurer un bon état nutritionnel, un développement et une croissance optimaux mais aussi, dans une certaine mesure, pour sa santé ultérieure. L'allaitement maternel est à l'évidence le meilleur choix, mais il doit être accompagné, en termes de pratique et de prévention, des risques caren¬tiels, toxiques et infectieux. À titre de substitut du lait maternel, aucun lait brut de mammifère ne convient au nourrisson. Il en est de même des boissons végétales, non adaptées, qui font courir le risque de carences graves. Parmi les multiples préparations infantiles disponibles, le critère principal de choix pour l'enfant de moins de 1an en bonne santé serait la présence d'acide arachidonique, composé que la réglementation européenne n'a pas rendu obligatoire. Il ne se dégage actuellement aucun autre critère de choix dont l'intérêt soit totalement prouvé pour tous les nourrissons. Les laits antireflux ont un intérêt contre les régurgitations, les laits sans lactose en cas de diarrhée sévère ou prolongée. Les hydrolysats poussés et les préparations à base de riz sont utilisés en cas d'allergie au lait de vache, remplacés par des mélanges d'acides aminés en cas d'allergie à ces deux substituts.

[Diversification de l'alimentation du nourrisson]. / Complementary feeding in infant.

Adequate dietary intake for infant development. The main nutrients required for an adequate infant de¬velopment, particularly neurological, are some lipids (essential fatty acids, arachidonic and docosahexaenoic acids), iron, calcium and vitamind. Appropriate energy intake is also necessary to allow growth. During the first 6 months, these needs are well covered by breastfeeding or infant formula. After complementary feeding intro¬duction, breastfeeding with iron supplementation or consumption of at least 700ml per day of infant for¬mula, addition of fat in each of the salty dishes and vitamin d supplementation allow to ensure all these basic needs. Contrary to popular belief, neither the reasonable addition of salt and sugar to infant meals, nor the excess protein intake induce any risk.

Les apports alimentaires indispensables au développement du nourrisson. Les principaux nutriments indispensables au bon développement, notamment neurologique, des nourrissons sont certains lipides (acides gras essentiels, acides arachidonique et docosahexaénoïque), le fer, le calcium et la vitamine  D. Des apports énergétiques suffisants sont aussi nécessaires pour assurer une croissance staturo-pondérale satisfaisante. Au cours des six premiers mois, ces besoins sont bien couverts par l'allaitement maternel ou une préparation infantile. Après la diversification, l'allaitement avec une supplémentation martiale ou la consommation d'au moins 700  mL par jour de lait infantile, l'ajout de graisses dans chacun des plats salés et la supplémentation en vitamine  D permettent d'assurer la totalité de ces besoins essentiels. Contrairement à une idée répandue, ni l'ajout raisonnable de sel et de sucre dans les plats du nourrisson ni l'excès d'apports protéiques n'exposent à un quelconque risque.

[Adequate dietary intake for infant development]. / Les apports alimentaires indispensables au développement du nourrisson.

Adequate dietary intake for infant development. The main nutrients required for an adequate infant de¬velopment, particularly neurological, are some lipids (essential fatty acids, arachidonic and docosahexaenoic acids), iron, calcium and vitamind. Appropriate energy intake is also necessary to allow growth. During the first 6 months, these needs are well covered by breastfeeding or infant formula. After complementary feeding intro¬duction, breastfeeding with iron supplementation or consumption of at least 700ml per day of infant for¬mula, addition of fat in each of the salty dishes and vitamin d supplementation allow to ensure all these basic needs. Contrary to popular belief, neither the reasonable addition of salt and sugar to infant meals, nor the excess protein intake induce any risk.

Les apports alimentaires indispensables au développement du nourrisson. Les principaux nutriments indispensables au bon développement, notamment neurologique, des nourrissons sont certains lipides (acides gras essentiels, acides arachidonique et docosahexaénoïque), le fer, le calcium et la vitamine  D. Des apports énergétiques suffisants sont aussi nécessaires pour assurer une croissance staturo-pondérale satisfaisante. Au cours des six premiers mois, ces besoins sont bien couverts par l'allaitement maternel ou une préparation infantile. Après la diversification, l'allaitement avec une supplémentation martiale ou la consommation d'au moins 700  mL par jour de lait infantile, l'ajout de graisses dans chacun des plats salés et la supplémentation en vitamine  D permettent d'assurer la totalité de ces besoins essentiels. Contrairement à une idée répandue, ni l'ajout raisonnable de sel et de sucre dans les plats du nourrisson ni l'excès d'apports protéiques n'exposent à un quelconque risque.

[Inadequate infant diets and false food allergies]. / Régimes alimentaires inadaptés du nourrisson et fausses allergies alimentaires.

INADEQUATE INFANT DIETS AND FALSE FOOD allergiesthe administration, by families, of more or less extensive avoidance diets of food to their infants has been a growing problem in recent years. Regardless of certain parental beliefs, these diets are also often set up to treat mild digestive disorders or suspected food allergies. In young children, these diets, without cow's milk protein, vegetarians or even vegans or eliminating foods on unsuitable allergological tests, not supervised by health professionals, can lead to nutritional complications which are sometimes serious and life-threatening. It is therefore important to detect possible nutritional deficiencies, to treat them and to resume, after explanations to the family, a diet as little restricted as possible.

RÉGIMES ALIMENTAIRES INADAPTÉS DU NOURRISSON ET FAUSSES ALLERGIES alimentairesla mise en place, par les familles, de régimes d'évictions, plus ou moins larges, de certains aliments pour leurs nourrissons est un problème croissant depuis quelques années. Indépendamment de certaines croyances parentales, ces régimes sont également souvent destinés à traiter des troubles digestifs bénins ou des allergies alimentaires supposées. Chez le jeune enfant, ces régimes qu'ils soient végétariens, végétaliens ou reposant sur des tests allergologiques inadaptés et non encadrés par des professionnels de santé, peuvent conduire à des complications nutritionnelles parfois graves, engageant le pronostic vital. Il est donc important de dépister d'éventuelles carences, de les traiter et de reprendre, idéalement après explications à la famille, un régime le moins restreint possible.

Gestational weight gain in 4 low- and middle-income countries and associations with birth outcomes: a secondary analysis of the Women First Trial.

BACKGROUND: Adequate gestational weight gain (GWG) is essential for healthy fetal growth. However, in low- and middle-income countries, where malnutrition is prevalent, little information is available about GWG and how it might be modified by nutritional status and interventions. OBJECTIVE: We describe GWG and its associations with fetal growth and birth outcomes. We also examined the extent to which prepregnancy BMI, and preconception and early weight gain modify GWG, and its effects on fetal growth. METHODS: This was a secondary analysis of the Women First Trial, including 2331 women within the Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan, evaluating weight gain from enrollment to ∼12 weeks of gestation and GWG velocity (kg/wk) between ∼12 and 32 weeks of gestation. Adequacy of GWG velocity was compared with 2009 Institute of Medicine recommendations, according to maternal BMI. Early weight gain (EWG), GWG velocity, and adequacy of GWG were related to birth outcomes using linear and Poisson models. RESULTS: GWG velocity (mean ± SD) varied by site: 0.22 ± 0.15 kg/wk in DRC, 0.30 ± 0.23 in Pakistan, 0.31 ± 0.14 in Guatemala, and 0.39 ± 0.13 in India, (P <0.0001). An increase of 0.1 kg/wk in maternal GWG was associated with a 0.13 cm (95% CI: 0.07, 0.18, P <0.001) increase in birth length and a 0.032 kg (0.022, 0.042, P <0.001) increase in birth weight. Compared to women with inadequate GWG, women who had adequate GWG delivered newborns with a higher mean length and weight: 47.98 ± 2.04 cm compared with 47.40 ± 2.17 cm (P <0.001) and 2.864 ± 0.425 kg compared with 2.764 ± 0.418 kg (P <0.001). Baseline BMI, EWG, and GWG were all associated with birth length and weight. CONCLUSIONS: These results underscore the importance of adequate maternal nutrition both before and during pregnancy as a potentially modifiable factor to improve fetal growth.

Tolerability and Effects of the Use of Energy-Enriched Infant Formula After Congenital Heart Surgery: A Randomized Controlled Trial.

BACKGROUND: Undernutrition is a common problem among children with congenital heart disease (CHD) and may lead to poorer surgical outcomes. A higher intake of energy during the postoperative period of CHD surgery seems to be associated with better outcomes. This study aimed to investigate the effect of the use of energy-enriched formula (EE-formula) compared with normocaloric formula during 30 days after CHD surgery. METHODS: A randomized controlled trial with patients undergoing heart surgery in a tertiary hospital in southern Brazil from March 2017 to December 2017 was performed. The intervention group received EE-formula (1 kcal/mL), and the control group received normocaloric formula (0.67 kcal/mL). The researcher in charge of anthropometric evaluation was blinded to the randomization. RESULTS: Fifty-nine patients were included; 30 in control group and 29 in intervention group. There were no statistically significant differences between groups regarding age, gender, anthropometry, and surgical risk classification after randomization. A statistically significant difference in z-score of weight for age and in weight gain variation rate between groups after intervention was observed. Antibiotic use was less frequent in the intervention group, and hospital length of stay was shorter. General gastrointestinal side effects were similar between groups, whereas diarrhea was more frequent in the intervention group. However, this side effect was limited and had spontaneous resolution in 4 out of 6 cases. CONCLUSION: This study demonstrates that EE-formula use after heart surgery of patients with CHD is well tolerated and may improve short-term nutrition outcome, decrease hospital stay, and reduce antibiotic use.

[Nutritional risk to pediatric internation (pilot study).] / Estudio piloto: riesgo nutricional al ingreso de la internación pediátrica.

Background: Malnutrition at admission of paediatric hospitalization is a risk factor for negative evolution and is associated with increased morbidity and mortality. The main objective was to learn about the frequency of malnutrition and undernourishment as well as the nutritional risk at hospital admission, through a sample of paediatric patients. Material and Methods: A descriptive cross-sectional was taken, chosen from long term patients in Hospital Dr. Humberto Notti. A nutritional screening (Strong Kids) was applied, assessing nutritional risk within 48 hours. of hospital admission and nutritional diagnosis was obtained with the corresponding anthropometric data. For the statistical analysis, Fisher Test and Student test were used. Results: 134 patients were admitted (59% women), 4 years of age, (1 to 9 years) (medium sized and IQR), and hospitalization lasted 4 days (3 to 7 days). At the ingress, 17% presented acute malnutrition, and 60% presented moderate nutritional risk. Those who suffered from high nutritional risk, went through more frequent pain, change of weight, less eating, diarrhea, and signs of undernourishment, than those who suffered from moderated nutritional risk. (Fisher < 0, 0001). Conclusion: Malnutrition or undernourishment at hospital admission affects about the 20% of patients and more than half presents moderated nutritional risk. These two observations justify the systematic carrying out of an evaluation of the nutritional status

Introducción: La desnutrición al ingreso de la internación pediátrica es un factor de riesgo de mala evolución y está asociado a mayor morbimortalidad. El principal objetivo fue conocer la frecuencia de desnutrición y riesgo nutricional al inicio de la hospitalización en una muestra de pacientes pediátricos. Población y métodos: Diseño descriptivo, transversal. Se incluyeron pacientes de 1 mes a 14 años internados entre marzo y julio de 2016, en el Hospital Dr. Humberto Notti. Se aplicó un tamizaje nutricional (Strong Kids) valorando riesgo nutricional dentro de las 48hs. de ingreso hospitalario y se obtuvo diagnóstico nutricional con los datos antropométricos correspondientes. Para el análisis estadístico se utilizó Test de Fisher y t de Student. Resultados: Ingresaron 134 pacientes, edad 4 (1 a 9) años (mediana e IQR) y la duración de la internación fue de 4 (3 a 7) días. Al momento del ingreso el 17% presentaba desnutrición aguda y el 60% un riesgo nutricional moderado. Los pacientes con alto riesgo nutricional al ingreso tuvieron más frecuentemente dolor, cambio de peso, menor ingesta, diarrea y signos de desnutrición que los que tuvieron un riesgo nutricional moderado (Fisher < 0,0001). Conclusión: La desnutrición al ingreso de la hospitalización afecta a casi la quinta parte de los pacientes y más de la mitad presenta riesgo nutricional moderado lo que justifica la realización sistemática de la evaluación del riesgo nutricional. Conclusión: La desnutrición al ingreso de la hospitalización afecta a casi la quinta parte de los pacientes y más de la mitad presenta riesgo nutricional moderado lo que justifica la realización sistemática de la evaluación del riesgo nutricional.

Infant nutrition and growth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015.

BACKGROUND: Levels of child undernutrition have declined in many middle-income countries, whereas overweight and obesity have increased. We describe time trends in nutritional indicators at age 1 year in the 1982, 1993, 2004 and 2015 Pelotas (Brazil) Birth Cohorts. METHODS: Each study included all children born in the urban area of the city, with over 4 200 births in each cohort. Children were measured at approximately 12 months of age. Anthropometric indicators were calculated according to World Health Organization Growth Standards. Stunting and wasting were defined as <-2 Z scores for length for age and weight for length, and overweight as >2 Z scores for weight for length. Prevalence was stratified by sex, maternal skin colour and family income. RESULTS: The prevalence of stunting declined by 53% (from 8.3% to 3.9%) from 1982 to 2015. Wasting prevalence remained stable at low levels (1.8% in 1982 and 1.7% in 2015), whereas overweight increased by 88% (6.5% to 12.2%). Undernutrition was more common among boys, those born to mothers with brown or black skin colour and in the poorest quintile of families. Socioeconomic inequalities in undernutrition decreased markedly over time. Overweight was markedly more common among the rich in 1982, but fast increase among the poor eliminated socioeconomic differences by 2015, when all groups showed similar prevalence. CONCLUSIONS: Our results confirm the rapid nutrition transition in Brazil, with marked reduction in levels and inequalities in undernutrition in parallel with a rapid increase in overweight, which became the main nutritional problem for children.

Evaluación de las conductas de lactancia materna y las prácticas de alimentación complementaria de las madres turcas y las madres refugiadas sirias / Evaluation of breastfeeding behaviors and complementary feeding practices of Turkish and Syrian refugee mothers

Objetivos: el objetivo de este estudio fue comparar la lactancia y los factores relacionados (edad, nivel educativo, edad al momento del primer embarazo, etc.) y las prácticas de alimentación complementaria de las madres refugiadas sirias y las madres turcas. Materiales y métodos: este estudio descriptivo y comparativo analizó las características nutricionales de los bebés de 9 a 60 meses de edad cuyas madres fueran turcas o refugiadas sirias que asistieron al Hospital Público de Kiziltepe entre enero y julio de 2022. Resultados: se incluyó a 204 madres (126 turcas y 78 sirias). La edad promedio de las madres turcas era 27,60 ± 5,17 años y la de las refugiadas sirias, 28,91 ± 5,62 años, sin una diferencia significativa entre ambos grupos (p: 0,091). La lactancia materna posparto fue del 91,3 % y la duración de la lactancia fue de 12 meses (0-24) en las ciudadanas turcas, mientras que, en las refugiadas sirias, fue del 84,6 % y 9 meses (0-24), respectivamente (consumo de leche materna, p: 0,144; tiempo de consumo, p: 0,161; sin diferencias estadísticas). El 23,8 % de las ciudadanas turcas y el 5,1 % de las refugiadas sirias recibieron capacitación sobre la lactancia, con una diferencia significativa entre ambos grupos (p: 0,001). Conclusión: en los grupos de refugiadas, las prácticas de nutrición infantil y materna se ven alteradas. En colaboración con las organizaciones locales e internacionales y los organismos estatales que ayudan a los grupos de refugiados se podrían mejorar las prácticas de nutrición maternoinfantil y reducir las brechas.

Objectives: The purpose of this study was to compare breastfeeding and related factors (age, level of education, age at first pregnancy, etc.), and complementary feeding practices between Syrian refugee and native Turkish mothers. Material and methods: This descriptive-comparative study examined the nutritional characteristics of infants aged 9 to 60 months whose mothers were Turkish or Syrian refugees who attended Kiziltepe State Hospital between January 2022 and July 2022. Results: 204 mothers (126 Turkish and 78 Syrian) who had a child aged 9-60 months were included. The average age of the mothers was 27.60 ± 5.17 years for Turkish citizens and 28.91 ± 5.62 for Syrian refugees, without significant difference between the two groups (p: 0.091). Postpartum breastfeeding was 91.3% and breastfeeding duration was 12 (0-24) months in Turkish citizens; in Syrian refugees, breastfeeding was 84.6% and average breastfeeding time was 9 (0- 24) months (respectively, breast milk intake p: 0.144, uptake time p: 0.161; no statistical difference). Breastfeeding training was received by 23.8% of Turkish citizens and 5.1% of Syrian refugees; there was a significant difference between the two groups (p: 0.001). Conclusion: In refugee groups, infant and maternal nutrition practices are disrupted. Working in conjunction with local and international organizations and state agencies that give help to refugee groups, the appropriate interventions, initiatives, supports, and awareness-raising activities would strive to improve practices in mother and baby nutrition and narrow gaps.

[Chronic Malnutrition among Children under Five in Peru: A Spatial Analysis of Nutritional Data, 2010-2016]. / Desnutrición crónica en menores de cinco años en Perú: análisis espacial de información nutricional, 2010-2016.

OBJECTIVE: Peru has implemented various strategies seeking to improve nutritional indicators in children under five years old. However, high prevalence of malnutrition in some regions still remains. The aim of this study was to assess changes in regional prevalence and to determine the presence of district conglomerates with a high prevalence of chronic childhood malnutrition (CCM) in 2010 and 2016. METHODS: A comparative descriptive analysis by regions and a district-level spatial analysis were conducted employing indicators reported by the Nutritional Status Information System. RESULTS: 23.9% (561.090/2.343.806) children under five years evaluated in Peru during 2010 and 18.0% (394.049/2.193.268) evaluated during 2016 were chronic malnutrition (reduction of 5.9 percentage points). We identified a decline of 7.6 percent points in rural areas and the persistence of prevalence above 30% in only one region (Huancavelica). The spatial analysis identified clusters of districts with high prevalence in 20% (379/1834) of Peruvian districts in 2010, and 17.2% (316/1834) of those in 2016, which are mainly spread across the sierra and jungle regions. . CONCLUSIONS: Peru has made significant progress in reducing stunting in children. Nevertheless, it still represents a health problem due to high prevalence in the sierra region, as well as expansion to jungle districts in 2016.

OBJETIVO: En Perú se han implementado diversas estrategias buscando mejorar los indicadores nutricionales en menores de cinco años. No obstante, persisten altas prevalencias de desnutrición en algunas regiones. El objetivo de este estudio fue evaluar los cambios en las prevalencias regionales y determinar la presencia de conglomerados distritales con altas prevalencias de desnutrición crónica infantil (DCI) en los años 2010 y 2016. METODOS: Se realizó un análisis descriptivo comparativo por regiones y un análisis espacial distrital a partir de los indicadores reportados por el Sistema de Información del Estado Nutricional. RESULTADOS: El 23,9% (561.090/2.343.806) de menores de cinco años evaluados en Perú durante el 2010 y el 18,0% (394.049/2.193.268) de evaluados en 2016 presentaron desnutrición crónica (reducción de 5,9 puntos porcentuales). Se identificó una reducción de 7,6 puntos porcentuales en el área rural y la persistencia de prevalencias por encima de 30% en una sola región (Huancavelica). El análisis espacial identificó que en el 2010 existieron agrupaciones distritales de altas prevalencias en el 20% (379/1834) de distritos peruanos y en el 17,2% (316/1834) de distritos para el 2016, los cuales están distribuidos principalmente en la región de la sierra y selva. CONCLUSIONES: En Perú se han logrado importantes avances en reducir la desnutrición crónica infantil, sin embargo, aún representa un problema de salud por las altas prevalencias en la sierra y la expansión hacia distritos de la selva en 2016.