Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children.

Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy.

Review of the importance of nutrition during the first 1000 days: maternal nutritional status and its associations with fetal growth and birth, neonatal and infant outcomes among African women.

Maternal nutritional status (MNS) is a strong predictor of growth and development in the first 1000 days of life and may influence susceptibility to non-communicable diseases in adulthood. However, the role of nutrition during this window of developmental plasticity in Africa is unclear. This paper reviews published data to address whether maternal nutrition during the first 1000 days is important for Africa, with a focus on MNS and its associations with fetal growth and birth, neonatal and infant outcomes. A systematic approach was used to search the following databases: Medline, EMBASE, Web of Science, Google Scholar, ScienceDirect, SciSearch and Cochrane Library. In all, 26 studies met the inclusion criteria for the specific objectives. MNS in Africa showed features typical of the epidemiological transition: higher prevalences of maternal overweight and obesity and lower underweight, poor diet quality 1 and high anaemia prevalence. Maternal body mass index and greater gestational weight gain (GWG) were positively associated with birth weight; however, maternal overweight and obesity were associated with increased risk of macrosomia and intrauterine growth restriction. Maternal anaemia was associated with lower birth weight. Macro- and micronutrient supplementation during pregnancy were associated with improvements in GWG, birth weight and mortality risk. Data suggest poor MNS in Africa and confirms the importance of the first 1000 days as a critical period for nutritional intervention to improve growth, birth outcomes and potential future health risk. However, there is a lack of data beyond birth and a need for longitudinal data through infancy to 2 years of age.

A comparison of body composition estimates using dual-energy X-ray absorptiometry and air-displacement plethysmography in South African neonates.

BACKGROUND/OBJECTIVES: Neonatal body composition is an important predictor of future metabolic risk; however, the comparability of objective assessment techniques, particularly in African populations undergoing rapid health transition, is not known. This paper compares body composition estimates by air-displacement plethysmography (ADP) and dual-energy X-ray absorptiometry (DXA) in South African neonates. SUBJECTS/METHODS: Fat mass, fat-free mass and body fat percentage (%fat) estimates by ADP and DXA were compared in 88 urban, black South African neonates. The level of agreement between the techniques was assessed using Bland-Altman analyses. RESULTS: Significant correlations were observed between ADP and DXA measurements of fat mass (r=0.766), fat-free mass (r=0.942) and %fat (r=0.630); however, ADP estimates of fat mass (408±172 g vs 337±165 g; P<0.001) and %fat (12.9±4.4% vs 9.9±4%; P<0.001) were significantly higher and fat-free mass (2681±348 g vs 2969±375 g; P<0.001) significantly lower than those by DXA. Fat-free mass estimates showed greater consistency in the level of agreement between the techniques compared with fat and %fat estimates where the differences between methods were less predictable. CONCLUSION: Although ADP and DXA body composition estimates are highly correlated in neonates, significant differences are observed between the techniques. This is particularly relevant for fat mass and %fat estimates, where differences are highly variable between methods. Further investigation is needed to minimise inter-method differences to ensure accurate and comparable assessment of body composition at birth and across longitudinal study follow-up.