Care groups in an integrated nutrition education intervention improved infant growth among South Sudanese refugees in Uganda's West Nile post-emergency settlements: A cluster randomized trial.

OBJECTIVE: This study examined the effects of a peer-led integrated nutrition education intervention with maternal social support using Care Groups on infant growth among South Sudanese refugees in Uganda. METHODS: A community-based cluster-randomized trial (RCT) was conducted among 390 pregnant women (third trimester). Two intervention study arms were Mothers-only(n = 131) and Parents-combined (n = 142) with a Control (n = 117). WHO infant growth standards defined length-for-age z-scores (LAZ) for stunting, weight-for-age z-scores (WAZ) for underweight and weight-for-length z-scores (WLZ) for wasting. The Medical Outcomes Study (MOS) social support index was a proxy measure for social support. A split-plot ANOVA tested the interaction effects of social support, intervention, and time on infant growth after adjusting for covariates. Further, pairwise comparisons explained mean differences in infant growth among the study arms. RESULTS: The mean infant birth weight was 3.1 ± 0.5 kg. Over the study period, infant stunting was most prevalent in the Control (≥ 14%) compared to Mothers-only (< 9.5%) and Parents-combined (< 7.4%) arms. There were significant interaction effects of the Care Group intervention and social support by time on infant mean LAZ (F (6, 560) = 28.91, p < 0.001), WAZ (F (5.8, 539.4) = 12.70, p = < 0.001) and WLZ (F (5.3, 492.5) = 3.38, p = 0.004). Simple main effects by the end of the study showed that the intervention improved infant mean LAZ (Mothers-only vs. Control (mean difference, MD) = 2.05, p < 0.001; Parents-combined vs. Control, MD = 2.00, p < 0.001) and WAZ (Mothers-only vs. Control, MD = 1.27, p < 0.001; Parents-combined vs. Control, MD = 1.28, p < 0.001). CONCLUSION: Maternal social support with an integrated nutrition education intervention significantly improved infant stunting and underweight. Nutrition-sensitive approaches focused on reducing child undernutrition among post-emergency refugees may benefit from using Care Groups in programs. TRIAL REGISTRATION: Clinicaltrials.gov, NCT05584969.

Home stimulation, development, and nutritional status of children under 2 years of age in the highlands of Madagascar.

BACKGROUND: The Vakinankaratra region of Madagascar has a high burden of child undernutrition which, in addition to poor psychosocial stimulation, is a strong risk factor of poor child development. However, there are limited studies evaluating the relations between developmental deficits, child nutrition outcomes, and home stimulation in the region. The purpose of this study was to assess the development of children aged 11-13 months in relation to their nutritional status and to examine parental home stimulation attitudes and practices in the Vakinankaratra region. METHODS: Cognitive (n = 36), language (n = 36), motor (n = 36), and socioemotional (n = 76) development were assessed using the Bayley Scales of Infant and Toddler Development III. Household stimulation environment was evaluated using the family care indicators survey. Stunting (length-for-age z-score < - 2) and underweight (weight-for-age z-score < - 2) were determined using the 2006 WHO growth standards. Perceptions of and barriers to greater home stimulation for children were collected using focus group discussions among parents and in-depth interviews with community nutrition agents. RESULTS: Almost all mothers reported that parent-child interaction with talk and play was very important. Alarmingly high stunting rates (> 69%) were observed in this subsample. Limited time and tiredness were the major barriers to home stimulation mentioned by parents and confirmed by key informants. Children had a very limited variety of play materials, and most of the mothers used household objects (75%) and materials from outside the house (71%) as children's toys. Composite cognitive [mean (SD): 60 (10.3)], motor [61.9 (13.4)], language [62 (13.2)], and socioemotional [85.1 (17.9]) scores were low. Fine motor, cognitive, and receptive and expressive language scores were correlated [0.4 < r < 0.7, p < 0.05]. CONCLUSIONS: The very high stunting rates and very low performance on cognitive, motor, language, and socioemotional development assessments of children in the Vakinankaratra region require urgent attention.

Relationship between Body Mass Index and Health and Occupational Performance among Law Enforcement Officers, Firefighters, and Military Personnel: A Systematic Review.

The prevalence of overweight and obesity among tactical populations is estimated at 70%-75%, which may negatively impact health and performance. The relationship between BMI and health and performance is well established among the general population, however, literature on such relationships among tactical populations has yet to be reviewed and evaluated. The purpose of this study was to systematically review available literature on the relationship between BMI and health and occupational performance among law enforcement officer, firefighters, and military personnel. After reviewing the literature, 27 articles were included. Nine studies found BMI was positively associated with cardiovascular disease (CVD) risk factors. Studies involving BMI and cancer were lacking. One study found BMI was positively associated with type 2 diabetes (T2DM) risk. Five studies on occupational/physical performance and 12 studies on injury found a higher BMI was often indicative of decreased performance and increased risk of injury in general, but protective against stress fractures. Overall, higher BMI was often associated with negative health and performance outcomes among tactical populations, especially when beyond the overweight classification. Public health practitioners should focus efforts on improving nutrition and physical activity to promote a healthy BMI among these individuals.

A Peer-Led Integrated Nutrition Education Intervention through Care Groups Improved Complementary Feeding of Infants in Postemergency Settlements in the West-Nile Region in Uganda: A Cluster Randomized Trial.

Background: Complementary feeding of infants in refugee settlements remains inadequate. Furthermore, there has been limited evaluation of interventions addressing these nutrition challenges. Objective: This study examined the effects of a peer-led integrated nutrition education intervention on infant complementary feeding by South Sudanese refugee mothers in the West-Nile region in Uganda. Methods: A community-based randomized trial enrolled 390 pregnant women (during third trimester) as the baseline. Two arms [mothers-only and parents-combined (both mothers and fathers)] comprised treatments with a control. Infant feeding was assessed using WHO and UNICEF guidelines. Data were collected at Midline-II and Endline. The medical outcomes study (MOS) social support index was used to measure social support. An overall mean score of >4 was considered optimal social support, a score of ≤2 was none or little support. Adjusted multivariable logistic regression models determined the effects of the intervention on infant complementary feeding. Results: At the end of the study, infant complementary feeding improved significantly in both mothers-only and parents-combined arms. There was a positive effect on the introduction of solid, semisolid, and soft foods (ISSSF) in the mothers-only arm at both Midline-II {adjusted odds ratio (AOR) = 4.0]} and Endline (AOR = 3.8). Likewise, ISSSF was better for the parents-combined arm at both Midline-II (AOR = 4.5) and Endline (AOR = 3.4). Minimum dietary diversity (MDD) was significantly better at the Endline for the parents-combined arm (AOR = 3.0). Minimum acceptable diet (MAD) was significantly better at Endline for both mothers-only (AOR = 2.3) and parents-combined arms (AOR = 2.7). Infant consumption of eggs and flesh foods (EFF) was improved only in the parents-combined arm at both Midline-II (AOR = 3.3) and Endline (AOR = 2.4). Higher maternal social support was associated with better infant MDD (AOR = 3.3), MAD (AOR = 3.6), and EFF (AOR = 4.7). Conclusion: Engaging both fathers and mothers in care groups benefited complementary feeding of infants. Overall, this peer-led integrated nutrition education intervention through care groups improved infant complementary feeding in the West-Nile postemergency settlements in Uganda.This trial was registered at clinicaltrials.gov as NCT05584969.

Breastfeeding among South Sudanese refugees in protracted settlements in Adjumani district, Uganda: facilitators and barriers.

BACKGROUND: Evidence suggests that forced migration and refugee status may adversely impact mothers' breastfeeding choices. Furthermore, suboptimal breastfeeding practices have been reported among vulnerable populations including those living in refugee settlements. Therefore, this study investigated the barriers and facilitators of breastfeeding in protracted settlements in Adjumani district, in the West Nile region in Uganda. METHODS: This study was conducted among refugees living in protracted settlements located in Uganda in July 2019. Participants, originally from South Sudan, included mothers (n = 63) and fathers (n = 32) of children less than 24 months of age. Agojo, Ayilo-I, and Nyumanzi were randomly selected among the 17 refugee settlements in Adjumani. Participants formed a total of six focus group discussions (FGDs); four FGDs for mothers and two FGDs for fathers. Each FGD consisted of 15-16 participants. Data were transcribed verbatim and back-translated into English. Thematic analysis was used and data were analyzed using NVivo, v. 12. RESULTS: Facilitators of breastfeeding included knowledge of breastfeeding benefits, support from husband/father, support from the community, and support from non-governmental organizations. Mothers and fathers noted that breastfeeding protected children from diseases and breastfed children grew well. Fathers, the community, and organizations provided material support for breastfeeding mothers. Four themes were identified as barriers to breastfeeding: physical, socioeconomic, knowledge, and psychosocial. Mothers and fathers described physical barriers such as mothers stop breastfeeding when they are sick or they feel they are not producing enough breastmilk. Mothers reported that working or educated mothers may use other milk to feed their infant. Some mothers and fathers believed infants under six months needed more than breastmilk. Fathers described psychosocial barriers such as mothers' fear of pain during breastfeeding and maternal mental health issues. CONCLUSION: Interventions and policies that aim to improve breastfeeding in protracted settlements should consider addressing the barriers to breastfeeding at each level: physical, socioeconomic, knowledge, and psychosocial. Involving and encouraging support from husbands/fathers, relatives, and the community may increase adherence to breastfeeding recommendations.

Process Evaluation of Two Interventions to Improve Health Environments in Family Child Care Homes.

Early care and education (ECE) environments influence children's lifelong health behaviors, growth, and development. Although the number of interventions to improve health in ECE environments is increasing, few have been designed for and tested in family child care homes (FCCHs). This study reports the process evaluation of two interventions to improve FCCH health environments, both part of Happy Healthy Homes, a matched-attention randomized-controlled intervention trial conducted in Oklahoma FCCHs. Participating child care providers received one of two multicomponent interventions: (a) an intervention focused on enhancing the quality of the nutrition environment, self-efficacy, and practices or (b) an intervention focused on improving providers' environmental health literacy, self-efficacy, and practices. Guided by "Implementation" constructs of the RE-AIM framework (i.e., reach, effectiveness, adoption, implementation, maintenance), intervention report forms and participant tracking were used to assess intervention dose delivered and interventionist-perceived challenges and successes to implementation. Interviews were conducted to obtain participant feedback after the intervention. Dose delivered was high for both interventions overall and across individual sessions, and provider feedback was positive. Implementation challenges and strengths identified for both interventions may be useful for further enhancing intervention appropriateness and success, particularly for interventions with FCCHs. Process evaluation findings indicate that the two Happy Healthy Home interventions can be conducted with high delivery and are well attended and considered to be valuable to FCCH providers.

Analysis of a State Police Academy Menu Cycle for Dietary Quality and Performance Nutrition Adequacy.

Law enforcement officers have high rates of overweight and obesity. With diet as a leading risk factor, training academies present an opportunity for early-career nutrition intervention. Our purpose was to determine the dietary quality (DQ) and performance nutrition adequacy of a state police academy's cafeteria menu. This cross-sectional content analysis included six weeks (three daily meals, Monday-Friday) of a police academy menu. Nutrient content was determined by portioning menus, gathering food specifications, and performing nutrient analysis. DQ was assessed using the Healthy Eating Index (HEI) 2015. Statistical analyses included independent t-tests and Cohen's d. The total HEI score was 54/100. Subcomponent scores indicating adequacy included added sugar (5/5), total protein (4.97/5) and whole fruits (4.77/5). Seafood/plant proteins (0.33/5), fatty acid ratio (1.31/5), and dairy scores (1.59/10) needed significant improvement. The menu met the recommended intake for 13 of 19 nutrients investigated. Nutrients that did not meet adequacy were calories (% mean difference, needs-menu = 36.7%), carbohydrates (52.3%), vitamins D (82.5%) and E (66.7%), magnesium (44.1%), and potassium (41.8%). The academy menu leaves room for improvement in DQ and shortfall nutrients. By increasing low scores, the overall DQ of the menu will increase and supplement missing nutrients.

The associations between women's empowerment measures, child growth and dietary diversity: Findings from an analysis of demographic and health surveys of seven countries in Eastern Africa.

Evidence on the efficacy of women's empowerment to improve child growth and minimum dietary diversity (MDD) in the Eastern Africa (EA) region is limited. This cross-sectional study used recent Demographic and Health Survey data of mother-child dyads from seven countries in EA to examine the associations between women's empowerment measures, child growth and MDD. Length-for-age z-scores, weight-for-length z-scores and weight-for-age z-scores were used to categorize growth indicators of 6-23 months old children. Multivariable logistic regression was used to identify significant associations. Among all countries, 32%-59% of children experienced growth failure. Children meeting MDD were 18%-45%. Women having self-esteem were associated with lower odds of stunting (adjusted odds ratio [AOR] = 0.62 in Rwanda), wasting (AOR = 0.38 in Uganda), underweight (AORs = 0.60 and 0.57 in Tanzania and Uganda, respectively) and growth failure (AOR = 0.64 in Rwanda). Having health decision control in Burundi was associated with lower odds of stunting (AOR = 0.49) and child growth failure (AOR = 0.52) and higher odds of meeting MDD (AOR = 2.50). Having Legal empowerment among women increased the odds of stunting (AOR = 1.79 in Burundi), underweight (AOR = 1.77 in Uganda) and growth failure (AOR = 1.87 in Burundi). Economic empowerment showed mixed associations with child growth and MDD among some countries. Women's self-esteem and health decision control were associated with better child growth and MDD for some countries in EA. Nutrition-sensitive interventions aimed at improving child growth and MDD should consider local contexts when addressing women's empowerment.

Family child care home providers' self-reported nutrition and physical activity practices, self-efficacy, barriers and knowledge: baseline findings from happy healthy homes.

OBJECTIVE: Describe nutrition and physical activity practices, nutrition self-efficacy and barriers and food programme knowledge within Family Child Care Homes (FCCH) and differences by staffing. DESIGN: Baseline, cross-sectional analyses of the Happy Healthy Homes randomised trial (NCT03560050). SETTING: FCCH in Oklahoma, USA. PARTICIPANTS: FCCH providers (n 49, 100 % women, 30·6 % Non-Hispanic Black, 2·0 % Hispanic, 4·1 % American Indian/Alaska Native, 51·0 % Non-Hispanic white, 44·2 ± 14·2 years of age. 53·1 % had additional staff) self-reported nutrition and physical activity practices and policies, nutrition self-efficacy and barriers and food programme knowledge. Differences between providers with and without additional staff were adjusted for multiple comparisons (P < 0·01). RESULTS: The prevalence of meeting all nutrition and physical activity best practices ranged from 0·0-43·8 % to 4·1-16·7 %, respectively. Average nutrition and physical activity scores were 3·2 ± 0·3 and 3·0 ± 0·5 (max 4·0), respectively. Sum nutrition and physical activity scores were 137·5 ± 12·6 (max 172·0) and 48·4 ± 7·5 (max 64·0), respectively. Providers reported high nutrition self-efficacy and few barriers. The majority of providers (73·9-84·7 %) felt that they could meet food programme best practices; however, knowledge of food programme best practices was lower than anticipated (median 63-67 % accuracy). More providers with additional staff had higher self-efficacy in family-style meal service than did those who did not (P = 0·006). CONCLUSIONS: Providers had high self-efficacy in meeting nutrition best practices and reported few barriers. While providers were successfully meeting some individual best practices, few met all. Few differences were observed between FCCH providers with and without additional staff. FCCH providers need additional nutrition training on implementation of best practices.

Baseline associations between biomarkers, cognitive function, and self-regulation indices in the Cognitive and Self-regulatory Mechanisms of Obesity Study.

OBJECTIVE: Understanding how biological, cognitive, and self-regulatory factors are related to obesity, and weight regulation is clearly needed to optimize obesity prevention and treatment. The objective of this investigation was to understand how baseline biological, cognitive, and self-regulatory factors are related to adiposity at the initiation of a behavioral weight loss intervention among treatment-seeking adults with overweight/obesity. METHODS: Participants (N = 107) in the Cognitive and Self-regulatory Mechanisms of Obesity Study (Identifier-NCT02786238) completed a baseline assessment with anthropometric, cardiometabolic, inflammatory, cognitive function, and self-regulation measures as part of a larger on-going trial. Data were analyzed with linear regression. RESULTS: At baseline, body mass index, body fat percentage, and waist circumference (WC) were positively associated with fasting insulin and insulin resistance. Higher WC was related to higher fasting glucose and hemoglobin A1c (HbA1c). Higher glucose and insulin resistance levels were related to lower list sorting working memory. Higher glucose and HbA1c levels were negatively associated with reading scores. Cognitive function and self-regulation indices were unrelated. CONCLUSIONS: In adults with overweight/obesity entering a weight loss treatment study: (1) elevated WC and associated glycemic impairment were negatively associated with cognition, (2) poorer executive function and reading abilities were associated with poorer glycemic control, and (3) objectively measured cognitive functions were unrelated to self-reported/behavioral measures of self-regulation. Such findings increase understanding of the relationships between adiposity, biomarkers, cognition, and self-regulation at treatment initiation and may ultimately inform barriers to successful obesity treatment response.

Fathers' involvement in child care activities: Qualitative findings from the highlands of Madagascar.

Few studies have investigated fathers' roles in child care in Madagascar. This study explored the perceptions, attitudes, and practices regarding fathers' involvement in child care using qualitative methods. Ten focus group discussions were conducted among parents of children aged 6-23 months; seven were among mothers, and three among fathers. In-depth semi-structured interviews (n = 8) were also conducted with key informants. Discussions and interviews were audio-recorded and the verbatim transcripts in Malagasy were translated into English. Data were analyzed using the thematic analysis approach. Provision of financial and material support as well as teaching and playing with the child were the main perceived roles of fathers. In practice, fathers spent their time alone with their children playing and holding them when the mother was unavailable. Busy schedules and separation due to work were major barriers to fathers' involvement. Traditional gender roles for child care in which the mother is seen as primarily responsible for the child were salient across the data. Consequently, men involved in child care activities and their wives were often criticized by the community. Nevertheless, there was self-reported interest from both mothers and fathers in involving men more in child care. Interventions aimed to increase fathers' involvement in child care may be more successful when they focus on shifting the community perceptions on the division of responsibilities between fathers and mothers.

Maternal Knowledge, Attitudes, and Practices of Complementary Feeding and Child Undernutrition in the Vakinankaratra Region of Madagascar: A Mixed-Methods Study.

BACKGROUND: Data are limited on how feeding knowledge and practices relate to child undernutrition in the highlands of Madagascar. OBJECTIVES: This study assessed maternal knowledge and practices of complementary feeding and their associations with anthropometrics of children aged 6-23 mo in the Vakinankaratra region of Madagascar. METHODS: Knowledge was assessed using WHO recommendations on child feeding, and WHO infant and young child feeding (IYCF) indicators were used to evaluate feeding practices. Child growth was measured as length-for-age, weight-for-age, and weight-for-length z-scores using the 2006 WHO growth standards. A z-score less than -2 was classified as child undernutrition. Logistic regression models were used to determine associations between independent variables and outcomes. Focus group discussions among mothers and in-depth interviews with key informants were conducted; barriers and facilitators of optimal feeding practices were identified using a thematic analysis approach. RESULTS: Maternal knowledge scores regarding child feeding averaged 6.4 of 11. Better knowledge scores were associated with higher odds of appropriate complementary feeding practices before and after covariate adjustments. The proportions of children achieving the minimum dietary diversity (35.8%), minimum acceptable diet (30.2%), and consuming meat, fish, and poultry (14.1%) were low. Only consumption of iron-rich foods was associated with lower odds of underweight (adjusted OR = 0.3; 95% CI: 0.1, 0.7; P < 0.05). None of the IYCF indicators were associated significantly with stunting or wasting. Maternal attitudes about complementary foods, as well as mothers' workload and very low income, were identified as barriers to optimal feeding practices. Maternal perceived benefits of giving appropriate complementary foods as well as their positive relationship with the community health workers were the main facilitators of optimal child feeding. CONCLUSIONS: Integrated nutrition-sensitive interventions addressing these barriers while enhancing the facilitators are critical in promoting better feeding practices in the Vakinankaratra region.

Variability in Dietary Quality of Elementary School Lunch Menus with Changes in National School Lunch Program Nutrition Standards.

National School Lunch Program (NSLP) standards recently changed significantly. The Healthy, Hunger-Free Kids Act (HHFKA) presumably improved the dietary quality (DQ) of meals, whereas Child Nutrition Program (CNP) Flexibilities appear to decrease DQ. This variability has not been quantified. Our objective was to determine differences in DQ between elementary school lunch menus meeting NSLP standards: School Meal Initiative (SMI), HHFKA, CNP Flexibilities, and evidence-based best practices (BP). A base menu was portioned per NSLP standards and analyzed for nutrient content and DQ. Statistical analyses included 1-factor ANOVA, Kruskal-Wallis, and Dunnett's test. The BP menu had higher whole fruit and whole grain Healthy Eating Index scores than SMI (Ps < 0.0083). The BP and HHFKA menus had higher refined grain and added sugars scores than SMI (Ps < 0.0083). The SMI menu had lower total vegetable and saturated fat scores than all menus (Ps < 0.0083). This study informs policy toward improving standards, positively affecting child health and academic performance through higher-DQ lunches.

The Association Between School Health Promotion Programs and School Wellness Policies.

OBJECTIVE: Determine school wellness policy quality and evaluate the association between health promotion programs on school wellness policy quality. METHODS: A descriptive cross-sectional study of 344 school districts in Oklahoma, a south-central region of the US. Secondary data including school districts' participation in health promotion programs for school years 2015 and 2016 and school wellness policy scores were used for this study. Descriptive statistics and Cohen d were used in the analysis. RESULTS: School wellness policies had a mean comprehensiveness score of 43.7% and a mean strength score of 21.8%. The presence of ≥3 health promotion programs had a small effect (Cohen d range = 0.20 to 0.48) on school wellness policy scores. CONCLUSIONS AND IMPLICATIONS: School wellness policies have room for improvement in both comprehensiveness and strength. Engagement in ≥3 health promotion programs may contribute to improved policy quality.

Interventions to promote healthy environments in family child care homes in Oklahoma-Happy Healthy Homes: study protocol for a randomized controlled trial.

BACKGROUND: Early childhood is a critical period of development. Caregivers, including providers of early care and education (ECE), have a substantial influence on the health of young children. Family child care homes (FCCHs), which are small, licensed ECE businesses operated out of the residences of providers, are important settings for promoting child health. However, to date, few interventions to promote the health of children have been developed for FCCHs. The purpose of this article is to describe the protocol for Happy Healthy Homes, a pilot interdisciplinary, community-based study to improve FCCH environments and the health of children in Oklahoma. We describe the development and evaluation of two interventions to be tested in a matched attention randomized controlled trial: 1) a nutrition intervention aimed at enhancing the nutritional quality of meals served to young children, incorporating the Child and Adult Care Food Program best practices, and improving nutritional self-efficacy of providers; and 2) an environmental intervention aimed at increasing providers' environmental health literacy, self-efficacy for integrated pest management (IPM), and awareness of less toxic cleaning practices and FCCH provider cleaning behaviors. METHODS: Both interventions are informed by common theoretical principles and are matched in attention (i.e., 6 h), format (i.e., two individual 90-min educational home visits and a 3-h small group class) and materials (i.e., tool kit of educational materials and supplies tailored to the allocated intervention). A randomized trial of both interventions is currently underway with 52 FCCH providers in the Oklahoma City metropolitan area who participate in the Child and Adult Care Food Program. Observed and self-reported measures will be collected at baseline, and 3 months and 12 months after baseline measurements. Randomization to one of the two interventions will occur after baseline data collection. DISCUSSION: This study aims to support FCCH providers in creating healthier FCCH environments for nutrition and environmental health. Successful completion will provide critical information about the nutritional quality and the environmental health of children in FCCHs, as well as much needed evidence about the efficacy of two community-based interventions to improve the nutrition and environmental health of children in home-based ECE settings. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03560050 . Retrospectively registered on 23 May 2018.

Parents' Perceptions of Childhood Obesity and Support of the School Wellness Policy.

OBJECTIVE: Investigate differences in familiarity of parents of school-aged children with school wellness polices (SWP) and perceptions of the problem of childhood obesity related to support for the SWP and school's role in providing a healthy environment. METHODS: Descriptive, cross-sectional study using telephone surveys conducted in spring, 2016. T test statistics compared differences between parents with high vs low SWP familiarity and agreement vs disagreement of childhood obesity as problematic. RESULTS: Nearly half of parents (49.5%) had low familiarity with SWP. Overall, fewer parents agreed that obesity was a local school problem compared with a statewide problem (P < .001). Differences in agreement about childhood obesity explained some differences in SWP support. CONCLUSIONS AND IMPLICATIONS: Greater awareness is needed among parents of schoolchildren regarding the SWP as well as the prevalence of childhood obesity. This could be achieved through increased development, implementation, and evaluation of communication efforts between schools and families regarding health-promoting environments.

Use of Community Readiness Model to Develop and Evaluate a Pilot Culinary Training Program for School Nutrition Staff.

OBJECTIVE: Use the Community Readiness Model (CRM) to develop and evaluate a contextually appropriate pilot culinary training program for school nutrition staff members. DESIGN: Mixed methods to guide intervention development. SETTINGS: Six school districts in rural and urban areas of a southwestern state. PARTICIPANTS: School nutrition staff (n = 36; female; <1 to >20 years' experience). INTERVENTION: Pre- and post-training assessments used the CRM. Findings from the pre-assessment were used to develop the pilot culinary training intervention. MAIN OUTCOME MEASURE: Readiness to integrate new food preparation methods into existing practices. ANALYSIS: The researchers used t and Wilcoxon tests to compare overall readiness and dimension scores (P ≤ .05). Thematic analysis was used to identify themes from the discussion component of the assessments. RESULTS: Overall readiness increased from vague awareness to preparation (P = .02). Improved dimensions were knowledge of efforts (P = .004), leadership (P = .05), and knowledge of issues (P = .04). Themes included barriers, leadership, and motivation. CONCLUSIONS AND IMPLICATIONS: The CRM was useful for developing and evaluating a contextually appropriate and effective culinary training program for school nutrition staff. Future efforts should address the provision of additional resources such as on-site chefs, small equipment grants, and engaging school stakeholders.

Targeted Metabolomics Reveals Abnormal Hepatic Energy Metabolism by Depletion of ß-Carotene Oxygenase 2 in Mice.

ß-carotene oxygenase 2 (BCO2) is a carotenoid cleavage enzyme located in the inner mitochondrial membrane. Ablation of BCO2 impairs mitochondrial function leading to oxidative stress. Herein, we performed a targeted metabolomics study using ultrahigh performance liquid chromatography-tandem mass spectroscopy and gas chromatography-mass spectroscopy to discriminate global metabolites profiles in liver samples from six-week-old male BCO2 systemic knockout (KO), heterozygous (Het), and wild type (WT) mice fed a chow diet. Principal components analysis revealed distinct differences in metabolites in the livers of KO mice, compared to WT and Het mice. However, no marked difference was found in the metabolites of the Het mouse liver compared to the WT. We then conducted random forest analysis to classify the potential biomarkers to further elucidate the different metabolomics profiles. We found that systemic ablation of BCO2 led to perturbations in mitochondrial function and metabolism in the TCA cycle, amino acids, carnitine, lipids, and bile acids. In conclusion, BCO2 is essential to macronutrient and mitochondrial metabolism in the livers of mice. The ablation of BCO2 causes dysfunctional mitochondria and altered energy metabolism, which further leads to systemic oxidative stress and inflammation. A single functional copy of BCO2 largely rescues the hepatic metabolic homeostasis in mice.

Situation and determinants of the infant and young child feeding (IYCF) indicators in Madagascar: analysis of the 2009 Demographic and Health Survey.

BACKGROUND: Studies evaluating child feeding in Madagascar are scarce despite its importance in child growth during the first two years of life. This study assessed the associations between the WHO infant and young child feeding (IYCF) indicators and stunting and identified determinants of inappropriate child feeding practices. METHODS: The most recent Demographic and Health Survey was used including a total of 1956 infants aged 0-23 months. Logistic regressions were performed for the association between IYCF indicators and stunting and for the determination of risk factors for inappropriate feeding practices. RESULTS: The rates of initiation of breastfeeding within one hour after birth (77.2%), continued breastfeeding at one year (99.6%) and timely introduction of solid, semi-solid or soft foods at 6-8 months (88.3%) were high. Exclusive breastfeeding under 6 months (48.8%), attaining minimum dietary diversity (22.2%) and consumption of iron-rich foods (19.6%) were relatively low. Higher length-for-age was associated with achieving minimum dietary diversity (p<0.01). The other indicators assessed (early initiation of breastfeeding, exclusive breastfeeding under 6 months, timely introduction of complementary foods and consumption of iron-rich foods) were not associated with stunting. Infants born to mothers who had first given birth at an age younger than 19 were more likely not to be breastfed within one hour after birth, not to be exclusively breastfed and not to have the recommended dietary diversity. Infants whose mothers had low media exposure were at increased risk of being inappropriately fed. Low household wealth also was associated with higher odds of not meeting the minimum dietary diversity. CONCLUSIONS: Despite almost total continued breastfeeding at one year and early initiation of breastfeeding by more than three-quarter of mothers, minimum dietary diversity scores were still low, confirming the need for more effective programs for improving child feeding practices in Madagascar. Improving dietary diversity in children aged 6-23 months may help reduce stunting. The identified risk factors for inappropriate feeding practices could be used in directing future nutrition sensitive interventions.

Determinants of stunting in children under 5 years in Madagascar.

Madagascar is among countries where the prevalence of stunting is dramatically high in under 5 years old children. This study investigated the determinants of child stunting based on the UNICEF framework on the causes of malnutrition. A cutoff at 24 months was used to separate the child population into two groups. By using the latest Demographic and Health Survey (2009), logistic regressions were performed to determine the variables associated with stunting. In 2009, 40.1% of the 1,863 children aged 0-23 months and 53.9% of the 2,911 children aged 24-59 months were stunted contributing to the 48.5% overall stunting prevalence in the sample. Girls were less likely to be stunted (adjusted odds ratio with confidence interval [AOR] = 0.69 [0.55-0.88] and 0.84 [0.72-0.97], p < 0.01) than boys; the risk of stunting increased with age. Regarding underlying predictors, increased maternal height was associated with lower odds of stunting in both age groups (AOR = 0.75 [0.68-0.83] and 0.69 [0.61-0.77], p < 0.001). Children living in households using iodized salt (>15 ppm) had lower risk of stunting in the younger group (AOR = 0.76 [0.61-0.94], p < 0.05). Children living in urban areas were less likely to be stunted in both age groups (AOR = 0.67 [0.51-0.88] and 0.73 [0.59-0.90] respectively, p < 0.01]. Region of residence was also a significant basic factor for stunting. This study contributes to the understanding of the determinants of child stunting in Madagascar. The results confirmed the need for specific interventions for each of the two age groups.