Exclusive breastfeeding and its effect on growth of Malawian infants: results from a cross-sectional study.

BACKGROUND: For the optimal nutrition of children under 2 years of age, it is considered important that they be exclusively breastfed for the first 6 months before being given complementary food. AIMS AND OBJECTIVES: A cross-sectional nutritional baseline survey was undertaken in 2011 in the Kasungu and Mzimba Districts of Malawi to assess the nutritional status of children under 2 years of age and its determinants in order to prepare a nutrition education intervention programme. The intention of this study was to assess the nutritional status of infants aged 0-<6 months with regard to food intake. METHODS: Interviews were conducted on randomly selected families with children under 2 years; anthropometric measurements were obtained from mothers and their children. Only infants between 0 and <6 months were selected for analysis (n  =  196). An ANCOVA test was performed on age of the infant with mothers' height and weight as covariates. RESULTS: Prevalence of stunting (infants' length-for-age Z-score (LAZ) <-2SD) was 39%, wasting (WLZ <-2SD) 2%, and underweight (WAZ <-2SD) 13%. Of the infants under 6 months, 43% were exclusively breastfed. Predominant breastfeeding and mixed breastfeeding were less common (21% and 36%, respectively). The ANCOVA confirmed the association between exclusive breastfeeding and LAZ and WAZ: exclusively breastfed infants had a higher mean (SE) LAZ (-1.13, 0.12) and WAZ (-0.41, 0.13) than infants not being exclusively breastfed (-1.59, 0.11, and -0.97, 0.11, respectively). There was no overall significant association between breastfeeding practice and WLZ. CONCLUSION: Exclusive breastfeeding of infants under 6 months is associated with higher mean LAZ and WAZ. Promotion of exclusive breastfeeding in low-income countries is important in preventing growth retardation.

Revised D-A-CH intake recommendations for folate: how much is needed?

The D-A-CH reference value (D-A-CH arises from the initial letters of the common country identification for the countries Germany (D), Austria (A) and Switzerland (CH)) for folate equivalents had been set at 400 µg/d for adults in the year 2000. By that time, the prevention of cardiovascular diseases through reduction of homocysteine was considered an important target of the reference value. Since that time a number of research papers revealed that in spite of an inverse association between folate-rich diet and chronic diseases, a preventive effect of folic acid intake on cardiovascular events was not supported by randomized controlled trials, and the reduction of plasma homocysteine levels to around 10-12 µmol/l did not reduce the risk for thromboembolic and cardiovascular diseases in persons already affected by these diseases. These results together with the observation that folate intakes below 400 µg/d result in a sufficient folate status justified a review of the current literature and-consequently-a reduction of the reference value to 300 µg/d for adults. This reference value is expressed as dietary folate equivalents that take into account the difference in bioavailability between folic acid and all types of folates in food. The recommendation to take a daily supplement of 400 µg of synthetic folic acid for women who intend to get pregnant and until the end of the first trimester of pregnancy is maintained.

[Promotion of fruit and vegetable consumption among school children--mission (im)possible?]. / Förderung des Obst- und Gemüseverzehrs bei Schulkindern--Mission (im-)possible?

A diet rich in fruits and vegetables in school children is important for the physical and cognitive development of the child as well as for the prevention of nutrition-related diseases. In Germany, 816 school children (boys and girls, aged 10-13 years) from 14 public schools in the state of Hesse were interviewed about their fruit and vegetable intake in May 2009. The subsequent intervention was conducted between November 2009 and April 2010 among 7 schools. The intervention group received work sheets on fruit and vegetables and had additional promotional and educational activities. The other schools served as controls. After the intervention period, a follow-up survey was carried out in all schools. Both surveys used the same standardised questionnaire for assessing the fruit and vegetable consumption. Comparison between baseline survey and follow-up showed no change in consumption amount among the children of the intervention group. In the control group, fruit consumption decreased statistically significantly (p=0.034). The intervention positively impacted on the diversity of consumed fruit and vegetables. The strategies of PRO GREENS provide a basis for the promotion of fruit and vegetable consumption among school children. They need to be further improved regarding the participation of parents, practical relevance, situational prevention, and long-lasting cooperation to ensure a diversified dietary and nutrient intake.

Interaction of nutrition and infections globally: an overview.

The interaction of nutrition and infections is known by experience by generations of medical doctors. Before the era of antibiotics, diet was an integral part of the management of infections. Now, it is necessary to take a fresh look at this interaction as the understanding of immune response has expanded considerably. Comparatively little research has addressed the impact of nutrition interventions on the management of infectious diseases. Most observations of the interaction between nutrition and infections are epidemiological in character. This holds especially true for measles as well as for tuberculosis. In AIDS, the deterioration of the nutritional status is an indicator of disease progression. Infections in undernourished children are a common cause of death, and taking this finding into account helps to reduce the case fatality rate in severely malnourished patients. Regarding the immune response, cellular as well as soluble components are affected by deficiencies of single nutrients or general undernutrition. The immunosuppressive effect of undernutrition starts during intrauterine life already: maternal nutrition status has been shown to impact on immune function in adult animals. Recent research suggests that not only undernutrition but also caloric overnutrition impacts on immune response to infections and immunization. This is partly due to the chronic inflammatory activity of the adipose tissue and partly due to neuroendocrine alterations. Infectious diseases also impact on the nutritional status, either specifically or through unspecific mechanisms, such as anorexia, tachypnea, and vomiting.

Parenteral nutrition-associated cholestasis--what do we know, what can we do?

In the early days of parenteral nutrition of children liver disease resulting in steatosis and cholestasis was assumed to be an inevitable complication of the procedure. Since then, the management of parenteral nutrition has improved so much that nowadays adolescents have a fair chance of surviving more than 15 to 20 years without severe liver disease. Nevertheless, we still see cases of parenteral nutrition-associated cholestasis (PNAC) due to various conditions such as recurrent infections, inflammatory response, inappropriate composition of the nutrient mixture, contaminants of the nutrient solution, and toxic substances from infusion bags and tubes. Recent research indicates that the administration of ursodesoxycholic acid and cysteine can prevent or even improve the cholestasis. A reversal of PNAC has been documented in an adolescent after small bowel transplantation from Japan. There is ample opportunity for prevention of PNAC with respect to the various pathophysiologic aspects: prevention, early detection, and management of infections, avoiding glucose overloads, cyclic infusion of nutrients, light protection of the solution, choice of paediatric amino acid solutions, and most important, oral or enteral feeding to support the bile flow by stimulating the cholecystokinine release.

[Child health in our world]. / Gesundheit der Kinder unserer Welt.

The health of children in poor countries is determined by their nutritional status and by the economic conditions of their families and societies. Socioeconomic differences are correlated with the infant mortality rate (IMR). The decline of the IMR in the industrialized countries mainly occurred before 1960. Programs for Primary Health Care cannot cope with the deterioration of economic problems due to the disadvantaged position of the poor countries in the world market. The typical clinical pattern of diseases in childhood in the tropics is essentially determined by the nutritional status (e.g. measles). The advantages of breastfeeding also relate to the immune response after immunization. The HIV-epidemic requires social assistance for the future of the AIDS-orphans in the first line. Additional assistance is needed for the procurement of medication, otherwise HIV-infected patients are in competition with non-HIV-infected patients.

Lissencephaly, abnormal lymph nodes, and T-cell deficiency in one patient.

We report on a child with lissencephaly type I, abnormal lymph nodes, and immunodeficiency, associated with recurrent infections, autoimmune disease, spastic tetraplegia, and psychomotor retardation. Diagnostic measures included cranial computer tomography (CT) and magnetic resonance imaging (MRI) scanning, several in vivo and in vitro immunological tests, and histology of skin, lymph nodes, and liver including electron microscopy and immunohistology. Despite medical supervision, the child died at age 4 years. A common pathogenetic mechanism of defective migration of neurons and the dysmaturation of lymph nodes is most probable. The T-cell deficiency may represent a common defect of the development of both neuronal and lymphatic tissue, as the six-layered cerebral cortex and the B-cell areas in lymph nodes develop at about the same gestational age. A common defect could also be assumed involving genetically determined cell surface proteins.