Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) in the Orthodox and Secular Jewish Communities in Israel.

Symptoms related to avoidant/restrictive food intake disorder (ARFID) are not well defined in the general population. The aim of this study was to determine whether differences exist in the presentation of ARFID-related eating disturbances between healthy, religious and secular Jewish children in Israel. Sixty-four families participated in this study. Parents completed standardized questionnaires to assess ARFID behaviors of children, parental feeding problems and overall functioning, anxiety and sensory-aversion. No significant between-group differences were found for almost all assessments. However, sensory-related pleasure and sensory-seeking behavior was greater in secular children. Overall, religious and non-religious Israeli children do not differ in parental-reported ARFID-related feeding and eating behaviors.

The impact of Option B+ on mother-to-child transmission of HIV in Africa: A systematic review.

OBJECTIVE: In 2015, the WHO released new guidelines to reduce mother-to-child transmission (MTCT) of HIV. The recommendations, known as Option B+, included initiation of lifelong highly active antiretroviral therapy regardless of CD4 count for all HIV-positive pregnant and breastfeeding mothers. For infants, exclusive breastfeeding for 6 months and antiviral therapy were sanctioned. Targets of <5% transmission in breastfeeding populations and <2% in non-breastfeeding populations were set. This review evaluated the impact of Option B+ on MTCT in African countries. METHODS: Using the PRISMA guidelines, a systematic search of PubMed and Google Scholar databases was conducted to identify relevant studies published between 2015 and 2021. All studies meeting inclusion criteria were evaluated. RESULTS: Of the 687 references screened, 22 studies from 11 countries (Cameroon, Ethiopia, Lesotho, Malawi, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe) met inclusion criteria. Six studies reported MTCT rates of <2%, 16 studies reported rates of 2-5% and two studies (Uganda and Zambia) reported 6% or more. Rates varied within the same study at different time points postpartum and amongst studies from the same country. Overall, reported MTCT rates appear to be close to WHO targets. However, diverse study designs, selection bias, extensive loss to follow-up and undocumented adherence rates to Option B+ protocols may significantly underestimate MTCT rates of HIV in Africa. CONCLUSIONS: Standardised protocols for impact evaluation must be established to provide evidenced-based data on the efficacy of Option B+ in Africa.

Prospective Longitudinal Assessment of Linear Growth and Adult Height in Female Adolescents With Anorexia Nervosa.

CONTEXT: Growth retardation is an established complication of anorexia nervosa (AN); however, findings concerning the adult height of AN patients are inconsistent. OBJECTIVE: The objective of this work was to assess linear growth and adult height in female adolescents with AN. DESIGN AND SETTING: A prospective observational study was conducted in a tertiary university hospital. PARTICIPANTS: Participants included all 255 female adolescent AN patients hospitalized in the pediatric psychosomatic department between January 1, 2000 and May 31, 2015. INTERVENTIONS: Height and weight were assessed at admission and during hospitalization. Patients were subsequently invited for measurement of adult height. Additional data collected included premorbid height data, menstrual history, skeletal age, pertinent laboratory studies, and parental heights. MAIN OUTCOME MEASURE: The main outcome measure of this study was adult height. RESULTS: Mean age at admission was 15.4 ±â€…1.75 years, mean body mass index (BMI) was 15.7 ±â€…1.8 kg/m2 (BMI SDS = -2.3 ±â€…1.45 kg/m2). Premorbid height SD scores (SDS) were not significantly different from those expected in normal adolescents (0.005 ±â€…0.96). However, height SDS at admission (-0.36 ±â€…0.99), discharge (-0.34 ±â€…0.96), and at adult height (-0.29 ±â€…0.95), were significantly (P < .001) lower than expected. Furthermore, adult height was significantly (P = .006) shorter compared to the midparental target height. Stepwise forward linear regression analysis identified age (r = 0.32, P = .002) and bone age (r = -0.29, P = .006) on admission, linear growth during hospitalization (r = 0.47, P < .001), and change in luteinizing hormone during hospitalization (r = -0.265, P = .021) as independent predictors of improvement in height SDS from the time of admission to adult height. CONCLUSIONS: Whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.

Feeding, Eating, and Emotional Disturbances in Children with Avoidant/Restrictive Food Intake Disorder (ARFID).

Avoidant/restrictive food intake disorder (ARFID) is a relatively new diagnostic category. We sought to determine whether the Stanford Feeding Questionnaire (SFQ), an instrument for assessing picky eating, can differentiate children with ARFID from control children, and whether children with ARFID would show more nonfeeding/eating emotional problems than controls. Fifty children with ARFID were compared to 98 controls. Parents completed the SFQ, Screen for Child Anxiety Related Emotional Disorders (SCARED), Strength and Difficulties Questionnaire (SDQ), and Sensory Responsiveness Questionnaire (SRQ). On the SFQ, 12 items represented child ARFID behaviors (SFQ-ARFID Scale), and another 15 items represented parental feeding problems (SFQ-PFP Scale). We found that the SFQ-ARFID and SFQ-PFP Scale scores were significantly higher in children with ARFID vs. controls. Children with ARFID demonstrated higher SDQ-Total-Difficulties, higher SDQ-Internalizing-Difficulties and lower SRQ-Hedonic scores compared with controls. Of all parameters, the SFQ-ARFID Scale best differentiated children with ARFID from control children (area under receiver operating characteristics curve = 0.939, 95% CI, 0.895-0.983, p < 0.001). These findings suggest that parental reports show more eating problems and emotional disturbances in children with ARFID vs. controls, and more parental feeding problems. Further research is required to determine whether the SFQ-ARFID Scale may serve as an effective screening tool for the identification of ARFID.

Maternal knowledge in complementary feeding following Baby Friendly Community Initiative in Koibatek, Kenya.

The Kenyan Ministry of Health has developed a National Strategy on Infant and Young Child Feeding with the goal of improving feeding practices for infants and children. In order to promote appropriate infant feeding, the government has explored implementation of the Baby Friendly Community Initiative (BFCI). This study assessed maternal knowledge of attributes of complementary feeding following implementation of BFCI in Koibatek, Kenya. A randomized control study composed of 270 mother-infant pairs previously enrolled in a BFCI programme in Koibatek was conducted. The study found that a significantly greater number of mothers in the intervention group were more knowledgeable about proper breastfeeding and complementary feeding aspects compared with controls (P ≤ 0.001). About half (53%) of mothers in the intervention group had high knowledge scores in comparison with 20% of mothers in the control group. When the relationship between mothers' knowledge and complementary feeding practices (minimum meal frequency, minimum dietary diversity and minimum acceptable diet) was assessed, significant associations were observed (P = 0.010, P ≤ 0.001 and P ≤ 0.001, respectively). The odds of having a high knowledge score regarding complementary feeding practices were significantly higher for the intervention group compared with the control group (odds ratio [OR]: 25.98, 95% confidence interval [CI] 13.62-49.55, P ≤ 0.001). The BFCI intervention effectively improved mothers' knowledge on complementary feeding and correlated with improved feeding practices.

Effectiveness of Baby Friendly Community Initiative (BFCI) on complementary feeding in Koibatek, Kenya: a randomized control study.

BACKGROUND: Appropriate infant and young child nutrition is critical for proper growth and development. In order to promote optimal nutrition at an early age, the World Health Organization (WHO) and UNICEF have developed the Baby Friendly Hospital Initiative (BFHI) to address poor breastfeeding practices in maternity wards. However, impact is limited in less developed countries like Kenya, where more than half of all births are home deliveries. Therefore, Kenya has explored the adoption of Baby Friendly Community Initiative (BFCI) in its rural settings. In contrast to the BFHI, the BFCI supports breastfeeding and optimal infant feeding in community. BFCI has been implemented in Koibatek, in rural Kenya. This study aimed at assessing the effectiveness of BFCI on complementary feeding practices of children aged 6-23 months, by comparing intervention and control groups. METHODS: This was a randomized control study design that included 270 mother-infant pairs enrolled in the Baby Friendly Community Initiative (BFCI) project in Koibatek. Evaluation was carried out using structured questionnaires. RESULTS: A statistically significantly higher proportion of children in the intervention group compared to the control group attained minimum dietary diversity (77% vs. 58%; p = 0.001), minimum meal frequency (96% vs. 89%; p = 0.046) and minimum acceptable diet (77% vs. 61%; p = 0.005). The odds of attaining minimum dietary diversity, minimum meal frequency and minimum acceptable diet were statistically significantly higher for the intervention group compared to control group (OR: 4.95; 95%CI 2.44-10.03, p = < 0.001; OR: 14.84; 95%CI 2.75-79.9, p = 0.002; OR: 4.61; 95%CI 2.17-9.78, p = < 0.001 respectively). CONCLUSION: The BFCI intervention was successful in improving complementary feeding practices. Strengthening and prioritizing BFCI interventions could have a significant impact on child health outcomes in rural Kenya. TRIAL REGISTRATION: ISRCTN03467700 . Registration 24 September 2014. Retrospectively registered.

Impact of Community-Based Nutrition Education on Geophagic Behavior and Dietary Knowledge and Practices among Rural Women in Nakuru Town, Kenya: A Pilot Study.

OBJECTIVE: Geophagia, the deliberate consumption of rocks, soil, or clay, is prevalent in developing countries, particularly sub-Saharan Africa. Health risks associated with this behavior include parasitosis, heavy metal poisoning, nutrient deficiencies, and poor birth outcomes. This pilot study was designed to reduce geophagic practices and improve nutrition among rural Kenyan women. METHODS: The researchers used snowball sampling to recruit participants (n = 135; aged 15-49 years) from low socioeconomic areas who consumed geophagic materials. Interviews were carried out before and after a nutrition intervention implemented by trained community health volunteers. RESULTS: Nutrition education focusing on geophagia significantly (P < .001) decreased the practice in 77% of participants. Postintervention interviews also demonstrated substantial improvement in understanding the concept of making half the plate vegetables using the healthy plate model. CONCLUSIONS AND IMPLICATIONS: Nutrition education can be useful for reducing geophagia (a largely ignored, unsafe dietary behavior) and enhancing nutritional knowledge in African women.

Associations of breastfeeding with bulimic behaviors and eating disorders among adolescents.

PURPOSE: To use the lifecourse framework to examine the association between duration of breastfeeding and risk of developing bulimic behaviors or a diagnosed eating disorder. METHOD: Questionnaires were sent every 12-24 months between 1996 and 2005 to 6,436 females and 5,756 males in the Growing Up Today Study, who were 9-14 years at baseline. Duration of breastfeeding was reported by the participants' mothers in 1997. We used generalized estimating equations to estimate the association of breastfeeding with purging, binge eating, engaging in bulimic behaviors, and having a diagnosed eating disorder. RESULTS: Compared to girls who were breastfed for more than 9 months, those who were breastfed for less than 4 months did not have a significantly different prevalence of purging, binge eating, bulimic behaviors, and self-reported history of diagnosed eating disorders. Adjusting for gestational age/birthweight, age, age at menarche, maternal history of an eating disorder, and maternal body mass index, short duration of breastfeeding was not associated with any outcome among the girls [adjusted odds ratios (AOR) ranged from 0.8 to 1.1]. Among the boys, the results showed no significant associations between duration of breastfeeding and purging, binge eating, and self-reported history of diagnosed eating disorder. However, there was a suggestion that boys who had been breastfed for less than 4 months were at a higher risk of engaging in bulimic behaviors [AOR: 1.5, 95% confidence interval (CI), 1.0-2.3]. DISCUSSION: No association was found between duration of breastfeeding and risk of developing bulimic behaviors or a diagnosed eating disorder among girls or boys with the one exception of longer duration of breastfeeding associated with fewer bulimic behaviors in boys. Although there are many benefits to breastfeeding, our data suggest that breastfeeding does not offer any protection against binge eating or purging, nor does it present harmful effects.

Linear growth and final height characteristics in adolescent females with anorexia nervosa.

OBJECTIVE: Growth retardation is an established complication of anorexia nervosa (AN). However, findings concerning final height of AN patients are inconsistent. The aim of this study was to assess these phenomena in female adolescent inpatients with AN. METHODS: We retrospectively studied all 211 female adolescent AN patients hospitalized in an inpatient eating disorders department from 1/1/1987 to 31/12/99. Height and weight were assessed at admission and thereafter routinely during hospitalization and follow-up. Final height was measured in 69 patients 2-10 years after discharge. Pre-morbid height data was available in 29 patients. RESULTS: Patients' height standard deviation scores (SDS) on admission (-0.285±1.0) and discharge (-0.271±1.02) were significantly (p<0.001) lower than expected in normal adolescents. Patients admitted at age ≤13 years, or less than 1 year after menarche, were more severely growth-impaired than patients admitted at an older age, (p = 0.03). Final height SDS, available for 69 patients, was -0.258±1.04, significantly lower than expected in a normal population (p = 0.04), and was more severely compromised in patients who were admitted less than 1 year from their menarche. In a subgroup of 29 patients with complete growth data (pre-morbid, admission, discharge, and final adult height), the pre-morbid height SDS was not significantly different from the expected (-0.11±1.1), whereas heights at the other time points were significantly (p = 0.001) lower (-0.56±1.2, -0.52±1.2, and -0.6±1.2, respectively). CONCLUSIONS: Our findings suggest that whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.

Stunting of growth as a major feature of anorexia nervosa in male adolescents.

OBJECTIVE: To assess growth retardation in male adolescent patients who have a diagnosis of anorexia nervosa (AN) and the effect of weight restoration on catch-up growth. METHODS: Medical charts of all male adolescent AN patients (n = 12) who were admitted to the Pediatric Psychosomatic Department at the Sheba Medical Center from January 1, 1994, to December 31, 1998, were reviewed. Height and weight measurements were obtained before the onset of AN, at admission, and thereafter routinely during hospitalization and follow-up. RESULTS: Eleven patients exhibited growth retardation during the course of their illness, as evident in a decrease in their height standard deviation score (SDS). The mean height SDS at the time of admission (-0.81 +/- 0.93) was significantly lower than the premorbid SDS (-0.21 +/- 0.91). Weight restoration resulted in accelerated linear growth (up to 2 cm/mo) in all patients. Positive weight gain (weight gain rate >1 kg/y) was associated with a mean height gain of 6.97 +/- 6.48 cm/y, whereas weight loss or failure to gain weight (weight gain rate