Dietary Strategies for Complementary Feeding between 6 and 24 Months of Age: The Evidence.

Suboptimal complementary feeding practices remain highly prevent. This review aims to comprehensively synthesize new emerging evidence on a set of topics related to the selection and consumption of complementary foods. We synthesized evidence related to five key topics focused on nutritional interventions that target the complementary feeding period, based on four systematic reviews that include updated evidence to February 2022. While there have been many studies examining interventions during the complementary feeding period, there is an overall lack of relevant information through which to draw conclusions on the ideal feeding schedule by food type. Similarly, few studies have examined the effects of animal milk versus infant formula for non-breastfed infants (6-11 months), though those that did found a greater risk of anemia among infants who were provided cow's milk. This review highlights a number of interventions that are successful at improving micronutrient status and anthropometry during the complementary feeding period, including fortified blended foods, locally and commercially produced supplementary foods, and small-quantity lipid-based nutrient supplements. Complementary feeding education for caregivers can also be used to improve nutrition outcomes among infants in both food secure and insecure populations.

Evaluation of two social norms nudge interventions to promote healthier food choices in a Canadian grocery store.

The objective of this study was to determine the impact of two nudge interventions on customers' produce purchases at a rural Canadian grocery store. A pre- and post-intervention observational study design was used. Sales data were gathered before and after the staggered implementation of two nudge-based interventions to encourage produce purchases: grocery cart dividers to encourage shoppers to fill one-third of their cart with produce and grocery cart plaques with information about how many fruits and vegetables were typically purchased in the store. The proportion of total sales accounted for by produce was compared between baseline and implementation of the first intervention (Phase 1), between implementation of the first intervention and the addition of the second intervention (Phase 2), and between baseline and post-implementation of both interventions together. There was a 5% relative increase (0.5% absolute increase) in produce spending between baseline and post-implementation of both interventions (10.3% to 10.8%, p < 0.001, 95% CI 0.2%, 0.7%). Intervention phase-specific produce spending showed no significant change in the percentage of produce spending from baseline to Phase 1 of the intervention, and an 8% relative increase (0.8% absolute increase) in the percentage of produce spending from Phase 1 to Phase 2 of the intervention (10.3% to 11.1%, p < 0.001, 95% CI 0.5, 1.1%). Simple, low-cost nudge interventions were effective at increasing the proportion of total grocery spend on produce. This study also demonstrated that partnerships with local businesses can promote healthier food choices in rural communities in Canada.

Malaria reduction drives childhood stunting decline in Uganda: a mixed-methods country case study.

BACKGROUND: Uganda has achieved a considerable reduction in childhood stunting over the past 2 decades, although accelerated action will be needed to achieve 2030 targets. OBJECTIVES: This study assessed the national, community, household, and individual-level drivers of stunting decline since 2000, along with direct and indirect nutrition policies and programs that have contributed to nutrition change in Uganda. METHODS: This mixed-methods study used 4 different approaches to determine the drivers of stunting change over time: 1) a scoping literature review; 2) quantitative data analyses, including Oaxaca-Blinder decomposition and difference-in-difference multivariable hierarchical modeling; 3) national- and community-level qualitative data collection and analysis; and 4) analysis of key direct and indirect nutrition policies, programs, and initiatives. RESULTS: Stunting prevalence declined by 14% points from 2000 to 2016, although geographical, wealth, urban/rural, and education-based inequalities persist. Child growth curves demonstrated substantial improvements in child height-for-age z-scores (HAZs) at birth, reflecting improved maternal nutrition and intrauterine growth. The decomposition analysis explained 82% of HAZ change, with increased coverage of insecticide-treated mosquito nets (ITNs; 35%), better maternal nutrition (19%), improved maternal education (14%), and improved maternal and newborn healthcare (11%) being the most critical factors. The qualitative analysis supported these findings, and also pointed to wealth, women's empowerment, cultural norms, water and sanitation, dietary intake/diversity, and reduced childhood illness as important. The 2011 Uganda Nutrition Action Plan was an essential multisectoral strategy that shifted nutrition out of health and mainstreamed it across related sectors. CONCLUSIONS: Uganda's success in stunting reduction was multifactorial, but driven largely through indirect nutrition strategies delivered outside of health. To further improve stunting, it will be critical to prioritize malaria-control strategies, including ITN distribution campaigns and prevention/treatment approaches for mothers and children, and deliberately target the poor, least educated, and rural populations along with high-burden districts.

Large-scale food fortification has great potential to improve child health and nutrition.

PURPOSE OF REVIEW: Undernutrition, including micronutrient deficiencies, continues to plague children across the world, particularly in low and middle-income countries (LMICs). The situation has worsened alongside the SARS-CoV-2 pandemic because of major systemic disruptions to food supply, healthcare, and employment. Large-scale food fortification (LSFF) is a potential strategy for improving micronutrient intakes through the addition of vitamins and minerals to staple foods and improving the nutritional status of populations at large. RECENT FINDINGS: Current evidence unquestionably supports the use of LSFF to improve micronutrient status. Evidence syntheses have also demonstrated impact on some functional outcomes, including anemia, wasting, underweight, and neural tube defects, that underpin poor health and development. Importantly, many of these effects have also been reflected in effectiveness studies that examine LSFF in real-world situations as opposed to under-controlled environments. However, programmatic challenges must be addressed in LMICs in order for LSFF efforts to reach their full potential. SUMMARY: LSFF is an important strategy that has the potential to improve the health and nutrition of entire populations of vulnerable children. Now more than ever, existing programs should be strengthened and new programs implemented in areas with widespread undernutrition and micronutrient deficiencies.

Adverse Birth Outcomes Associated with Types of Eating Disorders: A Review.

At least 5% of women have an eating disorder (ED) during pregnancy. These EDs affect prepregnancy body mass index (BMI) and weight gain during pregnancy, factors associated with birth complications and adverse neonatal outcomes. This review contributes to the literature by examining several adverse birth outcomes associated with EDs and differentiates between past and present EDs. Of the 18 articles reviewed, EDs were associated with preterm birth in 5/14 (36%) and small-for-gestational-age in 5/8 (63%) studies. Anorexia Nervosa increases the odds of a low birth weight baby, particularly when women enter pregnancy with a low BMI. Binge Eating Disorder is positively associated with having a large-for-gestational-age infant, and Bulimia Nervosa is associated with miscarriage when symptomatic during pregnancy. Having a current ED increases the risk for adverse birth outcomes more than a past ED. Since the aetiology of adverse birth outcomes is multi-factorial, drawing conclusions about causal relationships between EDs and birth outcomes is problematic given the small number of studies reporting these outcomes. Resources should target preconception interventions that put EDs into remission and help women achieve a healthier BMI prior to pregnancy, as these have been consistently shown to improve birth outcomes.