Current knowledge and future research on infant feeding in the context of HIV: basic, clinical, behavioral, and programmatic perspectives.

In 2008, between 129,000 and 194,000 of the 430,000 pediatric HIV infections worldwide were attributable to breastfeeding. Yet in many settings, the health, economic, and social consequences of not breastfeeding would have dire consequences for many more children. In the first part of this review we provide an overview of current knowledge about infant feeding in the context of HIV. Namely, we describe the benefits and risks of breastmilk, the evolution of recommended infant feeding modalities in high-income and low-income countries in the last two decades, and contextualize the recently revised guidelines for infant feeding in the context of HIV current knowledge. In the second section, we suggest areas for future research on the postnatal prevention of mother-to-child transmission of HIV (PMTCT) in developing and industrialized countries. We suggest two shifts in perspective. The first is to evaluate PMTCT interventions more holistically, to include the psychosocial and economic consequences as well as the biomedical ones. The second shift in perspective should be one that contextualizes postnatal PMTCT efforts in the cascade of maternal health services. We conclude by discussing basic, clinical, behavioral, and programmatic research questions pertaining to a number of PMTCT efforts, including extended postnatal ARV prophylaxis, exclusive breastfeeding promotion, counseling, breast milk pasteurization, breast milk banking, novel techniques for making breast milk safer, and optimal breastfeeding practices. We believe the research efforts outlined here will maximize the number of healthy, thriving, HIV-free children around the world.

A micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women.

Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries, despite longstanding efforts to fortify foods or to distribute medicinal supplements to pregnant women. The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients (iron, iodine, zinc, vitamin A, vitamin C, niacin, riboflavin, folate, vitamin B-12, vitamin B-6 and vitamin E) on the hemoglobin, iron and vitamin A status of pregnant women in Tanzania. A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a randomized double-blind controlled trial in which study women received 8 wk of supplementation. Hemoglobin, ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period. The supplement resulted in a 4.16 g/L increase in hemoglobin concentration and a 3 micro g/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56%, respectively. The risk of iron deficiency was reduced by 70% among those who had iron deficiency at baseline and by 92% among those who had adequate stores. The micronutrient-fortified beverage may be a useful and convenient preventative measure, one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies.

Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania.

BACKGROUND: Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies. OBJECTIVE: We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children (aged 6-11 y) attending primary schools. DESIGN: In this randomized, double-blind, placebo-controlled efficacy trial, children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo. RESULTS: There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status, serum retinol, and anthropometry. At the 6-mo follow-up, among children with anemia (hemoglobin < 110 g/L), there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group (9.2 and 0.2 g/L, respectively). Of those who were anemic at baseline, 69.4% in the nonfortified group and 55.1% in the fortified group remained anemic at follow-up (RR: 0.79), a cure rate of 21%. The prevalence of children with low serum retinol concentrations (< 200 microg/L) dropped significantly from 21.4% to 11.3% in the fortified group compared with a nonsignificant change (20.6% to 19.7%) in the nonfortified group. At follow-up, mean incremental changes in weight (1.79 compared with 1.24 kg), height (3.2 compared with 2.6 cm), and BMI (0.88 compared with 0.53) were significantly higher in the fortified group than in the nonfortified group. CONCLUSION: The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A deficiency.

Efficacy trials of a micronutrient dietary supplement in schoolchildren and pregnant women in Tanzania.

Traditionally, the main strategies used to control micronutrient deficiencies have been food diversification, consumption of medicinal supplements, and food fortification. In Tanzania, we conducted efficacy trials using a dietary supplement as a fourth approach. These were randomized, double-blind, placebo-controlled efficacy trials conducted separately first in children and later in pregnant women. The dietary supplement was a powder used to prepare an orange-flavored beverage. In the school trial, children consumed 25 g per school day attended. In the pregnancy trial, women consumed the contents of two 25-g sachets per day with meals. This dietary supplement, unlike most medicinal supplements, provided 11 micronutrients, including iron and vitamin A, in physiologic amounts. In both trials we compared changes in subjects consuming either the fortified or the nonfortified supplement. Measures of iron and vitamin A status were similar in the groups at the baseline examination, but significantly different at follow-up, always in favor of the fortified groups. Children receiving the fortified supplement had significantly improved anthropometric measures when compared with controls. At four weeks postpartum, the breast milk of a supplemented group of women had significantly higher mean retinol content than did the milk of mothers consuming the nonfortified supplement. The advantages of using a fortified dietary supplement, compared with other approaches, include its ability to control several micronutrient deficiencies simultaneously; the use of physiologic amounts of nutrients, rather than megadoses that require medical supervision; and the likelihood of better compliance than with the use of pills because subjects liked the beverage used in these trials.

Human nutrition in developing world

Publicação 29 da Food and Nutrition Series que apresenta uma cobertura dos problemas nutricionais dos países em desenvolvimento e sugere políticas e programas apropriados para eles. Enfatiza três pré-requisitos para uma boa nutrição: segurança alimentar, boa saúde e cuidados adequados. É possível acessar, separadamente, cada capítulo da publicação.

Human nutrition in developing world

Publicação 29 da Food and Nutrition Series que apresenta uma cobertura dos problemas nutricionais dos países em desenvolvimento e sugere políticas e programas apropriados para eles. Enfatiza três pré-requisitos para uma boa nutrição: segurança alimentar, boa saúde e cuidados adequados. É possível acessar, separadamente, cada capítulo da publicação

Micronutrient dietary supplements--a new fourth approach

Currently the three main widely used strategies to control micronutrient deficiencies are food diversification, fortification, and consumption of medicinal supplements. In Tanzania a fourth strategy has been evaluated in school children, and is to be studied in pregnant and lactating women. The dietary supplement comes in the form of a powder used to prepare a fruit flavored drink. Children consumed for six months 25 grams per school day attended, the powder being added to 200 ml of water. The dietary supplement provides between 40 and 100 percent of the RDA of 10 micronutrients, which includes iron, vitamin A and iodine. Unlike medicinal supplements it provides the multiple vitamins and minerals in physiologic, not megadoses. In a well conducted randomized double blind placebo controlled trial, a dietary supplement in the form of a fortified powder fruit drink produced statistically significant differences not only in vitamin A and iron status, but also in the growth of young school age children.

The influence of infant food advertising on infant feeding practices in St. Vincent

A survey to examine the extent to which infant food advertising could be shown measurably to influence infant feeding practice was carried out in S. Vincent in the eastern Caribbean. A questionaire was administered to mothers of about 200 children one to two uears old, nearly a complete sample in each of two towns. Infant food advertising was found to be uncommon. The typical infant feeding pattern, largely a combination of both breast and bottle feeding, had existed for decades. Despite the fact that this was not a very appropriate setting for such a study, and that there were a number of methodological constraints, the results of two multiple regression analyses suggested that the more a mother was influenced by infant food advertising, the sooner she began to bottle feed and the sooner she stopped breastfeeding. The cessation of all promotion of commercial infant foods to the public as well as to health professionals, is called for. (AU)

Infant feeding practices in St. Vincent and factors which affect them

Surveys of one to two-year old children in two towns in St. Vincent in 1975 found that there may have been a slight decline in breastfeeding since the late 1960s. Although lactation failure was rare, supplementary bottle feeding was usually begun during the early weeks of life. Sevrage, the complete cessation of breastfeeding, occurred by seven months of age for half of the children in the sample. One of the major factors leading to early sevrage was probably the introduction of bottle feeding. This may operate through an earlier return of fertility post-partum (and thus "pregnancy" as the reason for weaning), or because the sweet, easily-drained bottle is preferable to the breast for the infant (and thus the baby "weans himself"). While many of the factors influencing current infant feeding practices are now largely of historical interest, such as slavery, others are currently amenable to intervention. These include poor health and nutritional status of mothers, inappropriate advice given by health professionals, and the advertising and promotion of infant foods by their manufacturers and sales persons (AU)

Factors associated with nutritional status among young children in St. Vincent

A survey was undertaken in 1975 in St. Vincent, West Indies, among the mothers of nearly all children from one to two years old in two towns. The mean weight for age was 85 percent of the Boston Standard and the mean weight for height was 95.5 percent of the standard. Levels of malnutrition were similar to those found in a national survey eight years earlier. Using multiple regression analysis, the variable which had by far the greatest impact on nutritional status (weight for age) was economic level of living. Next in importance came length of breastfeeding, attendance at postnatal clinics, and (with a negative association) the number of siblings. Efforts to solve the EPM problem must seek to eradicate poverty, but should not neglect the importance of breastfeeding, child, spacing, and appropriate health care. (AU)

An evaluation of the use of change in hair root morphology in the assessment of protein-calorie malnutrition

A study was carried out to evaluate the use of changes in hair root morphology in the assessment of protein-calorie malnutrition (PCM) among a group of black West Indian children. The following five hair root characteristics were measured: percentage of anagen (the growing phase), percentage of telogen (the resting phase), percentage of atrophy, diameter of anagen bulbs, and shaft diameter. Significant differences in shaft diameter, percentage of anagen, and percentage of telogen were found only between well-nourished and severely malnourished children. Significant correlation coefficients were obtained between both bulb diameter and percentage of atrophy and muscle circumference. No significant differences in any of the hair root characteristics were obtained between children with nutritional marasmus and those with kwashiorkor. The method was found to be time-consuming; it can be said for differentiating well-nourished children only from those with severe PCM; and it is unsuitable for determining the prevalence of the three degrees of PCM. For these reasons, the method is not the field assessment of protein-calorie malnutrition.(AU)