Poverty adversely affects child development through multiple pathways in low- and middle-income countries. Relationships between diet and child development are poorly understood. In this study, we aimed to explore these associations in a longitudinal cohort of 305 children in rural Nepal (baseline mean age 14 months), evaluating dietary diversity and the consumption of specific food groups at three timepoints over 1.5 years. Child development was assessed using the Ages and Stages questionnaire-version 3 (ASQ-3). Associations between the number of days that children consumed minimum dietary diversity (MDD) (≥4/8 items) and specific food groups over time (range 0–3) and total and subscale ASQ scores at age 23–38 months were estimated using multiple linear and logistic regression, dichotomizing scores at the lowest quartile. After adjusting for confounders, each additional day of consuming MDD was associated with a 35% reduction in the odds of low total ASQ score [OR 0.65, 95% CI (0.46, 0.92)]. The consumption of animal source foods [OR 0.64, (0.46, 0.89)], and vegetables/fruits [OR 0.60, (0.41, 0.90), but not processed foods [OR 0.99, (0.62, 1.59)] was associated with lower odds of low total development. Vegetables, fruits and animal source foods may be important for child development in this setting.
Inadequate nutrient intakes are prevalent among many populations in sub-Saharan Africa and increasing fish consumption among pregnant/lactating women and children is one strategy to improve diets and address nutrient deficiencies. We report the nutrient content of two fish-based recipes-fish powder and fish chutney-that contain dried small fish available in local markets in Zambia. The contribution of a serving of each recipe to the recommended daily intakes of iron, zinc, calcium and docosahexaenoic acid (DHA) for pregnant/lactating women and children 6-24 months was calculated because these nutrients are commonly deficient in African diets. We found that one 10-g serving of fish powder provides 20% or more of the daily calcium recommendation and 37% or more of the daily DHA recommendation for both pregnant/lactating women and children. A 30-g serving of fish chutney provides over 40% of the daily calcium recommendation for pregnant women and over 50% for lactating women. Additionally, we investigated the nutrient density (nutrients per kilocalorie) of the fish powder and compared it with the nutrient density of a small-quantity lipid-based nutrient supplement plus (SQ-LNS-plus). SQ-LNS-plus is designed to enhance children's diets by providing micronutrients and DHA. Fish powder is similar to SQ-LNS-plus in iron and zinc density and even higher in calcium and DHA density. Consuming dried small fish as part of a daily meal can be a viable strategy for combatting nutrient deficiencies in the first 1000 days.
Objectives National food-based dietary guidelines (FBDGs) are adapted by governments reflecting their nation's food system and specific nutrition context, with varied approaches by country. Seafood is commonly included as one of many items in a “meat” or “animal-source” food group. It is currently unclear whether FBDG recommendations for seafood are achievable for the food supply, equitable for people, or sustainable for the planet. We seek to (1) Review the specific recommendations of national FBDGs related to seafood intake, quantifying the amount of seafood recommended for adults (2) Document the rationale for seafood consumption and mentions of sustainability (3) Estimate the supply required to meet recommendations and compare it with national fish production for each country. Methods The Food and Agriculture Organization (FAO) FBDG database was used to identify 92 countries with officially recognized FBDGs. Extracted data include (1) Recommended consumption of seafood (amounts, standard portion size, frequency of consumption and species/type) and (2) Mentions of sustainability. To calculate the fish supply needed to fulfill recommendations, conversions from cooked portions to raw (grams) seafood weights were used. These converted figures were then compared against that from FAO FishStat and the Sea Around Us database, and gaps/surpluses by country were identified. Mentions of sustainability were evaluated in terms of specific mention of fish vs. more generic recommendations. Results Out of 92 FBDGs, 77 mentioned seafood. Out of 40 high-income country's FBDG, 35 countries have a seafood servings per week recommendation, but only 23 provide serving size recommendations. Final presented results will illustrate the differences in the supply of seafood needed to meet recommended consumption levels. Sustainability was mentioned in eight guidelines independently of seafood and five additional mentioned seafood and sustainability together. Implications for sustainability of seafood production and global trade and nutritional status of populations will be discussed. Conclusions Seafood is systematically noted for healthy diets but rarely based on sustainable limits nor linked to sustainable goals. Funding Sources Johns Hopkins Bloomberg Distinguished Professor Fund, Johns Hopkins Center for a Livable Future.
Objectives Our objective was to assess changes in prelacteal feeding practices in rural Bangladesh over a 15-year period, from ∼2004 to ∼2019, and to identify household, maternal, and infant characteristics associated with that trend. Methods The analysis used data from 21,804 infants enrolled in a cluster-randomized controlled trial of newborn vitamin A supplementation from 2004–2006, and from 4631 infants enrolled in a cluster-randomized controlled trial of a digital health intervention from 2018–2019. In both studies, trained field workers collected data on household socioeconomic status and maternal demographic characteristics at the time of enrollment. Upon receiving notification of an infant's birth, field workers visited the home as soon as possible, collecting detailed data on breastfeeding initiation and any foods or liquids other than breast milk provided to the infant. Prelacteal feeding was defined as giving infants any food or liquid other than breast milk within first 3 days of life. We used bivariate and multivariate logistic regression analyses to examine the association between different household, maternal, and infant characteristics and prelacteal feeding. We then applied a regression decomposition method to understand the factors associated with the changing prevalence of prelacteal feeding over time. Results The prevalence of prelacteal feeding was 88.0% during the period of 2004–2006. Among women practicing prelacteal feeding, sugar/sugar candy water was the most commonly fed prelacteal (41.2%), followed by animal milk (40.0%), honey (35.4%), and drops (11.8%). By 2018–2019, the prevalence of prelacteal feeding had declined to 24.7%. Most frequently consumed prelacteals were most commonly sugar/sugar candy water (20.0%), honey (20.0%), animal milk (19.7%), and drops (14.3%). Final analysis will include examination of the changing factors associated with this decline including rising maternal education, improvements in socioeconomic status, and exposure to media. Conclusions The prevalence of prelacteal feeding has dropped considerably in rural Bangladesh since 2004. Funding Sources The Bill and Melinda Gates Foundation; United States Agency for International Development; Sight and Life.
Objectives To assess the impact of daily egg supplementation on infant growth from 6–12 months of age in Bangladesh. Methods A cluster randomized controlled trial was conducted in rural Bangladesh to test the effect of daily egg supplementation and nutrition education versus nutrition education alone on linear growth and stunting prevalence among infants. Infants were enrolled at 3 months of age and assigned to a trial arm based on their geographic sector of residence. Households were visited weekly to distribute eggs and monitor compliance starting at 6 months of age. Length, weight, head circumference, and mid upper arm circumference were measured at 6, 9, and 12 months, as well as dietary intake from home foods in the last 24 hours. Analyses were conducted on an intention-to-treat basis. Linear regression models were developed for continuous outcomes. For dichotomous outcomes, prevalence ratios were estimated using log-binomial regression models. Generalized estimating equations were used with all models to account for clustering. Each model was adjusted for the baseline measure of the outcome variable. Results Overall, 909 infants were enrolled in the treatment arm from 142 clusters and 842 infants in the control arm from 140 clusters. Prevalence of stunting at baseline was 19.4%, wasting was 6.7%, and underweight was 18.1%. After 6 months of supplementation, the intervention had no effect on mean length-for-age z-scores (β = 0.05, 95% CI: −0.12, 0.23) or prevalence of stunting (PR = 1.00, 95% CI: 0.90, 1.10). Infants in the egg arm had significantly higher mean weight-for-length z-scores (β = 0.11, 95% CI: 0.04, 0.18) and weight-for-age z-scores (β = 0.08, 95% CI: 0.03, 0.12), adjusting for baseline measures of the outcomes. Our presented results will include findings from mixed-effects regression analyses assessing the effect of the intervention on growth rate. Conclusions The provision of a daily egg for 6 months to infants in rural Bangladesh had an effect on ponderal but not linear growth. Funding Sources Bill and Melinda Gates Foundation.
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