Ten new abstracts on child nutrition, from researchers in China, Japan, Italy and more

Read the full abstract of the records shared in our blog post 'Ten new abstracts on child nutrition from researchers in China, Japan, Italy and more':

1. Factors associated with minimum dietary diversity, minimum meal frequency and minimum acceptable diet practices among children 6-23 months of age in Bobo-Dioulasso, Burkina Faso.
2. Composition and characteristics of polyunsaturated fatty acids in human milk in China and its comparative analysis of meeting the dietary nutrient intake of infants.
3. Impact of refrigeration and freezing-thawing of breast milk on in vitro digestibility and liposoluble vitamin bioaccessibility in breast-fed infants.
4. Association Between Interpregnancy Interval and Risk of Preterm Birth and Its Modification by Folate Intake: The Japan Environment and Children's Study.
5. Changes in Mature Human Milk Macronutrient Composition over 45 years in an Urban Population in Indonesia.
6. Toddler Milk Perceptions and Responses to Front-of-Package Claims and Product Warnings: A Qualitative Study of Caregivers of Toddlers.
7. Micronutrients and cognitive functions among urban school-going children and adolescents: A cross-sectional multicentric study from India.
8. Effects of 2-year dietary and physical activity intervention on cognition in children-a nonrandomized controlled trial.
9. Preventing Child Wasting in Africa's Dryland: An Exploratory Review of the Enabling Environment in 8 Sub-Saharan Countries Using a Food Systems Lens.
10. The Effectiveness of Promoting a Vegetable and Fruit Consumption Behavior Program among Preschool Children in Nakhon Si Thammarat Province, Thailand. 

1) Factors associated with minimum dietary diversity, minimum meal frequency and minimum acceptable diet practices among children 6-23 months of age in Bobo-Dioulasso, Burkina Faso. 

Hien A et al, African Journal of Food, Agriculture, Nutrition and Development, Volume 23, Issue 3 

The study assessed infant and young child feeding practices and associated factors among 6-23-month-old children in order to inform ongoing and future programs and projects in Bobo-Dioulasso area, in Burkina Faso. Information on child feeding practices and determinants in urban areas is limited in Burkina Faso. Data of 301 children, collected in 2013, were considered in this secondary analysis. Questionnaires were used to collect data on respondents' socio-demographic and economic situation. In addition to the information on child care practices, food consumption data were also collected using a 24h dietary recall questionnaire. Indicators of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were constructed and proportion of children meeting these indicators calculated. Binary logistic regression was used to see the association between the outcome variables and explanatory variables, and multivariable logistic regression was performed to identify factors associated with minimum dietary diversity, meal frequency and minimum acceptable diet. Data cleaning and analysis were done using SPSS version 25. Odds ratios (ORs) with 95 % confidence interval (CI) were computed to measure the strength of association. Almost 3 out of 4 mothers (72.5%) were housewives and 62.4% of them were illiterate. Among the 301 children, 40.2% were aged 18-23 months. About half of the children (45.2%) were born to mothers from high income households. The proportion of children 6-23 months who met the MDD and MMF for breastfed and non-breastfed children was 18.3% and 28.9%, respectively. Less than one fifth of breastfed children (16.1%) received MAD. Girls were more likely to meet the MDD (p=0.02) and MAD (p=0.04) than boys. The proportion of children 6-23 months meeting the three complementary feeding practice indicators in Bobo-Dioulasso in Burkina Faso were far below the WHO-recommended standard of 90% coverage. The MDD and MAD were positively associated to the female gender. This finding could be used to better target the children in order to improve the effects of the ongoing or future interventions in increasing appropriate complementary feeding practices. 

2) Composition and characteristics of polyunsaturated fatty acids in human milk in China and its comparative analysis of meeting the dietary nutrient intake of infants.

Wang Fangmin et al., China Oils and Fats, Volume 48, Issue 9  

Fat is an important component of human milk. Fatty acids in human milk are macronutrients with great changes, especially polyunsaturated fatty acids (PUFA), which play an important role in infant nutrition, immunity and neurocognitive function. In order to provide nutritional strategies for more scientifically sound breast feeding, the contents of n-6 PUFA, n-3 PUFA, linoleic acid (LA), α-linolenic acid (ALA), arachidonic acid (ARA), docosahexaenoic acid (DHA) and LA/ALA ratio in human milk in China were reviewed, and the composition and characteristics of PUFA in human milk in China were analyzed according to the reference intake of PUFA for infants from 0 to 6 months of age. The mature human milk in China contained high levels of LA, relatively stable levels of ARA, low and fluctuating levels of ALA and DHA, and the LA/ALA ratio ranged from 4.25 to 33.44. The PUFA composition of human milk can be improved by dietary intervention so as to increase the PUFA content required for the growth and development of breastfed infants. 

3) Impact of refrigeration and freezing-thawing of breast milk on in vitro digestibility and liposoluble vitamin bioaccessibility in breast-fed infants.

Ever Hernandez-Olivas et al., LWT - Food Science and Technology, Volume 187 

There is little information about the impact of refrigeration and freezing-thawing on breast milk digestibility under gastrointestinal conditions of healthy infants or those requiring pancreatic enzyme replacement therapy (PERT) such as infants with cystic fibrosis (CF). This study assessed the impact of refrigeration and freezing-thawing on fat and protein digestibility and liposoluble vitamin bioaccessibility of breast milk. In vitro digestion models mimicking both healthy infant and CF infant conditions were applied. Freezing-thawing significantly increased the fat globule particle size. For CF digestion, this change had a more negative impact when using a freezing-thawing process than when using refrigeration of breast milk, reducing lipolysis (up to 18%), proteolysis (up to 28%), and vitamin A and E bioaccessibility. Under healthy conditions, no significant effects were detected. An adequate pancreatic enzyme replacement therapy (PERT) dose (25 LU/mL of BM) would enable the same level of lipolysis (55%) as in the healthy scenario. In conclusion, breast milk is the only source of energy and nutrients for breast-fed infants, so to prevent the loss of nutrient absorption, those with CF should not be fed with frozen-thawed breast milk. All rights reserved, Elsevier. 

4) Association Between Interpregnancy Interval and Risk of Preterm Birth and Its Modification by Folate Intake: The Japan Environment and Children's Study.

Kanami Tanigawa et al., Journal of Epidemiology, Volume 33, Issue 3  

Background: Both short and long interpregnancy intervals (IPIs) have been associated with risk of preterm birth, but the evidence is limited in Asians. It is also uncertain whether the association is modified by dietary folate intake or folic acid supplementation during pregnancy. Thus, we examined associations between IPI and risk of preterm birth and effect modification of those associations by dietary intake of folate and supplementation with folic acid on the basis of a nationwide birth cohort study. Methods: Among 103,062 pregnancies registered in the Japan Environment and Children's Study, 55,203 singleton live-birth pregnancies were included in the analysis. We calculated IPI using birth date, gestational age at birth of offspring, and birth data of the latest offspring. Odds ratios (ORs) and 95% confidence intervals (CIs) of the risk of preterm birth were estimated according to IPI categories. Results: Both <6-month and ≥120-month IPIs were associated with an increased risk of preterm birth, compared with an 18-23- month IPI. The multivariable ORs were 1.63 (95% CI, 1.30-2.04) for <6-month and 1.41 (95% CI, 1.11-1.79) for ≥120-month IPIs. These associations were confined to women with inadequate intake of dietary folate and folic acid supplementation during pregnancy. Multivariable ORs were 1.76 (95% CI, 1.35-2.29) for <6-month IPI and 1.65 (95% CI, 1.24-2.19) for ≥120-month IPI. Conclusion: Both <6-month and ≥120-month IPIs were associated with an increased risk of preterm birth. These higher risks were confined to women with inadequate intake of dietary folate and folic acid supplementation during pregnancy. 

5) Changes in Mature Human Milk Macronutrient Composition over 45 years in an Urban Population in Indonesia. 

Neti Nurani et al., Journal of Human Lactation, Volume 39, Issue 4

Background: With improvement in a population's welfare, its food consumption patterns may change, including those of nursing mothers. This, in turn, could influence their human milk composition. Research Aim: To investigate the secular trend in macronutrient composition of mature human milk from mothers of healthy, full-term infants in urban populations in Indonesia from 1974 and 2019. Method: We compared the macronutrient composition of mature human milk of healthy full-term infants from 1974 and 2019. The data from 2019 used the Human Milk Analyzer MIRIS to quantify the milk's carbohydrate, fat, and protein content, while the historical data used methods available at that time, that is, methods described by Benedict, Gerber and Kjeldahl, respectively. Results: There were no significant differences in carbohydrate, protein and fat content across categories of maternal nutritional status in the respective periods. However, the fat content of human milk from 2019 was significantly higher than that of 1974 (4.7g/dl, SD=1.7g/dl vs. 3.3g/dl, SD=1.1g/dl; p <0.001), while its carbohydrate content was significantly lower (6.2g/dl, SD =2.1g/dl vs. 7.1g/dl, SD=0.2g/dl; p<0.001). There was no difference in the protein content between the two periods (1.4g/dl, SD=0.5g/dl vs. 1.6g/dl, SD=0.3g/dl; p=0.491). Conclusion: The mature human milk from 2019 has a higher fat and total energy content but lower carbohydrate content than those observed 4 decades ago. The protein content remained the same. © The Author(s) 2023. 

6) Toddler Milk Perceptions and Responses to Front-of-Package Claims and Product Warnings: A Qualitative Study of Caregivers of Toddlers. 

Ana Paula C. Richter et al., Journal of the Academy of Nutrition and Dietetics, Volume 123, Issue 11 

Background Toddler milk products are ultraprocessed milk-based beverages promoted for children aged 9 through 36 months. They often contain added sugars, which may contribute to unhealthy dietary habits. Aggressive promotion of toddler milk, particularly to the Latinx population, has likely led to rapid rises in sales. Objective The study aims were to qualitatively explore caregivers' experiences with, beliefs about, and attitudes toward toddler milk; to explore caregivers' reactions to health claims and product warnings on toddler milk packaging; and explore whether perceptions of toddler milk differ by Latinx ethnicity. Design Focus group discussions and in-depth interviews were conducted. Participants Fifteen online in-depth interviews and 4 online focus groups with US caregivers of children aged 9 through 36 months who reported serving toddler milk to their children were conducted in 2021. Statistical analyses performed Audio files were transcribed, coded, and analyzed in NVivo>. A thematic analysis with a hybrid analytical approach of deductive and inductive coding was conducted. Results Caregivers struggled to discern toddler milk from infant formula and perceived formula as a larger term that included toddler milk. 

Participants described offering toddler milk to their children for its convenience, nutritional profile, and perceived benefits tied to health claims present on the labels. Participants reported that health claims on toddler milk packaging attracted their attention; most participants did not express skepticism about the veracity of the claims. An "added sugar" warning increased understanding of the presence of added sugar in a toddler milk product. Latinx and non-Latinx participants largely reported similar perceptions, beliefs, and patterns of provision of toddler milk. Conclusions Health claims may lead caregivers to perceive toddler milk as a nutritionally adequate product. Research is needed to investigate caregiver-directed interventions for informing caregivers about the distinction between infant formula and toddler milk. All rights reserved, Elsevier. 

7) Micronutrients and cognitive functions among urban school-going children and adolescents: A cross-sectional multicentric study from India. 

Shweta Singh et al., PLoS ONE, Volume 18, Issue 2 

Background: Micronutrient deficiency (MD) is associated with deficits in cognitive functioning of children. However, no comprehensive multicentric study has been conducted in India to explore the role of multiple MD in cognition of children and adolescents. The present study aimed to explore association of MD with level of general intelligence and specific cognitive functions, in urban school-going children and adolescents across ten cities of India. Method: Cross-sectional multicentric study, enrolled participants aged 6-16 years. Blood samples were collected for biochemical analysis of calcium, iron, zinc, selenium, folate, vitamin A, D and B12. Colored Progressive Matrices / Standard Progressive Matrices (CPM/SPM), Coding, Digit Span and Arithmetic tests were used for the assessment of cognitive functions of participants. Height and weight measures were collected along with socio-economic status. Results: From April-2019 to February-2020, 2428 participants were recruited from 60 schools. No MD was found in 7.0% (134/1918), any one MD in 23.8% (457/1918) and ≥ 2 MD in 69.2% (1327/1918) participants. In presence of ≥ 2 MD, adjusted odds ratio (OR) for borderline or dull normal in CPM/SPM was 1.63, (95% CI: 1.05-2.52), coding was 1.66 (95% CI: 1.02-2.71), digit span was 1.55 (95% CI: 1.06-2.25) and arithmetic was 1.72 (95% CI: 1.17-2.53), controlling for gender, socioeconomic status and anthropometric indicators. Conclusion: Since ≥ 2 MD were found in more than 2/3rd of participants and was associated with impairment in cognitive function, attempts must be made to ameliorate them on priority in school going children in India. 

8) Effects of 2-year dietary and physical activity intervention on cognition in children-a nonrandomized controlled trial. 

Sehrish Naveed et al., Scandinavian Journal of Medicine & Science in Sports, Volume 33, Issue 11 

Background and Objective We investigated the effects of a combined dietary and PA intervention on cognition in children and whether changes in diet quality, PA, sedentary behavior (SB), and sedentary time (ST) are associated with changes in cognition. Methods We conducted a 2-year nonrandomized controlled trial in 504 children aged 6-9 years at baseline. The children were allocated to a combined dietary and PA intervention group (n = 237) or a control group (n = 160) without blinding. Interventions The children and their parents allocated to the intervention group had six dietary counseling sessions of 30-45 min and six PA counseling sessions of 30-45 min during the 2-year intervention period. The children were also encouraged to participate in after-school exercise clubs. Cognition was assessed by the Raven's Colored Progressive Matrices. We assessed dietary factors by 4 days food records and computed the Baltic Sea Diet Score (BSDS) as a measure of diet quality. PA and ST were assessed by a combined heart rate and body movement monitor, types of PA and SB by a questionnaire. Results The intervention had no effect on cognition. Increased BSDS and consumption of low-fat milk and decreased consumption of red meat and sausages were associated with improved cognition over 2 years. Increased organized sports, ST, and reading were positively, while unsupervised PA, computer use, and writing were negatively associated with cognition. Conclusion Combined dietary and PA intervention had no effect on cognition. Improved diet quality and increased organized sports and reading were associated with improved cognition. © 2023 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd. 

9) Preventing Child Wasting in Africa's Dryland: An Exploratory Review of the Enabling Environment in 8 Sub-Saharan Countries Using a Food Systems Lens. 

Persistent child wasting is evident across the Sahel and Horn of Africa, much of which is typically dryland and dependent on agropastoralism. Two events in 2021, the United Nations (UN) Food Systems Summit and the Tokyo Nutrition for Growth Summit, represented a watershed moment for the alignment of food systems and nutrition. Against this backdrop, the costed country operational roadmaps, developed in 22 countries as part of the joint UN Global Action Plan on Child Wasting (UNICEF 2021), recognized the importance of preventing child wasting using a multisectoral approach. We use a food systems lens to assess how current governance mechanisms, policies, and programming priorities in 8 sub-Saharan countries are responsive to the food security and nutritional needs of the most vulnerable people. For governance mechanisms, we draw from a narrative review of joint annual assessments conducted by the Scaling Up Nutrition Movement's national multistakeholder platforms since 2016. For policy frameworks, we analyze recommendations included in operational roadmaps and findings from the review of national multisectoral nutrition plans. For programming priorities, we analyze the typologies of costed interventions in the food and social protection systems. We present how nutrition and healthy diets were factored into national food systems pathways and how Government commitments to Nutrition for Growth integrate food systems and resilience. Results of this exploratory review suggest opportunities offered by the implementation of the country roadmaps should rely on a fundamental understanding of context-specific risks and vulnerabilities embedded in the systems and their dynamics. © The Author(s) 2023. 

10) The Effectiveness of Promoting a Vegetable and Fruit Consumption Behavior Program among Preschool Children in Nakhon Si Thammarat Province, Thailand. 

Suwichaya Wiriyasirikul et al., Sustainability, Volume 15, Issue 19 

This study aimed to design a program for promoting fruit and vegetable consumption behaviors among preschool children based on a domestic social support framework, with the goal of increasing their fruit and vegetable intake. This quasi-experimental study involved a set sample of preschool children and their caregivers who were randomly selected based on specific inclusion criteria. The study included 96 pairs of preschool-aged children and their caregivers, divided into experimental and control groups. The experimental group received the program, while the control group continued with their regular activities. The program development drew inspiration from the caregiving practices in Muang District, Nakhon Si Thammarat. The assessment tools included a preschooler's eating behavior evaluation and a knowledge test for caregivers regarding children's fruit and vegetable consumption and the ways to enhance it. Furthermore, experts approved the fruit and vegetable eating behavior assessment among the preschoolers, and a handbook for nurses and primary caregivers affirmed their suitability within the caregiver support framework. The developmental findings suggested that a 10-week program was appropriate and showed a promise in increasing fruit and vegetable consumption among the preschoolers. The findings, notably in the experimental group, demonstrate that caregivers should increase their knowledge of, and exhibit behavioral support in, fruit and vegetable consumption among preschoolers, and that this will eventually reflect a positive impact on preschoolers' dietary habits. © 2023 by the authors. Licensee MDPI, Basel, Switzerland.