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In utero or early-life exposure to aflatoxin, which contaminates staple crops in disadvantaged settings, may compromise pregnancy and infant outcomes, but investigations into the extent, persistence, and determinants of aflatoxin exposure at these life stages have lacked longitudinal data collection and broad geographic representation.Aflatoxin exposure and selected determinants thereof were characterized in mother-child dyads with serial plasma/serum samples in prenatal, perinatal, and early life in Malawi and Bangladesh.Circulating aflatoxin BMaternal AFBAmong pregnant women, aflatoxin exposure was persistently high in Malawi, while lower and seasonal in Bangladesh. Infants were partially protected from exposure in utero and with exclusive breastfeeding, but exposures reached adult levels by 18-24 mo of age. The Bangladesh and Malawi trials are registered at clinicaltrials.gov as NCT00860470 and NCT01239693.

BackgroundPregnant women in Malawi are at risk of selenium deficiency, which can have adverse effects on pregnancy outcomes. Interventions for improving selenium status are needed.ObjectivesTo assess the effect of provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to Malawian women during pregnancy on their plasma selenium concentrations at 36 wk of gestation.MethodsPregnant women (≤20 wk of gestation) were randomly assigned to receive daily either: 1) iron and folic acid (IFA); 2) multiple micronutrients (MMN; 130µg selenium per capsule); or 3) SQ-LNS (130µg selenium/20g). Plasma selenium concentrations were measured by inductively coupled plasma mass spectrometry at baseline and after ≥16 wk of intervention (at 36 wk of gestation) and compared by intervention group.ResultsAt 36 wk of gestation, median (quartile 1, quartile 3) plasma selenium concentrations (micromoles per liter) were 0.96 (0.73, 1.23), 0.94 (0.78, 1.18), and 1.01 (0.85, 1.28) in the IFA, MMN, and SQ-LNS groups, respectively. Geometric mean (GM) plasma selenium concentration was 5.4% (95% CI: 1.8%, 9.0%) higher in the SQ-LNS group than in the MMN group and tended to be higher than in the IFA group (+4.2%; 95% CI: 1.0%, 7.8%). The prevalence of adjusted plasma selenium concentrations&nbsp

OBJECTIVES: To inform the 2020–2025 Dietary Guidelines for Americans, USDA and HHS identified important public health questions to be examined by the 2020 Dietary Guidelines Advisory Committee. The Committee conducted 2 systematic reviews with support from USDA's Nutrition Evidence Systematic Review (NESR) team to answer the following questions: What is the relationship between dietary patterns (DP) consumed during 1) pregnancy and gestational weight gain (GWG)?, and 2) lactation and postpartum weight loss (PPWL)? METHODS: The Committee developed protocols that described how they would use NESR's systematic review methodology to examine the systematic review questions. NESR conducted a literature search and dual-screened the results using pre-defined inclusion and exclusion criteria to identify articles published between Jan 2000 and Nov 2019. NESR extracted data and assessed risk of bias of included studies. The Committee synthesized the evidence, developed conclusion statements, and graded the strength of the evidence underlying the conclusion statements. RESULTS: Twenty-six articles were included in the GWG review and 1 article in the PPWL review. The GWG review included 5 RCTs and 21 prospective cohort studies. Two RCTs showed that a “beneficial” DP was associated with lower GWG. Thirteen of the 20 observational studies showed an association between DP and GWG. Although the DPs examined were characterized by different combinations of foods and beverages, the patterns consistently associated with lower GWG were higher in vegetables, fruits, nuts, legumes, and fish and lower in added sugars and red and processed meats. The PPWL review included only one RCT, which was limited by high attrition, issues with implementing the intervention, and lack of blinding. CONCLUSIONS: Limited evidence suggests that certain DPs during pregnancy are associated with a lower risk of excessive GWG. These patterns are higher in vegetables, fruits, nuts, legumes, and fish, and lower in added sugar, and red and processed meat (Grade: Limited). Insufficient evidence is available to determine the relationship between DPs during lactation and PPWL (Grade: Grade Not Assignable). FUNDING SOURCES: USDA, Food and Nutrition Service, Center for Nutrition Policy and Promotion.

OBJECTIVES: To identify key changes in child diets during the transition to agriculture by synthesizing evidence on 1) infant and child hunter-fisher-gatherer diets to identify common elements of an evolutionary child diet and 2) early agricultural groups. METHODS: We searched five databases (Academic Search Complete via EBSCO, Anthropology Plus via EBSCO, Medline via PubMed, Scopus, and SocIndex with Full Text via EBSCO). Childhood was defined as children 10 years or younger. Early agriculture was defined as cultivation activities during the Neolithic or regional Neolithic equivalent era (e.g., Woodland Period), to account for the variation in the transition to agriculture. Studies examining hominins from the following species were eligible: Homo erectus/Homo ergaster, Homo neanderthalensis, Homo heidelbergensis, and Homo sapiens. We included peer-reviewed papers of qualitative, quantitative, and mixed methods on infant and childhood diets for groups whose primary subsistence method was hunting, fishing, or gathering or groups who were transitioning to early agriculture. Title and abstract reviews were conducted in Rayyan QCRI by two blinded authors. Discrepancies were reviewed by a third author. Full text review was also blinded. We scored studies with the Mixed Methods Appraisal Tool (2018), and we synthesized evidence using a narrative synthesis with sub-group analysis as appropriate. RESULTS: The publications covered a range of subsistence groups and study types (e.g., ethnography, isotopic analysis). Groups from Africa, Asia, Europe, North America and South America were represented, and time periods ranged from the Mesolithic Era to present. Our analysis indicated a significant shift in child diet accompanying the shift to agriculture. Hunter-gatherer-fisher children had more varied diets with a larger proportion of animal-source foods during and after the complementary feeding period compared to early agricultural groups. CONCLUSIONS: Early agricultural diets, similar to current child dietary patterns, have diverged from the diets of hunter-fisher-gatherer children in important ways. These differences could offer insight into child feeding guidelines today. FUNDING SOURCES: This project was internally funded by the E3 Nutrition Lab at Washington University in St. Louis.

OBJECTIVES: Processed food intake is becoming common among children globally and may have harmful effects. We assessed processed food intake in rural Bangladeshi children at 36 mo of age. METHODS: We conducted a cluster-randomized controlled effectiveness trial (the Rang-Din Nutrition Study) in which women and children received different combinations of nutrient supplements (iron and folic acid and lipid based nutrient supplements for pregnant and postpartum women; lipid-based nutrient supplements and micronutrient powder for 6 to 24 months old children). We collected data on processed food intake during the follow-up assessment when the children were 36 months old, including intake of processed food in the past 24 h and past 7 d using a dietary recall questionnaire. We carried out descriptive analysis of the full sample (n = 3444). RESULTS: In the past 24 h, the percentage of children consumed different processed food was: any kind of biscuits (70%), any kind of chocolates or candy (39%), any kind of bread or bun (36%), any kind of Bombay mix (33%), any kind of sweets (28%), chips or crisps (21%), cake or pastry of any kind (21%) and fruit juice or fruit flavored juice (16%). In the past 7 d, the mean (SD) of these foods consumption was: any kind of biscuits 4.3(2.4) d, any kind of chocolates or candy 2.4(2.3) d, any kind of bread or bun 2.4(2.4) d, any kind of Bombay mix 1.7(1.9) d, any kind of sweets 1.6(1.7) d, chips or crisps 1.2(1.6) d, cake or pastry of any kind 1.2(1.8) and fruit juice or fruit flavored juice 0.9(1.6) d. In the past 24 h, the median expenditure for processed food for the index child was 0.18 USD. CONCLUSIONS: Consumption of processed food among 36 mo-old children is very high in this setting. Further research is needed to understand the per capita energy intake from processed foods and the consequences of processed food consumption. FUNDING SOURCES: United States Agency for International Development (USAID).

OBJECTIVES: To examine the association of maternal functional health literacy (FHL), a mother's ability to understand health information written in words and pictures, with child health, growth, and development in rural Malawi. METHODS: Maternal FHL was measured at six months postpartum among 671 participants in the International Lipid-Based Nutrient Supplements (iLiNS) DYAD-M trial in Malawi. Field staff asked comprehension questions about written health materials that were common in Malawi, such as medication instructions, breastfeeding information, and growth charts. Outcomes were child length-for-age (LAZ) and weight-for-length (WLZ) z scores at age 6 and 18 mo, change in LAZ and WLZ from 6 to 18 mo, motor and language development at 18 mo, and illness monitored weekly from birth to 18 mo (highest quartile prevalence of diarrhea, highest quartile prevalence of malaria or undefined fever, and incidence of acute respiratory infection). In Model 1, we examined the unadjusted association between maternal FHL and each outcome. In Model 2, we adjusted for household and parental background characteristics collected at baseline, child age and sex, and trial group. In Model 3, we added maternal cognition, depression, and caregiving characteristics collected after baseline. RESULTS: Over 90% of participants understood the growth charts, immunization record, and breastfeeding information in the health passport. Understanding of medication instructions was lower, with 72% understanding malaria, 81% Panadol, and 63% erythromycin instructions (Figure 1). Maternal FHL z score significantly predicted motor (β ± SE = 0.087 ± 0.040, P = 0.029) and language z scores (β ± SE = 0.093 ± 0.040, P = 0.020) at 18 mo in unadjusted models. However, after adjusting for covariates, these associations were not significant. Maternal FHL was not significantly associated with any other outcomes. CONCLUSIONS: Revision of written medication instructions in Malawi may be needed to increase mothers’ understanding of how to deliver medication to their children. However, in this sample, maternal FHL was not associated with indicators of child growth, development, or illness after adjusting for parental, household, and caregiving characteristics. FUNDING SOURCES: This publication is based on research funded by a grant to the University of California, Davis from the Bill & Melinda Gates Foundation. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

OBJECTIVES: Little is known about the influence of maternal micronutrient (MN) supplementation during pregnancy/lactation on human milk (HM) MN concentrations. We evaluated B-vitamin (BV) concentrations in milk from mothers in Ghana and Malawi who participated in the International Lipid-Based Nutrient Supplements (iLiNS) Project. METHODS: Women (

OBJECTIVES: It is unknown whether prenatal lipid-based nutrient supplements (LNS) affect blood pressure. The cutoffs to define high blood pressure have recently changed and little research has examined the association between the newly proposed blood pressure cutoffs and birth outcomes. Our objectives were to assess 1) the impact of LNS on maternal blood pressure; and 2) the association between blood pressure and birth outcomes. METHODS: In total, 1320 pregnant women ≤ 20 wk gestation in Ghana were randomized to receive daily either: 1) iron and folic acid (IFA), 2) multiple micronutrients (MMN), or 3) LNS. Blood pressure was measured at enrollment and 36 wk gestation. Gestational age was determined by ultrasound and newborn anthropometry included weight, length, and head circumference. The effect of LNS on maternal blood pressure was analyzed using ANOVA and associations between maternal blood pressure and birth outcomes were examined by linear and logistic regressions. RESULTS: Mean (± SD) systolic and diastolic blood pressure (SBP and DBP) at 36 wk gestation were 110 ± 11 and 63 ± 8 mmHg, respectively, and did not differ by supplementation group (P > 0.05). At enrollment, higher DBP was associated with lower birth weight and shorter pregnancy duration; 6.6% of women had high SBP (≥ 130 mmHg) and 3.6% had high DBP (≥ 80 mmHg), and women with high DBP had greater odds of low birth weight (adjusted OR = 2.99 (95% CI = 1.04, 8.62)) and preterm birth (3.99 (1.46, 10.86)) but there were no significant associations with SBP. At 36 wk, higher SBP was associated with a lower birth weight, birth length, newborn head circumference, and a shorter pregnancy duration and higher DBP was associated with a lower birth weight and length; 4.3% of women had high SBP and 2.4% had high DBP and women with high DBP had greater odds of low birth weight (4.14 (1.26, 13.62)) but high SBP (≥ 130 mmHg) was not associated with any birth outcomes. CONCLUSIONS: Daily LNS during pregnancy did not have a significant effect on maternal blood pressure compared with IFA or MMN in this setting. Both higher SBP and higher DBP were associated with a shorter pregnancy duration and birth size; however, only high DBP was associated with adverse birth outcomes. It is unclear whether the new cutoff for high SBP is useful for identifying pregnancies at risk for adverse birth outcomes. FUNDING SOURCES: Funded through a grant from the Bill & Melinda Gates Foundation to the University of California, Davis.

OBJECTIVES: 1) to estimate the probability of inadequate amino acid intake among infants 9–10 months of age in rural Malawi 2) to evaluate whether dietary amino acid intake or protein quality are associated with length gain from 6 to 12 months of age METHODS: We assessed total amino acid intake from breast milk and complementary foods in 285 infants. Breast milk intake and complementary foods were estimated using dose-to-mother deuterium oxide dilution method and repeat 4-pass interactive 24-hour recall interviews, respectively. Amino acid composition values were taken from FAO human milk profile, Tanzania Food Composition table and International Minilist. Protein quality was estimated using Digestible Indispensable Amino Acid Score (DIAAS). Probability of intake below Estimated Average Requirement (EAR) for each amino acid was estimated using National Cancer Institute (NCI) method. We estimated protein quality of complementary food using median DIAAS. We assumed a DIAAS of ≥0.75 to represent a diet or food with good protein quality. Relationships between amino acid intake or protein quality with length gain were assessed using regression models. Length was measured at 6 and 12 months of age and length for age z-score (LAZ) velocity was calculated (ΔLAZ/months). RESULTS: The probability of inadequate amino acid intake from breast milk and complementary food that included a lipid-based nutrient supplement (LNS) was 3% for lysine, 0% for tryptophan, threonine, valine, histidine, isoleucine, leucine, sulfur containing amino acids (SAA), and aromatic amino acids (AAA). Without LNS, the probability was 7% for lysine and 0–2% for the other amino acids. The median (interquartile range) DIAAS for complementary food with and without LNS was 0.70 (0.28) and 0.64 (0.32), respectively. Dietary amino acid intake and protein quality were not significantly associated with length gain velocity from 6 to 12 months even after adjusting for confounding factors. CONCLUSIONS: The prevalence of inadequate amino acid intake in 9–10 months old infants in rural Malawi is very low. However, in conditions of frequent clinical or sub-clinical infections this situation may be different. Linear growth at 6–12 months does not appear to be limited by dietary amino acid intake or protein quality in this setting. FUNDING SOURCES: The Bill & Melinda Gates Foundation.