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Background: Physical activity (PA) and nutrition in children have an impact on overall physical and mental well-being, cognitive, and social development. This study aims to report on the best current available evidence on PA, body composition proxies, and nutritional status of South African children and adolescents, based on the published findings between 2018 and 2022, which comprise the 2022 Healthy Active Kids South Africa Report Card. Methods: A comprehensive literature search of online databases, along with hand searching and a gray literature search, was conducted based on PA, body composition proxies, and nutrition indicators defined, in part, by the Active Healthy Kids Global Alliance. Results: Compared with the 2018 report card, there was an improvement in the majority of PA indicators which include overall PA (B–), active transportation (B–), physical fitness (B–), and government policy and programs (C). Body composition proxies and most of the nutrition indicators remained unchanged. The indicators that regressed from 2018 to 2022 included community and environmental influences (D), as well as participation in organized sport (D–). Conclusions: Despite the apparent improvement in overall PA levels in children and adolescents, there is a lack of tangible evidence of actual implementation of policies and programs. There was also a lack of nationally representative data for most indicators. Overall, there is a need to identify intersectoral, equitable approaches for promoting PA and healthy eating in South African children and adolescents and ongoing monitoring and surveillance. [ABSTRACT FROM AUTHOR]

Many consumers are caregivers and, as part of caregiving, frequently make food choices for their dependents. This research examines how food choices made for children influence the healthiness of parents' subsequent self-choices. Whereas prior work focuses on choices for the self (others) as based on self-needs (other-needs), the authors theorize when and why self-choices involve consideration of other-needs. Five studies, including a nursery school field study, test the effect of choosing healthy food for a child on the healthiness of parents' self-choices, focusing on the role of anticipating potentially sharing self-choices with one's child. Potential sharing increased parents' likelihood of making an unhealthy subsequent self-choice if they first made a healthy choice for their child. This effect was driven by parents' present-focused parenting concerns about whether one's child would eat and enjoy healthy options chosen for them. This effect was mitigated when parents instead had future-focused parenting concerns. Additionally, this effect was mitigated after making an initial choice for the child that was (1) unhealthy or (2) healthy but relatively liked by the child. This research contributes to understanding how choices for others shape choices for the self and offers important marketing and policy implications. [ABSTRACT FROM AUTHOR]

Background and aim: Despite adequate food production and nutrition intervention coverage, stunting remains an enduring problem in Ntchisi, Malawi. Globally, gender and social norms are known to influence nutritional outcomes in children. This study explores how gender norms contribute to child stunting, in Ntchisi district, Central Malawi. Research methods: Informed by the UNICEF Framework for Malnutrition, nine focus group discussions were conducted with a target population of mothers (n = 24), fathers (n = 23) purposively targeted through growth monitoring sessions, and members of policy and health treatment committees (n = 21), spanning three different areas of Ntchisi district. Data were analysed through inductive thematic analysis, guided by the framework for Research in Gender and Ethics (RinGs). Results: Three primary themes were identified: 1) gender unequal decision making on the consumption, sale and distribution of food; 2) enshrined community norms influence feeding practices underpinned by gender-based violence; and 3) policy disconnections and gaps that reinforce gender norms regarding nutrition. Themes encompassed practices across household, health treatment, and policy level. Conclusion: Gender norms that underpin inequalities in decision making for production and consumption of food undermine children's nourishment and contributes towards sustained child malnutrition in Ntchisi. Existing policy documents should revise their guidelines to incorporate gender norms as key determinants of malnutrition. [ABSTRACT FROM AUTHOR]

Eating behaviors develop in early life and refine during childhood, shaping long-term food choice and dietary habits, which underpin optimum growth and health. The development of Food Oral Processing (FOP) is of major importance in the establishment of eating behaviors at two scale levels: for the initial acceptance of food texture and for the longer-term development of eating behaviors associated to food intake. To date, both processes have been studied as independent topics and the current review proposes a parallel vision on their development from the onset of complementary feeding to later childhood. Individual factors affecting these FOP-related behaviors as they relate to food texture acceptance are discussed, alongside examples of interventions aiming at modifying them. Opportunity to better consider food textures when designing foods for children is addressed. Altogether, the review demonstrates the critical role of food texture in the development of a child's FOP skills, eating habits, and dietary patterns. These scientific knowledges need to be considered for the development of healthier eating behavior. We identify research gaps that need to be addressed and highlight the need to design foods that can support the development of healthy oral processing and eating behaviors among infants and children. [ABSTRACT FROM AUTHOR]

Background: Poor dietary choices and consumption of unhealthy foods are major determinants of malnutrition among adolescents in Ethiopia. The school food environment is a valuable setting for exploring adolescents' eating habits. Teachers have an important role in understanding factors that impact students' dietary choices. The aim of this study is to explore secondary school teachers' perceptions towards adolescents' dietary habits in Ethiopia. Methods: The study employed a qualitative research design. Four focus group discussions, involving a total of 13 teachers, were conducted at governmental and private schools in Addis Ababa, Ethiopia. Additionally, observations of the food environment in these four schools. The transcripts from the focus group discussions and photographs from observations were analyzed using thematic analysis. Triangulation of data sources and persistent observation of the data were employed to enhance the study's trustworthiness. The study was approved by the Norwegian Center for Research Data and the Addis Ababa Health Bureau, and all participants provided informed consent. Result: Teachers perceived adolescents' dietary habits as unhealthy, characterized by the consumption of unsafe foods, limited variety, and reliance on processed foods. Factors negatively influencing adolescents' dietary habits include a lack of awareness about a healthy diet among both students and parents. Low familial income levels were also identified as a barrier to eating a healthy diet. The unavailability of healthy foods and the advertising of unhealthy and processed foods as well as peer influence were hindrances to a healthy diet both at school and home. Conclusion: This study provides additional evidence of the nutrition transition which is linked to the double burden of malnutrition among adolescents in low-income countries. Factors affecting adolescent diets at school are multileveled. Incorporating nutrition education into the school curriculum will likely improve dietary awareness mitigating peer influence. Regulating the school food environment and enforcing advertisement laws targeting adolescents can promote healthier school food environments. Providing short term nutrition trainings for biology or science teachers and strengthen their role in delivering nutrition education to children and their families, along with implementing measures to address food insecurity and restricting availability of unhealthy food at school need to be regarded as priorities. [ABSTRACT FROM AUTHOR]

Introduction: Childhood malnutrition is a complex issue with a range of contributing factors. The consequences of malnutrition are severe, particularly for children. This study aims to identify the factors contributing to inequality gaps in childhood malnutrition. Our study provides insights into modifiable elements to inform interventions targeted at distinct contexts and populations to improve child nutrition. Methods: This study utilized data from the Demographic and Health Surveys (DHS) of 27 countries. First, the risk differences (RDs) between the prevalence of childhood malnutrition among the determinant variables, household income, and maternal education categories were calculated. The Blinder‒Oaxaca decomposition was subsequently used to determine the extent to which the difference in childhood malnutrition prevalence between low-income and high-income groups and maternal education levels results from the contributory effects of the explanatory variables: child and maternal individual-level compositional factors. Results: We examined data from 138,782 children in 27 countries from 2015 to 2020. The prevalence of childhood malnutrition (10.5%) varied across countries, ranging from 6.5% in Burundi to 29.5% in Timor Leste. On average, the prevalence of childhood malnutrition was 11.0% in low-income households and 10.7% among mothers without education. Some nations had pro-low-income (i.e., malnutrition concentrated among children from poor households) or pro-no-maternal education (i.e., malnutrition concentrated among children from mothers with no formal education) inequality in childhood malnutrition, but most did not. We found a complex interplay of compositional effects, such as the child's age, maternal education, maternal health behavior, and place of residence, that influence the inequality in childhood malnutrition rates across 10 pro-low-income countries. In addition, we also found that a complex mix of compositional effects, such as the household wealth index, maternal health behavior, and maternal age, contribute to childhood malnutrition inequality between educated and uneducated mothers across the 7 pro-no maternal education countries. Conclusion: The prevalence of childhood malnutrition varies among low-income, high-income, and no maternal education-maternal education groups. This study highlights the need for a country-specific approach to addressing childhood malnutrition, with policies and interventions tailored to each country's specific context. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results Conclusion So What? Nutrition‐related obesity is rising among adolescents in New Zealand with an estimated one in eight children being obese. The school environment is an ideal community setting for encouraging a healthy lifestyle as schools contain a diverse population and involve students and parents. However, the healthiness of food available to intermediate and secondary school students (Years 7–13) is unknown. This study assessed how food and drink menus from schools align with policy guidelines for healthy school food environments.A convenience sample of NZ schools' (years 7–13; ages 10–19) menus was collected in 2020. Menus were classified using traffic light criteria. A toolkit was developed by three nutritionists and one dietitian (with trained staff support) to aid with menu classification. Menu quality was evaluated against school characteristics and policy use.Of the school menus assessed (n = 60), 3.3% met the recommendation for the provision of 75% ‘green’ items. ‘Red’ items were the main contributors (mean = 53.6%). Schools with high socio‐economic status (deciles 8–10; 14.3%; p < 0.05) and small school size (<749 students; 14.1%; p < 0.025) were associated with a higher proportion of ‘green’ items. Community (19.3%) and in‐house (25.9%) food providers provided a lower percentage of ‘amber’ items than school providers (39.3%; p < 0.001). In‐house providers (64.6%) had a greater percentage of ‘red’ items than school providers (48.2%; p = 0.017).Food available in schools (Years 7–13) tends to be unhealthy. A national nutrition policy could improve the school food environment, especially in schools with large populations and low socio‐economic status.School demographics have been associated with menu quality but further research within these schools is needed to identify the gaps to improve equitable outcomes within school food environments. [ABSTRACT FROM AUTHOR]

AbstractWe analysed the relationships between maternal feeding styles and children’s eating and nutritional factors. A cross-sectional study was developed with 416 mothers linked to 130 public higher education institutions in all Brazilian states and their children aged 18 months to six years. A semi-structured online questionnaire was applied using the Google Forms tool, with questions about sociodemographic conditions, food consumption and anthropometry of the children. The children’s food consumption was assessed based on the Food Consumption Markers Form (SISVAN) for the age groups up to 24 months (n = 84) and over 24 months (n = 332), and the parental style in feeding, based on the Parental Feeding Styles Questionnaire (QEPA). The assessment of the child’s nutritional status was based on the weight and height data reported by the mother. The body mass index/age (BMI/Age) was calculated and classified into age-specific WHO curves. Descriptive analysis and univariate analyses were performed, in the Statistical Package for the Social Sciences (SPSS, version 26.0) programs (SPSS Inc., Chicago, IL). To test the association between categorical variables, the Chi-square test or Fisher’s exact test was used, and multiple logistic regression was used to estimate the independent association between the variables of interest, with an estimated odds ratio and 95% confidence interval. Statistical significance was adopted at 5%. Children under 24 months of age with authoritative mothers were 8.7 times more likely to consume ultra-processed foods and 5.3 times less likely to consume foods rich in vitamin A than those with indulgent mothers. Children over 24 months old with authoritative mothers were 2.5 times more likely to eat meals while watching television, 2.0 times more likely to consume sandwich cookies, candies and sweets, and 2.3 times less likely to have at least the three main meals of a day, compared to those with indulgent mothers. The chances of overweight children being born to authoritative mothers were two times greater compared to underweight children. Higher scores in the demandingness domain among responsive mothers increased the odds ratios of children eating unhealthy foods, using screens during meals, and proved to be a protective factor against low child weight. [ABSTRACT FROM AUTHOR]

Background: Oral immunotherapy (OIT) has become the standard of care for children with food allergy (FA) and has substantially improved their quality of life. The effect of OIT on the quality of life in adults, however, has been studied to a much lesser degree. Methods: Patients with food allergy aged ≥ 18 years who underwent OIT at Shamir Medical Center completed the Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF) before and at the end of treatment. Adults with FA not undergoing OIT who completed the FAQLQ-AF at 2 time points, served as controls. Results: A total of 44 adults, median age 23.4 years, who underwent OIT for milk (n = 19), egg (n = 2), peanut (n = 9), sesame (n = 6), and tree nuts (n = 8), and 11 controls were studied. The median OIT starting dose was 23.8 mg protein. 33 patients (75%) reached full desensitization within a median of 10.3 months. The FAQLQ-AF baseline scores were comparable between the study and control groups for all items except for Food Allergy related Health (FAH) item in which the study group had a significantly better score (p = 0.02). At the second time point, the study group had significantly better scores in all items (Allergen Avoidance and Dietary Restrictions (AADR), p = 0.02; and Emotional Impact (EI), Risk of Allergen Exposure (RAE), FAH and the Total Score, p < 0.01). The change in scores for the study group was significantly better, statistically and clinically, in AADR, p = 0.04; EI, p < 0.01; RAE, p = 0.01, and in the total score, p = 0.01. Conclusions: OIT significantly improves quality of life of adults with FA. This finding adds important support for providing OIT in this population. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between the amount of ultra‐processed food (UPF) in the diet and low‐grade inflammation in children. This cross‐sectional study was conducted in 50 healthy children recruited from children attending the Social Paediatrics Outpatient Clinic for follow‐up of normal developmental stages. Low‐grade inflammation was calculated by INFLA‐score, dietary intake by three 24‐h dietary recalls and dietary content analyses by BeBiS™ software. The mean age of the 50 children included in our study was 10.18 ± 3.98 years (5–17 years). UPF accounted for 24.5% of the total daily energy intake of children. In children with higher inflammation scores (INFLA‐score ≥ 2), the amount in grams of UPF and the percentage of total energy from UPF were found to be significantly higher (p = 0.030 and p = 0.015, respectively). A weak positive correlation was found between the INFLA‐score and the percentage of daily dietary energy intake coming from UPFs (r = 0.350, p < 0.01), the average daily energy intake from UPFs (r = 0.313, p < 0.05), and the average daily amount of UPF consumed (r = 0.260, p < 0.05). The linear regression model revealed that every one‐unit increase (1%) in the percentage of total daily energy intake coming from UPF caused an increase in β = 0.154‐unit in the INFLA‐score. It was found that obesity was not a mediator in the association between the percentages of total energy intake from UPF on the INFLA‐score, instead, the energy intake from UPF had a significant direct association with the INFLA‐score. The average amount of UPF consumed daily showed an increasing pattern in parallel with inflammation‐score quartile classes (Q1 to Q4) with 33.3% in Q1, 38.5% in Q2, 53.8% in Q3 and 66.7% in Q4 (p = 0.049). In conclusion, a positive association was found between low‐grade inflammation and UPF consumption in children, independent of obesity. [ABSTRACT FROM AUTHOR]

Background: Linear growth faltering remains a pervasive public health concern that affects many children worldwide. This study aimed to investigate possible maternal factors promoting normal linear growth among children aged 6–23 months of age from impoverished Rwandan households. Methods: We used a three-stage cluster sampling procedure. The study population consisted of children aged six to 23 months and their mothers who lived in the study districts. A structured questionnaire helped to collect data from 807 selected mother-child dyads. The primary outcome variable was height-for-age Z scores. The main predictors were maternal income-generating activity, maternal education, maternal depression, household decision making, number of ANC visits, use of family planning method, types of family planning, and mode of delivery. We used univariate analysis to establish median, frequencies, and percentages. Furthermore, we used the Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation tests for bivariate analysis. We included in the final model of robust linear regression for multivariate analysis the potential confounding variables identified as significantly associated with the outcome (child age, participation in works for both parents, good handwashing practice, owning a vegetable garden, and the total number of livestock) along with maternal factors. Results: Maternal factors that promoted normal linear growth of children were the presence of maternal income generation activity (β= 0.640 [0.0269 1.253], p value = 0.041), the participation of the mother in the decision-making process of the household (β=0.147 [0.080 0.214], p-value < 0.001), and the higher frequency of consultations with ANC (β=0.189 [0.025 0.354], p-value = 0.024). Additionally, a combination of household decision-making with the number of ANC visits predicted an increase in the linear growth of the child (β=0.032 [0.019 0.045], p-value < 0.001). Conclusion: Maternal factors such as maternal income-generating activity, maternal participation in household decision making, and increased number of ANC visits were found to promote normal child linear growth. These results contribute valuable information to the formulation of interventions and policies to improve child nutrition and growth in the community studied. [ABSTRACT FROM AUTHOR]

This document is a summary of a Cochrane review that examines the effectiveness of various medications in treating gastroesophageal reflux disease (GORD) in infants and older children. The review found very low-certainty evidence regarding the benefits of medications for symptom improvement in infants. For older children, there was also very low-certainty evidence that proton pump inhibitors (PPIs) may or may not improve GORD outcomes. The review calls for further research with longer follow-up periods and improved trial design. It also highlights the potential side effects and conflicts of interest associated with these medications. [Extracted from the article]

This study sought to understand reported impacts of the COVID‐19 pandemic on maternal and child health and nutrition behaviours during the first 1000 days of life. This qualitative and participatory substudy was embedded within mixed methods formative research conducted during 2020–2022 across two urban, three rural and one estate sector site in Sri Lanka. Semi‐structured interviews among caregivers of children aged 6–23 months (n = 34), influencers of caregivers, such as health workers (n = 37), leaders (n = 10) and pregnant women (n = 20) were conducted. Participatory workshops (n = 14) triangulated interview findings. Interview data were analyzed to identify salient themes using Dedoose. Numerical data from voting conducted in workshops were summed and triangulated with interview data. Findings suggest that the COVID‐19 pandemic and imposed restrictions shaped maternal and child health and nutrition behaviours through a complex interplay of factors. Imposed restrictions and changes to the food system contributed to temporary unemployment for wage workers and reduced purchasing power to maintain food security for vulnerable households. While deciding whether to seek care, fears of infection prevented usual care‐seeking decisions. Also, reduced incomes and disrupted public transportation made transport to health care facilities for antenatal care services difficult. Once women reached facilities, medical services and quality of care were negatively impacted. Implementing expanded community‐based services during home visits focused on the first 1000 days and beyond was one effective strategy to maintain maternal and child health and nutrition during the early pandemic in Sri Lanka. [ABSTRACT FROM AUTHOR]

This commentary explores the intersection between climate, conflict, and child nutrition, highlighting the severe child nutrition crisis in Sub-Saharan Africa exacerbated by climate change and ongoing conflicts. Shifting climate patterns disrupt agricultural productivity and food security, while persistent conflicts displace populations and destroy infrastructure, significantly increasing food insecurity and malnutrition among children. Recent UNICEF data indicates that 1 in 4 children globally live in severe food poverty, with those affected up to 50% more likely to suffer from life-threatening malnutrition. Over half a billion children reside in areas prone to climate-related extreme weather events, challenging food production, distribution, and access. Extreme weather events have led to crop failures, food shortages, and price spikes, disproportionately affecting vulnerable populations. Changes in temperature and precipitation patterns also alter the nutritional content of crops, worsening nutritional challenges. Conflicts in SSA have led to a food crisis of unprecedented scale, with over 80% of the 137 million Africans facing acute food insecurity located in conflict-affected countries. The conflict between Russia and Ukraine has further disrupted global food and fertilizer supply chains, exacerbating food shortages and inflation in many African countries. Addressing this crisis requires a multifaceted approach integrating evidence-based, cost-effective strategies. This commentary advocates for the adoption of the 3 C approach—climate-smart school feeding programs, cultivation of edible insects, and community-based food hubs—as solutions to enhance child nutrition and build climate resilience. [ABSTRACT FROM AUTHOR]

This research analyses the 2013 Nigeria Demographic and Health Survey Data. The multilevel logistic regression is used as the model estimation technique. The study investigates how the intersection of being a paternal orphan or vulnerable child and having close versus distant biological relations with the household head impacts wasting. Findings indicate that paternal orphans or vulnerable children who are grandchildren face the greatest significant probability of wasting compared to paternal orphans or vulnerable children who are biological children and non-orphans/non-vulnerable children who are grandchildren. Grandparent-headed households are not meeting the nutritional needs of paternal orphans and vulnerable children who are grandchildren. Policy needs to focus on directing monetary, food, and health resources to grandmothers caring for orphaned and vulnerable grandchildren. [ABSTRACT FROM AUTHOR]

School feeding programs can support children's nutrition, health, and education in emergencies. This study assessed the feasibility, trade‐offs, cost efficiency, and perceived benefits of school feeding modalities operating in urban Yemen. It draws on primary data from a qualitative evaluation with 21 school feeding implementers and 88 beneficiaries conducted in Feb–Mar 2023, and secondary data from a desk review of published and program literature on school feeding operations. Results showed that school feeding provided students with on average 18%, 40%, and 66% of daily energy, protein, and micronutrient requirements, respectively. Models including fortified snacks were 3–11 times more cost‐efficient in terms of nutrient delivery. The most prominent strength of the models examined were the perceived benefits on child, family, and financial outcomes. Among the main weaknesses was the poor nutritional quality of the meal, which in turn emerged as a primary opportunity to improve school feeding through hybrid models providing a combination of fortified snacks and healthy meals. Other weaknesses such as poor water, sanitation, and hygiene infrastructure, and desired improvements such as the school kitchen and canteen, require considerable investments. Hybrid models are cost‐efficient, acceptable, and feasible in Yemen and can serve the diet and nutrition needs of school‐aged children. [ABSTRACT FROM AUTHOR]

Children today have limited food origin awareness. The further we move away from food production practices, the less exposure children have to them, and the more food vulnerable we become. This is especially true for children growing up in urban areas where there is limited space for food gardens. Schools have developed targeted pedagogical approaches to raise food origin awareness, and this paper examines one such attempt in Cairns, Australia. We compare how students aged 5-6 responded to an activity where they drew their immediate response to the word 'food'. Comparisons were then made between those learning under explicit instruction and those using a more experiential, place-based pedagogical approach. The findings suggest students in the experiential class who regularly use the garden as a learning space drew significantly higher levels of fresh, place-appropriate fruits and vegetables (U = 61.5, P = 0.002). We discuss the ramifications of exposure to a globalised food system and how experiences at school can nurture children's understanding of food. We interpret the outcomes of the different pedagogical approaches and unravel the importance of 'place' in a child's food experience. The evidence presented suggests that children's food knowledge could improve if food education is bolstered with experiential and place-responsive pedagogies. [ABSTRACT FROM AUTHOR]

Background: Food allergy (FA) is associated with poor health‐related quality of life and high levels of psychological distress. Psychological support is extremely important but not always available. As part of the Global Access to Psychological Services for Food Allergy (GAPS) study, we aimed to assess psychological distress and service use among adults, caregivers and children with FA in a global survey. Methods: Participants (n = 1329 adults with FA; n = 1907 caregivers of children with FA) from >20 countries were recruited through patient organisations, social media advertisements and online survey panels to complete an online survey. Surveys were available in six languages. Results: A total of 67.7% of adults and 77.2% of caregivers reported direct experience, and 51.6% of caregivers said their child had experienced FA‐related psychological distress. The most commonly reported issue was anxiety about having an allergic reaction. Less than 20% had been assessed for FA‐related psychological distress. There were significant differences across countries for levels of distress, screening for distress, seeing a mental health professional and being diagnosed with a FA‐related mental health disorder (all p <.001). The United Kingdom, Australia and Brazil had the highest number of participants reporting distress. The most commonly reported barrier to seeing a mental health professional was cost. Conclusions: FA‐related distress is common across countries, but with substantial country‐to‐country variability. Allergy providers are encouraged to routinely assess families for psychological distress and provide access to appropriate mental health resources. Development and implementation of evidence‐based, patient‐informed accessible, affordable FA interventions in multiple languages is urgently needed. [ABSTRACT FROM AUTHOR]

Background: Researchers over the years have underscored the role of birth spacing on maternal health, however, inadequate maternal repletion due to shorter birth intervals could also affect the health of the child. Even so, limited studies exist on the linkage between birth spacing and child nutrition. This study examines the association between birth spacing and child stunting and underweight using the 2014 Ghana Demographic and Health Survey. Methods: The study sourced data on 1, 904 children less than 59 months from the 2014 Ghana Demographic and Health Survey. The study employed bivariate analysis and logistic regressions to establish the association between birth spacing, and child stunting and underweight. Results: The analyses reveal that childbirth spacing between 24 and 35 months (OR = 0.62, 95% CI: 0.38–0.99; p < 0.05), 36 to 47 months (OR = 0.42, 95% CI: 0.25–0.70; p < 0 0.01), and beyond 47 months (OR = 0.47, 95% CI: 0.28–0.78; p < 0.01) have lower odds of child stunting than children with birth spacing less than 24 months. Children with birth spacing between 24 and 35 months (OR = 0.53, 95% CI: 0.29–0.98; p < 0.05), 36 to 47 months (OR = 0.44, 95% CI: 0.22–0.90; p < 0.01) and beyond 47 months (OR = 0.49, 95% CI: 0.26–0.94; P < 0.05) have lower odds of being underweight than those with birth spacing less than 24 months. Conclusion: The study reveals that mothers with a birth spacing of at least two to three years compared to their counterparts with less than two years of birth spacing have lower odds of having a stunted and underweight child under age five. The study recommends that Ghana Health Service and other healthcare providers should educate mothers on the gains of birth spacing of at least two years on their children. [ABSTRACT FROM AUTHOR]

Alive & Thrive (A&T) provides strategic technical assistance (TA) to develop effective policies; improve maternal, infant, and young child nutrition (MIYCN) programme design and implementation and enhance system capacity to sustain quality MIYCN service delivery at scale. A qualitative assessment was conducted using document review and stakeholder interviews (n = 79) to describe a selection of A&T's TA in six countries and systematically assess the contextual and TA process‐related factors that influenced the results achieved and document the lessons learned about MIYCN TA design and implementation. To facilitate the selection of different types of TA, we classified TA into two levels of stakeholder engagement and intensity. Under the Technical Advisor TA category, we assessed A&T's support to strengthen national policy formulation, monitoring, and implementation of the International Code of Marketing of Breast‐milk Substitutes. For Capacity Development TA, we assessed A&T support to scale‐up maternal nutrition services and to increase strategic use of data. Factors important for TA provision included identifying and engaging with the right people, using evidence to support advocacy and decision‐making, using multiple ways to strengthen capacity, developing packages of tools to support programme scale‐up, and reinforcing feedback mechanisms to improve service provision and data quality. Challenges included shifts in the political context, poorly functioning health systems, and limited resources to replicate or sustain the progress made. Continued investment in evidence‐based and practical TA that strengthens the institutionalization of nutrition across all stakeholders—including government, medical associations, civil society and development partners—is essential. Future TA must support governments to strengthen system capacity for nutrition, including financial and human resource gaps that hamper full scale‐up. [ABSTRACT FROM AUTHOR]

Objectives: Children with Tourette syndrome (TS) have been shown to exhibit high levels of food selectivity; however, its association with nutritional status has yet to be explored. The current study explored macro and micronutrient intake and food selectivity among children with and without TS, using 24-hour dietary recall and the Child Eating Behaviour Questionnaire.Method: Parents of 43 children diagnosed with TS and 38 age-matched children without a clinical diagnosis completed an online 24-hour food diary.Results: Fifty-eight per cent of children with TS were identified as falling outside of the healthy BMI range (underweight = 24.2%; overweight = 27.3%; obese = 6.1%). Children with TS also consumed fewer portions of fruit and vegetables along with meeting the daily reference nutrient intake guidelines significantly less often for vitamins B3, B6 and C, selenium and phosphorus compared to children without TS.Conclusions: Understanding the nutritional risk of children with TS relative to other children is important to clinicians and health care professionals who oversee nutritional inspection in primary care, and caregivers who are worried about the impact of limited or restricted diets. [ABSTRACT FROM AUTHOR]

Background: Schools and early years settings provide an opportunity to promote healthy and sustainable food, but standards and guidance in England focus predominantly on nutritional quality. The present study estimated greenhouse gas emissions (GHGE) of school lunches provided for children attending school nurseries, including comparison between meal options. Methods: Menus, recipes and portion weights for lunches provided for 3–4‐year‐old children attending nine school nurseries were collected daily for one week. GHGE for each food and recipe were calculated using Foodprint functionality of Nutritics software. GHGE were calculated for each menu option (main, vegetarian, jacket potato and sandwich) provided in each school, and for meals with and without meat/fish. Results: In total, 161 lunches including 273 foods were analysed. Median GHGE across all meals was 0.53 kgCO2e (i.e. kilograms of carbon dioxide equivalent) per portion, with significantly higher GHGE associated with main meals (0.71 kgCO2e per portion) compared to all other meal types (0.43–0.50 kgCO2e per portion; p < 0.001) which remained after adjustment for meal size and energy density. Red meat‐based meals were highest in GHGE (median 0.98 kgCO2e per portion and 0.34 kgCO2e per 100 g) and meals containing any meat/fish were significantly higher in GHGE (median 0.58 kgCO2e per portion) than vegetarian meals (median 0.49 kgCO2e per portion) (p = 0.014). Meals with higher adherence to the nutrient framework underpinning the early years guidelines had significantly higher GHGE than meals with lower adherence (p < 0.001). Conclusions: The results were comparable to previous estimates of school lunch GHGE and highlight variation by meal option. Consideration of GHGE alongside the nutritional quality of lunches by caterers could support provision of healthy and sustainable lunches. Highlights: Mean greenhouse gas emissions (GHGE) across all meal types provided for 3–4‐year‐old children attending school nurseries was 0.61 kgCO2e (i.e. kilograms of carbon dioxide equivalent) per portion (SD 0.32) (median 0.53 kgCO2e per portion).When GHGE were compared for different meal types, total GHGE were significantly higher for main meals compared to jacket potato meals, vegetarian meals, and sandwich meals, and this was the case whether compared per portion, per 100 g food or per 100 kcal.Red meat was the greatest contributor to GHGE per portion.There was larger variation in the GHGE of non‐vegetarian meals compared to vegetarian meals (depending on the protein included) and meals containing meat or fish had significantly higher GHGE than vegetarian meals.Meals with medium or high adherence to the nutrient framework underpinning the early years guidelines had significantly higher GHGE than meals with low adherence. [ABSTRACT FROM AUTHOR]

Our study aims to define resting energy expenditure (REE) and describe the main nutritional patterns in a single-center cohort of children with Smith-Magenis syndrome (SMS). REE was calculated using indirect calorimetry. Patients' metabolic status was assessed by comparing measured REE (mREE) with predictive REE (pREE). Patients also underwent multidisciplinary evaluation, anthropometric measurements and an assessment of average energy intake, using a 3-day food diary, which was reviewed by a specialized dietitian. Twenty-four patients (13 M) were included, the median age was 9 years (IC 95%, 6–14 years), 84% had 17p11.2 deletion, and 16% had RAI1 variants. REE was not reduced in SMS pediatric patients, and the mREE did not differ from the pREE. In patients with RAI1 variants (16%, n = 3/24), obesity was more prevalent than those with 17p11.2 deletion (100% vs 38%). Lower proteins intake and higher total energy intake were reported in obese and overweight patients, compared to healthy weight children. No significant difference was found between males and females in energy or macronutrient intake. Conclusions: In SMS, the onset of obesity is not explained by REE abnormalities, but dietary factors seem to be crucial. Greater concern should be addressed to patients with RAI1 variants. A better understanding of the molecular mechanisms causing obesity in SMS patients could set the basis for possible future targeted therapies. What is Known: • More than 90% of SMS patients after the age of 10 are overweight or obese. What is New: • Onset of overweight and obesity in SMS pediatric patients is not explained by abnormal resting energy expenditure. • The development of syndrome-specific dietary guidelines for SMS patients should be of utmost relevance and are highly needed. [ABSTRACT FROM AUTHOR]

To avoid complete elimination of hen eggs (HE) from diet, we introduced a very-low-dose (VLD) oral food challenge (OFC) in patients with severe HE allergy in 2019. Herein, we investigated the efficacy of VLD HE OFC for achieving the full dose OFC. Patients with an overt allergic reaction to LD (1/32 HE [≤100 mg]) or less, egg white (EW) protein within 6 months were included. In the VLD group, patients not achieving full-dose OFC (1/2 HE: 1600 mg EW protein) within 2 years were excluded. We retrospectively compared the rate of passing a full-dose OFC between patients who underwent a LD OFC before 2019 (LD group) and those who underwent a VLD OFC (1/100 HE: 32 mg EW protein) after 2019 (VLD group). The period for passing the full-dose OFC was evaluated using Kaplan–Meier survival analysis. We enrolled 411 and 111 patients in the LD and VLD groups, respectively. The median age at OFC initiation was 2.2 [1.5–3.6] and 2.1 [1.4–3.2] years in the LD and VLD groups, respectively. EW- and ovomucoid-specific IgE levels were 38.3 (12.5–72.9) and 21.0 (8.3–46.2) kU A /L in the LD group and 49.8 [18.8–83.9] and 32.1 [15.6–67.8] kU A /L in the VLD group, respectively. Over 4 years, the LD and VLD groups passed the full-dose OFC at rates of 70 and 95%, respectively, with significant differences (log-rank test, P < 0.001). VLD HE OFC may contribute to passing a full-dose OFC in patients with severe HE allergies. [ABSTRACT FROM AUTHOR]

• Studied a sample of 152 low-income Latino parents and their kindergarten children. • Examined unique relations between food practices and children's academic skills. • Food sharing practices positively related to children's literacy skills. • Food practices are part of the constellation of Latino home learning activities. Latino parents support children's academic skills through their involvement in daily living activities. Prior work has focused on conventional literacy (e.g., book reading) and numeracy activities (e.g., teaching numbers). Less-visible home activities that are high-priority, high-value cultural practices in Latino communities are food sharing (e.g., eating together) and food-related household chores (e.g., grocery shopping together). This study examined whether food sharing and food-related household chores contributed to children's academic skills beyond conventional literacy and numeracy activities, in a sample of 152 Latino parents from low-income households and their kindergarten children (M age = 67.24 months; 51.32% female). At the beginning of kindergarten, parents completed a home learning activities questionnaire and children's literacy and math skills were assessed. We found that food sharing, but not food-related household chores, positively related to children's literacy skills (vocabulary), beyond conventional literacy and numeracy activities. Food sharing and food-related household chores did not relate to children's math skills. Findings suggest the need to consider food sharing and food-related household chores as part of the constellation of Latino home learning activities that are likely to support children's academic skills. [ABSTRACT FROM AUTHOR]

The aim of this study was to estimate the global burden, trends and health inequality of childhood nutritional deficiencies (CND) from 1990 to 2019. This was an epidemiological study. Data were extracted from the 2019 Global Burden of Disease study. Estimates and 95% uncertainty intervals (UIs) for the rates and numbers were used to evaluate the global burden of CND. Temporal trends in the burden of CND were examined using Joinpoint analysis and average annual percentage changes. To assess health inequality, the slope index was used. In 2019, 52 million new cases of CND and 105,000 deaths related to CND were recorded. Additionally, 435 million prevalence cases and 26 million disability-adjusted life years (DALYs) were recorded in the same year. From 1990 to 2019, the incidence rate of CND generally increased globally, except for the years 2010–2017; conversely, the prevalence, death and DALY rates exhibited decreasing trends over the study period. Half of the analysed regions and countries/territories demonstrated decreasing trends in the incidence, prevalence, death and DALY rates associated with CND. The incidence and prevalence of CND remained high in low-middle sociodemographic index (SDI) and low-SDI regions; however, they exhibited decreasing trends over the 30-year study period. The slope indexes showed that there were no significant changes in SDI-related inequality over 30 years. Despite decreasing trends in the prevalence, death and DALY rates associated with CND over the three decades, the degree of inequality related to SDI in the burden of nutritional deficiencies has not shown a significant decline. In summary, CND remain a major public health burden in middle-SDI and low-SDI countries. [ABSTRACT FROM AUTHOR]

Amid national efforts to align priorities for nutrition and food assistance programs, little is known about the implementation of community-led efforts for children. This study aimed to estimate U.S. public school participation in weekend backpack programs (WBPs), to document program structure, and to consider characteristics of programs with more nutritious food offerings. The prevalence of WBP participation in 2022 was estimated using a state-stratified, random sample of n =413 public schools. Administrators from WBPs at 49 schools completed measures of implementation characteristics and nutritional quality of foods offered. In 2022–2023, using a multivariable-adjusted linear regression model, the authors explored the association between hypothesized implementation characteristics and Healthy Eating Index-2015 scores of foods provided. Half of public schools (53.7%, 95% CI: 46.8%, 60.7%) in the national sample reported participating in WBPs. Many WBPs in the subsample were affiliated with anti-hunger organizations (41%), led by school counselors and volunteers (55%), and funded by grants (51%). WBPs spent an average of $0.56 (sd=$0.36) per item. Foods provided averaged a Healthy Eating Index-2015 score of 58.4 (sd=12.3), similar to children's average diets. About half of WBPs (41%) reported accessing nutrition resources. Despite the decentralized structure and absence of dedicated funding mechanisms, WBPs were common in our national sample of schools, suggesting widespread perceptions of unmet food needs and extensive efforts from community members to mitigate weekend hunger. Further research on food procurement methods and program impacts on child nutrition outcomes is needed to advance national priorities for nutrition and food security. [ABSTRACT FROM AUTHOR]

Background: Social media platforms have become increasingly influential channels for discussing various aspects of children's health, including dietary habits and food choices. This research explores the impact of social media on childhood dietary habits regarding the foods children consume by analyzing published findings about online videos and other social media platforms. Methods: From a pool of 9646 articles available on Google Scholar, Science Direct, Web of Science, and ProQuest, 25 were selected for inclusion in this systematic literature review after meeting the qualifying criteria. The screened papers contained clinical studies, cross-sectional studies, and editorials published in English. Results: A review of these articles revealed that individuals' communication with friends via social media significantly enhanced their comprehension of conversations related to weight management. The results of this research inform efforts to combat poor diets and promote overall well-being among children at an earlier stage when personal interactions are likely limited. To promote the healthy growth of children, it is essential that the videos they engage with offer them appropriate guidance on maintaining a nutritious diet. Ultimately, this research provides insights into how social media creates environments conducive to the well-being of children. Conclusions: As a result, social media can serve as a valuable resource to help mitigate the prevalence of obesity in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Continued breastfeeding reduces infant mortality and provides nutritional, immunological, and developmental benefits for the child. Objectives: A prospective cohort study conducted in 2015 followed 608 children who were breastfed between 6 and 24 months. The study assessed the risk of breastfeeding interruption at 12, 18, and 24 months, as well as the factors associated with this outcome, in a cohort of newborns in Rio Branco, using the life table method. Methods: The factors associated with breastfeeding cessation and their 95% confidence intervals (CI95%) were analyzed using both crude and adjusted Cox proportional hazards regression in a hierarchical model. The risks of breastfeeding cessation at 12, 18, and 24 months were 19%, 65%, and 71%, respectively. Results: Factors positively associated with the risk of breastfeeding cessation include the use of a pacifier before 6 weeks of age (HR = 1.62; CI: 95% 1.24–2.11) and the use of a bottle during the first year of life (HR = 1.41; CI: 95% 1.11–1.78). Maternal return to work after the birth of the baby (HR = 0.78; CI: 95% 0.62–0.97) was found to be negatively associated with the risk of breastfeeding interruption. Conclusions: Early pacifier use before 6 weeks and the introduction of a bottle in the first year affect continued breastfeeding. Maternal employment was associated with reduced risk of breastfeeding cessation, contrary to most studies. [ABSTRACT FROM AUTHOR]

Globally, severe acute malnutrition (SAM), defined as a weight-for-length z-score more than three SDs below a reference mean (WLZ < −3), affects 14 million children under 5 years of age. Complete anthropometric recovery after standard, short-term interventions is rare, with children often left with moderate acute malnutrition (MAM; WLZ −2 to −3). We conducted a randomized controlled trial (RCT) involving 12- to 18-month-old Bangladeshi children from urban and rural sites, who, after initial hospital-based treatment for SAM, received a 3-month intervention with a microbiome-directed complementary food (MDCF-2) or a calorically more dense, standard ready-to-use supplementary food (RUSF). The rate of WLZ improvement was significantly greater in MDCF-2–treated children (P = 8.73 × 10−3), similar to our previous RCT of Bangladeshi children with MAM without antecedent SAM (P = 0.032). A correlated meta-analysis of plasma levels of 4520 proteins in both RCTs revealed 215 positively associated with WLZ (largely representing musculoskeletal and central nervous system development) and 44 negatively associated (primarily related to immune activation). Moreover, the positively associated proteins were significantly enriched by MDCF-2 (q = 1.1 × 10−6). Characterizing the abundances of 754 bacterial metagenome-assembled genomes in serially collected fecal samples disclosed the effects of acute rehabilitation for SAM on the microbiome and how, during treatment for MAM, specific strains of Prevotella copri function at the intersection between MDCF-2 glycan metabolism and anthropometric recovery. These results provide a rationale for further testing the generalizability of MDCF efficacy and for identifying biomarkers to define treatment responses. Editor's summary: Severe acute malnutrition affects millions of children worldwide. Hartman et al. performed a 3-month randomized controlled trial of a gut microbiome–directed food supplement in 12- to 18-month-old Bangladeshi children living in rural and urban locations with moderate acute malnutrition and who had already been treated in hospital for severe acute malnutrition. Their microbiome-directed complementary food (MDCF-2) improved ponderal growth better than a more calorically dense, commonly used supplement and increased plasma abundance of proteins involved in musculoskeletal and central nervous system development. The authors tied the improvements in the children's health to changes in growth-associated gut microbiome species, most notably Prevotella copri strains and their carbohydrate degrading pathways. —Catherine Charneski [ABSTRACT FROM AUTHOR]

Background: Understanding the timing of food introduction in infants is essential for promoting optimal complementary feeding practices. However, existing studies often rely on cross-sectional data, limiting the ability to capture age-specific patterns. We aimed to describe food introduction during the first year of life by identifying patterns related to age at food introduction and associated factors in a cohort of Brazilian infants. Methods: Data were collected through standardized questionnaires administered to mothers via face-to-face interviews during the infant's first month of life and at 3, 6, 9, and 12 months of age. Additionally, two telephone interviews were conducted at 2 and 4 months of age. Information regarding food intake was assessed using a list of 48 foods, with two key aspects recorded: whether the food was introduced (yes/no) and the age at introduction. To define food introduction patterns, we employed k-means cluster analysis. Hierarchical Poisson multiple regression was employed to examine the associations between sociodemographic, biological, and healthcare factors and patterns of food introduction. Results: Three distinct patterns were identified and named according to their main characteristics: Pattern 1 – "Low Infant Formula and Timely CF Introduction"; Pattern 2 – "High Infant Formula and Early CF Introduction"; and Pattern 3 – "High Infant Formula and Later Ultra-processed Food Introduction". Breastfeeding at six months showed a positive association with Pattern 1 (PR = 1.40; 95% CI = 1.10–1.80), while bottle use at four months was negatively associated with Pattern 1 (PR = 0.68; 95% CI = 0.53–0.87). No variables studied exhibited an association with Pattern 2. For Pattern 3, higher prevalences were observed among children whose mothers were aged < 20 years (PR = 1.54; 95% CI = 1.13–2.01) or > 34 years (PR = 1.42; 95% CI = 1.04–1.93). Not receiving guidance on the recommended duration of breastfeeding and complementary feeding during prenatal care was associated with a higher prevalence of children in this pattern (PR = 1.35; 95% CI = 1.01–1.80). Conclusions: We identified three distinct patterns of age at food introduction in the study population, although none perfectly aligned with Brazilian or WHO dietary recommendations. These findings underscore the need for targeted interventions to promote timely and healthy complementary feeding practices in Brazilian infants. [ABSTRACT FROM AUTHOR]

Background: Climate change adversely affects Africa's agriculture which would worsen the widespread food insecurity and nutritional deficiencies. Vulnerable populations, especially female farmers, women, and children are disproportionately affected. Methods: The paper synthesizes available peer-reviewed and grey literature on the intersections of climate change, food insecurity, agriculture, gender disparities, health, child nutrition, and micronutrient deficiencies in Africa. It explores the economic ramifications of these factors, particularly their impact on public health and economic stability. The work aggregates insights into the current and future challenges of agricultural sustainability and the expected human capital development and economic costs of climate variations. Results: The prevalence of hunger and undernourishment in Africa is notably higher compared to other regions. Climate change directly threatens agriculture, with anticipated reductions in crop and livestock yields, compounded by the negative impact of greenhouse emissions on the nutritional quality of staple foods. Female farmers contribute notably to agriculture, but their labor share is less dominant than previously assumed. Exposure to high temperatures, especially for outdoor workers and pregnant women, presents significant health risks, further impacting agricultural and economic output. These interdependencies are presented in a framework along with suggested interventions that could be contextualized to address the climate drivers and interconnectivity across agriculture, health, and livelihoods. Conclusion: The interdependence between food, agriculture, health, nutrition, and human productivity, all of which are exacerbated by the impacts of climate change in Africa, form a complex challenge with profound health and economic implications. A multifaceted strategy is needed, encompassing climate-resilient farming practices, gender-sensitive interventions, health-focused measures like micronutrient supplementation, and comprehensive economic policies. [ABSTRACT FROM AUTHOR]

Background: Children who are critically ill are often reliant on enteral and oral nutrition support. However, there is limited evidence to guide "what" to prescribe, and current practice is unknown. The primary objective of this study was to describe enteral nutrition prescription in children ≤2 years of age in the pediatric intensive care unit (PICU). The secondary objectives were to describe oral nutrition support practices and factors associated with the use of increased energy and protein density nutrition support. Methods: Children ≤2 years of age admitted to participating PICUs over a 2‐week period in June 2021 were enrolled. Data were collected on PICU admission days 1 to 7, 14, 21, and 28 on the mode of nutrition, enteral and oral nutrition support prescription, and dietitian intervention. Results: Eighty‐four children were included (49 [58%] male; 79 [94%] ≤1 year of age). Enteral nutrition was administered to 79 (94%) children (with expressed breast milk in 45 [57%]). Forty‐three children received formula as enteral nutrition. Increased energy and protein density formulas were provided to 14 (33%) children enterally, with concentrated standard infant formula powder being the most common (5 [12%]). Among children offered oral intake (22; 26%), three (14%) received oral nutrition support. Children who received increased energy and protein density enteral nutrition were more likely to receive dietitian intervention (P = 0.002). Conclusion: In children ≤2 years of age admitted to PICU, expressed breast milk was provided to half of those requiring enteral nutrition and oral nutrition support prescription was infrequent. One third of children receiving formula via enteral nutrition received an increased energy and protein density feed, and this was strongly associated with dietitian intervention. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion This study aims to investigate the factors that promote or hinder the feeding of children with minimal or no ultra‐processed products to inform the design of an mHealth strategy in Mexico and prevent child malnutrition among the economically vulnerable.An exploratory qualitative study was conducted, involving 24 in‐depth face‐to‐face interviews with caregivers of children aged 24–59 months from both urban and rural communities. To analyze the data, we used thematic analysis and incorporated a few elements of grounded theory.More barriers than facilitators were identified. Key barriers included: misconceptions and the widespread availability of junk food through an extensive network of grocery stores; neighbors and family gifting junk food; the association of soda with celebrations; the practice of indulging children with junk food; and the normalization of junk food consumption by both adults and children. Facilitators included: caregivers’ awareness of the health risks associated with junk food; economic constraints limiting junk food purchases; support from husbands in regulating children's junk food consumption; the presence of a family member with diabetes; specific cultural beliefs about children's digestive health; as well as displacement of “healthy” foods that nourish children.Based on our findings, we formulated recommendations for interventions at intrapersonal, interpersonal, organizational, community, and public policy levels to support healthier feeding practices for children. [ABSTRACT FROM AUTHOR]

Background: Evidence is needed to understand factors that influence child development and caregiving experiences, especially in marginalized contexts, to inform the development and implementation of early childhood development (ECD) interventions. This study explores caregiving practices for young children in an urban informal settlement with Kenyans and embedded refugees, and identifies factors shaping these caregiving experiences, to inform the design and development of potentially appropriate ECD interventions. Methods: A qualitative formative study, which included 14 focus group discussions (n = 125 participants), and 13 key informant interviews was conducted between August and October 2018. Purposive sampling approaches were used to select a diverse range of respondents including caregivers of children below three years of age and stakeholders of Kenyan nationality and refugees. Data were analysed using a thematic approach and the Nurturing Care Framework was used as an interpretative lens. Results: There was a fusion of traditional, religious and modern practices in the care for young children, influenced by the caregivers' culture, and financial disposition. There were mixed views/practices on nutrition for young children. For example, while there was recognition of the value for breastfeeding, working mothers, especially in the informal economy, found it a difficult practice. Stimulation through play was common, especially for older children, but gaps were identified in aspects such as reading, and storytelling in the home environment. Some barriers identified included the limited availability of a caregiver, insecurity, and confined space in the informal settlement, all of which made it difficult for children to engage in play activities. Physical and psychological forms of discipline were commonly mentioned, although few caregivers practiced and recognized the need for using non-violent approaches. Some overarching challenges for caregivers were unemployment or unstable sources of income, and, particularly for refugee caregivers, their legal status. Conclusion: These findings point to the interplay of various factors affecting optimal caregiving for young children in an urban informal settlement with Kenyans and refugees. Integrated ECD interventions are needed for such a mixed population, especially those that strive to anchor along caregivers' social support system, co-designed together with community stakeholders, that ideally focus on parent skills training promoting nurturing care and economic empowerment. [ABSTRACT FROM AUTHOR]

Summary Introduction Materials and Methods Results Conclusion Limited evidence exists on the relationship between ultra‐processed food (UPF) consumption and overweight/obesity amongst young children. This study aimed to assess UPF consumption, its socioeconomic correlates and its association with overweight/obesity amongst under‐five children in Lebanon.Data pertinent to children aged 6 months to 4.9 years (n = 893) from a cross‐sectional national survey were used. Anthropometric measurements were obtained, and multi‐component questionnaires were administered to mothers. Dietary intake was assessed using the 24‐h recall approach. NOVA classification was used to assign food items into four groups according to the extent of industrial processing. Contributions of each group to total energy intake (EI) and macronutrient and micronutrient intakes were estimated. Regression models were conducted to explore the correlates of UPF consumption as well as the association between UPF consumption and overweight/obesity status.UPFs were found to contribute 47% of daily EI. Girls and children with higher household income had significantly higher UPF intakes. Children whose mothers had an intermediate, high school, or technical diploma and were employed and whose fathers had higher education levels consumed significantly less EI from UPFs. Children whose %EI fell within the second and third tertiles of UPF intake had significantly higher odds of overweight/obesity as compared to those in the first tertile (adjusted odds ratio [AOR]: 1.21, 95% confidence interval [CI]: 1.09, 1.32 and AOR: 1.61, 95% CI: 1.47, 1.76, respectively), after adjusting for confounders.The high intake of UPFs coupled with its association with overweight/obesity call for public health nutrition interventions aimed at improving feeding and dietary practices in this age group. [ABSTRACT FROM AUTHOR]

Background: The correlation between the intake of certain nutrients and the development of oral pathologies has been demonstrated by several studies. The objective of this epidemiological investigation was to evaluate parents' knowledge and awareness of children's nutrition starting from the early stages of childhood. Methods: A questionnaire with 35 questions was handed over to 120 parents of infants aged 4 to 24 months. Among these, 20 questionnaires were excluded because they were incomplete; hence, the final sample analyzed consisted of 100 questionnaires. The outcome of this study revealed that the parents are well aware of many common topics, but their knowledge regarding specific prevention measures, i.e., the use of systemic fluoride as per the international guidelines, needs proper attention. Results: and Conclusions: After analyzing all the collected data, it is possible to conclude that prevention is the best investment to avoid the onset of the carious pathology, which can be possible through parental education, for example, by raising awareness among expectant mothers, through different actions in the territory. However, further research is needed as this study has some limitations and the convenience sample is hospital-based and not effectively representative of the whole population. [ABSTRACT FROM AUTHOR]

Food allergy (FA) affects approximately 6–8% of young children, with a peak prevalence at approximately one year of age. Tree nut and peanut allergies are among the main causes of anaphylaxis in the world. The gold standard for the diagnosis of FAs is the oral food challenge (OFC). Other diagnostic tests used in the clinical practice are skin prick tests (SPTs) and laboratory tests to measure out the presence of serum specific IgE (sIgE). In this narrative review, we collect the current evidence of the predictive value (PV) of SPTs and sIgE for the outcome of the OFCs. In literature, data are conflicting as to whether increasing sIgE concentration and wheal size in SPTs correlate with OFC outcomes. Most studies included in our review have shown that in vivo and in vitro tests may predict OFC outcomes with variable PV, but data are not conclusive; therefore, the OFC currently remains the gold standard for FA diagnosis. [ABSTRACT FROM AUTHOR]

Background: Poor early childhood development (ECD) is a major global health concern that is associated with various adverse outcomes over the lifecourse. Parenting interventions especially during the earliest years of life can benefit ECD. However, there is limited evidence from Kenya about the effectiveness of parenting interventions for improving ECD outcomes especially across rural disadvantaged communities. This paper describes the study protocol for an impact and implementation evaluation of a community-based group parenting program that aims to improve ECD in rural Kenya. Methods: We will conduct a cluster-randomized controlled trial to determine the effectiveness of a parenting program for caregivers of young children in Homabay and Busia counties in Western Kenya. Sixty-four village clusters will be randomly assigned to either the parenting intervention arm or the waitlist control arm with stratification by county. In each village, 10 primary caregivers with a child aged 0–24 months will be enrolled. The parenting program will be delivered through existing peer groups within communities whereby caregivers will receive counseling and psychosocial support to enhance their parenting skills and wellbeing to in turn promote ECD. The intervention curriculum comprises 21 sessions targeting various nurturing care messages, including early learning, responsive caregiving, child nutrition, health, protection, and caregiver mental health. Group sessions are facilitated by a trained volunteer biweekly for a total of 11 months. The primary trial outcome is an overall measure of ECD using the Global Scales of Early Development long form version. Secondary outcomes include various caregiver outcomes (e.g., parenting practices, mental health) and other child outcomes (e.g., socioemotional development, dietary diversity). All outcomes will be assessed at baseline and endline. We will also conduct a qualitative implementation evaluation at endline and interview various stakeholders to assess program fidelity, quality, and sustainability. Discussion: This trial will evaluate the effectiveness of a parenting intervention on ECD and caregiving outcomes and assess program implementation quality as delivered through existing community-based peer groups. This study will provide rigorous evidence that can be used to inform scale-up of this program model that leverages existing community social networks and resources for improving caregivers' parenting skills and promoting ECD in rural Kenya and other similar settings across LMICs. Trial registration: ClinicalTrials.gov #NCT06165315. Registered on December 11, 2023. [ABSTRACT FROM AUTHOR]

Early childbearing poses several potential risks to maternal and child health. This paper empirically analyses the association between teenage pregnancy and child nutritional status, maternal and child anaemia in three countries (Nigeria, India and Bangladesh) that account for the highest proportion of teenage births and/or total number of malnourished teenage mothers and children. Data were sourced from nine waves of Demographic and Health Surveys conducted in Bangladesh, India, and Nigeria from 2005–2018, covering a sample of 27,705 children from Bangladesh, 266,308 children from India and 54,719 children from Nigeria. Our outcome measures of maternal and child nutrition include (i) a composite measure of anthropometric failure for children (CIAF), (ii) maternal anaemia, (iii) childhood anaemia, and (iv) anaemia in maternal–child pairs. Using multivariate regression analysis, we examine the associations between early childbirth, child nutrition, and maternal and child anaemia, controlling for an array of household‐level socioeconomic and demographic characteristics. Across all three countries, the prevalence of CIAF (childhood anthropometric failure) is significantly higher among children born to women aged below 17 at first birth. We further find that early pregnancy and childbearing are associated with significantly higher rates of severe/moderate anaemia among both mothers and children in Bangladesh and Nigeria. In the three countries studied, the proportions of teenage mothers with vulnerable socioeconomic status and suboptimal pre‐conception care are relatively high, which raises the risk of maternal and child morbidity as well as mortality. [ABSTRACT FROM AUTHOR]

Background: Child food neophobia, i.e., rejection or avoidance of novel foods at a young age, is a prevalent nutrition problem that affects the quality of children's diet and impedes the development of healthy food preferences. Sensory sensitivity can relate to the degree of food neophobia, but previous studies rarely focused on the olfactory component of this problem in children. Objective: We aimed to thoroughly examine the relationship between various aspects of olfactory sensitivity and food neophobia in children. Methods: 246 children aged between three and nine years took part in a food neophobia assessment as well as in a comprehensive, psychophysical olfactory testing. Results: We found that certain smell perception aspects such as lower odor liking, poorer odor identification ability as well as lower sensitivity to an unknown non-food odor all significantly predicted higher food neophobia in children. Among individual characteristics of either a child or a caregiver, only the child's age significantly and positively predicted food neophobia. The exploratory model looking into the role of family environment factors predicting self-reported food neophobia in children revealed that food neophobia was associated with lower control given to a child in this child's feeding process, as well as with a more frequent use of food as a reward in feeding. Conclusions: We suggest that suppressed olfactory perception and performance can play a unique role in child nutritional difficulties. The study inspires further considerations of olfaction-engaging interventions to counteract food-neophobia in children. [ABSTRACT FROM AUTHOR]

Background: Interventions focusing on individual behaviours (physical activity, sedentary behaviour, sleep) of preschool-aged children have been widely studied. However, there is a lack of understanding about integrated interventions that target all three 24-hour movement behaviours. This is the first study to assess the effectiveness of an intervention aimed at improving all three 24-hour movement behaviours among preschoolers in Hong Kong. Methods: A 12-week randomised controlled trial with a 12-week follow-up was conducted. Parent-child pairs were randomised to integrated approach (targeting all three behaviours), dyadic approach (targeting physical activity and sedentary behaviour including screen time), or wait-list control group. Utilising the Internet-based delivery, this intervention consisted of education materials, workshops, and interactive questionnaires and reminders. Two intervention groups employed the same strategies, with the only difference being that the integrated approach targeted sleep in addition to physical activity and sedentary behaviour. The outcomes were preschoolers' overall 24-hour movement behaviours which were assessed by the Activity Sleep Index (ASI), movement behaviour composition, and absolute duration of movement behaviours. Generalised estimating equations were conducted to evaluate the intervention. Results: A total of 147 preschoolers (4.8 ± 0.9 years old, 56.5% boys) and their parents were included. Preschoolers in all groups had a lower ASI at follow-up compared with baseline. Preschoolers in the integrated approach had a smaller decline in ASI at follow-up, compared to that in the control group (3.41; 95% confidence interval [CI] = 0.07, 6.76). Preschoolers in both intervention groups had a smaller reduction of the composition of time spent in physical activity at follow-up, and a decreased screen time at postintervention and follow-up. No significant differences were found for the sleep subcomponent. Furthermore, preschoolers in the dyadic approach had a smaller increase in the sedentary behaviour subcomponent (vs. control: − 0.21; 95% CI = − 0.37, − 0.05) at follow-up. Conclusions: Both intervention groups showed a decrease in screen time at postintervention, but there were no significant changes in other behaviours. The favourable changes observed at follow-up demonstrated the effectiveness of both intervention approaches on alleviating the decline in the composition of time spent in physical activity and reducing screen time and revealed the possible effectiveness of the integrated approach in promoting overall movement behaviours among preschoolers. Trial registration: The study is prospectively registered at the Chinese Clinical Trial Registry (ChiCTR2200055958). [ABSTRACT FROM AUTHOR]

Background: In sub-Saharan African countries, preventable and manageable diseases such as diarrhea and acute respiratory infections still claim the lives of children. Hence, this study aims to estimate the rate of change in the log expected number of days a child suffers from Diarrhea (NOD) and flu/common cold (NOF) among children aged 6 to 11 months at the baseline of the study. Methodology: This study used secondary data which exhibit a longitudinal and multilevel structure. Based on the results of exploratory analysis, a multilevel zero-inflated Poisson regression model with a rate of change in the log expected NOD and NOF described by a quadratic trend was proposed to efficiently analyze both outcomes accounting for correlation between observations and individuals through random effects. Furthermore, residual plots were used to assess the goodness of fit of the model. Results: Considering subject and cluster-specific random effects, the results revealed a quadratic trend in the rate of change of the log expected NOD. Initially, low dose iron Micronutrient Powder (MNP) users exhibited a higher rate of change compared to non-users, but this trend reversed over time. Similarly, the log expected NOF decreased for children who used MNP and exclusively breastfed for six months, in comparison to their counterparts. In addition, the odds of not having flu decreased with each two-week increment for MNP users, as compared to non-MNP users. Furthermore, an increase in NOD resulted in an increase in the log expected NOF. Region and exclusive breastfeeding also have a significant relationships with both NOD and NOF. Conclusion: The findings of this study underscore the importance of commencing analysis of data generated from a study with exploratory analysis. The study highlights the critical role of promoting EBF for the first six months and supporting children with additional food after six months to reduce the burden of infectious diseases. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Children with autism spectrum disorder (ASD) experience high rates of atypical eating behaviours, such as food neophobia. Mobile health (mHealth) interventions have been found to improve communication, behaviour and social skills for children with ASD. However, there is limited evidence examining mHealth nutrition interventions among children with ASD.The present study comprised a qualitative descriptive study that used qualitative content analysis to explore parent and child experiences with a novel mHealth nutrition intervention. Ten parent–child dyads provided user feedback and evaluation of the intervention. Data collection tools included a semistructured interview guide and a quantitative questionnaire with open‐ended questions. Data analysis of the interview transcripts and open‐ended questionnaire responses was an iterative process that continued until saturation was achieved. Descriptive statistics were used to analyse quantitative questionnaire data.Analysis of the qualitative semistructured interviews led to emergence of three themes: (1) positive intervention outcomes; (2) parent suggestions for improvement; and (3) barriers to engagement. Each theme included subthemes. Questionnaire data revealed the ability to pick rewards and the virtual character that reinforced dietary goals (“Nutrition Ninja”) were the most liked components of the application. Sending messages within the application and the Nutrition Ninja game were the least liked components of the application.Collectively, findings indicated that the app served as an interactive tool prompting dietary change and conversations within families. Yet, for some families, the intervention design, resistance to change or child disinterest hindered use and implementation of the intervention. [ABSTRACT FROM AUTHOR]

Animal‐source foods (ASFs), contain high amounts of essential nutrients that are readily absorbed by the body. However, children in resource‐constrained settings often have limited access to these nutritious foods. This study aimed to investigate the reasons for the low consumption of ASFs among children in the Amhara region of Ethiopia. A community‐based mixed‐methods study was conducted, using exploratory qualitative methods supplemented by the analysis of secondary data from the Ethiopian Demographic and Health Survey (EDHS). The qualitative study employed a multiphase stepwise design and the maximum variation purposive sampling technique, enroling a diverse range of participants such as mothers and/or caregivers, household heads, religious and community leaders, health and nutrition experts, and others. The qualitative data were analysed using a thematic framework analysis method, while the quantitative data were analysed using SPSS v22 statistical software. Multivariable logistic regression analysis was performed to identify the predictors of ASFs among children under 5 years of age in the region. Despite the large and diverse livestock populations available, only 13.2% of children consumed at least one animal‐source food (ASF) in the prior day. The most consumed ASFs were dairy and eggs, whereas beef, organ meat, and seafood were the least consumed. Household demographics such as residence, literacy level, paternal age, and household wealth quintiles influenced the overall consumption of ASFs. The main reasons for the low consumption of ASFs among children were unaffordability and poor awareness among caregivers. In addition, religious misconceptions, price hikes, limited availability during certain seasons, low productivity, insufficient support from health professionals, and time constraints for caregivers were also mentioned as significant barriers to ASF consumption in the area. The consumption of ASFs among children in Ethiopia, particularly in the Amhara region, remains very low. This is mainly due to the caregivers' levels of awareness and unaffordability of ASFs. It is recommended that behavioural and sociocultural interventions be implemented that target caregivers to improve the consumption of ASFs among children. [ABSTRACT FROM AUTHOR]

The infant food market has expanded rapidly over the past two decades. However, the industry faces significant challenges, including concerns over the health effects of infant food additives and issues with food safety. However, new evidences suggest that certain food additives, such as those used to preserve and transport infant formula to keep it fresh for longer, should be avoided. Science into the effects of additives on human behavior makes up a sizable sector of the additives market. Problems such as hypernatremic dehydration, malnutrition, and obesity in infants are directly linked to faulty formula production. The Food and Drug Administration (FDA) has established the toxicity types and chemical tests necessary for evaluating the safety of food additives and GRAS (Generally Recognized as Safe) compounds. These tests are crucial in understanding the food safety aspects of food additives. The health effects of different types of food additives on infants are discussed in this context. The article gives an outline of various national and global agencies that provides recommendations and standards to gauge the quality of baby food. The immunological responses, allergic reaction pathways and other related health hazards among the infants and young children caused by the food additive are discussed in this article. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association among sun exposure time, vitamin D intake, dietary patterns, and socioeconomic status in Portuguese children. Methods: Participants aged 3–11 years (50.1% females) were recruited from public and private schools (n = 118) in the districts of Coimbra (n = 2980), Lisbon (n = 3066), and Porto (n = 2426). Parents reported their children's daily sun exposure time during the summer season and reported children's food consumption, including vitamin D food sources, using standardized questionnaires. Parents' education level was used as a proxy measure to the socioeconomic status (SES). The principal component factor analysis (PCA) method was used to identify dietary patterns. The eight dietary patterns identified were labeled in: "fast food", "rich in vitamin D", "sugary drinks", "vitamin D", "candies", "supplements", "rich in calcium" and "vegetables/healthy". Linear regression analyses were performed to investigate the association between sun exposure time and dietary patterns according to SES. Results: A total of 4755 children were included. Children from high SES had significantly longer sun exposure time (p <.001) and more frequently consumed vitamin D supplements (p <.001). "Fast food" pattern showed a negative association with sun exposure time in medium and high SES (p =.014 and p <.001, respectively). Conclusion: Children with lower SES spend less time exposed to the sun, consume fewer dietary sources of vitamin D, and consume more foods rich in fat and sugar. [ABSTRACT FROM AUTHOR]

Stunting, a consequence of chronic malnutrition, particularly affects children aged 0-24 months, impacting child mortality and development. This review aims to explore stunting prevention interventions in this age group, focusing on caregiving during the first 1000 days of life. A systematic search yielded 18 relevant studies published between 2019 and 2023, diverse in location and intervention approaches. Interventions varied from supplementation to community and healthcare programs. Integrating nutrition education with maternal support proved crucial. The review stresses the need for sustainable, context-specific approaches tailored to local contexts. Recommendations include integrating nutrition education into healthcare and community interventions. Continuous evaluation is vital. This review offers insights into stunting prevention, aiding evidence-based strategies globally. Future research should explore caregiving complexities and intervention sustainability. Nursing practitioners are key in implementing holistic approaches to stunting prevention and improving child health outcomes. [ABSTRACT FROM AUTHOR]

Nutrition is a basic need for a child to grow optimally. Improper child feeding practices are still found in the community, leading to malnutrition. The incidence of malnutrition has increased sharply in children aged 6 to 18 months in various countries, primarily due to ignorance and/or an inability to prepare food. The family plays a crucial role in the prevention and treatment of child nutrition problems. Families can provide education and practical supervision in addressing nutrition-related issues, including promoting healthy lifestyle patterns. The objective of this study was to determine the effectiveness of implementing family-centered care in changing child feeding practices. The research design employed was true experimental analysis with a pre-posttest group design. The population consisted of 130 respondents, infants aged 6 to 23 months, selected using a probability sampling technique with purposive random sampling. The research was conducted in Wonokromo, Surabaya, Indonesia, from March to June 2023. The measuring instrument utilized was a family-centered care-based child feeding guide. The independent variable in the study was family care, while the dependent variable was the change in the child's feeding practices. Test analysis was performed using the Mann-Whitney test. The results of the Mann-Whitney test indicated a significant difference in feeding practices before and after counseling with the family-centered care approach (p = 0.043). Thus, family-centered care was found to be effective in changing child feeding practices. [ABSTRACT FROM AUTHOR]