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ContextApproximately 7.3 million births occur annually among adolescents in low- and middle-income countries. Pregnant adolescents constitute a nutritionally vulnerable group that could benefit from intervention to mitigate the mortality and adverse birth outcomes associated with adolescent pregnancy.ObjectiveThe aim of this systematic review and meta-analysis was to assess the following: (1) the effect of multiple-micronutrient (MMN) supplementation vs iron and folic acid (IFA) supplementation among adolescents on maternal morbidity, birth outcomes, and mortality outcomes, (2) the effects of MMN supplementation in adolescents compared with the effects in adult women, and (3) the effect modification, if any, of MMN supplementation by baseline and geographic characteristics of adolescents.Data sourcesMEDLINE and Cochrane databases were searched, along with the reference lists of relevant reviews.Study selectionMultiple-micronutrient supplementation trials in pregnancy that were conducted in a low- or middle-income country and had included at least 100 adolescents (10-19 years of age) were eligible for inclusion. Two independent reviewers assessed study eligibility.Data extractionThirteen randomized controlled trials conducted in Africa and Asia were identified from 1792 reviews and 1578 original trials. Individual-level data was shared by study collaborators and was checked for completeness and extreme values. One- and two-stage individual participant data meta-analyses were conducted using data from randomized controlled trials of MMN supplementation.ResultsA total of 15 283 adolescents and 44 499 adult women with singleton births were included in the individual participant data meta-analyses of MMN supplementation vs IFA supplementation. In adolescents, MMN supplementation reduced low birth weight (1-stage OR = 0.87, 95%CI 0.77-0.97; 2-stage OR = 0.81; 95%CI 0.74-0.88), preterm birth (1-stage OR = 0.88, 95%CI 0.80-0.98; 2-stage OR = 0.86, 95%CI 0.79-0.95), and small-for-gestational-age births (1-stage OR = 0.90, 95%CI 0.81-1.00; 2-stage OR = 0.86, 95%CI 0.79-0.95) when compared with IFA supplementation. The effects of MMN supplementation did not differ between adolescents and older women, although a potentially greater reduction in small-for-gestational-age births was observed among adolescents. Effect modification by baseline characteristics and geographic region was inconclusive.ConclusionsMultiple-micronutrient supplementation can improve birth outcomes among pregnant adolescents in low- and middle-income countries. Policy related to antenatal care in these settings should prioritize MMN supplementation over the currently recommended IFA supplementation for all pregnant women, especially adolescents.

Maternal energy requirements increase during pregnancy but the magnitude of this increment is unknown among adolescents. We determined the effects of maternal age and weight status on adjustments in gestational weight gain, resting energy expenditure (REE), and growth among adolescents. Weight, and growth rates of pregnant adolescents (PA) [less than or equal to] 17 y during late pregnancy were compared with changes in nonpregnant adolescents (NPA) over a 5-mo period. REE was also measured monthly in the PA group. Paired t-tests and general linear models for repeated measures were used for the analysis; height was included as a confounding variable. Weight, height, and BMI of the PA and NPA women did not differ at baseline. During the follow-up period, NPA grew 0.94 [+ or -] 30 cm; growth rate was greater in adolescents [less than or equal to]14 y of age (P < 0.001) than in the older subjects. No growth occurred in the PA group. REE tended to increase linearly between 20 and 36 wk of gestation (P = 0.164); the net change in women >14 y (25%) tended (P = 0.164) to be greater than that of younger adolescents (7%). The mean increment of REE from wk 20 to wk 36 was 230 [+ or -] 30 kcal/d (962 [+ or -] 126 kJ/d) and the smallest increase occurred in women with BMI

Enzymatically modified soy proteins have the amino acid profile and functional properties required for dietary support. The objective of this study was to evaluate the nutritional and technological properties of an enzymatically modified soy protein ultrafiltered fraction with bound methionine ([F.sub.1-10]E) to be used as a protein ingredient for infant enteral formulas. [F.sub.10]E was chemically characterized and biologically evaluated. Thirty-six weaning Wistar rats were fed during 3 weeks with a 4% casein-containing diet. Rats were divided into three groups and recovered for 3 weeks with 18% protein-containing diets based on: (1) [F.sub.10]E, (2) casein or (3) soy isolate+methionine. Nutritional indicators were weight gain, protein efficiency ratio, plasma proteins, apparent digestibility and protein in the carcass. Additionally, [F.sub.10]E was added as a protein ingredient of an enteral formula, and its sensory and rheological properties were compared with a hydrolyzed-whey protein commercial formula. [F.sub.10]E contained 68% protein and 5% sulphur amino acids, with 60% of peptides [less than or equal to] 6 kDa. Casein-based and [F.sub.10]E-based diets were comparable (P > 0.05) in weight gain (108 g and 118 g, respectively), protein efficiency ratio (2.7), apparent digestibility (93% and 95%), plasma proteins (5.7 mg/100 ml) and carcass protein (61%), and better than soy isolate-based+methionine diet (P < 0.05). Viscosity of the commercial formula and our formula was similar during a 24-h period. Sensory acceptability was 8 for our formula and 3.5 for the commercial one, on a scale of 1-10 (P < 0.05). Due to its nutritional, sensorial and rheological properties, [F.sub.10]E could be used as a protein source in infant enteral formulas.

Objective: To simulate impact of Ca supplementation on estimated total Ca intakes among women in a population with low dietary Ca intakes, using WHO recommendations: 1·5-2·0 g elemental Ca/d during pregnancy to prevent pre-eclampsia.Design: Single cross-sectional 24 h dietary recall data were adjusted using IMAPP software to simulate proportions of women who would meet or exceed the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL) assuming full or partial adherence to WHO guidelines.Setting: Nationally and regionally representative data, Ethiopia's 'lean' season 2011.Subjects: Women 15-45 years (n 7908, of whom 492 pregnant).Results: National mean usual Ca intake was 501 (sd 244) mg/d. Approximately 89, 91 and 96 % of all women, pregnant women and 15-18 years, respectively, had dietary Ca intakes below the EAR. Simulating 100 % adherence to 1·0, 1·5 and 2·0 g/d estimated nearly all women (>99 %) would meet the EAR, regardless of dosage. Nationally, supplementation with 1·5 and 2·0 g/d would result in intake exceeding the UL in 3·7 and 43·2 % of women, respectively, while at 1·0 g/d those exceeding the UL would be <1 % (0·74 %) except in one region (4·95 %).Conclusions: Most Ethiopian women consume insufficient Ca, increasing risk of pre-eclampsia. Providing Ca supplements of 1·5-2·0 g/d could result in high proportions of women exceeding the UL, while universal consumption of 1·0 g/d would meet requirements with minimal risk of excess. Appropriately tested screening tools could identify and reduce risk to high Ca consumers. Research on minimum effective Ca supplementation to prevent pre-eclampsia is also needed to determine whether lower doses could be recommended. [ABSTRACT FROM AUTHOR]

Objective: Prevalence ranges to classify levels of wasting and stunting have been used since the 1990s for global monitoring of malnutrition. Recent developments prompted a re-examination of existing ranges and development of new ones for childhood overweight. The present paper reports from the WHO-UNICEF Technical Expert Advisory Group on Nutrition Monitoring.Design: Thresholds were developed in relation to sd of the normative WHO Child Growth Standards. The international definition of 'normal' (2 sd below/above the WHO standards median) defines the first threshold, which includes 2·3 % of the area under the normalized distribution. Multipliers of this 'very low' level (rounded to 2·5 %) set the basis to establish subsequent thresholds. Country groupings using the thresholds were produced using the most recent set of national surveys.Setting: One hundred and thirty-four countries.Subjects: Children under 5 years.Results: For wasting and overweight, thresholds are: 'very low' (≈6 times 2·5 %). For stunting, thresholds are: 'very low' (≈12 times 2·5 %).Conclusions: The proposed thresholds minimize changes and keep coherence across anthropometric indicators. They can be used for descriptive purposes to map countries according to severity levels; by donors and global actors to identify priority countries for action; and by governments to trigger action and target programmes aimed at achieving 'low' or 'very low' levels. Harmonized terminology will help avoid confusion and promote appropriate interventions. [ABSTRACT FROM AUTHOR]

In order to inform large scale supplementation programme design, we review and summarize the barriers and enablers for improved coverage and utilization of iron and folic acid (IFA) supplements by pregnant women in 7 countries in Africa and Asia. Mixed methods were used to analyse IFA supplementation programmes in Afghanistan, Bangladesh, Indonesia, Ethiopia, Kenya, Nigeria, and Senegal based on formative research conducted in 2012–2013. Qualitative data from focus‐group discussions and interviews with women and service providers were used for content analysis to elicit common themes on barriers and enablers at internal, external, and relational levels. Anaemia symptoms in pregnancy are well known among women and health care providers in all countries, yet many women do not feel personally at risk. Broad awareness and increased coverage of facility‐based antenatal care (ANC) make it an efficient delivery channel for IFA; however, first trimester access to IFA is hindered by beliefs about when to first attend ANC and preferences for disclosing pregnancy status. Variable access and poor quality ANC services, including insufficient IFA supplies and inadequate counselling to encourage consumption, are barriers to both coverage and adherence. Community‐based delivery of IFA and referral to ANC provides earlier and more frequent access and opportunities for follow‐up. Improving ANC access and quality is needed to facilitate IFA supplementation during pregnancy. Community‐based delivery and counselling can address problems of timely and continuous access to supplements. Renewed investment in training for service providers and effective behaviour change designs are urgently needed to achieve the desired impact. [ABSTRACT FROM AUTHOR]