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Indicators reflecting the double burden of malnutrition are rarely measured in nutrition surveys and are needed to strengthen national data systems. Indicators such as body composition reflect both metabolic response to undernutrition and obesity risk and nutrition-related noncommunicable diseases. Stable isotope techniques (SITs) provide accurate data on body composition, exclusive breastfeeding and vitamin A status that are otherwise problematic with routine methods. Integration of SIT-derived nutrition indicators in data systems could improve the design and evaluation of programmes focused on obesity prevention, food fortification and infant and young child feeding practices. The Working Group at the symposium considered "how SIT-derived nutrition indicators may be integrated into surveillance systems to strengthen data availability and capacity at national and regional levels". Practical considerations for the use of SITs include cost, sample size, rigorous training and logistics. It was concluded that SITs are best suited, at present, for use in sub-samples of population surveys and for validating tools that can be scaled-up more easily in population surveys. In the long term, SITs could be applied to larger surveys following potential innovations in more affordable, hand-held devices for analysis of stable isotope enrichment in the field and simpler specimen collection protocols. [ABSTRACT FROM AUTHOR]

Objective: There is growing evidence that childhood malnutrition is associated with non-communicable diseases (NCD) in adulthood and that body composition mediates some of this association. This review aims to determine if childhood body composition can be used to predict later-life cardiometabolic NCD and which measures of body composition predicts future NCD. Design: Electronic databases were searched for articles where: children aged under 5 years had body composition measured; cardiometabolic health outcomes were measured a minimum of 10 years later. Setting: The databases Embase, Medline and Global Health were searched through July 2020. Participants: Children aged under 5 years with a follow-up of minimum 10 years. Results: Twenty-nine studies met the inclusion criteria. Though a poor proxy measure of body composition, body mass index (BMI) was commonly reported (n 28, 97 %). 25 % of these studies included an additional measure (ponderal index or skinfold thickness). Few studies adjusted for current body size (n 11, 39 %). Conclusions: Many studies reported that low infant BMI and high childhood BMI were associated with an increased risk of NCD-related outcomes in later life but no conclusions can be made about the exact timing of child malnutrition and consequent impact on NCD. Because studies focussed on BMI rather than direct measures of body composition, nothing can be said about which measures of body composition in childhood are most useful. Future research on child nutrition and long-term outcomes is urgently needed and should include validated body composition assessments as well as standard anthropometric and BMI measurements. [ABSTRACT FROM AUTHOR]

Peanut milk-based ready-to-use therapeutic food (P-RUTF) primarily used to treat severe acute malnutrition at community setting is expensive. We developed an alternative milk-free soybean-maize-sorghum-based RUTF (SMS-RUTF) using locally grown ingredients that have the potential to support local economy and reduce the cost of RUTF. We describe the production process and results of acceptability of the new product. Acceptability and tolerance of SMS-RUTF was compared with P-RUTF among 45 children aged 4-11 years old based on a cross-over design. Each child consumed 250 g RUTF for 10 days followed by a five-day washout period and a subsequent 10-day period on the second RUTF. The SMS-RUTF was as acceptable as the P-RUTF among normal children aged 4-11 years of age with no associated adverse effects. SMS-RUTF was stable for at least 12 months without detectable microbiological or chemical deterioration. The major challenge encountered in SMS-RUTF development was the difficulty to accurately determine key nutrient composition due to its high oil content. Use of diversified locally available ingredients to produce RUTF is feasible. The SMS-RUTF meets expected standards and is acceptable to children aged 4-11 months old. Effectiveness and cost-effectiveness of SMS-RUTF is required. [ABSTRACT FROM AUTHOR]

Severe and moderate acute malnutrition are among the leading causes of mortality among children in low‐ and middle‐income countries. There is strong evidence that growth assessed anthropometrically from conception to 2 years of age marks later risk of ill health. This is central to the concept of the developmental origins of adult disease and is presumed to be related to modification of developmental processes during critical "window(s)" of vulnerability. Interventions to treat acute malnutrition have resulted in dramatic increase in the number of affected children surviving. Ensuring that these children thrive to fulfil their full physical and cognitive potential is a new challenge. Integral to this challenge is the need to be able to measure how earlier insults relate to the ability to survive and thrive to productive adulthood. Despite its obvious value, routine anthropometry does not adequately indicate how earlier adverse exposures affect more refined aspects of growth. Anthropometry is inadequate for predicting how disruption of healthy growth might modulate risk of disease or any subsequent interventions that correct this risk. A clear characterisation of healthy child growth is needed for determining which component best predicts later outcomes. The extent to which postnatal acute malnutrition is a consequence of maternal factors acting preconception or in utero and their relationship to postnatal health and long‐term risk of non‐communicable diseases is not clear. Body‐composition measurement has significant untapped potential allowing us to translate and better understand the relationship between early insults and interventions on early growth in the short‐term and long‐term health outcomes. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends exclusive breastfeeding for the first six months of life. A qualitative study was conducted to assess the factors that influence the practice of exclusive breastfeeding amongst mothers attending Wajir County Hospital, Kenya. Method: This study was part of a cross-sectional study to compare the exclusive breastfeeding rates amongst primiparous and multiparous mothers with infants under 6 months old attending Wajir County Hospital. Focus group discussions and key informant interviews were conducted to collect information on exclusive breastfeeding and related factors. Four focus group discussions were conducted with mothers who exclusively breastfed and the same number with mothers who did not exclusively breastfeed their babies. Key informant interviews were conducted with nine healthcare providers. The data were transcribed, and a content analysis identified common themes and inferences. Results: The exclusive breastfeeding rate among the mothers in the larger study was 45.5%. There was no disparity between the practice of exclusive breastfeeding between primiparous and multiparous mothers. Despite the high knowledge and positive attitudes towards exclusive breastfeeding of most mothers, the practice of exclusive breastfeeding was unsatisfactory. The major hindrances identified were cultural barriers propagated by mothers-in-law and traditional birth attendants; the belief that babies cannot live without water; and a few unsupportive health workers. The uptake of exclusive breastfeeding was enhanced by Islamic teaching on breastfeeding, education from a few supportive healthcare providers; support from husbands; and positive deviance among some lactating mothers who practiced exclusive breastfeeding. Conclusions: Deeply rooted cultural factors were the major hindrance to the practice of exclusive breastfeeding. Most of the mothers did not practice exclusive breastfeeding, despite the majority being knowledgeable and having positive attitudes towards the practice. The influence of mother-in-law's and traditional birth assistants were major barriers. Strengthening the Community Health Strategy through training traditional birth attendants on Infant Young Child Nutrition practices, designing mechanisms linking traditional birth assistants to existing health facilities for support, and capacity building and monitoring is critical in promoting exclusive breastfeeding. Behavior change and communication through multiple channels within the community should be utilized to maximize promotion of exclusive breastfeeding among all stakeholders. [ABSTRACT FROM AUTHOR]

Approximately 25% of the world's children aged <5 years have stunted growth, which is associated with increased mortality, cognitive dysfunction, and loss of productivity. Reducing by 40% the number of stunted children is a global target for 2030. The pathogenesis of stunting is poorly understood. Prenatal and postnatal nutritional deficits and enteric and systemic infections clearly contribute, but recent findings implicate a central role for environmental enteric dysfunction (EED), a generalized disturbance of small intestinal structure and function found at a high prevalence in children living under unsanitary conditions. Mechanisms contributing to growth failure in EED include intestinal leakiness and heightened permeability, gut inflammation, dysbiosis and bacterial translocation, systemic inflammation, and nutrient malabsorption. Because EED has multiple causal pathways, approaches to manage it need to be multifaceted. Potential interventions to tackle EED include: (1) reduction of exposure to feces and contact with animals through programs such as improved water, sanitation, and hygiene; (2) breastfeeding and enhanced dietary diversity; (3) probiotics and prebiotics; (4) nutrient supplements, including zinc, polyunsaturated fatty acids, and amino acids; (5) antiinflammatory agents such as 5-aminosalicyclic acid; and (6) antibiotics in the context of acute malnutrition and infection. Better understanding of the underlying causes of EED and development of noninvasive, practical, simple, and affordable point-of-care diagnostic tools remain key gaps. "Omics" technologies (genomics, epigenomics, transcriptomics, proteomics, and metabolomics) and stable isotope techniques (eg, 13C breath tests) targeted at children and their intestinal microbiota will enhance our ability to successfully identify, manage, and prevent this disorder. [ABSTRACT FROM AUTHOR]

Inadequate dietary calcium intake is a global public health problem that disproportionately affects low‐ and middle‐income countries. However, the calcium status of a population is challenging to measure, and there are no standard methods to identify high‐risk communities even in settings with an elevated prevalence of a disease caused or exacerbated by low calcium intake (e.g., rickets). The calcium status of a population depends on numerous factors, including intake of calcium‐rich foods; the bioavailability of the types of calcium consumed in foods and supplements; and population characteristics, including age, sex, vitamin D status, and genetic attributes that influence calcium retention and absorption. The aim of this narrative review was to assess candidate indicators of population‐level calcium status based on a range of biomarkers and measurement methods, including dietary assessment, calcium balance studies, hormonal factors related to calcium, and health outcomes associated with low calcium status. Several promising approaches were identified, but there was insufficient evidence of the suitability of any single indicator to assess population calcium status. Further research is required to develop and validate specific indicators of calcium status that could be derived from the analysis of data or samples that are feasibly collected in population‐based surveys. [ABSTRACT FROM AUTHOR]

Little is known about the style and quality of feeding and care provided in child day-care centres in slum areas. This study purposively sampled five day-care centres in Nairobi, Kenya, where anthropometric measurements were collected among 33 children aged 6-24 months. Mealtime interactions were further observed in 11 children from four centres, using a standardized data collection sheet. We recorded the child actions, such as mood, interest in food, distraction level, as well as caregiver actions, such as encouragement to eat, level of distraction and presence of neutral actions. Of the 33 children assessed, with a mean age of 15.9 ± 4.9 months, 14 (42%) were female. Undernutrition was found in 13 (39%) children with at least one Z score <-2 or oedema (2): height for age <-2 (11), weight for age <-2 (11), body mass index for age <-2 (4). Rates of undernutrition were highest (9 of 13; 69%) in children aged 18-24 months. Hand-washing before the meal was lacking in all centres. Caregivers were often distracted and rarely encouraged children to feed, with most children eating less than half of their served meal. Poor hygiene coupled with non-responsive care practices observed in the centres is a threat to child health, growth and development. [ABSTRACT FROM AUTHOR]

Community‐based Management of Acute Malnutrition using ready‐to‐use therapeutic food (RUTF) has revolutionised the treatment of severe acute malnutrition (SAM). However, 25% milk content in standard peanut‐based RUTF (P‐RUTF) makes it too expensive. The effectiveness of milk‐free RUTF has not been reported hitherto. This non‐blinded, parallel group, cluster randomised, controlled, equivalence trial that compares the effectiveness of a milk‐free soy–maize–sorghum‐based RUTF (SMS‐RUTF) with P‐RUTF in treatment of children with SAM, closes the gap. A statistician randomly assigned health centres (HC) either to the SMS‐RUTF (n = 12; 824 enrolled) or P‐RUTF (n = 12; 1103 enrolled) arms. All SAM children admitted at the participating HCs were enrolled. All the outcomes were measured at individual level. Recovery rate was the primary outcome. The recovery rates for SMS‐RUTF and P‐RUTF were 53.3% and 60.8% for the intention‐to‐treat (ITT) analysis and 77.9% and 81.8% for per protocol (PP) analyses, respectively. The corresponding adjusted risk difference (ARD) and 95% confidence interval, were −7.6% (−14.9, 0.6%) and −3.5% (−9,6., 2.7%) for ITT (P = 0.034) and PP analyses (P = 0.257), respectively. An unanticipated interaction (interaction P < 0.001 for ITT analyses and 0.0683 for PP analyses) between the study arm and age group was observed. The ARDs were −10.0 (−17.7 to −2.3)% for ITT (P = 0.013) and −4.7 (−10.0 to 0.7) for PP (P = 0.083) analyses for the <24 months age group and 2.1 (−10.3,14.6)% for ITT (P = 0.726) and −0.6 (−16.1, 14.5) for PP (P = 0.939) for the ≥24 months age group. In conclusion, the study did not confirm our hypothesis of equivalence between SMS‐RUTF and P‐RUTF in SAM management. [ABSTRACT FROM AUTHOR]

Dietary calcium deficiency is considered to be widespread globally, with published estimates suggesting that approximately half of the world's population has inadequate access to dietary calcium. Calcium is essential for bone health, but inadequate intakes have also been linked to other health outcomes, including pregnancy complications, cancers, and cardiovascular disease. Populations in low‐ and middle‐income countries (LMICs) are at greatest risk of low calcium intakes, although many individuals in high‐income countries (HICs) also do not meet recommendations. Paradoxically, many LMICs with lower calcium intakes show lower rates of osteoporotic fracture as compared with HICs, though data are sparse. Calcium intake recommendations vary across agencies and may need to be customized based on other dietary factors, health‐related behaviors, or the risk of calcium‐related health outcomes. The lack of standard methods to assess the calcium status of an individual or population has challenged efforts to estimate the prevalence of calcium deficiency and the global burden of related adverse health consequences. This paper aims to consolidate available evidence related to the global prevalence of inadequate calcium intakes and associated health outcomes, with the goal of providing a foundation for developing policies and population‐level interventions to safely improve calcium intake and status where necessary. [ABSTRACT FROM AUTHOR]

The impact of quality complementary food products on infant growth and body composition has not been adequately investigated. This study evaluated the effect on fat‐free mass (FFM) accrual, linear growth, and iron status of locally produced complementary food products comparing to a standard product. In a randomized, double‐blind trial, 499 infants at 6 months received nine monthly rations of (a) WinFood Classic (WFC) comprising germinated amaranth (71%), maize (10.4%), small fish (3%), and edible termites (10%); (b) WinFood Lite (WFL) comprising germinated amaranth (82.5%), maize (10.2%), and multimicronutrient premix; or (c) fortified corn–soy blend plus (CSB+). Primary outcomes were changes in FFM, length, and plasma ferritin and transferrin receptors (TfR). FFM was determined using deuterium dilution. Analysis was by intention to treat, based on available cases. Compared with CSB+, there were no differences in change from 6 to 15 months in FFM for WFC 0.0 kg (95% CI [−0.30, 0.29]) and WFL 0.03 kg (95% CI [−0.25, 0.32]) and length change for WFC −0.3 cm (95% CI [−0.9, 0.4]) and WFL −0.3 cm (95% CI [−0.9, 0.3]). TfR increased in WFC group 3.3 mg L−1 (95% CI [1.7, 4.9]) and WFL group 1.7 mg L−1 (95% CI [0.1, 3.4]) compared with CSB+. Compared with the increase in Hb in CSB+ group, there was a reduction in Hb in WFC of −0.9 g dl−1 (95% CI [−1.3, −0.5]) and a lower increase in WFL −0.4 g dl−1 (95% CI [−0.8, 0.0]). In conclusion, the tested WinFoods had the same effect on FFM and length as CSB+, whereas Hb and iron status decreased, suggesting inhibited iron bioavailability from the amaranth‐based WinFoods. [ABSTRACT FROM AUTHOR]

Background: Exclusive breastfeeding (EBF) is recommended for 6 months of age, with continued breastfeeding for 2 years of age or beyond. There is paucity of information on the disparity in Knowledge, Attitudes and Practices (KAP) on EBF between primiparous and multiparous mothers. This study compared the KAP on EBF between primiparous and multiparous mothers attending Wajir County Hospital, Wajir County, Kenya and investigated the association between maternal knowledge and attitudes and EBF. Methods: Information on maternal KAP on EBF was collected through structured researcher administered questionnaires for a total of 281 mothers, recruited from a maternal and child health centre in 2014; primiparous (n = 137) and multiparous (n = 144) with infants 0–5 months of age. Maternal knowledge and attitudes on various aspects of breastfeeding were determined. The knowledge and attitude scores were also calculated. The practice of EBF was determined based on a 24-h recall. Results: The prevalence of EBF among infants 0–5 months old was 45.5%. The rate of EBF among primiparous mothers was 39.4% and multiparous mothers 49.3%. The knowledge score on breastfeeding (out of a total of 10) for the primiparous mothers was 7.93 ± 2.10 and 7.49 ± 2.20 for the multiparous mothers. The mean attitude score (out of a total score of 40) for the primiparous mothers was 29.46 ± 5.65 and 28.65 ± 6.40 for the multiparous mothers. The prevalence of EBF and maternal knowledge and attitudes towards breastfeeding was similar among the two groups of mothers. Those mothers with positive attitudes towards breastfeeding were more likely to EBF (Fisher’s exact test; p = 0.00) compared with those with lower scores. Conclusions: Interventions to promote exclusive breastfeeding should be tailored to the needs of each population by identifying the factors that influence the practice in a given context. The findings of this study will be useful particularly for behavior change communication interventions by those organizations working in similar circumstances to the study area. [ABSTRACT FROM AUTHOR]

Background: We have previously shown that fat-free mass (FFM) at birth is associated with height at 2 y of age in Ethiopian children. However, to our knowledge, the relation between changes in body composition during early infancy and later linear growth has not been studied.Objective: This study examined the associations of early infancy fat mass (FM) and FFM accretion with linear growth from 1 to 5 y of age in Ethiopian children.Methods: In the infant Anthropometry and Body Composition (iABC) study, a prospective cohort study was carried out in children in Jimma, Ethiopia, followed from birth to 5 y of age. FM and FFM were measured ≤6 times from birth to 6 mo by using air-displacement plethysmography. Linear mixed-effects models were used to identify associations between standardized FM and FFM accretion rates during early infancy and linear growth from 1 to 5 y of age. Standardized accretion rates were obtained by dividing FM and FFM accretion by their respective SD.Results: FFM accretion from 0 to 6 mo of age was positively associated with length at 1 y (β = 0.64; 95% CI: 0.19, 1.09; P = 0.005) and linear growth from 1 to 5 y (β = 0.63; 95% CI: 0.19, 1.07; P = 0.005). The strongest association with FFM accretion was observed at 1 y. The association with linear growth from 1 to 5 y was mainly engendered by the 1-y association. FM accretion from 0 to 4 mo was positively associated with linear growth from 1 to 5 y (β = 0.45; 95% CI: 0.02, 0.88; P = 0.038) in the fully adjusted model.Conclusions: In Ethiopian children, FFM accretion was associated with linear growth at 1 y and no clear additional longitudinal effect from 1 to 5 y was observed. FM accretion showed a weak association from 1 to 5 y. This trial was registered at www.controlled-trials.com as ISRCTN46718296. [ABSTRACT FROM AUTHOR]

Because edible insects provide nutritional and environmental benefits, there is a focus on establishing and optimizing the insect production sector and developing the value chain. However, little is known about consumers’ reactions to insects as food. This paper provides a first insight into consumers’ preferences for termite-based food products (TBFPs) using data from a choice experiment survey in Kenya. A novel feature of this paper is that it investigates the combined effects of product-related and contextual attributes, as well as consumer attitudes on preferences for TBFPs. In addition, the paper focuses on the extent to which preferences may be affected depending on the meal formats, i.e. whether the termites are introduced either as whole insects or as a processed component in a typical daily meal. The results suggest that consumers prefer TBFPs with high nutritional value and especially when they are recommended by officials. Results further indicate that affirmative recommendations are particularly important for the processed TBFP, and consumers prefer to buy this type of product in kiosks or supermarkets than at local marketplaces. Despite a considerable degree of preference heterogeneity, most consumers react positively to whole as well as processed termites. Therefore, the introduction of TBFPs is likely to succeed regardless of whether the termites are processed or not, although introducing the processed product may require further information and quality assurances to alleviate perceived food risks. [ABSTRACT FROM AUTHOR]

The cost of ready-to-use therapeutic food ( RUTF) used in community-based management of acute malnutrition has been a major obstacle to the scale up of this important child survival strategy. The current standard recipe for RUTF [peanut-based RUTF ( P- RUTF )] is made from peanut paste, milk powder, oil, sugar, and minerals and vitamins. Milk powder forms about 30% of the ingredients and may represent over half the cost of the final product. The quality of whey protein concentrates 34% ( WPC34) is similar to that of dried skimmed milk ( DSM) used in the standard recipe and can be 25-33% cheaper. This blinded, parallel group, randomised, controlled non-inferiority clinical trial tested the effectiveness in treating severe acute malnutrition ( SAM) of a new RUTF formulation WPC- RUTF in which WPC34 was used to replace DSM. Average weight gain (non-inferiority margin Δ = −1.2 g kg−1 day−1) and recovery rate (Δ = −10%) were the primary outcomes, and length of stay ( LOS) was the secondary outcome (Δ = +14 days). Both per-protocol ( PP) and intention-to-treat ( ITT) analyses showed that WPC- RUTF was not inferior to P- RUTF for recovery rate [difference and its 95% confidence interval ( CI) of 0.5% (95% CI -2.7, 3.7) in PP analysis and 0.6% (95% CI -5.2, 6.3) in ITT analysis] for average weight gain [0.2 (−0.5; 0.9) for both analyses] and LOS [−1.6 days (95% CI, −4.6, 1.4 days) in PP analysis and −1.9 days (95% CI, −4.6, 0.8 days) for ITT analysis]. In conclusion, whey protein-based RUTF is an effective cheaper alternative to the standard milk-based RUTF for the treatment of SAM. [ABSTRACT FROM AUTHOR]

Highlights: [•] Winged termites are part of traditional diet in Kenya. [•] The termites are a rich source of protein, fat, zinc and iron. [•] The termites are a moderate source of n-3 fatty acids. [•] Lipids from termites can be used in infant formula, the n-6:n-3 ratio lipids conforms to CODEX. [•] Termites may be a part of high quality diets with high protein, zinc, and iron content. [Copyright &y& Elsevier]

Objective: To develop a method for determining the acceptability and safety of ready-to-use therapeutic foods (RUTF) before clinical trialing. Acceptability was defined using a combination of three consumption, nine safety, and six preference criteria. These were used to compare a soy/maize/sorghum RUTF (SMS-RUTFh), designed for the rehabilitation of human immunodeficiency virus/tuberculosis (HIV/TB) wasted adults, with a peanut-butter/milk-powder paste (P-RUTF; brand: Plumpy'nut) designed for pediatric treatment. Methods: A cross-over, randomized, controlled trial was conducted in Kenya. Ten days of repeated measures of product intake by 41 HIV/TB patients, >18 y old, body mass index (BMI) 18-24 kg · m-2, 250 g were offered daily under direct observation as a replacement lunch meal. Consumption, comorbidity, and preferences were recorded. Results: The study arms had similar age, sex, marital status, initial BMI, and middle upper-arm circumference. No carryover effect or serious adverse events were found. SMS-RUTFh energy intake was not statistically different from the control, when adjusted for BMI on day 1, and the presence of throat sores. General preference, taste, and sweetness scores were higher for SMS-RUTFh compared to the control (P < 0.05). Most consumption, safety, and preference criteria for SMS-RUTFh were satisfied except for the average number of days of nausea (0.16 versus 0.09 d) and vomiting (0.04 versus 0.02 d), which occurred with a higher frequency (P < 0.05). Conclusion: SMS-RUTFh appears to be acceptable and can be safely clinically trialed, if close monitoring of vomiting and nausea is included. The method reported here is a useful and feasible approach for testing the acceptability of ready-to-use foods in low income countries. [ABSTRACT FROM AUTHOR]

Objective: Malaria is a major cause of morbidity and mortality in tropical and subtropical regions, affecting mostly the impoverished sections of the population. Pregnant women living in malaria-endemic areas are at higher risk of malaria infection with higher density of parasitaemia than non-pregnant women. The aim of this study was to assess factors affecting the uptake of IPT among women attending antenatal clinics at Bondo District Hospital, Western Kenya. Methods: This study was a hospital-based cross-sectional survey among pregnant women attending clinics. Malaria is endemic in Bondo district. Both women from Bondo town (urban) and greater Bondo District (rural) who had been pregnant for at least 35 weeks or had delivered not more than 6 weeks prior to the survey), and had ANC cards were included in the study. The main outcomes were ANC attendance, IPT doses received and client and provider factors. Results: Results showed that women's knowledge on ANC and IPT was high. The uptake of IPT was low among pregnant women with those from urban areas more likely to make more ANC visits and to get more IPT doses than women from the rural areas. ANC attendance was hampered by the fear of being tested for HIV at the clinic. Perceived side effects associated with IPT-SP hindered IPT uptake and were linked to HIV-related symptoms. Negative attitude among health workers towards pregnant women also adversely impacted IPT uptake. Women suggested that IPT drugs be distributed through community health workers instead of the health facility for improved uptake. Conclusions: Retraining of health workers on the administration of IPT, harmonization of health messages, and assessment of alternative community-based IPT distribution channels ought to be urgently considered. More evidence on the influence of HIV pandemic on perceptions and attitudes toward and uptake of other health interventions is urgently needed. [ABSTRACT FROM AUTHOR]

Household food insecurity has been hypothesized to negatively impact breastfeeding practices and breast milk intake, but this relationship has not been rigorously assessed. To generate an evidence base for breastfeeding recommendations among food‐insecure mothers in settings where HIV is highly prevalent, we explored infant feeding practices among 119 mother–infant dyads in western Kenya at 6 and 24 weeks postpartum. We used the deuterium oxide dose‐to‐the‐mother technique to determine if breastfeeding was exclusive in the prior 2 weeks, and to quantify breast milk intake. Sociodemographic data were collected at baseline and household food insecurity was measured at each time point using the Household Food Insecurity Access Scale. Average breast milk intake significantly increased from 721.3 g/day at 6 weeks postpartum to 961.1 g/day at 24 weeks postpartum. Household food insecurity at 6 or 24 weeks postpartum was not associated with maternal recall of exclusive breastfeeding (EBF) in the prior 24 hr or deuterium oxide‐measured EBF in the prior 2 weeks at a significance level of 0.2 in bivariate models. In a fixed‐effects model of quantity of breast milk intake across time, deuterium oxide‐measured EBF in the prior 2 weeks was associated with greater breast milk intake (126.1 ± 40.5 g/day) and every one‐point increase in food insecurity score was associated with a 5.6 (±2.2)‐g/day decrease in breast milk intake. Given the nutritional and physical health risks of suboptimal feeding, public health practitioners should screen for and integrate programs that reduce food insecurity in order to increase breast milk intake. [ABSTRACT FROM AUTHOR]