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      Poor breastfeeding, complementary feeding and dietary diversity in children and their relationship with stunting in rural communities Translated title: Pobre lactancia materna, alimentación complementaria y diversidad de la dieta, y su relación con la baja talla en comunidades rurales

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          Abstract

          Abstract Introduction: stunted growth is the most common manifestation of malnutrition in México. Breastfeeding, adequate introduction of complementary feeding and dietary diversity can avoid this. Objective: to characterize the feeding practices in children 1-24 months of age in rural communities of Hidalgo and define their relationship with stunting. Methods: a 24-hour recall was used to obtain information. Z-scores for length-for-age (ZLA), complementary feeding (CF) and minimal dietary diversity (MDD) were determined. The sample was divided into breastfed and not breastfed children Results: one hundred eighty nine mother-child dyads were evaluated; 59.3% were breastfed and 40.7% were not. Stunting was found in 10.1% and was identified starting at the fourth month of life. This was accompanied by early CF close to the third month (57.0%) and by a reduction in exclusive breastfeeding during the second month of life to only 30%. The proportion of not breastfed children with stunting (27.5%) was almost twice that of breastfed children (12.0%) (p < 0.03). By age, mean ZLA was different with a trend towards stunting increasing with age (p < 0.05): 1-6 months -0.463 ± 1.445; 7-12 months -0.669 ± 1.225; and 13-24 months -0.985 ± 0.917. MDD was greater in not breastfed children (69.7%) (p < 0.04) and by age greater in children 13-24 months (69.7%) (p < 0.02). Conclusions: the feeding practices of most mothers did not meet WHO recommendations. It is necessary to carry out nutrition education interventions aimed at mothers in rural population.

          Translated abstract

          Resumen Introducción: el retraso en el crecimiento es la forma más común de desnutrición en México. La lactancia materna, la introducción adecuada de alimentos complementarios y la diversidad en la dieta pueden evitarla. Objetivo: caracterizar las prácticas de alimentación de niños de 1-24 meses de comunidades rurales de Hidalgo y determinar su relación con baja talla. Métodos: se aplicó un recordatorio de 24 horas para obtener la información. Se determinó la puntuación Z longitud para la edad (ZLE), alimentación complementaria (AC) y diversidad alimentaria mínima (DAM). La muestra fue dividida en niños amamantados y no amantados. Resultados: se evaluaron 189 diadas madre-hijo, 59.3% fueron amamantados y 40,7% no lo fueron. La baja talla fue del 10,1%, identificada a partir del cuarto mes, acompañada de AC precoz cerca del tercer mes (57,0%) y la disminución de la lactancia materna exclusiva durante el segundo mes de edad a solo 30%. La proporción de niños no amamantados con baja talla (27,5%) fue más del doble que los niños amamantados (12,0%) (p < 0,03). Por edad, las medias de ZLE fueron diferentes con tendencia hacia la baja talla, aumentando con la edad (p < 0,05): 1-6 meses, -0,463 ± 1,445; 7-12 meses, -0,669 ± 1,225; y 13-24 meses, -0,985 ± 0,917. La DAM fue mayor en los niños no amamantados (67,1%) (p < 0,04) y, por edad, mayor en niños de 13-24 meses (69,7%) (p < 0,02). Conclusión: las prácticas de alimentación en la mayoría de las madres evaluadas no cumplen con las recomendaciones de la WHO. Se recomienda realizar intervenciones educativas nutricionales dirigidas a las madres.

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          Breastfeeding and the use of human milk.

          Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, the mechanisms underlying these benefits, and in the clinical management of breastfeeding. This policy statement on breastfeeding replaces the 1997 policy statement of the American Academy of Pediatrics and reflects this newer knowledge and the supporting publications. The benefits of breastfeeding for the infant, the mother, and the community are summarized, and recommendations to guide the pediatrician and other health care professionals in assisting mothers in the initiation and maintenance of breastfeeding for healthy term infants and high-risk infants are presented. The policy statement delineates various ways in which pediatricians can promote, protect, and support breastfeeding not only in their individual practices but also in the hospital, medical school, community, and nation.
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            Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries

            Background Childhood undernutrition is prevalent in low and middle income countries. It is an important indirect cause of child mortality in these countries. According to an estimate, stunting (height for age Z score < -2) and wasting (weight for height Z score < -2) along with intrauterine growth restriction are responsible for about 2.1 million deaths worldwide in children < 5 years of age. This comprises 21 % of all deaths in this age group worldwide. The incidence of stunting is the highest in the first two years of life especially after six months of life when exclusive breastfeeding alone cannot fulfill the energy needs of a rapidly growing child. Complementary feeding for an infant refers to timely introduction of safe and nutritional foods in addition to breast-feeding (BF) i.e. clean and nutritionally rich additional foods introduced at about six months of infant age. Complementary feeding strategies encompass a wide variety of interventions designed to improve not only the quality and quantity of these foods but also improve the feeding behaviors. In this review, we evaluated the effectiveness of two most commonly applied strategies of complementary feeding i.e. timely provision of appropriate complementary foods (± nutritional counseling) and education to mothers about practices of complementary feeding on growth. Recommendations have been made for input to the Lives Saved Tool (LiST) model by following standardized guidelines developed by Child Health Epidemiology Reference Group (CHERG). Methods We conducted a systematic review of published randomized and quasi-randomized trials on PubMed, Cochrane Library and WHO regional databases. The included studies were abstracted and graded according to study design, limitations, intervention details and outcome effects. The primary outcomes were change in weight and height during the study period among children 6-24 months of age. We hypothesized that provision of complementary food and education of mother about complementary food would significantly improve the nutritional status of the children in the intervention group compared to control. Meta-analyses were generated for change in weight and height by two methods. In the first instance, we pooled the results to get weighted mean difference (WMD) which helps to pool studies with different units of measurement and that of different duration. A second meta-analysis was conducted to get a pooled estimate in terms of actual increase in weight (kg) and length (cm) in relation to the intervention, for input into the LiST model. Results After screening 3795 titles, we selected 17 studies for inclusion in the review. The included studies evaluated the impact of provision of complementary foods (±nutritional counseling) and of nutritional counseling alone. Both these interventions were found to result in a significant increase in weight [WMD 0.34 SD, 95% CI 0.11 – 0.56 and 0.30 SD, 95 % CI 0.05-0.54 respectively) and linear growth [WMD 0.26 SD, 95 % CI 0.08-0.43 and 0.21 SD, 95 % CI 0.01-0.41 respectively]. Pooled results for actual increase in weight in kilograms and length in centimeters showed that provision of appropriate complementary foods (±nutritional counseling) resulted in an extra gain of 0.25kg (±0.18) in weight and 0.54 cm (±0.38) in height in children aged 6-24 months. The overall quality grades for these estimates were that of ‘moderate’ level. These estimates have been recommended for inclusion in the Lives Saved Tool (LiST) model. Education of mother about complementary feeding led to an extra weight gain of 0.30 kg (±0.26) and a gain of 0.49 cm (±0.50) in height in the intervention group compared to control. These estimates had been recommended for inclusion in the LiST model with an overall quality grade assessment of ‘moderate’ level. Conclusion Provision of appropriate complementary food, with or without nutritional education, and maternal nutritional counseling alone lead to significant increase in weight and height in children 6-24 months of age. These interventions can significantly reduce the risk of stunting in developing countries and are recommended for inclusion in the LiST tool.
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              Introduction of complementary feeding before 4months of age increases the risk of childhood overweight or obesity: a meta-analysis of prospective cohort studies.

              The association between the age at introduction of complementary feeding and the risk of overweight or obesity during childhood has been hotly debated, but the result remains uncertain. This meta-analysis of prospective cohort studies attempted to evaluate this association, as well as provide evidence for infant feeding recommendations. The PubMed, Embase, and Cochrane databases were systematically searched for relevant original articles published prior to March 1, 2015 that met predefined inclusion criteria. The pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using fix-effect or random-effect models, which were chosen based on heterogeneity among studies. Ten articles consisting of 13 studies, where 8 measured being overweight as an outcome and 5 measured being obese, were included in this meta-analysis. There were a total of 63,605 participants and 11,900 incident cases in the overweight studies, and 56,136 individuals and 3246 incident cases in the obese studies. The pooled results revealed that introducing complementary foods before 4months of age compared to at 4 to 6months was associated with an increased risk of being overweight (RR, 1.18; 95% CI, 1.06-1.31) or obese (RR, 1.33; 95% CI, 1.07-1.64) during childhood. No significant relationship was observed between delaying introduction of complementary foods after 6months of age, and being overweight (RR, 1.01; 95% CI, 0.90-1.13) or obese (RR, 1.02; 95% CI, 0.91-1.14) during childhood. The results of this study suggest that the introduction of complementary foods to infants before 4months of age should be avoided to protect against childhood obesity.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                April 2018
                : 35
                : 2
                : 271-278
                Affiliations
                [1] Pachuca Hidalgo orgnameServicios de Salud de Hidalgo Mexico
                Article
                S0212-16112018000200271
                10.20960/nh.1352
                970e42bd-6d4f-4d91-96c8-7913dcde883c

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 8
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                Complementary feeding,Breastfeeding,Feeding practices,Alimentación complementaria,Lactancia materna,Practicas de alimentación

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