INTRODUCTION: The pattern and duration of breastfeeding (BF) and the age at onset of complementary feeding, as well as its quality, have been associated with the prevalence of overweight in childhood.
OBJECTIVE: To assess the effect of a pro-BF and healthy complementary feeding intervention, targeted to adolescent mothers and maternal grandmothers, on growth and prevalence of overweight and obesity in children at preschool age. This intervention had a positive impact on duration of BF and timing of onset of complementary feeding.
METHODS: This randomized clinical trial involved 323 adolescent mothers, their infants, and the infants' maternal grandmothers, when they cohabited. Mothers and grandmothers in the intervention group received counseling sessions on BF and healthy complementary feeding at the maternity ward and at home (7, 15, 30, 60, and 120 days after delivery). When children were aged 4 to 7 years, they underwent anthropometric assessment and collection of data on dietary habits. Multivariable Poisson regression with robust estimation was used for analysis.
RESULTS: BMI-for-age and height-for-age were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits.
CONCLUSION: Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years.
TRIAL REGISTRATION: ClinicalTrials.gov NCT00910377.
BACKGROUND: Interventions are needed to reduce poor perinatal health. We trained community health workers (CHWs) as home visitors to address maternal/infant risks.
METHODS: In a cluster randomised controlled trial in Cape Town townships, neighbourhoods were randomised within matched pairs to 1) the control, healthcare at clinics (n = 12 neighbourhoods; n = 594 women), or 2) a home visiting intervention by CBW trained in cognitive-behavioural strategies to address health risks (by the Philani Maternal, Child Health and Nutrition Programme), in addition to clinic care (n = 12 neighbourhoods; n = 644 women). Participants were assessed during pregnancy (2% refusal) and 92% were reassessed at two weeks post-birth, 88% at six months and 84% at 18 months later. We analysed 32 measures of maternal/infant well-being over the 18 month follow-up period using longitudinal random effects regressions. A binomial test for correlated outcomes evaluated overall effectiveness over time. The 18 month post-birth assessment outcomes also were examined alone and as a function of the number of home visits received.
RESULTS: Benefits were found on 7 of 32 measures of outcomes, resulting in significant overall benefits for the intervention compared to the control when using the binomial test (p = 0.008); nevertheless, no effects were observed when only the 18 month outcomes were analyzed. Benefits on individual outcomes were related to the number of home visits received. Among women living with HIV, intervention mothers were more likely to implement the PMTCT regimens, use condoms during all sexual episodes (OR = 1.25; p = 0.014), have infants with healthy weight-for-age measurements (OR = 1.42; p = 0.045), height-for-age measurements (OR = 1.13, p<0.001), breastfeed exclusively for six months (OR = 3.59; p<0.001), and breastfeed longer (OR = 3.08; p<0.001). Number of visits was positively associated with infant birth weight ≥2500 grams (OR = 1.07; p = 0.012), healthy head-circumference-for-age measurements at 6 months (OR = 1.09, p = 0.017), and improved cognitive development at 18 months (OR = 1.02, p = 0.048).
CONCLUSIONS: Home visits to neighbourhood mothers by CHWs may be a feasible strategy for enhancing maternal/child outcomes. However, visits likely must extend over several years for persistent benefits.
TRIAL REGISTRATION: ClinicalTrials.gov NCT00996528.
BACKGROUND: In this multi-country cluster-randomized behavioural intervention trial promoting exclusive breastfeeding (EBF) in Africa, we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities.
METHODS: A total of 82 clusters in Burkina Faso, Uganda and South Africa were randomised to either the intervention or the control arm. Feeding data and anthropometric measurements were collected at visits scheduled 3, 6, 12 and 24 weeks post-partum. We calculated weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ) z-scores. Country specific adjusted Least Squares Means with 95% confidence intervals (CI) based on a longitudinal analysis are reported. Prevalence ratios (PR) for the association between peer counselling for EBF and wasting (WLZ < -2), stunting (LAZ < -2) and underweight (WAZ < -2) were calculated at each data collection point.
RESULTS: The study included a total of 2,579 children. Adjusting for socio-economic status, the mean WLZ at 24 weeks were in Burkina Faso -0.20 (95% CI -0.39 to -0.01) and in Uganda -0.23 (95% CI -0.43 to -0.03) lower in the intervention than in the control arm. In South Africa the mean WLZ at 24 weeks was 0.23 (95% CI 0.03 to 0.43) greater in the intervention than in the control arm. Differences in LAZ between the study arms were small and not statistically significant. In Uganda, infants in the intervention arm were more likely to be wasted compared to those in the control arm at 24 weeks (PR 2.36; 95% CI 1.11 to 5.00). Differences in wasting in South Africa and Burkina Faso and stunting and underweight in all three countries were small and not significantly different.
CONCLUSIONS: There were small differences in mean anthropometric indicators between the intervention and control arms in the study, but in Uganda and Burkina Faso, a tendency to slightly lower ponderal growth (weight-for-length z-scores) was found in the intervention arms.
TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT00397150.
AIM: Exclusive breastfeeding (EBF) for 6 months is recommended for optimal infant health, but the evidence for longer-term impacts is weak. We examined whether randomization to receive EBF counselling (BFC) in rural Bangladeshi women had an impact on childhood growth trajectories and body composition.
METHODS: In the Maternal and Infant Nutrition Interventions in Matlab trial, 4436 pregnant women were randomized to six equally sized, food and micronutrient groups. Of these, 3214 were randomized during the last trimester of pregnancy to receive either BFC or the usual/standard health message (UHM). Their infants were extensively followed up, with anthropometric measurements between 0 and 54 months and assessment of body composition at 54 months.
RESULTS: The mean duration of EBF in the BFC group was 111 days compared to 76 days in the UHM group (mean difference: 35.0 days, 95% CI 30.6-39.5, p < 0.001). There was no difference in growth trajectories between the BFC and UHM groups and no difference in body composition at 54 months. Children exposed to prenatal multiple micronutrients (vs 60 mg iron and folate) combined with BFC (vs UHM), however, had slower linear growth (mean difference -0.17 SD score, p < 0.01).
CONCLUSION: Exclusive breastfeeding counselling resulted in neither differential growth trajectories in infancy and childhood, nor body composition differences at 54 months. The combination of prenatal multiple micronutrient supplementation (MMS) and BFC was unfavourable for linear growth during 0-54 months, which raises questions about possible negative effects of MMS.
BACKGROUND: According to current evidence, the prevention of obesity should start early in life. Even the prenatal environment may expose a child to unhealthy weight gain; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity. Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes.
METHODS: The study was a non-randomised controlled pragmatic trial aiming to prevent childhood obesity, the setting being municipal maternity health care clinics. The participants (n = 185) were mothers at risk of developing gestational diabetes mellitus and their offspring. The children of the intervention group mothers were born between 2009 and 2010, and children of the control group in 2008. The intervention started between 10-17 gestational weeks and consisted of individual counselling on diet and physical activity by a public health nurse, and two group counselling sessions by a dietician and a physiotherapist. The expectant mothers also received a written information leaflet to motivate them to breastfeed their offspring for at least 6 months. We report the proportion of mothers with pathological glucose tolerance at 26-28 weeks' gestation, the mother's gestational weight gain (GWG) and newborn anthropometry. Infant weight gain from 0 to 12 months of age was assessed as weight-for-length standard deviation scores (SDS) and mixed effect linear regression models.
RESULTS: Intervention group mothers had fewer pathological oral glucose tolerance test results (14.6% vs. 29.2%; 95% CI 8.9 to 23.0% vs. 20.8 to 39.4%; p-value 0.016) suggesting that the intervention improved gestational glucose tolerance. Mother's GWG, newborn anthropometry or infant weight gain did not differ significantly between the groups.
CONCLUSION: Since the intervention reduced the prevalence of gestational diabetes mellitus, it may have the potential to diminish obesity risk in offspring. However, results from earlier studies suggest that the possible effect on the offspring's weight gain may manifest only later in childhood.
TRIAL REGISTRATION: Clinical Trials gov: NCT00970710.
BACKGROUND: Obese women often have difficulties breastfeeding.
OBJECTIVE: We evaluated whether telephone-based support could increase the duration of breastfeeding in obese women and, thereby, reduce offspring growth.
DESIGN: We recruited 226 dyads of obese mothers and their singleton, healthy, term infants. The women were randomly assigned to 6 mo of breastfeeding support or standard care controls. At 6 mo, there were 207 dyads in the study; 105 dyads received support, and 102 dyads were control subjects. One International Board Certified Lactation Consultant carried out the intervention, which was based on structured interviews and consisted of encouraging telephone calls.
RESULTS: The support group breastfed exclusively for a median of 120 d (25th-75th percentiles: 14-142 d) compared with 41 d (3-133 d) for control subjects (P = 0.003). Any breastfeeding was maintained for a median of 184 d (92-185 d) for the support group compared with 108 d (16-185 d) for control subjects (P = 0.002). Support increased the adjusted ORs for exclusive breastfeeding at 3 mo and the ratios for partial breastfeeding at 6 mo to 2.45 (95% CI: 1.36, 4.41; P = 0.003) and 2.25 (95% CI: 1.24, 4.08; P = 0.008, respectively). Although the duration of exclusive breastfeeding was inversely associated with infant weight (β = -4.39 g/d; 95% CI: -0.66, -8.11 g/d; P = 0.021) and infant length at 6 mo (β = -0. 012 cm/d; 95% CI: -0.004, -0.02 cm/d; P = 0.004), the breastfeeding support did not achieve a significant effect on infant growth at 6 mo (n = 192).
CONCLUSIONS: Telephone-based advisory support was very effective in prolonging breastfeeding in obese mothers who often terminate the breastfeeding of their infants prematurely. A longer duration of breastfeeding may decrease risk of noncommunicable diseases in these infants. This trial was registered at clinicaltrials.gov as NCT01235663.
Inadequate feeding and care may contribute to high rates of stunting and underweight among children in rural families in India. This cluster-randomized trial tested the hypothesis that teaching caregivers appropriate complementary feeding and strategies for how to feed and play responsively through home-visits would increase children's dietary intake, growth and development compared with home-visit-complementary feeding education alone or routine care. Sixty villages in Andhra Pradesh were randomized into three groups of 20 villages with 200 mother-infant dyads in each group. The control group (CG) received routine Integrated Child Development Services (ICDS); the complementary feeding group (CFG) received the ICDS plus the World Health Organization recommendations on breastfeeding and complementary foods; and the responsive complementary feeding and play group (RCF&PG) received the same intervention as the CFG plus skills for responsive feeding and psychosocial stimulation. Both intervention groups received bi-weekly visits by trained village women. The groups did not differ at 3 months on socioeconomic status, maternal and child nutritional indices, and maternal depression. After controlling for potential confounding factors using the mixed models approach, the 12-month intervention to the CFG and RCF&PG significantly (P < 0.05) increased median intakes of energy, protein, Vitamin A, calcium (CFG), iron and zinc, reduced stunting [0.19, confidence interval (CI): 0.0-0.4] in the CFG (but not RCF&PG) and increased (P < 0.01) Bayley Mental Development scores (mean = 3.1, CI: 0.8-5.3) in the RCF&PG (but not CFG) compared with CG. Community-based educational interventions can improve dietary intake, length (CFG) and mental development (RCF&PG) for children under 2 years in food-secure rural Indian families.
BACKGROUND: The Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age.
METHODS: A quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models.
RESULTS: 196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI -0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (-0.31, 95%CI -0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding.
CONCLUSIONS: Despite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.
The pattern and duration of breastfeeding (BF) and the age at onset of complementary feeding, as well as its quality, have been associated with the prevalence of overweight in childhood.
OBJECTIVE:
To assess the effect of a pro-BF and healthy complementary feeding intervention, targeted to adolescent mothers and maternal grandmothers, on growth and prevalence of overweight and obesity in children at preschool age. This intervention had a positive impact on duration of BF and timing of onset of complementary feeding.
METHODS:
This randomized clinical trial involved 323 adolescent mothers, their infants, and the infants' maternal grandmothers, when they cohabited. Mothers and grandmothers in the intervention group received counseling sessions on BF and healthy complementary feeding at the maternity ward and at home (7, 15, 30, 60, and 120 days after delivery). When children were aged 4 to 7 years, they underwent anthropometric assessment and collection of data on dietary habits. Multivariable Poisson regression with robust estimation was used for analysis.
RESULTS:
BMI-for-age and height-for-age were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits.
CONCLUSION:
Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years.
