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Research highlights
In this section, the IYCN Project offers summaries of new and notable research related to maternal, infant, and young child nutrition. Each summary includes the findings and analysis of the study’s author(s) only. Check back periodically for new research highlights.
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How do household rice expenditures impact nutritional status?
January 2010
In a study published in The Journal of Nutrition in January 2010, researchers used data from the Bangladesh Nutrition Surveillance Project from 2000 to 2005 to explore the relationship between rice and non-rice expenditures on childhood stunting and maternal underweight. Previous studies had shown that as rice prices rise, individuals continue to consume the same amount of rice by spending a higher proportion of family income on rice and less on other foods such as meat, fruit, oils, and vegetables. This study explored how higher family rice expenditures impact nutritional status. More than 304,000 rural households with at least one child 6–59 months of age were included in the cross-sectional sample.
After adjusting for total weekly per capita household expenditures, families who spent more on non-rice foods were less likely to have stunted children in all age groups. This remained true after adjusting for factors including maternal age, education, body mass index, and child sex and age. Similarly, the prevalence of maternal underweight was lower in families that spent more on non-rice food items. The authors conclude that there is a clear protective effect of having a diverse diet and warn of the potential negative impact of rising staple food prices on malnutrition rates in developing countries.
Household Rice Expenditure and Maternal and Child Nutritional Status in Bangladesh
Ultra Rice® highly effective in boosting iron stores in young children
January 2010
Researchers conducted a double-blind, randomized trial in Brazil to determine the relative efficacy of iron drops and iron-fortified rice in curing mild anemia in children aged 6–24 months. Two groups of children received either iron drops and 10 kilograms of unfortified rice per month (control group) or placebo drops and 10 kilograms of an iron-fortified rice produced using the Ultra Rice® technology and fortified at a level that would provide an iron dose equivalent to drops. Primary health care workers gave both groups of mothers instructions on using the drops but no instructions on how much rice to feed their children.
Results published in the Journal of Nutrition in January 2010 indicate that Ultra Rice was well accepted and undistinguishable from unfortified rice. After five months, hemoglobin and serum ferritin, a measure of iron stores, improved in both groups, but the improvements were greater in the Ultra Rice group. Anemia decreased by approximately 38% in the Ultra Rice group and by 15% in the control group. Similarly, iron deficiency decreased by 44% in the Ultra Rice group compared to only 24% among controls.
While iron drops contain more absorbable iron, the authors hypothesize that the better results in the Ultra Rice group may be due to higher adherence with rice than drops, or because iron provided in small frequent doses from Ultra Rice was better absorbed than iron provided in larger less frequent doses from drops. The authors conclude that the low-cost, feasible, and efficacious technology of Ultra Rice could be part of a strategy to control anemia in rice-eating populations, noting that even though the iron level of the product used in the study was somewhat high, it is nonetheless safe for the general population and the strategy would not require separate iron-fortified foods for adults and young children.
Iron-Fortified Rice Is as Efficacious as Supplemental Iron Drops in Infants and Young Children
Continued breastfeeding improves survival into second year of life for HIV-negative infants born to HIV-positive mothers
February 2010
An article published in Clinical Infectious Diseases in February 2010 presents an analysis of data from the Zambia Exclusive Breastfeeding Study that the authors undertook to determine an age at which weaning safely could be recommended to HIV-infected mothers of uninfected infants. During the trial, which took place from 2001 to 2004, the intervention group was advised to wean abruptly at four months while the women in the control group were advised to wean at any time they wished.
In this analysis, the investigators compared mortality rates of children weaned at 4 to 5 months, 6 to 11 months, and 12 to 18 months with mortality rates of children who continued to breastfeed beyond 18 months. According to these age groups, weaning was associated with a 2.03-fold increase, a 3.54-fold increase, and a 4.22-fold increase in mortality risk, respectively. The elevated mortality risk associated with early weaning persisted after adjusting for maternal CD4 count during pregnancy, maternal mortality, low birth weight, number of children in the household, and reported food insecurity.
Among all women, any weaning from birth through 24 months was associated with a two-fold increased risk of mortality. The authors emphasized that the elevated mortality risk associated with early weaning is likely to be even higher in program settings because programs cannot realistically replicate the intensity of support for safer replacement feeding that study participants received.
Are multiple RDA multivitamin doses more effective than a single RDA for improving HIV-positive women’s pregnancy outcomes?
February 2010
In a study published in February 2010 in the American Journal of Clinical Nutrition, investigators compared the efficacy of multivitamin supplements delivering a single recommended daily allowance (RDA) versus supplements delivering multiple RDAs in improving pregnancy outcomes of HIV-positive women in Tanzania. Results from an earlier randomized trial in Tanzania by the same authors had shown that supplementation of HIV-positive pregnant women with multivitamins (B complex, C, and E) at levels many times that of the RDA decreased the risk of several adverse pregnancy outcomes. This trial randomized pregnant, HIV-infected women into two groups receiving a daily oral dose of a single RDA or multiple RDA multivitamin for an average of 3.9 months during gestation and 5.1 weeks postpartum. Adherence in both groups was greater than 85%. An intent-to-treat analysis showed no difference between the groups on all of the studied outcomes, including low birth weight, smallness for gestational age, fetal death, risk of miscarriage or stillbirth, and risk of perinatal or early infant death.
The incidence of adverse outcomes in both groups was similar to that found in the authors’ previous multiple-RDA study, suggesting that both the single- and multiple-RDA interventions of this study were effective. However, the investigators point out that some studies of multiple micronutrient supplementation in pregnancy have suggested that they may elevate perinatal mortality, and that multivitamin supplements should only be given where adequate antenatal and obstetric care is available. They conclude that these findings add to the results of many other studies indicating that HIV-infected pregnant women should receive at least a daily single RDA multivitamin.
Evidence supports coupling prevention with treatment of acute malnutrition
January 2009
After the Niger food crisis of 2004-2005, programs for community-based treatment of acute malnutrition found that the prevalence of acute malnutrition, although reduced from the level during the crisis, remained unacceptably high. In an anthropological study published in the January 2009 issue of Disasters, researchers investigated social factors that may predispose infants and young children to acute malnutrition and contribute to its high prevalence. The authors used a variety of qualitative research methods to elicit local understanding and coping practices, and they uncovered several harmful infant and young child feeding practices. The majority of mothers initiated breastfeeding late, failed to exclusively breastfeed, and stopped breastfeeding early. A new pregnancy was the most common reason for early breastfeeding cessation, leading mothers to wean their children abruptly. Complementary foods were dilute and contained large amounts of water, and, since children older than 1 year fed themselves from a common plate, adults had little influence over what or how much children consumed.
The authors suggested that social factors influence decision-making about resource allocation for children and aggravate the situation. For example, families were reluctant to invest extra resources for a sick or malnourished child because of their persistent poverty and livelihood insecurity. Based on the findings, the authors recommended that treatment-based nutrition programs should include long-term approaches to improve infant and young child feeding. Approaches, they suggested, should build on knowledge of local realities, constraints, beliefs, and practices, and should support sustainable improvements for children’s diets through agricultural approaches, or creation of local versions of nutritional rehabilitation foods.
The social context of childcare practices and child malnutrition in Niger’s recent food crisis
Can water safety interventions reduce diarrhea during weaning?
September 2009
After implementing the Kisumu Breastfeeding Study (KiBS) for one and a half years, the study’s safety board noted that infants had high rates of diarrhea at age 6 months—the age at which their mothers were advised to rapidly stop breastfeeding. In a study published in the Journal of Infectious Diseases in September 2009, investigators hypothesized that a main cause of infant diarrhea was waterborne pathogens. The authors implemented a set of household interventions to improve water safety for KiBS study participants, including providing sodium hypochlorite solution to treat water, providing water storage vessels, and delivering behavior change messages to improve hand washing and other hygiene practices. They hypothesized that this combination of interventions, called the safe water system (SWS), would reduce incidence of diarrhea during weaning. In comparison to infants who enrolled in KiBS before implementing the SWS, the number of clinic visits for diarrhea during the weaning period was lower during the recommended exclusive breastfeeding period (0–5 months of age) and following breastfeeding cessation (7–11 months of age). However, during the weaning period (6 months of age), the frequency of diarrhea was the same in both groups (16%), leading the authors to conclude that diarrhea during the weaning period may be attributable to factors other than waterborne pathogens. The findings, they say, suggest that additional studies are needed to help clarify the definition of “safe” replacement feeding.
Continued breastfeeding lowers the risk of serious gastroenteritis for HIV-exposed kids
January 2010
An article in the January 2010 issue of the Journal of Acquired Immune Deficiency Syndromes analyzed the risk of serious gastroenteritis in HIV-exposed infants who participated in two different trials in the same hospital in Uganda during different time periods. Each of the trials gave advice to mothers about when to stop breastfeeding their infants based on national guidance at the time the trials took place. In the HIV Network for Prevention Trial (HIVNET 012), investigators instructed mothers to exclusively breastfeed for six months and then to stop breastfeeding as soon as possible. In the HIV hyperimmune globulin/nevirapine trial (HIVGLOB/NVP), researchers encouraged mothers to exclusively breastfeed for three to six months and then to abruptly stop breastfeeding over a two-week period. The average duration of breastfeeding in the HIVNET and HIVGLOB trials was 9.3 and 4 months, respectively. In both trials, incidence of serious gastroenteritis peaked around the average time of breastfeeding cessation. However, at every age except 9–10 months, infants in the HIVGLOB trial (earlier breastfeeding cessation) had higher rates of serious gastroenteritis through 18 months, and cumulative mortality was also higher in that group. The authors found these results to be particularly worrisome since the early cessation mothers of the HIVGLOB trial had characteristics usually assumed to be associated with successful replacement feeding, including higher education and employment rates, compared to mothers in the other trial, whose children had lower rates of serious gastroenteritis. The authors call for the development of infant feeding strategies that decrease the risk of postnatal HIV transmission yet allow HIV-infected mothers longer and safer breastfeeding for optimal nutrition and reduced risk of serious gastroenteritis.
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