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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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Expressing and heat-treating breastmilk: a feasible and beneficial strategy for HIV-positive moms
August 2010
A study in Zimbabwe assessed the feasibility of HIV-positive women expressing and heat-treating (EHT) all breastmilk given to their infants after 6 months of age. Results were presented in August in The Journal of Nutrition. Twenty women received an initial demonstration, with an observed practice, of an EHT protocol, the materials (cooking pot and glass jars, soap, and a lidded plastic storage container) needed for safely heating milk. The study provided mothers with 21 supportive home visits and observed feedings over eight weeks, with daily visits during the first week.
Expressing and heat-treating breastmilk was implemented correctly during 96 percent of observations. All participants said they had family support, and none felt that EHT increased stigmatization associated with HIV infection. In addition to family support, an ongoing campaign promoting EHT as a means to sustain breastfeeding for all mothers probably contributed to reduced stigmatization, as did the recruitment process, which allowed mothers who feared stigma to decline participation. Average daily milk consumption peaked in weeks 2 to 4 at 479 ml. Mothers continued the practice for an average of 4.5 months, with inadequate production cited by 19 women as the reason for stopping. Infants who consumed a higher proportion of total energy, in comparison with complementary foods, from expressed and heat-treated milk experienced more improvement in weight and length for age.
The authors concluded that in countries implementing the 2009 World Health Organization infant feeding guidance, expressing and heat-treating breastmilk may be a useful interim strategy in the temporary absence of antiretroviral medications or as a strategy for safely providing breastmilk after 12 months.
Iron/folic acid supplementation during pregnancy protects against neonatal deaths
August 2010
Findings presented in the August Bulletin of the World Health Organization suggest that 20 percent of neonatal deaths in Indonesia could be averted through routine iron/folic acid (IFA) supplementation of pregnant women. Building on a previous finding that use of antenatal care decreased neonatal mortality among Indonesian newborns, investigators pooled data from three Demographic and Health Surveys conducted between 1994 and 2003 to determine if that decrease in death was associated with antenatal care itself or more specifically with IFA supplementation and/or tetanus toxoid (TT) vaccination. Data on more than 40,000 women/infants were analyzed and revealed that TT vaccination and IFA were associated, respectively, with 34 percent and 47 percent reductions in the risk of neonatal death. However, further analysis showed that without IFA, TT showed no protective effect and antenatal care showed only a slight protective effect. Moreover, a protective effect of IFA was present even among women who received no other form of antenatal care. The authors hypothesized that IFA may prevent neonatal death indirectly through reducing the risk of low birth weight.
Iron and Folic Acid Supplements and Reduced Early Neonatal Deaths in Indonesia
Can improved complementary foods prevent anemia without added micronutrients?
June 2010
The June issue of Public Health Nutrition reported that researchers presented the impact of two different food interventions on anemia among children ages 6-24 months in Burkina Faso. Two groups of children were fed, under supervision, an improved gruel processed to reduce its phytate content. The gruel was comprised of roasted millet and beans, peanuts, traditionally fermented sorghum, soumbala (a fermented condiment made from the seeds of the locust bean tree), sucrose, and iodized salt. For one of the groups, investigators also provided the children’s mothers with a capsule containing an iron, zinc, vitamin A, iodine, and ascorbic acid premix to add to the gruel. Children in both groups were treated for malaria and helminths.
After six months, mean hemoglobin concentration had increased significantly in both groups but not differently between them. The authors speculated that they did not observe treatment differences either because (a) the phytate-reducing processing procedures were ineffective and the gruel altered the bioavailability of the minerals in it, or (b) the procedures indeed were effective, and due to the diverse micronutrient sources available from the cereal/legume mix and the incorporation of iron-rich soumbala, the improved gruel provided sufficient micronutrients and rendered superfluous the micronutrients from the premix. They concluded that improving gruel made with locally available ingredients may be a useful intervention for improving hemoglobin status.
Nutrition education improves growth in rural China
April 2010
An article in the April 2010 issue of Public Health Nutrition presents findings from a randomized controlled trail of an education intervention designed to improve complementary feeding practices in China. Children ages 2 to 4 months in four intervention villages, each matched to a control village, were assigned to receive a set of interventions that included (1) group training on food selection, preparation, and hygiene, childhood nutrition and growth, and responsive feeding; (2) cooking demonstrations on preparation of enhanced complementary foods; (3) provision of printed materials with feeding guidance and complementary food preparation methods; and (4) home visits every three months to identify feeding problems and provide individualized counseling. The intervention was designed based on extensive formative research, including assessment of local infant feeding patterns and ingredients and methods of complementary food preparation. Family members and community leaders were included in group training sessions, and all interventions were conducted by local health providers. Results showed that children ages 6, 9, and 12 months in the intervention villages ate more meals each day and were more likely to eat important non-staple foods, including meats, eggs, dark green leafy vegetables, fruits, cooking oils, and beans. In addition, children in the intervention group gained significantly more weight and length and experienced faster growth velocity for both. These results provide further evidence that well-designed and implemented educational interventions can improve complementary feeding and growth in low-income but food-secure populations.
Point-of-use micronutrient fortification of school meals improves nutritional status
June 2010
The June 2010 issue of The Journal of Nutrition revealed results from a trial in India that tested the nutritional impact of school meals fortified onsite with a micronutrient premix. Investigators randomly assigned schools to receive either premix containing approximately 75 percent of the recommended daily allowance of iron, vitamin A, zinc, folic acid, and vitamin B-12, or a placebo premix. School cooks used the premix six days per week for eight months to prepare daily meals for children ages 6 to 10 years old, using scoops calibrated to measure for ten or two children. After adjusting for age, sex, and C-reactive protein (a measure of infection), children who received the fortified meals had higher total body iron and serum retinol, folate, and vitamin B-12 concentrations, and lower prevalence of low serum retinol, serum folate, and serum vitamin B-12. The authors concluded that point-of-use fortification of school meals using existing infrastructure is a cost-effective, locally acceptable, and sustainable way to implement micronutrient fortification programs.
Do low-phytate maize or zinc supplements enhance growth?
May 2010
An article published in the May 2010 issue of The Journal of Nutrition presents the results of a trial that measured the effect of giving low-phytate maize, zinc supplements, or both on linear growth velocity among infants aged 6 to 12 months in Guatemala. Stunting prevalence is high in this population, and zinc deficiency—resulting from low zinc intake and the absorption-reducing effects of high-phytate diets—is a suspected cause. Maize tends to be high in phytic acid, which inhibits zinc absorption. Infants were first randomized to receive either ‘control’ maize or low-phytate maize, and then randomized to receive either 5-mg zinc tablets or placebo daily. Infants who received zinc had higher serum zinc concentrations, but that did not translate to better growth. The authors suggested that the lack of an effect from low-phytate maize may be due to relatively low maize consumption in this age group, and especially due to low zinc intake from complementary foods such that total zinc intake may have been too low to demonstrate an effect of using low-phytate maize. The lack of an impact on child growth—despite higher-plasma zinc concentration—underscores the need to improve scientific understanding of the relationship between zinc and growth. Most notable, the authors say, is the high rate of stunting at an early age in this population, for which scientists, to date, have no conclusive explanation.
Does exclusive breastfeeding reduce HIV transmision by reducing mastitis?
March 2010
An article in the March 2010 issue of Clinical Infectious Diseases explores the hypothesis that lower frequency of mastitis among women who exclusively breastfeed (EBF) is the mechanism by which mother-to-child transmission of HIV (MTCT) is less common among EBF mothers than among those who practice mixed feeding. That is, the reduced suckling resulting from mixed feeding may lead to engorgement and mastitis, which in turn is associated with increased viral load and increased MTCT risk. Contrary to their hypothesis, the investigators found no association between mixed feeding and either mastitis (measured as elevated breast milk sodium-to-potassium ratio) or breast milk viral load. Even so, the authors confirmed earlier findings of an association between mastitis and breast milk HIV load, and also identified a positive interaction between mastitis and maternal plasma HIV load, by which the association between mastitis and breast milk HIV load strengthens with increasing plasma HIV load. Examining the MTCT impact of this interaction, they found that mastitis was associated with MTCT only when maternal HIV load was high, and even was protective when maternal HIV load was low—possibly due to increased levels of anti-infective factors resulting from mastitis. Thus, the increased MTCT risk of mixed feeding was not mediated by mastitis, and a new finding suggests further inquiry concerning the role of anti-infective factors.
The issue features a commentary on the article by Louise Kuhn, entitled: “Milk Mysteries: Why Are Women Who Exclusively Breast-feed Less Likely to Transmit HIV during Breast-Feeding?”
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