A Mixed Methods Exploration of Maternal Perceptions and Concerns about Their Young Child´s Weight and Maternal Feeding Practices in Bradford

Background: Childhood overweight should be prevented from early childhood. This thesis aims to contribute to the understanding of the factors that influence feeding practices amongst mothers of pre-school children living in Bradford. Methods: I used an explanatory sequential mixed methods design to explore the perceptions and concerns that mothers have about their child’s weight and their feeding practices. For the quantitative strand, data from the Born in Bradford cohort was used to: describe the mothers’ perceptions of their child’s and own weight, their concerns that their child will become overweight; identify mother and child characteristics associated with inaccurate estimations of the child’s weight, concern that the child will become overweight, maternal feeding practices; and explore the relationship between perceptions and concerns and feeding practices. The qualitative strand aimed to add depth and further insight into attitudes that mothers have towards their child’s weight, childhood overweight and feeding practices. One-to-one interviews were conducted with mothers, early years workers and health professionals, and analysed using thematic analysis. Results: Some mothers were unable to estimate their own and their child’s weight accurately. Pakistani mothers were more likely to underestimate in comparison to White British mothers. Concerns about childhood overweight seemed to be not as frequent as concerns about low weight. Underestimation of a healthy weight child may lead mothers to seek support, whereas mothers who do not recognise overweight may not seek support. Concerns about overweight and awareness that a child is overweight may not lead mothers to undertake healthier practices if they do not have strategies to undertake these. Conclusions: Health professionals and early years workers are a key resource to communicate effectively with the mothers about their expectations and concerns about their child’s growth and feeding practices and may refer to services that provide advice on how to maintain healthy growth

Estado nutricional, consumo de alimentos ultra procesados y trastorno por déficit de la atención, hiperactividad e impulsividad en alumnos de secundaria de la Ciudad de México

ResumenIntroducción. A la par del aumento prevalencia de obesidad y sobrepeso se han incrementado las ventas de productos ultra procesados (UP). Varios de los aditivos que contienen estos productos se han relacionado con la exacerbación de los síntomas del trastorno por déficit de atención con hiperactividad (TDAH). Objetivo. Identificar el estado nutricional, consumo de alimentos y presencia de TDAH y explorar la relación entre alimentación y TDAH, en alumnos de secundaria de la Ciudad de México. Método. Estudio transversal. Un grupo de estudiantes de Medicina fueron capacitados para obtener el Índice de Masa Corporal, consumo de alimentos y TDAH. Se calcularon frecuencias simples de IMC, consumo de alimentos y TDAH. Se utilizaron el coeficiente de correlación de Spearman y la prueba U de Mann-Whitney para explorar la relación entre alimentación y TDAH. Resultados. Se encontró que el 38.1% de los alumnos de secundaria tenía sobrepeso y obesidad.  Entre el 18.9% y el 40.5% de ellos consumía más de 3 productos UP por semana y entre el 16% y 29% más de tres al día. Alrededor del 50% de los alumnos no cumplían con las recomendaciones de consumo de frutas, verduras y agua. La prevalencia de casos sospechosos de TDAH fue de 2.5%. El consumo de golosinas se correlacionó con TDAH y sus componentes, el consumo de frituras se asoció estadísticamente sólo con hiperactividad. El consumo de frutas se correlacionó inversamente con hiperactividad. Conclusiones. Es necesario redoblar esfuerzos para prevenir el aumento de la obesidad en adolescentes, disminuir el consumo de UP y realizar más estudios para identificar su relación con TDAH.

Can an ethics code help to achieve equity in international research collaborations? Implementing the Global Code of Conduct for Research in Resource-Poor Settings in India and Pakistan.

The Global Code of Conduct for Research in Resource-Poor Settings (GCC) aims to stop the export of unethical research practices from higher to lower income settings. Launched in 2018, the GCC was immediately adopted by European Commission funding streams for application in research that is situated in lower and lower-middle income countries. Other institutions soon followed suit. This article reports on the application of the GCC in two of the first UK-funded projects to implement this new code, one situated in India and one in Pakistan. Through systematic ethics evaluation of both projects, the practical application of the GCC in real-world environments was tested. The findings of this ethics evaluation suggest that while there are challenges for implementation, application of the GCC can promote equity in international research collaborations

Eating strategies in university students, quality of breakfast, and socioeconomic conditions

Purpose: The purpose of this study was to analyze food strategies, the quality of breakfast and the practice of physical activity in medical students, related to their socioeconomic conditions, and body mass index. Methodology: This study was a cross-sectional comparative study in 2nd-year students sitting a course in medicine at the University of Mexico. An instrument was developed and validated to collect the variables indicated, which was applied online using the Formstack platform. We used X2 or Fisher’s exact and t-test for independent samples or the Mann–Whitney U-test and performed logistic regression. Results: The logistic regression model indicated that being over 20 years of age, male, obese, and with a low physical activity index were risk factors associated with unhealthy food strategies, with no statistically significant difference. The risk was 41.2-fold in individuals reporting a poor-breakfast quality and six-fold in those who did not eat breakfast. The odds ratio values for insufficient and satisfactory quality of breakfast were at risk, with no statistically significant difference. Not having enough food was a 7.9-fold predictor of risk. Unhealthy food strategies were observed in more than 70% of students with intermediate and inadequate economic resources and in which the average expenditure on food was low. Conclusion: Healthy eating habits need to be promoted at the Faculty of Medicine, in addition to stressing the importance of a good quality breakfast and engagement in physical activity among students

Community Perceptions of Zinc Biofortified Flour during an Intervention Study in Pakistan

Zinc-biofortified flour may be a cost-effective approach to improve zinc status of populations in low-resource settings. The success of biofortification programmes is subject to acceptability and uptake by consumers. This study explored community leaders’ and community members’ (n = 72) experiences and attitudes towards the flour provided during a cluster randomised controlled trial of zinc biofortified wheat in rural Pakistan (BiZiFED2). Focus group discussions (n = 12) were conducted and thematic analysis applied using an inductive, semantic, contextualist approach. Five themes were identified: (1) Contribution to food security; (2) Better sensory and baking properties than local flour; (3) Perceived health benefits; (4) Willingness to pay for the flour; and (5) Importance of trusted promoters/suppliers. Although the participants were blind to whether they had received control or biofortified flour, referred to collectively as “study flour”, the results indicated that the study flour performed well in terms of its taste and bread making qualities, with no adverse reports from participants in either arm of the BIZIFED2 RCT. Participants suggested that they would buy the biofortified wheat if this was available at a fair price due to perceived health benefits, reporting positive sensory characteristics and cooking attributes when compared to the flour available in the local markets. Overall, there was a positive reception of the programme and flour among the participants, and members of the community hoped for its continuation and expansion

Adverse Effects of Excessive Zinc Intake in Infants and Children Aged 0-3 Years: A Systematic Review and Meta-Analysis

Zinc supplementation reduces morbidity, but evidence suggests that excessive intakes may have negative health consequences. Current guidelines of upper limits (ULs) of zinc intake for young children are extrapolated from adult data. This systematic review (PROSPERO; registration no. CRD42020215187) aimed to determine the levels of zinc intake at which adverse effects are observed in young children. Studies reporting potential adverse effects of zinc intake in children aged 0–3 years were identified (from inception to August 2020) in MEDLINE, EMBASE and the Cochrane Library, with no limits on study design. Adverse clinical and physical effects of zinc intake were synthesized narratively, and meta-analyses of biochemical outcomes were conducted. Random effects models, forest plots were generated to examine the evidence by age category, dose, dose duration, chemical formula of zinc, and zinc vs placebo. The Joanna Briggs Institute Critical Appraisal Checklist, Cochrane Risk of Bias 2, and Grading of Recommendations Assessment, Development and Evaluation guideline (GRADE) were employed to assess risk of bias and to appraise the certainty of evidence. Fifty-eight studies assessed possible adverse effects of zinc doses ranging from 3 to 70 mg/d. Data from 39 studies contributed to meta-analyses. Zinc supplementation had an adverse effect on serum ferritin, plasma/serum copper concentration, sTfR, hemoglobin, hematocrit, and the odds of anemia in at least one of the subgroups investigated. Lactulose: mannitol ratio was improved with zinc supplementation, and no significant effect was observed on CRP, eSOD, ZPP and blood cholesterol and iron deficiency anemia. The certainty of the evidence, as assessed using GRADE, was very low to moderate. Although possible adverse effects of zinc supplementation were observed in some subgroups, it is unclear whether these findings are clinically important. The synthesized data can be used to undertake a dose-response analysis to update current guidelines of ULs of zinc intake for young children

Digital marketing of formula and baby food negatively influences breast feeding and complementary feeding: a cross-sectional study and video recording of parental exposure in Mexico

There is little evidence of the association between digital marketing of formula and baby food and infant and young child feeding (IYCF) practices. Assess parents' exposure to digital marketing of formula and baby food for children <2 years and its association with the purchase and IYCF practices in Mexico. Parents ≥18 years recruited from a market research panel completed an online survey (n=1074) and capture-on-screen (n=95) between December 2020 and January 2021. Logistic regressions were used to estimate the association between exposure to digital marketing of formula and baby foods with its purchase, motivation, consumption and IYCF practices. Digital marketing of formula and baby food was self-reported by 93.9% of parents in the online survey and observed by 93.7% in the capture-on-screen. Recorded ads did not comply with the International Code of Marketing of Breast-milk Substitutes. Parents who self-reported seeing a higher versus lower number of ads were less likely to exclusive breast feed (OR=0.38; 95% CI: 0.19 to 0.78), and more likely to give mixed feeding (OR=2.59; 95% CI: 1.28 to 5.21), formula (OR=1.84; 95% CI: 1.34 to 2.53), processed foods (OR=2.31; 95% CI: 1.59 to 3.32) and sugary drinks (OR=1.66; 95% CI: 1.09 to 2.54). Higher exposure to ads was associated with a higher chance of purchasing products motivated by nutritional (OR=2.1; 95% CI: 1.32 to 3.28) and organic claims (OR=2.1; 95% CI: 1.21 to 3.72). Digital marketing of formula and baby food may negatively influence IYCF and should be regulated to ensure children's nutrition and health. [Abstract copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Digital marketing of commercial breastmilk substitutes and baby foods: strategies, and recommendations for its regulation in Mexico

Background: Parents are exposed to breastmilk substitutes and baby foods marketing on the internet and social media, which hinders adequate breastfeeding and complementary feeding. This study identifies digital marketing strategies for breastmilk substitutes, specifically commercial milk formula and baby foods used by the industry to influence infant and young children’s feeding practices in Mexico and proposes regulatory recommendations that can be useful for similar countries. Methods: Qualitative study based on the CLICK monitoring framework developed by the World Health Organization, adapted for digital marketing of commercial milk formula and baby foods. Semi-structured interviews (n = 53) with key actors were conducted between November 2020 and March 2021, and used grounded theory for the analysis and interpretation with the MAXQDA 20 software. Results: Commercial milk formula and baby food companies use digital media to contact and persuade parents to use their products by sending electronic newsletters with advertising. Companies hire influencers to market their products because there is no regulation prohibiting the advertisement of breastmilk substitutes on social media, and promote formula among health professionals inviting them to participate in sponsored webinars on infant nutrition, ignoring conflict of interest and the International Code of Marketing of Breastmilk Substitutes. Parents trust formula and baby food advertisements, which use emotional messages and health and nutrition claims to encourage their consumption. Health professionals consider that claims contribute to the indiscriminate use of formula, and some actors propose the use of plain packaging for these products. Conclusions: Breastmilk substitutes companies promote their products in digital media using unethical strategies that fail to comply with the International Code of Marketing of Breastmilk Substitutes. They generate strong conflicts of interest with health professionals, taking advantage of legal framework gaps and the lack of monitoring and effective sanctions for non-compliers. Updating the legal framework and monitoring compliance, including digital media, is urgently needed to protect children’s right to breastfeeding, healthy nutrition and life, and the rights of women to health and informed decision-making

Perceived Diet Quality, Eating Behaviour, and Lifestyle Changes in a Mexican Population with Internet Access during Confinement for the COVID-19 Pandemic: ESCAN-COVID19Mx Survey

Perceived changes in diet quality, emotional eating, physical activity, and lifestyle were evaluated in a group of Mexican adults before and during COVID-19 confinement. In this study, 8289 adults answered an online questionnaire between April and May 2020. Data about sociodemographic characteristics, self-reported weight and height, diet quality, emotional eating, physical activity, and lifestyle changes were collected. Before and after confinement, differences by sociodemographic characteristics were assessed with Wilcoxon, Anova, and linear regression analyses. Most participants were women (80%) between 18 and 38 years old (70%), with a low degree of marginalisation (82.8%) and a high educational level (84.2%); 53.1% had a normal weight and 31.4% were overweight. Half (46.8%) of the participants perceived a change in the quality of their diet. The Diet Quality Index (DQI) was higher during confinement (it improved by 3 points) in all groups, regardless of education level, marginalisation level, or place of residence (p 0.001). Lifestyle changes were present among some of the participants, 6.1% stopped smoking, 12.1% stopped consuming alcohol, 53.3% sleep later, 9% became more sedentary, and increased their screen (43%) as well as sitting and lying down time (81.6%). Mexicans with Internet access staying at home during COVID-19 confinement perceived positive changes in the quality of their diet, smoking, and alcohol consumption, but negative changes in the level of physical activity and sleep quality. These results emphasise the relevance of encouraging healthy lifestyle behaviours during and after times of crisis to prevent the risk of complications due to infectious and chronic diseases