Worldwide implementation of the WHO Child Growth Standards

Abstract Objective To describe the worldwide implementation of the WHO Child Growth Standards (‘WHO standards'). Design A questionnaire on the adoption of the WHO standards was sent to health authorities. The questions concerned anthropometric indicators adopted, newly introduced indicators, age range, use of sex-specific charts, previously used references, classification system, activities undertaken to roll out the standards and reasons for non-adoption. Setting Worldwide. Subjects Two hundred and nineteen countries and territories. Results By April 2011, 125 countries had adopted the WHO standards, another twenty-five were considering their adoption and thirty had not adopted them. Preference for local references was the main reason for non-adoption. Weight-for-age was adopted almost universally, followed by length/height-for-age (104 countries) and weight-for-length/height (eighty-eight countries). Several countries (thirty-six) reported newly introducing BMI-for-age. Most countries opted for sex-specific charts and the Z-score classification. Many redesigned their child health records and updated recommendations on infant feeding, immunization and other health messages. About two-thirds reported incorporating the standards into pre-service training. Other activities ranged from incorporating the standards into computerized information systems, to providing supplies of anthropometric equipment and mobilizing resources for the standards' roll-out. Conclusions Five years after their release, the WHO standards have been widely scrutinized and implemented. Countries have adopted and harmonized best practices in child growth assessment and established the breast-fed infant as the norm against which to assess compliance with children's right to achieve their full genetic growth potentia

Child dietary patterns in Homo sapiens evolution: A systematic review

Dietary patterns spanning millennia could inform contemporary public health nutrition. Children are largely absent from evidence describing diets throughout human evolution, despite prevalent malnutrition today signaling a potential genome-environment divergence. This systematic review aimed to identify dietary patterns of children ages 6 months to 10 years consumed before the widespread adoption of agriculture. Metrics of mention frequency (counts of food types reported) and food groups (globally standardized categories) were applied to: compare diets across subsistence modes [gatherer-hunter-fisher (GHF), early agriculture (EA) groups]; examine diet quality and diversity; and characterize differences by life course phase and environmental context defined using Köppen-Geiger climate zones. The review yielded child diet information from 95 cultural groups (52 from GHF; 43 from EA/mixed subsistence groups). Animal foods (terrestrial and aquatic) were the most frequently mentioned food groups in dietary patterns across subsistence modes, though at higher frequencies in GHF than in EA. A broad range of fruits, vegetables, roots and tubers were more common in GHF, while children from EA groups consumed more cereals than GHF, associated with poor health consequences as reported in some studies. Forty-eight studies compared diets across life course phases: 28 showed differences and 20 demonstrated similarities in child versus adult diets. Climate zone was a driver of food patterns provisioned from local ecosystems. Evidence fro

Egg intervention effect on linear growth no longer present after two years.

The Lulun Project, a randomized controlled trial conducted in 2015, found that one egg per day for 6 months during early complementary feeding reduced stunting by 47% and increased linear growth by 0.63 length-for-age Z (LAZ). This follow-up cohort study (Lulun Project II) aimed to test whether the growth effect remained in the egg intervention group compared with the control group after approximately 2 years. Mothers or caregivers from the Lulun Project were recontacted and recruited for this study. Enumerators collected data on socio-economic and demographic factors, 24-hr frequency of dietary intakes, morbidities, and anthropometric measures of height, weight, and head circumference using World Health Organization protocols. Statistical analyses followed the same analytical plan as Lulun Project, applying generalized linear models and regression modelling to test group differences in height-for-age z (HAZ) from LAZ at Lulun Project endline, and structural equation modelling for mediation. One hundred thirty-five mother-child dyads were included in Lulun II, with 11% losses to follow-up from endline Lulun Project. Growth faltering across all children was evident with HAZ -2.07 ± 0.91 and a stunting prevelance of 50%. Regression modelling showed no difference between egg and control groups for the HAZ outcome and other anthropometric outcomes, and significant declines in HAZ from endline Lulun Project in the egg intervention are compared with control groups. Current dietary egg intake, however, was associated with reduced growth faltering in HAZ from Lulun Project endline to Lulun Project II, independent of group assignment and through mediation, explaining 8.8% of the total effect. Findings suggest the need for a longer intervention period and ongoing nutrition support to young children during early childhood

The potential of a simple egg to improve maternal and child nutrition

Evidence is mounting about the benefits of eggs for child nutrition and potential benefits for women during pregnancy and birth outcomes. Maternal consumption of eggs during lactation may also enhance the breast-milk composition of certain nutrients, thus contributing to the nutrition and potentially also to the development of breastfed children. Relative to single nutrient supplements, eggs deliver nutrients and other hormone or immune factors in compounds that may be more readily absorbed and metabolized. In addition to macronutrients, eggs contain a number of micronutrients, such as choline, that are known to have brain health promoting effects. Among children less than 2 years of age, consumption nearly universally increases with age. Large regional differences exist; the prevalence of egg consumption among African children is less than half that of most other world regions and threefold less than in Latin America and the Caribbean. Among women of reproductive age, egg consumption is strongly related to socio-economic status in a dose-response fashion with women in the lowest wealth quintile eating the fewest eggs and those in the highest wealth quintile eating the most. Cultural factors likely play a role in around consumption of eggs during pregnancy, lactation, and early childhood, though most reports are anecdotal in nature and few high-quality data exist. Well-informed social marketing and behaviour change communication strategies have led to large increases in egg consumption among young children. Economic barriers that limit access are likely to be far more important than cultural ones in explaining low consumption

Undernutrition, poor feeding practices, and low coverage of key nutrition interventions

PRIFPRI3; ISIPHN