Maternal Pre‐Pregnancy Body Mass Index Is Not Associated With Infant and Young Child Feeding in Low‐Income Mexican Children 1–24 Months Old

Pre-pregnancy overweight and obesity is associated with shorter breastfeeding (BF) duration. Whether pre-pregnancy overweight and obesity is associated with other aspects of infant and young child feeding (IYCF) hasnot been investigated. We used data from 370 children born January 1999–September 2001 in a semi-urbancommunity in Morelos, Mexico, where information on how they were fed was available at 1, 3, 6, 9, 12, 18 and 24months of age. We modified the World Health Organization’s dietary diversity indicator to assess the quality ofthe complementary foods. An index that included BF, quality of complementary foods and other behaviours wasconstructed to measure IYCF. We used survival analysis to examine the association of pre-pregnancy body massindex (pBMI) category and BF duration and mixed models for quality of complementary food and IYCF index.Mean maternal pBMI was 24.44.1; 31% were overweight, and 9% were obese. pBMI was not associated with BF duration. Quality of complementary food improved over time (6 months, 1.3 1.3; 24 months, 3.8 1.04).Compared with normal-weight women, overweight and obese women were more likely to feed from more foodgroups (0.24 0.11 point,P=0.03), but this did not improve diet diversity from 6 to 24 months. IYCF indexdecreased throughout follow-up (1 month, 7.8 2.4; 24 months, 5.5 1.8), and pBMI was not associated withIYCF (-0.11 0.13 point,P=0.4). We conclude that heavier women were not engaging in IYCF behaviours thatwere distinct from those of normal-weight women from 1 to 24 months post-partum

Educating and training a workforce for nutrition in a post-2015 world.

Nearly all countries in the world today are burdened with malnutrition, manifesting as undernutrition, micronutrient deficiencies, and/or overweight and obesity. Despite some progress, efforts to alleviate malnutrition are hampered by a shortage in number, skills, and geographic coverage, of a workforce for nutrition. Here, we report the findings of the Castel Gandolfo workshop, a convening of experts from diverse fields in March 2014 to consider how to develop the capacity of a global cadre of nutrition professionals for the post-2015 development era. Workshop participants identified several requirements for developing a workforce for nutrition, including an ability to work as part of a multisectoral team; communication, advocacy, and leadership skills to engage decision makers; and a set of technical skills to address future challenges for nutrition. Other opportunities were highlighted that could immediately contribute to capacity development, including the creation of a consortium to link global North and South universities, online training modules for middle managers, and practical, hands-on experiences for frontline nutrition workers. Institutional and organizational support is needed to enable workshop recommendations on education and training to be effectively implemented and sustained. The findings from the Castel Gandolfo workshop can contribute to the delivery of successful nutrition-relevant actions in the face of mounting external pressures and informing and attaining the forthcoming Sustainable Development Goals

Educating and Training a Workforce for Nutrition in a Post-2015 World

Nearly all countries in the world today are burdened with malnutrition, manifesting as undernutrition, micronutrient deficiencies, and/or overweight and obesity. Despite some progress, efforts to alleviate malnutrition are hampered by a shortage in number, skills, and geographic coverage, of a workforce for nutrition. Here, we report the findings of the Castel Gandolfo workshop, a convening of experts from diverse fields in March 2014 to consider how to develop the capacity of a global cadre of nutrition professionals for the post-2015 development era. Workshop participants identified several requirements for developing a workforce for nutrition, including an ability to work as part of a multisectoral team; communication, advocacy, and leadership skills to engage decision makers; and a set of technical skills to address future challenges for nutrition. Other opportunities were highlighted that could immediately contribute to capacity development, including the creation of a consortium to link global North and South universities, online training modules for middle managers, and practical, hands-on experiences for frontline nutrition workers. Institutional and organizational support is needed to enable workshop recommendations on education and training to be effectively implemented and sustained. The findings from the Castel Gandolfo workshop can contribute to the delivery of successful nutrition-relevant actions in the face of mounting external pressures and informing and attaining the forthcoming Sustainable Development Goals. Adv Nutr 2015;6:639–47

The Influence Of Maternal Fatness, Knowledge, And Diet On Infant And Young Child Feeding In Mexico

Maternal decisions about breastfeeding (BF), formula feeding, and complementary feeding are guided by biological and socio-cultural factors. Obese women often experience poor BF outcomes. Maternal weight is also a proxy for the food environment because diet is a determinant of weight. Our understanding of cultural knowledge and the mother-child food relationship in complementary feeding remain fragmentary. The aims of this dissertation were to examine the association between maternal fatness and child feeding practices from 0-24 mo and understand conceptualizations and practices of child feeding, particularly the mother-child food relationship within the household food environment. First we examined if maternal fatness was associated with BF duration, dietary diversity (DD), and child feeding index (CFI), using data from Mexican mother-child pairs. Maternal fatness was not associated with BF duration or DD. Maternal fatness was not a significant factor in CFI as measured by the index. Second, ethnography was used to examine how 31 mothers in Xoxocotla, Morelos, Mexico conceptualized complementary feeding practices. The eight concepts identified were: probaditas, preparing separate foods, readiness to eat solid foods, consistency, variety, child likes and dislikes, money and food costs, and healthiness of foods. There was strong evidence of cultural consensus. Household factors influenced feeding practices. Last, data from 24-h recalls of 25 mother-child pairs (9-18 mo-old) from the ethnographic study were used to examine the maternal-child food relationship and the household food environment. The frequency of shared meals and foods between mother and child was attributable to maternal concepts of child foods, time of day, the child's age and sleep patterns, family and maternal food preferences, maternal social roles, and presence of family members at meals. This complexity was captured by the maternal and child food space concept. This dissertation showed that maternal fatness was not of public health significance in child feeding, whereas maternal knowledge and household food environment were important. The ethnographic findings have implications for how we approach child feeding, such that to improve practices we must use the maternal system of knowledge and consider the social processes that construct the complementary diet beyond educating mothers on food quality and consistency

Analysing the potential impacts of three interventions on fruit and vegetable consumption in urban Kenya using participatory systems modelling

Abstract Objective: This study uses participatory modelling with stakeholders to assess the potential impacts of three interventions intended to increase fruit and vegetable (F&V) consumption in urban Kenya. Design: A participatory process using Group Model Building (GMB) developed a conceptual model of the determinants of vegetable consumption. A subsequent quantitative System Dynamics model using data from primary and secondary sources simulated vegetable consumption from 2020 to 2024 under three proposed interventions suggested by stakeholders: increasing consumer awareness, reducing post-harvest losses and increasing farm yields. Model analyses assumed mean parameter values and assessed uncertainty using 200 simulations with randomised parameter values. Setting: The research was implemented in Nairobi, Kenya with simulation analyses of mean per capita consumption in this location. Participants: Workshops convened diverse F&V value chain stakeholders (farmers, government officials, NGO staff and technical experts) to develop the conceptual model, data inputs and intervention scenarios. Results: Increasing consumer awareness was simulated to increase vegetable consumption by relatively modest amounts by 2024 (5 g/person/d from a base of 131 g/person/d) under mean assumed value of value chain response parameters. Reducing perishability was simulated to reduce consumption due to the higher costs required to reduce losses. Increasing farm yields was simulated to have the largest impact on consumption at assumed parameter values (about 40 g/person/d) but would have a negative impact on farm profits, which could undermine efforts to implement this intervention. Conclusions: The combination of GMB and simulation modelling informed intervention priorities for an important public health nutrition issue

“Sometimes You Get Good Ones, and Sometimes You Get Not-so-Good Ones”: Vendors’ and Consumers’ Strategies to Identify and Mitigate Food Safety Risks in Urban Nigeria

This paper uses detailed data from in-depth interviews with consumers (n = 47) and vendors (n = 37) in three traditional markets in Birnin Kebbi, Nigeria. We used observations from those markets to examine how consumers and vendors identify and avoid or manage food safety risks and whom they hold responsible and trust when it comes to ensuring food safety. At the level of the vendor, consumers mentioned seeking “clean” or “neat” vendors or stalls. Cleanliness was primarily related to the appearance of the vendor, stall, and surroundings; reliance on trusted, known vendors was also noted. Food products themselves were largely evaluated based on visual cues: insects, holes, and colors—with some reliance on smell, also. Similarly, vendors assessed safety of food from suppliers based on a visual assessment or reliance on trusted relationships. On the second research question, both consumers and vendors largely placed responsibility for ensuring food safety on government; when asked specifically, consumers also named specific steps that vendors could take to ensure food safety. Consumers and vendors also generally felt that they could limit many food safety risks through identifying the “good” products in the market or from suppliers. The paper discusses the implications of these results for behavior change interventions

What Is Safe and How Much Does It Matter? Food Vendors’ and Consumers’ Views on Food Safety in Urban Nigeria

This study examines the food safety beliefs of vendors and consumers in a mid-sized Nigerian city using data from in-depth interviews and cognitive mapping techniques drawn from ethnography. We examine vendors’ and consumers’ perspectives on which foods are safe, which are not, and why; the place of foodborne illness among other health concerns and motivators of food choice; and how salient food safety is as a concern for vendors. The main perceived causes of unsafe food were found to be chemicals and insects; while bacterial illnesses were widely mentioned as a cause of gastrointestinal symptoms, these were not necessarily linked to food in consumers’ minds. Respondents agreed strongly that certain foods (e.g., cowpea, beef, green leafy vegetables, and local rice) were less safe than others. The importance of food safety as a choice motivator among consumers varies depending on framing: when asked directly, it was prominent and closely related to visible cleanliness, but concerns about food safety competed in consumers’ minds against other salient motivators of food and vendor choice, such as price. Most vendors did not see food safety, cleanliness, or hygiene as a key trait of a successful vendor, and just over half of vendors had any concern about the safety of their food. In conclusion, we note the implications for intervention designs, particularly the need to build upon consumers’ and vendors’ current beliefs and practices related to food safety in order to make foodborne disease prevention a more salient concern in food choice

Nutrient Density as a Dimension of Dietary Quality: Findings of the Nutrient Density Approach in a Multi-Center Evaluation

The nutrient adequacy of a diet is typically assessed by comparing estimated nutrient intakes with established average nutrient requirements; this approach does not consider total energy consumed. In this multinational survey investigation in Indonesia, Mexico, and South Africa, we explore the applications of the “critical nutrient-density approach”—which brings energy requirements into the equation—in the context of public health epidemiology. We conducted 24 h dietary recalls in convenience samples of normal-weight (BMI 18.5–25 kg/m2) or obese (BMI > 30 kg/m2), low-income women in three settings (n = 290). Dietary adequacy was assessed both in absolute terms and using the nutrient density approach. No significant differences in energy and nutrient intakes were observed between normal-weight and obese women within any of the three samples (p > 0.05). Both the cut-point method (% of EAR) and critical nutrient density approach revealed a high probability of inadequate intakes for several micronutrients but with poor concordance between the two methods. We conclude that it may often require some approximate estimate of the habitual energy intake from an empirical source to apply a true critical nutrient density reference for a population or subgroup. This will logically signify that there would be more “problem nutrients” in the diets examined with this nutrient density approach, and efforts toward improved food selection or food- or biofortification will frequently be indicated

Bioaccessibility and bioavailability of biofortified food and food products: Current evidence

HarvestPlusBiofortification increases micronutrient content in staple crops through conventional breeding, agronomic methods, or genetic engineering. Bioaccessibility is a prerequisite for a nutrient to fulfill a biological function, e.g., to be bioavailable. The objective of this systematic review is to examine the bioavailability (and bioaccessibility as a proxy via in vitro and animal models) of the target micronutrients enriched in conventionally biofortified crops that have undergone post-harvest storage and/or processing, which has not been systematically reviewed previously, to our knowledge. We searched for articles indexed in MEDLINE, Agricola, AgEcon, and Center for Agriculture and Biosciences International databases, organizational websites, and hand-searched studies’ reference lists to identify 18 studies reporting on bioaccessibility and 58 studies on bioavailability. Conventionally bred biofortified crops overall had higher bioaccessibility and bioavailability than their conventional counterparts, which generally provide more absorbed micronutrient on a fixed ration basis. However, these estimates depended on exact cultivar, processing method, context (crop measured alone or as part of a composite meal), and experimental method used. Measuring bioaccessibility and bioavailability of target micronutrients in biofortified and conventional foods is critical to optimize nutrient availability and absorption, ultimately to improve programs targeting micronutrient deficiency