Child Nutrition Research Articles

From preschool to policy: A scoping review of recommended interventions for a systems approach to improve dietary intake in early childhood.

Early childhood is a key opportunity to establish healthy eating behaviors and prevent future non-communicable diseases associated with poor diets. How to effectively intervene in the system of the many determinants influencing children's dietary intake remains unclear. This scoping review aimed to map the determinants of nutrition and eating that have been addressed in early childhood nutrition interventions and identify which of these improve dietary intake. We searched six electronic databases to identify eligible studies published from January 2000 to January 2024. We included studies of any interventions reporting dietary intake among children aged between two and five years. A total of 193 eligible studies were identified and mapped to the Determinants of Nutrition and Eating (DONE) Framework. Parent (n = 97) and child (n = 76) food knowledge and skills were most frequently addressed. Most studies addressing parent (67%) and child (66%) food knowledge and skills reported improvements in dietary intake. Government regulations such as healthy food subsidies, and food advertising and labeling interventions showed promised, with 82% of studies reporting improvements in dietary intake. However, these interventions were predominantly implemented in the United States and Chile. This review provides a comprehensive and systematic map of a range of interventions that positively influence nutritional outcomes in preschool-aged children but recommends further policy-level action globally.

Serum metabolome indicators of early childhood development in the Brazilian National Survey on Child Nutrition (ENANI-2019).

Background: The role of circulating metabolites on child development is understudied. We investigated associations between children's serum metabolome and early childhood development (ECD).Methods: Untargeted metabolomics was performed on serum samples of 5,004 children aged 6-59 months, a subset of participants from the Brazilian National Survey on Child Nutrition (ENANI-2019). ECD was assessed using the Survey of Well-being of Young Children's milestones questionnaire. The graded response model was used to estimate developmental age. Developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Partial least square regression selected metabolites with a variable importance projection ≥ 1. The interaction between significant metabolites and the child's age was tested.Results: Twenty-eight top-ranked metabolites were included in linear regression models adjusted for the child's nutritional status, diet quality, and infant age. Cresol sulfate (β = -0.07; adjusted-p < 0.001), hippuric acid (β = -0.06; adjusted-p < 0.001), phenylacetylglutamine (β = -0.06; adjusted-p < 0.001), and trimethylamine-N-oxide (β = -0.05; adjusted-p = 0.002) showed inverse associations with DQ. We observed opposite directions in the association of DQ for creatinine (for children aged -1 SD: β = -0.05; p =0.01; +1 SD: β = 0.05; p =0.02) and methylhistidine (-1 SD: β = - 0.04; p =0.04; +1 SD: β = 0.04; p =0.03).Conclusion: Serum biomarkers, including dietary and microbial-derived metabolites involved in the gut-brain axis, may potentially be used to track children at risk for developmental delays.Funding: Supported by the Brazilian Ministry of Health and the Brazilian National Research Council.

Optimal allocation of antenatal and young child nutrition interventions: an individual-based global burden of disease calibrated microsimulation

BackgroundUndernutrition remains a global crisis and is a focus of Sustainable Development Goals. While there are multiple known, effective interventions, complex interactions between prevention and treatment and resource constraints can lead to difficulties in allocating funding. Simulation studies that use in silico simulation can help illuminate the interactions between interventions and provide insight into the cost-effectiveness of alternative packages of options.MethodsWe developed an individual-based microsimulation model based on the Global Burden of Disease (GBD) 2021 study data to test a range of nutrition interventions, including antenatal interventions (iron and folic acid, multiple micronutrients, and balanced energy protein supplementation) and child interventions (treatment for severe acute malnutrition, treatment for moderate acute malnutrition, and wasting prevention with small-quantity lipid-based nutrient supplements). We also developed an analytic approach to process the results of the microsimulation and identify the optimal intervention funding allocation for a given budget size. We use Ethiopia as an example in this paper.ResultsIn our illustrative example of Ethiopia, the reallocation of the baseline budget to minimize disability-adjusted life years (DALYs) resulted in first funding the antenatal multiple micronutrients to their maximum coverage and then funding treatment for severe child acute malnutrition. Relative to the baseline allocation, the reallocation optimized to minimizing DALYs resulted in 592,000 fewer annual DALYs, constituting an 8.3% reduction in total DALYs in Ethiopia.For budgets larger than the baseline, our model recommended funding first targeted moderate acute malnutrition treatment, second universal moderate acute malnutrition treatment, third wasting prevention with small-quantity lipid-based nutrient supplements, and fourth balanced energy protein supplementation.ConclusionsOur simulation is a novel model for estimating optimal allocation of spending on antenatal and child health nutrition interventions which accounts for the interaction between preventive and therapeutic approaches. Our illustrative results show that an optimized reallocation of current spending can substantially improve pregnancy-related and child health without additional funding. We hope this model can add validity and confidence to prior results to aid stakeholders in funding decisions.

Minimum acceptable diet and contributing factors among children aged 6–23 months in Afghanistan: insights from the 2022–2023 Multiple Indicator Cluster Survey

BackgroundUndernutrition among children is a public health concern in most low and middle-income countries (LMICs) and is associated with poor child growth and development. Knowledge about child feeding practices is needed for nutritional policies and programs. Hence, this study assessed the status of minimum acceptable diet (MAD) and its associated factors among children aged 6–23 months in Afghanistan.MethodsThis cross-sectional study was based on a secondary dataset of the 2022–2023 Afghanistan Multiple Indicator Cluster Survey (MICS 2022–23). Complete data from 7,876 children aged 6–23 months were analysed. The outcome variable was MAD and was defined according to the WHO and UNICEF recommendations and indicators for young child feeding practices. Bivariate and multivariate binary logistic regression analyses were used to identify factors associated with MAD.ResultsAbout 7.3% of children aged 6–23 months were fed with the recommended MAD. The likelihood of receiving MAD was higher in children aged 13–18 months [adjusted odds ratio (AOR) 2.01 (95%CI: 1.63–2.48)] and 19–23 months [2.11 (95%CI: 1.68–2.66)], in children belonging to households with higher wealth status [1.39 (95%CI: 1.04–1.87), 2.06 (95%CI: 1.51–2.82), and 3.07 (95%CI: 2.14–4.40) for the 3rd, 4th, and 5th quintile of wealth status, respectively], and in children living in rural areas [1.56 (95%CI: 1.21–2.01)]. On the other hand, the maternal age group 30–39 years [0.79 (95%CI: 0.64–0.96)] and non-institutional delivery [0.67 (95%CI: 0.54–0.83)] were associated with reduced odds of MAD.ConclusionOur study revealed that a small percentage (7.3%) of children received MAD in Afghanistan. This emphasizes the need for policies and interventions aimed at the improvement of child feeding practices to ultimately lead to better child nutrition and health in Afghanistan.

What Do Mothers Know About Nutrition? Impacts on Childhood Nutrition Outcomes in Sub-Saharan Africa.

Globally, the prevalence of undernutrition is highest in the sub-Saharan African region with over a third of the world's stunted children residing in this region. Many studies have explored child nutrition in sub-Saharan Africa, but they often overlook the intricate nuances of maternal knowledge. We examined the association between maternal nutritional knowledge and childhood nutritional outcomes. This was a secondary analysis utilizing data from the Demographic and Health Survey of eight sub-Saharan African countries that were conducted between 2019 and 2022, focusing on children aged 6 to 23 months. The study used latent class analysis to identify discrete patterns of nutrition and health-related knowledge and mixed-effects logistic regression to assess their association with childhood nutritional outcomes namely, stunting and wasting. Statistical significance was determined at p < 0.05. Most participants knew the importance of colostrum (76.8%) and continued breastfeeding (76.7%), as well as immunization (60.0%) and diarrhoea prevention and treatment strategies (65.1%). However, only 24.49% knew about family planning. Children of high knowledge group/class had a 17% lower risk of childhood stunting (crude model; COR = 0.83; 95%CI: 0.77, 0.90, adjusted model; AOR = 0.89; 95%CI: 0.82, 0.97) and a 22% lower risk of wasting (COR = 0.78; 95%CI: 0.69, 0.89, adjusted model; AOR = 0.84; 95%CI: 0.73, 0.96) compared to those from the low knowledge group/class. These results highlight the pivotal role of maternal knowledge in shaping children's health outcomes and emphasize the urgent need for targeted interventions and comprehensive maternal education programs to address the identified knowledge gaps and improve child health outcomes.

Farm production, marketing, and children's nutritional outcomes in rural Zambia

AbstractDespite increasing agricultural productivity, malnutrition remains high among food producers in many developing countries. This study examines how the difference between agricultural household nutrition requirements and production kept for home consumption, the Nutritient deficiency from own production (NDOP), impacts children's height‐for‐age z‐scores (HAZ) using a unique survey of 528 households in Zambia. The study also investigates the relationship between NDOP and market‐bought nutrition and the role of intra‐season price changes in nutrition. To address the endogeneity of NDOP, we use a control function approach. We find that NDOP is associated with lower HAZ. Both energy (calories) NDOP and nutrient‐specific NDOP, resulting from underproduction relative to nutritional requirements and from selling more than surplus food crops, are negatively correlated with HAZ. This result suggests that higher productivity and market participation do not always lead to better nutrition. We also find that crop sales (commercialization) only benefit nutrition if the household only sells surplus output relative to its nutritional requirements. Finally, we also find that NDOP does not correlate with market food purchases, and that the seasonal price increases for cereals further dampens market food purchases. The findings highlight that policies promoting smallholder commercialisation may overlook detrimental nutrition trade‐offs when own‐production falls short of household needs. Accounting for post‐harvest allocation of nutrients between own‐consumption, sales, and purchases can help ensure agricultural interventions improve farmer livelihoods and child nutrition.

Perspective: Can growth monitoring and promotion accurately diagnose or screen for inadequate growth of individual children? A critical review of the epidemiological foundations.

Growth monitoring and promotion (GMP), the process of periodic anthropometric measurements to assess the adequacy of individual child growth, is implemented across low- and middle-income countries (LMICs). The epidemiological foundations of GMP (i.e., that GMP can accurately diagnose or screen for inadequate growth) have never been critically reviewed. We first assessed growth patterns of individual healthy children. Using longitudinal data from low-, middle-, and high-income countries, we evaluated whether commonly used GMP criteria can be used for diagnosis and screening; i.e., if they accurately identify current, or predict subsequent, inadequate growth in individual children. The growth of individual healthy children does not track along a specific growth curve which challenges the notion that growth measurements alone can be used to distinguish between healthy and inadequate growth. We demonstrate that GMP criteria do not provide meaningful diagnostic information and that GMP is not a meaningful screening activity: commonly used GMP criteria are inaccurate predictors of (inadequate) growth later in childhood; and collecting individual children's weight and height does not help to identify who needs support or who will benefit. Our results do not undermine the importance of dedicated programs to diagnose wasting in individual children nor do they challenge the need for well-child care to support parents and to ensure children's optimal nutrition, health, and development. Our findings, however, highlight the need to carefully reconsider the current design of GMP in LMICs.

Gastrostomy tube feeding in children: a single-center experience

BackgroundDespite the widespread use of percutaneous endoscopic gastrostomy (PEG) in pediatric populations, there is a paucity of data on the indications and outcomes of this procedure in Switzerland. This manuscript presents our experience with PEG indication, outcomes, and related complications in children.MethodsThis single-center retrospective study included patients < 18 years old who underwent PEG placement between 2007 and 2016. We retrieved demographics, PEG indications, associated comorbidities, pre-placement workup, growth parameters up to 12 months, and associated complications.ResultsEighty-one patients were included, with a median age of 7 years. Common indications included inadequate caloric intake (85%), failure to thrive, and feeding difficulties. Neurological conditions (46%) were the most commonly associated comorbidity. Thirty-six patients (44%) underwent a pH study before PEG placement. There were significant increases in z-scores for weight (p < 0.002) and body mass index (p < 0.001) 12 months after PEG placement. Minor complications were relatively frequent (n = 55, 68%), mainly granulation tissue or local erythema. Two patients had major complications.ConclusionPEG is a safe technique for providing long-term enteral nutrition in children, with neurological disease being the most common clinical indication. Our experience demonstrated significant weight gain in children after one year of PEG, with frequent but well-controlled complications.

Assessment of the social importance and market potential of new types of meat products for nutrition of preschool and school-age children with an elevated body mass index in the Republic of Belarus

Assessment of the social importance and market potential of new types of meat products for nutrition of preschool and school-age children with an elevated body mass index in the Republic of Belarus

Meals, Mealtimes and moments for learning: Assessment of quality in Early Childhood Education and Care services

Abstract Objective: Early education and care (ECEC) is part of the everyday life of most children in developed economies presenting exceptional opportunity to support nutrition and ongoing food preferences. Yet, the degree to which such opportunity is captured in policy-driven assessment and quality ratings of ECEC services is unknown. Design: Abductive thematic analysis was conducted, guided by key domains of knowledge in nutrition literature and examining identified themes within these domains. Setting: ECEC services (n=38) in Queensland, Australia. Participants: Data were a random sample of field notes pertaining to mealtimes and food provision (n=182) collected as evidence to inform quality ratings during assessment visits to ECEC services. Results: The field notes mapped to three theory-driven domains: Provisions, Practices and Education. Reflecting policy specification, health, hygiene, and safety were a key focus but food quality and quantity were not. Assessors noted promotion of child autonomy at mealtimes yet little evidence pertaining to characteristics of educator-child interactions. Conclusions: Despite evidence that childhood nutrition is crucial for optimal development and learning, quality and quantity of food is not directly assessed. Relationships and interactions at mealtimes provide an environment ideal for promoting learning and development yet the policy guiding inspection and assessment of ECEC services directs focus to a more limited lens of safety, hygiene and promotion of ‘healthy foods’. Our findings identify a narrow conceptualisation of mealtimes focused on ‘health’ as limiting the potential to leverage mealtimes as places to support children’s nutrition and attendant development and learning.

The Costs of a Multisectoral Nutrition Program Implemented Through a Poultry Value Chain Platform in Burkina Faso

ABSTRACTUndernutrition in women and young children in Burkina Faso is a critical problem. Egg consumption is low despite many households raising poultry. The Soutenir l'Exploitation Familiale pour Lancer l'Élevage des Volailles et Valoriser l'Économie Rurale (SELEVER) project, an integrated agriculture‐nutrition intervention, promoted egg consumption and sales to investigate the impact of poultry production on child nutrition. Multisectoral nutrition‐sensitive agriculture programs address nutrition deficits but lack comparable cost information. This study estimates the costs of the SELEVER program, an integrated poultry and nutrition intervention. The study estimates the program's economic costs using a standardized methodology from the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS‐Nutrition) consortium, which aligns financial and economic costs along program impact pathways, allocating costs by activities and inputs. We conducted qualitative interviews and focus groups on time allocation and beneficiary out‐of‐pocket costs. Incremental economic costs were calculated by combining expenditures and economic costs. The total incremental program cost was USD$18,084,727.68 over 5 years, with annual incremental costs of USD$209.20 per direct beneficiary and $796.26 per household. Major cost drivers included overhead (18%), poultry extension (17%), training (16%), household counseling (7%), technical assistance (7%) and microcredit (6%). Total input costs were dominated by personnel (51%), supplies (13%), agricultural inputs (10%) and overhead (9%). We present the total incremental costs of a multisectoral nutrition intervention to generate revenue with poultry. The costs per beneficiary were higher than similar interventions, underscoring the need for cost‐effectiveness evaluations of multisectoral nutrition programs. A standardized cost methodology facilitates comparisons with multisectoral nutrition interventions and builds the evidence base.

Bayesian Sequential Pragmatic Cluster Randomized Clinical Trial Design for PrEventive Effect of MEditerranean Diet in Children: PEMED Trial Research Protocol.

Background: Childhood nutrition plays an important role in the promotion of long-term health. Introducing solid foods in alignment with the Mediterranean Diet during weaning fosters a preference for healthy foods early in life. However, access to nutritious diets remains a challenge in underserved communities. Scampia, a socioeconomically disadvantaged district in Naples, Italy, exemplifies a community where barriers to healthy eating persist. This research reports a trial protocol that plans for a study to evaluate the impact of the Mediterranean Diet on child health and to establish preventive strategies for chronic diseases. Methods: The PEMED (PrEventive effect of MEditerranean Diet in Children) trial is a Bayesian Sequential Pragmatic Cluster Randomized Clinical Trial. Family Pediatricians (FPs) are randomized to deliver either Mediterranean Diet-based dietary guidance starting at weaning or standard dietary practices using typical baby foods. Children will be followed up for six years, with regular assessments of growth, microbiome composition, and adherence to the Mediterranean Diet, using validated tools. Interim analyses will be conducted at three-year intervals to evaluate the efficacy and monitor adverse events. Saliva and stool samples will be collected for genetic and microbiome analyses, and adherence will be monitored through quarterly dietary recalls and biomarkers. Results: This trial will consider Italy's established FP network for implementing innovative dietary intervention in a real-world setting. Conclusions: This study will address nutritional disparities in the underserved Scampia community and provide a scalable model for early dietary interventions. The results will shed light on the role of the Mediterranean Diet in improving childhood health and informing public health strategies globally.

Anthropometric Trajectories in Children Prior to Development of Inflammatory Bowel Disease

Poor nutrition and growth in childhood have short-term and long-term consequences, so understanding the timing of the onset of an impaired nutritional status is crucial for diagnosing and treating inflammatory bowel disease (IBD) at its earliest stage. To assess anthropometric trajectories before a pediatric diagnosis of IBD and growth recovery after diagnosis. This population-based cohort study included children born in Denmark from January 1, 1997, through December 31, 2015, with weight and length or height measurements at birth and at least 1 length or height and weight measurement at school age based on the Danish Medical Birth Register and the Danish National Child Health Register. Within this population, all individuals diagnosed with IBD at ages 5 to 17 years, according to the Danish National Patient Register, were identified. Data were analyzed from October 13, 2023, to April 17, 2024. A pediatric diagnosis of IBD compared with the corresponding population without the disease. The outcome measures were z scores for length or height, weight, and body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) before and after pediatric IBD diagnosis compared with reference and sibling populations. The final study population included 916 133 individuals (51.2% male) with a median of 3 pairs of length or height and weight measurements collected (IQR, 2-6 pairs). Of those, 1522 (median age, 14.3 years [IQR, 11.8-16.3 years]; 763 female [50.1%]) were diagnosed with IBD (851 [55.9%] with Crohn disease [CD] and 671 [44.1%] with ulcerative colitis [UC]). Compared with children without IBD, individuals with a later diagnosis of CD had declining anthropometric measures 3 years (weight: mean, -0.12 g [95% CI, -0.20 to -0.03 g]; BMI: mean, -0.13 [95% CI, -0.21 to -0.04]) and 1 year (length or height: mean, -0.20 cm [95% CI, -0.29 to -0.10 cm]) prior to diagnosis, whereas this was observed 1 year prior to a diagnosis of UC for weight (mean, -0.12 g [95% CI, -0.22 to -0.02 g]) and BMI (mean, -0.13 [95% CI, -0.23 to -0.03]). Deviating anthropometric patterns persisted after diagnosis, with the slowest recovery observed in children with CD. The findings of this large-scale population-based cohort study of anthropometrics in children suggest impaired nutritional status as assessed by weight up to 3 years and by length or height 1 year before a diagnosis of CD and by weight up to 1 year before a diagnosis of UC. These findings emphasize that the onset of pediatric IBD may occur years prior to diagnosis, that growth recovery may first occur after diagnosis and treatment, and that frequent nutritional screenings may help ensure a healthy transition to adulthood.

Adolescent pregnancy, maternal and child anaemia: Empirical analysis from India, Bangladesh, and Nigeria.

Early childbearing poses several potential risks to maternal and child health. This paper empirically analyses the association between teenage pregnancy and child nutritional status, maternal and child anaemia in three countries (Nigeria, India and Bangladesh) that account for the highest proportion of teenage births and/or total number of malnourished teenage mothers and children. Data were sourced from nine waves of Demographic and Health Surveys conducted in Bangladesh, India, and Nigeria from 2005-2018, covering a sample of 27,705 children from Bangladesh, 266,308 children from India and 54,719 children from Nigeria. Our outcome measures of maternal and child nutrition include (i) a composite measure of anthropometric failure for children (CIAF), (ii) maternal anaemia, (iii) childhood anaemia, and (iv) anaemia in maternal-child pairs. Using multivariate regression analysis, we examine the associations between early childbirth, child nutrition, and maternal and child anaemia, controlling for an array of household-level socioeconomic and demographic characteristics. Across all three countries, the prevalence of CIAF (childhood anthropometric failure) is significantly higher among children born to women aged below 17 at first birth. We further find that early pregnancy and childbearing are associated with significantly higher rates of severe/moderate anaemia among both mothers and children in Bangladesh and Nigeria. In the three countries studied, the proportions of teenage mothers with vulnerable socioeconomic status and suboptimal pre-conception care are relatively high, which raises the risk of maternal and child morbidity as well as mortality.

Association between maternal mental health and early childhood development, nutrition, and common childhood illnesses in Khwisero subcounty, Kenya.

Despite the significant public health burden of maternal mental health disorders in sub-Saharan Africa (SSA), limited data are available on their effects on early childhood development (ECD), nutritional status, and child health in the region. This study investigated the association between maternal mental health and ECD, nutritional status, and common childhood illnesses, while controlling for biological, social, financial, and health-related factors and/or confounders. As part of the Innovative Partnership for Universal and Sustainable Healthcare (i-PUSH) program evaluation study, initiated in November 2019, a cohort of low-income rural families, including pregnant women or women of childbearing age with children under five, was recruited for this study. A total of 24 villages were randomly selected from a list of villages near two health facilities. Following a census to identify eligible households, 10 households per village were randomly selected. Data collection included maternal mental health, assessed using Centre for Epidemiological Studies Depression (CES-D) scale, ECD, nutritional status (anthropometric measurements), and common childhood illnesses, their symptoms, and healthcare utilization. This study presents a cross-sectional analysis of the data drawn from endline survey of 299 target mothers and 315 children. The majority of the mothers were aged between 25 and 34 years. The mean age of children was 3.2 years, with 53% being male. The overall maternal mental health score, as measured by the CES-D scale, was 28. Children of mothers with higher CES-D scores exhibited poorer ECD domains, lower nutritional status indicators, and increased incidence of ill-health in the previous two weeks, in both unadjusted and adjusted analyses. Individual, parental, and household factors-including maternal age, household wealth index, and decision-making regarding child healthcare-were significantly associated with children's development, nutrition status, and health outcomes. Children of mothers with low mental health scores demonstrated suboptimal developmental outcomes, nutritional status, and overall well-being, particularly for those from impoverished households. These findings suggest that improving the socioeconomic conditions of low-income households is essential for promoting children's development, nutritional status, and well-being. Longitudinal studies are needed to further investigate the impact of maternal mental health on child development, nutrition, and health outcomes, considering additional factors across the maternal, newborn, and child health continuum. ClinicalTrials.gov (NCT04068571), AEA Registry (AEARCTR-0006089) and PACTR (PACTR202204635504887).

Maintenance treatment with vedolizumab in paediatric inflammatory bowel disease (VEDOKIDS): 54-week outcomes of a multicentre, prospective, cohort study.

Infliximab and adalimumab are the only biologics thus far approved for paediatric patients with inflammatory bowel disease (IBD), so other biologics, such as vedolizumab, are prescribed off-label. Despite its frequent use, prospective data for vedolizumab treatment in children are available only for short-term induction outcomes. We aimed to evaluate the long-term efficacy and safety of maintenance therapy with vedolizumab in paediatric patients with IBD. In this multicentre, prospective, cohort study (VEDOKIDS), children younger than 18 years with Crohn's disease, ulcerative colitis, or IBD unclassified (analysed with the ulcerative colitis group) who had initiated intravenous vedolizumab were enrolled from 17 centres in six countries (Israel, the USA, Italy, Ireland, Denmark, and Slovenia). Patients initiating vedolizumab to prevent postoperative recurrence were excluded. Vedolizumab dose or schedule were not standardised, and concomitant treatment with any other medication was permitted. Patients were prospectively followed up for 54 weeks, with repeated biosampling. The primary outcome was complete remission at week 54, defined as clinical remission (weighted Paediatric Crohn's Disease Activity Index [wPCDAI] of <12·5 points in Crohn's disease and Paediatric Ulcerative Colitis Activity Index [PUCAI] of <10 in ulcerative colitis) without the need for surgery, exclusive enteral nutrition for children with Crohn's disease, or steroids (steroid-free and exclusive enteral nutrition-free clinical remission) plus CRP concentration lower than 1·5 times the upper limit of normal (ULN) of 0·5 mg/dL. In cases of missing data on CRP, ESR was used instead (concentrations <1·5 times the ULN, which was 25 mm/h). Data were analysed by intention to treat. This study is registered with ClinicalTrials.gov, NCT02862132. Between May 19, 2016, and April 1, 2022, we enrolled 142 patients. Five children who had received only one or two infusions of their three-infusion induction before switching drugs due to COVID-19 pandemic-related reasons were excluded, leaving 137 children (64 [47%] with Crohn's disease, 64 [47%] with ulcerative colitis, and nine [7%] with IBD unclassified; 63 [46%] male and 74 [54%] female; age range of 0·7-17·6 years) in the intention-to-treat population. The median wPCDAI score in children with Crohn's disease decreased from 35 (IQR 18 to 49) at baseline to 13 (0 to 25; median of differences -14 [95% CI -33 to 0]) at week 54, and the median PUCAI score in children with ulcerative colitis decreased from 25 (IQR 15 to 50) at baseline to 5 (0 to 25) at week 54 (median of difference -10 [-30 to 0]). Improvements in disease activity were significant by week 6, with no further significant changes between visits. At week 54, 16 (25%) of 64 children with Crohn's disease and 34 (47%) of 73 with ulcerative colitis or IBD unclassified were in complete remission. 38 vedolizumab-related adverse events were recorded in 29 (21%) of 137 children, the most common being headache (n=7), myalgia (n=4), and fever (n=4), and none were serious. Vedolizumab maintenance seems safe and efficacious in children, with a higher efficacy in those with ulcerative colitis than in those with Crohn's disease. The European Crohn's and Colitis Organisation, the European Society for Paediatric Gastroenterology Hepatology and Nutrition, and Takeda.

Reference growth charts for height and weight, for the UAE, the UAEMCGS 2 study

Background Growth charts are the most commonly used tool for evaluating the development and nutrition of children. The UAE had its first chart produced 30 years ago. Aim The goal of the present study was to derive updated growth charts based on the current UAE child population. A national cross-sectional study involving children in all the seven Emirates that comprise the UAE was undertaken (UAEMCGS 2 study- the United Arab Emirates Multi-Centre Growth Study 2). Subjects and methods Anthropometric measurements (height/length and weight) were made on 20,998 children of both sexes from birth to 18 years of age. Growth charts were constructed using the LMS method and are presented. Results On comparing the 1992 and the 2021 UAE growth charts it was found that there was a significant increase in the height of Emirati children at ages 4 and 5 years in 2021. Conclusion The children’s heights and weights in this study were generally larger than those of the UAE children measured in 1992, and the countries in the WHO study, but were generally smaller than those of USA children as seen from the CDC charts.

Parents' Understanding of the 2014 Balanced Nutrition Guidelines by Indonesia's Ministry of Health: A Case Study at Almaarif Kindergarten

The problem of malnutrition in children remains a controversial topic of discussion and an unresolved challenge, especially concerning parental knowledge. Parents must be knowledgeable about balanced nutrition before proceeding to the implementation stage. The purpose of this study was to determine the extent of parental knowledge about the 2014 Balanced Nutrition Guidelines that were developed by the Ministry of Health in Indonesia. In order to collect data, the questionnaire was distributed to 80 respondents who were parents of students at Al-Maarif Singosari Kindergarten in Malang Regency. The questionnaire focused on evaluating parents' understanding of the recommendations for a balanced diet. The research findings revealed that 64% of parents demonstrated a strong comprehension of the balanced diet recommendations, while 36% exhibited a moderate understanding. However, these results are insufficient to ensure the effective implementation of balanced nutrition in children unless the knowledge is consistently translated into practice. Further research is needed on the relationship between parents' understanding of balanced nutrition and children's nutritional levels.

Caste, wealth and geographic equity in program reach and expected outcomes: an exploratory analyses of Suaahara in Nepal.

Monitoring and evaluation of maternal and child nutrition programs typically concentrates on overall population-level results. There is limited understanding, however, of how intervention reach and expected outcomes differ among sub-populations, necessary insight for addressing inequalities. These analyses aim to determine if maternal exposure to social and behavior change (SBC) interventions is associated with scales of maternal practices (antenatal care, iron and folic acid in pregnancy, diet in pregnancy, postnatal care, iron and folic acid postpartum, and maternal dietary diversity) and child practices (institutional birth, health mothers' group participation, growth monitoring and promotion, early initiation of breastfeeding and infant and young child feeding) in Nepal, overall and by wealth, caste, and geography. Cross-sectional data from 2022 from the USAID-funded Suaahara program in Nepal were used for analysis. The study focused on households with children aged 0-2 years (N = 1815). Descriptive analysis was followed by regression models, adjusted for potentially confounding child, mother, and household factors, as well as community-level clustering. Greater intensity of maternal engagement with the SBC interventions was positively associated with both scales for maternal and child nutrition-related practices. The magnitude of the positive associations, however, was less for the socially excluded caste versus others for maternal nutrition; there was almost no caste-based variation in associations for child nutrition. Positive associations were found only among the lower 40% socio-economically when mothers engaged with at least two platforms for maternal nutrition and at least three platforms for child nutrition. In contrast, engagement with one platform for the relatively wealthier was positively associated with both maternal and child outcomes. Similarly, the positive associations were stronger among those residing in the terai (lowland plains) than those in the hills and mountains for both maternal and child outcomes. The scope for improving maternal and child nutrition practices is significant, in part via well-designed, targeted, SBC programs. These analyses highlight the importance of considering different domains of equity both in implementation and related research. Further mixed methods research is needed to more deeply explore why certain types of interventions reach and/or have a greater effect on sub-populations.

Pemanfaatan “SAKESI” Sari Kedelai Melancarkan Produksi ASI

Background: WHO and UNICEF recommend that newborns receive exclusive breastfeeding for 6 months in early life until the age of two years. The low level of exclusive breastfeeding in the community is caused by various challenges such as the assumption that the supply of breast milk is insufficient and the lack of knowledge about natural methods to increase breast milk production. Community service is carried out in RW II, Siwalankerto, Surabaya. Method: Using a natural approach, educational workshops and direct training in preparing soy milk, aimed at mothers, pregnant women, and posyandu cadres. This program focuses on the use of soy-based products, especially "SAKESI" (Soy Milk), as a natural method to increase lactation. Pre- and post-intervention surveys were conducted to assess changes in knowledge and behavior regarding exclusive breastfeeding and the use of soy products. The study findings showed significant improvements in both knowledge and practical application of these methods, indicating the effectiveness of the program in promoting breastfeeding practices. Conclusion: The project highlights the potential of an affordable local resource such as soybeans to address public health challenges related to maternal and child nutrition and also the importance of ongoing community education and support to sustain these improvements.