Maternal Undernutrition Research Articles

Fetal programming and lactation: modulating gene expression in response to undernutrition during intrauterine life.

Adverse environmental conditions during intrauterine life, known as fetal programming, significantly contribute to the development of diseases in adulthood. Fetal programming induced by factors like maternal undernutrition leads to low birth weight and increases the risk of cardiometabolic diseases. We studied a rat model of maternal undernutrition during gestation (MUN) to investigate gene expression changes in cardiac tissue using RNA-sequencing of day 0-1 litters. Moreover, we analyzed the impact of lactation at day 21, in MUN model and cross-fostering experiments, on cardiac structure and function assessed by transthoracic echocardiography, and gene expression changes though qPCR. Our analysis identified specific genes with altered expression in MUN rats at birth. Two of them, Agt and Pparg, stand out for being associated with cardiac hypertrophy and fibrosis. At the end of the lactation period, MUN males showed increased expression of Agt and decreased expression of Pparg, correlating with cardiac hypertrophy. Cross-fostering experiments revealed that lactation with control breastmilk mitigated these expression changes reducing cardiac hypertrophy in MUN males. Our findings highlight the interplay between fetal programming, gene expression, and cardiac hypertrophy suggesting that lactation period is a potential intervention window to mitigate the effects of fetal programming. Heart remodeling involves the alteration of several groups of genes and lactation period plays a key role in establishing gene expression modification caused by fetal programming. We could identify expression changes of relevant genes in cardiac tissue induced by undernutrition during fetal life. We expose the contribution of the lactation period in modulating the expression of Agt and Pparg, relevant genes associated with cardiac hypertrophy. This evidence reveal lactation as a crucial intervention window for preventing or countering fetal programming.

Birth weight mediates the association of maternal undernutrition with child undernutrition prevalence in West Africa.

Maternal nutritional status before and during pregnancy is an important determinant of foetal health. In West Africa, maternal and child undernutrition remains a major public health problem and it is important to establish the mechanistic pathway linking the two disorders to help address the problem. We therefore assessed the mediating role of low birth weight (LBW) in the relationship of maternal undernutrition with child undernutrition in West Africa. We included recent (2010-2019) DHS data from thirteen West African countries. Poisson regression model with robust standard errors was used to assess the relationship between maternal undernutrition (body mass index and anaemia) and child undernutrition (stunting, wasting, underweight, and anaemia). Structural equation modelling was used to conduct the mediation analysis. Prevalence of stunting, wasting, underweight, and anaemia among under-five children in West Africa was found to be 32.4%, 8.1%, 20.1%, and 71.5%, respectively. We found children of underweight mothers to be more likely to be undernourished (stunted, wasted, and underweight) and anaemic compared to children of normal-weight mothers. Also, children of anaemic mothers were more likely to be stunted and anaemic but not wasted compared with children of non-anaemic mothers. LBW mediated the observed relationships between maternal BMI and childhood stunting (22.6%), and maternal anaemia and childhood stunting (24.9%), wasting (11.7), and anaemia (6.6%). We found maternal undernutrition to be associated with child undernutrition in West Africa with LBW noted to be a mediator of the observed relationship. We recommend that, to address the child undernutrition problem in West Africa, governments and policymakers must integrate measures to address the burden of LBW.

Impact of Gut–Brain Axis on Hepatobiliary Diseases in Fetal Programming

The hepatobiliary system is vital for the biotransformation and disposition of endogenous molecules. Any impairment in the normal functioning of the hepatobiliary system leads to a spectrum of hepatobiliary diseases (HBDs), such as liver cirrhosis, fatty liver, biliary dyskinesia, gallbladder cancer, etc. Especially in pregnancy, HBD may result in increased maternal and fetal morbidity and mortality. Maternal HBD is a burden to the fetus’s growth, complicates fetal development, and risks the mother’s life. In fetal programming, the maternal mechanism is significantly disturbed by multiple factors (especially diet) that influence the development of the fetus and increase the frequency of metabolic diseases later in life. Additionally, maternal under-nutrition or over-nutrition (especially in high-fat, high-carbohydrate, or protein-rich diets) lead to dysregulation in gut hormones (CCK, GLP-1, etc.), microbiota metabolite production (SCFA, LPS, TMA, etc.), neurotransmitters (POMC, NPY, etc.), and hepatobiliary signaling (insulin resistance, TNF-a, SREBPs, etc.), which significantly impact fetal programming. Recently, biotherapeutics have provided a new horizon for treating HBD during fetal programming to save the lives of the mother and fetus. This review focuses on how maternal impaired hepatobiliary metabolic signaling leads to disease transmission to the fetus mediated through the gut–brain axis.

A qualitative study of Suaahara II influence on nutrition governance in Nepal.

Maternal and child undernutrition remain major public health problems in Nepal. Suaahara is a USAID-funded multi-sectoral nutrition programme aiming to strengthen local nutrition governance to reduce maternal and child undernutrition, among other objectives. The purpose of this study is to present findings from a recent qualitative evaluation of Suaahara II's influence on the decentralised implementation of Nepal's Multi-sectoral Nutrition Plan (MSNP) and identifying gaps and areas for improvement at the federal, provincial, and local levels to strengthen nutrition governance. This study employed multiple qualitative methods, engaging over 100 multi-sectoral nutrition stakeholders across three levels of government and eight districts. Thematic qualitative analysis was employed to identify emergent and salient themes, which were triangulated with other secondary data sources. Suaahara II had a positive influence on strengthening horizontal coordination for implementing the MSNP and effectively leveraged existing networks to strengthen implementation of nutrition-focused activities at the municipal level. Although there was an observable increased demand for nutrition budgets attributable to Suaahara II activities, sufficient allocation and utilisation, particularly in non-health sectors, did not meet these levels. Nepal's shift to federalism hindered vertical coordination of MSNP implementation. Some formal coordination mechanisms were strengthened, but variation in their effectiveness to strengthen horizontal and vertical coordination to implement MSNP activities continues. Finally, limited government ownership over nutrition activities and facilitating multi-sector coordination to implement the MSNP threatened sustainability of Suaahara II's outcomes on nutrition governance. Future programmes should continue to build on the progress made under Suaahara II, and specifically aim to address challenges in vertical coordination to strengthen nutrition governance in Nepal.

Feasibility and acceptability of a supplementary food with added fish oil and choline for undernourished pregnant women in Sierra Leone

Maternal ready-to-use supplementary foods (M-RUSF) have been shown to improve birth outcomes among undernourished pregnant women. Docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and choline have been hypothesized to further improve gestational duration and cognitive development. The primary objective of this study was to determine the acceptability and feasibility of a new formulation of M-RUSF, referred to as M-RUSF+, that included fish oil, containing about 400 to 500 mg DHA and EPA, and 550 mg choline among pregnant women in the Pujehun District of Sierra Leone. Both the control and the experimental supplementary foods contained 18 g of high quality protein and 580 kcal, with generous amounts of all essential micronutrients. The ration size was 100 g/d. Both intervention and control recipes were locally produced using peanut paste by the Project Peanut Butter Factory in Freetown, Sierra Leone. The fish oil was added to the M-RUSF+ after all the grinding had been accomplished to limit degardation. The study used a 2x2 crossover design to assess the acceptability of the M-RUSF and M-RUSF+ formulations. Pregnant women were assigned to one of two sequences of foods: either M-RUSF+ followed by M-RUSF, or M-RUSF followed by M-RUSF+. Each food was given for one week. Fifty-one pregnant women were enrolled (day 0), with data collection occurring on days 3, 7, 10 and 14 after enrollment. At each visit, women returned the packets, either empty or partially consumed. Acceptability was assessed at all follow-up visits based on overall consumption, likeability, and adverse events reported. Consumption of M-RUSF and M-RUSF+ averaged 99%. The likability scores averaged 4.8 and 4.9 out of 5 for M-RUSF and M-RUSF+, respectively. For 85/90 visits during which M-RUSF+ was being consumed and 77/83 visits during which M-RUSF was being consumed, the foods were rated with a likability score of 5. Adverse events, defined as diarrhea, vomiting or rash were infrequent (<7%) and showed no significant differences. These results suggest that both M-RUSF and M-RUSF+ are acceptable and feasible for use among pregnant women in the Pujehun District, Sierra Leone. Key words: Maternal undernutrition, supplementary food, docosahexaennoic acid (DHA), eicosapentaenoic acid (EPA), choline

The effect of maternal undernutrition on adverse obstetric outcomes among women who attend antenatal care in Gedeo zone public hospitals, cohort study design

BackgroundUndernutrition refers to an overall deficiency of nutrients due to an inadequate intake of a well-balanced diet. Undernourishment during pregnancy is an important contributor to maternal morbidity and mortality. It remains a persistent problem in developing countries, where women usually fall behind men in having access to food, health care, and education. Despite the high prevalence of maternal undernourishment, its direct impact on obstetric outcomes has not been studied in developing countries, including Ethiopia.ObjectiveThis study aimed to assess the effect of maternal undernutrition on adverse obstetric outcomes in Gedeo zone public hospitals.MethodA cohort study design was employed in Gedeo zone public hospitals from June 30, 2022, to February 28, 2023. This study included 721 pregnant women, 237 were exposed group whereas 484 were non-exposed. A systematic random sampling technique was used to select a non-exposed group and the exposed group was selected consecutively. Both groups were followed for 7 months, from 16 weeks of gestation to 24 h of delivery. The pretested interviewer-administered questionnaire and checklist were used. EpiData 4.4.1.2.version was used for data entry and analyzed using Stata version 16 software. A modified Poisson regression model with robust standard errors was used to determine relative risk, and the statistical association was declared at a p-value ≤ 0.05. Finally, the findings were reported in figures, tables, and words.ResultThe incidence of adverse obstetrics outcomes among undernourished and normally nourished mothers was hypertensive disorder during pregnancy (HDDP) (7.49% vs. 3.19%), antepartum haemorrhage (7.49% vs. 3.19%), obstructed labor (1.53% vs. 3.49%), premature rupture of the membrane (2.5% vs. 3.33%), preterm labor (6.52% vs. 6.93%), instrumental vaginal delivery (1.8% vs. 4.3%), postpartum haemorrhage (5.95% vs. 3.88%), and sepsis (3.74% vs. 1.94%). The risk of adverse obstetric outcomes among undernourished women was hypertensive disorder during pregnancy (HDDP) (aRR) = 4.07, 95%CI: 2.53–6.55), antepartum haemorrhage (APH) (aRR = 5.0, 95% CI: 2.08–12.72), preterm labor (aRR = 1.8, 95%CI: 1.23–2.62), operative delivery (aRR = 1.24, 95%C: 0.87–1.78), postpartum haemorrhage (aRR = 3.02, 95%CI: 1.91–4.79), and sepsis/chrioaminitis (aRR = 3.55, 95%CI: 1.83–6.89) times higher than normally nourished women.ConclusionThe incidence rates of hypertensive disorder during pregnancy (HDDP), antepartum haemorrhage, postpartum haemorrhage, and sepsis were higher among undernourished women than normally nourished women. Undernourished women during pregnancy have an increased risk of adverse obstetrics outcomes including hypertensive disorder during pregnancy, antepartum, preterm labor, operative delivery, postpartum haemorrhage, and sepsis/chorioamnionitis.

Burden of undernutrition among under-five Bengali children and its determinants: Findings from Demographic and Health Surveys of Bangladesh and India.

Globally, undernutrition is the leading cause of mortality among under-five children. Bangladesh and India were in the top ten countries in the world for under-five mortality. The aim of the study was to investigate the nutritional status of Bengali under-five children. Data on 25938 under-five children were retrieved from the Bangladesh Demographic and Health Survey 2017-18 (BDHS) and the National Family Health Survey of India 2015-16 (NFHS-4). Stunting, wasting, underweight and thinness were considered to understand the nutritional status of under-five children. Binary logistic regression was used to identify associated factors of undernutrition among children. Over one-quarter of Bengali under-five children were found to be suffering from the problem of stunting (31.9%) and underweight (28.1%), while other nutritional indicators raised serious concern and revealed inter-country disparities. In the cases of wasting, underweight and thinness, the mean z-scores and frequency differences between Bangladesh and India were significant. The nutritional status of Bengali under-five children appeared to have improved in Bangladesh compared to India. Child undernutrition had significant relations with maternal undernutrition in both countries. Girls in Bangladesh had slightly better nutritional status than boys. In Bangladesh, lack of formal education among mothers was a leading cause of child undernutrition. Stunting and underweight coexist with low household wealth index in both counties. The research revealed that various factors were associated with child undernutrition in Bengalis. It has been proposed that programmes promoting maternal education and nutrition, along with household wealth index be prioritised. The study recommends that the Governments of Bangladesh and India should increase the budget for health of children so as to reach the sustainable development goals.

Assessing the effect of women’s empowerment on their dietary intake: a cross-sectional study

Background: Women empowerment is an important strategy to reduce maternal and child undernutrition, which continues to be a major health burden in low- and middle-income countries. The present study aimed to assess the effect of women empowerment on their dietary intake in the two selected blocks of Sultanpuri urban slums, West Delhi. Methods: The baseline was conducted using a cross-sectional research method with girls and women (15-35 years). The research was conducted through a predesigned, pretested, semi-structured questionnaire to capture the information on socio-demographic profiles along with knowledge on social skills, self-esteem, and decision-making. The data were collected on the consumption of food groups in the last 24 hours from 2402 girls and women. We employed unadjusted and adjusted step-wise regression models to assess the effect of domains of women empowerment on dietary intake. Results: The median (interquartile range) age of the women was 27 (22-31) years. We found a 0.17-point increase in the dietary diversity score per one-unit increase in the self-esteem score of the women. Similarly, there was a 0.06-unit increase in the dietary diversity score per one-unit increase in the social skills score of the women. The association remained statistically significant even after adjustments for co-variates like age, education status, and socio-economic status. Conclusions: The present study recommends that focusing on women's empowerment dimensions, particularly social skills, self-esteem, and decision-making power, can be an effective strategy for improving dietary intake among women.

Continuum of care for maternal and child health and child undernutrition in Angola

BackgroundContinuum of care (CoC) for maternal and child health provides opportunities for mothers and children to improve their nutritional status, but many children remain undernourished in Angola. This study aimed to assess the achievement level of CoC and examine the association between the CoC achievement level and child nutritional status.MethodsWe used nationally representative data from the Angola 2015–2016 Multiple Indicator and Health Survey. Completion of CoC was defined as achieving at least four antenatal care visits (4 + ANC), delivery with a skilled birth attendant (SBA), child vaccination at birth, child postnatal check within 2 months (PNC), and a series of child vaccinations at 2, 4, 6, 9 and 15 months of child age. We included under 5 years old children who were eligible for child vaccination questionnaires and their mothers. The difference in CoC achievement level among different nutritional status were presented using the Kaplan-Meier method and examined using the Log-Lank test. Additionally, the multivariable logistic regression analysis examined the associations between child nutritional status and CoC achievement levels.ResultsThe prevalence of child stunting, underweight and wasting was 48.3%, 23.2% and 5.9% respectively. The overall CoC completion level was 1.2%. The level of achieving CoC of mother-child pairs was 62.8% for 4 + ANC, 42.2% for SBA, 23.0% for child vaccination at birth, and 6.7% for PNC, and it continued to decline over 15 months. The Log-Lank test showed that there were significant differences in the CoC achievement level between children with no stunting and those with stunting (p < 0.001), those with no underweight and those with underweight (p < 0.001), those with no wasting and those with wasting (p = 0.003), and those with malnutrition and those with a normal nutritional status (p < 0.001). Achieving 4 + ANC (CoC1), 4 + ANC and SBA (CoC 2), and 4 + ANC, SBA, and child vaccination at birth (CoC 3) were associated with reduction in child stunting and underweight.ConclusionsThe completion of CoC is low in Angola and many children miss their opportunity of nutritional intervention. According to our result, improving care utilization and its continuity could improve child nutritional status.

Maternal undernutrition results in transcript changes in male offspring that may promote resistance to high fat diet induced weight gain.

Maternal nutrition during embryonic development and lactation influences multiple aspects of offspring health. Using mice, this study investigates the effects of maternal caloric restriction (CR) during mid-gestation and lactation on offspring neonatal development and on adult metabolic function when challenged by a high fat diet (HFD). The CR maternal model produced male and female offspring that were significantly smaller, in terms of weight and length, and females had delayed puberty. Adult offspring born to CR dams had a sexually dimorphic response to the high fat diet. Compared to offspring of maternal control dams, adult female, but not male, CR offspring gained more weight in response to high fat diet at 10 weeks. In adipose tissue of male HFD offspring, maternal undernutrition resulted in blunted expression of genes associated with weight gain and increased expression of genes that protect against weight gain. Regardless of maternal nutrition status, HFD male offspring showed increased expression of genes associated with progression toward nonalcoholic fatty liver disease (NAFLD). Furthermore, we observed significant, sexually dimorphic differences in serum TSH. These data reveal tissue- and sex-specific changes in gene and hormone regulation following mild maternal undernutrition, which may offer protection against diet induced weight gain in adult male offspring.

Prevalence of undernutrition and its associated factors among pregnant women in north Shewa, Ethiopia: A multi-center cross-sectional study.

Maternal undernutrition remains a public health issue, particularly in low-income countries such as Ethiopia, which increases the possibility of a cycle of malnutrition in future generations. This study assessed the prevalence of undernutrition and its associated factors among pregnant women in Minjar Shenkora district north Shewa, Ethiopia. The study used a multicenter cross-sectional study design. The study was conducted from June to August 2021 with 334 pregnant women selected using systematic random sampling techniques. A semi-structured questionnaire was used to collect the sociodemographic, obstetric, and dietary data. The nutritional status of the pregnant women was assessed using mid-upper arm circumference measurements. Multivariate logistic regression was used to identify independent variables associated with maternal undernutrition, with an adjusted odds ratio (AOR) of p < 0.05 indicating statistical significance. The prevalence of undernutrition was 22.2%. Low monthly household average income (AOR = 3.69, 95% CI: 1.62-8.40), women's education limitation (AOR = 1.24, 95% CI: 0.28-5.46), poor nutritional attitude (AOR = 2.54, 95% CI: 1.21-5.32), and inadequate dietary diversity score (AOR = 4.42, 95% CI: 1.53-12.8) were significantly associated with undernutrition. Maternal undernutrition prevalence was very high based on the WHO standards, and low monthly household average income, women's education level, poor nutritional attitude, and inadequate dietary diversity scores were associated with undernutrition. Therefore, policies and programs aimed at reducing maternal undernutrition are needed. Socioeconomic strengthening and nutritional counseling during pregnancy are also recommended for improved nutritional status.

Food aversion and its association with pregnant women's nutritional status in Teticha Woreda, Sidama Region, Ethiopia: A community-based mixed comparative cross-sectional study.

Food aversion is one of the reasons for maternal undernutrition. Early screening for maternal undernutrition risk factors would improve the ability to recognize this problem and intervene early. Hence, this study was intended to identify the association of food aversion with maternal nutritional status. To assess food aversion and its association with pregnant women's nutritional status in Teticha Woreda, Sidama region, Ethiopia, March, 2022. In Teticha Woreda, a mixed community-based comparative cross-sectional study was carried out from 1 March to 15 April 2022. Data were collected using an unstructured interview guide for qualitative data and a structured questionnaire for quantitative data. Epi-Data version 3.1 was used to enter quantitative data. Quantitative data were exported and cleaned and analyzed in SPSS version 20. For the quantitative data, descriptive statistics were calculated. To identify predictors of low nutritional status and control for confounders, multivariable logistic regression was utilized. Using Pearson's Chi-square test, the association between food aversion and the anthropometric status of pregnant women was examined. Maternal undernutrition was found in 109 (48.9%; 95% CI: 42.4%-55.4%) of pregnant women with food aversion and 69 (30.9%; 95% CI: 25.1%-37.2%) women without food aversion (mid-upper arm circumference 23 cm). A significant proportion of mothers 95 (42.6%) stated that food aversion stemmed from the taste or smell of the food. Some mothers avoided "Enset," while others avoided foods like cereal, milk, and coffee. In the Chi-square test, pregnant women who had food aversion had a higher likelihood of maternal undernutrition as compared to women who did not have food aversion (p-value of 0.000). This study found higher magnitude of undernutrition among pregnant women who had food aversion as compared to their counterparts. Nutritional interventions, especially nutritional counseling focusing on food aversion, are essential to tackle maternal undernutrition.

Hand Washing Practice and Food Insecurity are Associated With Undernutrition of Breastfeeding Mothers in Rural Ethiopia: A Cross-sectional Study.

Breastfeeding mothers are prone to undernutrition. However, factors contributing to maternal undernutrition are not exhaustively understood. Hence, this study aimed to determine prevalence of undernutrition among breastfeeding mothers and identify associated factors. A cross-sectional study was conducted among 606 breastfeeding mothers from selected rural districts in Oromia and Sidama regional states of Ethiopia. Data were collected through an interviewer-administered questionnaire. Nutritional status was assessed using body mass index (BMI) and mid-upper-arm-circumference (MUAC). Logistic regression analysis was used to identify factors associated with maternal undernutrition. One out of ten breastfeeding mothers was found undernourished as determined by BMI (12.6%) and MUAC (10.7%). Mothers who did not practice hand washing after cleaning children's bottom were 2 and 3 times more likely to be undernourished compared to their counters, as measured by BMI (AOR = 2.29, P = .002) and MUAC (AOR = 3.03, P < .001), respectively. Mothers living in mildly or moderately food insecure households (AOR = 2.37, P = .019) were more than two times more likely to be undernourished as determined by MUAC. Mothers who breastfed children in the age range of 9 to 11 (AOR = 2.79, P = .025) or 12 to 23 (AOR = 2.57, P = .018) months were more than two and half times more likely to be undernourished as determined by BMI. Maternal undernutrition is a medium-level public health problem in rural districts of Oromia and Sidama regional states in Ethiopia. The lack of hand washing practice after cleaning a child's bottom, household food insecurity and higher child age increased the odds of maternal undernutrition. Mothers should prioritize and improve their nutritional care as the age of their breastfed child increases. Nutrition programs in rural districts of Ethiopia should also aim to improve personal hygiene practices and food insecurity integrated with implementation researches to evaluate program's impact on nutritional status of breastfeeding mothers.

Calorie restriction during gestation impacts maternal and offspring fecal microbiome in mice.

Maternal undernutrition is the most common cause of fetal growth restriction (FGR) worldwide. FGR increases morbidity and mortality during infancy, as well as contributes to adult-onset diseases including obesity and type 2 diabetes. The role of the maternal or offspring microbiome in growth outcomes following FGR is not well understood. FGR was induced by 30% maternal calorie restriction (CR) during the second half of gestation in C57BL/6 mice. Pup weights were obtained on day of life 0, 1, and 7 and ages 3, 4 and 16 weeks. Fecal pellets were collected from pregnant dams at gestational day 18.5 and from offspring at ages 3 and 4 weeks of age. Bacterial genomic DNA was used for amplification of the V4 variable region of the 16S rRNA gene. Multivariable associations between maternal CR and taxonomic abundance were assessed using the MaAsLin2 package. Associations between microbial taxa and offspring outcomes were performed using distance-based redundancy analysis and Pearson correlations. FGR pups weighed about 20% less than controls. Beta but not alpha diversity differed between control and CR dam microbiomes. CR dams had lower relative abundance of Turicibacter, Flexispira, and Rikenella, and increased relative abundance of Parabacteroides and Prevotella. Control and FGR offspring microbiota differed by beta diversity at ages 3 and 4 weeks. At 3 weeks, FGR offspring had decreased relative abundance of Akkermansia and Sutterella and increased relative abundance of Anaerostipes and Paraprevotella. At 4 weeks, FGR animals had decreased relative abundance of Allobaculum, Sutterella, Bifidobacterium, and Lactobacillus, among others, and increased relative abundance of Turcibacter, Dorea, and Roseburia. Maternal Helicobacter abundance was positively associated with offspring weight. Akkermansia abundance at age 3 and 4 weeks was negatively associated with adult weight. We demonstrate gut microbial dysbiosis in pregnant dams and offspring at two timepoints following maternal calorie restriction. Additional research is needed to test for functional roles of the microbiome in offspring growth outcomes.

Undernutrition among exclusive breastfeeding mothers and its associated factors in Southwest Ethiopia: A community-based study.

An exclusive breastfeeding period is a time when the infant's feeding depends on only breast milk. Inadequate maternal nutrition during this period could lead to insufficient infant feeding, which can further lead to childhood undernutrition and developmental restrictions. Evidently, the burden of maternal undernutrition was higher in resource-limited countries, including Ethiopia. This study aimed to assess the proportion of undernutrition among exclusive breastfeeding mothers and its associated factors in Southwest Ethiopia. The study used a community-based cross-sectional design. The study was conducted among 442 nursing mothers from 10 to 30 June 2022. The participants were selected using multistage sampling techniques. An interviewer-administered structured questionnaire was used to collect information. Statistical software EpiData version 3.1 and SPSS version 20 were used for data entry and analysis, respectively. The factors associated with undernutrition were identified using a binary logistic regression analysis. In the bivariable analysis, a p-value of less than 0.25 was used to include the variable in the multivariable analysis, whereas p-value less than 0.05 was an odds ratio used to declare an independent association at a 95% confidence interval. The proportion of undernutrition among the participants was found to be 24.8% in the study area. Poor intake of extra meals (adjusted odds ratio = 2.104; 95% confidence interval: 1.208, 3.664), poor dietary diversity habits (adjusted odds ratio = 3.605; 95% confidence interval: 2.112, 6.153), a lack of nutrition information (adjusted odds ratio = 1.853; 95% confidence interval: 1.070, 3.212), and household food insecurity (adjusted odds ratio = 4.424; 95% confidence interval: 2.639, 7.417) were identified as factors enhancing undernutrition among exclusive breastfeeding mothers in the area. A quarter of exclusive breastfeeding mothers were undernourished in the area. Poor dietary diversity habits, poor intake of extra meals, a lack of nutrition information, and household food insecurity were found to be the factors determining undernutrition. Hence, it is important to reinforce nutrition intervention programs, including maternal nutrition education and counseling.

Assessing implementation outcomes for launching balanced energy protein supplementation: A formative study in rural Bangladesh.

Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight and is recommended by World Health Organization (WHO) in countries with high maternal undernutrition. Few countries have implemented BEP programmes due in part to high cost, lack of data on acceptability and feasibility, and complexity of delivery. We sought to address implementation gaps in BEP interventions through a formative study designed to understand implementation outcomes. We conducted 52 in-depth interviews and 8 focus-group discussions with married women of reproductive age, family members, health care providersand pharmacists in three unions of the Gaibandha district in rural Bangladesh. Interviews were translated and transcribed in English and analysed using an analytic framework for implementation science in nutrition. BEP was viewed as an acceptable and appropriate intervention to combat undernutrition in this setting. There was a lack of clarity on who should or could be responsible for providing/distributing BEP in a way convenient to mothers. Many participants preferred door-to-door delivery and thought this approach could address social and gender inequities, but providers mentioned already being overworked and worried about adding new tasks. Participants were concerned about the affordability of BEP and opportunity costs associated with travel to proposed distribution sites such as ANC or pharmacies. Women in these communities do not always have the agency to travel without supervision or make purchasing decisions. BEP supplementation is a complex intervention; future trials seek to assess ways to overcome these implementation challenges and inform a long-term systems-owned BEP intervention.

Maternal diet during gestation affect prostatic tissue component in SHR/Izm offspring.

Numerous studies have investigated the associations between maternal nutritional status and various diseases, with the underlying mechanism often attributed to epigenetic changes. However, limited research has been conducted on the relationship between maternal nutrition and benign prostatic hyperplasia (BPH). In this study, we aimed to explore the potential association between maternal nutrition and BPH using an animal experiment and evaluating the findings through fluorescent immunostaining and genetic analysis. Female spontaneously hypertensive rats (SHR/Izm) were randomly assigned to three groups at the start of pregnancy: a standard diet group (SD; 17% protein, 7% fat), a low-protein diet group (LPD; 6% protein, 7% fat), and a high-fat diet group (HFD; 22% protein, 35% fat). The diets were maintained throughout gestation. After giving birth, both the mothers and their pups were exclusively fed a standard diet. Male pups were euthanized at 48 weeks, and their prostates were removed. The composition of the ventral prostate (VP) was evaluated using fluorescent immunostaining with antibodies for cytokeratin, vimentin, and Ki-67. Microarray analysis, real-time RT-PCR, and DNA methylation analysis using pyrosequencing were performed. Statistical analysis was conducted using one-way ANOVA and Tukey's multiple comparison test, with a significance level set at p < 0.05. Pups in the LPD group exhibited significant underweight from birth (1 day; SD vs.LPD vs.HFD: 4.46 vs. 4.08 vs. 4.35, p = 0.04) until weaning (21 days; SD vs.LPD vs.HFD: 30.8 vs. 27.4 vs. 29.2, p = 0.03). However, they exhibited catch-up growth, and there was no significant difference at 48 weeks (p = 0.84). The epithelial area in the ventral prostate was significantly increased in the LPD group (SD vs.LPD vs.HFD: 39% vs. 48% vs. 37%, p = 0.01), while the stromal area was significantly increased in the HFD group (SD vs.LPD vs.HFD: 11% vs. 11% vs. 15%, p < 0.01). Gene ontology analysis of the gene expression microarray showed increased activity in developmental processes (SD vs.LPD: p = 6.3E-03, SD vs.HFD: p = 7.2E-03), anatomical structure development (SD vs.LPD: p = 6.3E-03, SD vs.HFD: p = 5.3E-03), and cell differentiation (SD vs.LPD: p = 0.018, SD vs.HFD: p = 0.041) in both the LPD and HFD groups. Real-time RT-PCR revealed high expression levels of the transcription factors NFκB (p < 0.01) and Smad3 (p < 0.01) in both the LPD and HFD groups. XIAP, an apoptosis inhibitor, was increased in the LPD group (p = 0.02). The TGF beta pathway, associated with epithelial mesenchymal transition (EMT), and vimentin (p < 0.01) were upregulated in the HFD group. Pyrosequencing DNA methylation analysis of the TGF beta pathway indicated hypomethylation of TGFb1, TGFbR1, and Smad3 in all groups, although there were no significant differences. Our findings suggest that both maternal undernutrition and obesity influence the prostatic development of offspring. Maternal consumption of a low protein diet promotes epithelial hyperplasia through the upregulation of apoptosis inhibitors, while a high fat diet leads to increased stromal growth through the induction of EMT.

24 Effects of Gestational and Postweaning Nutrition on Brain Development and Puberty in Beef Heifers

Abstract Approximately 5 million beef heifers enter the U.S. cow herd annually, and their lifetime productivity is largely dependent upon their ability to attain puberty and produce a calf by 24 mo of age. However, a considerable proportion of heifers within existing U.S. production systems fail to achieve these goals, particularly in southern regions where Bos indicus-influenced cattle predominate. Consequently, managerial approaches are needed that employ nutritional programming of the reproductive neuroendocrine axis, while minimizing feeding costs and optimizing the consistent attainment of puberty by approximately 14 mo of age. Our previous research has clearly demonstrated that increased BW gain between 4 and 8 mo of age facilitates pubertal development by programming hypothalamic centers that regulate gonadotropin releasing-hormone (GnRH) secretion. Among the different metabolic hormones, leptin has a critical role in conveying nutritional information to the hypothalamus and controlling puberty. Two hypothalamic neuronal populations that express the orexigenic peptide neuropeptide Y (NPY) and the anorexigenic peptide alpha melanocyte-stimulating hormone (αMSH; a product of the POMC gene) are key components of afferent pathways that convey inhibitory (NPY) and excitatory (αMSH) inputs to GnRH and kisspeptin neurons. Our studies have demonstrated that short-term increases in dietary energy intake after early weaning at 4 mo of age result in epigenetic, structural, and functional modifications in these hypothalamic pathways to promote high-frequency, episodic release of GnRH and luteinizing hormone. However, integrating the foundational knowledge of metabolic imprinting of the brain for early puberty with issues related to lifetime performance is complex. One approach has been to employ a novel stair-step nutritional regimen involving alternating periods of dietary energy-restriction and re-feeding during juvenile development. This approach is designed to support early onset of puberty by imprinting functional alterations in the hypothalamus during key periods of brain development while optimizing other aspects of growth and performance. Finally, while several key processes of fetal brain development occur during late gestation, neither maternal undernutrition (BCS 3.0-3.5) nor maternal obesity (BCS 7.5-8.0) during the last two trimesters of gestation impacted the organization of hypothalamic neurocircuitries controlling GnRH/LH secretion or age at puberty in the heifer offspring. Collectively, these results indicate that the adult reproductive phenotype in Bos indicus-influenced females is resilient to significant degrees of nutritional stress imposed during prenatal development, particularly if early gestation (first trimester) is avoided. These findings are in contrast with reports in Bos taurus females in which late gestation nutritional extremes result in delayed puberty in heifer offspring, suggesting that potential genotype-specific differences may exist. Research support: USDA-NIFA-AFRI (2018-67015-27595 and 2021-67015-33676).

The misbeliefs and food taboos during pregnancy and early infancy: a pitfall to attaining adequate maternal and child nutrition outcomes among the rural Acholi communities in Northern Uganda

BackgroundIn developing countries, the practice of food taboo is pervasive. The types of foods considered as taboos and the reasons attached to taboos vary from society to society. Food taboos have been recognized as one of the factors contributing to maternal undernutrition in pregnancy, especially in rural settings. In the rural Acholi community where malnutrition is prevalent, very little is known about these food taboos and misbeliefs. This study, therefore, aims to explore various misbeliefs and food taboos in the time of pregnancy that can influence maternal and child nutrition outcomes in Acholi.MethodsA community-based qualitative cross-sectional study was conducted between April and May 2022 in five districts in the Acholi subregion. Focus group discussions (FGDs) and key informant interviews (KIIs) were used to collect data. Data transcription was done verbatim, organised into themes, assigned unique color codes, and manually analysed thematically.ResultsUpon scrutiny of the transcripts, three themes were eminent. The first theme focused on foods that are considered taboos in Acholi community and the reasons linked to them. Participants indicated offals, chicken, wild birds, smoked meat and fish, sugarcane, garden egg (‘Tula’), groundnut, bush meat, mushrooms, honey, sour fruits, or meals (oranges, mango, passion fruits, lemon, tamarind, ‘Malakwang’), goat’s meat, ‘Lalaa’ (the bitter green leafy vegetable), and ‘Lamola’ (Hyptis spicigera) as the major taboo foods. The second theme was the reasons underlying the adherence to the food taboos and misconceptions. Cultural dictates, individual characteristics, and societal context were the main reasons for the adherence to food taboos. The third theme looked at the misconceptions and other taboos during pregnancy. It was found that pregnant women are not allowed to touch grave soil, shave their hair, walk over an anthill, slaughter chicken or birds, have sex during pregnancy, sit on animal’s hide or skin, and/or touch needles.ConclusionsNutritional counseling and education should focus more on addressing food taboos. The mode of delivery of the nutrition message should be inclusive, targeting pregnant women and their spouses, school-going children, adolescent girls, and cultural leaders at their respective points of contact.

Prevalence of Undernutrition Among Tribal Lactating Mothers in Andhra Pradesh, India.

Background In Andhra Pradesh, India, tribal communities face unique nutritional challenges due to limited access to healthcare and a predominantly plant-based diet. Maternal undernutrition is a significant concern, impacting the well-being of both mothers and their offspring. This study focuses on assessing the prevalence of undernutrition among tribal mothers in Andhra Pradeshusing the BMI-for-age criterion. Objectives The aim of this study was to comprehensively evaluate the prevalence of undernutrition among tribal mothers, explore associations with demographic factors, and assess the impact of a nutritional intervention program. The ultimate goal was to contribute to targeted interventions and policies for improving the health and well-being of these communities. Materials and methods A cohort study was conducted in the Guntur district of Andhra Pradesh, involving 340 lactating mothers and their infants. Data collection and anthropometric measurements were performed. Results The study found that 67 (19.71%) of tribal mothers were underweight at baseline. There were statistically significant associations with the Yenadi tribe, low educational status of the mother, and history of lower segment Caesarean section with a high prevalence of being underweight. No significant associations with age, occupation, or socioeconomic status were observed. Undernutrition was more common among mothers with older children and was associated with specific obstetric factors. Conclusion While the prevalence of undernutrition is lower than in some previous studies, it remains a critical concern, particularly within disadvantaged communities. These undernourished mothers face health risks, including anemia. Urgent policy interventions and nutritional programs are needed to address this issue and enhance the well-being of tribal communities in Andhra Pradesh.