Nutrition Program Research Articles

Prenatal intention to human milk feed in the native Hawaiian population: predictors of any human milk feeding from birth to six months postpartum

BackgroundRates of non-communicable diseases are disproportionately high among Native Hawaiian (NH) people, and the proportion of NH infants being fed human milk (HM) is the lowest among all ethnicities within the state of Hawaiʻi. The aim of this study was to explore biological, socio-economic, and psychosocial determinants of the initiation and duration of human milk feeding (HMF) among a study of NH mothers and infants.MethodsA sample of 85 NH mother-infant dyads who were participating in a larger prospective study were involved in this research. Recruitment for the parent was delayed due to the COVID-19 pandemic. Recruitment started in November 2020 and continued until April 2022. Questionnaires were distributed at birth, two-months, four-months, and six-months postpartum. Questionnaires addressed topics relating to maternal and infant characteristics and infant feeding practices. Descriptive statistics, comparative analysis, and multivariate logistic regression tests were conducted.ResultsThe majority of participating mothers were aged between 31 and 35 years, had some college education or more, were employed, and multiparous. The majority of infants were receiving HM at each timepoint (94% at birth, 78% at two-months postpartum, and 76% at four and six-months postpartum). Factors found to be significantly associated with HMF initiation and duration were prenatal intention to HMF, maternal educational attainment, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) recipiency. A prenatal intention to HMF was found to be a strong predictor of HMF at birth (aOR = 64.18, 95% CI 2.94, 1400.28) and at two-months postpartum (aOR = 231.55, 95% CI 2.18, 2418.3). Participants not involved with WIC were more likely to be HMF at four-months postpartum (aOR = 6.83, 95% CI 1.01, 46.23).ConclusionThis research supports existing evidence that prenatal intention to HMF and higher maternal educational attainment are positive predictors of HMF. WIC participation and being a SNAP recipient were found to be negatively associated with HMF which suggests a need for more culturally tailored support. Further research is required to reduce the gap in knowledge related to the determinants of HMF in NH.

School health and nutrition services for children and adolescents in Tanzania: A review of policies and programmes.

School health and nutrition programmes are effective strategies to address the health problems among school-going children and adolescents. We examined the policy environments, successesand bottlenecks associated with school health and nutrition programmes in Tanzania. We used the 'policy triangle framework' to examine 22 national and regional school health and nutrition policies and programmes in Tanzania. We also interviewed 16 key informants to gain further insights into school health and nutrition programmes. Several school health and nutrition policies in Tanzania outline the basic elements of school-based health and nutrition services. Yet, these documents neither recognise vulnerable groups, recommend age-appropriate strategies to address children's and adolescents' varied and transient needs, nor provide a framework for implementing and tracking recommended activities. In these documents, underweight and infectious diseases, including humanimmunodeficiency virus/acquired immunodeficiency syndrome, are frequently identified as major concerns of young people, with little or no consideration of social determinants. Diverse strategies including school feeding, water and sanitation services, health and nutrition educationand promotion of healthy behaviours are identified. In doing so, these documents adequately define the roles and responsibilities of all government actors, but young people and their guardians are not actively engaged in design and implementation. Additionally, there are several challenges to implementing these policies including budgetary constraints, limited resources, a lack of inter-sectoral coordinationand insufficient capacity within targeted schools. To improve the health and nutritional status of school-going children and adolescents in Tanzania, adequate budgets, strengthened coordination and implementation efforts, the development of school-based stakeholders' capacity, as well as the involvement of all other stakeholders, including adolescents, are imperative.

Study on Nutritional Status of the Adolescent Relationship with their Socio-Economic Status in Bagha, Rajshahi

Background: Adolescents' nutritional status is crucial to their overall health and development. Various socio-economic factors play significant roles in influencing this status, especially in rural areas. Objective: The study aimed to identify the factors contributing to adolescents' nutritional status and to examine the relationship between these factors and the adolescents' socio-economic characteristics in Bagha, Rajshahi. Method: Data were collected from 250 adolescents using structured interview schedules. Key variables studied included the adolescents' education, mothers' education, family income, food intake, and nutritional knowledge. Correlation and multiple linear regression analyses were conducted to evaluate the associations between these variables and the adolescents' BMI and nutritional status. Result: The study revealed that adolescents' BMI had significant positive correlations with their education, mothers' education, family income, food intake, and nutritional knowledge. An inverse correlation was found between nutritional status and disease information. Other factors, such as gender, religion, family size, fathers' education, and hygiene practices, showed positive but non-significant associations. Negative, non-significant correlations were observed with age, physical activity, transportation, leisure activities, and participation in nutrition programs. A substantial majority (89.6%) of respondents were inactive in calorie intake, with only 2.4% being active. Most adolescents (79.6%) were underweight, while 20% had normal weight. Most mothers (63.3%) and fathers (55%) had primary-level education. Multiple linear regression analysis indicated that annual family income, food intake, and nutritional awareness were positively correlated with nutritional status, whereas disease information had a significant negative correlation. Conclusions: The findings highlight the critical impact of socio-economic factors on adolescents' nutritional status. .......

Delivery platforms for reaching adolescents with nutrition interventions in low- and middle-income countries.

Adolescents in low- and middle-income countries (LMICs) are a vulnerable population given increased nutritional needs as puberty approaches. School-based nutrition programs exist in some settings, but the comprehensive provision of nutrition services requires knowledge of the mechanisms to reach out-of-school adolescents. A comprehensive scopingreview was performed using formal and informal search strategies to landscape all potential delivery platforms with nutrition services to reach adolescents. Peer-reviewed studies, institutional strategies, program evaluations, and programmatic reports in LMICs were reviewed, including gray literature. A total of 87 out of 270 identified publications and reports describing nutrition programs for adolescents were identified. Although nutrition programs targeted at adolescents were sparse, various innovative and inclusive delivery platforms were included, such as school feeding programs, school-based anemia control, and nutrition-friendly school initiatives; health facility-based, youth-friendly health and nutrition services; social safety nets targeted at adolescents; community-based approaches targeting youth development and peer education within youth centers and faith-based settings; and technology-based platforms, including digital health services and mass media communication sensitization and mobilization efforts. Existing delivery mechanisms and platforms in health and other sectors that target adolescents offer great potential to extend nutrition interventions to this vulnerable yet hard-to-reach population.

Wasting and Its Associated Nutritional and Non-Nutritional Factors among Under-Five Children in Marrakesh Province, Morocco

Introduction: Malnutrition is the most common nutritional disorder in developing countries and it remains one of the most common causes of morbidity and mortality among children worldwide. Therefore, the current study aimed to assess the prevalence of wasting and its associated factors among under-five children in Marrakesh province in Morocco. Method: A community-based cross-sectional study design was used to determine the prevalence of wasting and its associated factors among under-5 years old children. A structured questionnaire was used to collect data from 430 children paired with their mothers. Anthropometric measurements and determinant factors were collected. SPSS version 19.0 statistical software was used for analysis. Multivariate logistic regression analysis was conducted to identify factors associated to the wasting of the children. Statistical association was declared significant if p value was less than0.05. Results: In this study, the prevalence of wasting was 9.3%. The proportions of severe and moderate wasting children were 6.5% and 2.8%, respectively. Higher odds of wasting children among illiterate mothers were 17 times more likely compared with mothers with high levels (ORa = 17.17; 95% CI: 1.01–13.70). In line with this, the odds of wasting children among lower household incomes were 13 times more likely when compared to those with higher household incomes (ORa = 13.114; 95% CI: 1.13–7.60). Similarly, the odds of wasting children among mothers primiparous were 12 times more likely compared with multiparous (ORa = 12.88; 95% CI: 1.04–4.08). The odds of wasting children were more observed among children who did not benefit from exclusive breastfeeding (ORa = 12.297; 95% CI: 2.47–13.03, 1.03–5.34). Conclusions: The current study showed that the prevalence of wasting among under-five children in Marrakesh province was relatively common. Mother’s education level, household income, parity, and exclusive breastfeeding were significantly associated with wasting. Therefore, nutritional educational intervention programs in Marrakesh province should focus on these factors.

The intricate relationship between obesity, type 2 diabetes and female breast cancer: A retrospective study of 335 women.

Type 2 diabetes (T2D) is a risk factor for female breast cancer (FBC). Obesity has also been associated with FBC, also depending on menopausal status. This study aimed to evaluate the impact of obesity and T2D on the development, aggressiveness, and invasiveness of FBC. Demographic, clinical, and histopathological data from 335 women with FBC were collected, and analyzed according to weight category (102 normal weight, 117 overweight, and 116 living with obesity) and the presence/absence of T2D. Age at oncologic diagnosis was not statistically significantly different for body weight; women with overweight or obesity were more likely to have an oncologic diagnosis after menopause than normal weight (p<0.001). The presence of overweight/obesity and T2D seemed to be associated with a higher incidence of metastasis, recurrence, and triple-negative breast cancer (TNBC) subtype (p<0.001). Excess body weight was also associated with high histologic grade (G3) (p<0.005). These results confirm excess body weight and T2D as unfavorable prognostic factors in terms of the presence of the TNBC subtype, tumor metastasis, recurrence, and aggressiveness (G3 and Ki-67>20%). This study highlights the importance of prevention in all women, with early screening, and adequate nutritional programs.

The Policy of Compulsory Large-Scale Food Fortification in Sub-Saharan Africa.

Food fortification with micronutrients was initially justified in developed countries by a lack of availability of micronutrients in staple crops, mainly due to soil exhaustion. However, in Sub-Saharan arable lands, soil fatigue is not predominant, and communities consume mostly home-grown, organic, non-processed crops. Sub-Saharan food systems are nevertheless deeply entwined with food insecurity, driver of illnesses. Family production can promote subsistence, food stability, and self-sufficiency, the main SSA setback being the vicious cycle of poverty and the lack of dietary variety, contributing to malnutrition. Poverty reduction and women's education are significant strategies for reducing child and adolescent undernourishment. Fortification of foods consumed daily by individuals makes sense and can minimize, if not entirely, eliminate deficiencies. Compulsory mass fortification of foods in Sub-Saharan Africa (SSA) with single micronutrients is, however, controversial since they work in synergy among each other and with the food matrix, for optimal absorption and metabolism. Since the causes of malnutrition are many, caused by diverse, unequal, and unjust food distribution, interrelated with political, social, cultural, or economic factors, education status of the population, season and climatic changes, and effectiveness of nutrition programs, just food fortification cannot solve the composite of all these elements. Further, compulsory fortification is excessive, unproductive, and likely harmful to human health, while many challenges remain in assessing the quality of available premixes. Furthermore, aiming at dietary diversification is the best approach of increasing trace element intake from commonly accessible and easily available food sources.

Long COVID and the Higher Risk of Food Insecurity Among Participants and Nonparticipants of Food Assistance Programs in the United States

BackgroundIn the aftermath of the COVID-19 public health emergency, it is important to understand the extent of socioeconomic burdens of long COVID, defined as continuation of symptoms after initial infection, including food insecurity. ObjectiveThis study aimed to assess the association between long COVID and family food insecurity among low-income individuals (or any of their family members living with them) who were participants and nonparticipants in public food assistance programs (Supplemental Nutrition Assistance Program [SNAP], Special Supplemental Nutrition Program for Women, Infants, and Children [WIC], and National School Lunch Program [NSLP]) in the United States. DesignThe study used an observational cross-sectional design. Participants/settingData on 7151 adults (aged 18+ years), with family income of < 200% of the Federal Poverty line, from the 2022 National Health Interview Survey, were analyzed. Main outcome measuresLevel of family food security, based on responses to a set of 10 questions measuring family’s food security during the past 30 days. Statistical analyses performedMultinomial logistic regression models were estimated to obtain relative risk ratios of marginal and low/very low food security, relative to the base outcome of high food security, for long COVID status. Multivariable models were estimated separately for the full sample and for subgroups of food assistance participants and nonparticipants. A seemingly unrelated regression (SUR) specification was estimated to assess whether the estimates were different across the participant and nonparticipant subgroups. ResultsCompared with individuals who never had COVID-19, the adjusted relative risks of experiencing marginal and low/very low food security were 1.42 (95% CI, 1.00–2.02) and 1.43 (95% CI, 1.08–1.91) times higher, respectively, for individuals who had long COVID. Although the adjusted risks were not observed to be statistically significant in the participant subgroup, among nonparticipants, adjusted relative risk ratios were 2.34 (95% CI, 1.43–3.82) and 1.56 (95% CI, 1.02–2.39), respectively. SUR results showed that relationships between long COVID and food insecurity were only different for marginal and not low/very low levels of food security between food assistance participant and nonparticipant groups. ConclusionsStudy findings highlight a significantly higher risk of marginal and low/very low- food security among low-income adults who had long COVID, especially those who were nonparticipants in public food assistance programs. Further research is warranted to explore the causal pathways of this relationship for informing policies to mitigate the burden of long COVID.

The Use of Pictorial Recall Aids Modifies Dietary Assessment Results: Experiences from Quantitative 24-hour Dietary Recalls of Young Children in Nepal and Senegal

BackgroundRecall bias or memory error is a known limitation of recall-based dietary assessment methods and can lead to substantial misrepresentation of diets. Pictorial recall aids have been used by various studies to mitigate recall bias, but their effect on quantitative, 4-pass 24-h dietary recall (24HR) results has not yet been measured. ObjectivesThis article examines uptake of pictorial recall aids among caregivers of young children in Kathmandu Valley, Nepal, and Guédiawaye Department, Senegal; describes what foods/beverages are subject to recall bias in these contexts; and assesses the effect of these recall aids on estimated dietary outcomes. MethodsWe used cross-sectional data from 24HR surveys that provided a recall aid to reduce caregiver recall bias. Young children’s dietary outcomes were calculated from the 24HR data. Logistic regressions were used to compare characteristics and estimated dietary outcomes of children by recall aid uptake. McNemar’s test and paired t-tests were used to compare estimated dietary outcomes in initial 24HR data with revised 24HR data that incorporated omitted items identified by the recall aid. ResultsPictorial recall aids had relatively high uptake by caregivers in both contexts. Beverages, unhealthy snacks, and fruit were most subject to recall bias. Adding omitted items identified by recall aids resulted in statistically significant changes in most dietary outcomes assessed. Children of caregivers who chose to use the recall aid had significantly different estimated dietary outcomes than children of caregivers who did not use the recall aid. ConclusionsThe use of pictorial recall aids modifies 24HR results in these 2 contexts. Rigorous research is needed to fully understand the impact of recall aids on 24HR methodology and results, with an aim to improve the accuracy of dietary assessment and ultimately inform evidence-based nutrition programming, policy, and recommendations.

Dr. Coluthur Gopalan: Father of Indian Nutrition Science.

Dr. Coluthur Gopalan, a towering figure in nutrition science in India, made seminal contributions that transformed public health and nutrition policy in the country. Born in Salem, Tamil Nadu, in 1918, Dr. Gopalan's illustrious academic journey began at the Christian College High School and Madras Medical College, where he earned his M.D. in General Medicine in 1943. The Bengal Famine of 1942 profoundly influenced his career, steering him towards nutrition research. Awarded the Nuffield Foundation Scholarship, he earned a Ph.D. in nutrition from the University of London in just 30 months. Upon his return to India, he joined the Nutrition Research Laboratories (NRL) in Coonoor in 1949, which later became the National Institute of Nutrition (NIN), where he significantly broadened the scope of nutrition research. Dr. Gopalan's work laid the foundation for pivotal national nutrition programs, such as the Integrated Child Development Services (ICDS) and the midday meal scheme for schoolchildren. His tenure as Director of NIN (1960-1974) and later as Director General of the Indian Council of Medical Research (ICMR) from 1974 to 1979 saw major advancements in addressing malnutrition and emerging issues like overnutrition. His dedication to improving women's and children's nutritional status left a lasting impact on public health in India. Dr. Gopalan's pioneering research on protein-calorie malnutrition, micronutrient deficiencies, and holistic approaches to nutritional problems provided critical insights and guided thenational policies. As an institution builder, he transformed NIN into a premier research center and during his tenure established new research institutes at ICMR, fostering a robust framework for future research. His advocacy ensured that nutrition was prioritized in national development plans, leading to significant health improvements. Internationally recognized, Dr. Gopalan's contributions included efforts to improve global nutrition, earning him numerous accolades. His legacy, encapsulated in the Nutrition Foundation of India, and his several contributionscontinueto be a vital resource for nutritionists and policymakers, ensuring lasting benefits for future generations. Dr. Gopalan's compassionate personality, visionary leadership, and holistic approach have indelibly advanced the nutritional status and health of millions globally.

Special Supplemental Nutrition Program for Women, Infants, and Children Enrollment and Adverse Pregnancy Outcomes Among Nulliparous Individuals.

To evaluate the relationship between changes in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment during pregnancy from 2016 to 2019 and rates of adverse pregnancy outcomes in U.S. counties in 2019. We conducted a serial, cross-sectional ecologic study at the county level using National Center for Health Statistics natality data from 2016 to 2019 of nulliparous individuals eligible for WIC. The exposure was the change in county-level WIC enrollment from 2016 to 2019 (increase [more than 0%] vs no change or decrease [0% or less]). Outcomes were adverse pregnancy outcomes assessed in 2019 and included maternal outcomes (ie, gestational diabetes mellitus [GDM], hypertensive disorders of pregnancy, cesarean delivery, intensive care unit [ICU] admission, and transfusion) and neonatal outcomes (ie, large for gestational age [LGA], small for gestational age [SGA], preterm birth, and neonatal intensive care unit [NICU] admission). Among 1,945,914 deliveries from 3,120 U.S. counties, the age-standardized rate of WIC enrollment decreased from 73.1 (95% CI, 73.0-73.2) per 100 live births in 2016 to 66.1 (95% CI, 66.0-66.2) per 100 live births in 2019, for a mean annual percent change decrease of 3.2% (95% CI, -3.7% to -2.9%) per year. Compared with individuals in counties in which WIC enrollment decreased or did not change, individuals living in counties in which WIC enrollment increased had lower rates of maternal adverse pregnancy outcomes, including GDM (adjusted odds ratio [aOR] 0.71, 95% CI, 0.57-0.89), ICU admission (aOR 0.47, 95% CI, 0.34-0.65), and transfusion (aOR 0.68, 95% CI, 0.53-0.88), and neonatal adverse pregnancy outcomes, including preterm birth (aOR 0.71, 95% CI, 0.56-0.90) and NICU admission (aOR 0.77, 95% CI, 0.60-0.97), but not cesarean delivery, hypertensive disorders of pregnancy, or LGA or SGA birth. Increasing WIC enrollment during pregnancy at the county level was associated with a lower risk of adverse pregnancy outcomes. In an era when WIC enrollment has decreased and food and nutrition insecurity has increased, efforts are needed to increase WIC enrollment among eligible individuals in pregnancy.

Combined effects of a Mediterranean diet and respiratory muscle training on higher education woodwind musicians: A randomized controlled trial

A two-factor within subjects and randomized controlled was conducted with three groups (two experimental and one control) to explore the effects of the Mediterranean diet and respiratory muscle training on ventilatory fatigue, stress, and emotional performance of woodwind musicians. 70 students from the Valencia Conservatory of Music were recruited and randomized into three groups: respiratory training group + nutrition program (RTG; n = 17), control group (CG; n = 35) and nutrition program group (NPG; n = 18). The nutritional program was based on Mediterranean a diet. Body composition, emotional intelligence, physiological stress and ventilatory response were assessed for all groups before and after intervention. Mixed ANOVA showed main effects of diet and training interventions on emotional attention (F = 8.042; p = 0.006), clarity (F = 9.306; p = 0.003), repair (F = 5.527; p = 0.022), Forced-Expiratory-Volume (F = 30.196; p < 0.000) and Forced-Vital-Capacity (F = 21.052; p < 0.000), with both interventions improving emotional intelligence and ventilatory variables. Bonferroni post-hoc analysis revealed significant differences of RTG and CG for emotional attention (MD = 4.60; p = 0.023), comprehension (MD = 5.734; p = 0.005), repair (MD = 8.576; p < 0.000), FEV1 (MD = 0.862; p = 0.005), and FCV (MD = 1.608; p < 0.001); with similar results when comparing NTG and CG: emotional attention (MD = 4.156; p = 0.041), comprehension (MD = 4.473; p = 0.033), repair (MD = 6.511; p = 0.001), Forced-Expiratory-Volume (MD = 1.608; p < 0.001), and Forced-Vital-Capacity (MD = 1.183; p < 0.001). No significant effects of experimental groups were observed for physiological stress variables (p > 0.05). This results suggests that respiratory training enhances emotional intelligence and lessens respiratory fatigue in musicians, and a combination of a Mediterranean diet and respiratory muscle training further boosts emotional intelligence, albeit with limited impact on physiological stress. This study represents a novel investigation into the approach by dietary interventions and respiratory muscle training in wind musicians since there are no studies that analyze it.

Summary of the best evidence for nutritional support programs in nasopharyngeal carcinoma patients undergoing radiotherapy.

To evaluate and summarize the best evidence for nutritional support in patients receiving radiotherapy for nasopharyngeal carcinoma and to offer guidance for clinical practice. Patients with nasopharyngeal carcinoma undergoing radiotherapy often experience a high prevalence of malnutrition, and there is a lack of compiled guideline recommendations, which complicates the provision of a reference for clinical nursing. A systematic literature search revealed the best evidence of nutritional support for nasopharyngeal carcinoma patients undergoing radiotherapy. Included in the review were various types of literature, such as clinical guidelines, expert consensus, systematic evaluations, meta-analyses, evidence summaries, and original studies. The evidence was graded according to the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Evidence Pre-Grading System (2016 version). Data were gathered from a range of sources, including BMJ Best Practice, the Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Web of Science, CINAL, CNKI, the WanFang database, SinoMed, the Yi Maitong Guidelines Network, Dingxiangyuan, the Chinese Nutrition Society, the European Society for Clinical Nutrition and Metabolism website, and the American Society for Parenteral and Enteral Nutrition website. The search spanned from January 2013 to 2023. A comprehensive review identified a total of 3,207 articles, comprising six guidelines, eight expert consensus articles, four systematic evaluations, five randomized controlled trials, two cohort trials, and two observational studies. From these articles, we synthesized 63 pieces of evidence spanning six domains: nutritional risk screening and assessment, nutrient requirements, nutritional support, management of nutritional symptoms, functional exercise, and nutritional monitoring and follow-up. A total of lines of evidence supporting nutritional support for nasopharyngeal carcinoma patients receiving radiotherapy were summarized. However, the evidence should be combined with the actual clinical situation, and it should be validated in the future by combining large-sample and multicenter studies to provide a more scientific and beneficial nutritional support program for nasopharyngeal carcinoma patients receiving radiotherapy.

Impact of iron tablet administration and nutritional counseling: Hemoglobin level improvement in anemic pregnant women

Background: According to the 2013 Riskesdas, the prevalence of anemia in Indonesia was 37.1%. Data from the Pariaman City Health Office showed that the prevalence of anemia in 2014 was 43.1%. This study aims to determine the effect of iron (Fe) tablets and nutritional counseling on hemoglobin levels in pregnant women with anemia in the Pariaman City area in 2016. Methods: This study is a quantitative study using a quasi-experimental design. The study population consisted of third-trimester pregnant women with anemia, divided into two groups: the Fe tablet group (n=20) and the Fe tablet plus nutritional counseling group (n=20). Data analysis was performed using univariate and bivariate analysis with the Dependent T-Test statistical test. Findings: The results showed that the average knowledge score in the Fe group was 0.3, while in the Fe plus nutritional counseling group it was 1.4. The average change in knowledge scores between the two groups showed a significant increase (p=0.002). The average attitude score in the Fe group was 2.15, while in the Fe plus nutritional counseling group it was 2.75. The average change in attitude scores between the two groups was not significant (p=0.205). The average action score in the Fe group was 1.050, while in the Fe plus nutritional counseling group it was 2.7. The average change in action scores between the two groups showed a significant increase (p=0.002). The average difference in hemoglobin levels in the Fe group was 0.280, while in the Fe plus nutritional counseling group it was 0.690. The average change in hemoglobin levels between the two groups showed a significant increase (p=0.008). Conclusion: It can be concluded that the provision of Fe supplementation and nutritional counseling results in a higher increase in hemoglobin levels compared to Fe tablets alone. It is hoped that nutritionists in the field will be more active in providing nutritional counseling to pregnant women with anemia to increase their knowledge about anemia. Novelty/Originality of this article: This study proposes an integrated nutritional intervention model combining Fe tablets with a community-based interactive nutritional counselling program. This model can increase the effectiveness of anaemia control programs in pregnant women by combining supplementation and education.

Beliefs of Torajanese Pregnant Mother

Introduction: Various factors impact the health of pregnant women, including access to healthcare facilities and a nutritious diet. Cultural norms and beliefs prevalent in Indonesian society may influence food consumption patterns. This study explores dietary restrictions and preferred food choices during pregnancy among Toraja ethnic pregnant women.Methods: Employing a qualitative research methodology, specifically a descriptive phenomenological approach, this study was conducted within the jurisdiction of the Ge'tengan Community Health Center, Mengkendek District, Tana Toraja, Indonesia. The research adopted purposive sampling, involving eight pregnant women as participants. Data was collected through individual interviews, lasting 45 to 60 minutes for each participant.Results: The findings revealed three overarching themes: prohibited foods during pregnancy, reduced staple food intake, and the influence of elders on dietary practices and beliefs.Conclusion: Leveraging traditional wisdom regarding dietary recommendations can serve as valuable input in designing nutritional education programs tailored to meet the needs of Toraja ethnic pregnant women. Meanwhile, there are some foods that mothers need as support in fulfilling nutrition, and this is contrary to health. Therefore, it is very important to raise public awareness by disseminating accurate information about nutrition for pregnant women in the Toraja tribe by maintaining culture if it is not contrary to health, then helping people to adapt to cultures that benefit health called negotiation, and changing or replacing culture if the culture or habit is detrimental.

Kyrgyz Republic production-resource and export potential state regulation mechanism

The study addressed the mechanism of state regulation of the production, resource and export potential of the Kyrgyz Republic. The study aimed to improve the system of state regulation of the agricultural sector to increase national food security. The analysis revealed a steady increase in production of the main types of agricultural products over the period 2014-2024: cereals by 11.6%, potatoes by 12.5%, vegetables by 18.2%, meat by 24.5% and milk by 17.1%. However, the study also showed uneven levels of self-sufficiency across different types of products: the high levels of self-sufficiency in potatoes (167.4%), vegetables (164.5%) and milk (116.5%) contrast with the low levels of self-sufficiency in fruit and berries (18.2%), vegetable oil (44%) and sugar (69%). An analysis of the existing state regulatory mechanisms revealed a comprehensive legal framework, including the Law of the Kyrgyz Republic No. 320 “On Food Security” and the “Food Security and Nutrition Programme for 2019-2023”, but their implementation is limited by insufficient funding and administrative barriers. Based on the analysis, recommendations were developed to optimise the state regulatory mechanism, including the introduction of a differentiated subsidy system, optimisation of the structure of exports and imports of agricultural products, increasing the efficiency of agricultural production, development of agricultural processing and improving the food quality control system. Proposed measures include the creation of the brand “Ecologically clean products of Kyrgyzstan”, the introduction of the Global G.A.P. certification system, the creation of a network of regional agricultural-consulting centres, the development of agro-industrial parks and the modernisation of quality control laboratories. The implementation of these measures aims to overcome the identified problems create more favourable conditions for the development of agriculture and ensure food security in the Kyrgyz Republic

Mixed Methods Study Investigating Adolescent Acceptance and Implementation Outcomes of Serving Spicy Vegetables in School Lunch

BackgroundOnly a few adolescents are meeting their daily vegetable requirement. At the same time, spicy food is increasingly popular and familiar across cultures. ObjectivesTo explore the implementation of spicy vegetables into school meals, the primary objective is to determine adolescents’ preferred degree of hot spice on steamed broccoli. Secondary objectives include estimating the appropriateness and acceptability of spicy vegetables in the National School Lunch Program and identifying strategies to promote spicy vegetables within school meals. MethodsOne hundred participants between the age 11 and 17 y sampled 4 steamed broccoli florets with varying levels of a ground red and cayenne pepper spice blend (0, 0.9, 2.0, and 4.0 g). Participants rated their likeability of each broccoli sample on a 9-point hedonic scale and answered a survey assessing chili liking, chili consumption patterns, appropriateness, and acceptability. An interview assessed perspectives on spicy vegetables within school lunch.Regression analyses assessed relationships between participant attributes and sample ratings and survey outcomes. Agglomerative hierarchical cluster analysis was conducted to cluster together participants with similar sample liking ratings. ResultsSeventy-seven percent of participants reported that chili pepper makes food taste better, and 67% consumed spicy food weekly or daily. Chili likers (n = 41) were the dominant cluster group, compared with moderates (n = 31) and chili dislikers (n = 28). Thematic analysis results suggested that most participants support incorporating spicy vegetables into school lunch but mushy vegetable texture may undermine the impact of changing school vegetable spice levels. ConclusionsSpicy foods are commonly consumed by adolescents, and these findings support the inclusion of spicy vegetables in school lunch. Additional research is needed to identify policies and practices to improve the texture of vegetables in school meals and determine additional strategies to support cultural humility in child nutrition programs.

The SABER School Feeding policy tool: a 10-year analysis of its use by countries in developing policies for their national school meals programs.

Since its launch in 2011, 59 governments have used the World Bank's Systems Approach for Better Education Results (SABER) policy tool to design their national school-based health and nutrition programs. This tool guides governments to self-evaluate their education system policies against international benchmarks and identify actionable priorities to strengthen national programs. Thirty-two of the 49 countries in sub-Saharan Africa (65%) have undertaken a SABER review, and globally the approach has been adopted by 68% of the world's low-income countries and 54% of lower-middle-income countries. Analysis of 51 comparable SABER School Feeding surveys suggests that countries with longer established national school meals frameworks tend also to be more advanced in other policy areas, and vice versa. The SABER reviews consistently identify, perhaps predictably, that the weakest policy areas relate to program design, implementation and fiscal space. This analysis also found that the tool had an additional value in tracking the evolution of policies when implemented over several time points, and showed that policy areas become more advanced as national programs mature. These benefits of the tool are particularly relevant to the 98 countries that co-created the global School Meals Coalition in 2021. The Coalition member countries have the specific goal of enhancing coverage and support for the well-being of schoolchildren and adolescents affected by the school closures during the COVID-19 pandemic. The SABER tool has the demonstrated potential to implement, accelerate and track changes in school meals policy and, since it has been previously used by 74% (31/42) of low- and lower-middle-income countries in sub-Saharan Africa, is an already accepted element of the political economies of those countries and so has the potential to be deployed rapidly.

Synergistic impact of plasma albumin and cognitive function on all-cause mortality in Chinese older adults: a prospective cohort study.

Hypoalbuminemia and cognitive impairment (CI) each independently increase the mortality risk in older adults. However, these two geriatric syndromes can occur simultaneously. In community-dwelling older adults, is the combination of hypoalbuminemia and CI linked to a higher mortality risk than either condition alone? We aimed to investigate the association between plasma albumin, cognitive function, and their synergistic effect on mortality in Chinese community-dwelling older adults. Data from the Chinese Longitudinal Healthy Longevity Survey (2012) included 1,858 participants aged ≥65. Baseline assessments comprised albumin levels and cognitive status. All-cause mortality was confirmed through 2014-2018 surveys. Cox proportional hazards models assessed associations, and restricted cubic splines explored albumin-mortality relationship. During a median follow-up of 48.85 months, 921 deaths. Albumin≥35 g/L vs < 35g/L [HR: 1.33 (95%CI, 1.10, 1.62)] and CI vs normal cognition [HR: 1.69 (95%CI, 1.43, 1.99)] independently predicted mortality. A dose-response relationship with mortality was observed for albumin quartiles (p < 0.001). Each SD increase in MMSE or albumin correlated with 22% and 15% lower mortality risk, respectively. Combined hypoproteinemia and CI increased the mortality risk by 155%, with a notably higher risk in males, those aged <85 years, and individuals living in rural areas. Interaction effects of albumin and CI on mortality were observed (p < 0.001). In the single CI group, older adults had a 61% increased risk of mortality in the hypoproteinaemia group compared with the albumin-normal group. Restricted cubic spline revealed a reverse J-shaped association, particularly for participants without CI. For individuals with CI, albumin levels were inversely associated with mortality risk. Hypoproteinemia and CI, individually and combined, increased all-cause mortality risk in Chinese older adults, with stronger effects observed in males, younger older adults, and those living in rural areas. These findings emphasize the importance of targeted adjustments and early nutrition programs in health prevention and clinical care for older adults.

Low Birth Weight as Predictor of Underweight and Stunting Among Female Students Aged 6-9 Years: an Observational Study in Surakarta

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Undernutrition remains a leading cause of premature mortality among children in developing countries. Previous studies discussed that the risk of undernutrition elevated with child’s age, stressing the need to address undernutrition in older children. Maternal factors also caused undernutrition through intergenerational transmission. However, data related to nutritional status of female children age &amp;gt;5 years in Indonesia are lacking. This study aimed to elucidate determinants associated with nutritional status among primary school girls in Surakarta.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was an observational, cross-sectional study. A total of 61 female students aged 6-9 years from Nur Hidayah Primary School Surakarta participated in this study. Data were collected through online questionnaire filled by parents who were directed to follow the procedures of anthropometric measurement at home. Z-score was calculated using WHO AnthroPlus software. Nutritional status of children was measured in weight-for-age and height-for-age. Statistical analyses were performed using Spearman’s correlation and backward linear regression. Variables with p&amp;lt;0.05 from the final model were considered as the determinants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Among study participants, 4.9% were underweight and 9.9% were stunted. Our study found one common determinant of nutritional status by weight-for-age and height-for-age, namely birth weight (p=0.027 and p=0.011 respectively). Maternal height was, in particular, associated with nutritional status by height-for-age (p=0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Birth weight was significantly associated with nutritional status by weight-for-age and height-for-age, while maternal height was significantly correlated with only nutritional status by height-for-age. Nutrition programs for female students such as school lunch and multivitamin supplementation could be implemented to prevent the intergenerational effects of stunting and underweight.&lt;/p&gt;