Non-Breast Milk Feeding in Developing Countries: Challenge from Microbial and Chemical Contaminants

Weisstaub, Gerardo; Uauy, Ricardo

doi:10.1159/000338203

Cited by 15 publications

(6 citation statements)

References 48 publications

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“…The third category, food and water safety , relates primarily to the infection pathway to stunted growth, but may also contribute through inorganic contaminants and environmental pollutants (Weisstaub & Uauy ). Household‐level hygiene practices such as hand washing, safe water source and storage, and sanitation conditions affect the risk of diarrhoea and other morbidities interfering with growth (Checkley et al .…”

Section: Causes Of Stunted Growth and Developmentmentioning

confidence: 99%

Contextualising complementary feeding in a broader framework for stunting prevention

Stewart

Iannotti

Dewey

et al. 2013

Maternal & Child Nutrition

597

548

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An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6-24 months, represents an important period of sensitivity to stunting with lifelong, possibly irrevocable consequences. Interventions to improve complementary feeding practices or the nutritional quality of complementary foods must take into consideration the contextual as well as proximal determinants of stunting. This review presents a conceptual framework that highlights the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short-and long-term consequences. Contextual factors are organized into the following groups: political economy; health and health care systems; education; society and culture; agriculture and food systems; and water, sanitation and environment. We argue that these community and societal conditions underlie infant and young child feeding practices, which are a central pillar to healthy growth and development, and can serve to either impede or enable progress. Effectiveness studies with a strong process evaluation component are needed to identify transdisciplinary solutions. Programme and policy interventions aimed at preventing stunting should be informed by careful assessment of these factors at all levels.

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Section: Causes Of Stunted Growth and Developmentmentioning

confidence: 99%

Contextualising complementary feeding in a broader framework for stunting prevention

Stewart

Iannotti

Dewey

et al. 2013

Maternal & Child Nutrition

597

548

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“…Human breast milk and homemade complementary foods may bear significant contamination with microorganisms and aflatoxins, particularly in low-income countries [47,48,49,50], whereas commercial baby foods generally contain very low amounts of mycotoxins [51]. Aflatoxin contamination of foods contributes a significant public health burden in low-income countries due to their carcinogenicity and their growth-impairing effects in children [52].…”

Section: Microorganisms and Their Toxinsmentioning

confidence: 99%

Quality and Safety Aspects of Infant Nutrition

Koletzko¹,

Shamir

Ashwell

2012

Ann Nutr Metab

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Quality and safety aspects of infant nutrition are of key importance for child health, but oftentimes they do not get much attention by health care professionals whose interest tends to focus on functional benefits of early nutrition. Unbalanced diets and harmful food components induce particularly high risks for untoward effects in infants because of their rapid growth, high nutrient needs, and their typical dependence on only one or few foods during the first months of life. The concepts, standards and practices that relate to infant food quality and safety were discussed at a scientific workshop organized by the Child Health Foundation and the Early Nutrition Academy jointly with the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, and a summary is provided here. The participants reviewed past and current issues on quality and safety, the role of different stakeholders, and recommendations to avert future issues. It was concluded that a high level of quality and safety is currently achieved, but this is no reason for complacency. The food industry carries the primary responsibility for the safety and suitability of their products, including the quality of composition, raw materials and production processes. Introduction of new or modified products should be preceded by a thorough science based review of suitability and safety by an independent authority. Food safety events should be managed on an international basis. Global collaboration of food producers, food-safety authorities, paediatricians and scientists is needed to efficiently exchange information and to best protect public health.

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“…Although these might be explained by potential contamination of complementary foods due to inadequate hygiene, 22 a more biological rationale should also be considered. Breastmilk is known to confer immunological benefits to infants that are especially important for preterm infants, 23 and breastmilk intake is likely to have been lower among infants in the 4 month group, as discussed earlier.…”

Section: Discussionmentioning

confidence: 99%

Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial

Gupta

Agarwal

Aggarwal

et al. 2017

The Lancet Global Health

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SummaryBackgroundEvidence on the optimal time to initiation of complementary feeding in preterm infants is scarce. We examined the effect of initiation of complementary feeding at 4 months versus 6 months of corrected age on weight for age at 12 months corrected age in preterm infants less than 34 weeks of gestation.MethodsIn this open-label, randomised trial, we enrolled infants born at less than 34 weeks of gestation with no major malformation from three public health facilities in India. Eligible infants were tracked from birth and randomly assigned (1:1) at 4 months corrected age to receive complementary feeding at 4 months corrected age (4 month group), or continuation of milk feeding and initiation of complementary feeding at 6 months corrected age (6 month group), using computer generated randomisation schedule of variable block size, stratified by gestation (30 weeks or less, and 31–33 weeks). Iron supplementation was provided as standard. Participants and the implementation team could not be masked to group assignment, but outcome assessors were masked. Primary outcome was weight for age Z-score at 12 months corrected age (WAZ12) based on WHO Multicentre Growth Reference Study growth standards. Analyses were by intention to treat. The trial is registered with Clinical Trials Registry of India, number CTRI/2012/11/003149.FindingsBetween March 20, 2013, and April 24, 2015, 403 infants were randomly assigned: 206 to receive complementary feeding from 4 months and 197 to receive complementary feeding from 6 months. 22 infants in the 4 month group (four deaths, two withdrawals, 16 lost to follow-up) and eight infants in the 6 month group (two deaths, six lost to follow-up) were excluded from analysis of primary outcome. There was no difference in WAZ12 between two groups: −1·6 (SD 1·2) in the 4 month group versus −1·6 (SD 1·3) in the 6 month group (mean difference 0·005, 95% CI −0·24 to 0·25; p=0·965). There were more hospital admissions in the 4 month group compared with the 6 month group: 2·5 episodes per 100 infant-months in the 4 month group versus 1·4 episodes per 100 infant-months in the 6 month group (incidence rate ratio 1·8, 95% CI 1·0–3·1, p=0·03). 34 (18%) of 188 infants in the 4 month group required hospital admission, compared with 18 (9%) of 192 infants in the 6 month group.InterpretationAlthough there was no evidence of effect for the primary endpoint of WAZ12, the higher rate of hospital admission in the 4 month group suggests a recommendation to initiate complementary feeding at 6 months over 4 months of corrected age in infants less than 34 weeks of gestation.FundingIndian Council of Medical Research supported the study until Nov 14, 2015. Subsequently, Shuchita Gupta's salary was supported for 2 months by an institute fellowship from All India Institute Of Medical Sciences, and a grant by Wellcome Trust thereafter.

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Non-Breast Milk Feeding in Developing Countries: Challenge from Microbial and Chemical Contaminants

Cited by 15 publications

References 48 publications

Contextualising complementary feeding in a broader framework for stunting prevention

Contextualising complementary feeding in a broader framework for stunting prevention

Quality and Safety Aspects of Infant Nutrition

Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial

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