The double task of preventing malnutrition and overweight: a quasi-experimental community-based trial

Abstract

BackgroundThe Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age.MethodsA quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models.Results196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI −0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (−0.31, 95%CI −0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding.ConclusionsDespite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.

Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review

“…First, the majority of included studies utilized BMI or an equivalent outcome rather than or in addition to prevalence of overweight or obesity, with seven of the nine successful interventions only showing a decrease in BMI or weight-for-length and two interventions demonstrating a decrease in proportion of overweight. 21,35 However, though none of the interventions demonstrated reduced obesity prevalence, a downward shift in BMI within the study population may nonetheless translate to prevention of obesity if up-scaled to larger populations. Second, there is a wide range in follow-up duration — most of the effective interventions measured proximal outcomes, and several of those that had later follow-up did not demonstrate sustained effects, likely indicating dilution by future influences.…”

“…48 However, in a prior review of early life obesity prevention interventions, Bluford et al 7 note that less than half of interventions utilize a theoretic framework to guide their work. In the current review, only one completed intervention explicitly referenced a conceptual model for child growth—notably, this intervention resulted in decreased odds of child overweight 21 —while four studies alluded to a life-course conceptual framework for obesity 26,32,33,40 and six studies reported a model or theory guided the intervention design 20,21,35,36,44,46 (Appendix Table 1). The following is a discussion of how conceptual frameworks could be utilized to optimize prevention of childhood obesity in the first 1,000 days, as well as consideration of intervention models that can appropriately complement the chosen conceptual framework.…”

“…Another intervention in which community health workers provided education around maternal diet and infant feeding practices at a combination of home and group visits successfully reduced child BMI z-score by 0.31 ( p =0.001) and reduced risk of overweight by 57% ( p =0.005) at 13–24 months. 21 …”

Effectiveness of community-based peer support for mothers to improve their breastfeeding practices: A systematic review and meta-analysis

“…Among them, two were quasi-experimental studies [6, 25] and the rest were RCTs. Furthermore, we conducted subgroup analyses by dividing all of these studies by different EBF duration.…”

Aproveitamento Integral de Alimentos e o seu Impacto na Saúde

“…Em crianças, a "desnutrição é sinônimo de falha no crescimento", levando a déficits, tais como baixa estatura adulta ou mesmo nanismo, menor escolaridade e produtividade econômica e prole reduzida (NAVARRO et al, 2013). Já a "má nutrição", comumente resulta da combinação de dietas inadequadas e infecção.…”