The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

Bill & Melinda Gates Foundation.

Climate change is a growing threat to population health, with dangerous combinations of heat and humidity increasing in frequency, particularly in South Asia. Evidence suggests that high temperatures and heat stress influence breastfeeding behaviour and may lead to suboptimal infant and young child nutrition.

Few studies have quantified the relationship between ambient heat and breastfeeding. Here we evaluate associations between wet-bulb temperature and daily breastfeeding patterns in a rural community in Bangladesh.

We used 23 months of daily time-diary data from 68 maternal-child dyads and regional wet-bulb temperatures to test the hypothesis that increased heat and humidity negatively influence breastfeeding outcomes among Shodagor fisher-traders.

We found that higher wet-bulb temperatures predicted reduced daily breastfeeding time allocation, particularly among fishers, and drove shifts towards increased night-time and decreased mid/late morning feeding. Maternal occupation and the interaction of child age with heat strongly influenced diurnal breastfeeding patterns.

These results highlight an important role of maternal work on infants' vulnerability to environmental stress. Dyads' ability to behaviourally compensate for extreme heat may be constrained by extended heatwaves, humidity, and economic circumstances, suggesting that climate change will likely exacerbate heat-related risks to global child health going forward.

Exploring the stage-specific effects of prenatal exposure to organophosphate esters (OPEs) on offspring growth and developmental trajectories is critical for early-life health management.

Based on 2519 mother-child dyads from the Ma'anshan Birth Cohort, we examined the concentrations of OPEs in maternal urine during the three trimesters. Seventeen follow-up visits were made to the children, and physical data were collected. A grouped trajectory model was used to fit the growth trajectories.

First-trimester bis(2-butoxyethyl) phosphate (BBOEP) was inversely associated with the children's adiposity rebound (AR) timing (β = -0.33, 95 % CI: -0.65, -0.01), and the ORs (95 % CIs) for early age at AR for each doubling of BBOEP and dibutyl phosphate (DBP) were 1.07 (1.00, 1.14) and 1.12 (1.03, 1.22), respectively. BBOEP increased the risk of a high-stable BMI-for-age z score (BMIz) group (OR = 1.18, 95 % CI: 1.01, 1.39), whereas tris(2-chloroethyl) phosphate (TCEP) and bis(2-ethylhexyl) phosphate reduced this risk. Diphenyl phosphate (OR = 0.74, 95 % CI: 0.59, 0.94) and aromatic OPEs (OR = 0.70, 95 % CI: 0.54, 0.90) reduced the odds of an extreme-high body fat group. TCEP also reduced the risk of a high body fat percentage group (p < 0.05). There appeared to be sex and ester bond differences in these associations, and breastfeeding could counteract the association between the OPEs and growth trajectories. No mixed effects of OPEs on BMIz trajectories were found.

The present study identified a heterogeneous association between OPE exposure during pregnancy and AR timing and physical growth patterns in offspring. Future studies are needed involving more regions and populations, with consideration of other developmentally toxic compounds, to obtain more reliable and comprehensive results.

Despite recommendations by the International Code of Marketing of Breastmilk Substitutes (the Code), regulatory bodies in the United States continue to permit commercial milk formula (CMF) marketing that threatens public health. The increasing popularity of online shopping highlights the need for more research on virtual CMF product marketing. To assess marketing strategies from the e-customer standpoint, we analyzed a sample of 26 bestselling virtual infant formula (IF) products from three US-based e-commerce giants. All product display content, including visual and audible components, was evaluated according to Code guidelines, analyzed thematically and assessed for theme co-occurrence. No IF labels were compliant with the Code due to widespread health benefit claims and idealization of IF. Furthermore, no US-based products were compliant with critical Code guidelines for powdered IF reconstitution instructions. Thematic analysis of virtual product web pages revealed 17 themes, of which four were novel to public health literature: purity, nature, innovation and eco-friendly. These themes co-occurred in patterned ways to capture consumers. The most popular online IF products in the United States combine Code violations with compelling online materials that idealize IF and shape cultural expectations about infant feeding and care. These practices reinforce the formula industry's well-documented efforts to undermine breastfeeding. A review of US regulations and implementation of the Code is urgently needed to protect public health.

To examine the impact of the Baby Friendly Community Initiative (BFCI) on breastfeeding outcomes worldwide, specifically the duration of any and exclusive breastfeeding, compared to standard maternal care.

A systematic review and meta-analysis were conducted. Seven electronic databases were searched from November 1998 to July 2024. Quantitative studies examining the effects of BFCI on breastfeeding outcomes were included. The quality of included studies was assessed using the Cochrane risk of bias tools and NHLBI study quality assessment tools. Narrative synthesis was performed for studies not suitable for meta-analysis.

Out of 14,495 identified records, 13 were included after the removal of duplicates and ineligible articles. The majority of included studies found that BFCI, whether implemented partially, fully or in combination with other initiatives, is an effective intervention for improving breastfeeding outcomes. The meta-analysis showed an increase prevalence of exclusive breastfeeding at 6 months postpartum in BFCI group (OR=4.00; 95 % CI 1.29-12.38, P = 0.02). Further studies are needed to investigate the statistical significance of BFCI on any breastfeeding from 6 months to 2 years postpartum.

BFCI has the potential to significantly enhance long-term exclusive breastfeeding rates and may also improve any breastfeeding rates from 6 months onward. However, the nature of BFCI implementation posed limitations to study design, which reduced the overall methodological quality of the included studies.

The protocol for this review was registered on PROSPERO (registration number CRD42023460801) on 17th September 2023.

International provisions are in place to restrict marketing practices that idealise the use of commercial milk formula (CMF) and discourage breastfeeding. In high-income countries, women of lower socioeconomic position (SEP) are less likely to breastfeed. This study aimed to characterise the nature of exposure to CMF marketing in the UK, the extent to which women hold positive beliefs about CMF and examine the relationship between exposure to CMF marketing, holding positive beliefs about CMF and SEP. Data on these topics were collected for 1052 pregnant women and mothers of children under 18 months of age between February 2020 and February 2021. Participants were assigned a 'CMF marketing score' according to the number of locations where they recalled seeing advertisements, engaging with companies or receiving promotional activity. The extent to which women held positive beliefs about CMF ('CMF positivity score') was determined by level of agreement with 17 statements. Principal component analysis, analyses of covariance and regression analyses were applied. Every woman reported exposure to CMF marketing from multiple channels. CMF marketing score did not vary across SEP groups (p = 0.342). Women of lower and middle SEP held stronger CMF positive beliefs than women of higher SEP, including 'Breastfeeding and formula feeding provide a baby with the same health benefits' (p < 0.005). CMF marketing score was not associated with CMF positivity score. Marketing suggesting CMF provides benefits similar to, or greater than, breastfeeding should be restricted to help mitigate current inequalities in infant feeding practices.

Diarrhoea remains a major cause of mortality among children under five, despite global efforts to reduce childhood morbidity and mortality. Exclusive breastfeeding (EBF) has been recognised as an effective and cost-effective intervention to reduce diarrhoeal disease burden in infants. This rapid review and meta-analysis aimed to assess the association of EBF on diarrhoea morbidity in early childhood, a critical period for growth and development, while addressing existing gaps by employing standardised definitions of EBF. A systematic search was conducted in Medline, Scopus, Embase, and Web of Science databases for studies published between 2010 and 2024. Seventeen studies met inclusion criteria and underwent quality assessment using the Joanna Briggs Institute (JBI) critical appraisal tool. Data from the identified studies were extracted, and a meta-analysis was conducted using random effects models to calculate the pooled effect size, with odds ratios (OR) and 95% confidence intervals (CI). This review found that EBF significantly reduces the risk of diarrhoeal diseases in infants under 6 months of age across diverse geographical regions and study designs. The meta-analysis of the association between exclusive breastfeeding and diarrhoea in infants aged 0-6 months resulted in a pooled OR of 0.57 (95% CI: 0.51, 0.63; I² = 57.66%). These findings underscore the critical role of promoting and supporting EBF as a pivotal public health strategy to enhance early childhood health outcomes and contribute to achieving global child health goals.

Breastfeeding in UK Pakistani and Bangladeshi communities is positively and negatively influenced by cultural beliefs and practices. The LIFT (Learning about Infant Feeding Together) project aimed to understand the determinants of infant feeding in these target communities and to engage them in the development of a culturally specific and acceptable infant feeding intervention to support breastfeeding. Reported here is phase one of the LIFT project guided by the REPLACE approach (a framework for the development of community-based interventions). The project involved an initial lengthy period of engagement with the target communities, using methods such as a community outreach event and identification of community peer group champions to help build trust. This was followed by iterative community workshops used to explore and build an understanding of infant feeding practices and the social norms and beliefs underlying these, and to assess community readiness to change. Consistent with previous research, the six key practices and beliefs identified from the workshops were: (1) Disparities between personal views versus cultural and normative barriers, (2) Family relationships and the influence on infant feeding decisions, (3) Pardah (modesty) and being unable to breastfeed in front of others, (4) Discarding colostrum (first breast milk), (5) Pre-lacteal feeds (feeds within a few hours of birth and before any breast or formula milk has been given) and complementary feeding before the baby is 6 months old, and (6) The belief that bigger babies are better and that formula helps babies to grow. Participants perceived that Pakistani and Bangladeshi communities would be amenable to intervention that aimed to change some but not all of the infant feeding behaviours identified. Findings informed the co-development of a culturally appropriate intervention toolkit to optimise infant feeding behaviour.

The human milk content of some micronutrients including thiamine depends on maternal status, and if low, breastfed infants are at risk of deficiency. Thiamine deficiency remains an important cause of morbidity and mortality among infants in Asia. We aimed to explore correlations between maternal thiamine diphosphate (ThDP) or erythrocyte transketolase activation coefficient (ETKac) and human milk thiamine concentration (MTh) and between MTh and infant ThDP or ETKac among breastfed infants < 6 months of age in northern Lao PDR. Hospitalized infants (aged ≥ 21 days) with symptoms suggestive of thiamine deficiency were eligible. Infants in a community comparison group were matched by age, sex and residence. Venous whole blood ThDP and MTh were determined by HPLC-FLD, and ETKac in washed erythrocytes by UV spectrophotometry. Associations between biomarkers were assessed using Spearman's ρ correlations and linear regression. Among all women combined (n = 489), the prevalence of ThDP < 95 nmol/L was 78.5%, elevated ETKac (> 1.25) 52.6%, and low MTh (< 90 µg/L) 45.4%. Maternal ThDP was moderately correlated with MTh (ρ = 0.50) and ETKac was strongly correlated with MTh (ρ = -0.71). Among all infants combined (n = 359), the prevalence of ThDP < 95 nmol/L was 79.2% and elevated ETKac (> 1.25) 50.2%. MTh was moderately correlated with infant ThDP concentration (ρ = 0.39) and with infant ETKac (ρ = -0.52). Maternal thiamine status predicts the thiamine concentration in human milk, and thiamine status of breastfed infants < 6 months of age depends on the thiamine provided through this milk. Effective interventions are needed to improve maternal and infant thiamine status and wellbeing. TRIAL REGISTRATION: Clinicaltrials.gov NCT03626337.

Worldwide, around 2.7 million children are not in the care of their parents, and access to breastmilk is often absent from foster care policies. We aimed to explore the evidence available on how foster families, health and social workers and mothers with infants in care can be supported in providing breastfeeding and expressed breastmilk (EBM), and to identify barriers and facilitators for breastfeeding and EMB in foster care. The JBI methodology for scoping reviews was used. Three academic databases and grey literature were searched in March 2023, and data extraction charts were used. The findings were synthesised using thematic analysis. In total, 11 papers were included, 5 peer-reviewed papers and 6 from the grey literature. Five themes were identified in the analysis: 'Is this safe?', 'Substance use: Protecting the breastfeeding rights of mothers and infants', 'Making milk accessible through breastfeeding and EBM', 'Where are the policies'? and 'Attitudes around breastfeeding'. The findings showed concern from foster parents around the safety of breastmilk and the challenges of supporting breastmilk provision when infants are in foster care. Training, positive attitudes and multi-disciplinary team involvement can support breastfeeding and the breastfeeding rights for infants in foster care. Health and social care professionals who support mothers and foster families with breastfeeding and EBM feeding lack knowledge and guidance in how to do this safely and with a rights-based approach. We found that facilitating breastfeeding is not prioritised when an infant is placed into foster care and that the breastfeeding rights of mothers and infants require urgent attention in policies and guidelines to facilitate safe and person-centred infant feeding.

Scant attention has been given to the marketing of infant feeding bottles and teats with claimed equivalence to breastfeeding. Such bottles are purported as having 'breast-like' qualities and to be interchangeable with breastfeeding, encouraging breastfeeding mothers to combine breast and bottle feeding. However, the introduction of bottle feeding alongside breastfeeding can have a negative impact on breastfeeding duration and lead to cessation. We investigated features of infant feeding bottles marketed in the United Kingdom to replicate breastfeeding and appraised the underpinning evidence. We searched online to identify the most popular bottles marketed for breastfeeding in the United Kingdom and captured marketing materials from the bottle brand websites, importing them into NVivo11 for data analysis. We coded data in relation to features of bottles associated with breastfeeding and used Johanna Briggs Institute (JBI) critical appraisal tools to appraise the evidence used to underpin the bottle features. We identified 10 bottle brands and 8 main advertised features of bottles aligned to breastfeeding. Features included bottles that simulated the breast, imitated breastfeeding physiology and aided combined breast and bottle feeding. Scientific evidence to support the bottle features was scarce, misleading, and inadequate, with only one study deemed to be high quality. Our findings show that infant feeding bottles are being marketed as equivalent to breastfeeding; however, the scientific evidence used to support features of these bottles is almost non-existent. Research on the impact of the marketing of bottles on breastfeeding and more effective controls of bottle company advertising are needed.

Timely support given to breastfeeding mothers can result in life-saving benefits for both mothers and infants. Progress in achieving results from existing efforts to improve breastfeeding practices can be accelerated with adequate investments in effective interventions. We aimed to document expenditures incurred by three diverse programs in Bangladesh, Ethiopia, and Vietnam that demonstrated improved breastfeeding outcomes. Based on expenditure records, we retrospectively calculated annual and per participant expenditures. The results represent the incremental financial needs of strengthening existing efforts in low- and middle-income countries to inform budget planning. The programs reached between 400,000 to 1.2 million pregnant women, infants, and mothers annually at an average expenditure of USD 0.55 to 1.90 per woman and infant. The largest proportion of expenditures were incurred for training frontline workers and delivering interpersonal communication or counseling. These ranged from 73.4% of total expenditures in Bangladesh to 63.9% in Ethiopia and 55.1% in Vietnam. Management and administration expenditures ranged from 13.3% and 19.6% across countries; the range in expenditures for planning and strategy development was 2.5%-9.9%; for materials development and production was 1.1%-15.1%; and for monitoring was 1.7%-18.7%. The results show that existing cadres of facility and community workers can deliver effective breastfeeding counseling on a large scale with substantial economies of scale. Budgetary needs will differ by country due to delivery system strengths and weaknesses, pre-existing coverage, and demand for counseling services. The study provides a basis for realistic budget estimates for strengthening breastfeeding counseling in large-scale programs.

Breastfeeding rates in the UK are amongst the lowest in the world, largely driven by individual- and social-level barriers. Evidence has also highlighted that cultural factors can play an important part, such as for the UK South Asian community. Although aggregated breastfeeding data indicates that initiation is high amongst the UK South Asian population, sub-group data shows that this is substantially lower amongst people of Pakistani and Bangladeshi ethnicity. As such, culturally tailored interventions are called for. This research aimed to systematically develop an evidence-based culturally tailored intervention to support the optimisation of infant feeding in these communities. The 'Learning about Infant Feeding Together' (LIFT) intervention was co-developed by researchers, six community peer group champions, and a 3rd sector organisation supporting UK South Asian women. Development was guided by the REPLACE approach (a framework for the development of culturally specific community-based interventions) and the Behaviour Change Wheel (a framework for describing, designing and evaluating behaviour change strategies). It involved three co-development intervention workshops as part of a rigorous systematic intervention development approach. A culturally tailored intervention incorporating nine behaviour change techniques was produced. The intervention aims to increase breastfeeding by targeting six infant feeding behaviours identified as important, changeable and pertinent to the communities involved. The final intervention includes posters, leaflets, and an animation. The transparent reporting of intervention content and the approach taken to development will support the growth of evidence-based practice in the field of infant feeding.

Breast milk represents the gold standard for neonatal nutrition, especially for preterm and term infants with a low birthweight. This awareness is based not only on the nutritional properties of human milk, which is specifically designed for the growth of humans but also on breast milk's non-nutritional properties, such as protection against infection. In fact, breast milk should be considered a heterogeneous ecosystem, including a wide range of cells in addition to those involved in immune function; growth factors, such as vascular endothelial growth factor; multiple noncoding microRNAs; immune cells; epithelial cells and multipotent mesenchymal stem cells. This recent identification of a pool of progenitor stem cells in human milk is the driving force behind the growing research aimed at identifying the nature of these stem/progenitor cells and their sources.

Increasing breastfeeding rates among Aboriginal and Torres Strait Islander (hereafter, respectfully Aboriginal) infants could improve health outcomes that disproportionately affect Aboriginal children into adulthood. This study was undertaken with mothers birthing Aboriginal children in Adelaide, Australia. The study sought to: understand their perceptions, motivations, influences and experiences around breastfeeding; explore factors affecting the ability to breastfeed; perceptions of alternative feeding options; and experiences of care to support breastfeeding.

Semi-structured Research Yarning interviews were conducted between November 2020 and May 2022 with 30 mothers who birthed an Aboriginal baby within metropolitan Adelaide, Australia, within the previous 18 months. Women were invited to participate if they were enrolled in a larger cohort study known as the Aboriginal Families and Baby Bundles Study, or had antenatal care from the local Aboriginal community controlled health service, were aged 16 and over, and were involved in feeding the child since birth. Three female Aboriginal researchers undertook the Yarning interviews, which were transcribed and analysed thematically.

Participants demonstrated a strong desire to breastfeed and described a range of factors impacting on their ability to establish or maintain breastfeeding. The role of healthcare providers was key to breastfeeding success with participants reporting both positive and negative care experiences. Participants described supportive experiences as those where non-judgemental care was provided that was tailored to their needs, included Aboriginal staff, and provision of continuity of care. Mothers described negative effects of their experiences of racism and ageism (young mothers) from care providers.

Aboriginal women expressed a range of challenges to sustaining breastfeeding that could be addressed by increased investment in provision of timely, non-judgemental postnatal care tailored to their social and cultural needs, including access to specialised lactation care in the hospital and including facilitated continuation of successful breastfeeding at home.

Postpartum sleep disorder and mental disorders are common unpleasant conditions faced by women after delivery, and they have many adverse effects on both mothers and infants. It is unclear whether breast milk composition is affected by maternal sleep, psychological state, diet and gut microbiome. This study aims to explore the effects of these key factors on the functional protein components of breast milk.

With a prospective design, this pilot study included a total of 41 postpartum women. Breast milk and maternal faecal samples collected at 42 days and 3 months postpartum were tested by liquid chromatography-mass spectrometry and 16S RNA sequencing, respectively. Sleep state, psychological state and dietary intake data were also collected from the mothers with validated questionnaires.

In the early postpartum period, sleep disorders and depression were associated with a decrease in the functional proteins in breast milk. Disordered sleep was significantly negatively correlated with α-lactalbumin (cor = -0.578, p < 0.001), osteopontin (cor = -0.522, p < 0.01) and κ-casein (cor = -0.451, p < 0.01). Depression was negatively correlated with αs1-casein (cor = -0.422, p < 0.01), β-casein (cor = -0.317, p < 0.05) and casein (cor = -0.318, p < 0.05). In 3 months postpartum, most associations were disappeared. But a positive correlation was observed between β-casein (cor = 0.414, p < 0.01), casein (cor = 0.372, p < 0.05), total protein (cor = 0.376, p < 0.05) and depression, while a positive correlation was found between total protein (cor = 0.357, p < 0.05) and disordered sleep at 3 months postpartum. Faecal microbiome data illustrated that changes in the gut microbiome at early postpartum were associated with sleep disorders/depression, but not with the diet. Furthermore, functional pathway analysis revealed metabolic regulation in the amino acid synthesis and metabolic pathways associated with specific microbes was involved in the reduction of breast milk protein.

Sleep disorders/depression could lead to significant changes in breast milk profiles at 42 days postpartum. Maternal gut microbiome might affect breast milk protein composition through regulating amino acid synthesis and metabolic pathways.

Childhood obesity is defined as a medical condition characterised by abnormally high amounts of body fat relative to lean body mass, which increases the risk of adverse health outcomes among children and adolescents from birth to 18 years. The prevalence of childhood obesity, which has serious healthcare implications, is surging, together with its healthcare burden. In this review we explore the intricate interplay of hereditary, environmental, behavioural, cultural and metabolic factors contributing to the global increase in childhood obesity rates. We examine the influence of prenatal factors, genetic predispositions and epigenetic mechanisms on obesity susceptibility and treatment strategies, emphasising the importance of a multilevel life course framework to understand the multifactorial causes of obesity.

This narrative review examines the epidemiology, burden, aetiology and impact of childhood obesity by focusing on published literature and the efficacy of multilevel interventions. Comprehensive algorithms are provided to illustrate the causes of childhood obesity through the lens of a multilevel life course framework, taking into consideration individual, family, community and societal factors.

Genetic predispositions, including inherited tendencies towards emotional eating, metabolic variations and body fat distribution, significantly influence a child's obesity risk. Environmental factors, such as limited access to nutritious food, sedentary behaviour, insufficient opportunities for physical activity and obesogenic environments, contribute to the increasing prevalence of childhood obesity. Prenatal influences, including maternal hyperglycaemia and nutritional exposures, lead to epigenetic alterations that predispose children to obesity and metabolic disorders. The social environment, including parental influences, cultural norms and peer dynamics, shapes children's dietary habits and physical activity levels. Additionally, the review highlights the importance of early detection of metabolic alterations associated with paediatric obesity and insulin resistance and the potential for epigenetic mechanisms as therapeutic targets. Recommendations are made for tailored medical nutrition therapy, screening for syndromic obesity and multilevel interventions targeting individual and societal factors.

This review underscores the necessity of a comprehensive, multilevel approach that integrates genetic, environmental, behavioural and cultural factors along with lifestyle modifications and public health initiatives to address the complex and multifaceted issue of childhood obesity effectively. Targeted interventions across the life course, policy reforms, community engagement and technological innovations are recommended to mitigate obesity risks and promote long-term health. An infographic is available for this article. INFOGRAPHIC.

Breastfeeding has been widely studied as a factor that improves maternal and newborn health outcomes. Immediate or early skin-to-skin contact interventions have been proposed in health care services to increase breastfeeding or exclusive breastfeeding rates following caesarean births although the findings are inconclusive.

This systematic review and meta-analysis aimed to synthesize the available evidence on early or immediate skin-to-skin contact and breastfeeding in women and newborns following caesarean birth.

A systematic search was performed using in the MEDLINE, EMBASE, Cochrane Library and Web of Science databases from inception to June 2024. The effects of early or immediate skin-to-skin contact were reported as relative risks (RRs) with 95 % confidence intervals (CIs) provided by the original articles. Pooled estimates were calculated using the DerSimonan and Laird methods. The intervention groups received early or immediate skin-to-skin contact and the control group received standard care after caesarean birth. The risk of the bias of the randomized controlled trials was assessed using the Cochrane risk of bias tool for randomized controlled trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) assessment tool for nonrandomized studies. Publication bias was assessed with funnel plot asymmetry and Egger's test. Zotero reference manager and Stata 17 software were used.

Eight randomized controlled trials and three quasiexperimental studies involving a total of 1.990 participants were included. The findings indicate that skin-to-skin contact decreased the time to first attachment by 51.73 min (95 % CI: -68.54 to -34.91; I2: 85.3), increased the breastfeeding rates in the first 2 h after birth (RR: 4.86; 95 % CI: 2.71 to 7.01; I2: 44.1) and the exclusive breastfeeding rate at discharge (RR: 1.69; 95 % CI 1.36 to 2.01; I2: 13.7), but not the exclusive breastfeeding rate at one month from birth or later (RR: 1.13; 95 % CI 0.73 to 1.54; I2: 0.0).

This study revealed that early or immediate skin-to-skin contact after caesarean birth improved breastfeeding rates and exclusive breastfeeding rates during the health care stay. Trials with longer follow-up times are needed to assess whether interventions based on early or immediate skin-to-skin contact maintain their effectiveness over time and to clarify whether early or immediate skin-to-skin contact is safe for preterm newborns or women with certain health conditions.

The aim was to investigate feeding type at discharge; exclusively breastfeeding (EBF), mixed breastfeeding (MBF), and formula milk feeding (FMF), factors associated with feeding type, and changes in weight-for-age z-score (ΔWAZ) in infants admitted to Danish neonatal units.

Using data from the Danish National Quality Database for Births and the Danish Newborn Quality Database, we included 8639 mother-infant dyads admitted ≥5 days between February 2019 and December 2021. We used logistic regression to investigate associations between maternal and infant factors and feeding type, and descriptive statistics to describe ΔWAZ and feeding type at discharge.

Of all infants 59.1% were EBF, 16.9% MBF and 24.0% FMF at discharge. Gestational age <37 weeks, caesarean section, multiple births, small for gestational age, weeks at hospital, ≥6 h before skin-to-skin contact, and few weeks at hospital were associated with failure to EBF at discharge. Median (min-max) ΔWAZ in EBF, MBF and FMF infants was -0.44 (-4.78 to 4.88), -0.43 (-3.47 to 4.42) and -0.39 (-3.54 to 4.03), respectively. ΔWAZ was higher in EBF compared to FMF infants, p-value 0.01, but no significant difference in ΔWAZ between MBF and FMF infants, p-value 0.06.

Danish newborn infants demonstrated satisfactory growth during admission to the neonatal unit, independent of feeding type at discharge. Rates of exclusively breastfeeding need improvement.

Breastfeeding is the most cost-effective intervention for reducing infant morbidity and mortality, offering benefits for infants and mothers. Despite extensive promotion, global adherence remains below 50 %, resulting in significant clinical, economic, and environmental impacts. Thus, this overview of reviews aims to synthesize barriers and facilitators of breastfeeding, analyze research trends, and identify gaps to guide future research. A comprehensive literature search was conducted, including systematic reviews that examine these factors. The search covered seven electronic data repositories. The methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Bibliometric analysis focused on identifying top journals, authors, and countries, assessing their impact, and exploring trends over time. Findings were classified and analyzed thematically through line-by-line coding, theme description, and analytical formulation. A total of 123 reviews were included, mostly of high quality and published in top journals. Key trends comprised a growing focus on psychosocial and cultural factors, increased representation from low- and middle-income countries, and improved methodological rigor. However, geographical representation remains biased towards high-income countries, and some breastfeeding outcomes need further exploration. Thematic analysis revealed four categories: Therapeutic and care interventions; Support networks and education; Maternal-infant health issues; and Societal and environmental context. In conclusion, this overview of reviews identifies barriers and facilitators of breastfeeding and emphasizes the need for more inclusive research and tailored support. Addressing gaps in evidence for enhancing healthcare systems and policies can improve breastfeeding practices and outcomes worldwide.

Many infants receive formulas to support growth, some of which contain high protein (≥2.5 g per 100 kcal) to increase weight gain. The risk-benefit of these formulas is unclear. This review evaluated high-protein formula (HPF) versus standard-protein formula (SPF) and low-protein formula (LPF) in healthy, formula-fed term infants to prevent undernutrition, obesity, and adverse events.

We searched CENTRAL, MEDLINE, Embase and other databases without language restrictions. Cochrane Collaboration tool and GRADE instrument assessed the risk of bias of randomized controlled trials and certainty of their evidence. We performed random-effects meta-analyses, calculating risk ratios (RR) and mean differences (MD) with 95 % confidence intervals (95 % CI) for the outcomes.

We included 11 trials (1185 infants) and found very low-certainty evidence that HPF versus SPF had little or no effect on underweight, stunting, and wasting (MD weight-for-age z-score 0.05 standard deviations (SDs), 95 % CI -0.09 to 0.19; P = 0.51; height-for-age 0.15 SDs, 95 % CI -0.05 to 0.35; P = 0.14). HPF versus SPF had little or no effect on overweight or obesity at five years (RR 1.26, 95 % CI 0.63 to 2.51; P = 0.51). Very low-certainty evidence indicated SPF versus LPF had little or no effect on underweight, stunting, and wasting. HPF versus SPF or LPF may have little or no effect on adverse effects in the first year.

We are unsure if HPF versus SPF influences undernutrition or obesity, and there may be little difference in the risk of adverse effects between formulas. Ongoing studies may change these conclusions.

Artificial intelligence (AI) is increasingly used in healthcare interventions to provide accessible, continuous, and personalized patient support. This study investigates the impact of a mobile breastfeeding counseling application developed with artificial AI on mothers' breastfeeding self-efficacy, success, and anxiety levels.

A quasi-experimental design was employed, involving 60 mothers. Participants were divided into two groups: 30 mothers received AI-based counseling, and 30 mothers were provided a booklet. Data collection tools included a personal information form, Breastfeeding Charting System and Assessment Tool (LATCH), Postnatal Breastfeeding Self-Efficacy Scale, and Beck Anxiety Inventory. Data were collected from mothers who delivered at a state hospital's obstetrics and gynecology department and were followed for ten days postpartum (postpartum days 1, 3, 7, and 10).

No significant differences were found in the demographic characteristics of the two groups (p > 0.05). Statistically significant improvements were observed in breastfeeding self-efficacy over time for both groups (AI group: f = 36.356, p = 0.000; booklet group: f = 43.349, p = 0.000). At day 10, the AI group scored significantly higher than the booklet group (Z=-2.216, p = 0.027). For breastfeeding success, as measured by the LATCH tool, significant differences were also noted over time for both groups (AI group: f = 68.466, p = 0.000; booklet group: f = 68.088, p = 0.000). At day seven, the AI group outperformed the booklet group (Z=-2.995, p = 0.003). Anxiety levels showed no significant differences between groups.

AI-based breastfeeding counseling positively impacts breastfeeding self-efficacy and success. The findings highlight the potential of AI applications in healthcare. AI-based chatbots can serve as effective tools for breastfeeding education, offering accessible, personalized, and continuous support. The significant improvements in breastfeeding outcomes indicate that innovative AI-assisted interventions can effectively support mothers during the critical early postpartum period. This research demonstrates the feasibility of integrating AI technology into maternal care and serves as a foundation for future studies.

Not applicable.

The World Health Organization recommends initiating breastfeeding in the first hour of life, exclusive breastfeeding for six months, and continued breastfeeding for at least two years. Aggressive marketing of breast milk substitutes (BMS) undermines breastfeeding and is linked to adverse child and maternal health outcomes. This is particularly problematic in the Global South, where socioeconomic conditions often amplify the risks associated with BMS. The adoption of national BMS legislation in line with the 1981 International Code of Marketing of Breast-milk Substitutes is therefore crucial but difficult due to strong opposition from the transnational formula milk industry. Breastfeeding advocates in Kenya were able to overcome this powerful opposition when the country adopted a strict BMS Act in 2012, which has since facilitated and protected remarkable improvements in breastfeeding rates. We conduct a qualitative case study to identify the political enablers of the successful adoption of this important law.

BMS legislation was first politically debated in Kenya in the 1980s following mobilization of women-led civil society organizations, namely the Breastfeeding Information Group and the Maendeleo ya Wanawake Organization. The issue re-emerged on the political agenda in the 2000s but faced opposition from the transnational formula milk industry. Kenya's BMS Act was ultimately adopted during a policy window opened by a constitutional reform. Support for the adoption of this landmark law was led by effective female political leaders, including public health minister Beth Mugo, the ministry's nutrition division head Terrie Wefwafwa, and members of the Kenya Women's Parliamentary Association. In the formulation and adoption of the law, these female leaders received important support from international organizations, such as the United Nations Children's Fund, as well as from powerful male allies, including president Mwai Kibaki.

The Kenyan case illustrates how women's political leadership can counteract the power of the transnational formula milk industry and help achieve strict BMS legislation. Effective female leadership for BMS legislation can occur in various political offices and positions, including those of ministers, legislators and bureaucrats. Female leaders can leverage their own influence by strategically exploiting policy windows and recruiting male allies.

Although lactation may reduce maternal risk of breast cancer, other potential long-term health benefits of lactation for mothers are largely unknown.

We examined whether the durations of predominant and any lactation were associated with maternal risks of coronary heart disease (CHD) and stroke.

In this prospective cohort study, we followed 6,857 mothers from the Copenhagen Perinatal Cohort who gave birth during 1959-61 at median age 24 y (IQR 20-30). Durations of predominant and any lactation were assessed at the infant's 1-y examination. Diagnoses of CHD (n=701 at 45-70 y, n=593 at >70 y) and stroke (n=410 at 45-70 y, n=535 at >70 y) were obtained from national health registers during 1977-2022. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox regressions without and with adjustment for demographics, metabolic risk during pregnancy, pregnancy complications, and reproductive history.

Durations of predominant and any lactation were inversely associated with the risk of CHD, but not with stroke, when using lactation as a continuous variable. In categorical analyses, mothers who lactated for >4 months had a 41% (HR, 0.59; 95% CI, 0.46-0.75) and 34% (0.66; 0.48-0.92) lower risk of CHD and stroke, respectively, at ages 45-70 y, compared to mothers who lactated ≤0.5 months. After adjustment for demographic, metabolic and reproductive risk factors during pregnancy, these associations attenuated (0.78, 0.60-1.01 for CHD and 0.90, 0.64-1.27 for stroke). No associations were observed with CHD or stroke diagnosed after age 70 y.

We found limited evidence of an association between lactation and maternal risk of stroke. Longer durations of lactation were associated with lower risks of maternal CHD diagnosed before age 70 y. Adjustment for risk factors attenuated the associations, which suggests these factors may partly confound the benefits of lactation on maternal risks of CHD.

Empirical evidence with respect to the protective effect of breastfeeding on childhood obesity remains inconclusive, and studies on sex-specific associations are sparse. We investigated whether (H1) longer breastfeeding duration reduces the risk of entry into elevated body mass (EBM); and (H2) longer breastfeeding duration increases the likelihood of exit from EBM. Using the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), our sample comprised 10,550 mother-child pairs after excluding 100 non-biological pairs. The ECLS-B assessed children from 9 months of age through kindergarten, spanning infancy through 7 years of age. We used two transitions in weight status (i.e., entry to EBM and exit from EBM) as outcome variables. The main predictor was breastfeeding duration (i.e., never breastfed, up to 2 months, 3 to 7 months, and 8 months or longer). Multilevel discrete-time models for recurrent transitions were employed to examine bidirectional changes in weight status. Among girls, breastfeeding for 8 months or longer reduced the risk of transitioning into overweight (adjusted Hazard Ratio (AHR): 0.76, 95% CI: 0.64, 0.89) or obesity (AHR: 0.66, 95% CI: 0.53, 0.82). Breastfeeding duration increased the likelihood of exiting EBM in a dose-response fashion among girls. Among boys, breastfeeding for 3 to 7 months was associated with preventing overweight (AHR: 0.79, 95% CI: 0.67, 0.92) or obesity (AHR: 0.82, 95% CI: 0.68, 0.98), but it did not help overcome EBM, regardless of breastfeeding duration. Breastfeeding duration helped to prevent EBM or overcome it, but these effects varied by the child's sex. Further research should elucidate how the benefits of breastfeeding may differ for boys and girls, and explore the potential need for sex-specific public health policies.

Disparities in the incidence, prevalence and outcomes of multiple sclerosis (MS) exist in the USA, often to the detriment of Black and Hispanic people. Despite the common misconception that MS is a disease of white people, the incidence is highest in Black people. Disability accumulates faster and at younger ages in Black and Hispanic people with MS than in their white counterparts, and MS-related mortality in early and mid-adulthood is highest in Black people. These differences are often erroneously interpreted as evidence of innate racial or ethnic variations. In this Perspective, we demonstrate how race and ethnicity - social constructs with a limited biological basis that are often assigned by systems of power - can influence biology through lived experiences, a phenomenon termed 'embodiment'. We review how downstream consequences of structural racism can lead to biological outcomes strongly associated with MS susceptibility, such as imbalanced immune system development, dysregulated immune responses to the Epstein-Barr virus and childhood obesity. We also consider how inequitable health-care access and quality, combined with the younger age of onset and higher comorbidity burdens, might explain racial and ethnic disparities in MS prognosis. Our proposed conceptual model offers a roadmap for generating knowledge and implementing interventions to narrow racial and ethnic disparities in MS susceptibility and outcomes.

Approximately 3%-6% of infants were born with congenital birth defects worldwide every year, which ranked as the third leading cause of deaths among the population under 20 years of age in 2021.

By adopting the methodology from Global Burden of Disease Study 2021, we systematically analysed the burden and temporal trend of congenital birth defects at the global and regional levels. Correlations between these metrics and Healthcare Access and Quality (HAQ) Index were investigated by the Spearman correlation analyses.

In 2021, there were 7.2 million cases of congenital birth defects and 0.53 million associated deaths. The highest incidence rates were observed in Central Asia, Central Sub-Saharan Africa and Western Sub-Saharan Africa, while the highest mortality rates were reported in Oceania, Western Sub-Saharan Africa and the Caribbean. Congenital heart anomalies remained the leading cause of deaths and disability-adjusted life years (DALYs). The proportion of years lived with disability (YLD) in total DALY increased significantly from 1990 to 2021, indicating a shift from fatal to non-fatal burden. The global age-standardised mortality rate markedly declined from 1990 to 2021, while the YLD rate remained relatively stable. Negative correlations were observed between the incidence, mortality, years of life lost (YLL) and DALY rates of congenital birth defects and HAQ Index of 204 countries and territories, whereas positive correlations were found for prevalence and YLD.

Although remarkable progress has been made in reducing the global burden of congenital birth defects, it remains a major health issue in low sociodemographic index regions lacking equitable access to healthcare facilities. The shift from fatal to non-fatal burden underscores specific medical conditions for the increasing number of adult patients with congenital birth defects to promote postoperative rehabilitation and prevent complications.

Early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) are critical practices for ensuring optimal early-life and long-term well-being among human populations, particularly in resource-limited settings. Although Ethiopia enjoys a high rate of breastfeeding (BF) overall, common practices, such as colostrum avoidance, impede the nation from attaining the BF targets set by the World Health Organization (WHO).

To assess colostrum avoidance and its associated factors among mothers of children under the age of six months in the Sekota Zuria Woreda of the Waghimra Zone, Ethiopia, 2022.

A community-based cross-sectional study was conducted between June 26 and July 30, 2022, in the Sekota Zuria Woreda of the Waghimra Zone, Ethiopia. The study included 421 mothers of children under the age of six months, selected using a multistage sampling technique. Once written consent was obtained from all participants, a pretested and reliability-checked questionnaire was employed to interview and gather data. During the analysis, descriptive statistics and logistic regression models were employed to summarize and explore the statistical associations between the dependent and explanatory variables. In the bivariate logistic regression analysis, variables with a P-value of < 0.25 were exported to the multivariate logistic regression model for further analysis. Finally, using a P-value of < 0.05 as an indicator of statistical significance, the Adjusted Odds Ratio (AOR) at 95% Confidence Intervals (CI) was calculated.

According to this study, 19.0% (95% CI: 15.0-22.8%) of the mothers in Sekota Zuria Woreda avoided colostrum. In addition, mothers who did not receive Antenatal Care (ANC) (AOR = 2.9, 95% CI: 1.1-7.8), gave birth at home (AOR = 4.6, 95% CI: 2.0-10.8), lacked participation in the Women's Health Developmental Army (WHDA) (AOR = 4.7, 95% CI: 1.9-11.4), gave pre-lacteal feeds (AOR = 3.0, 95% CI: 1.2-7.1), had insufficient knowledge (AOR = 3.0, 95% CI: 1.2-7.6), and had a negative attitude toward colostrum feeding (AOR = 6.5, 95% CI: 3.0-14.2) were more likely to avoid colostrum.

In Sekota Zuria Woreda, the prevalence of colostrum avoidance is high, with nearly one in five mothers withholding colostrum from their newborns. This practice is primarily driven by poor utilization of healthcare services, lack of participation in the WHDA, inadequate knowledge, and negative attitudes toward colostrum. Creating an environment that encourages, enables, and supports mothers to utilize healthcare services and participate in the WHDA while also improving their knowledge and attitudes toward colostrum is crucial for decreasing the prevalence of colostrum avoidance in the Woreda.

Timely breastfeeding initiation within one hour of birth is recommended to reduce neonatal and early infant mortality. However, rates of early breastfeeding remain suboptimal in India, especially among marginalized tribal communities, which continue to experience disproportionately high infant mortality. The study investigated the association between the late breastfeeding initiation and infant mortality among the tribal population in India.

The study utilized data from the fifth round if the National Family Health Survey, which provided a sample of 232,920 most recent live births in the past five years with data on breastfeeding initiation time and infant mortality. Associations between late initiation (> 1 hour) and mortality were analysed using Cox proportional hazards regression and Kaplan-Meier survival curves.

The results showed that infants breastfed after the first hour of life had a 30% higher risk of infant mortality compared to those breastfed within an hour of birth (aHR: 1.30, 95% CI: 1.06-1.60). The Kaplan-Meier curves further highlighted the lower chances of survival when breastfeeding was delayed.

These findings underscore the need for promoting early breastfeeding initiation through culturally appropriate interventions in tribal areas as a strategy to reduce persistent child survival disparities in India.

To assess the relationship between lifetime breastfeeding and all-cause and cause-specific mortality in Mexican women.

We used prospective data of 88 597 women from the Mexican Teachers' Cohort. Hazard ratios (HRs) were estimated from Cox regression models for total mortality, and a competing risk model was used for cause-specific mortality, adjusted for childhood/adolescence socioeconomic and lifestyle factors, age at first birth, and number of births. A dose-response relation was assessed using smoothed splines.

Participants, on average, breastfed for 6 months per birth, with a mean total breastfeeding duration of 13 months. After a mean follow-up of 11 years, 1556 deaths were found. Compared with parous women who did not breastfeed, all-cause mortality was lower for women who breastfed (<6 months: 0.78, 95% confidence interval [CI] 0.67-0.91; for 6-12 months: 0.76, 95% CI 0.64-0.90; for 12-24 months: 0.73, 95% CI 0.62-0.86; and for >24 months: 0.77, 95% CI 0.64-0.91). The dose-response relationship between breastfeeding and all-cause mortality was non-linear (P = 0.023). This trend was consistent when accounting for single live births and excluding women with gestational conditions. Those who breastfed >6 months had lower risk of cardiovascular and breast cancer-specific mortality.

Breastfeeding was associated with reduced all-cause, cardiometabolic, and breast cancer mortality in Mexican women. The findings support the need for comprehensive policies to support breastfeeding, considering the potential for significant public health benefits. Additionally, the study highlighted a substantial gap in breastfeeding practices in Mexico, with average durations far below international recommendations.

Breastfeeding counseling is a proven strategy to protect and promote breastfeeding, as evidenced by numerous studies. However, there is limited research on its application during the dyad's stay in rooming-in and its impact on the duration of exclusive breastfeeding. This study aims to evaluate the effectiveness of individualized counseling during the dyad's rooming-in period and its role in maintaining exclusive breastfeeding until the sixth month of life, compared to standard care.

This randomized, multicenter, parallel, and open clinical trial was conducted at two Brazilian university hospitals. A total of 102 primiparous women, who had conditions and intentions favorable to breastfeeding, were enrolled between December 2023 and April 2024. Following hospital discharge, participants were followed up via telephone until the child reached six months of age, with the study concluding in October 2024. Participants were randomly assigned to one of two groups. The intervention group received two to four breastfeeding counseling sessions during their hospital stay, while the control group received standard institutional care. Both groups were provided with educational materials on the benefits of breastfeeding and information on where to seek help if complications arose. During the telephone follow-ups, outcomes were measured without any additional interventions. The primary outcome measured was the exclusive breastfeeding rate since birth to the sixth month.

A total of 97 breastfeeding women completed the follow-up, forming the sample for analysis. Compared to the control group, women who received counseling were more likely to maintain exclusive breastfeeding at the fourth month (27/48 (56.2%) vs. 15/50 (30.0%), Prevalence Ratio = 1.88 (Confidence Interval 95% 1.15, 3.07) and the sixth month of the child's life (27/47 (57.4%) vs. 12/50 (24.0%), Prevalence Ratio = 2.40 (Confidence Interval 95% 1.38, 4.16).

Breastfeeding counseling during the dyad's stay in rooming-in was effective in maintaining exclusive breastfeeding until the child's sixth month of life.

UTN: U1111-1284-3559 / RBR-4w9v5rq (2023-03-20).

In Pakistan, maternal micronutrient deficiencies are highly prevalent, and stunting affects 43% of infants by six-months postpartum. Human milk composition for some micronutrients can be negatively affected by suboptimal maternal nutrition; however, it is unknown whether this affects infant growth.

We aimed to determine whether mothers receiving a multiple-micronutrient supplement (MMS) versus the standard of care had (1) greater concentrations of iodine, vitamins A, E, and B12, and folate in their milk at three-months postpartum; and (2) improved growth of their offspring. Associations between milk micronutrients and infant growth were also explored.

This substudy was nested within a district-based, cluster-randomized, controlled trial (MaPPS Trial; 25,477 females) with the primary aim of evaluating whether maternal MMS (preconception: twice-weekly, pregnancy and postpartum: daily, to six-months postpartum) compared to the standard of care (preconception: no intervention; pregnancy and postpartum: daily iron and folic acid supplementation, to six-months postpartum) in rural Pakistan improved infant birthweight. Substudy mother-infant dyads (n=186) were recruited if infants were term-born and predominantly or exclusively breastfed. Milk micronutrient concentrations were compared to reference values derived from mother's milk (mother's milk adequacy estimates; MAEs).

MMS increased milk iodine and vitamin A concentrations, but not vitamins B12 or E, nor folate. Importantly, few milk sample micronutrients in either arm were above existing MAEs. MMS compared to standard of care did not improve infant growth. Independent of allocation, having all five milk micronutrients below MAEs was associated with decreased infant length -for-age z-score (β=-0.39, 95% CI: -0.73,-0.04; P=0.03).

In a population with maternal micronutrient deficiencies, providing maternal MMS was not associated with milk micronutrient concentrations above MAEs; however, infants born to mothers with milk below MAEs for all investigated micronutrients appeared to experience poorer growth. Further research is needed to understand longer-term implications, if any.

ClinlicalTrials.gov: NCT04451395 (https://clinicaltrials.gov/study/NCT04451395) and NCT03287882 (https://clinicaltrials.gov/study/NCT03287882).

Background/Objectives: Children's health may be influenced by maternal eating habits during pregnancy. A Mediterranean diet (MedDiet)-based pattern has been associated with benefits in infectious disease and allergies in children. Methods: From a total 2228 pregnant women evaluated between 2015 and 2017 in the St. Carlos cohort, 1292 women belonging to the intervention group (IG) undertook a MedDiet supplemented with extra virgin olive oil (EVOO) and nuts from early on in pregnancy. The control group (CG) consisted of 516 pregnant women who were advised to follow a fat-restricted MedDiet. The modified 12-point Mediterranean diet adherence screener (MEDAS) was applied. A total of 1808 (81.2%) children were analyzed at 6 years postpartum. All women from both groups received the same postpartum nutritional recommendations as the IG had during pregnancy. Results: Children from the IG showed lower rates of bronchiolitis and atopic eczema compared to the CG. Children whose mother's MEDAS score was ≥6 at 24-28 GW vs. MEDAS scores < 6 presented lower rates of bronchiolitis [222/695 (28.8%) vs. 441/1113 (39.6%); p = 0.022] and atopic eczema [311/695 (39.0%) vs. 564/1113 (50.7%); p = 0.039]. The offspring of mothers with MEDAS scores ≥ 8 (n = 176) vs. MEDAS scores ≤ 3 (n = 564) showed a lower relative risk (RR) (95% CI) for developing bronchiolitis [0.75 (0.58-0.97)] and atopic eczema [0.82 (0.69-0.98)], with both having a p < 0.001 trend. Conclusions: A higher adherence to a MedDiet supplemented with EVOO and nuts during pregnancy is associated with health benefits in offspring at 6 years of age.

Exclusive (EBF) and continued breastfeeding (CBF) as defined by the World Health Organization are the optimal feeding practices. Perinatal Mental Health Conditions (PMHCs) such as anxiety and depression may influence breastfeeding practices. We aimed to examine if maternal postpartum anxiety and depression symptoms, individually and combined (comorbid), influence EBF and CBF practices.

A cross-sectional survey was conducted between November 2022 and March 2023 with 326 mothers of children 0-23 months old, all residing in Clark County, Nevada, USA. Descriptive, bivariate, and multivariable logistic regression analyses were conducted to examine the association between self-reported postpartum anxiety and depression symptoms and EBF and CBF in the 24 h prior to the survey.

The prevalence of EBF among infants under 6 months old and CBF among children 6-23 months old was 36.3% (n = 41) and 52.1% (n = 111), respectively. After adjusting for maternal socio-demographic, perinatal, and infant/child characteristics, decreased odds of EBF were associated with the presence of postpartum depressive symptoms (AOR 0.13; 95% CI 0.03,0.55) and the comorbid presence of postpartum anxiety and depression symptoms (AOR 0.16; 95% CI 0.04,0.66). Similarly, decreased odds of CBF were associated with the presence of postpartum anxiety symptoms (AOR 0.36; 95% CI 0.16,0.82).

Postpartum anxiety and depression symptoms decreased the odds of breastfeeding practices among mothers of children under two years old in Clark County, Nevada. However, the relationship may be bidirectional or inverse, requiring further research to clarify. Culturally appropriate interventions to reduce postpartum anxiety and depression are essential to improve breastfeeding practices.