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Arndt MB, Abate YH, Abbasi-Kangevari M, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdulah DM, Abdulkader RS, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abtew YD, Abu-Gharbieh E, Abu-Rmeileh NME, Acuna JM, Adamu K, Adane DE, Addo IY, Adeyinka DA, Adnani QES, Afolabi AA, Afrashteh F, Afzal S, Agodi A, Ahinkorah BO, Ahmad A, Ahmad S, Ahmad T, Ahmadi A, Ahmed A, Ahmed LAA, Ajami M, Aji B, Akbarialiabad H, Akonde M, Al Hamad H, Al Thaher Y, Al-Aly Z, Alhabib KF, Alhassan RK, Ali BA, Ali SS, Alimohamadi Y, Aljunid SM, Al-Mekhlafi HM, Almustanyir S, Alomari MA, Al-Tammemi AB, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Ameyaw EK, Amin TT, Amiri S, Amu H, Amugsi DA, Anagaw TFF, Ancuceanu R, Angappan D, Ansari-Moghaddam A, Antriyandarti E, Anvari D, Anyasodor AE, Arabloo J, Aravkin AY, Ariffin H, Aripov T, Arkew M, Armocida B, Arumugam A, Aryastami NK, Asaad M, Asemi Z, Asemu MT, Asghari-Jafarabadi M, Astell-Burt T, Athari SS, Atomsa GH, Atorkey P, Atout MMW, Aujayeb A, Awoke MA, 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Chung SC, Claro RM, Columbus A, Cortese S, Cruz-Martins N, Dabo B, Dadras O, Dai X, D'Amico E, Dandona L, Dandona R, Darban I, Darmstadt GL, Darwesh AM, Darwish AH, Das JK, Das S, Davletov K, De la Hoz FP, Debele AT, Demeke D, Demissie S, Denova-Gutiérrez E, Desai HD, Desta AA, Dharmaratne SD, Dhimal M, Dias da Silva D, Diaz D, Diress M, Djalalinia S, Doaei S, Dongarwar D, Dsouza HL, Edalati S, Edinur HA, Ekholuenetale M, Ekundayo TC, Elbarazi I, Elgendy IY, Elhadi M, Elmeligy OAA, Eshetu HB, Espinosa-Montero J, Esubalew H, Etaee F, Etafa W, Fagbamigbe AF, Fakhradiyev IR, Falzone L, Farinha CSES, Farmer S, Fasanmi AO, Fatehizadeh A, Feigin VL, Feizkhah A, Feng X, Ferrara P, Fetensa G, Fischer F, Fitzgerald R, Flood D, Foigt NA, Folayan MO, Fowobaje KR, Franklin RC, Fukumoto T, Gadanya MA, Gaidhane AM, Gaihre S, Gakidou E, Galali Y, Galehdar N, Gardner WM, Garg P, Gebremeskel TG, Gerema U, Getacher L, Getachew ME, Getawa S, Ghaffari K, Ghamari SH, Ghasemi Nour M, Ghassemi F, Ghith N, 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Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2025; 404:2543-2583. [PMID: 39667386 PMCID: PMC11703702 DOI: 10.1016/s0140-6736(24)01821-x] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Collaborators] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/16/2024] [Accepted: 08/29/2024] [Indexed: 12/14/2024]
Abstract
BACKGROUND 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. METHODS 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. FINDINGS 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. INTERPRETATION 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. FUNDING Bill & Melinda Gates Foundation.
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Collaborators
Michael Benjamin Arndt, Yohannes Habtegiorgis Abate, Mohsen Abbasi-Kangevari, Samar Abd ElHafeez, Michael Abdelmasseh, Sherief Abd-Elsalam, Deldar Morad Abdulah, Rizwan Suliankatchi Abdulkader, Hassan Abidi, Olumide Abiodun, Richard Gyan Aboagye, Hassan Abolhassani, Yonas Derso Abtew, Eman Abu-Gharbieh, Niveen Me Abu-Rmeileh, Juan Manuel Acuna, Kidist Adamu, Denberu Eshetie Adane, Isaac Yeboah Addo, Daniel Adedayo Adeyinka, Qorinah Estiningtyas Sakilah Adnani, Aanuoluwapo Adeyimika Afolabi, Fatemeh Afrashteh, Saira Afzal, Antonella Agodi, Bright Opoku Ahinkorah, Aqeel Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmadi, Ali Ahmed, Luai A A Ahmed, Marjan Ajami, Budi Aji, Hossein Akbarialiabad, Maxwell Akonde, Hanadi Al Hamad, Yazan Al Thaher, Ziyad Al-Aly, Khalid F Alhabib, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Syed Shujait Ali, Yousef Alimohamadi, Syed Mohamed Aljunid, Hesham M Al-Mekhlafi, Sami Almustanyir, Mahmoud A Alomari, Alaa B Al-Tammemi, Khalid A Altirkawi, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Edward Kwabena Ameyaw, Tarek Tawfik Amin, Sohrab Amiri, Hubert Amu, Dickson A Amugsi, Tadele Fentabel Fentabil Anagaw, Robert Ancuceanu, Dhanalakshmi Angappan, Alireza Ansari-Moghaddam, Ernoiz Antriyandarti, Davood Anvari, Anayochukwu Edward Anyasodor, Jalal Arabloo, Aleksandr Y Aravkin, Hany Ariffin, Timur Aripov, Mesay Arkew, Benedetta Armocida, Ashokan Arumugam, Ni Ketut Aryastami, Malke Asaad, Zatollah Asemi, Mulu Tiruneh Asemu, Mohammad Asghari-Jafarabadi, Thomas Astell-Burt, Seyyed Shamsadin Athari, Gamechu Hunde Atomsa, Prince Atorkey, Maha Moh'd Wahbi Atout, Avinash Aujayeb, Mamaru Ayenew Awoke, Sina Azadnajafabad, Rui M S Azevedo, Darshan B B, Ashish D Badiye, Nayereh Baghcheghi, Nasser Bagheri, Sara Bagherieh, Atif Amin Baig, Jennifer L Baker, Madhan Balasubramanian, Ovidiu Constantin Baltatu, Maciej Banach, Palash Chandra Banik, Martina Barchitta, Till Winfried Bärnighausen, Ronald D Barr, Amadou Barrow, Lingkan Barua, Azadeh Bashiri, Pritish Baskaran, Saurav Basu, Alehegn Bekele, Sefealem Assefa Belay, Uzma Iqbal Belgaumi, Shelly L Bell, Luis Belo, Derrick A Bennett, Isabela M Bensenor, Girma Beressa, Amiel Nazer C Bermudez, Habtamu B Beyene, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Natalia V Bhattacharjee, Zulfiqar A Bhutta, Saeid Bitaraf, Virginia Bodolica, Milad Bonakdar Hashemi, Dejana Braithwaite, Muhammad Hammad Butt, Zahid A Butt, Daniela Calina, Luis Alberto Cámera, Luciana Aparecida Campos, Chao Cao, Rosario Cárdenas, Márcia Carvalho, Carlos A Castañeda-Orjuela, Alberico L Catapano, Maria Sofia Cattaruzza, Francieli Cembranel, Ester Cerin, Joshua Chadwick, Julian Chalek, Eeshwar K Chandrasekar, Jaykaran Charan, Vijay Kumar Chattu, Kirti Chauhan, Ju-Huei Chien, Abdulaal Chitheer, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Dinh-Toi Chu, Isaac Sunday Chukwu, Sheng-Chia Chung, Rafael M Claro, Alyssa Columbus, Samuele Cortese, Natalia Cruz-Martins, Bashir Dabo, Omid Dadras, Xiaochen Dai, Emanuele D'Amico, Lalit Dandona, Rakhi Dandona, Isaac Darban, Gary L Darmstadt, Aso Mohammad Darwesh, Amira Hamed Darwish, Jai K Das, Saswati Das, Kairat Davletov, Fernando Pio De la Hoz, Aklilu Tamire Debele, Dessalegn Demeke, Solomon Demissie, Edgar Denova-Gutiérrez, Hardik Dineshbhai Desai, Abebaw Alemayehu Desta, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Diana Dias da Silva, Daniel Diaz, Mengistie Diress, Shirin Djalalinia, Saeid Doaei, Deepa Dongarwar, Haneil Larson Dsouza, Sareh Edalati, Hisham Atan Edinur, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Iffat Elbarazi, Islam Y Elgendy, Muhammed Elhadi, Omar Abdelsadek Abdou Elmeligy, Habitu Birhan Eshetu, Juan Espinosa-Montero, Habtamu Esubalew, Farshid Etaee, Werku Etafa, Adeniyi Francis Fagbamigbe, Ildar Ravisovich Fakhradiyev, Luca Falzone, Carla Sofia E Sá Farinha, Sam Farmer, Abidemi Omolara Fasanmi, Ali Fatehizadeh, Valery L Feigin, Alireza Feizkhah, Xiaoqi Feng, Pietro Ferrara, Getahun Fetensa, Florian Fischer, Ryan Fitzgerald, David Flood, Nataliya A Foigt, Morenike Oluwatoyin Folayan, Kayode Raphael Fowobaje, Richard Charles Franklin, Takeshi Fukumoto, Muktar A Gadanya, Abhay Motiramji Gaidhane, Santosh Gaihre, Emmanuela Gakidou, Yaseen Galali, Nasrin Galehdar, William M Gardner, Priyanka Garg, Teferi Gebru Gebremeskel, Urge Gerema, Lemma Getacher, Motuma Erena Getachew, Solomon Getawa, Kazem Ghaffari, Seyyed-Hadi Ghamari, Mohammad Ghasemi Nour, Fariba Ghassemi, Nermin Ghith, Maryam Gholamalizadeh, Ali Gholami, Ali Gholamrezanezhad, Sherief Ghozy, Paramjit Singh Gill, Tiffany K Gill, James C Glasbey, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Houman Goudarzi, Michal Grivna, Habtamu Alganeh Guadie, Mohammed Ibrahim Mohialdeen Gubari, Temesgen Worku Gudayu, Avirup Guha, Damitha Asanga Gunawardane, Anish Kumar Gupta, Bhawna Gupta, Rahul Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Hailey Hagins, Arvin Haj-Mirzaian, Alexis J Handal, Asif Hanif, Graeme J Hankey, Harapan Harapan, Arief Hargono, Josep Maria Haro, Ahmed I Hasaballah, Md Mehedi Hasan, Hamidreza Hasani, Abdiwahab Hashi, Soheil Hassanipour, Rasmus J Havmoeller, Simon I Hay, Khezar Hayat, Jiawei He, Mahsa Heidari-Foroozan, Claudiu Herteliu, Kamran Hessami, Demisu Zenbaba Heyi, Kamal Hezam, Yuta Hiraike, Ramesh Holla, Praveen Hoogar, Sheikh Jamal Hossain, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Soodabeh Hoveidamanesh, Junjie Huang, Kyle Matthew Humphrey, Salman Hussain, Foziya Mohammed Hussien, Bing-Fang Hwang, Licia Iacoviello, Pulwasha Maria Iftikhar, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Leeberk Raja Inbaraj, Farideh Iravanpour, Sheikh Mohammed Shariful Islam, Farhad Islami, Nahlah Elkudssiah Ismail, Hiroyasu Iso, Gaetano Isola, Masao Iwagami, Chidozie Declan Iwu, Linda Merin J, Louis Jacob, Haitham Jahrami, Mihajlo Jakovljevic, Elham Jamshidi, Manthan Dilipkumar Janodia, Krishnamurthy Jayanna, Sathish Kumar Jayapal, Shubha Jayaram, Rime Jebai, Alelign Tasew Jema, Bijay Mukesh Jeswani, Jost B Jonas, Abel Joseph, Nitin Joseph, Charity Ehimwenma Joshua, Jacek Jerzy Jozwiak, Mikk Jürisson, Billingsley Kaambwa, Ali Kabir, Zubair Kabir, Vidya Kadashetti, Vineet Kumar Kamal, Bhushan Dattatray Kamble, Himal Kandel, Neeti Kapoor, Ibraheem M Karaye, Patrick Dmc Katoto, Joonas H Kauppila, Harkiran Kaur, Gbenga A Kayode, Worku Misganaw Kebede, Jemal Yusuf Kebira, Tibebeselassie S Keflie, Jessica A Kerr, Mohammad Keykhaei, Yousef Saleh Khader, Himanshu Khajuria, Nauman Khalid, Mohammad Khammarnia, M Nuruzzaman Khan, Moien Ab Khan, Taimoor Khan, Yusra H Khan, Javad Khanali, Shaghayegh Khanmohammadi, Khaled Khatab, Moawiah Mohammad Khatatbeh, Sorour Khateri, Mahalaqua Nazli Khatib, Hamid Reza Khayat Kashani, Jagdish Khubchandani, Zemene Demelash Kifle, Gyu Ri Kim, Ruth W Kimokoti, Adnan Kisa, Sezer Kisa, Farzad Kompani, Shivakumar Km Marulasiddaiah Kondlahalli, Hamid Reza Koohestani, Oleksii Korzh, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Vijay Krishnamoorthy, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Mohammed Kuddus, G Anil Kumar, Manasi Kumar, Nithin Kumar, Almagul Kurmanova, Om P Kurmi, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Dharmesh Kumar Lal, Anders O Larsson, Kamaluddin Latief, Caterina Ledda, Paul H Lee, Sang-Woong Lee, Wei-Chen Lee, Yo Han Lee, Jacopo Lenzi, Ming-Chieh Li, Wei Li, Virendra S Ligade, Stephen S Lim, Paulina A Lindstedt, Chun-Han Lo, Justin Lo, Rakesh Lodha, Arianna Maever Loreche, László Lorenzovici, Stefan Lorkowski, Farzan Madadizadeh, Áurea M Madureira-Carvalho, Preetam Bhalchandra Mahajan, Konstantinos Christos Makris, Elaheh Malakan Rad, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Deborah Carvalho Malta, Helena Manguerra, Abdoljalal Marjani, Santi Martini, Miquel Martorell, Awoke Masrie, Elezebeth Mathews, Andrea Maugeri, Maryam Mazaheri, Rishi P Mediratta, Man Mohan Mehndiratta, Yohannes Adama Melaku, Walter Mendoza, Ritesh G Menezes, George A Mensah, Alexios-Fotios A Mentis, Tuomo J Meretoja, Tomislav Mestrovic, Tomasz Miazgowski, Ted R Miller, G K Mini, Mojgan Mirghafourvand, Andreea Mirica, Erkin M Mirrakhimov, Moonis Mirza, Sanjeev Misra, Prasanna Mithra, Karzan Abdulmuhsin Mohammad, Abdollah Mohammadian-Hafshejani, Shafiu Mohammed, Mohammad Mohseni, Ali H Mokdad, Lorenzo Monasta, Mohammad Ali Moni, Maryam Moradi, Yousef Moradi, Shane Douglas Morrison, Vincent Mougin, Sumaira Mubarik, Ulrich Otto Mueller, Francesk Mulita, Daniel Munblit, Efren Murillo-Zamora, Christopher J L Murray, Ghulam Mustafa, Ahamarshan Jayaraman Nagarajan, Vinay Nangia, Sreenivas Narasimha Swamy, Zuhair S Natto, Muhammad Naveed, Biswa Prakash Nayak, Seyed Aria Nejadghaderi, Georges Nguefack-Tsague, Josephine W Ngunjiri, Phuong The Nguyen, QuynhAnh P Nguyen, Robina Khan Niazi, Chukwudi A Nnaji, Nurulamin M Noor, Jean Jacques Noubiap, Chisom Adaobi Nri-Ezedi, Dieta Nurrika, Vincent Ebuka Nwatah, Bogdan Oancea, Kehinde O Obamiro, Onome Bright Oghenetega, Ropo Ebenezer Ogunsakin, Hassan Okati-Aliabad, Akinkunmi Paul Okekunle, Daniel Micheal Okello, Osaretin Christabel Okonji, Andrew T Olagunju, Diriba Dereje Olana, Gláucia Maria Moraes Oliveira, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Sok King Ong, Doris V Ortega-Altamirano, Alberto Ortiz, Sergej M Ostojic, Adrian Otoiu, Abdu Oumer, Alicia Padron-Monedero, Jagadish Rao Padubidri, Adrian Pana, Songhomitra Panda-Jonas, Anamika Pandey, Seithikurippu R Pandi-Perumal, Paraskevi Papadopoulou, Shahina Pardhan, Maja Pasovic, Jay Patel, Aslam Ramjan Pathan, Deepak Paudel, Shrikant Pawar, Veincent Christian Filipino Pepito, Gavin Pereira, Marcos Pereira, Norberto Perico, Simone Perna, Ionela-Roxana Petcu, Fanny Emily Petermann-Rocha, Zahra Zahid Piracha, Nishad Plakkal, Naeimeh Pourtaheri, Amir Radfar, Venkatraman Radhakrishnan, Catalina Raggi, Pankaja Raghav, Fakher Rahim, Vafa Rahimi-Movaghar, Azizur Rahman, Md Mosfequr Rahman, Md Obaidur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Vahid Rahmanian, Setyaningrum Rahmawaty, Rajesh Kumar Rai, Ivano Raimondo, Sathish Rajaa, Prashant Rajput, Pradhum Ram, Shakthi Kumaran Ramasamy, Sheena Ramazanu, Chythra R Rao, Indu Ramachandra Rao, Sowmya J Rao, Drona Prakash Rasali, Ahmed Mustafa Rashid, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, Salman Rawaf, Lal Rawal, Elrashdy M Moustafa Mohamed Redwan, Giuseppe Remuzzi, Kannan Rr Rengasamy, Andre M N Renzaho, Malihe Rezaee, Nazila Rezaei, Mohsen Rezaeian, Abanoub Riad, Jennifer Rickard, Alina Rodriguez, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Peter Rohloff, Bedanta Roy, Godfrey M Rwegerera, Chandan S N, Aly M A Saad, Maha Mohamed Saber-Ayad, Siamak Sabour, Mamta Sachdeva Dhingra, Basema Ahmad Saddik, Erfan Sadeghi, Malihe Sadeghi, Saeid Sadeghian, Umar Saeed, Sahar Saeedi Moghaddam, Sher Zaman Safi, Fatemeh Saheb Sharif-Askari, Amirhossein Sahebkar, Harihar Sahoo, Soumya Swaroop Sahoo, Mirza Rizwan Sajid, Marwa Rashad Salem, Abdallah M Samy, Juan Sanabria, Rama Krishna Sanjeev, Senthilkumar Sankararaman, Itamar S Santos, Milena M Santric-Milicevic, Sivan Yegnanarayana Iyer Saraswathy, Saman Sargazi, Yaser Sarikhani, Maheswar Satpathy, Monika Sawhney, Ganesh Kumar Saya, Abu Sayeed, Nikolaos Scarmeas, Markus P Schlaich, Rachel D Schneider, Aletta Elisabeth Schutte, Subramanian Senthilkumaran, Sadaf G Sepanlou, Dragos Serban, Allen Seylani, Mahan Shafie, Pritik A Shah, Ataollah Shahbandi, Masood Ali Shaikh, Adisu Tafari T Shama, Mehran Shams-Beyranvand, Mohd Shanawaz, Mequannent Melaku Sharew, Pavanchand H Shetty, Rahman Shiri, Velizar Shivarov, Seyed Afshin Shorofi, Kerem Shuval, Migbar Mekonnen Sibhat, Luís Manuel Lopes Rodrigues Silva, Jasvinder A Singh, Narinder Pal Singh, Paramdeep Singh, Surjit Singh, Anna Aleksandrovna Skryabina, Amanda E Smith, Yonatan Solomon, Yi Song, Reed J D Sorensen, Jeffrey D Stanaway, Mu'awiyyah Babale Sufiyan, Muhammad Suleman, Jing Sun, Dev Ram Sunuwar, Mindy D Szeto, Rafael Tabarés-Seisdedos, Seyed-Amir Tabatabaeizadeh, Shima Tabatabai, Moslem Taheri Soodejani, Jacques Lukenze Jl Tamuzi, Ker-Kan Tan, Ingan Ukur Tarigan, Zerihun Tariku, Md Tariqujjaman, Elvis Enowbeyang Tarkang, Nathan Y Tat, Birhan Tsegaw Taye, Heather Jean Taylor, Yibekal Manaye Tefera, Arash Tehrani-Banihashemi, Mohamad-Hani Temsah, Masayuki Teramoto, Pugazhenthan Thangaraju, Rekha Thapar, Arulmani Thiyagarajan, Amanda G Thrift, Ales Tichopad, Jansje Henny Vera Ticoalu, Tala Tillawi, Tenaw Yimer Tiruye, Marcello Tonelli, Roman Topor-Madry, Mathilde Touvier, Marcos Roberto Tovani-Palone, Mai Thi Ngoc Tran, Sana Ullah, Eduardo A Undurraga, Bhaskaran Unnikrishnan, Tolassa Wakayo Ushula, Seyed Mohammad Vahabi, Alireza Vakilian, Sahel Valadan Tahbaz, Rohollah Valizadeh, Jef Van den Eynde, Shoban Babu Varthya, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Madhur Verma, Massimiliano Veroux, Dominique Vervoort, Vasily Vlassov, Stein Emil Vollset, Rade Vukovic, Yasir Waheed, Cong Wang, Fang Wang, Molla Mesele Wassie, Kosala Gayan Weerakoon, Melissa Y Wei, Andrea Werdecker, Nuwan Darshana Wickramasinghe, Asrat Arja Wolde, Gedif Ashebir Wubetie, Ratna Dwi Wulandari, Rongbin Xu, Suowen Xu, Xiaoyue Xu, Lalit Yadav, Kazumasa Yamagishi, Lin Yang, Yuichiro Yano, Sanni Yaya, Fereshteh Yazdanpanah, Sisay Shewasinad Yehualashet, Arzu Yiğit, Vahit Yiğit, Dong Keon Yon, Chuanhua Yu, Chun-Wei Yuan, Giulia Zamagni, Sojib Bin Zaman, Aurora Zanghì, Moein Zangiabadian, Iman Zare, Michael Zastrozhin, Bethany Zigler, Mohammad Zoladl, Zhiyong Zou, Nicholas J Kassebaum, Robert C Reiner,
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Starkweather K, Ragsdale H, Butler M, Zohora FT, Alam N. High wet-bulb temperatures, time allocation, and diurnal patterns of breastfeeding in Bangladeshi fisher-traders. Ann Hum Biol 2025; 52:2461709. [PMID: 39992293 DOI: 10.1080/03014460.2025.2461709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 01/24/2025] [Accepted: 01/26/2025] [Indexed: 02/25/2025]
Abstract
BACKGROUND 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. AIM 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. SUBJECTS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Kathrine Starkweather
- Department of Anthropology, University of Illinois, Chicago, Illinois, USA
- Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Haley Ragsdale
- Department of Anthropology, University of Illinois, Chicago, Illinois, USA
| | - Margaret Butler
- Center of Excellence in Maternal and Child Health, School of Public Health, University of Illinois, Chicago, Illinois, USA
| | - Fatema T Zohora
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- Community Health Sciences; School of Public Health, University of Illinois, Chicago, Chicago, Illinois, USA
| | - Nurul Alam
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
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Wang X, Tong J, Li H, Lu M, Liu Y, Gan H, Wang Y, Geng M, Qie X, Wu X, Gao H, Zhu B, Tao S, Tao X, Yan S, Gao G, Wu X, Huang K, Cao Y, Tao F. Sex-and stage-specific effect of prenatal exposure to organophosphate esters with children's physical growth patterns and adiposity rebound timing: Modification by breastfeeding. JOURNAL OF HAZARDOUS MATERIALS 2025; 493:138309. [PMID: 40252324 DOI: 10.1016/j.jhazmat.2025.138309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 04/14/2025] [Accepted: 04/14/2025] [Indexed: 04/21/2025]
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Xing Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China
| | - Juan Tong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China
| | - Han Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China
| | - Mengjuan Lu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China
| | - Yuan Liu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China
| | - Hong Gan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China
| | - Yifan Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China
| | - Menglong Geng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China
| | - Xuejiao Qie
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China
| | - Xiulong Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Ma'anshan Maternal and Child Health Care Hospital, Ma'anshan, Anhui 243011, China
| | - Hui Gao
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China; Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Beibei Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China
| | - Shuman Tao
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China
| | - Xingyong Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Care Hospital, Ma'anshan, Anhui 243011, China
| | - Guopeng Gao
- Ma'anshan Maternal and Child Health Care Hospital, Ma'anshan, Anhui 243011, China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, Anhui 230032, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, Anhui 230032, China
| | - Yunxia Cao
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, Anhui 230032, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui 230032, China; MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, Anhui 230032, China; Anhui Provincial Key Laboratory of Environment and Population Health across the Life Course, Anhui Medical University, Hefei, Anhui 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, Anhui 230032, China.
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Froley S, Watkins C, Tomori C. Infant Formula in the Digital Age: How US Online Formula Marketing Targets Parents. MATERNAL & CHILD NUTRITION 2025; 21:e70034. [PMID: 40265742 DOI: 10.1111/mcn.70034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 03/09/2025] [Accepted: 03/27/2025] [Indexed: 04/24/2025]
Abstract
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.
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Affiliation(s)
- Simone Froley
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Cristina Watkins
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cecília Tomori
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Chan YF, Ip HL, Yip KH, Choi MSL, Fan YW, Ip P, Chan KKL, Lok KYW. Impact of the baby friendly community initiative on breastfeeding outcomes: A systematic review and meta-analysis. Midwifery 2025; 146:104395. [PMID: 40187237 DOI: 10.1016/j.midw.2025.104395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Revised: 03/18/2025] [Accepted: 03/21/2025] [Indexed: 04/07/2025]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. DISCUSSION 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. REGISTRATION The protocol for this review was registered on PROSPERO (registration number CRD42023460801) on 17th September 2023.
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Affiliation(s)
- Yuen Fan Chan
- School of Nursing, University of Hong Kong, Hong Kong
| | - Hoi Lam Ip
- School of Nursing, University of Hong Kong, Hong Kong
| | - Ka Hing Yip
- School of Nursing, University of Hong Kong, Hong Kong
| | | | - Ying Wei Fan
- School of Nursing, University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics & Adolescent, University of Hong Kong, Hong Kong
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Athanasiadou M, Sheen F, Smith AD, Llewellyn C, Conway R. Cross-Sectional Associations Between Exposure to Commercial Milk Formula Marketing, Beliefs About Its Use, and Socioeconomic Position Among Pregnant Women and Mothers in the UK. MATERNAL & CHILD NUTRITION 2025; 21:e70022. [PMID: 40125991 DOI: 10.1111/mcn.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 01/24/2025] [Accepted: 02/26/2025] [Indexed: 03/25/2025]
Abstract
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.
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Affiliation(s)
- Martha Athanasiadou
- Research, Department of Behavioural Science and Health, University College London, London, UK
| | - Florence Sheen
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Andrea D Smith
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Clare Llewellyn
- Research, Department of Behavioural Science and Health, University College London, London, UK
| | - Rana Conway
- Research, Department of Behavioural Science and Health, University College London, London, UK
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7
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Ganbold G, Farnaz N, Scutts T, Borg B, Mihrshahi S. The Association Between Exclusive Breastfeeding and Diarrhoea Morbidity in Infants Aged 0-6 Months: A Rapid Review and Meta-Analysis. MATERNAL & CHILD NUTRITION 2025; 21:e70042. [PMID: 40265740 DOI: 10.1111/mcn.70042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 03/27/2025] [Accepted: 04/08/2025] [Indexed: 04/24/2025]
Abstract
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.
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Affiliation(s)
- Gantsetseg Ganbold
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Nadia Farnaz
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Taylah Scutts
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Bindi Borg
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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8
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Kwah K, Sharps M, Bartle N, Choudhry K, Blissett J, Brown K. Engaging South Asian Communities in the United Kingdom to Explore Infant Feeding Practices and Inform Intervention Development: Application of the REPLACE Approach. MATERNAL & CHILD NUTRITION 2025; 21:e70009. [PMID: 39979791 DOI: 10.1111/mcn.70009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 02/05/2025] [Accepted: 02/06/2025] [Indexed: 02/22/2025]
Abstract
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.
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Affiliation(s)
- Kayleigh Kwah
- Public Health and Applied Behaviour Change Laboratory, University of Hertfordshire, Hatfield, UK
| | - Maxine Sharps
- Health and Life Sciences, School of Applied Social Sciences, De Montfort University, Leicester, UK
| | | | - Kubra Choudhry
- School of Social Sciences and Humanities, Coventry University, Coventry, UK
| | | | - Katherine Brown
- Public Health and Applied Behaviour Change Laboratory, University of Hertfordshire, Hatfield, UK
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9
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Hess SY, Arnold CD, Smith TJ, Allen LH, Hampel D, Jones KS, Parkington DA, Meadows SR, Sitthideth D, Kounnavong S. Thiamine Concentration in Human Milk Is Correlated With Maternal and Infant Thiamine Status: A Cross-Sectional Analysis of the Lao Thiamine Study. MATERNAL & CHILD NUTRITION 2025; 21:e70027. [PMID: 40211576 DOI: 10.1111/mcn.70027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 02/24/2025] [Accepted: 03/05/2025] [Indexed: 06/11/2025]
Abstract
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.
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Affiliation(s)
- Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, California, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, California, USA
| | - Taryn J Smith
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Lindsay H Allen
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, California, USA
- USDA-Agricultural Research Service, Western Human Nutrition Research Center, Davis, California, USA
| | - Daniela Hampel
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, California, USA
- USDA-Agricultural Research Service, Western Human Nutrition Research Center, Davis, California, USA
| | - Kerry S Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Damon A Parkington
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Sarah R Meadows
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Dalaphone Sitthideth
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
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10
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Mitchell V, White M, Shinwell S, Biazus-Dalcin C. Supporting Breastmilk Feeding for Infants in Foster Care: A Scoping Review. MATERNAL & CHILD NUTRITION 2025; 21:e13810. [PMID: 39925196 DOI: 10.1111/mcn.13810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 01/14/2025] [Accepted: 01/17/2025] [Indexed: 02/11/2025]
Abstract
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.
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Affiliation(s)
- Vicky Mitchell
- Mother, Infant and Child Health Research Group, University of Dundee, Dundee, Scotland
| | | | - Shona Shinwell
- Mother, Infant and Child Health Research Group, University of Dundee, Dundee, Scotland
| | - Camila Biazus-Dalcin
- Mother, Infant and Child Health Research Group, University of Dundee, Dundee, Scotland
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11
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Maxwell C, Self B, Bould K. A Descriptive Investigation of Infant Feeding Bottles Marketed in the UK Designed to Replicate Breastfeeding and the Evidence That Underpins Them. MATERNAL & CHILD NUTRITION 2025; 21:e70008. [PMID: 40023778 DOI: 10.1111/mcn.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Revised: 02/04/2025] [Accepted: 02/06/2025] [Indexed: 03/04/2025]
Abstract
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.
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Affiliation(s)
- Clare Maxwell
- School of Public and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Becky Self
- School of Public and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Kathryn Bould
- School of Psychology, Liverpool John Moores University, Liverpool, UK
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12
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Sanghvi TG, Homan R, Nguyen T, Mahmud Z, Nersesyan M, Preware P, Frongillo EA, Mathisen R. Expenditures on Strengthening Large Scale Breastfeeding Counseling Programs in Bangladesh, Ethiopia, and Vietnam. MATERNAL & CHILD NUTRITION 2025; 21:e70031. [PMID: 40183644 DOI: 10.1111/mcn.70031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 12/16/2024] [Accepted: 03/12/2025] [Indexed: 04/05/2025]
Abstract
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.
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Affiliation(s)
- Tina G Sanghvi
- Alive & Thrive initiative, FHI 360, Family Health International, Washington DC and Durham, North Carolina, USA
| | - Rick Homan
- FHI 360, Health Services Research, Global Health and Population, Durham, North Carolina, USA
| | | | | | - Marina Nersesyan
- Alive & Thrive initiative, FHI 360, Family Health International, Washington DC and Durham, North Carolina, USA
| | - Patricia Preware
- Alive & Thrive initiative, FHI 360, Family Health International, Washington DC and Durham, North Carolina, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
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13
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Kwah K, Bartle N, Sharps M, Choudhry K, Blissett J, Brown K. Application of the Behaviour Change Wheel to Optimise Infant Feeding in Bangladeshi and Pakistani Communities in the UK: Co-Development of the Learning About Infant Feeding Together (LIFT) Intervention. MATERNAL & CHILD NUTRITION 2025; 21:e70019. [PMID: 40275628 DOI: 10.1111/mcn.70019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 02/18/2025] [Accepted: 02/24/2025] [Indexed: 04/26/2025]
Abstract
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.
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Affiliation(s)
- Kayleigh Kwah
- Public Health and Applied Behaviour Change Laboratory, University of Hertfordshire, Hatfield, UK
| | | | - Maxine Sharps
- Department of Health and Life Sciences, School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Kubra Choudhry
- School of Social Sciences and Humanities, Coventry University, Coventry, UK
| | - Jackie Blissett
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Katherine Brown
- Public Health and Applied Behaviour Change Laboratory, University of Hertfordshire, Hatfield, UK
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14
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Faa G, Pichiri G, Coni P, Dessì A, Fraschini M, Fanos V. They will be famous: Multipotent stem cells in breast milk. World J Clin Pediatr 2025; 14:101080. [PMID: 40491730 PMCID: PMC11947875 DOI: 10.5409/wjcp.v14.i2.101080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 01/20/2025] [Accepted: 02/12/2025] [Indexed: 03/18/2025] Open
Abstract
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.
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Affiliation(s)
- Gavino Faa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari 09100, Sardegna, Italy
| | - Giuseppina Pichiri
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari 09100, Sardegna, Italy
| | - Pierpaolo Coni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari 09100, Sardegna, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, Cagliari 09100, Sardegna, Italy
| | - Matteo Fraschini
- Department of Ingegneria Elettrica ed Elettronica, University of Cagliari, Cagliari 09100, Sardegna, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, AOU and University of Cagliari, Neonatal Intensive Care Unit, Monserrato 09042, Italy
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15
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Hawke K, Bowman A, Cameron C, Peterson KL, Middleton P, Leane C, Deverix J, Collins-Clinch A, Rumbold A, Glover K. Breastfeeding experiences and infant feeding decisions for women birthing Aboriginal children in Adelaide, South Australia: a qualitative study. Int Breastfeed J 2025; 20:48. [PMID: 40481537 PMCID: PMC12144733 DOI: 10.1186/s13006-025-00742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Accepted: 06/01/2025] [Indexed: 06/11/2025] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Karen Hawke
- Aboriginal Families and Communities Health Research Alliance (ACRA), Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- Flinders University, Adelaide, Australia
| | - Anneka Bowman
- Aboriginal Families and Communities Health Research Alliance (ACRA), Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Casey Cameron
- Aboriginal Families and Communities Health Research Alliance (ACRA), Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Karen L Peterson
- Aboriginal Families and Communities Health Research Alliance (ACRA), Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Philippa Middleton
- School of Medicine, University of Adelaide, Adelaide, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Cathy Leane
- Aboriginal Health Division, Women's and Children's Health Network, Adelaide, Australia
| | - Janiene Deverix
- Aboriginal Health Division, Women's and Children's Health Network, Adelaide, Australia
| | | | - Alice Rumbold
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
- School of Medicine and Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Women and Babies Division, Women's and Children's Health Network, Adelaide, Australia
| | - Karen Glover
- Aboriginal Families and Communities Health Research Alliance (ACRA), Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
- School of Medicine, University of Adelaide, Adelaide, Australia.
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
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16
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Yang C, Na X, Yang H, Xi M, Yang Y, Yan Y, Duan S, Li T, Szeto IMY, Zhao A. Maternal sleep and psychological status in the postpartum period are associated with functional protein alterations in breast milk:a mother-infant cohort study. Clin Nutr ESPEN 2025; 67:510-522. [PMID: 40187732 DOI: 10.1016/j.clnesp.2025.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 10/29/2024] [Accepted: 03/25/2025] [Indexed: 04/07/2025]
Abstract
BACKGROUND & AIMS 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Celi Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Xiaona Na
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Haibing Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Menglu Xi
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yucheng Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yalu Yan
- National Center of Technology Innovation for Dairy, Hohhot 010110, China
| | - Sufang Duan
- National Center of Technology Innovation for Dairy, Hohhot 010110, China
| | - Ting Li
- National Center of Technology Innovation for Dairy, Hohhot 010110, China
| | | | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute for Healthy China, Tsinghua University, Beijing, China.
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Verma M, Kapoor N, Senapati S, Singh O, Bhadoria AS, Khetarpal P, Kumar S, Bansal K, Ranjan R, Kakkar R, Kalra S. Comprehending the Epidemiology and Aetiology of Childhood Obesity: Integrating Life Course Approaches for Prevention and Intervention. Diabetes Ther 2025; 16:1177-1206. [PMID: 40299281 PMCID: PMC12085512 DOI: 10.1007/s13300-025-01734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 03/20/2025] [Indexed: 04/30/2025] Open
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Nitin Kapoor
- Department of Endocrine, Diabetes and Metabolism, Christian Medical College, Vellore, TN, 632004, India
- Non-communicable Disease Unit, The Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Sabyasachi Senapati
- Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India
| | - Omna Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Ajeet Singh Bhadoria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Preeti Khetarpal
- Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India
| | - Shashank Kumar
- Department of Biochemistry, Central University of Punjab, Bathinda, 151401, India
| | - Kanika Bansal
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rakhsha Ranjan
- Department of Paediatrics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Rakesh Kakkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, 132001, India.
- University Centre for Research and Development, Chandigarh University, Mohali, India.
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Martínez-Hortelano JA, Saz-Lara A, González JLG, Cristóbal-Aguado S, Iglesias-Rus L, Martínez-Vizcaíno V, Garrido-Miguel M. Skin-to-skin contact and breastfeeding after caesarean section: A systematic review and meta-analysis of intervention studies. Int J Nurs Stud 2025; 166:105038. [PMID: 40086104 DOI: 10.1016/j.ijnurstu.2025.105038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 02/14/2025] [Accepted: 02/25/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND 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. OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- José Alberto Martínez-Hortelano
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado Comunitario y Determinantes Sociales de la Salud, Madrid, Spain; University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain
| | - Alicia Saz-Lara
- CarVasCare Research Group (2023-GRIN-34459), Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jorge Luis Gómez González
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado Comunitario y Determinantes Sociales de la Salud, Madrid, Spain.
| | - Soledad Cristóbal-Aguado
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado Comunitario y Determinantes Sociales de la Salud, Madrid, Spain
| | - Laura Iglesias-Rus
- Universidad de Alcalá, Facultad de Enfermería y Fisioterapia, Departamento de Enfermería y Fisioterapia, Enfermería, Cuidado Comunitario y Determinantes Sociales de la Salud, Madrid, Spain
| | - Vicente Martínez-Vizcaíno
- University of Castilla-La Mancha, Health Care and Social Research Center, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Miriam Garrido-Miguel
- Universidad de Castilla-La Mancha, Facultad de Enfermería de Albacete, Albacete, Spain
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Honoré KD, Jespersen JS, Zachariassen G. Infants admitted to Danish neonatal units demonstrate satisfactory growth independent of feeding type at discharge. Acta Paediatr 2025; 114:1275-1282. [PMID: 39749824 DOI: 10.1111/apa.17563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 12/09/2024] [Accepted: 12/18/2024] [Indexed: 01/04/2025]
Abstract
AIM 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. METHODS 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. RESULTS 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. CONCLUSION Danish newborn infants demonstrated satisfactory growth during admission to the neonatal unit, independent of feeding type at discharge. Rates of exclusively breastfeeding need improvement.
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Affiliation(s)
- Karina Dyrvig Honoré
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Jonas Sveen Jespersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Gitte Zachariassen
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Danish National Quality Database for Births (DNQDB), Aarhus, Denmark
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Miranda AR, Barral PE, Scotta AV, Cortez MV, Soria EA. An overview of reviews of breastfeeding barriers and facilitators: Analyzing global research trends and hotspots. GLOBAL EPIDEMIOLOGY 2025; 9:100192. [PMID: 40129756 PMCID: PMC11931314 DOI: 10.1016/j.gloepi.2025.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 02/12/2025] [Accepted: 03/04/2025] [Indexed: 03/26/2025] Open
Abstract
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.
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Affiliation(s)
- Agustín Ramiro Miranda
- MoISA, University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, 911 Avenue d'Agropolis, Cedex 5, 34394 Montpellier, France
| | - Paula Eugenia Barral
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, INICSA, Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Ana Veronica Scotta
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, INICSA, Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Mariela Valentina Cortez
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, INICSA, Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
| | - Elio Andrés Soria
- Universidad Nacional de Córdoba, Facultad de Ciencias Médicas, Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, INICSA, Bv. de la Reforma, Ciudad Universitaria, 5014 Córdoba, Argentina
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21
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Gonzalez-Garay AG, Serralde-Zúñiga AE, Hidalgo LV, Alonso Ocaña MV, Estrada-Moya F, Vera IM. High protein intake in formula-fed term infants: Abridged republication of the cochrane systematic review. Clin Nutr ESPEN 2025; 67:476-492. [PMID: 40147761 DOI: 10.1016/j.clnesp.2025.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Accepted: 03/18/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
| | - Aurora E Serralde-Zúñiga
- Clinical Nutrition Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Mathy Victoria Alonso Ocaña
- Clinical Nutrition Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Estrada-Moya
- Clinical Nutrition Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Isabel Medina Vera
- Methodology Research Unit, Instituto Nacional de Pediatría, Mexico City, Mexico
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Kerimoglu Yildiz G, Turk Delibalta R, Coktay Z. Artificial intelligence-assisted chatbot: impact on breastfeeding outcomes and maternal anxiety. BMC Pregnancy Childbirth 2025; 25:631. [PMID: 40448061 DOI: 10.1186/s12884-025-07753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2025] [Accepted: 05/23/2025] [Indexed: 06/02/2025] Open
Abstract
BACKGROUND 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. METHODS 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). RESULTS 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. CONCLUSIONS 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. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Gizem Kerimoglu Yildiz
- Faculty of Health Sciences, Department of Pediatric Nursing, Hatay Mustafa Kemal University, Hatay, Türkiye
| | - Rukiye Turk Delibalta
- Faculty of Health Sciences, Department of Women Health and Nursing, Kafkas University, Kars, Türkiye.
| | - Zehra Coktay
- Internal Medicine Service, Iskenderun State Hospital, Hatay, Türkiye
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Wamahiu M, Baker P, Dorlach T. Generating political priority for breastfeeding and the adoption of Kenya's 2012 BMS act: the importance of women's leadership. Global Health 2025; 21:32. [PMID: 40442767 PMCID: PMC12123713 DOI: 10.1186/s12992-025-01127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 05/21/2025] [Indexed: 06/02/2025] Open
Abstract
BACKGROUND 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Maryanne Wamahiu
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Kulmbach, Germany.
- Bayreuth International Graduate School of African Studies, University of Bayreuth, Bayreuth, Germany.
| | - Phillip Baker
- School of Public Health, University of Sydney, Sydney, Australia
| | - Tim Dorlach
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Kulmbach, Germany
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Christensen SH, Aarestrup J, Rasmussen KM, Baker JL, Pedersen DC, Bjerregaard LG. Duration and intensity of lactation and maternal risk of subsequent incident coronary heart disease and stroke - a prospective cohort study. Am J Clin Nutr 2025:S0002-9165(25)00316-8. [PMID: 40449891 DOI: 10.1016/j.ajcnut.2025.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 05/21/2025] [Accepted: 05/27/2025] [Indexed: 06/03/2025] Open
Abstract
BACKGROUND Although lactation may reduce maternal risk of breast cancer, other potential long-term health benefits of lactation for mothers are largely unknown. OBJECTIVE We examined whether the durations of predominant and any lactation were associated with maternal risks of coronary heart disease (CHD) and stroke. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Sophie Hilario Christensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Julie Aarestrup
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Jennifer L Baker
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Dorthe C Pedersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lise G Bjerregaard
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
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25
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Park H, Reither EN. Associations between breastfeeding duration and weight status transitions in early childhood. PLoS One 2025; 20:e0323967. [PMID: 40440349 PMCID: PMC12121782 DOI: 10.1371/journal.pone.0323967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 04/16/2025] [Indexed: 06/02/2025] Open
Abstract
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.
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Affiliation(s)
- Hyojun Park
- Department of Sociology and Anthropology, Utah State University, Logan, Utah, United States of America
| | - Eric N. Reither
- Department of Sociology and Anthropology, Utah State University, Logan, Utah, United States of America
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26
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Langer-Gould AM, Cepon-Robins TJ, Benn Torres J, Yeh EA, Gildner TE. Embodiment of structural racism and multiple sclerosis risk and outcomes in the USA. Nat Rev Neurol 2025:10.1038/s41582-025-01096-5. [PMID: 40425864 DOI: 10.1038/s41582-025-01096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2025] [Indexed: 05/29/2025]
Abstract
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.
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Affiliation(s)
- Annette M Langer-Gould
- Department of Neurology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, CA, USA.
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Tara J Cepon-Robins
- Department of Anthropology, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Jada Benn Torres
- Department of Anthropology, Genetic Anthropology and Biocultural Studies Laboratory, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Ann Yeh
- Department of Paediatrics Neurology, University of Toronto, Toronto, Ontario, Canada
- Paediatric MS and Neuroinflammatory Disorders Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Theresa E Gildner
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO, USA
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Duan J, Ding R, Yu Y, Li M, Ruan Y, Hu Y, He Y, Sun Z. Global and regional burden of congenital birth defects, 1990-2021: persistent healthcare disparities and emerging challenges from non-fatal health burden. BMJ PUBLIC HEALTH 2025; 3:e001608. [PMID: 40433070 PMCID: PMC12107580 DOI: 10.1136/bmjph-2024-001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 04/30/2025] [Indexed: 05/29/2025]
Abstract
Introduction 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. Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Junchao Duan
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China
| | - Ruiyang Ding
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China
| | - Yongbo Yu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Menglong Li
- Department of Child and Maternal Health, School of Public Health, Capital Medical University, Beijing, China
| | - Yanping Ruan
- Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yifei Hu
- Department of Child and Maternal Health, School of Public Health, Capital Medical University, Beijing, China
| | - Yihua He
- Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhiwei Sun
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China
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Mohammed FZ, Berie MD, Mekuria AD, Yesuf SM, Urgie BM. Colostrum avoidance and associated factors among mothers of children under the age of six months in Sekota Zuria woreda, Waghimra zone, Ethiopia. BMC Pregnancy Childbirth 2025; 25:605. [PMID: 40420042 PMCID: PMC12105285 DOI: 10.1186/s12884-025-07717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/13/2025] [Indexed: 05/28/2025] Open
Abstract
BACKGROUND 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). OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Fitsum Zekarias Mohammed
- Department of Public Health, Asrat Woldeyes Health Sciences Campus, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Mulugeta Desalegn Berie
- Department of Public Health, Asrat Woldeyes Health Sciences Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abinet Dagnaw Mekuria
- Department of Public Health, Asrat Woldeyes Health Sciences Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Sadat Mohammed Yesuf
- Department of Public Health, Asrat Woldeyes Health Sciences Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Besufekad Mulugeta Urgie
- Department of Internal Medicine, Asrat Woldeyes Health Sciences Campus, Debre Berhan University, Debre Berhan, Ethiopia
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Hammad M, Rahman MHU. Early nourishment, better survival: association between breastfeeding initiation and infant mortality in Indian tribes. BMC Public Health 2025; 25:1898. [PMID: 40410715 PMCID: PMC12100779 DOI: 10.1186/s12889-025-23084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/07/2025] [Indexed: 05/25/2025] Open
Abstract
BACKGROUND 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. METHOD 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Mohammad Hammad
- Manipal Tata Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Mohammad Hifz Ur Rahman
- Manipal Tata Medical College, Manipal Academy of Higher Education, Manipal, India.
- Department of Public Health, College of Medicine and Health Sciences, National University of Science and Teachnology, Sohar, Oman.
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Lozano-Esparza S, Unar-Munguía M, Trabert B, Gómez-Flores-Ramos L, Brochier M, Hernández-Ávila JE, Stern D, Lajous M. Lifetime breastfeeding and mortality among parous women in the Mexican Teacher's Cohort. Int J Gynaecol Obstet 2025. [PMID: 40402204 DOI: 10.1002/ijgo.70183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 04/08/2025] [Accepted: 04/14/2025] [Indexed: 05/23/2025]
Abstract
OBJECTIVE To assess the relationship between lifetime breastfeeding and all-cause and cause-specific mortality in Mexican women. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
| | - Mishel Unar-Munguía
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Britton Trabert
- Department of Obstetrics and Gynecology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT and Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Liliana Gómez-Flores-Ramos
- SECIHTI - Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Marion Brochier
- Faculté de médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada
| | | | - Dalia Stern
- SECIHTI - Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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31
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Xu Q. Comment on: Ability to Breastfeed After Breast Reduction. Aesthetic Plast Surg 2025:10.1007/s00266-025-04985-8. [PMID: 40404847 DOI: 10.1007/s00266-025-04985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2025] [Accepted: 05/01/2025] [Indexed: 05/24/2025]
Affiliation(s)
- Qi Xu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Nanyang Medical College, Nanyang, China.
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China.
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Ruiz MT, da Conceição Rodrigues E, Christoffel MM, de Resende CV, Cavalcanti MC, Ferreira MG, da Silva JA, da Silva KEPO, Wernet M, Gomes ALM, Raponi MBG, de Oliveira JF, Contim D, Linares AM. Effectiveness of individualized breastfeeding counseling during the dyad's stay in rooming-in: a randomized, multicenter, open and parallel study. Int Breastfeed J 2025; 20:41. [PMID: 40400003 PMCID: PMC12093738 DOI: 10.1186/s13006-025-00710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 03/11/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION Breastfeeding counseling during the dyad's stay in rooming-in was effective in maintaining exclusive breastfeeding until the child's sixth month of life. TRIAL REGISTRATION UTN: U1111-1284-3559 / RBR-4w9v5rq (2023-03-20).
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Affiliation(s)
- Mariana Torreglosa Ruiz
- Stricto sensu Graduate Program in Health Care, Federal University of Triangle Mineiro, Av. Getúlio Guaritá, 107, Uberaba, Minas Gerais, 38025-440, Brazil.
- Didactic-Scientific Department of Nursing in Hospital Care, Institute of Health Sciences, Federal University of Triangle Mineiro, Av. Getúlio Guaritá, 107, Uberaba, Minas Gerais, CEP: 38025- 440, Brazil.
| | - Elisa da Conceição Rodrigues
- Posgraduate Program in Nursing, Anna Nery School of Nursing, Rua Afonso Cavalcanti, 275, Cidade Nova, Rio de Janeiro, Rio de Janeiro, 20211110, Brazil
| | - Marialda Moreira Christoffel
- Posgraduate Program in Nursing, Anna Nery School of Nursing, Rua Afonso Cavalcanti, 275, Cidade Nova, Rio de Janeiro, Rio de Janeiro, 20211110, Brazil
| | - Cynthya Viana de Resende
- Stricto sensu Graduate Program in Health Care, Federal University of Triangle Mineiro, Av. Getúlio Guaritá, 107, Uberaba, Minas Gerais, 38025-440, Brazil
| | - Michele Curcino Cavalcanti
- Posgraduate Program in Nursing, Anna Nery School of Nursing, Rua Afonso Cavalcanti, 275, Cidade Nova, Rio de Janeiro, Rio de Janeiro, 20211110, Brazil
| | - Marianne Guterres Ferreira
- Posgraduate Program in Nursing, Anna Nery School of Nursing, Rua Afonso Cavalcanti, 275, Cidade Nova, Rio de Janeiro, Rio de Janeiro, 20211110, Brazil
| | - Jéssica Aparecida da Silva
- Stricto sensu Graduate Program in Health Care, Federal University of Triangle Mineiro, Av. Getúlio Guaritá, 107, Uberaba, Minas Gerais, 38025-440, Brazil
| | | | - Monika Wernet
- Pos graduate Program in Nursing Federal, University of Sāo Carlos, Rodovia Washington Luis, km 235, Sāo Carlos, São Paulo, 13565905, Brazil
| | - Ana Letícia Monteiro Gomes
- Posgraduate Program in Nursing, Anna Nery School of Nursing, Rua Afonso Cavalcanti, 275, Cidade Nova, Rio de Janeiro, Rio de Janeiro, 20211110, Brazil
| | - Maria Beatriz Guimarães Raponi
- School of Medicine, Nursing Course, Federal University of Uberlândia, Avenida Pará, Bloco 2U, 1720, Umuarama, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Jacqueline Faria de Oliveira
- Clinic Hospital of Federal University of Triangle Mineiro, Av. Getúlio Guaritá, 130, Uberaba, Minas Gerais, CEP: 38025-440, Brazil
| | - Divanice Contim
- Stricto sensu Graduate Program in Health Care, Federal University of Triangle Mineiro, Av. Getúlio Guaritá, 107, Uberaba, Minas Gerais, 38025-440, Brazil
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Baxter JAB, Wasan Y, Daniel AI, Begum K, Hussain A, Iqbal J, Aufreiter S, Beggs MR, Duan L, Greco A, Huang C, Soofi S, Bandsma RHJ, Bhutta ZA, O'Connor DL. Maternal multiple micronutrient supplementation in rural Pakistan increased some milk micronutrient concentrations, but not infant growth, at three-months postpartum: a RCT substudy. Am J Clin Nutr 2025:S0002-9165(25)00274-6. [PMID: 40409469 DOI: 10.1016/j.ajcnut.2025.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 05/08/2025] [Accepted: 05/19/2025] [Indexed: 05/25/2025] Open
Abstract
BACKGROUND 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. OBJECTIVE 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. METHODS 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). RESULTS 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). CONCLUSIONS 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. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE ClinlicalTrials.gov: NCT04451395 (https://clinicaltrials.gov/study/NCT04451395) and NCT03287882 (https://clinicaltrials.gov/study/NCT03287882).
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Affiliation(s)
- Jo-Anna B Baxter
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada; Centre for Global Child Health, Hospital for Sick Children, Ontario, Canada.
| | - Yaqub Wasan
- Centre of Excellence in Women and Child Health, Aga Khan University, Sindh, Pakistan
| | - Allison I Daniel
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada; Translational Medicine Program, Hospital for Sick Children, Ontario, Canada
| | - Kehkashan Begum
- Centre of Excellence in Women and Child Health, Aga Khan University, Sindh, Pakistan
| | - Amjad Hussain
- Centre of Excellence in Women and Child Health, Aga Khan University, Sindh, Pakistan
| | - Junaid Iqbal
- Centre of Excellence in Women and Child Health, Aga Khan University, Sindh, Pakistan
| | - Susanne Aufreiter
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada; Translational Medicine Program, Hospital for Sick Children, Ontario, Canada
| | - Megan R Beggs
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada; Translational Medicine Program, Hospital for Sick Children, Ontario, Canada
| | - Lauren Duan
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada
| | - Adrianna Greco
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada; Translational Medicine Program, Hospital for Sick Children, Ontario, Canada
| | - Carolina Huang
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada
| | - Sajid Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Sindh, Pakistan
| | - Robert H J Bandsma
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada; Centre for Global Child Health, Hospital for Sick Children, Ontario, Canada; Translational Medicine Program, Hospital for Sick Children, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Ontario, Canada
| | - Zulfiqar A Bhutta
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada; Centre for Global Child Health, Hospital for Sick Children, Ontario, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Sindh, Pakistan; Institute for Global Health and Development, Aga Khan University, Sindh, Pakistan
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada; Translational Medicine Program, Hospital for Sick Children, Ontario, Canada; Department of Paediatrics, Mount Sinai Hospital, Ontario, Canada
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del Valle L, Melero V, Bodas A, Martín O’Connor R, Ramos-Levi A, Barabash A, Valerio J, de Miguel P, Díaz Pérez JÁ, Familiar Casado C, Moraga Guerrero I, Jiménez-Varas I, Marcuello Foncillas C, Pazos M, Rubio-Herrera MA, López-Plaza B, Runkle I, Matía-Martín P, Calle-Pascual AL. A Greater Adherence to the Mediterranean Diet Supplemented with Extra Virgin Olive Oil and Nuts During Pregnancy Is Associated with Improved Offspring Health at Six Years of Age. Nutrients 2025; 17:1719. [PMID: 40431459 PMCID: PMC12113803 DOI: 10.3390/nu17101719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2025] [Revised: 05/13/2025] [Accepted: 05/16/2025] [Indexed: 05/29/2025] Open
Abstract
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.
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Affiliation(s)
- Laura del Valle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Verónica Melero
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Andrés Bodas
- Paediatrics Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain;
| | - Rocío Martín O’Connor
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Ana Ramos-Levi
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Ana Barabash
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Johanna Valerio
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Paz de Miguel
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - José Ángel Díaz Pérez
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Cristina Familiar Casado
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Inmaculada Moraga Guerrero
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Inés Jiménez-Varas
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Clara Marcuello Foncillas
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Mario Pazos
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Miguel A. Rubio-Herrera
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Bricia López-Plaza
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
| | - Pilar Matía-Martín
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Alfonso L. Calle-Pascual
- Endocrinology and Nutrition Department, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain; (L.d.V.); (V.M.); (R.M.O.); (A.R.-L.); (A.B.); (J.V.); (P.d.M.); (J.Á.D.P.); (C.F.C.); (I.M.G.); (I.J.-V.); (C.M.F.); (M.P.); (M.A.R.-H.); (I.R.)
- Facultad de Medicina, Medicina II Department, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
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Neupane S, Vuong AM, Haboush-Deloye A, Mancha K, Buccini G. Association between postpartum anxiety and depression and exclusive and continued breastfeeding practices: a cross-sectional study in Nevada, USA. Int Breastfeed J 2025; 20:39. [PMID: 40390039 PMCID: PMC12090565 DOI: 10.1186/s13006-025-00734-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 05/10/2025] [Indexed: 05/21/2025] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Smriti Neupane
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
| | - Amanda Haboush-Deloye
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
- Nevada Institute for Children's Research and Policy, School of Public Health, University of Nevada, Las Vegas, NV, United States of America
| | - Kaleigh Mancha
- Heart and Sol Collective, Las Vegas, NV, United States of America
| | - Gabriela Buccini
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV, United States of America.
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36
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Saavedra LPJ, Raposo SR, Assakawa ALM, Lucredi NC, Peres MNC, Piovan S, Gonçalves GD, Moreira VM, Barbosa LF, Sousa D, Farias Dos Santos FC, Amaro A, Ferreira-Junior MD, Graceli JB, Matafome P, Comar JF, Gomes RM, Jiménez-Chillarón JC, Almeida DL, Mathias PCDF. Fenofibrate treatment during lactation prevents liver and adipose tissue associated metabolic dysfunction in a rat model of childhood obesity. Biomed Pharmacother 2025; 188:118166. [PMID: 40393278 DOI: 10.1016/j.biopha.2025.118166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Revised: 05/08/2025] [Accepted: 05/09/2025] [Indexed: 05/22/2025] Open
Abstract
Childhood obesity and associated comorbidities in adulthood are of great concern worldwide. Evidence highlights the importance of lactation in later disease development. In this sense, obese children are at great risk of developing adult obesity, insulin resistance, type 2 diabetes, and cardiovascular disease at adulthood. PPARα activation during lactation promotes the expression of key enzymes involved in lipid oxidation, and it was associated with reduced adiposity in children. Therefore, we hypothesized that an animal model of childhood obesity, small litter (SL), would lead to the development of obesity and metabolic dysfunction in adulthood, which could be prevented by postnatal PPARα agonism. Wistar dams had their litter reduced, leading to postnatal overfeeding and obesity early in life. SL male pups were treated with fenofibrate, an PPARα agonist, during lactation, from postnatal day (PND) 1 until weaning (PND21), to verify whether PPARα activation prevents the developmental programming at adulthood (PND120). Childhood obesity induced by postnatal overfeeding leads to decreased markers for oxidative metabolism during infancy, leading to increased visceral adiposity and oxidative stress, insulin resistance, hepatic microvesicular steatosis, and increased fibroblast growth factor 21 (Fgf21) expression, followed by decreased brown adipose tissue (BAT) sympathetic nerve activity and decreased Fgfr1 hypothalamic expression in adulthood. Agonist-induced PPARα activation during lactation mitigated the development of aforementioned alterations in adulthood. Postnatal fenofibrate treatment prevents the developmental programming of visceral obesity, liver-associated metabolic dysfunction and BAT autonomic sympathetic hypoactivity in an animal model of childhood obesity.
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Affiliation(s)
| | - Scarlett Rodrigues Raposo
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, Maringá, PR, Brazil
| | - Ana Letícia Manso Assakawa
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, Maringá, PR, Brazil
| | | | | | - Silvano Piovan
- Department of Biochemistry, State University of West Paraná, Cascavel, PR, Brazil
| | - Gessica Dutra Gonçalves
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, Maringá, PR, Brazil
| | - Veridiana Mota Moreira
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, Maringá, PR, Brazil
| | - Letícia Ferreira Barbosa
- Department of Biotechnology, Genetics, and Cellular Biology, State University of Maringá, Maringá, PR, Brazil
| | - Diana Sousa
- Institute of Physiology and Institute of Clinical and Biomedical Research, Faculty of Medicine and Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal Coimbra Health School, ESTeSC, Instituto Politécnico de Coimbra, Coimbra, Portugal Clinical Academic Center of Coimbra, Coimbra, Portugal; Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra 3000-548, Portugal; CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra. Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine. Ph.D. Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Azinhaga de Santa Comba, Coimbra 3000-548, Portugal
| | | | - Andreia Amaro
- Institute of Physiology and Institute of Clinical and Biomedical Research, Faculty of Medicine and Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal Coimbra Health School, ESTeSC, Instituto Politécnico de Coimbra, Coimbra, Portugal Clinical Academic Center of Coimbra, Coimbra, Portugal; Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra 3000-548, Portugal; CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra. Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine. Ph.D. Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Azinhaga de Santa Comba, Coimbra 3000-548, Portugal
| | | | - Jones Bernardes Graceli
- Department of Morphology, Federal University of Espírito Santo, Vitória, Brazil; Animal Science, School of Agricultural Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Paulo Matafome
- Institute of Physiology and Institute of Clinical and Biomedical Research, Faculty of Medicine and Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal Coimbra Health School, ESTeSC, Instituto Politécnico de Coimbra, Coimbra, Portugal Clinical Academic Center of Coimbra, Coimbra, Portugal
| | | | - Rodrigo Mello Gomes
- Laboratory of Endocrine Physiology and MetabolismDepartment of Physiological Sciences, Federal University of Goiás, Goiânia, GO, Brazil; Department of Structural and Functional Biology, Institute of Biology, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil; Obesity and Comorbidities Research Center, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Josep C Jiménez-Chillarón
- Institut de Recerca Sant Joan de Déu (IRSJD), Endocrinology, Esplugues, Spain; Universitat de Barcelona-Facultat Medicina-Bellvitge, L'Hospitalet, Spain
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Csatári-Kovács R, Röszer T, Csősz É. Comparative Analysis of Omega-3, Omega-6, and Endocannabinoid Content of Human, Cattle, Goat, and Formula Milk. Foods 2025; 14:1786. [PMID: 40428565 PMCID: PMC12110994 DOI: 10.3390/foods14101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Revised: 05/09/2025] [Accepted: 05/15/2025] [Indexed: 05/29/2025] Open
Abstract
Human milk is the primary source of infant nutrition, although breastfeeding rates are declining today, and human milk is often replaced by animal milk-based infant formula. Infant formula is intended to replicate the composition of human milk, albeit significant differences remain in the physiological responses to breastfeeding and formula feeding in offspring. More research is needed on the composition of human milk and other milk types, especially regarding their lipid content. A comparative analysis of different milk samples was carried out in this study. The amount of omega-3 fatty acids, omega-6 fatty acids, and endocannabinoids was measured in human, cattle, and goat milk as well as in goat milk- and cow milk-based infant formulas using chromatography coupled to mass spectrometry. Significant differences between the human and animal milks were observed in the case of omega-6 fatty acid and endocannabinoid content, with higher omega-6 fatty acid and lower endocannabinoid levels in human milk than in animal milk samples and infant formulas. Goat milk shares the highest similarity to human milk in terms of the analyzed lipid species. However, our results indicate that the levels of the examined bioactive lipid species in human milk failed to be replaced by goat milk- and cow milk-derived infant formulas.
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Affiliation(s)
- Renáta Csatári-Kovács
- Proteomics Core Facility, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Metabolomics Research Group, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Doctoral School of Molecular Cell and Immune Biology, University of Debrecen, Egyetem tér 1, 4032 Debrecen, Hungary
| | - Tamás Röszer
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Éva Csősz
- Proteomics Core Facility, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- Metabolomics Research Group, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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Dubé-Zinatelli E, Mayotte E, Cappelletti L, Ismail N. Impact of the maternal microbiome on neonatal immune development. J Reprod Immunol 2025; 170:104542. [PMID: 40403512 DOI: 10.1016/j.jri.2025.104542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 03/22/2025] [Accepted: 05/15/2025] [Indexed: 05/24/2025]
Abstract
Historically, multigenerational health and disease transmission have primarily focused on genetic inheritance. However, the discovery that beneficial microorganisms known as commensal microbiota outnumber human genes tenfold has reshaped this perspective, highlighting their critical role in maintaining homeostasis and protecting against pathogens. Unlike the human genome, commensal microbiota is not genetically inherited but is acquired anew with each generation. with initial gut colonization playing a pivotal role in shaping an infant's immune system, neurodevelopment, and long-term health, all heavily influenced by maternal factors. In this review, we examine emerging research on maternal microbial influences on the fetus beginning in utero. We provide an updated overview of the current insights into the impact of the vaginal microbiome during parturition on offspring immunity and discuss the potential long-term health implications for infants born via cesarean section. We explore the advantages and limitations of techniques designed to mitigate these effects, such as vaginal seeding and emphasize that the development of the neonatal immune system is a dynamic process influenced by maternal factors beyond birth, including the transfer of microbiota through breast milk and skin contact. Finally, we present gaps in current research and propose future research directions to deepen our understanding of the impacts of the maternal microbiome on her child. Together, these insights demonstrate how maternal influence on offspring health and immunity extends beyond genetic factors, encompassing the transmission of microbiota, which, in turn, has profound long-term implications for health and disease resilience, offering a novel perspective on intergenerational health dynamics.
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Affiliation(s)
- Eleni Dubé-Zinatelli
- NISE Laboratory, School of Psychology, Faculty of Social Science, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Room 2076B, Ottawa, Ontario K1N 6N5, Canada.
| | - Edwige Mayotte
- NISE Laboratory, School of Psychology, Faculty of Social Science, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Room 2076B, Ottawa, Ontario K1N 6N5, Canada.
| | - Luna Cappelletti
- NISE Laboratory, School of Psychology, Faculty of Social Science, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Room 2076B, Ottawa, Ontario K1N 6N5, Canada.
| | - Nafissa Ismail
- NISE Laboratory, School of Psychology, Faculty of Social Science, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Room 2076B, Ottawa, Ontario K1N 6N5, Canada; LIFE Research Institute, University of Ottawa, Thompson Hall, 25 University Private, room 227, Ottawa, Ontario K1N 6N5, Canada; University of Ottawa Brain and Mind Research Institute, Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada.
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Hjertholm KG, Iversen PO, Holmboe-Ottesen G, Jepsen R. Risk factors for undernutrition and poor growth during the first 6 months of life in sub-Saharan Africa: A scoping review. Clin Nutr ESPEN 2025; 68:309-318. [PMID: 40383255 DOI: 10.1016/j.clnesp.2025.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 04/25/2025] [Accepted: 05/10/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND & AIMS Early infant undernutrition and suboptimal growth represent significant public health challenges in many low- and middle-income countries, yet information regarding the risk factors for poor growth remains limited. A scoping review was conducted to map the existing evidence on indicators of undernutrition and poor growth and related risk factors among infants aged 0-6 months in sub-Saharan Africa. METHODS This scoping review was conducted in accordance with the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. MEDLINE, Embase, and Scopus were systematically searched for eligible studies, with no restrictions on time or language. RESULTS A total of 50 studies met the inclusion criteria for this review. The most frequently reported indicator of undernutrition was stunting, followed by underweight and wasting. Sex, feeding, illness, and birth size were the most studied infant risk factors for poor growth. The maternal risk factors most frequently investigated included age, education, human immunodeficiency virus infection, and occupation. Socioeconomic status and factors related to water, sanitation, and hygiene were the most studied household risk factors. CONCLUSIONS Several indicators of undernutrition and poor growth were identified, with stunting being the most frequently reported. Associated risk factors included multiple infant-, maternal-, and household factors, highlighting the need for complex multilayered interventions to address undernutrition and poor growth among these vulnerable infants.
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Affiliation(s)
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Haematology, Oslo University Hospital, Oslo, Norway; Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa.
| | - Gerd Holmboe-Ottesen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Norway
| | - Randi Jepsen
- Centre for Health Research, Zealand University Hospital, Nykøbing F., Denmark
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Li W, Kuang G, Chen Y, Yu P, Zhang M. Development and validation of a model for predicting the risks for delayed onset of lactogenesis stage II for Chinese pregnant women. Sci Rep 2025; 15:17074. [PMID: 40379739 PMCID: PMC12084521 DOI: 10.1038/s41598-025-01597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2024] [Accepted: 05/07/2025] [Indexed: 05/19/2025] Open
Abstract
Delayed onset lactogenesis II has adverse effects on breastfeeding and neonatal health. This study aimed to determine the risk factors of DOL II, develop a predictive model for DOL II, and test its validity. This was a retrospective cohort study. A total of 450 pregnant women were involved in this study, including 112 cases with DOL II and 338 cases without DOL II, who were hospitalized between October 2023 and April 2024. Univariate and multivariate logistic regression analyses were conducted to determine the risk factors of DOL II, which were then included in the nomogram. The performance of the nomogram model was evaluated by the area under the receiver operating curve, calibration curve, and Hosmer-Lemeshow test. Decision curve analysis was used to evaluate the clinical efficacy of the nomogram. The results showed that maternal age, pre-pregnancy BMI, gestational age, parity, delivery mode, length of stage II labor, gestational diabetes, EPDS, maternal-infant separation, breastfeeding education during pregnancy, formula use, and onset of breastfeeding within the first hour were independent risk factors. In the derivation cohort, the AUC was 0.786. Youden index was 1.526, with a sensitivity of 0.781 and a specificity of 0.745. In the verification cohort, AUC was 0.748. The nomogram model has good consistency and performance, which can identify women who are at high risk of DOL II.
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Affiliation(s)
- Wenting Li
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guofang Kuang
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanqiu Chen
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Yu
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meng Zhang
- Department of Obstetrics, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Koray MH, Wanjiru JN, Kerkula JS, Dushimirimana T, Mieh SE, Curry T, Mugisha J, Kanu LK. Factors influencing exclusive breastfeeding in Sub-Saharan Africa: analysis of demographic and health surveys. BMC Public Health 2025; 25:1790. [PMID: 40375216 PMCID: PMC12080165 DOI: 10.1186/s12889-025-23045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 05/05/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND Low rates of exclusive breastfeeding (EBF) contribute to high child mortality rates. This study aimed to identify the prevalence and factors influencing EBF in SSA using nationally representative data from the Demographic Health Survey program (DHS). METHODS A cross-sectional study design using the most recent DHS data of 25 SSA countries from 2010 to 2023. A total of 17,431 women aged 15-49 years with infants below six months were included. Pearson's chi-square and multivariable logistic regression tests were used to test the association and predictors of EBF at a 95% confidence interval (CI) at a significance level of p ≤ 0.05. RESULTS The pooled prevalence of EBF across 25 Sub-Saharan African countries was 49%, ranging from 83% in Burundi to 19% in Gabon. Multivariable logistic regression revealed that older infants aged 2-3 months (AOR = 0.511, 95% CI: 0.458-0.570) and 4-5 months (AOR = 0.176, 95% CI: 0.156-0.198) had significantly lower odds of EBF compared to newborns (0-1 month). Overweight infants (AOR = 0.800, 95% CI: 0.647-0.987) and those experiencing fever (AOR = 0.805, 95% CI: 0.704-0.921) or diarrhea (AOR = 0.799, 95% CI: 0.683-0.935) were also less likely to be exclusively breastfed. Mothers with higher education (AOR = 0.700, 95% CI: 0.516-0.948) had reduced EBF odds. Wealthier households demonstrated higher odds (middle: AOR = 1.411, 95% CI: 1.185-1.681; richer: AOR = 1.539, 95% CI: 1.254-1.889; richest: AOR = 1.455, 95% CI: 1.119-1.892). Rural, the East (AOR = 2.588, 95% CI: 2.162-3.099) or West Africa (AOR = 3.018, 95% CI: 2.464-3.697) significantly increased EBF odds compared to urban areas and Central Africa, respectively. CONCLUSION This study highlights key factors influencing EBF in 25 Sub-Saharan African countries. The findings provide complex interplay of individual and community factors influencing EBF. To improve EBF, targeted interventions should focus on: supporting mothers of older infants, integrating counseling into child health services, addressing wealth gaps, and implementing region-specific strategies. Strengthening health systems and community engagement is crucial to overcome barriers and promote equitable breastfeeding practices.
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Affiliation(s)
| | | | | | | | | | - Tanya Curry
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Lucas K Kanu
- University of Makeni (UNIMAK), Makeni, Sierra Leone
- Southern Medical University, Guangzhou, China
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Huynh LT, Tran HT, Vanhaesebrouck S. Review of Low-Cost Interventions for Reducing Neonatal Mortality and Morbidity in Low- and Middle-Income Countries. Acta Paediatr 2025. [PMID: 40364732 DOI: 10.1111/apa.70133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 04/21/2025] [Accepted: 05/06/2025] [Indexed: 05/15/2025]
Abstract
AIM This review examines low-cost interventions for reducing neonatal mortality and morbidity in low- and middle-income countries (LMICs). METHODS A systematic PubMed search and neonatal care data from World Health Organization (2014-2024) were used to revise interventions including prenatal care, early essential newborn care (EENC), resuscitation and therapeutic hypothermia, Kangaroo mother care (KMC), respiratory support, breastfeeding, sepsis prevention, safe neonatal transfer, neonatal network in LMICs and suggestions for improvement. Out of 9295 initially identified articles, 252 studies were selected as relevant to the research objectives. RESULTS In LMICs, the use of antenatal corticosteroids and magnesium sulfate remains limited in routine obstetric practice. Although EENC, KMC and early breastfeeding significantly reduce neonatal mortality, these interventions are under-prioritised and insufficiently implemented. Neonatal resuscitation and respiratory support are constrained by inadequate equipment and a shortage of trained healthcare personnel. Healthcare-associated sepsis, compounded by antibiotic resistance, continues to strain neonatal intensive care units. Additionally, unsafe neonatal transfers and poor coordination among different levels of neonatal care highlight the need for better integration within regional health systems. CONCLUSIONS To reduce neonatal mortality and enhance care in LMICs, systematic training, effective implementation and the sustainable delivery of proven, low-cost, high-impact interventions are urgently needed.
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Affiliation(s)
- Le Thi Huynh
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Faculty of Nursing, Da Nang University of Medical Technology & Pharmacy, Da Nang, Vietnam
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Belgium and Neonatal Intensive Care Unit, University Hospitals Ghent, Ghent, Belgium
| | - Hoang Thi Tran
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
| | - Sophie Vanhaesebrouck
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Belgium and Neonatal Intensive Care Unit, University Hospitals Ghent, Ghent, Belgium
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Crimmins MR, Sims CR, Williams DK, Andres A, Sobik S. Breastfeeding beyond infancy supports adequate growth, development, and nutritional intake. Pediatr Res 2025:10.1038/s41390-025-04111-z. [PMID: 40369241 DOI: 10.1038/s41390-025-04111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 03/14/2025] [Accepted: 03/28/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to examine the associations of breastfeeding beyond infancy (BBI, >1 year) on toddler growth, development, and diet. METHODS Participants (n = 185) of a prospective longitudinal study were categorized into 3 groups: formula fed (FF, N = 22), breastfed up to 12 months (BF, N = 108), and breastfed up to 24 months (PBF, N = 55). Data collected included demographics, anthropometrics, toddler Healthy Eating Index (HEI), Child Feeding Questionnaire (CFQ), and Bayley scales of infant and toddler development (BSID). RESULTS At age 24 months, linear modeling showed PBF children had lower weight-for-length z-scores in comparison to both FF and BF children. FF infants had lower HEI scores for total fruit compared to BF and PBF infants, whereas PBF infants had higher seafood HEI scores. Feeding responsibility was lower in BF parents than FF parents. Restriction was lower in BF and FF groups compared to PBF, and pressure feeding was less common in PBF. Developmental testing revealed no significant differences between the three groups. CONCLUSION These results strengthen evidence that BBI supports adequate childhood growth, nutritional status, and development. Further studies are needed to evaluate the effect of BBI on health status in childhood. CLINICAL TRIAL ID #NCT01131117 IMPACT: This research supports the current recommendations to continue breastfeeding up to 24 months. This research indicates that breastfeeding beyond infancy supports adequate growth, nutritional status, and overall development. This article adds to the growing body of literature that breastfeeding beyond 12 months should be supported. This article is one of the first prospective longitudinal studies to investigate breastfeeding beyond infancy.
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Affiliation(s)
| | - Clark R Sims
- Arkansas Children's Nutrition Center, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Aline Andres
- Arkansas Children's Nutrition Center, Little Rock, AR, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sarah Sobik
- Arkansas Children's Nutrition Center, Little Rock, AR, USA.
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Hamnøy IL, Kjelsvik M, Baerug AB, Dahl BM. Fatherhood and breastfeeding: a qualitative exploration of counselling experiences. Int Breastfeed J 2025; 20:36. [PMID: 40361194 PMCID: PMC12076809 DOI: 10.1186/s13006-025-00730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 05/04/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Including fathers as breastfeeding facilitators and providing qualified breastfeeding counselling from healthcare professionals are key factors that increase breastfeeding outcomes. It is essential to explore how healthcare professionals can effectively support fathers in navigating their roles and addressing the challenges they encounter to promote breastfeeding. We aimed to explore fathers' experiences of being in a breastfeeding family with a particular focus on their interactions with midwives and public health nurses during breastfeeding counselling. The purpose was to gain deeper insights into the phenomenon of breastfeeding counselling from the father's perspective to develop knowledge that can better help fathers support breastfeeding mothers. METHODS A qualitative content analysis with a phenomenological hermeneutic approach was employed using individual interviews with ten fathers in Norway between January and October 2022. The study adhered to the COREQ Checklist for reporting. RESULTS The meaning of fathers` experiences of being in a breastfeeding family and receiving breastfeeding counselling was formulated into three interrelated themes: being a caregiver and breastfeeding facilitator, meaning to be prepared for the father's role and supporting mother and child; being part of a breastfeeding family which means being included or excluded in breastfeeding counselling, desire to nurture parent-child bonds and develop resilience as a couple. Managing everyday life means making their own decisions, and competent breastfeeding counsellors provide security and trust, while inadequate counselling leaves fathers feeling trapped in a chaotic situation. CONCLUSIONS To enable fathers to fulfil their roles as caregivers and breastfeeding facilitators, healthcare professionals should actively encourage their participation and involvement in breastfeeding counselling and discussions regarding breastfeeding. Additionally, to help fathers navigate daily life confidently, healthcare professionals must offer qualified breastfeeding counselling, be aware of their needs and provide appropriate support. Empowering fathers to support breastfeeding may contribute to promoting breastfeeding, closer relationships and better health for the family.
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Zimmerman DR, Brooks N, Wasser J, Vaknin-Alon L, Dweck T, Alroy-Preis S. Breastfeeding rates in Israel and their health policy implications. Isr J Health Policy Res 2025; 14:28. [PMID: 40361190 PMCID: PMC12077002 DOI: 10.1186/s13584-025-00689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 04/10/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Monitoring breastfeeding rates has important health policy implications, as breastfeeding has significant positive impacts on maternal and child health and healthcare costs. This up-to-date, national, population-based breastfeeding rates study in Israel provides important information for health policy development. METHODS Breastfeeding rates were determined for the years 2016-2022 by retrospective analysis of Machshava Briah electronic medical records used by many Israeli Maternal and Child Health Clinics. This reflects approximately 70% of Israeli children with a nationwide distribution. Comparisons were conducted measuring breastfeeding rates over time and between different sub-groups. RESULTS The dataset consists of 945,437 infant records. The percentages of women with any breastfeeding as well as exclusive breastfeeding have shown a gradual decline annually from 2016 to 2022 and are lower than international goals. Sub-group analyses were conducted for 2022. Breastfeeding rates were higher among multipara mothers (versus primapara). Singleton mothers had much higher breastfeeding rates than twin mothers with the difference even more pronounced in exclusive breastfeeding rates. Mothers of preterm infants (< 37 weeks) and low birthweight infants breastfed less than mothers of full term infants and normal birthweight and were less likely to exclusively breastfeed. Mothers living in urban areas had the highest rates of breastfeeding and those living in rural areas had the lowest. A subanalysis performed at two months postpartum for 2022 found the effect of maternal age with the highest rates of breastfeeding among 20-24 year old mothers. Inter-pregnancy interval also had an effect with the highest rates among those whose last pregnancy was 21-33 months ago and the lowest rates among those with an interval of < 1 year. CONCLUSIONS The population-based data provides an important baseline marker. This study shows a drop in breastfeeding rates, indicating a need to investigate reasons for discontinuing breastfeeding and identifying possible areas for offering support. This data and similar follow-up studies provide the background evidence to warrant that Ministry of Health policies in the hospitals and in the community, help accomplish their goals.
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Affiliation(s)
| | - Nati Brooks
- Digital and Data Technologies Division, Ministry of Health, Jerusalem, Israel
| | - Janice Wasser
- Public Health Directorate, Ministry of Health, Jerusalem, Israel.
| | - Linoy Vaknin-Alon
- Digital and Data Technologies Division, Ministry of Health, Jerusalem, Israel
| | - Tunie Dweck
- Public Health Directorate, Ministry of Health, Jerusalem, Israel
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Takemoto AY, Ichisato SMT, Rossa R, Michalczyszyn KC, Prado ED, Christoffel MM, Oliveira RRD, Marcon SS. Incidence of exclusive breastfeeding: influence of care received during hospitalization for birth. Rev Gaucha Enferm 2025; 46:e20240100. [PMID: 40366963 DOI: 10.1590/1983-1447.2025.20240100.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 12/09/2024] [Indexed: 05/16/2025] Open
Abstract
OBJECTIVE Identify the incidence of exclusive breastfeeding in the sixth month of life and associated factors according to care received during hospitalization for birth. METHOD A prospective cohort study was conducted in two hospitals (A and B) in Guarapuava, Paraná, Brazil, with 291 pregnant women/puerperal women. Data collection was performed in four moments through interviews and the completion of questionnaires. The outcome variable was the duration of exclusive breastfeeding, while the independent variables were the characteristics of the care received during hospitalization for birth. The proportion difference test was used, with presentation of relative risk. RESULTS The incidence of exclusive breastfeeding in the sixth month of the newborn in hospital A and B was 13.8% and 13.0%, respectively. The absence of formula supplementation to the newborn showed a significant association of protection to exclusive breastfeeding. The lack of guidance on breastfeeding techniques and late initiation of breastfeeding showed a significant association for the interruption of exclusive breastfeeding. CONCLUSION The care received during hospitalization for birth was associated with the duration of exclusive breastfeeding. It reinforces the implementation of intra-hospital strategies that promote exclusive breastfeeding, aiming at increasing its rates and favoring maternal and child health.
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Affiliation(s)
| | | | - Roberta Rossa
- Universidade Estadual de Maringá (UEM). Maringá, Paraná, Brasil
| | | | - Eleandro do Prado
- Centro de Pesquisas Oncológicas de Santa Catarina (CEPON). Florianópolis, Santa Catarina, Brasil
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Dantas-Silva A, Sánchez ODR, Faria-Schützer DB, Santiago SM, Surita FG. Black women perceptions regarding the birthing experience: A qualitative study. Midwifery 2025; 147:104458. [PMID: 40424987 DOI: 10.1016/j.midw.2025.104458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 04/17/2025] [Accepted: 05/12/2025] [Indexed: 05/29/2025]
Abstract
BACKGROUND Positive experience of labour and birth is an outcome that should be sought in all maternity services. Negative birthing experiences are associated with poorer health outcomes and preventing them improves the quality of maternity care. Racial disparities impact negatively in maternal health and reflect structural inequalities in health. Understanding Black women's perspectives and expectations regarding birth can help to improve the quality of care. AIM this study aims to realize the meanings Black women attribute to their birthing experiences. METHODS We developed a qualitative study through open, face-to-face, semi-structured interviews with postpartum Black women in a maternity care service in Southeast Brazil. For data analysis, we conducted a thematic analysis to identify codes, themes, and subthemes of the data based on the academic work of researchers on the ethno-racial theme in the Brazilian context and woman-centered care framework. FINDINGS We interviewed 21 postpartum women between October 2023 and February 2024. Based on the analysis, three themes were identified: (1) The unspoken: experiences of skin colour and maternity care; (2) The many manifestations of pain in the birth experience; (3) Autonomy and information: the lack of information can lead to a feeling of losing control of the process. CONCLUSION In our study, Black women denied skin colour influence over their birthing experience and reported pain in its various manifestations, both physical and psychological, and lack of information and autonomy. These reflect the complexity of racism regarding obstetric care, and highlights the importance of woman-centered and respectful maternity care.
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Affiliation(s)
- Amanda Dantas-Silva
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Brazil.
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Rowley C, Kalucy D, Honeysett H, Brown T, Elliott-Rudder M, Finlay SM, Nepal S, Williams K, Fikkers R, Nixon J, Smith N, Larsen P, Honeysett A, Dickson M, Sherriff S. Yalbilinya Miya (learn together): community-led program to support Aboriginal and Torres Strait Islander women through their breastfeeding journey-a protocol. BMJ Open 2025; 15:e096288. [PMID: 40350195 PMCID: PMC12067767 DOI: 10.1136/bmjopen-2024-096288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 04/11/2025] [Indexed: 05/14/2025] Open
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander women have been nurturing and sustaining babies through breastfeeding for over 65 000 years. Breastfeeding is an important practice for nutrition, culture, connection and well-being, and is associated with positive short- and long-term health and well-being outcomes for the mother and baby. Developing community-led supports that empower Aboriginal and Torres Strait Islander mothers through their breastfeeding journeys is vital for supporting the health and well-being of the next generations. METHODS AND ANALYSIS Yalbilinya Miya is a holistic and culturally responsive breastfeeding project being designed and led by an Aboriginal Community Controlled Health Service in New South Wales (NSW). This project aims to identify, implement and evaluate the breastfeeding supports preferred by Aboriginal and Torres Strait Islander women. Phase 1 will use yarning methodology to gather the experiences of local Aboriginal and Torres Strait Islander women and their recommendations for breastfeeding support. The information gathered will inform the development of a culturally responsive breastfeeding support programme. In phase 2, Aboriginal and Torres Strait Islander women who were ≥28 weeks gestation will be invited to participate in the pilot breastfeeding support programme. Phase 3 will evaluate the appropriateness and effectiveness of the holistic breastfeeding supports provided in the pilot programme and provide key recommendations based on the findings of the evaluation. ETHICS AND DISSEMINATION Ethical approval was granted by the Aboriginal Health and Medical Research Council of NSW (#2132/23). The findings from this project will be disseminated through community presentations, videos, brochures, infographics, social media, reports, conference presentations and peer-reviewed journal articles.
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Affiliation(s)
- Chelsea Rowley
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Deanna Kalucy
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Hilary Honeysett
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Tarnie Brown
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Megan Elliott-Rudder
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Summer M Finlay
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Smriti Nepal
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristy Williams
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Rachael Fikkers
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Janice Nixon
- The Sax Institute, Sydney, New South Wales, Australia
| | - Natalie Smith
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Peta Larsen
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Annika Honeysett
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Michelle Dickson
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Simone Sherriff
- Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia
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Hellinga AH, Zuurveld M, Mank M, Kraneveld AD, Garssen J, Spann K, Bode L, Willemsen LEM, van’t Land B. Secretor and non-secretor human milk oligosaccharides differentially modulate immune response in the presence of cow's milk allergen β-lactoglobulin in an in vitro sensitization model. Front Immunol 2025; 16:1575656. [PMID: 40416953 PMCID: PMC12098339 DOI: 10.3389/fimmu.2025.1575656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Accepted: 04/17/2025] [Indexed: 05/27/2025] Open
Abstract
Introduction Food allergies, like cow's milk allergy, significantly impact children, with sensitization often beginning during the first year of life. Human milk oligosaccharides (HMOs) may influence this process, as specific HMOs differentially affect mucosal immune responses in vitro. Given the distinct HMO profiles of secretor (Se+) and non-secretor (Se-) milk, we investigate how the full HMO profiles from Se+ and Se- milk affect immune responses in the absence or presence of a cow's milk allergen. Methods Monocyte-derived dendritic cells (moDCs) were exposed to isolated Se+ and Se- pooled HMOs (pHMOs), and subsequently co-cultured with naïve T cells to confirm immune modulation. We compared the type 2-activation capability of several cow's milk proteins via direct exposure to moDCs or via intestinal epithelial cells (IECs) co-cultured with moDCs. Finally, we studied the effect of pHMOs in the presence of cow's milk allergen β-lactoglobulin (BLG) (via (IECs)) on moDCs and subsequent T cell response. Results Both Se+ and Se- pHMOs dose-dependently activated moDCs, indicated by increased IL8 release and %CD80+ moDCs. Se+ pHMOs tended to increase type 2-associated markers, while also increasing regulatory IL10 release. Se+ pHMOs-pre-exposed moDCs instructed T cells to produce type 2 cytokines like IL13. Se- pHMOs reduced the %CD86+ moDCs but did not drive a type 2 signature in T cells. In the presence of BLG, Se+ pHMOs-pre-exposed moDCs also instructed IL13 release by T cells, while increasing the percentage regulatory T cells. In contrast, co-exposure of BLG with Se- pHMOs only slightly affected moDC phenotype, and these moDCs did not modify T cell phenotypes. Conclusions Se+ and Se- pHMOs with BLG differentially affected moDC activation. Se+ pHMO-pre-exposed moDCs induced a type 2- and regulatory-associated T cell phenotype. These data suggest that depending on the secretor status, HMOs differentially modulate immune responsiveness in vitro.
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Affiliation(s)
- Anneke H. Hellinga
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands
| | - Marit Zuurveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands
| | - Marko Mank
- Global Center of Excellence Human Milk Research and Analytics, Danone Global Research and Innovation Center, Utrecht, Netherlands
| | - Aletta D. Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands
- Department of Neuroscience, Faculty of Science, Vrije Universiteit (VU) University, Amsterdam, Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands
- Global Center of Excellence Immunology, Danone Global Research and Innovation Center, Utrecht, Netherlands
| | - Kennedy Spann
- Department of Pediatrics, Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), and the Human Milk Institute (HMI), University of California San Diego, La Jolla, CA, United States
| | - Lars Bode
- Department of Pediatrics, Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), and the Human Milk Institute (HMI), University of California San Diego, La Jolla, CA, United States
| | - Linette E. M. Willemsen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands
| | - Belinda van’t Land
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
- Global Center of Excellence Immunology, Danone Global Research and Innovation Center, Utrecht, Netherlands
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Abdelrahmman K, Borg B, Gribble K, Mihrshahi S. Facilitators and barriers of wet nursing: a qualitative study with implications for emergencies. Front Nutr 2025; 12:1456675. [PMID: 40416370 PMCID: PMC12098040 DOI: 10.3389/fnut.2025.1456675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 04/15/2025] [Indexed: 05/27/2025] Open
Abstract
Introduction Supporting recommended breastfeeding practices, including wet nursing in emergencies, is crucial to providing safe and nutritious food for infants and young children to support their health and wellbeing in critical resourced situations. However, it is only now that practical guidelines for implementing wet nursing in emergencies are being developed (by UNICEF). As there is very little literature on wet nursing in contemporary settings, this study aimed to explore current wet nursing experiences to identify the facilitators and barriers of the practice, especially in emergencies. Methods Online semi-structured interviews were conducted from September to November 2023 with eight breastfeeding counselors and advocates. Transcripts were inductively analyzed using a reflexive thematic approach. Results Seven themes were identified that reflect the factors affecting wet nursing. These included "wet nursing saved lives," "breastfeeding is valued," "infant formula is normalized," "risk of infection transmission," "all stakeholders' acceptance," "counseling approach," and "planning for implementation." These results suggest that facilitators and barriers that generally affect maternal breastfeeding in emergencies also influence wet nursing. Certain obstacles may have a particular impact on wet nursing, including the risk of infection transmission, negative attitudes toward wet nursing and the need for culturally sensitive counseling to mediate wet nursing. Conclusion Promoting wet nursing is an Infant and Young Children Feeding in Emergencies recommendation (IYCF-E) for non-breastfed infants. Implementing wet nursing programs can be in line with supporting good breastfeeding practices in emergencies. The results of this study can guide practical steps for implementing wet nursing and future investigation in different contexts.
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Affiliation(s)
- Khadija Abdelrahmman
- Master of Public Health (MPH), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Bindi Borg
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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