An educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India

Complementary feeding practices are often inadequate in developing countries, resulting in a significant nutritional decline between 6 and 18 mo of age. We assessed the effectiveness of an educational intervention to promote adequate complementary feeding practices that would be feasible to sustain with existing resources. The study was a cluster randomized controlled trial in communities in the state of Haryana in India. We developed the intervention through formative research. Eight communities were pair matched on their baseline characteristics; one of each pair was randomly assigned to receive the intervention and the other to no specific feeding intervention. Health and nutrition workers in the intervention communities were trained to counsel on locally developed feeding recommendations. Newborns were enrolled in all of the communities (552 in the intervention and 473 in the control) and followed up every 3 mo to the age of 18 mo. The main outcome measures were weights and lengths at 6, 9, 12, and 18 mo and complementary feeding practices at 9 and 18 mo. All analyses were by intent to treat. In the overall analyses, there was a small but significant effect on length gain in the intervention group (difference in means 0.32 cm, 95% CI, 0.03, 0.61). The effect was greater in the subgroup of male infants (difference in mean length gain 0.51 cm, 95% CI 0.03, 0.98). Weight gain was not affected. Energy intakes from complementary foods overall were significantly higher in the intervention group children at 9 mo (mean +/- SD: 1556 +/- 1109 vs. 1025 +/- 866 kJ; P < 0.001) and 18 mo (3807 +/- 1527 vs. 2577 +/- 1058 kJ; P < 0.001). Improving complementary feeding practices through existing services is feasible but the effect on physical growth is limited. Factors that limit physical growth in such settings must be better understood to plan more effective nutrition programs.     

Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh

This prospective randomized trial was carried out to test the efficacy of a specific intervention for reducing the extent of their malnutrition and to change behaviour of mothers relating to child-feeding practices, care-giving, and health-seeking practices under the Bangladesh Integrated Nutrition Project (BINP). The study was conducted in rural Bangladesh among 282 moderately-malnourished (weight-for-age between 61% and 75% of median of the National Center for Health Statistics standard) children aged 6-24 months. Mothers of the first intervention group received intensive nutrition education (INE group) twice a week for three months. The second intervention group received the same nutrition education, and their children received additional supplementary feeding (INE+SF group). The comparison group received nutrition education from the community nutrition promoters twice a month according to the standard routine service of BINP. The children were observed for a further six months. After three months of interventions, a significantly higher proportion of children in the INE and INE+SF groups improved (37% and 47% respectively) from moderate to mild or normal nutrition compared to the comparison group (18%) (p < 0.001). At the end of six months of observation, the nutritional status of children in the intervention groups improved further from moderate to mild or normal nutrition compared to the comparison group (59% and 86% vs 30%, p < 0.0001). As the intensive nutrition education and supplementation given were highly effective, more children improved from moderate malnutrition to mild or normal nutritional status despite a higher incidence of morbidity. The frequency of child feeding and home-based complementary feeding improved significantly (p < 0.001) in both the intervention groups after three months of interventions and six months of observation. Body-weight gain was positively associated with age, length-for-age, weight-for-length, frequency of feeding of khichuri, egg, and potato (p < 0.05). Ability of mothers to identify malnutrition improved from 15% to 99% in the INE group and from 15% to 100% in the INE+SF group, but reduced from 24% to 21% in the comparison group. Use of separate feed pots, frequency of feeding, and cooking of additional complementary feeds improved significantly in the INE and INE+SF groups compared to the comparison group after three months of interventions and six months of observation. It can be concluded from the findings of the study that intensive nutrition education significantly improves the status of moderately-malnourished children with or without supplementary feeding.     

Reduced Morbidity Motivated Adoption of Infant and Young Child Feeding Practices after Nutrition Education Intervention in Rural Malawi

This study assessed caregivers’ knowledge and practices and factors that influence the adoption of improved infant and young child feeding (IYCF) practices after nutrition education in Kasungu and Mzimba districts among 198 caregivers. Mixed-methods convergent-parallel design, including knowledge tests, focus group discussions, and in-depth interviews in the intervention areas, was used to collect quantitative and qualitative data. Data were analyzed using count regression and content analysis, which showed that knowledge increased among caregivers after nutrition education. The knowledge about diet diversification for young children as well as about hygienic practices when preparing food and during feeding improved in addition. Enhanced health among children motivated caregivers to apply improved IYCF practices. The study was based on the caregivers’ reports. Long-term effects of exposure to nutrition education are unknown. However, the nutrition education that focused on the child’s health benefits motivated mothers to adopt improved IYCF practices.     

Training in complementary feeding counselling of healthcare workers and its influence on maternal behaviours and child growth: a cluster-randomized controlled trial in Lahore, Pakistan

Malnutrition is common among children aged 6-24 months in developing countries. It increases the risk of mortality. Interventions to improve infant-feeding hold the promise of reducing malnutrition among these children. A study in Brazil has shown the success of training in communication and counselling skills among health workers in improving the nutritional status of young children. Questions were raised whether the method used in the study in Brazil would also be effective when applied in other countries. The aim of the present study was to reduce growth faltering in young children through proper nutrition-promotion techniques. The objective of the study was to determine the efficacy of training health workers in nutrition counselling in enhancing their communication skills and performance, improving feeding practices, and reducing growth faltering in children aged 6-24 months. A cluster-randomized controlled trial was carried out. The method used in this study was a replica of the method in a similar study in Pelotas, Brazil. Forty health centres were paired, and one centre of each pair was randomly allocated to the intervention group, and the other to the control group. The Integrated Management of Childhood Illness (IMCI) module-'Counsel the mother'-was used for training health workers in the health centres in the intervention group. Data from 36 paired health centres and 375 mothers and their children aged 6-24 months recruited from these health centres following consultation with health workers were included in analysis. Independent observers, masked to the intervention status, examined the performance of health workers within the first month after training. Mother-child pairs were visited at home within two weeks, 45 days, and 180 days after recruitment. Information was recorded on the feeding practices, recall of the recommendations of health workers, and sociodemographic variables at these home-visits. Weight and length of the child were measured at each contact. The communication skills and consultation performance of health workers were significantly better in the intervention group than in the control group. The mothers' recall of the recommendation of health workers and reported infant-feeding practices were also significantly better in the intervention group than in the control group, even 180 days after the recruitment consultation. Growth faltering was less in the intervention group, with the largest effect observed among children in the age-group of 12 + months. These results indicate that training in IMCI feeding counselling can enhance the communication skills and performance of health workers. Improved feeding practices of counselled mothers can, in turn, reduce growth faltering in their children.     

A Night Without Stars (Book)

Children with disabilities need adequate nutritional intake to survive and thrive. Many are at risk and in need of nutritional intervention. In this study we evaluated the outcomes of nutrition services for children with disabilities and their families using an integrated model of feeding and nutrition. Thirty-five children and families who received nutrition intervention services participated in the study. Children with disabilities and inadequate nutrition significantly benefited from nutrition interven- tion services. Children increased in weight-for-height ratios. Families reported in- creased alertness for their children with improved nutritional status. Families of children with greater feeding difficulties experienced increased stress and decreased social support. These findings can help families and professionals work in partnership to meet the nutrition needs of children with disabilities and chronic health care problems before a child becomes severely malnourished or a family becomes dys- functional.     

Helping Families Meet the Nutritional Needs of Children With Disabilities: An Integrated Model

Children with disabilities need adequate nutritional intake to survive and thrive. Many are at risk and in need of nutritional intervention. In this study we evaluated the outcomes of nutrition services for children with disabilities and their families using an integrated model of feeding and nutrition. Thirty-five children and families who received nutrition intervention services participated in the study. Children with disabilities and inadequate nutrition significantly benefited from nutrition interven- tion services. Children increased in weight-for-height ratios. Families reported in- creased alertness for their children with improved nutritional status. Families of children with greater feeding difficulties experienced increased stress and decreased social support. These findings can help families and professionals work in partnership to meet the nutrition needs of children with disabilities and chronic health care problems before a child becomes severely malnourished or a family becomes dys- functional.     

Quasi-experimental evaluation of a nutritional educational intervention among home support assistants for the elderly

BACKGROUND: The French National Program on Nutrition and Health has defined two specific objectives targeting older persons: (i) to improve their status in calcium and vitamin D and (ii) to prevent undernutrition. Home help provides support in activities of daily living, including meals, to dependent persons. The objective of our study was to evaluate the impact of a nutritional education intervention on knowledge and practices among home support assistants for the elderly. METHODS: Three facilities providing home support in Gironde (France) selected 132 home support assistants to follow an education program and 134 controls. Nutrition training was conducted in the intervention group by a dietician during two half-day sessions in May-June 2004. A non randomized controlled trial design was used for evaluation. Nutritional knowledge (20 questions) and practice (5 questions) of home support assistants were assessed by questionnaire before (April 2004) and after (September 2004) the training period in each group. Satisfaction of the intervention group was also assessed. RESULTS: The intervention group included 101 participants and the control group 106 persons who answered both questionnaires before and after the education program. The intervention group was significantly younger (p < 0.05), less educated (p = 0.01) and had less often participated to previous nutrition training (p < 0.001) than the control group. There was no significant difference between the two groups before intervention for their mean scores of knowledge or practices. The intervention group significantly improved its knowledge score (mean gain 2.5 points, p < 0.001) after the training period, whereas the score remained unchanged in the control group (mean gain 0.5 points, p = 0.06). The impact of the nutritional education was very significant (p < 0.0001) after adjustment for the characteristics which differed between the two groups. The practice scores did not differ significantly after intervention in multivariate analyses. Satisfaction of trained home support assistants was very high. Conclusion: An education program of home support assistants for elderly persons can improve their nutritional knowledge, but this study cannot conclude that the intervention was efficient to improve the nutritional status of older persons.     

广州市幼儿家长营养知识和育儿行为调查

目为了解幼儿家长营养知识、态度和行为状况．对广州市四所幼儿园的1300名家长进行了问卷调查，结果表明：家长营养知识水平普遍低下，及格率仅为29．5％,育儿行为不够合理．其主要喂养误区为不能合理地为孩子选择食物．存在一些广东传统的、不科学的“凉”“热”禁忌，但绝大部分的家长具有良好的接受营养教育的态度，他们最希望获得营养教育的途径是：广播电视等公众传媒以及营养咨询和讲座。提示：在幼儿家长中进行营养教育应在利用公众传媒的基础上，加强有营养专业人员参与的咨询和讲座的力度；营养教育的内容则在全面宣教营养基础知识的前提下,重点宣教食物的营养价值，贫血与佝偻病的预防，饮食与疾病的关系及纠正广东传统的、不科学的喂养行为。     

Delivery of Enteral Nutrition after the Introduction of Practice Guidelines and Participation of Dietitians in Pediatric Critical Care Clinical Teams

Provision of optimal nutrition is often difficult to achieve in the critically ill child, but can improve with better nutritional support practices. This study evaluated the joint impact of the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds on enteral nutrition (EN) intake and practices in children in intensive care. Nutritional intake and EN practices were audited before (period A) and after (period B) the introduction of enteral feeding practice guidelines and participation of dietitians in daily ward rounds in a pediatric intensive care unit. Information was collected on a daily basis and nutritional intake was compared with predefined targets and the United Kingdom dietary reference values. There were 65 patients and 477 nutritional support days in period A and 65 patients and 410 nutritional support days in period B. Basal metabolic rate (BMR) energy requirements were achieved in a larger proportion of nutritional support days in period B (BMR achieved [% nutritional support days]; period A: 27% vs period B: 48.9%; P<0.001). In patients admitted for nonsurgical reasons, median energy, protein, and micronutrient intake improved significantly. In the same group, the percentage of daily fluid intake delivered as EN increased post implementation (period A: median=66.8%; interquartile range=40.9 vs period B: median=79.6%; interquartile range=35.2; P<0.001). No significant changes were seen in patients admitted for corrective heart surgery. Implementation of better EN support practice can improve nutritional intake in some patients in critical care, but can have limited benefit for children admitted for corrective heart surgery.     

Nutrition intervention program for the management of iron‐deficiency anemia in a group of pregnant women in Jordan

The impact of a nutrition education intervention program on the prevention of iron deficiency anemia in a group of pregnant Jordanian women was evaluated. The program was based on planned meals from local food sources in combination with nutritional counseling as an alternative approach to more costly iron supplementation.

Data on dietary intake, anthropometric measures, iron status indices and nutrition knowledge were used in evaluation of program effectiveness.

The treatment group showed increased nutrition knowledge, more adequate nutrient intake, normal weight gain and better iron status than the control group, which received only usual care including limited nutrition counseling.

Results of the study indicate the feasibility of the nutrition intervention program in the management of iron‐deficiency and prevention of anemia in women from communities of low socio‐economic status.     

大庆市城区婴幼儿营养与喂养状况调查及干预研究

目的掌握大庆市城区2岁以内婴幼儿营养与喂养现状、存在的主要问题;探索城市婴幼儿营养与喂养健康教育的有效方法。方法按照随机抽样原则,从儿童保健门诊抽取常规体检的0～18个月健康儿童400人为研究对象,进行基线调查,对儿童主要看护人实施为期半年的干预后再次进行终末调查。所有数据资料应用SPSS10.0软件进行统计分析。结果 6月龄内婴儿母乳喂养率86.0%。家长在儿童营养与喂养知识方面存在误区,家长对此方面的知识有广泛需求。结论经对家长举办培训,家长喂养行为与喂养方法得到改善,项目开发的宣传资料及宣教方式干预效果良好,基本满足家长和医生的需求,可广泛推广应用。     

不同健康教育模式对婴儿营养性疾病干预效果评价

目的了解评价和营养支持计划（SOAP）营养咨询与儿童保健常规指导对婴儿营养性疾病的干预效果。方法选取在山西省妇幼保健院儿童保健科体检的100名婴儿为观察对象,随机分为SOAP组和常规指导组,共观测6个月。对SOAP组家长进行SOAP营养咨询,对常规指导组家长采用儿童保健门诊常规指导。干预6个月后检测两组婴儿营养性疾病发生情况,评价两组婴儿家长营养知识及喂养行为变化。结果干预6个月后,两组家长的营养知识-信念-行为较干预前均有改善,经重复测量方差分析,SOAP组家长的婴儿辅食添加情况、营养知识和喂养技术得分（分别为27.21±1.37、10.00±0.00、5.00±0.00）的增加高于常规指导组（分别为21.79±2.26、5.85±0.86、2.87±0.80）,差异有统计学意义（P〈0.05）;SOAP组婴儿的营养性贫血、碘缺乏、锌缺乏的发生率均较常规指导组低,差异有统计学意义（P〈0.05）。结论接受SOAP营养咨询的家长其营养知识-信念-行为的改善优于常规指导组,其婴儿某些营养性疾病的发生率较低,SOAP营养咨询是一种行之有效的健康教育方式。     

Nutrition education worksite intervention for university staff: application of the health belief model

OBJECTIVE: To evaluate the efficacy of an 8-week worksite nutrition education intervention for university staff using the Health Belief Model (HBM) to promote healthful dietary behaviors that reduce risks for cardiovascular disease and cancer. DESIGN: 2 3 2 repeated measures baseline/posttest ex post facto research design. PARTICIPANTS: Staff employees were randomly assigned to treatment (n = 28) and control groups (n = 25). INTERVENTION: The intervention focused on specific health beliefs, nutrition knowledge, and dietary practices to demonstrate treatment effect. MAIN OUTCOME MEASURES: Dependent variables were specific health beliefs, nutrition knowledge, and dietary behaviors. Independent variables were demographic characteristics and group assignment. ANALYSES: Tests of parametric assumptions, power analyses, analysis of variance, and Kuder-Richardson and Pearson product-moment coefficients were computed and specificity of treatment effects was assessed. RESULTS: Perceived benefits of healthy nutrition practices and nutrition knowledge related to cardiovascular disease and cancer significantly improved among the treatment participants, P <.001. Treatment group participants also significantly reduced total calories, fat, saturated fat, and cholesterol intake (each P <.001). CONCLUSIONS: The intervention appears to be related to treatment effects and significantly increased nutrition knowledge and decreased energy, fat, saturated fat, and cholesterol intake to levels consistent with national recommendations.     

初产妇妊娠晚期的营养知识、态度、行为调查

目的对本院2011年1-12月间初产妇共150例进行妊娠晚期的营养知识、态度和行为调研,以作为有效防治初产妇营养不良、提高母婴健康的有效依据。方法对照组70例初产妇仅定期进行检查;研究组80例初产妇均采用营养干预方法。结果研究组初产妇营养知识、营养行为调查平均分和及格率均明显高于对照组,差异有统计学意义（P〈0.05）。两组初产妇营养态度平均分和及格率差异无统计学意义（P〉0.05）。结论初产妇妊娠晚期有较好的营养态度,但多数孕妇在营养知识和营养行为方面欠缺,影响母婴健康,营养干预有助于改善初产妇营养知识结构和行为。     

儿童饮奶行为干预

目的：利用巧克密改变部分学龄儿童不喜欢饮用牛奶的行为,达到利用天然食品补充钙。方法：在牛奶中加人巧克密给100名学龄儿童饮用,观察两周并进行营养知识调查。结果：牛奶中加入巧克密饮用使学生饮奶的比例由45．0％增至88．2％。家长的文化水平和营养知识可以引导学生更科学地利用现有的食物。结论：用巧克密掩盖牛奶中不适的口味和气味,基本能够达到利用天然食品预防缺钙。同时提示营养宣教和饮食习惯的干预是解决我国儿童缺钙的有效途径之一。     

补充富含类胡萝卜素的蔬菜对儿童维生素A营养状况的影响

于１９９６年９月～１２月在山东省泰安市某幼儿园的两个班使用富含类胡萝卜素的蔬菜进行了干预试验。所选择两个班４１名儿童的平均年龄为５．３～６．５岁,其中３９％的儿童血清视黄醇低于０．３０ｍｇ／Ｌ,处于边缘缺乏状态。分为２个组：对照组,不改变日常膳食,平均每日每人摄入１９３ｇ浅色蔬菜（圆白菜、大白菜、土豆、黄瓜、菜花和白萝卜等）和５６ｇ黄绿色蔬菜（菠菜、空心菜、胡萝卜和红心红薯等）;试验组,平均每日每人摄入２３８ｇ黄绿色蔬菜和３４ｇ浅色蔬菜。结果表明膳食中黄绿色蔬菜对改善学龄前儿童的维生素Ａ营养有重要影响,且安全、廉价。     

Longitudinal Nutritional Intakes in Italian Pregnant Women in Comparison with National Nutritional Guidelines

Background: Nutritional quality during pregnancy is crucial for mother and child health and their short/long-term outcomes. The aim of this study is to evaluate the adherence to nutritional recommendations in Italy during the three pregnancy trimesters in Normal Weight (NW) and Over Weight (OW) women. Methods: Data from a multicenter randomized controlled trial included 176 women (NW = 133; OW = 43) with healthy singleton pregnancies enrolled within 13 + 6 weeks of gestation. Dietary intake was assessed every trimester by a Food Frequency Questionnaire. Results: OW and NW had similar gestational weight gain. However, as Institute of Medicine (IOM) recommend lower gestational weight gain (GWG) for OW, they exceeded the suggested range. In both groups, caloric intake during the three trimesters never met recommendations. Protein intake in first and second trimester was higher than recommendations, as was sugars percentage. Dietary fiber intake was lower in OW. Polyunsaturated fatty acids, calcium, iron and folic acid requirements were never satisfied, while sodium intake exceeded recommendations. Conclusions: NW and OW women in Italy do not adhere to nutritional recommendations during pregnancy, with lower caloric intake, protein and sugars excess and inadequacies in micronutrients intake. Pregnant women in Italy should be provided with an adequate counseling and educational intervention as well as supplementation when indicated.     

Position of the American Dietetic Association: benchmarks for nutrition in child care

It is the position of the American Dietetic Association that child-care programs should achieve recommended benchmarks for meeting children's nutrition needs in a safe, sanitary, and supportive environment that promotes optimal growth and development. Use of child care has become increasingly common and is now the norm for the majority of families in the United States. Therefore, it is essential that registered dietitians; dietetic technicians, registered; and other food and nutrition practitioners work in partnership with child-care providers and families of children in child care to meet children's nutrition needs and provide them with models of healthful eating and active lifestyles. This Position Paper provides guidance for food and nutrition practitioners, health professionals, and child-care providers regarding recommendations for nutritional quality of foods and beverages served; menus, meal patterns, and portion sizes; food preparation and service; physical and social environment; nutrition training; nutrition consultation; physical activity and active play; and working with families. This Position Paper targets children aged 2 to 5 years attending child-care programs and highlights opportunities for food and nutrition practitioners to promote healthful eating in child care through both intervention and policy-based initiatives.     

The efficacy of dietetic intervention in patients with chronic obstructive pulmonary disease

Background: Clinical trials have shown that pulmonary rehabilitation can improve the functional status and quality of life of chronic obstructive pulmonary disease (COPD) patients (Lacasse, 2006) but there is no research examining the efficacy of group dietetic intervention during standard 8 week rehabilitation courses. Current input is usually limited to a 1 h nutrition education session. This pilot study aimed to investigate whether patients receiving additional dietetic intervention during pulmonary rehabilitation significantly increased their general nutritional knowledge, thereby facilitating improvements in dietary intake and nutritional status. Methods: Patients were recruited from two courses of pulmonary rehabilitation and randomly allocated to a control group or an intervention group. Anthropometry (height, weight, body mass index, mid arm circumference and triceps skinfold), 3 day food diaries and nutritional knowledge questionnaires covered guidelines, food groups, choosing healthy options and diet and COPD were completed at baseline and at the end of 8 weeks. In week 2 both groups received the same nutrition education session which covered healthy eating during periods of stability as well as advice on coping with loss of appetite and reduced intake during illness and exacerbations. The intervention group was followed up during weeks 4, 6 and 7 when further anthropometric measurements were taken and additional dietary advice was provided, which addressed issues raised by individual patients. Information from food diaries was converted to nutrients using Windiets dietary analysis software. Statistical analyses were carried out using SPSS (v14) and included Mann–Whitney U non parametric tests, paired t‐tests and Spearman correlations used for comparisons over time and between groups. For analysis purposes patients were classified as normal weight (NW) and overweight (OW). Approval was obtained from the appropriate Ethics Committee. Results: Changes reported were not statistically significant (P > 0.05). Complete data sets were obtained for six control (NW = 2, OW = 4) and five intervention (NW = 1, OW = 4) patients. Nutritional knowledge increased in the control group by 5% compared to 3% in the intervention group. Control NW patients increased their energy intake resulting in a mean weight gain of 0.5 kg (SD 3.3). OW control group patients increased their energy intake by 12.4% (16.9) with a mean weight gain of 0.2 kg (2.5). All control patients increased their intake of in total fat, saturated fatty acids (SFA), sugars and sodium. Conversely there was a decrease in energy intake in the intervention group of 14.4% (17.8) and a mean weight loss of 1.5 kg (1.2) (three out of four overweight patients lost weight). Improvements in diet were shown with reduced intakes of total fat, SFA, sugars and sodium. The NW patient in the intervention group regained weight that had previously been lost. These changes did not correlate with changes in nutritional knowledge. Discussion: An increase in nutritional knowledge was expected to facilitate appropriate changes in dietary intake and nutritional status. Despite the lack of correlation between dietary knowledge and intake, beneficial outcomes were none‐the‐less observed in the intervention group. The trend for weight gain in OW control group patients, and weight loss in OW intervention group patients contrasted with results seen by Slinde et al. (2002) where the control OW patients lost weight, and OW intervention patients gained weight. It is possible that in the current study, patients in the intervention group were motivated to lose weight with repeated exposure to the dietitian, rather than an increase in nutritional knowledge. Significant anthropometrical changes were unlikely to be observed in 8 weeks, and further follow up may be necessary to establish sufficient evidence for the most efficacious level of dietetic intervention. The small sample sizes, especially with regard to weight sub groups, limits the conclusions which can be drawn. Further research is recommended, using a larger sample size, in order to make recommendations for dietetic best practice. Conclusion: The results of this study did not show statistical significance and the association between nutritional knowledge and improved nutritional outcomes remains unclear. However, the findings may have clinical significance since they appear to show that additional dietetic intervention may benefit the nutritional status of patients with COPD attending pulmonary rehabilitation. References Lacasse, Y., Goldstein, R., et al. (2006) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 4, CD003793. Slinde, F., Gronberg, A.M., et al. (2002) Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation. Respir. Med. 96, 330–336.