Search Results (331)

This review aimed to be comprehensive and to critically analyze the factors that may affect the macronutrient and energy content of breast milk. Systematic reviews were prioritized, even though other types of literature reviews on the subject, as well as studies not included in these reviews, were included. Reported factors that potentially affect the macronutrient and energy content of breast milk comprise: maternal factors, such as age, nutritional status, dietary intake, smoking habits, lactation stage, circadian rhythmicity, and the use of galactagogues; obstetrical factors, such as parity, preterm delivery, multiple pregnancies, labor and delivery, and pregnancy morbidities including intrauterine growth restriction, hypertensive disorders, and gestational diabetes mellitus; and newborn factors, including sexual dimorphism, and anthropometry at birth. Some factors underwent a less robust assessment, while others underwent a more in-depth analysis. For example, the milk from overweight and obese mothers has been reported to be richer in energy and fat. A progressive decrease in protein content and an increase in fat content was described over time during lactation. The milk from mothers with hypertensive disorders may have a higher protein content. Higher protein and energy content has been found in early milk from mothers who delivered prematurely. Full article

Background: A national study from China in 2023 predicted that the prevalence of overweight and obesity among children aged 7–18 will increase from 23.4% in 2019 to 32.7% by 2030. Objectives: This study aimed to investigate the longitudinal association between parental feeding practices and children’s body composition and weight status, and to assess the mediation effect of parental feeding practices in the relationship between socioeconomic status and childhood body composition. Methods: This longitudinal observational study was conducted between September and November 2021 in eight primary schools located in Luohu District, Shenzhen. Baseline and two follow-up surveys were administered annually during the same period from 2021 to 2023 (with one-year intervals). A total of 620 third-grade students (aged 8–10 years at baseline) and their parents were ultimately included in the study. Associations between parental feeding practices and children’s weight status and body composition were analyzed using mixed-effects models. The mediation effect of parental feeding practices on the relationship between socioeconomic status and childhood body composition was assessed through bootstrapping analysis. Results: At follow-up, a significant upward trend in the prevalence of central obesity among children was observed. Among all parental feeding dimensions, perceived child weight (PCW) demonstrated a strong association with central obesity after Bonferroni correction (OR = 1.33, 95% CI = 1.16, 1.51); similarly, monitoring (MN) and concern about child weight (CN) were both significantly associated with central obesity as risk factors for central obesity (OR = 1.14, 95% CI = 1.06, 1.23; OR = 1.16, 95% CI = 1.07, 1.27), both p < 0.001. These associations were modified by baseline child sex, parental BMI, and maternal and paternal education levels. However, restriction (RST) was not significantly associated with either body composition or weight status. The relationship between family socioeconomic status (SES) and childhood overweight and obesity was mediated by pressure to eat (PE) (p < 0.05). Conclusions: MN, PCW, and CN are associated with an increased risk of obesity in children. However, no significant association was found between parental feeding practices and changes in children’s body composition. Full article

Background/Objectives: Studies demonstrate better health outcomes for infants consuming milk with higher concentrations of ω3 (ALA and DHA) and negative health outcomes associated with higher ω6 (LA and AA) PUFAs. We studied the relationship between maternal BMI and PUFA levels in maternal plasma and breast milk. Methods: Women at 7–8 weeks postpartum were grouped according to normal BMI (18–24.9 kg/m²) and overweight/obese (OW/OB; ≥25 kg/m²). Maternal blood and continuous breast milk samples obtained from foremilk to hindmilk were analyzed for lipidomics. Results: The plasma levels of ω3 and ω6 PUFA were significantly lower in OW/OB subjects, with a total ω3 and ω6 FA level of 50% for women with normal BMI. Conversely, breastmilk levels of total ω3 and ω6, including their respective precursors of LCFAs (ALA and LA), were significantly increased in both foremilk and hindmilk samples of OW/OB. Despite this, DHA (ω3 PUFA) levels in OW/OB women were similar in foremilk and significantly decreased in hindmilk samples as compared to normal BMI women. Consequently, the ratio of DHA/Total ω3 significantly decreased in foremilk and hindmilk samples of OW/OB women. However, proinflammatory AA (ω6 PUFA) levels increased, resulting in an increased ratio of AA/DHA in OW/OB women. Breast milk DHA was positively correlated, whereas AA was negatively correlated with maternal plasma. Conclusions: Marked differences in maternal plasma and breast milk ω3 and ω6 FA concentrations among women with OW/OB indicate significant differences in nutritional exposures for their infants. Reduced milk DHA may be a consequence of reduced mammary peroxisomal conversion of ALA to DHA due to increased insulin/reactive species within the maternal obese environment. The imbalance of ω3 and ω6 FAs suggests that DHA supplementation and approaches to limit plasma to breast milk AA transfer in OW/OB subjects may be of value. Full article

Background: Vietnam is experiencing a significant “double burden” of malnutrition, characterized by the persistent challenge of undernutrition, particularly stunting in ethnic minority and mountainous regions, alongside a rising prevalence of overweight and obesity. Understanding dual nutritional status and its related factors in adolescents from these vulnerable areas is crucial for effective intervention. Objective: The current study explored the nutritional status of ethnic minority secondary school students in some mountainous provinces in the northwest of Vietnam and identified some related factors. Methods: We conducted a cross-sectional study over six months (June–December 2023), involving 1847 ethnic minority high school students from Son La and Dien Bien provinces, recruited through convenience sampling in primary healthcare settings. Nutritional status was determined using WHO 2006 Child Growth Standards, specifically height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). A 4-point scale assessed nutritional practices, including food consumption frequency and eating habits. Results: This study identified a stunting (HAZ < −2 SD) prevalence of 16.7% and wasting (BAZ < −2 SD) of 5.6%; overweight/obesity (BAZ > +1 SD) prevalence was 8.2%. Key factors related to stunting were being male, having more siblings, poor/near-poor household economic status, low maternal education level, and frequent occurrences of gastrointestinal and respiratory diseases. A higher risk of overweight/obesity was associated with consuming more than three meals daily, nocturnal snacking, frequent intake of fried foods, insufficient consumption of vegetables and fruits, and inadequate daily physical activity. Conclusions: Our study shows a comprehensive picture of malnutrition among children in ethnic minority areas. Essential nutritional intervention programs, projects, and models are a top priority to reduce the disease burden for children’s bright future and to enhance socio-economic development in the mountainous regions of Vietnam. Full article

Background/Objectives: The global prevalence of childhood obesity and overweight is steadily increasing, representing a pressing public health concern due to its persistence during adolescence and adulthood and its association with elevated morbidity and mortality risks. This cross-sectional study was designed to examine the potential association between overweight/obesity and the presence of depressive and anxiety symptoms in children aged 6 to 9 years. Methods: A total of 4098 children from various urban and rural regions in Greece were enrolled. Data was collected through maternal questionnaires capturing sociodemographic characteristics, perinatal outcomes, anthropometric measurements, breastfeeding practices, and physical activity levels. Children fulfilled the Children’s Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children—State form (STAIC-S) to evaluate symptoms of depression and anxiety, respectively. Results: Childhood overweight/obesity was independently and significantly associated with a more than two-fold increased likelihood of presenting depressive and anxiety symptoms. Childhood overweight/obesity was also significantly associated with maternal obesity, gestational weight gain, childbirth weight, mode of delivery, exclusive breastfeeding, and children’s physical activity. Conclusions: Overweight and obesity in children aged 6–9 years are significantly associated with an elevated risk of psychological distress, including depression and anxiety. These findings underscore the need for targeted public health policies and nutritional interventions aimed at promoting healthy lifestyle practices from early childhood. Educational efforts should also support new mothers in adopting and sustaining health-promoting behaviors to mitigate the long-term consequences of childhood obesity. Full article

Background: Maternal nutrition is one of the main determinants of healthy pregnancy outcomes. The aim of this study is to investigate maternal nutritional risks and their relationship with gestational weight gain (GWG) among Saudi women. Methods: This is a cross-sectional study conducted in the antenatal clinics of a university hospital. The FIGO Nutrition Checklist was used to investigate the nutritional habits of pregnant women attending their regular antenatal visits. The FIGO tool includes a brief food frequency questionnaire (FFQ) and total nutritional risk score (NRS). Data on other variables were collected, including participant demographics and obstetric history. Current weight and height were extracted from nursing notes of the current visit, and the pre-pregnancy weight was self-reported by participants. GWG was reported and participants were classified according to IOM Guidelines. All data were analyzed using SPSS (Version 30, release September 2024) and p < 0.05 was defined as statistically significant. Results: A total of 570 pregnant women participated in the study, of whom 96% had at least one nutritional risk. More than 90% of participants reported sufficient folic acid intake, normal hemoglobin level and adequate meat and poultry intake. Only 23.9% of participants had sufficient fish intake and 24.6% reported proper sun exposure. Additionally, 10% of participants scored poorly on the FFQ, while 30% were classified as high-risk based on NRS scale. Poor nutritional scores were not associated with any clinical or socioeconomical variables. According to IOM guidelines, 26.3% of the participants achieved adequate GWG, while 49.5% had inadequate GWG, and 24.2% exceeded recommended GWG. Inadequate GWG was most common among those with low pre-pregnancy BMI (60%), followed by overweight (43.2%) and obese (37%) women. Neither parity nor nutritional scores significantly influenced GWG. Conclusions: Although poor nutritional quality and high nutritional risk are relatively uncommon among Saudi women, the prevalence rates remain consistent across all sociodemographic groups. This suggests widespread, uniform patterns of suboptimal dietary habits within the community. While GWG was not affected by nutritional status or parity of the participants, nearly half of participants had inadequate GWG, particularly those with a low pre-pregnancy BMI. Full article

Objective: The aim of this study was to assess complementary feeding practices and dietary diversity in relation to the nutritional status of children under five attending health facilities in the Thabazimbi sub-district, Limpopo Province. Methods: A cross-sectional study was conducted among 409 mother–child pairs. Data on socio-demographics, feeding practices, and anthropometry were collected using validated tools. Nutritional status was assessed using WHO growth standards, and dietary diversity was evaluated using WHO infant and young child feeding (IYCF) indicators and a 24 h dietary recall. Associations were analyzed using prevalence ratios in STATA 18. Results: Among 409 children (median age: 18 months, IQR: 12–24), 38% were stunted, 13% were underweight, 5% were thin, and 17% were overweight/obese. Exclusive breastfeeding was reported in 27%, and only 24% met the minimum dietary diversity (DDS ≥ 4). Complementary feeding practices varied significantly by maternal age, with mixed feeding more common among older mothers and younger mothers more likely to receive feeding advice (p = 0.001). Stunting was associated with being a boy (PR = 1.27; 95% CI: 1.00–1.61), age > 24 months (PR = 0.33; 95% CI: 0.16–0.65), and DDS ≥ 4 (PR = 0.72; 95% CI: 0.52–0.99). Underweight was more prevalent among boys (PR = 2.40; 95% CI: 1.40–4.11), but less likely in children with DDS ≥ 4 (PR = 0.43; 95% CI: 0.20–0.92) and those from spouse-headed households (PR = 0.33; 95% CI: 0.13–0.87). Thinness was associated with DDS ≥ 4 (PR = 2.70; 95% CI: 1.13–6.45) and age 12–24 months (PR = 2.80; 95% CI: 1.02–7.64). Overweight/obesity was linked to age 12–24 months (PR = 1.94; 95% CI: 1.25–3.03) and household income > ZAR 15,000 (PR = 4.09; 95% CI: 2.33–7.17). Conclusions: Complementary feeding and dietary diversity deficits contribute significantly to the dual burden of malnutrition in rural Limpopo, highlighting the need for targeted, context-specific nutrition interventions. Full article

Background/Objectives: The objective of this study was to assess the diagnostic accuracy of sonographic estimated fetal weight (EFW) in predicting small (SGA)- or large-for-gestational-age (LGA) birthweight and examine whether the accuracy is associated with maternal body mass index (BMI). Methods: The participants of NICHD Fetal Growth Studies with complete data on maternal BMI (10–13.9 weeks), EFW within 14 days of delivery (18–41.3 weeks), and birthweight were included in this study. Participants were categorized as normal (BMI 18.5–24.9 kg/m²) or overweight/obese (BMI > 24.9 to 44.9 kg/m²). EFW accuracy was evaluated using area under the Receiver Operating Characteristic curves (AUCs) for SGA and LGA classification, and EFW error was analyzed across BMI groups. Results: Among 1289 women, 714 (55.4%) were in the normal BMI group. AUCs for LGA prediction were similar between BMI groups (0.77 ± 0.03 for normal vs. 0.79 ± 0.02 for overweight/obese, p = 0.593). However, for SGA, AUCs were higher in the overweight/obese group (.91 ± 0.01 vs. 0.84 ± 0.02, p = 0.004), indicating improved accuracy. EFW absolute and percent errors were comparable across BMI groups in the full, AGA, and LGA birth cohorts separately, but they trended lower (p = 0.12 and 0.15 for absolute and percent errors, respectively) in the overweight/obese group in the SGA birth cohort. Conclusions: EFW has acceptable accuracy for predicting LGA, unaffected by BMI. However, for SGA, EFW accuracy is significantly higher in the overweight/obese group, suggesting that BMI influences diagnostic performance in SGA but not LGA classification. Full article

Background/Objectives: This study investigates the prevalence and impact of the double burden of malnutrition (DBM), malnutrition and overnutrition, in infants aged 0–24 months in the rural municipality of Ampefy, Itasy region, Madagascar. The Global Nutrition Report 2022 highlights the widespread issue of malnutrition, affecting 2 billion adults and 38 million children under five. Madagascar, characterized by severe poverty and high malnutrition rates, serves as a critical case study. Methods: A structured questionnaire was administered to 437 mother–child pairs from November 2022 to March 2023, collecting data on maternal education, dietary habits, and socio-economic status. Anthropometric measurements were taken using either a stadiometer or UNICEF length charts to assess height/length and an electronic scale to determine weight. Results: Findings reveal a high prevalence of malnutrition, with 29.7% of children affected by either wasting, stunting, and/or underweight, and 13.3% classified as overweight or obese. This study identifies significant age-related differences, with younger children more likely to be overweight and older children more likely to suffer from stunting or wasting. Maternal nutritional status, breastfeeding practices, and socio-economic conditions are strongly associated with child malnutrition outcomes. Lower dietary diversity among mothers and insufficient antenatal care are significant risk factors. Households with lower incomes and limited access to water and transport face higher malnutrition risks. Conclusions: This study underscores the critical need for targeted nutritional interventions and education to address DBM in Madagascar, highlighting the importance of maternal health and dietary diversity in early childhood development. Further longitudinal research is recommended to establish causality and develop comprehensive public health strategies. Full article

Background/Objectives: The number of children with overweight and obesity is gradually increasing worldwide. This is an emergent public health problem as overweight and obesity persist through the next stages of human life, being associated with high risk of morbidity and mortality. In this respect, the purpose of the current cross-sectional survey is to explore whether the overweight/obesity of children aged 6–9 years may be related to the risk of developing perceived stress and poor sleep quality symptoms. Methods: This study recruited 4350 primary school children from diverse Greek rural and urban regions. The mothers of the enrolled children completed relevant questionnaires on children and maternal sociodemographics, anthropometric parameters, perinatal outcomes, breastfeeding practices, and lifestyle factors. The enrolled mothers also completed the Perceived Stress Scale (PSS) and the Pittsburgh Sleep Quality Index (PSQI) to evaluate the perceived stress and sleep quality of their matched children, respectively. Results: Our analysis reveals independently significant associations between diverse factors and children’s overweight/obesity such as child’s gender, family economic status, maternal gestational weight gain, childbirth weight, kind of delivery, exclusive breastfeeding, and children physical activity. Childhood overweight and obesity were independently associated with a more than three-fold higher risk of perceived stress and a more than two-fold higher likelihood of poor sleep quality after adjustment for multiple confounding factors. Conclusions: Obesity and overweight are related to enhanced risk of perceived stress and poor sleep quality in children aged 6–9 years. Public policies and dietary counseling interventions should be applied to inform new mothers about the harmful effects of childhood overweight/obesity and to direct them to adopt healthy dietary practices for their children. Full article

Background: Almost half of all deaths worldwide in children under five are related to malnutrition. Malnutrition encompasses a wide array of nutritional conditions and emerging evidence indicates a growing overlap of these different forms of malnutrition. Nutrimetry, which combines assessments of height-for-age (HAZ) with BMI-for-age (BMIZ) to offer a more integrated assessment of nutritional status, can be particularly useful in low-resource settings to correctly reflect the complex interplay of stunting and overweight. Objective: The objective of this study is to explore the impact of malnutrition on children in Madagascar and demonstrate how integrating HAZ assessments with BMIZ can reveal the double burden of malnutrition—encompassing both undernutrition and overnutrition—within the same population. Methods: This cross-sectional observational study employing Nutrimetry was carried out in rural communities in the Itasy region of Madagascar. A systematic random sampling method was used to choose the 500 women to invite to participate from the approximately 5000 who formed the pool of potential participants. A total of 437 were able to be invited and all invited women agreed to participate, resulting in 437 mother–child (0–24 months) pairs being included in the study. Results: Chronic undernutrition or thinness (31.6%), overweight and obesity (21.3%), and stunting (57.6%) were prevalent among the children included in the study. Among children with chronic undernutrition, 55.06% were identified as stunted. Among children with overweight or obese, 61.03% were identified as stunted. This highlights a significant overlap between inadequate weight and stunting. A socioeconomic analysis revealed significant barriers, including limited financial resources and poor dietary diversity, exacerbating malnutrition. Maternal nutritional status and breastfeeding practices also emerged as critical determinants of child nutritional outcomes. Conclusions: The study underscores the importance of prioritizing height assessments as a preliminary step in nutritional evaluations to prevent undetected acute malnutrition. Full article

Objective: Dinoprostone vaginal inserts are widely used as one of the primary pharmacological methods for labor induction. In this study, we aimed to investigate whether BMI affects the duration of the different phases of labor in pregnant women undergoing vaginal delivery induced with slow-release dinoprostone. Methods: A prospective study was conducted on pregnant women at a tertiary maternity hospital between August 2021 and February 2023. Patients were categorized into three groups according to BMI: normal-weight, overweight, and obese. The duration of total labor and each phase of induced labor was recorded. Multivariate analysis was used to determine the association between maternal obesity and the duration of each phase of the labor process. Results: The final analysis included 205 women who received slow-release dinoprostone for labor induction. The mean maternal age was significantly lower in the normal-weight group (p < 0.01). The obese group showed a higher need for oxytocin augmentation and had a higher median infant birth weight compared to the normal and overweight groups. After adjusting for confounders, multivariate linear regression analysis showed that the duration of the latent phase of labor did not differ between the groups. However, the duration of the active phase of labor and total induced labor were significantly longer in the obese group. Conclusions: An increased BMI in pregnant women is associated with a longer active phase and overall labor duration during dinoprostone-induced delivery. Full article

Background/Objectives: In recent years, due to the emergence of antimicrobial resistance, probiotics have been increasingly used during pregnancy and lactation with real maternal–fetal benefits. Probiotic intervention, especially multi-strain probiotics, due to their anti-inflammatory, metabolic, and immunomodulatory actions, can be performed prophylactically and therapeutically with promising results regarding maternal, fetal, and neonatal health. The administration of probiotics can modulate the maternal microbiome, regulate microflora imbalance in various conditions (overweight/obesity, gestational diabetes mellitus (GDM), preeclampsia, allergic diseases), and influence several reactions such as modulating the non-specific cellular immune system, metabolic processes, and inhibition of pathogens. This study aimed to analyze, based on available data, how the administration of probiotic supplements to women during pregnancy can modify immunometabolic responses to microbial dysbiosis to limit weight gain and the risk of obesity, to improve glucose homeostasis and reduce the risk of GDM, to prevent preeclampsia and its effects on maternal–fetal outcomes, and to reduce rates of atopic eczema and allergic diseases in infants. Methods: We performed a systematic search in MEDLINE/PubMed to identify studies that have investigated the effects of probiotic intervention on the immunometabolic response in pregnancy and lactation, especially in women with diabetes, overweight/obesity, preeclampsia, and allergic conditions. Results: Fifty-six RCT studies, totaling 15,044 women, matched the inclusion criteria, of which eight were for interventions on the immune response, twenty on allergic conditions, seven on obesity and excess weight gain in pregnancy, and twenty-one on GDM. Conclusions: Due to the heterogeneous structure and the size of the samples, the methodologies, formulations, moment of initiation, and study durations, future research is needed to establish their effectiveness and safety in pregnancy and lactation regarding maternal-fetal health and outcomes in childhood and adult life. Full article

Although the adverse health effects of consuming ultra-processed foods (UPFs) are well-documented, limited evidence exists on their impact during lactation. This study examined the association between maternal UPF consumption, feeding practices, and malnutrition in breastfed infants. A cross-sectional analysis was conducted with 111 mother–child pairs up to 150 days postpartum. Infant feeding practices were assessed using WHO indicators, and malnutrition was evaluated by length-for-age and BMI-for-age. Maternal dietary intake was estimated using two 24 h recalls, and UPF consumption was classified by the Nova classification. Dyads were grouped based on the highest UPF consumption quartile, and adjusted binary logistic regression was applied. UPFs accounted for 26% of the maternal diet on average. While 71.2% of infants were exclusively breastfed, one-third were overweight, and 11.7% were stunted. High maternal UPF consumption (>32% of energy) was associated with increased odds of malnutrition by BMI-for-age (wasting or overweight) (OR 3.38; 95% CI: 1.29–8.83) and stunting (OR 3.89; 95% CI: 1.04–14.58). Feeding practices showed no association. These findings highlight that maternal UPF consumption is associated with malnutrition odds in breastfed infants in the population assessed, emphasizing the need for dietary guidance during lactation to improve infant health outcomes. Full article

Objectives: Excessive fetal growth is the most common fetal complication associated with gestational diabetes (GDM), resulting in adverse short- and long-term outcomes. Our main objective was to evaluate the influence of excessive fetal growth on Doppler ultrasonographic measurements of the Umbilical Artery (UA) among women with GDM during the third trimester of pregnancy. Methods: A retrospective study among 472 women with GDM was conducted. UA-PI was measured by Doppler ultrasonography three different times during the third trimester of pregnancy at 28, 32, and 36 weeks. Pregnancies were grouped according to the fetal weight centile or birthweight in two groups: large for gestational age (LGA) group (>90th percentile or ≥4000 g at birth) and adequate for gestational age (AGA) group (<90th percentile or <4000 g at birth, not including the intrauterine growth restrictions). Results: In the LGA group (n = 57, 12.1%), women had higher BMI (p = 0.0001) and fasting blood glucose than the AGA group (97.08 ± 40.69 vs. 86.29 ± 39.58 mg/dL; p = 0.0550). They required insulin therapy more frequently to achieve glycemic control (63.2% vs. 34%, p = 0.0001). In LGA, UA-PI decreased progressively from 28 to 36 weeks (p = 0.0048). The most pronounced reduction occurred at 32 weeks (p = 0.0076). Conclusions: All fetuses from mothers with GDM had a significant and progressive decline in UA-PI during the third trimester of pregnancy. LGA fetuses showed lower UA-PI values compared with AGA fetuses. Since maternal hyperglycemia increases the risk of fetal overweight and GDM may represent a fetal vascular disorder, it therefore seems possible that in LGA fetuses, maternal hyperglycemia could influence the fetal vasculature. Full article