Article

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

BMC Public Health (Impact Factor: 2.26). 03/2013; 13(1):212. DOI: 10.1186/1471-2458-13-212
Source: PubMed

ABSTRACT

Background
The Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age.

Methods
A quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models.

Results
196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI −0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (−0.31, 95%CI −0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding.

Conclusions
Despite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Investigation of the determinants of metabolic outcomes associated with non-communicable diseases is increasingly important in developing countries, but such parameters have not been explored extensively during childhood. The present study assessed the impact of weight gain, measured as BMI-for-age Z-scores, on glucose and insulin concentrations, homeostasis model assessment index of insulin resistance (HOMA-IR) values, and systolic and diastolic blood pressure during school years among Amazonian children. A population-based prospective study of 696 children aged >4 to ≤ 10 years with complete anthropometric information at baseline (51 % females and 86 % of mixed race) was carried out; 411 children had data on metabolic parameters after a median follow-up period of 2·0 years (range 1·7-2·6 years). During follow-up, there was a significant increase in the proportion of overweight children (BMI-for-age Z-score >1) from 10·1 to 15·8 % (P= 0·003). In linear regression models adjusted for the child's sex, age, race/ethnicity, baseline household wealth, birth weight and pubertal development stage, for each unit of BMI-for-age Z-score variation during follow-up, an increase of 8·58 (95 % CI 7·68, 9·60) pmol/l in fasting plasma insulin concentrations and 1·47 (95 % CI 1·30, 1·66) in HOMA-IR values was observed. There was no significant impact of weight gain on glucose concentrations and systolic and diastolic blood pressure. In conclusion, we found evidence that an increase in BMI during a 2-year period affected insulin resistance during school years. Considering the significant increase in overweight in this age group, special attention should be paid to monitoring increases in BMI in children from the Brazilian Amazon.
    Full-text · Article · Oct 2014 · British Journal Of Nutrition
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim: To update a previous systematic review and meta-analyses about the effect of breastfeeding promotion interventions on child growth. Methods: Studies evaluating the effect of any type of breastfeeding promotion intervention on child weight, length (or height) and weight/height (or BMI) were screened. Papers published between 2006 and 2014 were checked using the following databases: PubMed/Medline, Embase, Cochrane Database of Systematic Reviews, Lilacs and Scielo. Results: Sixteen studies were added to 19 other studies identified in the previous review, resulting in 35 studies. Meta-analyses of studies reporting on mean weight, length, weight/length or BMI showed that the interventions had no impact on weight or length/height z scores [pooled effect: 0.03 (95% confidence interval: -0.06;0.12) and 0.03 (95% confidence interval: -0.02;0.08), respectively] and had a modest, but significant, reduction in body mass index/weight-for-height z scores [z score mean difference: -0.06 (95% confidence interval: -0.12;0.00)], which was limited to studies from low and high incomes settings. For all three outcomes there was important heterogeneity among studies, that should be taken into account when interpreting the results. Conclusion: Breastfeeding promotion interventions were not associated with significant changes in weight or length, but led to a modest, albeit significant, reduction in body mass index/weight-for-height z scores. This article is protected by copyright. All rights reserved.
    Full-text · Article · Sep 2015 · Acta Paediatrica
  • Source

    Preview · Article · Dec 2015