Abstract: Early childhood settings (ECS) offer a unique opportunity to intervene to improve children’s nutrition. This paper reviews the literature on early childhood setting interventions that aim to improve children’s dietary intake. Environmental and individual determinants of children’s dietary intakes were also investigated. Prospective intervention studies targeting centres, staff, parents/caregivers or children, were reviewed. Methodological quality was assessed. Twenty six studies (14 weak, 12 moderate quality) were included. Interventions were delivered primarily via training workshops and/or written materials. Study findings favoured intervention effectiveness in 23 studies. Improvements were seen in children’s intake for 8 out of 11 studies assessing dietary intake outcomes. Small increases in fruit and vegetable consumption were observed in five studies. Most studies measuring parental or centre food provision observed post-intervention improvements across a number of food groups, including fruit, vegetables, whole grains and sweetened beverages. Significant improvements in child, parent and/or staff knowledge, attitudes or behaviours were observed consistently across studies. For those studies that included a comparison group, these improvements were observed only in the intervention group. ECS interventions can achieve changes in children’s dietary intake and associated socio- environmental- determinants, although the quality of current research limits confidence in study findings. Future intervention development needs to carefully consider the behavioural targets, modifiable determinants and utilise age-appropriate and effective behaviour change theory, in addition to inclusion of dietary intake outcomes.

Keywords: Early childhood settings, child care, preschool, nutrition, diet, review.

Abstract: Objective: This study examined the impact of various levels of 100% fruit juice (FJ) consumption on intake of nutrients, diet quality, and weight in children using the more recent national data.

Methods: This was a cross-sectional study examining the data from children 2-18 years of age (n=6,090). Intake of nutrients and diet quality were assessed using the 24-hr dietary recall and Healthy Eating Index-2010, respectively. Various consumption levels of 100% FJ were determined. Covariate adjusted linear regression means, and standard errors were determined (p<0.01).

Results:Average per capita consumption of 100% FJ consumed was 3.6 fl oz (50 kilocalories; 2.9% energy intake); 30% of children 2-6 years exceeded the recommendation for 100% FJ. Among 100% FJ consumers, the mean amount of 100% FJ consumed was 10.6 fl oz (147 kilocalories; 8.4% energy intake). Intakes of vitamin C, magnesium, and potassium and overall diet quality were higher with more 100% FJ consumed; no difference was found in total fiber intake. No trends were seen in weight with increased amounts of 100% FJ consumed.

Conclusions: Consumption of 100% FJ should be recommended as a component of a healthy diet.

Keywords: Fruit juice,whole fruit, dietary intake, NHANES, children.

Abstract: Childhood undernutrition is a health crisis in the rapidly expanding informal settlements of low-income countries worldwide. Nearly half of Kenyan children in the Kibera settlement, in Nairobi, were reported to be stunted, indicating low height-for-age. Stunted children are at greater risk for poor cognitive and physical health outcomes in the long-term, problems that tend to be perpetuated in subsequent generations. Animal-source foods (ASF) supply a calorically dense source of micro- and macronutrients, and supplementation with ASF has been shown to improve linear growth and cognition. Correspondingly, increasing consumption of ASF by pregnant women and children has been proposed as a means to disrupt the intergenerational cycle of undernutrition caused by food insecurity. Household surveys indicate that consumption of ASF is low in urban slums, despite the availability of these foods in local markets. Here we review the studies addressing the role of ASF in the diets of the urban poor and identify knowledge gaps relevant to improving nutrition by increasing consumption of ASF. Based predominantly on studies in Kibera and greater Nairobi, these gaps include determining the minimal amount and frequency of dietary ASF to prevent stunting, defining how consumer preferences, markets, and income interact to impede or promote ASF consumption, and understanding the interaction between diet and both clinical and sub-clinical enteric disease on growth outcomes.

Keywords: Maternal health, Child malnutrition, Undernutrition, Food security, Informal urban settlements.

Abstract:This paper demonstrates the effect of an innovative community-based management programme on acute malnutrition among children under three years of age, through an observationallongitudinalcohort study in tribal blocks in central-eastern India.

The key components of the programme include child care through crèches, community mobilisation and systems strengthening to ensure better child feeding and caring practices and delivery of public health and nutrition services.

For a cohort of 587 children, the increase in children in the non-wasting category is from 72% to 80% (p<0.001) and the reduction in Severe Acute Malnutrition (SAM) from 8% to 4% (p<0.005), a reduction of 46.6%. Normalcy is fairly well maintained at 89%. Among the severely wasted, 16% show no improvement, 49% moved into a moderate wasting category and 36% to normalcy over 4-6 months. Among the moderately wasted, 26% showed no improvement and 7% declined to a severely wasted category, and 67% moved to normalcy. The average Weight for Height Z-score (WHZ) for the cohort improved from -1.41 in the initial period to -1.13 in November (p<0.0001).

This study suggests that this medium term strategy using a rights-based participatory approach for community based management of malnutrition may be comparatively effective by current WHO guidelines and other known community based interventions in terms of mortality, cost, degree and pace of improvements.

Keywords: Malnutrition, wasting, SAM, crèche, community based management of malnutrition, acute malnutrition, underweight, CMAM, growth monitoring.