Nutrition Interventions Addressing Structural Racism: A Scoping Review

African Americans experience high rates of obesity and food insecurity in part due to structural racism, or overlapping discriminatory systems and practices in housing, education, employment, health care, and other settings. Nutrition education and nutrition-focused policy, systems, and environmental changes may be able to address structural racism in the food environment. This scoping review aimed to summarize the available literature regarding nutrition interventions for African Americans that address structural racism in the food environment and compare them to the “Getting to Equity in Obesity Prevention” framework of suggested interventions. An electronic literature search was conducted with the assistance of a research librarian encompassing 6 databases—MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX, and ProQuest Dissertations & Theses. A total of 30 sources were identified detailing interventions addressing structural barriers to healthy eating. The majority of nutrition interventions addressing structural racism consisted of policy, systems, and/or environmental changes in combination with nutrition education, strategies focused on proximal causes of racial health disparities. Only two articles each targeted the “reduce deterrents” and “improve social and economic resources” aspects of the framework, interventions which may be better suited to addressing structural racism in the food environment. Because African Americans experience high rates of obesity and food insecurity and encounter structural barriers to healthy eating in the food environment, researchers and public health professionals should address this gap in the literature.

Comprehensive Nutrition Interventions in First Nation-Operated Schools in Canada

Comprehensive school-based nutrition interventions offer a promising strategy to support healthy eating for First Nations children. A targeted strategic review was performed to identify nutrition interventions in 514 First Nation-operated schools across Canada through their websites. Directed content analysis was used to describe if interventions used 1 or more of the 4 components of the Comprehensive School Health (CSH) framework. Sixty schools had interventions. Nearly all (n = 56, 93%) schools offered breakfast, snack, and (or) lunch programs (social and physical environment). About one-third provided opportunities for students to learn about traditional healthy Indigenous foods and food procurement methods (n = 18, 30%) (teaching and learning) or facilitated connections between the school and students’ families or the community (n = 16, 27%) (partnerships and services). Few schools (n = 10, 17%) had a nutrition policy outlining permitted foods (school policy). Less than 1% (n = 3) of interventions included all 4 CSH components. Results suggest that most First Nation-operated schools provide children with food, but few have nutrition interventions that include multiple CSH components. First Nation-operated schools may require additional financial and (or) logistical support to implement comprehensive school-based nutrition interventions, which have greater potential to support long-term health outcomes for children than single approaches.

Early-Life Nutrition Interventions Improved Growth Performance and Intestinal Health via the Gut Microbiota in Piglets

Intestinal infections in piglets are the main causes of morbidity before and after weaning. Studies have not explored approaches for combining pre-weaning and post-weaning nutritional strategies to sustain optimal gut health. The current study thus sought to explore the effects of early-life nutrition interventions through administration of synthetic milk on growth performance and gut health in piglets from 3 to 30 days of age. Twelve sows were randomly allocated to control group (CON) and early-life nutrition interventions group (ENI). Piglets were fed with the same creep diet from 7 days of age ad libitum. Piglets in the ENI group were provided with additional synthetic milk from Day 3 to Day 30. The results showed that early-life nutrition interventions improved growth performance, liver weight, spleen weight, and reduced diarrhea rate of piglets after weaning (P < 0.05). Early-life nutrition interventions significantly upregulated expression of ZO-1, Occludin, Claudin4, GALNT1, B3GNT6, and MUC2 in colonic mucosa at mRNA level (P < 0.05). Early-life nutrition interventions reduced activity of alkaline phosphatase (AKP) in serum and the content of lipopolysaccharides (LPS) in plasma (P < 0.05). The number of goblet cells and crypt depth of colon of piglets was significantly higher in piglets in the ENI group relative to that of piglets in the CON group (P < 0.05). The relative mRNA expression levels of MCP-1, TNF-α, IL-1β, and IL-8, and the protein expression levels of TNF-α, IL-6, and IL-8 in colonic mucosa of piglets in the ENI group were lower compared with those of piglets in the CON group (P < 0.05). Relative abundance of Lactobacillus in colonic chyme and mucosa of piglets in the ENI group was significantly higher relative to that of piglets in the CON group (P < 0.05). Correlation analysis indicated that abundance of Lactobacillus was positively correlated with the relative mRNA expression levels of ZO-1, Claudin4, and GALNT1, and it was negatively correlated with the level of MCP-1 in colonic chyme and mucosa. In summary, the findings of this study showed that early-life nutrition interventions improved growth performance, colonic barrier, and reduced inflammation in the colon by modulating composition of gut microbiota in piglets. Early-life nutrition intervention through supplemental synthetic milk is a feasible measure to improve the health and reduce the number of deaths of piglets.

Risk Factors of Stunting in Children Aged 6–59 Months: A Case-Control Study in Horticulture Area

BACKGROUND: Stunting is a critical public health problem in Indonesia because it affects cognitive and physical development and contributes to child mortality. AIM: This study aims to identify risk factors for stunting in children aged 6–59 in the horticultural area. METHODS: A casecontrol study was conducted to compare previous exposure between stunted children and non-stunted children. Measurements and interviews were conducted with 160 participants (120 controls and 40 cases), including mothers or caregivers. SPSS was used for χ2 statistical analysis, multiple logistic regression, and odds ratios. RESULTS: The study identified four risk factors for stunting: children who were born short (adjusted odds ratio [AOR] = 17.57; 95% confident interval [CI]: 5.02–61.51), LBW (AOR = 4.35; 95% CI: 1.38–13.78), and got a low protein intake (AOR = 4.96; 95% CI: 1.22–20.26). Significantly, a relationship between stunting and access to sanitation was also found (AOR = 6.06; 95% CI: 1.25–29.35). CONCLUSIONS: The risk factors for stunting in children aged 6–59 are related to nutrition during pregnancy and the child’s quality of food. Nutrition interventions should emphasize improving the nutritional status of pregnant women and children and women empowering to affect access to resources and allocations for children’s nutrition.

Analysis of the Successful Implementation of Tazi's Important Innovations in Tackling Stunting in the Work Area of the Rusip Antara Public Health Center

The research objectives were to analyze the successful implementation of Tazi's Important Innovations in Strategy, Interventions, increasing the scope of interventions for the target of 1000 HPK households, improving nutrition intake and reducing infections and the impact of Tazi's important innovations in preventing stunting in the working area of ​​the Rusip Health Center. The type and design of the research is descriptive qualitative. Data sources consist of Primary Data and Secondary Data. Data collection techniques consist of interviews, observations and documentation, data analysis techniques in the form of data reduction, data presentation, and drawing conclusions. Testing the validity of the data using source triangulation and member check. Quality control process is carried out by applying PDCA. Research ethics such as Informed consent, Anominity and confidentiality. The Regent of Central Aceh has made Regulation Number 14 of 2019 concerning stunting handling in Central Aceh Regency and is very committed to the prevention and reduction of stunting by implementing a stunting reduction strategy through 5 pillars, specific nutrition interventions and sensitive nutrition carried out in an integrated and converged manner with a target of 1000 HPK . The impact of Tazi's Important innovation is able to reduce the prevalence of stunting in Tirmiara Village. Implementation of the Strategy for the Acceleration of Stunting Prevention is based on five main pillars. Interventions to accelerate stunting prevention consist of specific and sensitive interventions. increasing the scope of intervention in the target of 1000 HPK households

Scoping Review of Intervention Strategies for Improving Coverage and Uptake of Maternal Nutrition Services in Southeast Asia

Maternal undernutrition can lead to protein-energy malnutrition, micronutrient deficiencies, or anemia during pregnancy or after birth. It remains a major problem, despite evidence-based maternal-nutrition interventions happening on ground. We conducted a scoping review to understand different strategies and delivery mechanisms to improve maternal nutrition, as well as how interventions have improved coverage and uptake of services. An electronic search was conducted in PubMed and Google Scholar for published studies reporting on the effectiveness of maternal-nutrition interventions in terms of access or coverage, health outcomes, compliance, and barriers to intervention utilization. The search was limited to studies published within ten years before the initial search date, 8 November 2019; later, it was updated to 17 February 2021. Of 31 studies identified following screening and data extraction, 22 studies were included for narrative synthesis. Twelve studies were reported from India and eleven from Bangladesh, three from Nepal, two from both Pakistan and Thailand (Myanmar), and one from Indonesia. Nutrition education and counselling, home visits, directly observed supplement intake, community mobilization, food, and conditional cash transfer by community health workers were found to be effective. There is a need to incorporate diverse strategies, including various health education approaches, supplementation, as well as strengthening of community participation and the response of the health system in order to achieve impactful maternal nutrition programs.

Malnutrition and the Risk of Catastrophic Health Expenditure in Nigeria

BACKGROUND: Malnutrition among children not only affects their health consequences but also does it burden their households’ finance especially in developing countries. This study evaluates the household risk of catastrophic health expenditure (CHE) due to malnutrition treatments among malnourished children in Nigeria, according to zones and wealth quintiles. We simulate the CHE risk among households with malnourished children who seek treatment.  METHODS: The CHE risk due to malnutrition among treated was computed based on 1) the out-of-pocket (OOP) expenditure and indirect costs associated with malnutrition treatment, and 2) household consumption expenditures. I derived the CHE risk associated with malnutrition across zones and wealth quintiles in Nigeria, using secondary data sources for healthcare utilization, OOP expenditures, and consumption expenditures. RESULTS: There was a large variation of CHE risk according to zones and wealth quintiles. Among the poorest households, those in northeast and northwest would have the highest risk of CHE, up to 59 and 47%, while those in southwest would have the lowest risk of 14%. For all zones, as the wealth increases, the CHE risk would decrease. There would be zero or very little CHE risk among the richest households in any zones. INTERPRETATION: Nutrition interventions will help malnourished children improve their health status. However, we should also be wary about the financial consequences of the treatment that households should bear.

Outcomes and Treatment Costs of Skilled Nursing Facility Patients with Pressure Injuries and Malnutrition

Skilled nursing facilities (SNF) provide care for individuals requiring skilled care while transitioning to a more permanent residence post hospitalization. This analysis shows that diagnosed malnutrition and pressure injuries (PI) adversely impact SNF patients’ health and recovery. Length of SNF stay, total charges, and discharge disposition were analyzed using SNF claims from 2016-2020 Centers for Medicare & Medicaid Services (CMS) Standard Analytical File databases. An average of 4.5% SNF patients had diagnosed PIs, and 4.9% had diagnosed malnutrition. Patients with diagnosed malnutrition were more likely to have PIs than patients without diagnosed malnutrition (11.9% vs 4.1%). Patients with PIs had higher charges ($12,304 vs. $10,937), were less likely to be discharged home (11.1% vs 18.9%), and more likely to be discharged to a hospital (15.8% vs 11.0%) or deceased (2.8% vs 1.6%). Patients with diagnosed malnutrition displayed a similar pattern for charges ($11,587 vs $10,969), and discharge to home (14.5% vs 18.8%), hospital (13.5 vs 11.1%) or deceased (2.8% vs 1.6%). Length of SNF stay did not differ between patients with and without PIs (18.5 vs 18.6) and was slightly shorter for patients with diagnosed malnutrition (17.3 vs 18.9). While higher probability of rehospitalization or death could impact these results, drivers behind these differences need further investigation. Because malnourished patients were more likely to have PIs and both PI and malnutrition are associated with poorer patient discharge outcomes and higher costs, efforts to identify malnutrition and implement proper nutrition interventions should be prioritized as part of SNF quality improvement initiatives.

THE PREVALENCE OF STUNTING, POVERTY, AND ECONOMIC GROWTH IN INDONESIA: A PANEL DATA DYNAMIC CAUSALITY ANALYSIS

In recent years, policy discussions and debates have emphasised the efficiency of development policies to translate economic growth into sustainable economic development. One of the main aspects in this regard is achieving improvement in child nutrition through economic development. Nevertheless, there is a scarcity of literature that empirically verifies the causality between stunting, poverty, and economic growth in 34 provinces in Indonesia using Klassen’s typology analysis and Panel VECM. This study indicates that the prevalence of stunting has a direct causality towards poverty and economic growth in the long-term by 0.02%. Handling high the prevalence of stunting needs to be focused on in all provinces in Indonesia. Poverty directly affects the stunting prevalence and economic growth in the long-term by 0.06%. The percentage of the population, poverty outside Java, including Nusa Tenggara, Moluccas, and Papua, is also higher than in Java. Therefore, efforts to tackle poverty should be more focused on these areas. Economic growth has a direct causality to the prevalence of stunting and poverty by 0.57%. It proves that the country’s economic growth is accompanied by socioeconomic development and improving the poor’s livelihoods and welfare. Can also recommend specific nutrition and sensitive nutrition interventions to impact the massive reduction of stunting in Indonesia.Keywords: Stunting, Poverty, Economic Growth, IndonesiaJEL: I10; I18; I32; O10; O15; P36