Complementary feeding to combat malnutrition

By Nilma Dole

We often think that the rise in cost of living contributes to the malnutrition problem.

While it could be true for some, research has proven that it is the complementary feeding habits of mothers, midwives, relatives and even what the astrologer says that have a considerable influence in the way we feed our children.

Auspicious observances are not negative but it has been shown that this has indirectly contributed to the malnutrition problem which happens at a young age and affects when they are adults.

Breastfeeding should continue when the child is two years of age, but complementary feeding also should be done hand-in-hand after the child is six months.

Food culture

“In Sri Lanka, we have what is called a food culture. We have reported success in breast-feeding exclusively but we should introduce good complementary feeding immediately after six months,” said Consultant Physician at the Family Health Bureau Dr. Hiranya Jayawickrama at a seminar at the Health Education Bureau.

The childhood effects of malnutrition especially during the growing stages makes an impact on the child when they grow as adults.

“There is an increased risk of illness and death, lower performance in studies, shorter adult height, reduced adult height, high risk of non-communicable diseases (NCDs) and low birth weight babies born to women with malnutrition if the child doesn't have proper nutrition at a young age,” she said.

There are policies and strategies in place to tackle malnutrition but also it is the duty of mothers, families, midwives and doctors to help in ensuring that they are followed.

Improper practices in complementary feeding contribute to the malnutrition problem. The right methods of feeding your child should be adopted.

Dr. Jayawickrama said, “When complementary feeding starts, make sure that the quantity of food is adequate, don't feed the child food alternatives or meal replacements such as sweets and biscuits which don't contain much nutrition. Even though your child doesn't eat, make sure you don't distract the child to eat something by making them get used to unhealthy sweet and salty foods because it contributes to obesity and juvenile diabetic problems at an early age.” If poor quality foods such as watery soup without any soft semi-solids is given, it isn't nutritious.

Flavours

“Prepare food hygienically, gradually add a range of new foods so that a child can get used to the different types of food flavours,” she said. The right amount of food should be given to the child where at six to eight months, mothers should start feeding the child with two to three teaspoonfuls per feed gradually increasing to about 100 ml of thick soup. At nine to 11 months, about a 150 ml and at 12 to 13 months, 200 ml of thick soup should be given.

It is important to give the child healthy food during illness as a majority of mothers reduce the level of nutrition with watery soups and just liquids but this shouldn't be done. She said, “More food and healthy liquids such as juices should be given to the child during illness and immediately after they recover, because this will strengthen their immune system and proper nutrition will help in the recovery process.”

She said that a child of seven to eight months needs two or three main meals a day with one or two healthy snacks in between and a child of nine to 24 months needs three to four main meals a day with one or two meals in between.

There also needs to be consistency in the food with well-mashed and boiled food given at six months to fine particles which won't make the child choke. After the age of one, finger foods and soft semi-solids with partly solid food should be given with close supervision.

Giving his comments about child nutrition was renowned paediatrician Prof. Harendra de Silva, who said, “The problem is giving the child thin gruel. You should give your child thick soup and congee which is good for growth.” According to the paediatrician, mothers should introduce complementary foods in a form thick enough to stay in the spoon which is easy for the child to eat and not hard-solid food but in a semi-solid form.

The doctor said, “I have seen that leftover rice-water washed from the rice that is used to give household members is given to the child which contains absolutely no nutrition. I think that the water washed after eating rice has more nutrition because it carries the oils from curries but that isn't what we should give the child.”

Prof. de Silva said that introducing essential fatty acids and oils is important to help giving the right nutrition to your child. He said, “Introducing butter and oils such as coconut oil will give your child good nutrition in the form of high calories and high energy density food. This won't make your child obese but will promote good nutrition.

The doctor said, “What is given for the child to eat at a young age impacts not only nutrition and health at a young age but also their food habits when they are adults.”

Food with a high energy density will help nurture your child but also eating the right food such as carbohydrates, rice, pulses such as lentils (parippu), fresh vegetables and fruits, seeds such as jak seeds and a variety of mashed nuts in the food will contribute to good nutrition.”

Judgements

Another point that he raised was that parents think they are always correct when it comes to knowing what is right for the child and make judgements based on the child's behaviour. The doctor said, “I have come across parents who speak for their child because how can a child talk about what is wrong and right?”

He said that during complementary feeding, if the child stops breast-feeding on their own, the mother thinks that they prefer eating food instead of wanting their milk.

“This is a misconception but it happens because the mother gives the child a tit or a bottle which resembles a nipple which confuses the child that that is their milk instead of cow's milk,” he said.

The doctor said that responsive feeding was important to get the child to eat food, taste a variety and see what they like and the ability to eat without being force-fed.

“When getting a child to eat, the secret is to encourage the child to eat with the family, sitting on the feeding chair and get them to eat with you and get the child involved. Don't feed the child separately or distract the child because it won't make them concentrate on eating their food,” he said.

The paediatrician also raised the auspicious observances pertaining to eating the first meal.

He said, “The Indul Kata Gama ceremony has made an impact on the statistics of malnutrition being more prevalent among boys than girls. Going by the Indul Kata Gama ceremony, girls eat earlier than boys.”

Auspicious times

According to astrologers, for boys, an auspicious time during six, eight and 10 (even number) months of age from the birth for boys is considered best for the ceremony and five, seven, nine, 11 months from the birth for girls are considered the best.

However, according to Prof. de Silva if you want the best for your child, you should introduce food at six months no matter what gender.

UNICEF's Sri Lanka representative, Dr. Reza Hossaini said, “In a country of abundance and aplenty it is difficult to imagine that Sri Lanka has a malnutrition problem. “However, you need to tackle this problem at a grassroot level with educating families to check the nutrition levels of their babies, toddlers and children so that doctors can advise them accordingly,” he said.

Moreover, the UNICEF country representative said that if Sri Lanka can combat malnutrition it is possible that Sri Lanka can become a developed nation. He said, “Sri Lanka's leaders want to develop the country from a low middle-income country to a high middle-income country, but you need healthy citizens to ensure that productivity is kept to an optimum.”

A donation of anthropometric equipment to measure nutrition levels in children courtesy UNICEF and the Family Health Bureau was given to the Ministry of Health's Director General, Plantation Human Development Trust as malnutrition was a big problem in the plantation sector.

Food poisoning: Delay in identifying source fatal

As illustrated by the 2011 E. coli outbreak in Germany in 2011, any delay in identifying the source of food poisoning outbreaks can cost lives and cause considerable political and economical damage.

An international multidisciplinary team of scientists have shown that difficulties in finding the sources of contamination behind food poisoning cases are inevitable due to the increasing complexity of a global food traffic network where food products are constantly crossing country borders, generating a worldwide network.

As consumers we are used to seeing country of origin labels on certain foods, but what about on products with more than one ingredient? A recent study by the Food Safety Authority of Ireland showed that 53 countries contributed to the ingredients of an ordinary “Chicken Kiev” in a Dublin restaurant.

This diversity of sources is partly to blame for the failure to identify the sources of food poisoning outbreaks, and has lead to calls for international health agencies to initiate a system to monitor this ‘human food web.’ But just how complex is the human food web? What is its structure, can we quantify it, and what can we learn from it?

Network

In the first study of its kind, published in the journal PLoS ONE, the scientists studied databases of food import and export to understand how ‘food fluxes’ generate a complicated worldwide network.

They were led by Professor József Baranyi of the Institute of Food Research, which is strategically funded by the Biotechnology and Biological Sciences Research Council.

Using agri-food import-export data from the UN and FAO databases, the authors chart out the worldwide food-transport network and show that it forms an amazingly complex transport web.

With the help of network science methods they reveal that it has highly vulnerable hotspots and demonstrate that, without increased control, some of these are prime positions for making outbreak tracing difficult.

The research identifies a number of countries as being central to the network or holding particular influence due to the dynamics of the food traffic, and stricter regulation in monitoring food trade here could benefit the network globally. Countries that take in many ingredients, process these into products, and act as distribution hubs are of particular concern.

Melting pot

“We found that the current structure of international food trade effectively makes The Netherlands a combined melting pot and Lazy Susan, with the busiest link to Germany,” said Professor Baranyi.

“This could explain why the tracing of the source suffered long delays in these countries in two serious outbreaks in 2011.

This could be observed in both the E. coli outbreak in sprouts and the dioxin contamination in eggs.”

The findings are supported by two types of analyses: one is based on the graph theoretical analysis of the structure of the international food trade network that allows the identification of the network core using the well-established “betweenness centrality” measures of nodes and edges for this purpose; the other is a measure based on the dynamics of the food-flow on the network, expressing to what extent a country is a “source” or a “sink”.

This work also introduces and validates for the first time a rigorous, quantitative methodology to help with biotracing and identifying the sources of food poisoning outbreaks, a problem that is only expected to increase in its magnitude, complexity and impact, in the face of current globalisation trends.

-MNT

New interactive smoking cessation website designed

Stop Advisor is a new web-based smoking cessation program, which takes smokers from preparation for the target quit date to the quit date itself.

It achieves this by offering expert advice through a combination of interactive menus and personalised sessions.

Post quit date, it encourages users to report important information that the program will use to help them overcome the difficulties they encounter along the way. In their study, Robert West and Susan Michie from University College London and collaborators describe the development process of the StopAdvisor intervention.

Need

Their work appears online in Translational Behavioral Medicine: Practice, Policy, Research, published by Springer.

Since smoking remains the largest single preventable cause of premature death and illness worldwide, there is a pressing need to find better ways to help smokers to quit.

The internet has huge potential and is extremely cost-effective, i.e. low cost per user.

StopAdvisor is the result of the analysis and synthesis of 19 theoretical principles, 33 evidence- or theory-based behavior change techniques, 26 web-design principles and 9 principles from user-testing.

It is designed to be attractive and effective across social groups. To make StopAdvisor relevant to all social groups, user-testing was conducted among less educated smokers in lower paid jobs, a group notoriously difficult to reach and engage.

Unique

What is unique about the research team's approach is the use of an open-source web-development platform (LifeGuide), which allowed the researchers to test individual elements of their intervention and adjust them as they went along, based on user and researcher feedback throughout the development phase.

The authors said, “To our knowledge, this is the first attempt to be fully transparent about the content and development of a population-reach behaviour change intervention.”

The paper describes the development process of the StopAdvisor intervention and provides a full description of how the intervention works.

Its effectiveness is currently being evaluated in a randomised controlled trial (the highest level of evidence for a scientific study).

The authors have made a commitment to continue incrementally developing and building the technology as a community of researchers.

- topix

Neural rhythms found to drive physical movement

A new model for understanding how nerve cells in the brain control movement may help unlock the secrets of the motor cortex, a critical region that has long resisted scientists’ efforts to understand it, researchers report in Nature.

Scientists at Washington University in St. Louis, Stanford University and Columbia University have shown that the motor cortex's effects on movement can be much more easily understood by looking at groups of motor cortex neurons instead of individual nerve cells.

In the study, scientists identified rhythmic brain cell firing patterns coordinated across populations of neurons in the motor cortex.

They linked those patterns to different kinds of shoulder muscle movements.

Neurons

“Populations of neurons in the motor cortex oscillate in beautiful, coordinated ways,” says co-first author John Cunningham, assistant professor of biomedical engineering at Washington University in St. Louis.

“These patterns advance our understanding of the brain's control of movement, which is critical for understanding disorders that affect movement and for creating therapies that can restore movement.”

Until now, scientists had based their studies of the motor cortex on decades-old insights into the workings of the visual cortex.

In this region, orientation, brightness and other characteristics of objects in the visual field are encoded by individual nerve cells.

However, researchers could not detect a similar direct encoding of components of movement in individual nerve cells of the motor cortex.

“We just couldn't look at an arm movement and use that to reliably predict what individual neurons in the motor cortex had been doing to produce that movement,” Cunningham says.

For the new study, conducted at Stanford University, scientists monitored motor cortex activity as primates reached for a target in different ways. They showed that the motor cortex generated patterns of rhythmic nerve cell impulses.

“Finding these brain rhythms surprised us a bit, as the reaches themselves were not rhythmic,” says co-first author Mark Churchland, who was a postdoctoral researcher at Stanford at the time of the study and is now assistant professor of neuroscience at Columbia University. “In fact, they were decidedly arrhythmic, and yet underlying it all were these unmistakable patterns.”

Cunningham compares the resulting picture of motor cortex function to an automobile engine. The engine's parts are difficult to understand in isolation but work toward a common goal, the generation of motion.

Spark plug

“If you saw a piston or a spark plug by itself, would you be able to explain how it makes a car move?” Cunningham asks. “Motor-cortex neurons are like that, too - they are understandable only in the context of the whole.”

Researchers are applying their new approach to understanding other puzzling aspects of motor cortex function.

“With this model, the seemingly complex system that is the motor cortex can now be at least partially understood in more straightforward terms,” says senior author Krishna Shenoy, PhD, associate professor of electrical engineering at Stanford.

-bioportfolio