Early Life Nutrition and Lifelong Health - Derbyshire Local Medical ...

BMA Board of ScienceInterventions to improve maternal nutritionBox 11: Comment on nutritional intervention in women living in poverty‘In the UK the health and wellbeing of millions of women areinfluenced by living in poverty. Food choices, dietary intake andfeeding behaviour are far from optimal among poorer women,and this situation is reflected in higher rates of diet-relatedmorbidity and mortality well beyond maternal and child healthconsiderations. Interventions to change diet need to take accountof the factors that influence household economic status andshould be integrated at policy, community and individual level.There is a dearth of research on effective interventions in thissubgroup of the population from within the UK, although thereare some encouraging United States’ (US) examples to draw onin terms of possible intervention approaches.Lack of evidence does not mean that policy work should bedelayed. It is recognised that engaging with ‘hard to reach’groups of women is a challenge for intervention implementationand evaluation, and it is essential that policy work should beevaluated for its ability to engage with target groups as well asfor behavioural change and health outcomes.’ 259Professor Annie Anderson, Professor of Food ChioceUniversity of Dundee (2007)A systematic review of interventions that aimed to improve diet in women who were pregnant orof childbearing age suggested that interventions that included elements of education orcounselling, support and empowerment can improve nutrition knowledge and behaviour. 260 Muchof the existing evidence on interventions to improve maternal nutrition comes from evaluation ofthe federally funded US health programmes. These include the US Special Supplemental NutritionProgramme for Women, Infants and Children (WIC) and the Expanded Food and NutritionEducation Programme (EFNEP) both of which focus on people from disadvantaged backgrounds.Evaluation suggests that the WIC programme which combines food supplementation, nutritioncounselling and referral to health and social services, can lead to improvement in maternal dietduring pregnancy, increased maternal weight gain and increased breastfeeding rates. 261WIC programmes have also been effective at increasing fruit and vegetable consumption. 262EFNEP, which aims to give low-income families food knowledge and skills and to bring aboutdietary behaviour change through practical sessions delivered by peers, has been shown toimprove food practices among recipients. 263 Evaluation of smaller-scale intervention programmeswithin the UK has also suggested that imparting food knowledge and skills to women fromdisadvantaged backgrounds has the potential to improve diet in this group. The Cookwell project,set in eight urban communities in Scotland aims to improve diet in areas of social deprivation bydelivering food skills sessions each week over a seven-week period: in a study of 113 adults livingin areas of social deprivation, 88 per cent of whom were women, the intervention led to earlyincreases in fruit consumption and at six months follow-up there was a significant increase in theproportion of subjects who reported confidence in following recipes and cooking from basicingredients. 264Early life nutrition and lifelong health 55