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

BMA Board of ScienceKey messagesUS programmes which combine food supplementation, nutrition counselling, cookery skillsand referral to health and social services, can lead to an improvement in maternal diet duringpregnancy and to increased breastfeeding rates.Two recent systematic reviews have considered the effectiveness of interventions which aim toincrease fruit and vegetable consumption in adults and the findings of both have relevance forwomen of childbearing age. The first focused on community interventions that were effective inincreasing fruit and vegetable consumption in people aged four years and over. 265 Fifteen studies,all of which were based in the USA, were included in the review. Four trials were specificallytargeted at parents with young children. The most effective interventions gave clear messagesabout the benefits of fruit and vegetables, were intensive and used multiple strategies deliveredover a prolonged period of time, and involved families as a group in the intervention. The second,and more recent, systematic review collated evidence from the published and grey literaturerelating to programmes that promote fruit and vegetable consumption in adults. 266 Forty-fourstudies were reviewed, with over 70 per cent set in the USA and around 16 per cent in Europe.Consistent positive effects were seen in studies involving face-to-face education or counselling.A more recent US intervention study of 269 adults from low-income backgrounds evaluated theimpact of the Sisters in health nutrition education programme which aimed to increase fruit andvegetable consumption among low-income groups. 267 The intervention, which involved peer-ledsmall group sessions to teach cooking skills and provide social support, led to significantimprovements in fruit and vegetable intake at the end of the intervention programme.Key messageThere is limited evidence of interventions that are effective in improving maternal nutrition.There is, however, some evidence that interventions that include elements of education orcounselling can bring about improvements in nutrition knowledge and behaviour.Improving breastfeeding initiation and increasing durationof breastfeedingWomen surveyed in the most recent IFS were asked about their experience of breastfeeding;73 per cent of the women who initiated breastfeeding, but who gave up in the survey period, saidthat they would have preferred to have continued to breastfeed for longer. 131 The most commonreason given for stopping breastfeeding was insufficient milk. Stopping breastfeeding within twoweeks of birth was associated with rejection of the breast, or painful breasts; in later months,returning to work or college was also associated with stopping breastfeeding.Interventions that educate women about the benefits and practice of breastfeeding are effective atincreasing breastfeeding initiation. A recent Cochrane systematic review of seven randomisedcontrolled trials (RCTs) of 1,388 women demonstrated that interventions based on one-to-onehealth education and support are effective at increasing initiation rates. 268 Overall, the relativelikelihood of breastfeeding initiation was 1.59 (95% CI 1.25 to 1.88) in the group who receivededucational interventions compared with those who received routine care. A further systematicreview based on non-randomised controlled trials as well as RCTs has suggested that peer support56Early life nutrition and lifelong health