High-fat diet during early life reshapes the gut microbiome and is associated with the disrupted mammary microenvironment in later life in mice.

The influence of gut microbiota on gut health is well-documented, but it remains obscure for extraintestinal diseases such as breast cancer. Moreover, it is entirely unknown how gut dysbiosis during early life contributes to breast tumorigenesis later in life. In this study, we hypothesized that a high-fat diet during early life leads to alterations in the gut microbiome and is associated with disruptions in the mammary microenvironment. Female C57BL/6 mice were fed a low-fat diet (10% kcal fat) or a high-fat diet (HF, 60% kcal fat) for 8 weeks from the age of 4 to 12 weeks, which is equivalent to human childhood and adolescence. Twelve mice were sacrificed immediately after the 8-week feeding, the remainder were euthanized after switching to a normal lifecycle-supporting diet for an additional 12 weeks; the gut microbiome was then sequenced. The 8-week HF diet feeding altered the beta-diversity (Bray & Jaccard P < .01), and the difference remained significant after switching the diet (Bray & Jaccard P < .05). Immediately after HF feeding, a greater number of microbial taxa (>50) were altered, and about half of the taxa (25) remained significantly changed after switching the diet. The abundance of Alistipes, Bilophila, and Rikenellaceae stood out as significantly associated with multiple metabolic and inflammatory biomarkers in mammary tissue, including aromatase, Ccl2, and Cox2. In conclusion, an 8-week early-life HF feeding reshaped the gut microbiome, which connected with disrupted mammary microenvironments.

Nutritional Challenges among African Refugee and Internally Displaced Children: A Comprehensive Scoping Review.

BACKGROUND: Children's nutrition in Africa, especially among those displaced by conflicts, is a critical global health concern. Adequate nutrition is pivotal for children's well-being and development, yet those affected by displacement confront distinctive challenges. This scoping review seeks to enhance our current knowledge, filling gaps in understanding nutritional and associated health risks within this vulnerable population. OBJECTIVE: We conducted a scoping review of the literature on the nutritional status and associated health outcomes of this vulnerable population with the goal of informing targeted interventions, policy development, and future research efforts to enhance the well-being of African refugee and internally displaced children. METHODS: This scoping review adopted Arksey and O'Malley (2005)'s methodology and considered studies published between 2000 and 2021. RESULTS: Twenty-three published articles met the inclusion criteria. These articles highlighted a wide variation in the levels of malnutrition among African refugee/internally displaced (IDP) children, with the prevalence of chronic malnutrition (stunting) and acute malnutrition (wasting) ranging from 18.8 to 52.1% and 0.04 to 29.3%, respectively. Chronic malnutrition was of 'high' or 'very high' severity (according to recent WHO classifications) in 80% of studies, while acute malnutrition was of 'high' or 'very high' severity in 50% of studies. In addition, anemia prevalence was higher than the 40% level considered to indicate a severe public health problem in 80% of the studies reviewed. CONCLUSION: In many settings, acute, chronic, and micronutrient malnutrition are at levels of great concern. Many countries hosting large, displaced populations are not represented in the literature, and research among older children is also lacking. Qualitative and intervention-focused research are urgently needed.

Thai novice nurses' lived experiences and perspectives of breastfeeding and human milk in the Neonatal Intensive Care Unit (NICU).

BACKGROUND: Breastfeeding and human milk have well-documented health benefits for newborn infants, particularly those who are sick. However, breastfeeding rates and human milk feeding among infants in neonatal intensive units (NICU) in Thailand are still low; thus, breastfeeding promotion and support are required for Thai mothers of premature infants. Newly graduated nurses can play a critical role within the healthcare support system and can have a significant impact on improving breastfeeding practices in the NICU. The objective of this study was to investigate the lived experiences and perspectives of Thai novice nurses on supporting breastfeeding and human milk feeding in the NICU. METHODS: The study was conducted between March 2021 and May 2022 at three medical centers in the central region of Thailand. This study employed a descriptive phenomenological approach to explore Thai novice nurses' experiences and perspectives on breastfeeding. Purposive sampling was used to invite Thai novice nurses who have work experience in providing breastfeeding support to NICU mothers and their infants to participate in online interviews using a video conference platform (Zoom). Semi-structured questions were used to interview study participants in their native language. Data were analyzed using Colaizzi's method of data analysis to identify emergent themes. Member checks, peer debriefing, and self-reflection were applied to ensure the validity and trustworthiness of the study results. Back-translation was also used as a quality and accuracy assurance. RESULTS: A total of thirteen novice nurses agreed to participate in the study. All were female, and their ages ranged from 21 to 24 years old at the time of the interview. The researchers identified five major themes related to the overall study objectives and research questions. They are: positive attitude toward breastfeeding and human milk, facing breastfeeding challenges at work, self-confidence rooted in experience, professional skill needs, and requiring further support. CONCLUSIONS: Our results suggest that breastfeeding education plays a vital role in encouraging new nurses to provide breastfeeding support to mothers of preterm infants. Establishing breastfeeding support training and innovative learning strategies can be crucial in developing appropriate breastfeeding practice guidelines and policies to support Thai breastfeeding mothers in the NICU.

Effects of Food-Based Approaches on Vitamin A Status of Women and Children: A Systematic Review.

Vitamin A deficiency (VAD) increases risk for morbidity and mortality. Food-based approaches offer one strategy to improve vitamin A status. This systematic review assessed evidence of the effects of food-based approaches on the vitamin A status of women and children under 5 y. VAD was defined as clinical ocular symptoms, such as loss of vision, and/or retinol plasma or serum concentration <0.70 µmol/L. Searches on food-based approaches to improve vitamin A status were conducted for the period 2011-2022 on PubMed, CINHAL, Web of Science, and Google Scholar using PRISMA guidelines. English-language publications were included. Case studies, unpublished dissertations, and non-peer-reviewed studies were excluded. This review comprises 24 of 27,322 identified studies; 23 included studies focused on provitamin A carotenoids. There were 17,214 participants across the 24 studies with sample sizes ranging from 8 to 3571 individuals. Intervention studies spanned from 3 wk to 2 y. Fifteen (63%) studies were randomized control trials, 7 were cross-sectional, and 2 were longitudinal studies. Most studies (N = 21) used biochemical measurements, for example, serum retinol, to assess vitamin A status; other studies used clinical symptoms (for example, xerophtalmia) or dietary intake. Thirteen (54%) studies reported a statistically significant effect of food-based interventions (N = 8) or an association of diet (N = 5) on vitamin A status. This systematic review indicated that some food-based interventions improved vitamin A status, thus offering a safe and effective delivery mechanism for vitamin A. There appeared to be significant association between vitamin A status and consumption of foods with high concentrations of preformed vitamin A and provitamin A carotenoids. Differences across studies in regard to the period of evaluation, food approaches used, and statistical power may explain the lack of effectiveness of food-based approaches on vitamin A status in some studies.

Building on Community Research Partnerships and Training Students in a Multi-Phase Community-Based Participatory Research Study With Young Women of Cambodian Heritage in Massachusetts.

Refugees bring significant economic and cultural benefits to communities and yet face elevated risk of chronic disease and barriers to good health in the U.S. Community-based participatory research (CBPR) can benefit refugee communities and provide training/mentoring opportunities for students. The Cambodian Women's Health Study was a four-phase, multi-year CBPR university-community collaboration with the Massachusetts Cambodian community that focused on health, nutrition, pregnancy, and food security among primarily young women of Cambodian heritage ages 15-30 years old. Phase 1 was a focus group discussion (FGD, n = 4) and cross-sectional survey (n = 56) with pregnant women. Phase 2 was a cross-sectional survey (n = 107) with nonpregnant women. Phase 3 was a series of FGD (seven FGD, n = 38) with women. Phase 4 was a student-led translational nutrition intervention (three classes) with women (n = 11) and men (n = 10). The study design included compensation and support for the community partner and included structured mentoring of students (six graduates, eight undergraduates) in CBPR methods, adult learning, and cultural humility. Benefits to the community agency included enhanced research capacity, including supervising student research assistants, and robust compensation. Benefits to students included intensive mentoring and training. Successes included cost-effectiveness and strong recruitment and experiences with participants. Challenges included issues with student-led recruitment and organization that required additional mentoring and reflection. To work toward socially just and equitable research and interventions, CBPR collaborative efforts should include intentional meaningful compensation and community capacity-building as well as structured mentoring and training for student researchers and should build on existing work and relationships within communities.

Breastfeeding Duration Is Inversely Associated with Postpartum Allostatic Load: A Possible Mechanism for Improved Maternal Health.

Background: Allostatic load, a multisystem composite measure of chronic stress reflecting the cumulative wear and tear on the body, has utility in explaining maternal and child health disparities and predicting future health when measured during the peripartum period. Research using cross-sectional data has demonstrated an inverse association between concurrent breastfeeding status and maternal postpartum allostatic load. However, the relationship between breastfeeding duration and postpartum allostatic load has not been determined. Objective: This study aimed to examine the association between breastfeeding duration and postpartum allostatic load using prospective data, and to compare the association by race/ethnicity to better understand etiologies of health inequities. Materials and Methods: A secondary analysis of a data sample of 1,791 postpartum women from the Community Child Health Research Network was conducted. Multiple linear regression tested the association between and breastfeeding duration and allostatic load (range 0-10, calculated from 10 biomarkers) at 6 and 12 months postpartum, adjusting for race/ethnicity, maternal age, education, poverty level, study center, smoking, marital status, and prepregnancy body mass index. Stratified analyses examined differences in associations by race/ethnicity. Results: Breastfeeding duration was inversely associated with maternal allostatic load. In adjusted models, mothers who breastfed ≥6 months had 0.41 points lower allostatic load at 6 months (95% CI: -0.71 to -0.11) and 0.36 points lower allostatic load at 12 months postpartum (95% CI: -0.69 to -0.036) compared with mothers who never breastfed. Effect sizes varied in strength and significance across race/ethnic groups. Conclusions: Study findings suggest that extended breastfeeding for at least 6 months is linked with reduced chronic stress load in mothers during the first year postpartum. The inconsistency of findings across race/ethnic groups signals the importance of adjusting for prepregnancy allostatic load in future studies.

New Moms Wellness Study: the randomized controlled trial study protocol for an intervention study to increase fruit and vegetable intake and lower breast cancer risk through weekly counseling and supplemental fruit and vegetable box delivery in breastfeeding women.

BACKGROUND: Laboratory studies indicate that chemicals in fruits and vegetables have anti-carcinogenic and anti-inflammatory activities that can lower breast cancer risk. However, epidemiologic studies of the association between fruit and vegetable intake and breast cancer risk have produced mixed results. Measurement error, confounding, and an emphasis on diet in later adulthood may contribute to weak associations. This paper describes a randomized controlled diet intervention trial in breastfeeding women to examine the effect of high fruit and vegetable intake on breast cancer risk factors, including weight, DNA methylation and inflammatory markers. METHODS: Eligible breastfeeding women who reside within a 35-mile radius of Amherst, MA are enrolled at five to six weeks postpartum and randomly assigned to a Fruit and Vegetable Intervention Arm (target n = 200) or to a USDA MyPlate Control Arm (target n = 200). The Fruit and Vegetable Intervention group receives weekly telephone or video-based counseling to encourage intake of at least eight to ten daily servings of fruits and vegetables and a weekly delivery of a supplemental box of fruits and vegetables for 20 weeks, and less intensive counseling for up to one year. Breastmilk and infant fecal specimens are collected at baseline, 10 and 20 weeks. Anthropometric measurements are obtained at these timepoints and at the 1-year follow-up. The primary outcomes are change in DNA methylation in breast epithelial cells and change in inflammatory markers in breastmilk from randomization to 20 weeks; and change in weight, waist circumference, and fruit and vegetable intake for the period from randomization to 20 weeks and 1 year. DISCUSSION: This 1-year randomized diet intervention trial in breastfeeding women will assess whether intake of at least eight to ten daily servings of fruits and vegetables per day improves biomarkers of breast cancer risk directly in the breast (i.e., DNA methylation and inflammatory markers) and helps women maintain a healthy weight. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04374747. Registered May 5, 2020. https://www. CLINICALTRIALS: gov/ct2/show/NCT04374747 .

The prevalence of overweight/obesity and its association with household food insecurity among women living with HIV in rural Eswatini.

BACKGROUND: Eswatini is currently afflicted by an extremely high prevalence of HIV (27%) and malnutrition (both under-and over-nutrition). While rates of overweight/obesity in the general adult population have been documented, data on overweight/obesity and associated risk factors among women living with HIV (WLHIV) in Eswatini is limited. This study examines the prevalence of overweight/obesity and associated risk factors, with an emphasis on clarifying the association between household food insecurity and overweight/obesity for WLHIV in rural Eswatini. METHODS: This cross-sectional study was conducted among WLHIV (n = 166) in rural communities of Eswatini. Data were collected using an interviewer-administered survey questionnaire between October and November, 2017. Body Mass Index (BMI) was calculated to determine overweight and obesity among study participants. Women with BMI values of 25 kg/m2 or greater were classified as being overweight/obese. Multivariable log-binomial regression models were used to examine associations between household food insecurity and overweight/obesity in our study. RESULTS: Nearly a third (32.5%) of the women in our study were overweight and almost a quarter were obese (22.9%). We found significant associations between household food insecurity and overweight/obesity, with women who experienced household food insecurity the most being 0.38 times less likely to be overweight/obese compared to those who experienced household food insecurity the least (ARR: 0.38, 95% CI: 0.2-0.71). In our study sample, women who perceived themselves as being in poor health were less likely to be overweight/obese compared to those who perceived themselves as being in good health (ARR: 0.58, 95% CI: 0.39-0.86). We found significant associations between overweight/obesity and alcohol use, with the risk of overweight/obesity nearly 1.5 times higher among women who consumed alcohol compared to those who did not (ARR: 1.49, 95% CI: 1.07-2.05). CONCLUSIONS: The high prevalence of overweight/obesity among food insecure women in poverty stricken communities may pose significant challenges for nutritional health and HIV management. With an increasing prevalence of overweight/obesity in food insecure households, there is a need to re-evaluate current strategies and develop multi-level targeted interventions that include prevention of excessive weight gain among women, particularly those living with HIV in rural Eswatini. HIV programs could include screening to identify individuals at risk for overweight/obesity in this population, and provide nutrition education for weight management for those individuals.

Predictors of vitamin A rich food consumption among women living in households growing orange-fleshed sweetpotatoes in selected regions in Uganda.

Objective: Vitamin A deficiency (VAD) has serious public health consequences including morbidity and mortality for populations in low and middle-income countries (LMICs), especially for children under 5 years and pregnant women. LMICs are at greater risk of VAD, in part due to low levels of consumption of vitamin A-rich foods most of which are plant-based, such as orange-fleshed sweet potatoes (OFSP), with lower bioavailability than animal sources of the vitamin A. Food-based approaches such as biofortification of OFSP, including promoting the consumption of vitamin A-rich biofortified staple crops, has been shown to be potentially effective in improving the status of vitamin A and other micronutrients. This study examined vitamin A-rich food consumption and its predictors among women of reproductive age from OFSP-growing households in two regions of Uganda. Methods: A cross-sectional survey was conducted among 617 OFSP growing households, focusing on women in the reproductive age group from the northern and eastern regions of Uganda. Households were not receiving any VAD-related intervention at the time of the survey. Quantitative data included vitamin A-rich food consumption, knowledge on vitamin A, and rich food sources dietary intake, using a 7-day food frequency questionnaire. Vitamin A consumption and risk of deficiency were estimated using the Hellen Keller International guide. Results: The majority of women in this study were either pregnant (80%) or lactating (17%). More than 70% of the study population had a weighted vitamin A rich food consumption mean score of <6 days per week, indicating a high risk of VAD. Knowledge about vitamin A [b (SE) = -0.18 (0.50), p < 0.001] was significantly and inversely associated with vitamin A rich food consumption. Conclusion: Components of food insecurity such as availability, affordability, utilization, and changing food preferences may contribute to the unexpected inverse relationship between knowledge and consumption of vitamin A rich foods. Scaling up biofortified food initiatives, including OFSP, can improve consumption of vitamin A rich foods with effective strategies to comprehensively address consumption barriers such as lack of nutrition education, cooking skills, and storage facilities, as well as low production levels and perceived contamination of biofortified foods.

Rural-urban disparities in the nutritional status of younger adolescents in Tanzania.

Research on geographic differences in health focuses largely on children less than five years; little is known about adolescents-and even less regarding younger adolescents-a vulnerable group at a critical stage of the life course. Africa's rapid population growth and urbanization rates, coupled with stagnant rates of undernutrition, further indicate the need for country-specific data on rural-urban health disparities to inform development policies. This study examined rural-urban disparities in body mass index-for-age-and-sex (BAZ) and height-for-age-and-sex z-scores (HAZ) among younger adolescents in Tanzania. Participants were randomly selected adolescents aged 10-14 years (N = 1,125) residing in Kilosa (rural) and Moshi (urban) districts of Tanzania. Individual and household-level data were collected using surveys and anthropometric data was collected on all adolescents. Age, sex, household living conditions, and assets were self-reported. BAZ and HAZ were calculated using the WHO reference guide. The prevalence of undernutrition was 10.9% among rural and 5.1% among urban adolescents (p<0.001). Similarly, stunting prevalence was greater in rural (64.5%) than urban (3.1%) adolescents (p<0.001). After adjusting for covariates, rural residence was significantly and inversely associated with BAZ (B = -0.29, 95% CI: -0.52, -0.70, p = 0.01), as well as with HAZ (B = -1.79, 95% CI: -2.03, -1.54, p<0.001). Self-identified males had lower BAZ (B = -0.23, 95% CI: -0.34, -0.11, p<0.001) and HAZ (B = -0.22, 95% CI: -0.35, -0.09, p = 0.001) than self-identified female adolescents. Rural-urban disparities in nutritional status were significant and gendered. Findings confirm place of residence as a key determinant of BAZ and HAZ among younger adolescents in Tanzania. Targeted gender-sensitive interventions are needed to limit growth faltering and improve health outcomes in rural settings.

Breastfeeding Is Inversely Associated with Allostatic Load in Postpartum Women: Cross-Sectional Data from Nationally Representative US Women.

BACKGROUND: The postpartum period is a critical transition period when exposures to protective factors such as breastfeeding can have long-lasting health impact. Studies have suggested downregulating effects of breastfeeding on stress biomarkers such as cortisol but have not explored the way breastfeeding interacts with allostatic load, a multisystem indicator of chronic stress. OBJECTIVE: We aimed to examine the association between breastfeeding and maternal allostatic load among women within 2 y postpartum using nationally representative data. METHODS: A cross-sectional analysis of 10 waves of data from the NHANES (1999-2018) was conducted in a sample of 1302 women aged ≥18 y who provided information on breastfeeding through the reproductive health questionnaire. Clinical and empirical allostatic load scores (range: 0-10; higher numbers associated with increased risk) were derived for each participant based on 10 biomarkers reflecting metabolic, cardiovascular, and immune health. Multiple linear regression tested associations between breastfeeding and allostatic load, adjusting for maternal age, race and ethnicity, education, poverty level, and survey wave. RESULTS: Breastfeeding had a significant inverse association with allostatic load in unadjusted and adjusted models. Controlling for age, race and ethnicity, education, poverty level, and survey wave, breastfeeding women had a 0.36-point lower clinical allostatic load score than nonbreastfeeding women (ß = -0.36, SE = 0.11; 95% CI: -0.59, -0.14; P = 0.002) and a 0.44-point lower empirical allostatic load score (ß = -0.44, SE = 0.15; 95% CI: -0.74, -0.14; P = 0.005). CONCLUSIONS: Our study suggests that breastfeeding is protective of maternal stress and provides a more comprehensive picture of breastfeeding's influence on multiple body systems, exemplifying physiological benefits beyond effects on single biomarkers. However, limitations of cross-sectional data and non-classification of breastfeeding duration, mode, and intensity should be considered when interpreting these findings, and further research to address the role of breastfeeding and allostatic load is needed.

A quantitative analysis of food insecurity and other barriers associated with ART nonadherence among women in rural communities of Eswatini.

BACKGROUND: Eswatini has the highest global prevalence of HIV despite decades of universal access to free antiretroviral therapy (ART). We conducted a mixed methods study to investigate barriers to ART adherence among women living with HIV (WLHIV) in rural communities of Eswatini. Qualitative findings were reported in our previous publication. This subsequent paper expands on our qualitative analysis to examine the magnitude to which identified barriers impacted ART adherence among WLHIV in the same communities. METHODS: We used an exploratory sequential design to collect data from WLHIV (n = 166) in rural Eswatini. Quantitative data were collected using interviewer-administered survey questionnaires between October and November 2017. ART adherence was measured using the CASE Adherence Index, with scores less than 10 indicating nonadherence. Log-binomial regression models were used to examine the extent to which critical barriers affected ART adherence among study participants. RESULTS: A majority of the women in our study (56%) were nonadherent to ART. Of the barriers identified in our prior qualitative analysis, only eight were found to be significantly associated with ART nonadherence in our quantitative analysis. These include, with adjusted risk ratios (ARR) and 95% confidence intervals (95% CI): household food insecurity (ARR: 3.16, 95% CI: 1.33-7.52), maltreatment by clinic staff (ARR: 2.67, 95% CI: 1.94-3.66), forgetfulness (ARR: 1.80, 95% CI: 1.41-2.31), stress (ARR: 1.47, 95% CI: 1.14-1.88), gossip (ARR: 1.57, 95% CI: 1.21-2.04), mode of transport (ARR: 0.59, 95% CI: 0.44-0.79), age (ARR: 0.98, 95% CI: 0.97-0.99), and lack of community support (ARR: 0.55, 95% CI: 0.35-0.85). CONCLUSIONS: Among numerous barriers identified in our study, food insecurity was found to be a significant contributor toward ART nonadherence among women living with HIV in rural Eswatini. Future strategies aimed at improving ART adherence in Eswatini should include programs which provide food and nutrition support for people living with HIV, particularly rural women living in poverty.

Traditional plant use during lactation and postpartum recovery: Infant development and maternal health roles.

ETHNOPHARMACOLOGICAL RELEVANCE: Evidence of phytochemical roles in infant development and maternal recovery offers insights into beneficial functions of traditional plant use during lactation and the postpartum period. Ethnopharmacological research has relevance to global priorities on maternal and child health, to understanding origins and determinants of human self-medication, and for reconciling traditional postpartum practices and mainstream healthcare. AIM OF THE STUDY: Present emerging evidence, within evolutionary and socio-cultural contexts, on the role of maternal consumption on transfer of phytochemicals into breast milk with impacts on maternal and child health, and on infant development. Establish current state of knowledge and an ethnopharmacological research agenda that is attentive to cross-cultural and regional differences in postpartum plant use. MATERIALS AND METHODS: An extensive literature review using Medline, Scopus, and Web of Science focused on traditional and contemporary use and socio-cultural context, as well as physiological, pharmacological, toxicological, and behavioral activities of plants used medicinally by women during postpartum recovery and lactation. RESULTS: The most widely reported postpartum plants show antimicrobial, anti-inflammatory, immunological, and neurophysiological activities, with low toxicity. Phytochemicals transfer from maternal consumption into breast milk in physiological concentrations, while animal studies demonstrate immunomodulation and other actions of medicinal plants during lactation. Reporting on the use and diverse traditional knowledge of women about plants during the postpartum period is obscured by the marginal place of obstetric issues and by gender biases in ethnobotanical research. In many contemporary contexts use is prejudiced by precautionary risk warnings in health literature and practice that confound lactation with pregnancy. CONCLUSIONS: Although systematic investigation of postpartum plant use is lacking, known pharmacological activities support potential benefits on infant development and maternal health with immediate and long-term consequences in relation to allergic, inflammatory, autoimmune, and other diseases. An ethnopharmacological agenda focused on the perinatal period requires directed methodologies and a regional approach in relation to culturally-specific knowledge and practices, traditional plant use, and local health needs. Testing the hypothesis that phytochemicals transferred from medicinal plants into breast milk impact the human immune system and other aspects of infant development requires extended analysis of phytochemicals in human milk and infant lumen and plasma, as well as effects on gastrointestinal and milk microbiome.

A Scoping Review of the Health of African Immigrant and Refugee Children.

Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.

Global survey of medicinal plants during lactation and postpartum recovery: Evolutionary perspectives and contemporary health implications.

ETHNOPHARMACOLOGICAL RELEVANCE: Cross-cultural comparison of plants used during lactation and the postpartum period offers insight into a largely overlooked area of ethnopharmacological research. Potential roles of phytochemicals in emerging models of interaction among immunity, inflammation, microbiome and nervous system effects on perinatal development have relevance for the life-long health of individuals and of populations in both traditional and contemporary contexts. AIM OF THE STUDY: Delineate and interpret patterns of traditional and contemporary global use of medicinal plants ingested by mothers during the postpartum period relative to phytochemical activity on immune development and gastrointestinal microbiome of breastfed infants, and on maternal health. MATERIALS AND METHODS: Published reviews and surveys on galactagogues and postpartum recovery practices plus ethnobotanical studies from around the world were used to identify and rank plants, and ascertain regional use patterns. Scientific literature for 20 most-cited plants based on frequency of publication was assessed for antimicrobial, antioxidant, anti-inflammatory, immunomodulatory, antidepressant, analgesic, galactagogic and safety properties. RESULTS: From compilation of 4418 use reports related to 1948 species, 105 plant taxa were recorded ≥7 times, with the most frequently cited species, Foeniculum vulgare, Trigonella foenum-graecum, Pimpinella anisum, Euphorbia hirta and Asparagus racemosus, 81, 64, 42, 40 and 38 times, respectively. Species and use vary globally, illustrated by the pattern of aromatic plants of culinary importance versus latex-producing plants utilized in North Africa/Middle East and Sub-Saharan Africa with opposing predominance. For 18/20 of the plants a risk/benefit perspective supports assessment that positive immunomodulation and related potential exceed any safety concerns. Published evidence does not support a lactation-enhancing effect for nearly all the most-cited plants while antidepressant data for the majority of plants are predominately limited to animal studies. CONCLUSIONS: Within a biocultural context traditional postpartum plant use serves adaptive functions for the mother-infant dyad and contributes phytochemicals absent in most contemporary diets and patterns of ingestion, with potential impacts on allergic, inflammatory and other conditions. Polyphenolics and other phytochemicals are widely immunologically active, present in breast milk and predominately non-toxic. Systematic analysis of phytochemicals in human milk, infant lumen and plasma, and immunomodulatory studies that differentiate maternal ingestion during lactation from pregnancy, are needed. Potential herb-drug interaction and other adverse effects should remain central to obstetric advising, but unless a plant is specifically shown as harmful, considering potential contributions to health of individuals and populations, blanket advisories against postpartum herbal use during lactation appear empirically unwarranted.

Individual, household, and community level barriers to ART adherence among women in rural Eswatini.

BACKGROUND: Despite access to free antiretroviral therapy (ART) for all people living with human immunodeficiency virus (HIV), noncompliance to treatment continues to be a significant challenge in Eswatini. Yet studies investigating barriers to ART adherence in Eswatini are scarce. Most notably, there is a lack of research regarding rural women in Eswatini, who are currently the country's most vulnerable to HIV infection. Therefore, the objective of the study is to investigate individual, household, and community level barriers to ART adherence among rural women living with HIV. METHODS: We conducted a qualitative study to investigate individual, household, and community level barriers to ART adherence. We conducted focus group discussions with HIV-infected women (n = 4) from rural villages in Eswatini, and in-depth interviews with healthcare workers (n = 8) serving the area clinics. Open and axial coding techniques were used for data analysis and interpreted within a social ecological framework. RESULTS: Our findings revealed several individual level barriers including hunger, side effects of ART, personal stress, lack of disclosure of HIV status, alcohol use, and forgetting to take ART. Lack of food, unemployment and scarcity of financial resources were identified as critical barriers at the household level. Community and institutional barriers encompassed factors related to health delivery such as lack of privacy, travel time, transportation costs, excessive alcohol use by healthcare workers, maltreatment, public and self-stigma, gossip, and long waits at clinics. CONCLUSIONS: Rural women living with HIV face multilevel barriers to ART adherence. Support programs aimed at increasing ART adherence among this vulnerable population need to develop targeted polices to alleviate challenges rural women face, beginning with expanding qualifications for food assistance programs.

A Systematic Review of Mobile Produce Markets: Facilitators and Barriers to Use, and Associations with Reported Fruit and Vegetable Intake.

BACKGROUND: Diet-related chronic diseases are a major public health burden. There is growing awareness that disparities in healthful food access contribute to disparities in health. Mobile produce markets (MPMs) have emerged as a strategy to improve fruit and vegetable access and consumption, particularly among low-income, minority, and other vulnerable populations (eg, older adults and children) in food desert neighborhoods. OBJECTIVE: This review examined research on MPMs in the United States and specifically aimed to assess the relationship between MPM use and fruit and/or vegetable intake, and facilitators and barriers related to MPM use within a social ecological framework. METHODS: A systematic review of the literature consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted. Articles published through December 2017 were identified using the following databases: Web of Science, PubMed, Agricola, and CAB Abstracts. MPM studies published in English and in peer-reviewed journals were eligible for inclusion if they were based on primary research of MPMs in the United States, included results, and if MPMs were analyzed separately from other market venues and sold predominantly fruits and/or vegetables. A total of 24 studies were identified for inclusion, which varied in study types as follows: quantitative (n=15), qualitative (n=3), and mixed methods (n=6). RESULTS: An association was found between MPM use and higher reported fruit and/or vegetable intake, although existing studies that measured fruit and vegetable intake were not rigorous in study design (eg, lack of control group, use of convenience sample, small sample size). MPM location was the most commonly cited facilitator of MPM use. Other institutional factors (eg, nutrition education), as well as policy factors (eg, food-assistance programs), community factors (eg, market site liaisons), interpersonal factors (eg, socializing at market), and intrapersonal factors (eg, awareness of the benefits of fruit and/or vegetable intake) were identified. CONCLUSIONS: MPMs offer a promising strategy to improve access to fruits and vegetables and may further support healthful-food purchasing and consumption through food-assistance incentives and enticements for consumers (eg, opportunities for social networking and nutrition education). Future research on MPMs would benefit from more rigorous experimental designs, such as including a control group, and examining multiple levels within a social ecological framework.

Dietary Intervention to Increase Fruit and Vegetable Consumption in Breastfeeding Women: A Pilot Randomized Trial Measuring Inflammatory Markers in Breast Milk.

BACKGROUND: Diets rich in fruits and vegetables (F/V) can reduce the inflammatory profile of circulating cytokines and potentially decrease the risk of breast cancer. However, the extent to which a diet rich in F/V alters cytokine levels in breast tissue remains largely unknown. Breast milk provides a means of assessing concentrations of secreted cytokines in the breast microenvironment and is a potential tool for studying the effects of diet on inflammation in breast tissue and breast cancer risk. OBJECTIVE: The aim of this pilot randomized trial was to test the feasibility of increasing F/V intake in breastfeeding women and of measuring changes in markers of inflammation in breast milk. DESIGN AND INTERVENTION: Participants randomized to the intervention (n=5) were provided weekly boxes of F/V, along with dietary counseling, to increase consumption of F/V to 8 to 10 daily servings for 12 consecutive weeks. Controls (n=5) were directed to the US Department of Agriculture's "ChooseMyPlate" diet for pregnancy and breastfeeding. PARTICIPANTS/SETTING: Ten breastfeeding women consuming fewer than five servings of F/V per day, as estimated by the National Institutes of Health "All-Day" Fruit and Vegetable Screener (F/V Screener), were recruited through flyers and a lactation consultant between February and May 2016 in the Western Massachusetts area. MAIN OUTCOME MEASURES: Baseline demographic and F/V intake data were collected during enrollment. At week 1 and week 13 (final) home visits, participants provided milk samples and anthropometric measurements were recorded. Participants completed F/V screeners at baseline and at study end. Adiponectin, leptin, C-reactive protein, and 11 additional cytokines were measured in breast milk collected at weeks 1 and 13. STATISTICAL ANALYSES: F/V consumption at baseline and after the final visit, and between controls and intervention groups, was compared with dependent and independent t tests, respectively. Differences between cytokine levels at weeks 1 and 13 were assessed with a mixed-effects repeated-measures model. RESULTS: All women in the intervention increased F/V intake and were consuming more servings than controls by week 13; daily serving of F/V at baseline and final visit: controls=1.6 and 2.0, diet=2.6 and 9.9. Most cytokines were detected in the majority of milk samples: 12 were detected in 90% to 100% of samples, one was detected in 75% of samples, and one was detected in 7.5% of samples; coefficients of variation were below 14% for 11 of the cytokines. CONCLUSIONS: These preliminary findings indicate that it is feasible to significantly increase F/V intake in breastfeeding women and provide support for conducting a larger diet intervention study in breastfeeding women, in which longer-term benefits of the intervention are assessed.

Barriers to Exclusive Breastfeeding Among Women With Gestational Diabetes Mellitus in the United States.

OBJECTIVE: To identify differences in breastfeeding-related knowledge, attitudes, beliefs, and experiences between women with gestational diabetes mellitus (GDM) and women without GDM. DESIGN: Cross-sectional and prospective cohort study. SETTING: Secondary analysis of data from the U.S. Infant Feeding Practices Study II. PARTICIPANTS: Pregnant women with GDM (n = 195) and pregnant women without GDM (n = 2,815) were included in cross-sectional analyses. For prospective analyses, complete data were available at the postpartum time point for 107 women with and 1,626 women without GDM. METHODS: We compared women with and without GDM for breastfeeding knowledge, attitudes, and beliefs during pregnancy and hospital experiences and problems with breastfeeding after birth. We used multivariate logistic regression to estimate associations between GDM and dependent variables. RESULTS: Women with GDM were less likely to say that breastfeeding is the best way to feed an infant (adjusted odds ratio [aOR] = 0.62, 95% confidence interval [CI] [0.46, 0.85]), more likely to say that the fathers of their infants prefer formula feeding (aOR = 1.74, 95% CI [1.02, 2.97]) or mixed feeding (aOR = 1.78, 95% CI [1.21, 2.61]), and more likely to say their physicians prefer formula (aOR = 2.82, 95% CI [1.17, 6.79]). Women with GDM were less likely to report feeling comfortable breastfeeding in front of female friends (aOR = 0.70, 95% CI [0.50, 0.98]). Newborns of women with GDM were less likely to stay in their mothers' hospital rooms (aOR = 0.55, 95% CI [0.36, 0.85]). CONCLUSION: We identified differences in breastfeeding-related knowledge, attitudes, beliefs, and experiences between women with GDM and women without GDM that could be targets for further research and intervention.

Mobile produce market influences access to fruits and vegetables in an urban environment.

OBJECTIVE: To assess the influence of a mobile produce market (MPM) on fruit and vegetable access. DESIGN: Novel application of a structured assessment (five dimensions of access framework) to examine fruit and vegetable access through self-administered surveys on shopping behaviours, and perceptions and experiences of shopping at the MPM. SETTING: Low-income neighbourhoods with limited access to fruits and vegetables. SUBJECTS: Older (≥60 years) and younger (18-59·9 years) shoppers. RESULTS: Participants were more likely to be women and non-White, one-third lived alone and nearly half were older adults. Compared with younger, older participants had different shopping behaviours: tended to purchase food for one person (P < 0·001), be long-term shoppers (P=0·002) and use electronic benefit transfer (EBT) cards (P=0·012). Older adults were more likely to like the market location (P=0·03), while younger adults were more likely to want changes in location (P=0·04), more activities (P=0·04), taste sampling (P=0·05) and nutritional counselling (P=0·01). The MPM captured all dimensions of access: availability, indicated by satisfaction with the produce variety for nearly one-third of all participants; accessibility, indicated by participants travelling <1 mile (<1·6 km; 72·2 %) and appreciation of location (72·7 %); affordability, indicated by satisfaction with price (47·6 %); acceptability, indicated by appreciation of produce quality (46·2 %); and accommodation, indicated by satisfaction with safety of location (30·1 %) and high EBT use among older adults (41·8 %). CONCLUSIONS: MPM may influence fruit and vegetable access in low-income urban neighbourhoods by facilitating the five dimensions of access and may especially benefit older adults and individuals living alone.