Explore the vast range of titles available.

Micronutrients are essential to sustain life and for optimal physiological function. Widespread global micronutrient deficiencies (MNDs) exist, with pregnant women and their children under 5 years at the highest risk. Iron, iodine, folate, vitamin A, and zinc deficiencies are the most widespread MNDs, and all these MNDs are common contributors to poor growth, intellectual impairments, perinatal complications, and increased risk of morbidity and mortality. Iron deficiency is the most common MND worldwide and leads to microcytic anemia, decreased capacity for work, as well as impaired immune and endocrine function. Iodine deficiency disorder is also widespread and results in goiter, mental retardation, or reduced cognitive function. Adequate zinc is necessary for optimal immune function, and deficiency is associated with an increased incidence of diarrhea and acute respiratory infections, major causes of death in those <5 years of age. Folic acid taken in early pregnancy can prevent neural tube defects. Folate is essential for DNA synthesis and repair, and deficiency results in macrocytic anemia. Vitamin A deficiency is the leading cause of blindness worldwide and also impairs immune function and cell differentiation. Single MNDs rarely occur alone; often, multiple MNDs coexist. The long-term consequences of MNDs are not only seen at the individual level but also have deleterious impacts on the economic development and human capital at the country level. Perhaps of greatest concern is the cycle of MNDs that persists over generations and the intergenerational consequences of MNDs that we are only beginning to understand. Prevention of MNDs is critical and traditionally has been accomplished through supplementation, fortification, and food-based approaches including diversification. It is widely accepted that intervention in the first 1,000 days is critical to break the cycle of malnutrition; however, a coordinated, sustainable commitment to scaling up nutrition at the global level is still needed. Understanding the epidemiology of MNDs is critical to understand what intervention strategies will work best under different conditions.

Key Points Micronutrient deficiencies during pregnancy are a global public health concern, yet the full extent of their burden and health consequences are unclear due to infrequent and inadequate assessment Micronutrient deficiencies have been linked to compromised conception, length of gestation, and fetal development and growth, which can lead to pregnancy loss, preterm delivery, small birth size, birth defects and long-term metabolic disturbances Antenatal supplementation with multiple micronutrients can improve birth outcomes and merits policy and program consideration in low-income settings Preconception and periconception intervention research is needed to further assess the full public health effect of micronutrient adequacy on pregnancy outcomes Vitamin and mineral deficiencies during pregnancy can have a major effect on neonatal development. In this Review, Gernand and colleagues discuss the evidence supporting the need for micronutrient supplementation and how it can benefit pregnancy, especially in low-income settings. Micronutrients, vitamins and minerals accessible from the diet, are essential for biologic activity. Micronutrient status varies widely throughout pregnancy and across populations. Women in low-income countries often enter pregnancy malnourished, and the demands of gestation can exacerbate micronutrient deficiencies with health consequences for the fetus. Examples of efficacious single micronutrient interventions include folic acid to prevent neural tube defects, iodine to prevent cretinism, zinc to reduce risk of preterm birth, and iron to reduce the risk of low birth weight. Folic acid and vitamin D might also increase birth weight. While extensive mechanistic and association research links multiple antenatal micronutrients with plausible materno–fetal health advantages, hypothesized benefits have often been absent, minimal or unexpected in trials. These findings suggest a role for population context in determining health responses and filling extensive gaps in knowledge. Multiple micronutrient supplements reduce the risks of being born with low birth weight, small for gestational age or stillborn in undernourished settings, and justify micronutrient interventions with antenatal care. Measurable health effects of gestational micronutrient exposure might persist into childhood but few data exists on potential long-term benefits. In this Review, we discuss micronutrient intake recommendations, risks and consequences of deficiencies, and the effects of interventions with a particular emphasis on offspring.

Since October, 2023, Palestinian children in the Gaza Strip have suffered war-induced displacement, food insecurity, malnutrition, and elevated risks of famine and mortality. In this study, we aimed to document the extent of, and patterns in, wasting malnutrition in children aged 6–59 months across the Gaza Strip between January, 2024, and August, 2025. This longitudinal, cross-sectional, surveillance study was conducted across a total of 16 UN Relief and Works Agency for Palestine Refugees in the Near East health centres and 78 medical points established within school shelters and tent encampments across the five governorates of Gaza. Children aged 6–59 months were screened for wasting malnutrition by mid-upper arm circumference (MUAC) measurement. Children with a MUAC of less than 125 mm were enrolled into therapeutic feeding regimens. MUAC Z scores were derived from published WHO age-specific and sex-specific arm circumferential growth curves. Monthly prevalence of acute wasting (MUAC Z scores less than –2) and severe wasting (MUAC Z scores less than –3) were described by age, sex, type of screening facility, and governorate. Between Jan 1, 2024, and Aug 15, 2025, 265 974 measurements were obtained from 219 783 uniquely identified children, with two-thirds of children screened in Khan Younis and Middle Governorates. The monthly prevalence of acute wasting ranged from 5% (34 of 722 children) to 7% (794 of 10 907) between January and June, 2024. After approximately 4 months of severe aid restrictions between September, 2024, and mid-January, 2025, the prevalence of wasting increased from 8·8% (1601 of 18 225 children) to 14·3% (1661 of 11 619), with the highest prevalence observed in Rafah (32·2%; 95 of 295) and among children aged 24–59 months (21·0%; 1366 of 6518). After a 6-week ceasefire, marked by a substantial increase in the number of aid trucks entering through territory borders, by March, 2025, the prevalence of wasting had declined to 5·5% (831 of 15 165). However, after an 11-week blockade from March to May, 2025, and continued severely restricted entry of food, water, medicines, fuel, and other essentials thereafter, by early August, 2025, 15·8% (1213 of 7668) of screened children were acutely wasted, including 3·7% (280 of 7668) severely wasted, equating to more than 54 600 children in need of therapeutic care. After nearly 2 years of war and severe restrictions in humanitarian aid, tens of thousands of preschool-aged children in the Gaza Strip are suffering from preventable acute malnutrition and facing an increased risk of mortality. UN Relief and Works Agency for Palestine Refugees in the Near East.

Background Does preschool height predict adult stature in undernourished settings? The extent to which preschool length or height forecasts young adult stature is unclear in chronically undernourished populations. Methods In 2006-8, we assessed height in a cohort of 2074 young adults, aged 16–23 years, in rural Nepal who, as preschoolers ( ≤  4 year), were measured at baseline and again 16 months later during a vitamin A supplementation trial in 1989-91. We assessed by linear regression the ability of preschool length (L, measured < 24 mo) or height (Ht, 24–59 mo), at each year of age to predict 16–23 year old height, adjusted for month of young adult age, interval duration (in months), caste, preschool weight-for-height z-score and, in young women, time since menarche, marriage status and pregnancy history. Results Young women were a mean of 0.81, 1.11, 0.82, 0.24, 0.44 cm taller (all p  < 0.01) and young men, 0.84, 1.18, 0.74, 0.64 and 0.48 cm taller (all p  < 0.001) per cm of attained L/Ht at each successive preschool year of age and, overall, were 2.04 and 2.40 cm taller for each unit increase in preschool L/Ht z-score (L/HAZ) (both p  < 0.001). Coefficients were generally larger for 16-month follow-up measurements. The percent of young adult height attained by children with normal L/HAZ (>-1) increased from 38–40% mid-infancy to ∼ 69–74% by 6 years of age. By 3–6 years of age heights of stunted children (L/HAZ<-2) were consistently ∼ 4–7% lower in their young adult height versus normal statured children. There was no effect of preschool vitamin A receipt. Conclusions Shorter young children become shorter adults but predictive effects can vary by sex, age assessed, and may be influenced by year or season of measurement.

Background Early and exclusive breastfeeding may reduce neonatal and post-neonatal mortality in low-resource settings. However, prelacteal feeding (PLF), the practice of giving food or liquid before breastfeeding is established, is still a barrier to optimal breastfeeding practices in many South Asian countries. We used a prospective cohort study to assess the association between feeding non-breastmilk food or liquid in the first three days of life and infant size at 3–5 months of age. Methods The analysis used data from 3,332 mother-infant pairs enrolled in a randomized controlled trial in northwestern rural Bangladesh conducted from 2018 to 2019. Trained interviewers visited women in their households during pregnancy to collect sociodemographic data. Project staff were notified of a birth by telephone and interviewers visited the home within approximately three days and three months post-partum. At each visit, interviewers collected data on breastfeeding practices and anthropometric measures. Infant length and weight measurements were used to produce length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores. We used multiple linear regression to assess the association between anthropometric indices and PLF practices, controlling for household wealth, maternal age, weight, education, occupation, and infant age, sex, and neonatal sizes. Results The prevalence of PLF was 23%. Compared to infants who did not receive PLF, infants who received PLF may have a higher LAZ (Mean difference (MD) = 0.02 [95% CI: -0.04, 0.08]) score, a lower WLZ (MD=-0.06 [95% CI: -0.15, 0.03]) score, and a lower WAZ (MD=-0.02 [95% CI: -0.08, 0.05]) score at 3–5 months of age, but none of the differences were statistically significant. In the adjusted model, female sex, larger size during the neonatal period, higher maternal education, and wealthier households were associated with larger infant size. Conclusion PLF was a common practice in this setting. Although no association between PLF and infant growth was identified, we cannot ignore the potential harm posed by PLF. Future studies could assess infant size at an earlier time point, such as 1-month postpartum, or use longitudinal data to assess more subtle differences in growth trajectories with PLF. Trial registration ClinicalTrials.gov: NCT03683667 and NCT02909179.

Prelacteal feeding (PLF)—giving infants food or liquid other than breastmilk within the first 3 days of life—remains common and hinders optimal breastfeeding in Bangladesh. This study assessed changes in PLF practices in rural Bangladesh from 2004 to 2019 and examined associate household, maternal, and infant factors. We analyzed data from two cluster-randomized trials in rural northwest Bangladesh (n = 16,551; n = 4,401). Trained staff collected sociodemographic and birth data through household visits. We used multivariable logistic regression to examine associations between household, maternal, and infant characteristics and PLF and a non-linear approximation of the Oaxaca-Blinder regression decomposition to understand the factors associated with the changing prevalence of PLF. The prevalence of PLF declined from 89% in 2004 to 24% in 2019. Factors associated with PLF shifted over time, particularly household wealth, infant sex, and birth weight. Institutional delivery (OR=0.27; 95% CI 0.22, 0.32 in 2004; OR=0.78; 95% CI 0.61, 1.00 in 2019) and multigravida status (OR=0.68; 95% CI 0.58, 0.79 in 2004; OR=0.73; 95% CI 0.58, 0.93 in 2019) were consistently associated with reduced odds of PLF across cohorts in the multivariable analysis. The decomposition analysis based on the two trials indicated that changes in prevalence of the covariates explained 15% of the decrease in prevalence of PLF, primarily accounted for by increases in health facility deliveries (86%), increases in infant birth weight (13%), and increasing gravidity (12%). 85% of the change remains unexplained by the measured variables. The prevalence of PLF declined considerably in rural Bangladesh over the 15-year period. There are shifts in factors associated with PLF overtime. Improvements in socio-demographic factors played a modest but meaningful role in reducing PLF. However the majority of the reduction remains unexplained by the measured variables. Further research is needed to identify other potential drivers for changes in the prevalence of PLF.

The 2015 earthquake in Nepal caused massive damages and triggered relief activities to minimize human suffering. The post-earthquake nutrition and food security situation in the hardest hit areas remains uncertain. Two national cross-sectional surveys were conducted in 2014 and 2016 among households (HH) with pre-school aged children or newly married women. Of the 21 village development committees (VDCs) included in this sample, 7 fell within \"earthquake-affected\" areas. This paper presents data from 982 HH, 1015 women, and 883 children from 2014 and 1056 HH, 1083 women, and 998 children from 2016 living in these areas, with longitudinal overlap of about 55%. Prevalence estimates and 95% confidence intervals were calculated, and logistic regression was used to calculate p-values, both using robust estimates of standard errors to account for clustering. From 2014 to 2016, child wasting (weight-for-height z score <-2) fell from 4.5% (95% CI 3.3%- 6.1%) to 2.1% (1.4%- 3.1%) and food insecurity (assessed using the household food insecurity access scale) dropped from 17.6% (11.7%- 25.6%) to 12.4% (6.9%- 21.2%). Child stunting prevalence remained similar at both time-points. Improvements were also evident in dietary diversity and breastfeeding indicators. Nutrition and food security conditions remained comparable or improved one year after the earthquake despite evidence of structural and other damage. Livelihood resilience to shocks and/or effective nutrition, food or health interventions may have helped buffer the impact on nutrition, although this hypothesis requires further exploration.

Background Optimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring proper infant nutrition, growth and development. Methods We used data from a nationally representative survey in 21 district sites across the Mountains, Hills and Terai (southern plains) of Nepal in 2013. Determinants of early initiation of breastfeeding, feeding of colostrum, prelacteal feeding and predominant breastfeeding were explored in 1015 infants < 12 months of age. Prelacteal feeds were defined as food/drink other than breast milk given to newborns in first 3 days. Predominant breastfeeding was defined as a child < 6 months of age is mainly breastfed, not fed solid/semi-solid foods, infant formula or non-human milk, in the past 7 days. Adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated, using log Poisson regression models with robust variance for clustering. Results The prevalence of breastfeeding within an hour of birth, colostrum feeding, prelacteal feeding and predominant breastfeeding was 41.8, 83.5, 32.7 and 57.2% respectively. Compared to infants not fed prelacteal feeds, infants given prelacteal feeds were 51% less likely to be breastfed within the first hour of birth (APR 0.49; 95% CI 0.36, 0.66) and 55% less likely to be predominantly breastfed (APR 0.45; 95% CI 0.32, 0.62). Infants reported to have received colostrum were more likely to have begun breastfeeding within an hour of birth (APR 1.26; 95% CI 1.04, 1.54) compared to those who did not receive colostrum. Infants born to mothers ≥ 20 years of age were less likely than adolescent mothers to initiate breastfeeding within 1 hour of birth. Infants in the Terai were 10% less likely to have received colostrum (APR 0.90; 95% CI 0.83, 0.97) and 2.72 times more likely to have received prelacteal feeds (APR 2.72; 95% CI 1.67, 4.45) than those in the Mountains. Conclusions Most infants in Nepal receive colostrum but less than half initiate breastfeeding within an hour of birth and one-third are fed prelacteal feeds, which may negatively affect breastfeeding and health throughout early infancy.

Background/Objectives: Ready-to-use therapeutic foods (RUTFs) are a common treatment for children under five years diagnosed with acute malnutrition. However, traditional RUTFs are often not locally produced, and the costs of the RUTF can be a barrier to access in India and Pakistan. Our goal was to utilize linear programming (LP) to generate an RUTF formulation based on ingredients locally available in India and Pakistan. We also aim to evaluate the effectiveness of LP in generating such a recipe that is also nutrient-optimized to promote neurocognitive recovery. Methods: The RUTF recipe was generated by applying linear programming to a database of crop ingredients available in India, subject to nutritional constraints. The resulting formulation was produced and evaluated for nutrition content and shelf life. The efficacy of the LP tool was also evaluated based on the formulated product. Results: We demonstrate that the linear programming tool is largely accurate in predicting the true nutritional content of the formulation. Furthermore, the generated formulation, per 100 g, meets many global macronutrient standards for RUTFs while maintaining a predicted cost that is lower than that of industry-standard products. The conducted shelf-life study indicates the viability of the RUTF throughout an accelerated testing period. In addition, the satisfactory consideration of LA and ALA levels provides our RUTF with the potential to address concerns about low DHA levels, and thereby cognitive health, as compared to traditional RUTFs. Conclusions: We use linear programming to generate an affordable and fatty acid-optimized RUTF based on locally available ingredients. Therefore, this formulation holds immense potential to benefit communities in India and Pakistan facing high levels of child malnutrition.

Background/Objectives: Zinc deficiency remains a public health concern in South Asia but is rarely studied through gestation to infancy. Methods: We identified maternal and infant factors related to plasma zinc of 3 mo old Bangladeshi infants (n = 317) in the context of a trial of a daily antenatal to 3 mo postpartum multiple micronutrient supplementation (MMS) with 15 vitamins and minerals, including 12 mg zinc, versus iron–folic acid (IFA). Factors explored included maternal age, parity, and plasma zinc in early (pre-supplementation) and late pregnancy, at 3 months postpartum, and in milk; cord blood zinc (n = 83); birth outcomes; and infant feeding and biomarkers. Consequently, infant zinc was explored with 3 mo anthropometry and growth rates. Results: Mean ± SD infant plasma zinc was 15.63 ± 6.65 µmol/L, with 10.1% deficiency (<9.9 µmol/L). In adjusted analyses, infant zinc was positively associated with maternal age [20–30 years +0.11 µmol/L (p = 0.018) and ≥30 years +0.28 µmol/L (p = 0.003) relative to <20 years], maternal early pregnancy zinc (+0.01 µmol/L per 1 µmol/L maternal zinc, p = 0.011), and infant ferritin (+0.001 µmol/L per 1 µg/L, p = 0.007); conversely, infant zinc was −0.13 µmol/L lower (p = 0.013) with maternal parity ≥2 versus 0–1 and with partial versus exclusive breastfeeding (−0.15 µmol/L, p = 0.038). Relationships with MMS, maternal later pregnancy, postpartum, milk, and cord blood zinc were absent. Length-for-age (+0.02 per µmol/L, p = 0.047) but not weight-for-length Z-scores at 3 months were associated with infant zinc. Conclusions: Thus, infant zinc was associated with pre- but not post-MMS maternal zinc, age and parity, feeding style, and infant iron status. Infant length but not weight was associated with plasma zinc.