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11 papers

Nutrition as the Foundation of Human Capital: Pathways to Holistic Development.

Hassen DM. · Jul 1, 2026

Human capital is widely recognized as central to economic growth and social progress. However, commonly used development measurements often assess outcomes achieved in adolescence or adulthood. These approaches overlook the formative biological processes that shape lifelong capability. In line with this, this Perspective argues that maternal and early childhood nutrition, particularly during the first 1000 days, constitutes the critical foundation of human capital formation. During this critical window, rapid brain development, immune programming, and metabolic adaptation occur, making nutritional adequacy, quality, and diversity essential for cognitive development, executive function, and long-term productivity. Human capital development during the first 1000 days-rooted in maternal and early-life nutrition and identified as the Creation phase in this Perspective-is considered a necessary condition for investments in education and skill formation in later life stages. Despite this, widely used development measures, including the human development index (HDI), remain largely retrospective in approach and output-oriented in focus. The Perspective proposes an adjustment to the HDI by incorporating maternal, birth, child nutrition, and early developmental indicators to better capture the biological foundations of capability. This approach would create an opportunity to ensure multisectoral accountability, address intergenerational and geographic inequities, and align policy priorities with the origins of human capital and development.

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Feasibility and Acceptability of a Breastfeeding Support Intervention Among Mothers of Infants Under Six Months Old Discharged From Malnutrition Treatment in Kilifi County.

Unda J et al. · Jul 1, 2026

Malnourished infants under 6 months experience poor growth and development. A pilot study applied the WHO guideline for treatment of acute malnutrition and found that it was possible to re-establish exclusive breastfeeding during inpatient treatment. However, weight gain could not be sustained 6 weeks after discharge suggesting that follow-up breastfeeding support may be required. Our study aimed to pilot the feasibility and acceptability of a follow-up intervention among infants discharged from malnutrition treatment. A home-based post-discharge breastfeeding support intervention was developed to be delivered by breastfeeding peer supporters in a series of three home visits and three intervention phone calls over a period of 7 weeks after discharge from the hospital. The intervention was piloted among 20 mother-infant pairs providing quantitative and qualitative data from a standardized questionnaire and in-depth interviews. Data was analyzed descriptively and using thematic analysis. The median infant birth weight was 2.07 kg and > 50% of the mothers had primary education or less. The intervention was feasible with 100% reach of the target participants with a geographic spread of 25% urban and 75% rural areas. All intervention components were applied consistently, resulting in 100% adherence over a 6-month period. The intervention was accepted by mothers, perceived to be beneficial, and reported to increase breastfeeding confidence. It was adaptable, adjusting to emerging challenges, and was successfully integrated into existing health services. The pilot demonstrated high feasibility and widespread acceptance of the intervention. Its effectiveness to improve weight gain among recovering infants is being determined in a trial.

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Use of WHO Growth Standards Rather Than Locally Specific Linear Growth Curves Promotes Equity in Pediatric Growth Research for Children Younger Than 5 Years.

Finaret AB et al. · Jul 1, 2026

There is strong evidence that healthy children around the world grow according to the World Health Organization Child Growth Standards when they benefit from healthy environments, regardless of race, ethnicity, or nationality. Despite this, arguments still exist in the scientific literature that child growth curves specific to local populations are necessary. We use a narrative review of the literature on child growth to focus on articles in which different, locally specific child growth curves have been developed or recommended. We synthesize the arguments against a universal child growth standard to provide an understanding of these problematic claims, in the context of new efforts to address remaining echoes of scientific racism in the field of nutrition and other biomedical sciences. Child nutrition assessment should take place using high-quality tools and metrics that do not depend on race, ethnicity, or nationality.

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Diets, Fruit and Vegetable Intake, and Nutritional Status in Benin, Fiji, the Philippines, Sri Lanka, and Tanzania: Foreword.

Olney DK et al. · Jul 1, 2026

Improving diets can improve nutrition and health outcomes. In this supplement, evidence from five low-and-middle-income countries on the country specific dietary (including F&V) intake patterns, nutrition issues and evaluated solutions to improve diets across population groups is presented. Based on this evidence, the final paper offers perspectives and future priorities.

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Farming Systems, Food Security, Dietary Intakes, and Nutrition Status Among Young Children in Rural Tanzania Before and After Harvest.

Muhimbula H et al. · Jul 1, 2026

Subsistence farming households are at risk of food insecurity and poor nutritional status due to dependence on farm production for consumption. This study aimed to examine the relationship between household farming systems, food security and infant nutrition status pre- and post-harvest. Households with mothers and infants and young children < 24 months were recruited from rural villages in Morogoro and Shinyanga, Tanzania. Demographics, anthropometrics, dietary intakes and household food insecurity were recorded. ANCOVA was used to examine differences and interactions between farming systems, seasons, food security, and nutrition status. The results showed high food insecurity pre-harvest, highest within the Mixed Crop Livestock (MCL) farming system (82%) and Mixed Food Crop (MFC) farming system (74%). Post-harvest, food insecurity was lowest for MCL households (21%) and highest for Single Food Crop (SFC) households (49%). MFC infants and young children had lower WAZ and LAZ and Cash Crop (CC) infants and young children had higher WAZ and LAZ pre-harvest. Within the MFC and MCL farming systems, a significant increase pre to postharvest in MUAC was observed (p < 0.01 and p < 0.001, respectively). This study highlighted high food insecurity, poor dietary intakes and poor nutrition status pre-harvest. Our findings revealed that the CC farming system had a greater income-generating pathway and that MCL and MFC families had food group diversification post-harvest. Therefore, interventions to improve nutrition status should improve both farming systems, while addressing seasonal gaps through food storage and preservation, market access and nutrition education for better child nutrition.

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Crossing Borders of Care: The Professionalization of Women in Nursing and China-US Collaboration at Xiangya, 1909-1926.

Tang Y et al. · Jul 1, 2026

This article examines the development of modern nursing education in China through a case study of the Xiangya School of Nursing in Changsha between 1909 and 1926. Founded in 1911 by the Yale-in-China Association, a non-denominational mission, Xiangya was among the earliest nursing schools in China to promote undergraduate nursing education and public health nursing. Drawing on archival materials, published primary sources, and Chinese and English historiography, we analyze the cultural, political, and gendered challenges that shaped the school's development under the leadership of American nurse Nina Gage. While Gage initially sought to implement an Americanized model of nursing education, she and her colleagues adapted admission policies, educational goals, and curricula to local social and cultural conditions. Recognizing the need for Chinese nursing leadership, they prioritized the establishment of a Bachelor of Science degree to prepare nurses for teaching, administration, and public health roles. By 1926, Xiangya had trained approximately 16% of China's qualified nurses and had become one of only two schools in China offering university-level nursing education. This history highlights the interplay of transnational influence, cultural adaptation, and gendered reform in the professionalization of nursing in early 20th-century China.

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Obesity and Its Association With Micronutrient Deficiency Among Mexican Children and Adolescents: A Systematic Review and Meta-analysis.

Herrera-González A et al. · Jul 1, 2026

Context Obesity and micronutrient deficiencies in the pediatric population of Mexico pose significant public health challenges. However, the relationship between these two conditions is still being studied. Objective To systematically review evidence on the association between overweight and obesity and micronutrient deficiencies among Mexican children and adolescents. Data sources A systematic search was conducted in 13 databases and one search engine. Data analysis Sixteen studies met the eligibility criteria and were included in this review. A total of 20 043 participants were included across the included studies, and the results were highly varied, as not all micronutrients showed a significant deficit in the presence of obesity. Calcium, phosphorus, magnesium, and vitamin E deficiencies were noted among participants with obesity; however, these did not significantly differ from those of individuals with normal weight. Current evidence suggests that Mexican children who have overweight or obesity are more likely to have zinc, iron, and vitamins D and B6 deficiency. A random-effects meta-analysis of 4 studies showed that children who have overweight or obesity were significantly more likely to have a deficit of vitamin D (odds ratio [OR], 1.84; 95% CI, 1.46-2.32), which was stronger for school-aged children (OR, 1.99; 95% CI, 1.56-2.55). Conclusion Current evidence suggests that Mexican children and adolescents who have overweight or obesity are more likely to experience vitamin D deficiency, and some evidence suggests that they are also prone to zinc, iron, and vitamin B6 deficiencies. For this reason, health-promotion and -prevention efforts must be comprehensive and address micronutrient deficiencies, common risk factors, and broader social determinants linked to noncommunicable diseases. Systematic review registration PROSPERO registration no. CRD42019154132.

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Maternal Health and Sociodemographic Characteristics Influence Infant Growth to 24 Months in the Tunza Mwana Cohort: A Prospective Cohort Study.

Hendrixson DT et al. · Jul 1, 2026

Upstream pathways influencing child growth are complex. Weight-for-age z-score (WAZ) reflects both ponderal and linear growth and can identify children at high mortality risk. Using data from a prospective cohort of 326 mother-child pairs in Kenya, we evaluated whether associations between maternal exposures and child growth outcomes in early and later childhood. Growth trajectories were examined using locally weighted scatterplot smoothing and piecewise linear mixed-effect models with a knot at age 3 months. Poisson regression models examined associations between maternal characteristics and child underweight (WAZ < -2) and stunting (LAZ < -2) before and after 3 months. Mean WAZ increased to a peak at 3 months before declining steadily through 24 months. Lower maternal education (adjusted β [aβ] -0.18; 95% CI: -0.24, -0.13), household crowding (aβ -0.2; 95% CI: -0.28, -0.11), lower wealth quintile (aβ -0.04; 95% CI: -0.06, -0.02) and multiparity (aβ -0.16; 95% CI: -0.23, -0.1) were associated with lower monthly rate of change in WAZ prior to age 3 months. Younger maternal age was associated with an increased monthly rate of change in WAZ (aβ = 0.13; 95% CI: 0.08, 0.18) before 3 months and decreased monthly WAZ (aβ -0.02; 95% CI: -0.03, -0.01) after 3 months. Preterm birth was associated with increased risk of underweight in both periods (aRR 2.77; 95% CI: 1.39-5.50). Maternal mental health, intimate partner violence and adverse childhood experiences were not significantly associated with child growth. Maternal nutritional, socio-economic and household-level factors shape early growth, emphasising the need for cross-sectoral programs to support growth.

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Combining Treatment of Acute Malnutrition With Integrated Community Case Management: A Cluster-Randomised Controlled Trial (SETiPlus).

Cronin G et al. · Jul 1, 2026

Achieving good treatment coverage and outcomes for acutely malnourished children is challenging in resource limited and remote settings. Inclusion of treatment within integrated community case management (iCCM) programmes has shown promise, but evidence is limited. We conducted a cluster randomised controlled trial in rural villages within the districts of Hargeisa, Gabiley, and Faraweyne in Somaliland. We compared treatment coverage and outcomes between 18 villages implementing iCCM, where cases of malnutrition (mid-upper arm circumference (MUAC) < 12.5 cm and/or oedema) were referred to MCH clinics, and 19 villages implementing iCCM +, where malnutrition treatment was provided by family health workers (FHW) at village level. Coverage was measured in a closed household cohort at baseline and after 6 months of intervention. Treatment outcomes were determined in an open cohort of cases that were identified by the iCCM FHW and followed up on each month. The prevalence of acute malnutrition diagnosed using MUAC was four-fold lower compared to that diagnosed using weight-for-height z-scores (WHZ) (3% vs. 13%). This larger than expected difference resulted in the study being underpowered. Treatment coverage was 27% and 23% in the control and intervention arms at baseline and increased sharply in the intervention arm with an adjusted difference of 20 percentage points. However, the improvement was not statistically significant (adjusted OR 2.55 (95% CI 0.4, 18.8) p = 0.344). Cases were more likely to start treatment in the intervention arm (difference 71.9% (95% CI 58.1, 85.7) p < 0.001), but relapse and non-response were more frequent (p = 0.041 & p = 0.004). Over diagnosis of acute malnutrition by FHW was high, with 67.4% and 77.4% of cases being misdiagnosed in the control and intervention arm, respectively. While the integration of malnutrition treatment with iCCM shows potential for improving treatment coverage in some contexts, careful consideration should be given to the level of training and supervision required. TRIAL REGISTRATION: ISRCTN31437934. Registered 3/10/2023.

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Understanding Opportunity Costs of Women Participating in Maternal and Child Nutrition Interventions in Southern Angola: Evidence From the MuCCUA Trial.

Martin-Cañavate R et al. · Jul 1, 2026

Stunting remains highly prevalent in Angola. Multisectoral interventions are essential to prevent this public health issue, and while economic evaluations have assessed the costs and consequences of these interventions, they have largely overlooked costs incurred by participants. The MuCCUA trial evaluates the cost-effectiveness of three interventions to prevent stunting during the first 1000 days: standard of care (SOC), SOC plus nutritional supplementation (SOC + NS), and SOC plus cash transfers (SOC + CT). This study aimed to estimate participants' opportunity costs and to explore women's experiences. After 12 months of implementation, data were collected from participant women through focus group discussions, interviews and questionnaires on travel and waiting times, and transport costs for attending health posts and community sessions in the SOC arm, and for quarterly distribution visits in the SOC + NS and SOC + CT arms. Total opportunity costs per participant were estimated by intervention arm and community category (close/far from services and/or distribution points). The total opportunity cost of participants over 1 year were US$9373.91 for SOC, US$16,142.09 for SOC + NS and US$18,231.38 for SOC + CT, corresponding to US$1.69, US$2.80 and US$3.17 per participant per month respectively. Value of travel and waiting times accounted for 75%-85% of opportunity costs, with women in remote villages facing substantially higher burdens. These findings highlight the importance of accounting for opportunity costs, especially time and geographic accessibility, when designing maternal and child health and nutrition interventions. Incorporating a societal perspective in economic evaluations is essential to capture unintended participant burdens and promote equitable, effective participation. Trial Registration: NCT05571280. Registered 7 October 2022.

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