Background: Undernutrition contributes to up to 45% of deaths globally in children <5 years, with an optimal time for intervention before 24 months of age. Breastmilk microbiome helps establish the infant intestinal microbiome and impacts infant intestinal and nutritional health. Inadequacies in breastmilk composition such as low vitamin A contribute to infant nutrient deficiencies. Changes in milk fatty acid composition (reduced saturated and increased unsaturated fatty acids) may reduce susceptibility to enteric infection and increase protective intestinal bacteria. Moringa oleifera leaves (moringa) provide high nutrient concentrations (including protein, iron, vitamin A) and increase milk production; this may enhance breastmilk quantity and quality and improve infant health.Objective: To investigate the role of moringa supplementation to improve maternal and infant nutritional and intestinal health via changes in maternal milk quantity and quality.Methods: Fifty mother‐infant pairs exclusively breastfeeding will be enrolled in a single‐blinded randomized controlled trial in Kombewa County Hospital and Chulaimbo SubCounty Hospital, Kisumu, Kenya.Intervention: Dietary Supplementation of 20 g of Moringa oleifera leaf powder divided twice daily in corn porridge consumed daily for 3 months while control comparator will receive porridge daily for 3 months.Outcomes: Change in infant growth and maternal milk output (primary); maternal and infant vitamin A and iron status, changes in infant and maternal intestinal health (secondary).Participating Centers: Pamoja Community Based Organization, Kombewa Sub‐County Hospital, and Chulaimbo Sub‐County Hospital.

Background: Cardiometabolic risk factors (impaired fasting glucose, abdominal obesity, high blood pressure, dyslipidemia) cluster in children, may predict adult disease burden, and are inadequately characterized in South American children. Objectives: To quantify the burden of cardiometabolic risk factors in South American children (0–21 years) and identify knowledge gaps. Methods: We systematically searched PubMed, Google Scholar, and the Latin American and Caribbean Health Sciences Literature via Virtual Health Library from 2000–2021 in any language. Two independent reviewers screened and extracted all data. Results: 179 studies of 2,181 screened were included representing 10 countries (n = 2,975,261). 12.2% of South American children experienced obesity, 21.9% elevated waist circumference, 3.0% elevated fasting glucose, 18.1% high triglycerides, 29.6% low HDL cholesterol, and 8.6% high blood pressure. Cardiometabolic risk factor definitions varied widely. Chile exhibited the highest prevalence of obesity/overweight, low HDL, and impaired fasting glucose. Ecuador exhibited the highest prevalence of elevated blood pressure. Rural setting (vs. urban or mixed) and indigenous origin protected against most cardiometabolic risk factors. Conclusions: South American children experience high rates of obesity, overweight, and dyslipidemia. International consensus on cardiometabolic risk factor definitions for children will lead to improved diagnosis of cardiometabolic risk factors in this population, and future research should ensure inclusion of unreported countries and increased representation of indigenous populations.

Background: Childhood vitamin A deficiency leads to increased morbidity and mortality. Human milk is the only source of vitamin A for exclusively breastfed infants. Dried Moringa oleifera leaf powder (moringa) is a good food source of provitamin A and other carotenoids. Its effect during lactation on human milk vitamin A and carotenoid content is unclear. Objectives: Our objective was to investigate the effect of maternal moringa consumption on human milk retinol and carotenoid concentrations and maternal and infant vitamin A status. Methods: We conducted a 3-month pilot single-blinded cluster-randomized controlled trial in breastfeeding mother–infant pairs (n = 50) in Kenya. Mothers received corn porridge with (20 g/d) or without moringa with complete breast expressions and maternal and infant serum collected at enrollment (infant <30 days old) and 3 months. Milk was analyzed for retinol and selected carotenoids; maternal/infant serum was analyzed for retinol binding protein (RBP). Results: 88% (n = 44) pairs completed milk and serum samples. Four mothers (9%) had vitamin A deficiency (RBP <0.07 µmol/L); 11 (25%) were vitamin A insufficient (VAI; RBP <1.05 µmol/L). Alpha-carotene concentration in milk was higher in the moringa than the control group at baseline (p = 0.024) and at exit (least squares means, LSM, 95%CI µg/mL 0.003, 0.003–0.004 moringa vs. 0.002, 0.001–0.003 control, n = 22/cluster; p = 0.014). In mothers with VAI, alpha-carotene was higher in the moringa group than controls at exit (LSM, 95%CI µg/mL 0.005, 0.003–0.009 moringa, n = 3, vs. 0.002, 0.000–0.004 control, n = 8, p = 0.027) with no difference at baseline. Milk carotenoids did not correlate with vitamin A status (serum RBP) in infants or mothers. Conclusions: Maternal moringa consumption did not impact concentration of milk vitamin A and resulted in limited increase in milk carotenoids in this cohort.

Feeding of human milk enhances infant health and survival over alternative feeding methods, but early cessation often occurs due to perceived or real insufficient milk supply. Moringa oleifera leaves are nutrient dense and may increase milk output. We investigated the impact of maternal dried moringa leaf powder supplementation (moringa) on milk composition and output and infant and maternal health. Breastfeeding mother–infant pairs (n = 50) living in Kisumu County, Kenya, were cluster-randomized by location to consume moringa powder (20 g/d) in corn porridge (the moringa group) or corn porridge alone (the control group) for 3 mo. Milk and maternal/infant blood were collected and 24-h expressed milk volume evaluated at baseline and 3 mo. Maternal and infant anthropometrics were measured monthly. Milk lipid and protein concentrations and maternal and/or infant serum retinol-binding protein, ferritin/soluble transferrin receptor, and insulin-like growth factor (IGF)-1 concentrations were measured. Nearly, all dyads (n = 45, 90%) completed the study. Baseline characteristics were similar between groups. At 3 mo, mothers in the moringa group (mean: 947 mL; 95% CI: 794, 1113 mL) expressed twice as much milk as controls (mean: 618 mL; 95% CI: 486, 763 mL; P = 0.003). Infant serum IGF-1 concentration was greater in the moringa group (mean: 25.2 ng/mL; 95% CI: 21.0, 29.5 ng/mL) than that in the control group (mean: 17.8 ng/mL; 95% CI: 13.6, 22.0 ng/mL; P = 0.017). There was no effect of moringa on total milk lipid and protein concentrations, fatty acids, or infant growth. In this population, 3 mo of maternal moringa consumption was associated with increased expressed milk output and higher circulating infant IGF-1 without impacting infant growth. Additional studies are needed to understand the mechanisms driving these effects and their influence on long-term health. This trial was registered at clinicaltrials.gov as NCT04587271 (https://clinicaltrials.gov/ct2/show/NCT04587271).

Background: In middle-income countries, malnutrition concentrates in marginalized populations with a lack of effective preventive strategies. Objective: Identify risk factors for undernutrition in a peri-urban Ecuadorian community of children aged 12 to 59 months. Methods: Data from a cross-sectional survey in 2011 of children 1 to 5 years were analyzed including demographic data, medical history and examination, food frequency questionnaire (FFQ), anthropometric measurements, and blood for complete blood count, C-reactive protein, vitamin A, iron, and zinc levels. Dietary Diversity Score (DDS) was calculated from FFQ. Bivariate and multivariate analysis assessed effects on primary outcome of undernutrition by DDS, vitamin deficiencies, and demographic and nutritional data. Results: N = 67, 52.2% undernourished: 49.3% stunted, 25.4% underweight, and 3% wasted; 74.6% (n = 50) were anemic and 95.1% (n = 39) had low serum zinc. Dietary Diversity Score was universally low (mean 4.91 ± 1.36, max 12). Undernutrition was associated with lower vitamin A levels (20 306, IQR: 16605.25-23973.75 vs 23665, IQR: 19292-26474 ng/mL, P = .04); underweight was associated with less parental report of illness (43.8%, n = 7 vs 80% n = 40, P = .005) and higher white blood count (13.7, IQR: 11.95-15.8 vs 10.9, IQR: 7.8-14.23 × 10⁹/L, P = .02). In multiple regression, risk of undernutrition decreased by 4% for every $10 monthly income increase (95 CI%: 0.5%-7.4%, P = .02, n = 23); risk of underweight decreased by 0.06 for every increased DDS point (adjusted odds ratio: 0.06; 95 CI%: 0.004-0.91, P = .04, n = 23). Conclusions: In this peri-urban limited-resource, mostly Indigenous Ecuadorian community, stunting exceeds national prevalence, lower monthly income is the strongest predictor of undernutrition, lower DDS can predict some forms of undernutrition, and vitamin deficiencies are associated with but not predictive of undernutrition.