IMPACT OF NUTRITIONAL COUNSELING DURING CHILDCARE CONSULTATIONS ON GROWTH AND ANEMIA PREVENTION IN INFANTS: A SYSTEMATIC REVIEW OF CLINICAL TRIALS

Abstract

Background: Childcare consultations are key opportunities for preventive interventions in early childhood. However, uncertainty remains about the impact of nutritional counseling provided during these visits on growth, anemia, and infant feeding practices. Methods: Prospective systematic review with a registered protocol. Randomized controlled trials in infants aged 0–24 months were included if they evaluated nutritional counseling during well-child consultations versus a comparator (usual care or another intervention). Searches were conducted in electronic databases, with screening and data extraction performed in duplicate; risk of bias was assessed using RoB 2.0. A primary analysis (studies with predominantly counseling interventions, n=4) and a sensitivity analysis (including 2 trials with supplementation) were defined. Results: Of 280 records identified, 190 unique studies were screened; 10 full-text articles were assessed and 6 trials (published between 2017–2024) were included. Combined sample size: 4,069 participants (primary analysis) and 8,446 including sensitivity analysis. Counseling consistently improved feeding practices (increased exclusive breastfeeding, earlier initiation, greater feeding frequency, and dietary diversity). Modest positive effects were observed on anthropometric indicators in the short to medium term (≤24 months), which tended to attenuate over longer follow-ups (>24–36 months). In trials measuring hemoglobin, counseling alone did not increase levels or reduce anemia prevalence; anemia reduction occurred only in intervention arms including nutritional supplementation (e.g., LNS). Conclusions: Nutritional counseling during childcare consultations effectively improves feeding practices and may yield modest short-term growth benefits, but it is insufficient to prevent iron-deficiency anemia in at-risk settings without supplementation or fortification. An integrated approach combining education with direct micronutrient provision is recommended where appropriate.