Improving maternal and infant nutrition: a framework for action

Appendix 4: NICE Public Health Guidance 11 Research Recommendations

NICE recommends research commissioners and funders should:

1. Commission research into effective ways of improving the nutritional status of pre-conceptual women, pregnant and breastfeeding women and young children. This should identify effective ways of engaging with women both before and during pregnancy. It should pay particular attention to: teenage parents, low-income families and families from minority ethnic or disadvantaged groups; promoting oily fish, vegetable and fruit consumption; helping women who may become pregnant, particularly those who are obese, to achieve a healthy body weight prior to pregnancy; and promoting uptake of folic acid supplements prior to conception and the uptake of vitamin D supplements during pregnancy and while breastfeeding.

2. Commission research into how best to encourage and support women to breastfeed exclusively during the first 6 months and how to ensure all women breastfeed for longer.

3. Commission research on interventions which reduce the incidence of food allergy among infants and young children, particularly when introducing solid foods.

4. Commission research into the acceptability of dietary and lifestyle interventions to improve the vitamin D status of mothers and children aged up to five years, particularly those from vulnerable groups. This should also assess the relative contribution made by exposing the skin to ultra-violet light and dietary supplements.

5. Commission research into the prevention of early dental caries among children aged up to five years, especially those from vulnerable groups. This should focus on children's drinks and snacks.

6. Research councils, national and local research commissioners and funders, research workers and journal editors should include as standard in nutritional research and policy evaluation reports: a clear, detailed description of what was delivered, over what period, to whom in what setting; the costs of delivering the intervention; measurable and clearly defined health outcomes; an estimation of the sample size required to demonstrate, with adequate statistical power, the impact on health; differences in access, recruitment and (where relevant data are available) uptake according to socioeconomic and cultural variables such as social class, education, gender, income or ethnicity; a description and rationale of the research methods and forms of interpretation used; embedded process evaluations that include recipient perspectives. Develop methods for synthesising and interpreting results across studies conducted in different localities, policy environments and population groups. Formulate rigorous and transparent methods for assessing external validity and for translating evidence into practice.

7. Policy makers, research commissioners and local services should collect baseline data before implementing local interventions or policy changes that may have an impact on health and ensure evaluation is part of the funding proposal. Work in partnership with health authorities, public health observatories or universities to evaluate local initiatives, but allow adequate time for the intervention to take effect. Monitoring and evaluation should always estimate the potential impact on maternal and child health among different social groups.

8. Policy makers, research funders and health economists should, as a priority, commission research on the cost-effectiveness of maternal and child nutrition interventions. This includes balancing the cost of primary prevention of nutrition-related ill health against the costs of detecting and treating disease (both short and long term).

9. Policy makers, research commissioners and local services should commission research into the impact of routine growth and weight monitoring on child health and parenting behaviour.

NICE have also produced an audit tool to support the implementation of NICE guidance. The aim is to help NHS organisations with a baseline assessment and to assist with the audit process, thereby helping to ensure that practice is in line with the NICE recommendations. The audit support is based on the key recommendations of the guidance and includes criteria and data collection tools . http://guidance.nice.org.uk/PH11/AuditSupport/doc/English