A culturally integrated framework for infant nutrition beyond health education: lessons and a model from the Tibetan population.

Background: Improving infant and young child nutrition among marginalized ethnic groups urgently requires a paradigm shift from traditional health education to culturally integrated systemic interventions. Nutrition in the first 1,000 days is critical for long-term health and human capital development. Amid global efforts to eliminate health disparities, Tibetan infants face severe nutritional challenges, with stunting and anemia rates far exceeding national averages. Feeding practices, rooted in their unique high-altitude environment and deep cultural traditions, are a key social determinant of their health. Objective: This study aimed to comprehensively describe the traditional feeding practices among Tibetan infants aged 0-24 months via an integrative review, assess their health impacts, analyze influencing factors using the socio-ecological model, and ultimately construct a multi-level, culturally adapted public health intervention framework. Methods: An integrative review methodology was employed. Multiple English and Chinese databases (PubMed, Web of Science, Scopus, CNKI, etc.) were systematically searched for quantitative, qualitative, and mixed-methods studies on Tibetan infant feeding practices. Evidence was thematically analyzed and synthesized based on the socio-ecological model. Results: The review revealed significant deviations between traditional Tibetan feeding practices and scientific guidelines: low rates of exclusive breastfeeding, prevalent early introduction of complementary foods (median age ~1 month), primarily Tsampa, and high dietary monotony. These feeding patterns were reported to be associated with a high burden of stunting and anemia, with anemia rates exceeding 60% in some areas, and early introduction of traditional infant feeding items such as Tsampa was also described in some reports as a possible factor related to neonatal necrotizing enterocolitis (NEC). Socio-ecological analysis identified potential multi-level factors including individual knowledge gaps, community cultural norms and inadequate health services, and macro-level high-altitude environment and poverty. Conclusion: This study proposes a novel, culturally integrated intervention conceptual framework that systematically elucidates the multi-level determinants of malnutrition and provides a conceptual basis for multi-sectoral collaboration. The framework aims to reconcile traditional practices with nutritional science, highlighting the necessity of systemic, multi-level interventions, and may offer a context-sensitive conceptual reference for thinking about culturally embedded health inequities in other marginalized communities, although its applicability beyond Tibetan populations requires empirical validation in other cultural and geographic settings.