The prevalence of undernutrition and associated factors in older obese patients

BACKGROUND

Both obesity and malnutrition are common health problems in older adults.

AIM

The aim of our study is to investigate the prevalence of undernutrition and related factors in older obese patients.

METHODS

1911 older outpatients who underwent comprehensive geriatric assessment were included in this cross-sectional study. Body mass index (BMI) was categorized as follows: 'Underweight' = BMI < 18.5, 'Normal weight' = 18.5 ≤ BMI < 25, 'Overweight' 25 ≤ BMI < 30, and 'Obesity' ≥ BMI 30. Mini-Nutritional Assessment scores > 23.5, 17-23.5, or < 17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Those who were not well-nourished were considered undernutrition.

RESULTS

Of 1911 patients, with a mean age of 77.34 ± 8.0 years, 931 (48.7%) were obese. Of whom 6.0% were malnourished and 26.3% were at risk of malnutrition. Age, females, widowed and those living with their children, the number of drugs used, and the presence of heart failure, Parkinson's disease, and dementia, decreased calf circumference and muscle strength were higher in obese patients with undernutrition than obese well-nourished patients (p < 0.05). After adjustment for the aforementioned factors, basic and instrumental activities of daily livings, and Tinetti scores were lower, and falls and Geriatric Depression Scale-15 scores were higher in those with undernutrition compared to those with well-nourished among older obese patients (p < 0.05).

CONCLUSIONS

Half of the older patients were obese and undernutrition was observed in one out of every three older obese patients. Undernutrition was associated with decreased functional capacity, impairment in balance and gait functions, falls, and depressed mood. Therefore, we recommend to screen older obese patients for nutritional status.

Undernutrition and its associated factors among pregnant women at the public hospitals of Bench-Sheko and Kaffa zone, southwest Ethiopia

Background

Undernutrition in pregnant women, expressed as low mid-upper arm circumference, is responsible for maternal mortality and morbidity, adverse birth outcomes, subsequent childhood malnutrition, and mortality. As a result, the purpose of this study was to determine the prevalence of maternal undernutrition and associated factors during pregnancy in public hospitals in the Bench-Sheko and Kaffa zones of southwest Ethiopia.

Methods

A facility-based cross-sectional study design was employed among 566 women who received antenatal care from March-May 2021 at the public hospitals of the Bench-Sheko and Kaffa zones, Southwest Ethiopia. A systematic random sampling technique was used to select the research unit. Undernutrition was measured by mid-upper arm circumference. The data were entered into Epi- Data version 3.1 and then exported to Statistical Package for Social Science (SPSS) version 21 software for analysis. Multivariate logistic regression models were constructed using variables with a P-value <0.25 in bivariate logistic regression analysis. Finally, in multivariate logistic regression analysis, the variable with a (P-value < 0.05) is considered statistically significant.

Results

A total of 566 pregnant women participated in our study with a response rate of 98.3%. The overall prevalence of undernutrition among pregnant women was 42.4% (95% CI: 38.3, 46.5). In multivariate logistic regression, the age of mothers between 16-24 years old (AOR = 3.9, 95% CI: 1.60, 9.70), household food insecurity (AOR = 1.81, 95% CI: 1.04, 3.15), and poor dietary knowledge (AOR = 3.25, 95% CI: 1.94, 5.47) were the factors significantly associated with undernutrition among pregnant women.

Conclusion

According to this study finding, the prevalence of undernutrition was very much high in the study area, which was significantly associated with the age groups of 16-24 years older women, poor dietary knowledge, and household food insecurity. Therefore, the strategies and programs targeted towards reducing and preventing undernutrition among pregnant mothers should be made at all levels to improve their nutritional status, and also health information, nutrition counseling, and food assistant should be provided.

Undernutrition is feeding the tuberculosis pandemic: A perspective

Tuberculosis (TB) is a major cause of death worldwide, with 1.5 million deaths in 2020. While TB incidence and mortality had previously been on a downwards trend, in 2020, TB mortality actually rose for the first time in a decade, largely due to the COVID-19 pandemic. Undernutrition is the leading risk factor for TB, with a population attributable fraction (PAF) of 15%, compared to 7.6% for HIV. Individuals who are undernourished are more likely to develop active TB compared to those with a healthy bodyweight. They are also more likely to have greater severity of TB, and less likely to have successful TB treatment outcomes. The likelihood of TB mortality significantly increases as weight decreases. Nutritional interventions are likely to improve both nutritional status and TB treatment success, thereby decreasing TB mortality. However, many previous studies focusing on nutritional interventions have provided insufficient calories or been underpowered. Nutritional supplementation will be particularly important as factors such as the COVID-19 pandemic, climate change, and political conflict further threaten food security. The global TB elimination effort can no longer afford to ignore undernutrition.

Under-nutrition and associated factors among pregnant women in public health care hospitals of Gedeo Zone, southern Ethiopia: A cross-sectional study

Background

Balanced and adequate nutritious food during pregnancy helps to improve maternal weight and for the healthy growth of the fetus. There has been little progress in reducing pregnant undernutrition in Ethiopia; it has been too slow.

Objective

The objective of this study was to assess the prevalence of undernutrition and associated factors among pregnant women in public health care hospitals of Gedeo Zone, Southern Ethiopia.

Method

A cross-sectional study design was used in public hospitals of Gedeo Zone, Southern Ethiopia from February 01 to March 01, 2019. Pretested structure questionnaire was used to collect data on the socio-economic and demographic characteristics of the study participants. Epi-data was used to code and enter the data and SPSS-25 was used to analyse and interpret the data. To assess the relationship between the dependent and the independent variables, bi-variable and multivariable logistic regression analysis was done.

Results

In this study, the prevalence of undernutrition among pregnant women was 21% (95% CI: 20.8-21.2). After controlling other co-variables, the multivariable logistic regression model revealed that average monthly income, women's educational status, nutrition education and counseling, and parity were found to have a significant association with pregnant women's nutritional status. The odds of under-nutrition among pregnant women whose monthly income is <800 ETB were 2.8 times higher than those whose monthly incomes were >1500 (AOR: 2.89; 95%CI: 1.49-5.6).

Conclusion

In this study the magnitude of undernutrition among pregnant women was found to be higher than the previously reported findings. Average household monthly income, family size, mother's educational status, nutrition education and counseling, current health condition of the mother, and parity were factors significantly associated with undernutrition of pregnant mothers. Therefore, Interventions should be initiated in earlier stages of pregnancy to prevent the high level of undernutrition during the second and third trimester in this study area.

Nutrition and Physical Therapy: A Position Paper by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition (Secondary Publication)

Several patients undergoing physical therapy have nutritional problems. Knowledge of nutrition is necessary for addressing nutritional problems, such as malnutrition, sarcopenia, frailty, and cachexia. However, the relationship between physical therapy and nutrition is not fully understood. Physical therapy plays an important role in nutritional management, and evaluations, such as muscle strength and muscle mass evaluations, play an important role in nutritional screening and diagnosis. Exercise, as the core of physical therapy, is essential for nutritional interventions. Several recent studies have suggested that a combination of nutrition and physical therapy interventions can maximize the function, activity, participation, and quality of life of patients. The combination of nutrition and physical therapy interventions is key to addressing the needs of modern and diverse populations. This position paper was developed by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition in consultation with the Japanese Society of Nutrition and Swallowing Physical Therapy.

Nourishing Hope? Changes in Malnutrition and Changes in Girls' Aspirations-Evidence From the Suaahara II Adolescent Girls Panel in Nepal

PURPOSE

Malnutrition is a pressing public health challenge in South Asia with adverse consequences for adolescent girls' well-being and, potentially, aspirations as drivers of developmental progress. This study aimed to investigate associations between changes in malnutrition and changes in girls' aspirations in key life domains.

METHODS

We analyzed two-period panel data from the Suaahara II Adolescent Girls Panel (10-19 years) in Nepal (2018-2019, n = 613). Height, weight, blood samples, 24-hour dietary recalls, and indicators of girls' educational, occupational, marital, and fertility aspirations were collected. Height-for-age z-scores, body mass index-for-age z-scores, hemoglobin concentration (Hb g/dL), and dietary diversity scores for women were calculated. Through cluster-robust fixed-effects regressions, we examined whether changes in thinness (body mass index-for-age z-scores < -2 standard deviation), anemia (Hb <115 g/L nonpregnant <11 years; Hb <120 g/L nonpregnant >12 years; Hb <110 g/L pregnant), and reaching minimum dietary diversity for women were associated with changes in educational, marital, or fertility aspirations.

RESULTS

A change from thinness to no thinness increased girls' aspired ages of having a first child by 2.77 years (standard error [SE] 1.22, p = .025). A change from anemia to no anemia increased girls' aspired years of education by .54 (SE .27, p = .044). This association was stronger for postmenarche girls (b -.62, SE .29, p = .035). No associations were found between changes in minimum dietary diversity for women and any of the aspirations.

CONCLUSIONS

Thinness and anemia were negatively associated with adolescent girls' aspirations in domains of fertility and education. Multisectoral integrated policies and programs that improve adolescent nutritional status and diets have the potential to foster adolescent girls' aspirations and thereby increase their future potential.

Prognostic value of geriatric nutritional risk index for aspiration pneumonia: a retrospective observational cohort study

BACKGROUND

The clinical characteristics and prognostic factors of aspiration pneumonia remain poorly defined. Geriatric nutrition risk index (GNRI) has recently been reported to exhibit a prognostic value for several diseases in older adults.

AIMS

We investigated the clinical characteristics and prognostic significance of GNRI for aspiration pneumonia in older adult patients.

METHODS

In this retrospective observational cohort study, conducted in a single-institute acute-phase community hospital, patients with aspiration pneumonia diagnosed at our institute between April 2014 and March 2016 were enrolled. Data on patient characteristics, microbiological findings, and clinical course were collected. The outcome was in-hospital mortality. Receiver operating characteristic curve (ROC) analysis was conducted to compare the predictive value of each parameter. Logistic regression analysis was performed to identify independent prognostic factors.

RESULTS

Overall, 587 aspiration pneumonia patients aged ≥ 65 years were enrolled. Their mean age was 86 years. Among them, 97 (16.5%) died. In ROC analysis for in-hospital mortality, as compared to albumin, body mass index, and A-DROP score, GNRI had a greater area under the curve value, with a significant difference between GNRI and albumin (p = 0.0058). Male sex (p = 0.028), chronic heart failure (p = 0.023), history of malignancy (p = 0.0025), lower GNRI (p < 0.001), and initial antibiotic change (p < 0.001) were identified as independent adverse prognostic factors in multivariate analysis.

DISCUSSION AND CONCLUSIONS

Our findings indicate that GNRI is a potential prognostic marker for older adults with aspiration pneumonia and may act as a proxy for disease severity. Our results support the use of GNRI in the clinical management of aspiration pneumonia.

Maternal anemia and baby birth size mediate the association between short birth interval and under-five undernutrition in Ethiopia: a generalized structural equation modeling approach

Background

Studies assessing the association between short birth interval, a birth-to-birth interval of less than 33 months, and under-five undernutrition have produced inconclusive results. This study aimed to assess the relationship between short birth interval and outcomes of stunting, underweight, and wasting among children aged under-five in Ethiopia, and potential mediation of any associations by maternal anemia and baby birth size.

Method

Data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used. Stunting, wasting, and underweight among children aged under-five were outcome variables. Generalized Structural Equation Modeling (GSEM) was used to examine associations between short birth interval and outcomes, and to assess hypothesized mediation by maternal anemia and baby birth size.

Results

Significant associations between short birth interval and stunting (AOR = 1.49; 95% CI = 1.35, 1.66) and underweight (AOR = 1.43; 95% CI = 1.28, 1.61) were found. There was no observed association between short birth interval and wasting (AOR = 1.05; 95% CI = 0.90, 1.23). Maternal anemia and baby birth size had a significant partial mediation effect on the association between short birth interval and stunting (the coefficient reduced from β = 0.337, p < 0.001 to β = 0.286, p < 0.001) and underweight (the coefficient reduced from β = 0.449, p < 0.001 to β = 0.338, p < 0.001). Maternal anemia and baby birth size mediated 4.2% and 4.6% of the total effect of short birth interval on stunting and underweight, respectively.

Conclusion

Maternal anemia and baby birth size were identified as mediators of the association between short birth interval and under-five undernutrition status. Policies and programs targeting the reduction of under-five undernutrition should integrate strategies to reduce maternal anemia and small baby birth size in addition to short birth interval.

Conflict and Child Malnutrition: a Systematic Review of the Emerging Quantitative Literature

PURPOSE OF REVIEW

Reduction of child malnutrition in conflict settings is on top of the international agenda on sustainable development. This association between child malnutrition and conflict has been hypothesised in the academic literature but not rigorously examined empirically till recently. This paper reviews the emerging quantitative literature, including conflict as an explanatory variable to understand the aspects of child malnutrition studied and how violent events are associated with child nutritional status. Limitations are also highlighted.

RECENT FINDINGS

Child malnutrition is investigated into its three main dimensions of stunting, wasting and undernourishment computed as z-score. Conflict is mostly studied in terms of duration, number of events, typology and intensity. The emerging literature generally establishes a significant and negative association between conflict and child malnutrition. However, limitations persist and are mainly due to the type of available data.

Assessment of regional networks on nutrition in South Asia: a multi-methods study

BACKGROUND

Many national and international organizations are working to improve maternal and child nutrition in countries with high malnutrition prevalence and burdens. While there has been progress in strengthening multi-organizational networks on nutrition at country and global levels, the regional level has received much less attention. We conducted a study to 1) determine the existing relationships and levels of engagement between international organizations working to improve nutrition at the regional level or in at least two countries in South Asia; and 2) examine the experiences and perspectives of international organizations on regional-level communication, coordination or collaboration on nutrition in South Asia.

METHODS

 A mixed methods approach involving organizational network analysis (ONA) and semi-structured interviews was used to develop an understanding of the existing network and relationships between international organizations working on nutrition in South Asia. ONA data from 43 international organizations was analysed using a social network analysis software (UCINET) to systematically quantify and visualize the patterns of relationships between organizations.

RESULTS

We found a high degree of connectivity between most of the international organizations in South Asia, but there were gaps between the many organizations that knew each other and the work they did together regionally on nutrition. Most organizations worked together only 'rarely' or 'sometimes' on nutrition at the regional level and high-intensity (collaborative) working relationships were uncommon. Organizations of the same type tended to cluster together, and a small number of UN agencies and multilateral organizations were central brokers in the nutrition working relationships. Perceived constraints to the nutrition working relationships included organizations' agenda and mandate, threats to visibility and branding, human and financial resources, history, trust and power relations with other organizations, absence of a regional network for cooperation, and donor expectations. There was high demand to remedy this situation and to put network mechanisms in place to strengthen communication, coordination and collaboration on nutrition.

CONCLUSIONS

Opportunities are being missed for organizations to work together on nutrition at the regional level in South Asia. The effectiveness of regional nutrition networks in influencing policy or programme decisions and resources for nutrition at country level should be explored.

Low awareness of community-dwelling older adults on the importance of dietary protein: new insights from four qualitative studies

Meeting the recommended daily protein intake can be a challenge for community-dwelling older adults (CDOA). In order to understand why, we studied attitudes towards protein-rich products and healthy eating in general; identified needs and preferences, barriers and promotors and knowledge regarding dietary behaviour and implementation of high protein products. Attitudes towards protein-rich products and healthy eating were evaluated in focus groups (study 1, n 17). To gain insights in the needs and preferences of older adults with regard to meals and meal products (study 2, n 30), visual information on eating behaviour was assessed using photovoicing and verified in post-photovoice interviews. In studies 3 and 4, semi-structured interviews were conducted to identify protein consumption-related barriers, opportunities (n 20) and knowledge and communication channels (n 40), respectively. Risk of low protein intake was assessed using ProteinScreener55+ (Pro55+) in studies 2–4 (n 90). Focus groups showed that participants were unaware of potential inadequate dietary protein. Photovoicing showed that sixteen of thirty participants mainly consumed traditional Dutch products. In post-photovoice interviews, participants indicated that they were satisfied with their current eating behaviour. Barriers for adequate use of protein-rich products were ‘lack of knowledge’, ‘resistance to change habits’ and ‘no urge to receive dietary advice’. Promotors were ‘trust in professionals’ and ‘product offers’. Sixty-two percent had a low risk of low protein intake. CDOA feel low urgency to increase protein intake, possibly linked to low knowledge levels. A challenge for professionals would be to motivate older adults to change their eating pattern, to optimise protein intake.

Dietary Intake and Nutritional Status of the adult Kheria Sabar males of West Bengal, India

Kheria Sabars are an indigenous community living in the rural areas of Purulia, West Bengal, India. This work aims to study dietary intake and its relation to nutritional status among adult Kheria Sabar males aged 18-60. The study entails the recording of anthropometric variables like height (cm) and weight (kg) as per the standard protocol and calculating body mass index (BMI). Dietary intake was recorded on the basis of the 24-h dietary recall method. The intake of different nutrients was computed and compared with the Recommended Dietary Allowances (RDA) for Indians by the Indian Council of Medical Research Expert Committee. Results revealed a paradox where undernutrition was prevalent (44.28%) despite balanced nutrient intake. This paradox creates scope for further exploratory research among other communities living in similar habitats.

Ketogenic diet impairs neurological development of neonatal rats and affects biochemical composition of maternal brains: evidence of functional recovery in pups

The ketogenic diet (KD) is a type of diet in which the intake of fats significantly increases at the cost of carbohydrates while maintaining an adequate amount of proteins. This kind of diet has been successfully used in clinical therapies of drug-resistant epilepsy, but there is still insufficient evidence on its safety when used in pregnancy. To assess KD effects on the course of gestation and fetal development, pregnant females were fed with: (i) KD during pregnancy and lactation periods (KD group), (ii) KD during pregnancy replaced with ND from the day 2 postpartum (KDND group) and (iii) normal diet alone (ND group). The body mass, ketone and glucose blood levels, and food intake were monitored. In brains of KD-fed females, FTIR biochemical analyses revealed increased concentrations of lipids and ketone groups containing molecules. In offspring of these females, significant reduction of the body mass and delays in neurological development were detected. However, replacement of KD with ND in these females at the beginning of lactation period led to regainment of the body mass in their pups as early as on the postnatal day 14. Moreover, the vast majority of our neurological tests detected functional recovery up to the normal level. It could be concluded that the ketogenic diet undoubtedly affects the brain of pregnant females and impairs the somatic and neurological development of their offspring. However, early postnatal withdrawal of this diet may initiate compensatory processes and considerable functional restitution of the nervous system based on still unrecognized mechanisms.

Prevalence and associated factors of undernutrition among adult TB patients attending Amhara National Regional State hospitals, Northwest Ethiopia

Background

TB (tuberculosis) is an infectious disease affecting millions of people worldwide; globally, an estimated 10 million people developed TB disease in the past two years; and there were an estimated 1.4 million TB deaths. In Ethiopia, the burden of TB is ranked third and seventh in Africa and the world, respectively. Hence, studies are limited to solving many of the problems related to undernutrition. Therefore this study aimed to assess the prevalence and associated factors of undernutrition among adult TB patients attending Amhara National Regional State hospitals, Northwest Ethiopia.

Methods

A cross-sectional study was conducted in the TB clinics of Amhara Regional State Referral hospitals from March to April 2020. A total of 405 TB patients participated in the study. Proportional allocation and Systematic random sampling were employed to get representative study participants. The outcome variable, undernutrition, was determined by using Body Mass Index (BMI). Interviewer administered structured questionnaire, anthropometric measurements and patients' document review were done. Bivariable and multivariable logistic regressions were done to identify factors associated with undernutrition. Crude odds ratios (COR) and adjusted odds ratios (AOR) with 95% confidence intervals and P-values < 0.05 were employed to declare the significance and strength of association.

Results

The prevalence of under nutrition was 42.2% [95%CI: 32.8, 51.6]. The mean (±SD) BMI was 19.30(±2.83). The odds of undernutrition was higher among TB patients with poor wealth status [AOR = 2.39, 95%CI; 1.19, 4.79], alcohol consumption [AOR = 1.57; 95%CI, 1.01, 2.47], bedridden [AOR = 3.02, 95%CI; 1.21, 7.50] and ambulatory patient [AOR = 2.11, 95%CI; 1.36, 3.26]. Furthermore, being farmer [AOR = 2.59;95%CI,1.08,6.20], housewife [AOR = 2.72;95%CI,1.22,6.06] and unemployed [AOR = 2.46;95%CI,1.18,5.13] were significantly associated with undernutrition.

Conclusion and recommendations

This study illustrated that a considerably high proportion of TB patients were undernourished in Amhara regionals state referral hospitals. Behavioral and socio-economic characteristics were significantly associated with undernutrition. Therefore, nutritional and social support activities are essential for TB patients, particularly those who are socio-economically disadvantaged. Regular nutritional screening and management, as well as behavioral interventions, should be strengthened.

Social determinants of malnutrition in Chilean children aged up to five

Background

This study aimed to ascertain the Social Determinants (SDs) of malnutrition (over and undernutrition) of Chilean children aged up to five.

Methods

The study was carried out using a sample of children from zero to five years old (n = 1,270,485; 52.2% female) from the National Socioeconomic Characterization Survey (CASEN) 2017. A multinomial logistic regression model was used, where the “child nutritional status” outcome variable assumed three possible values: normal nutrition, overnutrition, and undernutrition, while taking those variables reported in previous literature as independent variables.

Results

The model, by default, set normal nutrition as the reference group, Count R2 = 0.81. Results show a higher likelihood of both overnutrition and undernutrition among male children from the lowest quintiles, with native ethnic backgrounds, reporting health problems, having public health insurance, and who attend kindergarten. Additionally, higher probabilities of undernutrition in younger than two and living in the north of the country, while overnutrition is more likely in the south.

Conclusions

Socioeconomic variables are fundamentally related to both over and undernutrition; the current single schema program to prevent malnutrition should consider SDs such as ethnicity and geographical location, among others; moreover, successful nutritional programs—which focused on the lowest quintiles, need to be expanded to other vulnerable groups and pay more attention to overnutrition.

Behavioral and Cognitive Problems as Determinants of Malnutrition in Long-Term Care Facilities, a Cross-Sectional and Prospective Study

OBJECTIVES

To investigate the cross-sectional and prospective associations between behavior and cognitive problems and malnutrition in long-term care facilities (LTCF).

DESIGN

Cross-sectional and prospective routine care cohort study.

SETTING

6874 Residents in Dutch LTCFs (period 2005-2020).

PARTICIPANTS

Data were obtained from the InterRAI-LTCF instrument. Cross-sectional analyses on prevalence of malnutrition at admission included 3722 residents. Prospective analyses studied incident malnutrition during stay (total follow-up time 7104 years) and included data of 1826 residents with first measurement on admission ('newly-admitted') and n=3152 with first measurement on average ~1 year after admission ('existing').

MEASUREMENTS

InterRAI scales for communication problems (CS), aggressive behavior (ABS), social engagement (RISE), depressive symptoms (DRS), cognitive performance (CPS) and the total number of behavior and cognitive problems were investigated as independent variables and malnutrition (ESPEN 2015 definition) as dependent variable in regression analyses. Results were stratified for gender and group 'newly-admitted' vs. 'existing'.

RESULTS

On admission, 9.5% of residents was malnourished. In men, low social engagement was associated with prevalence of malnutrition. In women, all behavior and cognitive problems except depression were associated with malnutrition in the unadjusted analyses, but this attenuated in the full model taking all problems into account. The incidence of malnutrition during stay amounted to 8.9%. No significant associations of behavior and cognitive problems with malnutrition incidence were seen in 'newly-admitted' male residents while in 'existing' male residents all determinants were significantly associated. In 'newly-admitted' female residents CS, ABS and CPS, and in 'existing' female residents CS, RISE, ABS and CPS were significantly associated with incident malnutrition. All associations slightly attenuated after adjustment. Malnutrition incidence increased with increasing number of combined behavior and cognitive problems.

CONCLUSION

Residents with behavior and cognitive problems are at an increased risk of being malnourished at admission, or becoming malnourished during stay in a LTCF, especially residents with multiple behavior and cognitive problems.

Applied nutritional investigation Determinants of undernutrition among private and public primary school children: A comparative cross-sectional study toward nutritional transition in northwest Ethiopia

OBJECTIVES

Undernutrition is a major public health concern, particularly in children. The burden is higher in developing countries. Undernutrition is considered when there is one or more of the following: stunting, underweight, or wasting. Childhood undernutrition can have numerous long-term effects: a lower physical capacity for work, lower intellectual quotients, greater risk for morbidity and mortality, and cognitive impairment. Undernourished children also can have poor cognitive scores, a high absenteeism rate, and high class repetition compared with non-undernourished children. The aim of this study was to assess undernutrition and its associated factors among public and private primary school children in Gondar town, northwest Ethiopia.

METHODS

A school-based, cross-sectional study was conducted from March 5 to April 9, 2019. A multistage sampling technique was applied to select study participants. A simple random (lottery) sampling method was used to select seven public schools and five private schools. Systematic random sampling was used to select 774 study participants. The data were collected through face-to-face interviews. Multivariable logistic regressions were conducted to identify factors associated with undernutrition. The World Health Organization (WHO) AnthroPlus software was used to determine the status of undernutrition. Participants with a Z-score less than -2 were considered to be undernourished. Statistical significance was declared at P < 0.05 and odds ratios (ORs) were reported with a 95% confidence interval (CI).

RESULTS

The prevalence of undernutrition was higher among public school children (37.1%) than those attending private schools (28.3%). Not having family car (adjusted OR [aOR], 0.28; 95% CI, 0.09-0.84), snack frequency no more than twice a day (aOR, 5.29; 95% CI, 1.37-20.37), and vigorous intensity sports (aOR, 0.53; 95% CI, 0.32-0.91) were significantly associated with undernutrition among public primary school students. Family income below the median (aOR, 2.12; 95% CI, 1.23-3.53), no preference for sweets (aOR, 0.59; 95% CI, 0.36-0.97), and not habits while reading (aOR, 0.42; 95% CI, 0.19-0.89) were the factors significantly associated with undernutrition among private primary school students.

CONCLUSION

The prevalence of undernutrition was high. Children in public schools were highly vulnerable to undernutrition compared with those in private schools. Not having a family car, snack frequency no more than twice daily, and vigorous intensity sports increase the risk for undernutrition among public school children. Family income below the median, not preferring sweets, and not having a habit of eating while reading increase the risk for undernutrition among private school children. It is better to give attention to healthy dietary habits and healthy lifestyles to reduce childhood undernutrition.

Guidance for Systematic Integration of Undernutrition in Attributing Cause of Death in Children

Minimally invasive tissue sampling (MITS) is increasingly being used to better understand causes of death in low-resource settings. Undernutrition (eg, wasting, stunting) is prevalent among children globally and yet not consistently coded or uniformly included on death certificates in MITS studies when present. Consistent and accurate attribution of undernutrition is fundamental to understanding its contribution to child deaths. In May 2020, members of the MITS Alliance Cause of Death Technical Working Group convened a panel of experts in public health, child health, nutrition, infectious diseases, and MITS to develop guidance for systematic integration of undernutrition, as assessed by anthropometry, in cause of death coding, including as part of the causal chain or as a contributing condition, in children <5 years of age. The guidance presented here will support MITS and other researchers, public health practitioners, and clinicians with a systematic approach to assigning and interpreting undernutrition in death certification.

Ageing rate of older adults affects the factors associated with, and the determinants of malnutrition in the community: a systematic review and narrative synthesis

BACKGROUND

Malnutrition negatively impacts on health, quality of life and disease outcomes in older adults. The reported factors associated with, and determinants of malnutrition, are inconsistent between studies. These factors may vary according to differences in rate of ageing. This review critically examines the evidence for the most frequently reported sociodemographic factors and determinants of malnutrition and identifies differences according to rates of ageing.

METHODS

A systematic search of the PubMed Central and Embase databases was conducted in April 2019 to identify papers on ageing and poor nutritional status. Numerous factors were identified, including factors from demographic, food intake, lifestyle, social, physical functioning, psychological and disease-related domains. Where possible, community-dwelling populations assessed within the included studies (N = 68) were categorised according to their ageing rate: 'successful', 'usual' or 'accelerated'.

RESULTS

Low education level and unmarried status appear to be more frequently associated with malnutrition within the successful ageing category. Indicators of declining mobility and function are associated with malnutrition and increase in severity across the ageing categories. Falls and hospitalisation are associated with malnutrition irrespective of rate of ageing. Factors associated with malnutrition from the food intake, social and disease-related domains increase in severity in the accelerated ageing category. Having a cognitive impairment appears to be a determinant of malnutrition in successfully ageing populations whilst dementia is reported to be associated with malnutrition within usual and accelerated ageing populations.

CONCLUSIONS

This review summarises the factors associated with malnutrition and malnutrition risk reported in community-dwelling older adults focusing on differences identified according to rate of ageing. As the rate of ageing speeds up, an increasing number of factors are reported within the food intake, social and disease-related domains; these factors increase in severity in the accelerated ageing category. Knowledge of the specific factors and determinants associated with malnutrition according to older adults' ageing rate could contribute to the identification and prevention of malnutrition. As most studies included in this review were cross-sectional, longitudinal studies and meta-analyses comprehensively assessing potential contributory factors are required to establish the true determinants of malnutrition.

Association of early-life undernutrition and risk of dyslipidemia in adulthood: a population-based cohort study

BACKGROUND

The association of early-life undernutrition and dyslipidemia found in previous studies may be confounded by the uncontrolled age difference between exposed and unexposed participants. The study aimed to investigate the association of early-life undernutrition and the risk of dyslipidemia in adulthood with good control of the age variable.

METHODS

We took the Great Chinese Famine (1959-1961) as a natural experiment of severe undernutrition. This study was based on the baseline investigation of a population-based cohort in rural China. Undernutrition in early life was defined as being exposed to famine at younger than 3 years of age. Three approaches including Adjustment, Restriction, and Matching were applied to control the confounding effect of age. Logistic regression models were applied to evaluate the association between early-life famine and the presence of dyslipidemia. Stratified analysis by gender was also performed, and potential effect modification was tested by adding the interaction term of the famine exposure variable and gender into the model.

RESULTS

Undernutrition in early life was associated with increased risk of borderline high and above (BHA) levels of total cholesterol (TC, OR_Adjustment = 1.61; OR_Restriction = 1.56; OR_Matching = 1.87), triglycerides (TG, OR_Adjustment = 1.33; OR_Restriction = 1.30; OR_Matching = 1.34), low-density lipoprotein cholesterol (LDL-C, OR_Adjustment = 1.75; OR_Restriction = 1.53; OR_Matching = 1.77) and dyslipidemia (OR_Adjustment = 1.52; OR_Restriction = 1.45; OR_Matching = 1.60), as well as high levels of TC, TG, LDL-C and dyslipidemia. An inverse association of undernutrition and risk of low high-density lipoprotein cholesterol (HDL-C) was found. Female participants with undernutrition experience had an increased risk of BHA TG and LDL-C (TG: OR_{Adjustment, female} = 1.45; OR_{Restriction, female} = 1.39; OR_{Matching, female} = 1.51; LDL-C: OR_{Adjustment, female} = 2.11; OR_{Restriction, female} = 1.80; OR_{Matching, female} = 2.15), but this association was not found in males.

CONCLUSION

Early-life undernutrition increased the risk of TC, TG, LDL-C, and dyslipidemia. Gender would significantly modify this effect for TG and LDL-C. These results emphasize the importance of nutritional conditions in the early stages of life to long-term health consequences.

Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya

BACKGROUND

Undernourished children in low- and middle-income countries remain at elevated risk of death following hospital discharge, even when treated during hospitalisation using World Health Organisation recommended guidelines. The role of community health workers (CHWs) in supporting post-discharge recovery to improve outcomes has not been adequately explored.

METHODS

This paper draws on qualitative research conducted as part of the Childhood Acute Illnesses and Nutrition (CHAIN) Network in Bangladesh and Kenya. We interviewed family members of 64 acutely ill children admitted across four hospitals (a rural and urban hospital in each country). 27 children had severe wasting or kwashiorkor on admission. Family members were interviewed in their homes soon after discharge, and up to three further times over the following six to fourteen months. These data were supplemented by observations in facilities and homes, key informant interviews with CHWs and policy makers, and a review of relevant guidelines.

RESULTS

Guidelines suggest that CHWs could play a role in supporting recovery of undernourished children post-discharge, but the mechanisms to link CHWs into post-discharge support processes are not specified. Few families we interviewed reported any interactions with CHWs post-discharge, especially in Kenya, despite our data suggesting that opportunities for CHWs to assist families post-discharge include providing context sensitive information and education, identification of danger signs, and supporting linkages with community-based services and interventions. Although CHWs are generally present in communities, challenges they face in conducting their roles include unmanageable workloads, few incentives, lack of equipment and supplies and inadequate support from supervisors and some community members.

CONCLUSION

A multi-pronged approach before or on discharge is needed to strengthen linkages between CHWs and children vulnerable to poor outcomes, supported by clear guidance. To encourage scale-ability and cost-effectiveness of interventions, the most vulnerable, high-risk children, should be targeted, including undernourished children. Intervention designs must also take into account existing health worker shortages and training levels, including for CHWs, and how any new tasks or personnel are incorporated into hospital and broader health system hierarchies and systems. Any such interventions will need to be evaluated in carefully designed studies, including tracking for unintended consequences.

Spatial patterns and determinants of undernutrition among late-adolescent girls in Ethiopia by using Ethiopian demographic and health surveys, 2000, 2005, 2011 and 2016: a spatial and multilevel analysis

Background

Undernutrition among late-adolescent girls (15–19 years) in Ethiopia is the highest among Southern and Eastern African countries. However, the spatial variation of undernutrition as a national context is not well understood in Ethiopia. This study aimed at the spatial patterns and determinants of undernutrition among late-adolescent girls in Ethiopia.

Methods

Secondary data analysis was conducted from women’s data of four consecutive Ethiopian Demographic and Health Surveys (EDHS) from 2000 to 2016. A total of 12,056 late-adolescent girls were included in this study. The global spatial autocorrelation was assessed using the Global Moran’s I autocorrelation to evaluate the presence of geographical clustering and variability of undernutrition. SaTScan cluster analysis by using the Bernoulli model to detect most likely SaTScan cluster areas of significant high-rate and low-rate of undernutrition was explored. A Multilevel binary logistic regression model with cluster-level random effects was fitted to determine factors associated with undernutrition among late-adolescent girls in Ethiopia.

Results

Undernutrition was clustered nationally during each survey (Global Moran’s I = 0.009–0.045, Z-score = 5.55–27.24, p-value < 0.001). In the final model, individual and community level factors accounted for about 31.02% of the regional variations for undernutrition. The odds of undernutrition among 18–19 years of adolescent girls, was 57% (AOR = 0.43; 95% CI: (0.35–0.53) lower than those 15–17 years old. Late-adolescent girls with higher educational status were 4.40 times (AOR = 4.40; 95% CI: (1.64–11.76) more likely to be undernourished than those with no educational status. The odds of undernutrition among late-adolescent girls, with the occupation of sales, was 40% (AOR = 0.60; 95% CI: 0.43–0.84) lower than those with not working adolescents. The odds of undernutrition, among late-adolescent girls, having an unimproved latrine type, was 1.79 times (AOR = 1.79; 95% CI: 1.15–2.79) higher than those participants with improved latrine type. The odds of undernutrition among late-adolescent girls with rural residents was 2.33 times higher (AOR = 2.33; 95% CI: 1.29–4.22) than those with urban residents.

Conclusion

Undernutrition among late-adolescent girls was spatially clustered in Ethiopia. The local significant clusters with high prevalence of undernutrition was observed in Northern and Eastern Ethiopia. Those regions with a high prevalence of undernutrition should design interventions to combat undernutrition.

Behavioral consequences of postnatal undernutrition and enriched environment during later life

In rat models, large litter groups during suckling are used in the study of undernutrition. Large litter sizes are known to promote alterations in memory processes and anxiety-like behavior. Nevertheless, the effect of large litter size on sexual behavior and the reproductive system is still unknown. Environmental enrichment has been reported to (EE) enhance behavior and to correct some of the alterations produced by postnatal undernutrition. We used the Elevated Plus Maze (EPN), Morris Water Maze (MWM), Object Recognition test (OR) and several parameters of sexual behavior to determine the effect of large litter size on rats exposed to enriched and non-enriched environments. Newborn Wistar rats of both sexes were assigned to be suckled under lactation conditions, in litters of 8 pups or 16 pups. The large litter size (16 pups) caused a reduction in weight gain during the lactation period. On PND 45, four experimental groups were established for both sexes: Well-nourished Non-enriched (WN); Well-nourished Enriched (WE); undernourished Non-enriched (UN); Undernourished Enriched (UE). On PND 90, the UN males spent more time in the open arms on EPM. On PND 100, the UE females increased the latency to find the platform in training days (D1-4) in MWM. On probe day (D5) the UE males spent more time in the target quadrants in MWM. On PND 110, irrespective of EE the large litter size had increased the exploration time in both groups (UN) and (UE) in OR test. On PND 120, the performance of sexual behavior was more evident by effect of EE irrespective of the litter size. In conclusion, the large litter size showed no effects on sexual behavior, in contrast, EE has a sharp influence on sexual behavior. Conversely, memory processes and anxiety-like behavior are altered by large litter size.

Determinants of stunting and wasting in street children in Northwest Ethiopia: A community-based study

OBJECTIVE

This study aimed to identify determinant factors of stunting and wasting in street children ages 5 to 18 y in Northwest Ethiopia.

MATERIALS AND METHODS

A community-based cross-sectional study design was employed. An interviewer-administered, structured, and pretested questionnaire was used to collect the data. A convenience sampling technique was used to recruit participants. Stunting and wasting were defined as having a height-for-age and weight-for-height Z score of less than -2 SDs, respectively. Both bivariable and multivariable logistic regression analyses were fitted to identify factors associated with stunting and wasting. A 95% confidence interval (CI) and P < 0.05 were used to declare statistical significance.

RESULTS

The overall prevalence of stunting and wasting was 46.4% (95% CI: 41.6-51.5%) and 15.3 % (95% CI: 11.7-19.0%), respectively. Age (adjusted odds ratio [AOR] = 0.18, 95% CI: 0.08, 0.47), substance use (AOR = 2.07, 95% CI: 1.33, 3.21), and loss of appetite (AOR = 2.00, 95% CI: 1.31, 3.04) were independently associated with stunting. Whereas age (AOR = 0.49, 95% CI: 0.27, 0.89), illness (AOR = 2.38, 95% CI: 1.27, 4.48), and open defecation (AOR = 2.27, 95% CI: 1.14, 4.51) were factors associated with wasting.

CONCLUSION

Stunting and wasting were found to be critical problems in street children. Age, loss of appetite, and substance use were significantly associated with stunting, whereas child age, illness, and open defecation practice were significantly associated with wasting. Thus, tailored nutritional interventions are urgently required in this population to improve their nutritional status.

Nutritional status and associated factors among community-dwelling elderly

BACKGROUND AND AIMS

Although the ageing of the Cameroonian population is a public health issue in the coming years, the nutritional status of the elderly is unknown. The aim of the study was to assess the nutritional status, health status and associated socio-demographic factors among elderly in Cameroon.

METHODS

A cross-sectional study of 599 elderly (aged ≥ 60) was conducted in urban and rural areas. Several socio-demographic, sanitary, and anthropometric (weight, height, body mass index (BMI), Waist Circumference (WC), Mid-Upper Arm Circumference (MUAC)) data were collected. Nutritional status was defined according to WHO. Multinomial analysis was performed to identify factors associated with nutritional status. The threshold of statistical significance was 5%.

RESULTS

The population, representative of the elderly, was aged 68.9 ± 7.2 years, with sex ratio M/F = 0.93, weight 68.5 ± 14.7 kg, BMI 24.7 ± 5.3, WC 90.1 ± 12.8 cm and MUAC 28.2 ± 5.0 cm. According to BMI, undernutrition was 19.7%, normal status 37.9%, overweight 24.9%, obesity 17.5%. The concordance for undernutrition between BMI and MUAC was weak (kappa = 0.3). In multinomial analysis, only no medication was negatively associated with undernutrition (OR = 0.3). Obesity was positively associated with the urban environment (OR = 4.8) and inactivity (OR = 2.9) and negatively associated with male gender (OR = 0.4), widowed (OR = 0.2), head of household (OR = 0.4), no income (OR = 0.3), one pathology (OR = 0.4), no medication (OR = 0.2), having normal diastolic pressure (OR = 0.2).

CONCLUSIONS

Undernutrition and obesity (more frequent in women, and in urban area) affect 37.2% of the elderly. These nutritional disorders are a public health problem that cannot be ignored.