101
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Heidkamp RA, Kang Y, Chimanya K, Garg A, Matji J, Nyawo M, Craig H, Arimond M, Lyman ALT. Implications of Updating the Minimum Dietary Diversity for Children Indicator for Tracking Progress in the Eastern and Southern Africa Region. Curr Dev Nutr 2020; 4:nzaa141. [PMID: 32935072 PMCID: PMC7478897 DOI: 10.1093/cdn/nzaa141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 01/02/2023] Open
Abstract
Minimum dietary diversity (MDD), a population-level dietary quality indicator, is commonly used across low- and middle-income countries to characterize diets of children aged 6-23 mo. The WHO and UNICEF recently updated the MDD definition from consumption of ≥4 of 7 food groups in the previous 24 h (MDD-7) to ≥5 of 8 food groups (MDD-8), adding a breastmilk group. The implications of this definition change were examined across 14 countries in Eastern and Southern Africa where improving complementary feeding is a policy priority. A lower MDD-8 score was found compared with MDD-7 across all countries; in 3 countries the difference between indicators was >5 percentage points. Country-level variability is driven by differences in breastfeeding rates and dietary diversity score. As countries transition to the new indicator it is important to actively publicize changes and to promote valid interpretation of MDD trends.
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Affiliation(s)
- Rebecca A Heidkamp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Joan Matji
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Mara Nyawo
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Hope Craig
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Andrew L Thorne Lyman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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102
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Association of age of initiation and type of complementary foods with body mass index and weight-for-length at 12 months of age in preterm infants. J Perinatol 2020; 40:1394-1404. [PMID: 32152493 DOI: 10.1038/s41372-020-0637-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess whether in very preterm infants (1) body mass index (BMI) Z-score and weight-for-length (WtFL) Z-score at 1 year of age and (2) head growth from discharge to 1 year are associated with breastfeeding at discharge and the age of onset and type of complementary foods. STUDY DESIGN Observational cohort study. RESULTS Infants started on only ready-made complementary (RMC) feedings at ≤26 weeks adjusted age had the highest adjusted BMI Z-score and WtFL Z-score at 1 year of age. Adjusted change in fronto-occipital circumference was highest in infants either discharged on breastmilk or receiving home-made complementary food with/without RMC (HMM) at ≤26 weeks adjusted age. CONCLUSIONS Infants started on RMC ≤26 weeks adjusted age had the highest BMI Z-score and WtFL Z-score at 1 year. Head growth from discharge to 1 year was highest in infants either discharged on breastmilk or receiving HMM at ≤26 weeks adjusted age.
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103
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Huibers MHW, Kityo C, Boerma RS, Kaudha E, Sigaloff KCE, Balinda SN, Bertagnolio S, Nakanjako R, Mugyenyi P, Calis JCJ, Boele van Hensbroek M, Rinke de Wit TF. Long-term virological outcomes, failure and acquired resistance in a large cohort of Ugandan children. J Antimicrob Chemother 2020; 74:3035-3043. [PMID: 31289811 DOI: 10.1093/jac/dkz266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate long-term virological failure (VF) and drug resistance among HIV-infected Ugandan children on first-line ART. METHODS In a multicentre prospective cohort study, viral load (VL) and drug resistance mutations (DRMs) were investigated at baseline and 6 monthly intervals in children (age ≤ 12 years). VF (two consecutive VLs >1000 copies/mL or death after 6 months of ART) was defined as early VF (0-24 months of ART) or late VF (25-48 months of ART). An active regimen was defined as partially active if the genotypic susceptibility score (GSS) was <3. RESULTS Between 2010 and 2011, 316 children were enrolled. Viral suppression was achieved in 75.8%, 71.5%, 72.6% and 69.2% at 12, 24, 36 and 48 months. VF occurred in 111/286 (38.8%), of which 67.6% was early and 32.4% late VF. Early VF was associated with a partially active regimen at baseline (OR 6.0, 95% CI 1.9-18.5), poor adherence (OR 3.1, 95% CI 1.3-7.4) and immunodeficiency (OR 3.3, 95% CI 1.1-10.2). Late VF was associated with age >3 years (OR 2.5, 95% CI 1.0-6.6) and WHO stage 3/4 (OR 4.2, 95% CI 1.4-13.4). Acquired DRMs were detected in 27.0% before 24 months, versus 14.4% after 24 months (P < 0.001). A total of 92.2% of the children with early VF, versus 56.2% with late VF, had a partially active regimen (P < 0.001). CONCLUSIONS VF rates were high, occurred predominantly in the first 24 months and appeared to increase again in year four. Risk factors and patterns of early VF/DRMs were different from those of late VF/DRMs. Virological control may improve by close monitoring and prompt switching to second-line therapy in the first 24 months. Late VF may be prevented by early start of ART.
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Affiliation(s)
- M H W Huibers
- Global Child Health Group, Emma Children's Hospital, Amsterdam UMC, The Netherlands.,Amsterdam Institute of Global Health Development (AIGHD), Amsterdam, The Netherlands
| | - C Kityo
- Joint Clinical Research Centre (JCRC), Kampala, Uganda
| | - R S Boerma
- Amsterdam Institute of Global Health Development (AIGHD), Amsterdam, The Netherlands
| | - E Kaudha
- Joint Clinical Research Centre (JCRC), Kampala, Uganda
| | - K C E Sigaloff
- Amsterdam Institute of Global Health Development (AIGHD), Amsterdam, The Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - S N Balinda
- Joint Clinical Research Centre (JCRC), Kampala, Uganda
| | - S Bertagnolio
- World Health Organization, HIV/AIDS Department, Geneva, Switzerland
| | - R Nakanjako
- Joint Clinical Research Centre (JCRC), Kampala, Uganda
| | - P Mugyenyi
- Joint Clinical Research Centre (JCRC), Kampala, Uganda
| | - J C J Calis
- Global Child Health Group, Emma Children's Hospital, Amsterdam UMC, The Netherlands.,Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam UMC location AMC, The Netherlands.,Department of Paediatrics and Child Health, College of Medicine, Blantyre, Malawi
| | | | - T F Rinke de Wit
- Amsterdam Institute of Global Health Development (AIGHD), Amsterdam, The Netherlands
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104
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Gama A, Rosado-Marques VÍ, Machado-Rodrigues AM, Nogueira H, MourÃo I, Padez C. Prevalence of overweight and obesity in 3-to-10-year-old children: assessment of different cut-off criteria WHO-IOTF. AN ACAD BRAS CIENC 2020; 92:e20190449. [PMID: 32785443 DOI: 10.1590/0001-3765202020190449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/21/2019] [Indexed: 11/21/2022] Open
Abstract
This study compares the prevalence of overweight and obesity between WHO/IOTF criteria. A total of 17,277 Portuguese children aged 3-10 years old were analysed. The prevalences of overweight-obesity were higher at WHO classification (19.8%-20.7%) than at IOTF classification (8.2%-16.1%), (p<0.001). Agreement between the criteria were substantial for overweight (Kappa= 0.67, p<0.001) and moderate for obesity (Kappa= 0.47, p<0.001). The prevalences ratio for inequality between criteria were greater for boys than for girls and lesser for children aged 6-7 than children aged 8-10 years old. The disparities between the two criteria and the higher overweight obesity prevalences highlight the needs to develop more studies.
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Affiliation(s)
- Augusta Gama
- Departamento de Biologia Animal, Universidade de Lisboa, Lisboa, Portugal
| | - VÍtor Rosado-Marques
- Centro de Investigação em Antropologia e Saúde, Universidade de Coimbra, Coimbra, Portugal
| | | | - Helena Nogueira
- Centro de Investigação em Antropologia e Saúde, Universidade de Coimbra, Coimbra, Portugal
| | - Isabel MourÃo
- Centro de Investigação em Ciência do Desporto, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Cristina Padez
- Centro de Investigação em Antropologia e Saúde, Universidade de Coimbra, Coimbra, Portugal
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105
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Abstract
OBJECTIVE In low- and middle-income countries, undernutrition remains a major risk factor for child growth retardation. In addition, the emergence of obesity in recent years is adding another public health concern in that both stunting and obesity are associated with serious adverse health consequences. This review was designed to evaluate the prevalence of stunting and obesity in Ecuador. DESIGN Electronic databases were searched for articles published through February 2018 reporting the prevalence of stunting and/or obesity. Selected data were subjected to meta-analysis and pooled prevalence and their 95 percentiles (95 % CI) were calculated. SETTING Studies were identified in Medline, Web of Science, CINAHL, Cochrane Database and Ibero-America databases. PARTICIPANTS Population of Ecuador. RESULTS Twenty-three articles were selected according to the inclusion/exclusion criteria of the study. The estimate of pooled prevalence of stunting was 23·2 % (95 % CI 23·3, 23·5) in preschoolers (age < 5 years), but was markedly higher in indigenous and rural communities. Pooled prevalence of obesity was 8·1 % (95 % CI 6·9, 9·3), 10·7 % (95 % CI 9·6, 11·7) and 10·5 % (95 % CI 9·2, 11·8) in preschoolers, school-age children (age: 5-11 years) and adolescent (age: 12-18 years), respectively. In adults (age ≥ 19 years), the rate of obesity was remarkably high as indicated by an overall estimate equal to 44·2 % (95 % CI 43·1, 45·4). CONCLUSIONS This study underlines high levels of stunting among children and obesity among adults in Ecuador, both of which are not equally distributed among the population. The magnitude of this double burden emphasises the need for sustained and targeted interventions.
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106
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Pollifrone MM, Cunningham K, Pandey Rana P, Philbin MM, Manandhar S, Lamsal KP, Mandal RN, Deuja V. Barriers and facilitators to growth monitoring and promotion in Nepal: Household, health worker and female community health volunteer perceptions. MATERNAL AND CHILD NUTRITION 2020; 16:e12999. [PMID: 32657015 PMCID: PMC7507439 DOI: 10.1111/mcn.12999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/29/2022]
Abstract
Growth monitoring and promotion (GMP) is both a service for diagnosing inadequate child growth in its earliest stages and a delivery platform for nutrition counselling. The widespread use of GMP services in developing countries has the potential to substantially reduce persistent child undernutrition through early diagnosis and by linking caregivers and their children to key health and nutrition services. However, researchers have questioned the effectiveness of GMP services, which are frequently undermined by underdeveloped health systems and inconsistent implementation. This analysis examined both supply‐ and demand‐side factors for GMP utility in Nepal from the perspectives of beneficiaries and service providers, particularly focusing on three components of GMP: growth assessment, analysis of growth status and counselling. The most common factors influencing GMP uptake included beneficiaries' perceptions of the relative importance of GMP and the knowledge and skill of frontline workers. Both providers and beneficiaries viewed GMP as a secondary health and nutrition activity and therefore less important than curative services. We found deficits in GMP‐related knowledge and skills among providers (i.e. health workers and female community health volunteers), as well as indications of poor training quality and coverage. Furthermore, we found variation in GMP utilization by maternal age, education and residency (alone, nuclear or extended), as well as household socio‐economic well‐being and rurality. This study is the first to assess factors influencing both beneficiaries and service providers for GMP utilization. Further research is needed to explore the implementation of improved GMP protocols and to evaluate facility‐level implementation barriers.
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Affiliation(s)
- Madeline M Pollifrone
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | | | | | - Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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107
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Andrawes NG, Saker HM, Salah El-Din NY, Abd Elhakim Hussain M. Tissue-inhibitors of metalloproteinase-1 and vascular-endothelial growth-factor in severe haemophilia A children on low dose prophylactic recombinant factor VIII: Relation to subclinical arthropathy. Haemophilia 2020; 26:607-614. [PMID: 32445517 DOI: 10.1111/hae.14041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Subclinical synovitis occur long before clinical haemophilic arthropathy (HA). New biomarkers are needed for early detection of HA. AIM To compare the levels of tissue inhibitors of metalloproteinase-1 (TIMP-1) and vascular endothelial growth factor (VEGF)in severe haemophilia A boys on prophylaxis and on-demand therapy to healthy boys and correlate them with the haemophilia joint health score (HJHS) & the Denver magnetic resonance imaging (MRI) scale; hence, determine their values in early detection of HA. METHODS Haemophilia joint health score, serum TIMP-1, VEGF and Denver MRI score were assessed in 50 boys with severe haemophilia A (31 on prophylactic factor VIII therapy (62%) with a dose of 15 IU/kg/twice weekly) and 50 age-matched healthy boys. RESULTS Boys with severe haemophilia A had significantly higher TIMP-1 240 ng/mL, SD200-350 (P < .001) and VEGF 600 pg/mL, SD400-1100 (P < .001). Their mean HJHS was 4.5 ± 3.0 (0-11) and their mean Denver MRI score was 5.55 ± 1.6 (2.00-8.00). A significant positive correlation was found between TIMP-1 and VEGF (P < .001), BMI Z-score (P = .029), HJHS (P = .041)and total MRI score (<.001). Significant correlations were found between VEGF and age (P < .001), HJHS (P = .003) and total MRI score (P < .001). Boys with severe haemophilia A on prophylaxis therapy had significantly lower HJHS (P = .021), VEGF (P < .001), TIMP-1 (P = .002) and total MRI score (P = .021) than those on on-demand therapy. Receiver operating characteristic curve, defined a cut-off value of 160 ng/mL for TIMP-1 with a sensitivity of 90% and specificity of 60% and that of 350 pg/mL for VEGF with a sensitivity of 78% and specificity of 88% for discrimination between severe haemophilia A and healthy boys. CONCLUSION Vascular endothelial growth factor and TIMP-1 can be used for early detection of HA. Further prospective studies should include larger study populations. In addition, studies should address the role of various anti-VEGFs as potential therapy for HA and their impact on prevention and treatment of HA.
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Affiliation(s)
| | - Hossam Mousa Saker
- Radiology Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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108
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Baptista Menezes AM, Oliveira PD, Wehrmeister FC, Anselmi L, Gonçalves H, Martorell R, Black RE, Barros FC, Victora CG. Associations between growth from birth to 18 years, intelligence, and schooling in a Brazilian cohort. Am J Clin Nutr 2020; 112:187-194. [PMID: 32239193 PMCID: PMC7326584 DOI: 10.1093/ajcn/nqaa047] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/24/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Growth faltering in the first 1000 d is associated with lower human capital among adults. The existence of a second window of opportunity for nutritional interventions during adolescence has been postulated. OBJECTIVES We aimed to verify the associations between growth from birth to 18 y and intelligence and schooling in a cohort. METHODS A total of 5249 hospital-born infants in Pelotas, Brazil, were enrolled during 1993. Follow-up visits to random subsamples took place at 6, 12, and 48 mo and to the full cohort at 11, 15, and 18 y. Weight and length/height were collected in all visits. The Wechsler Adult Intelligence Scale was applied at age 18 y, and primary school completion was recorded. Conditional length/height and conditional BMI were calculated and expressed as z scores according to the WHO Growth Standards. These express the difference between observed and expected size at a given age based on a regression that includes earlier anthropometric measures. Analyses were adjusted for income, parental education, maternal skin color and smoking, and breastfeeding duration. RESULTS In the adjusted analyses, participants with conditional length ≥1 z score at 1 y had mean intelligence quotient (IQ) scores at 18 y 4.50 points (95% CI: 1.08, 7.92) higher than those with conditional length ≤-1 at 1 y. For height-for-age at 4 y, this difference was equal to 3.70 (95% CI: 0.49, 6.90) IQ points. There were no associations between conditional height at 11, 15, or 18 y and IQ. For the same previously mentioned comparison, the prevalence ratio for less than primary schooling was 1.42 (95% CI: 1.12, 1.80) for conditional height at 1 y. There were no consistent associations with conditional BMI. CONCLUSIONS Our findings show that adolescent growth is not associated with intelligence and schooling, and are consistent with the literature on the associations between intelligence and schooling and early linear growth.
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Affiliation(s)
| | - Paula D Oliveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Luciana Anselmi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Robert E Black
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fernando C Barros
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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109
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McLaren S, Steenkamp L, McCarthy HD, Rutishauser-Perera A. Screening for overweight using mid-upper arm circumference (MUAC) among children younger than two years in the Eastern Cape, South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2020. [DOI: 10.1080/16070658.2020.1782027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Shawn McLaren
- Dietetics Department, Nelson Mandela University, Port Elizabeth, South Africa
- School of Human Sciences, London Metropolitan University, London, United Kingdom
| | - Liana Steenkamp
- HIV & AIDS Research Unit, Nelson Mandela University, Port Elizabeth, South Africa
| | - H David McCarthy
- Dietetics Department, Nelson Mandela University, Port Elizabeth, South Africa
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110
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Ceratto S, Savino F, Vannelli S, De Sanctis L, Giuliani F. Growth Assessment in Preterm Children from Birth to Preschool Age. Nutrients 2020; 12:nu12071941. [PMID: 32629786 PMCID: PMC7400378 DOI: 10.3390/nu12071941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 11/17/2022] Open
Abstract
Preterm infant growth is a major health indicator and needs to be monitored with an appropriate growth curve to achieve the best developmental and growth potential while avoiding excessive caloric intake that is linked to metabolic syndrome and hypertension later in life. New international standards for size at birth and postnatal growth for preterm infants are available and need implementation in clinical practice. A prospective, single center observational study was conducted to evaluate the in-hospital and long-term growth of 80 preterm infants with a mean gestational age of 33.3 ± 2.2 weeks, 57% males. Size at birth and at discharge were assessed using the INTERGROWTH-21ST standards, at preschool age with World Health Organization (WHO) child growth standards. The employment of INTERGROWTH-21ST Preterm Postnatal longitudinal standards during the in-hospital follow-up significantly reduced the diagnosis of short term extrauterine growth restriction when compared to commonly used cross sectional neonatal charts, with significant lower loss of percentiles between birth and term corrected age (p < 0.0001). The implementation of a package of standards at birth, preterm postnatal growth standards and WHO child growth standards proved to be consistent, with correlation between centile at birth and at follow-up, and therefore effective in monitoring growth in a moderate and late preterm infant cohort without chronic or major morbidities. Infants identified as small for gestational age at birth showed significantly more frequently a need for auxological referral.
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Affiliation(s)
- Simone Ceratto
- Postgraduate School of Pediatrics, University of Torino, 10126 Turin, Italy;
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, 13875 Ponderano (Biella), Italy
| | - Francesco Savino
- Early Infancy Special Care Unit, Regina Margherita Children Hospital, A.O.U. Città della Salute e della Scienza di Torino, 10126 Torino, Italy;
| | - Silvia Vannelli
- Pediatric Endocrinology and Diabetology Unit, Regina Margherita Children Hospital, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.V.); (L.D.S.)
| | - Luisa De Sanctis
- Pediatric Endocrinology and Diabetology Unit, Regina Margherita Children Hospital, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.V.); (L.D.S.)
- Pediatric Endocrinology, Department of Public Health and Pediatric Sciences, University of Torino, 10124 Torino, Italy
| | - Francesca Giuliani
- Early Infancy Special Care Unit, Regina Margherita Children Hospital, A.O.U. Città della Salute e della Scienza di Torino, 10126 Torino, Italy;
- Correspondence:
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111
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Stagi S, Papacciuoli V, Boiro D, Maggioli C, Ndambao NN, Losi S, Chiappini E, Toni S, Ndiaye O. Auxological and endocrinological features in internationally adopted children. Ital J Pediatr 2020; 46:82. [PMID: 32522220 PMCID: PMC7288436 DOI: 10.1186/s13052-020-00832-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/11/2020] [Indexed: 01/17/2023] Open
Abstract
In internationally adopted children disorders of linear growth, puberty development, thyroid function, and bone metabolism are frequently reported. It is important that these children receive careful auxological and endocrinological evaluations and follow-up.Pediatricians and other healthcare providers should be aware that auxological and endocrinological problems are common in newly arrived international adoptees.
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Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Valeria Papacciuoli
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Djibril Boiro
- Service Universitaire de Pediatrie, UCAD, Dakar, Senegal
| | - Chiara Maggioli
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | | | - Stefania Losi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Elena Chiappini
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Sonia Toni
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Ousmane Ndiaye
- Service Universitaire de Pediatrie, UCAD, Dakar, Senegal
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112
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Zupanič N, Hristov H, Gregorič M, Blaznik U, Delfar N, Koroušić Seljak B, Ding EL, Fidler Mis N, Pravst I. Total and Free Sugars Consumption in a Slovenian Population Representative Sample. Nutrients 2020; 12:nu12061729. [PMID: 32526954 PMCID: PMC7352580 DOI: 10.3390/nu12061729] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 01/09/2023] Open
Abstract
Excessive free sugars consumption is associated with poor health outcomes. Thus, the World Health Organization (WHO) recommends limiting free sugars intake to no more than 10% of total energy intake. To evaluate current intakes of dietary sugars and monitor the adherence to the guidelines, the objective of this study was to comprehensively assess total and free sugars consumption of different age groups within the Slovenian population. The Slovenian national food consumption survey SI.Menu 2017/18 was conducted on representative samples of adolescents (10–17 years), adults (18–64 years), and the elderly (65–74 years) using two non-consecutive 24-h dietary recalls. The analyses were carried out on a sample of 1248 study participants. Free sugars content in food was estimated based on previously established databases. The population weighted median free sugars intake accounted for 10.1% of total energy intake (TEI) among adolescents, 6.4% among adults, and 6.5% in the elderly population. Both total and free sugars consumption in the percentage of TEI were higher among women than men, in participants with lower education, and those with higher family net income. The main sources of free sugars in adolescents were beverages, cakes, muffins, pastry, and dairy products; for adults and the elderly, the key sources of free sugars were beverages, cakes, muffins, pastry, and sugars, honey, and related products. A total of 56% of adolescents, 84% of adults, and 81% of the elderly population adhered to the WHO free sugars guidelines. Additional measures will be required to further decrease free sugars consumption among the teenage population, in which dietary patterns are still of greatest concern.
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Affiliation(s)
- Nina Zupanič
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia; (N.Z.); (H.H.)
- Department of Food Science and Technology, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia
| | - Hristo Hristov
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia; (N.Z.); (H.H.)
| | - Matej Gregorič
- National Institute of Public Health, Trubarjeva 2, SI-1000 Ljubljana, Slovenia; (M.G.); (U.B.); (N.D.)
| | - Urška Blaznik
- National Institute of Public Health, Trubarjeva 2, SI-1000 Ljubljana, Slovenia; (M.G.); (U.B.); (N.D.)
| | - Nataša Delfar
- National Institute of Public Health, Trubarjeva 2, SI-1000 Ljubljana, Slovenia; (M.G.); (U.B.); (N.D.)
| | | | - Eric L. Ding
- Department of Nutrition, Harvard Chan School of Public Health, Boston, MA 02115, USA;
| | - Nataša Fidler Mis
- Department of Gastroenterology, Hepatology and Nutrition, University Children’s Hospital, University Medical Centre Ljubljana, Bohoričeva ulica 22a, SI-1000 Ljubljana, Slovenia;
| | - Igor Pravst
- Nutrition Institute, Tržaška cesta 40, SI-1000 Ljubljana, Slovenia; (N.Z.); (H.H.)
- Department of Food Science and Technology, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia
- VIST—Higher School of Applied Sciences, Gerbičeva cesta 51A, SI-1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-590-68871; Fax: +386-310-07981
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Misclassification of stunting, underweight and wasting in children 0-5 years of South Asian and Dutch descent: ethnic-specific v. WHO criteria. Public Health Nutr 2020; 23:2078-2087. [PMID: 32476641 PMCID: PMC7358702 DOI: 10.1017/s1368980019004464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Several authors have questioned the suitability of WHO Child Growth Standards (WHO-CGS) for all ethnic groups. The aim of this study was to identify potential misclassification of stunting, underweight and wasting in children of Surinamese Asian Indian, South Asian (Pakistan/India) and Dutch descent. DESIGN A series of routine cross-sectional measurements, collected 2012-2015. South Asian-specific normative growth references for weight-for-age and weight-for-length/height were constructed using the LMS method based on historic growth data of Surinamese Asian Indians born between 1974 and 1976. WHO-CGS and ethnic-specific references were applied to calculate z-scores and prevalence of stunting, underweight and wasting. SETTING Youth HealthCare, providing periodical preventive health check-ups. PARTICIPANTS 11 935 children aged 0-5 years. RESULTS Considerable deviations from WHO-CGS were found, with higher-than-expected stunting rates, especially in the first 6 months of life. Surinamese Asian Indian children showed stunting rates up to 16·0 % and high underweight and wasting over the whole age range (up to 7·2 and 6·7 %, respectively). Dutch children consistently had mean WHO-CGS z-scores 0·3-0·5 sd above the WHO baseline (>6 months). The application of ethnic-specific references showed low rates for all studied indicators, although South Asian children were taller and larger than their Surinamese Asian Indian counterparts. CONCLUSIONS WHO-CGS misclassify a considerable proportion of children from all ethnic groups as stunted in the first 6 months of life. Underweight and wasting are considerably overestimated in Surinamese Asian Indian children. Ethnic-specific growth references are recommended for Surinamese Asian Indian and Dutch children. The considerable differences found between South Asian subpopulations requires further research.
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Crevier‐Sorbo G, Brunette‐Clément T, Medawar E, Mathieu F, Morgan BR, Hachem L, Fallah A, Weil AG, Ibrahim GM. Assessment and treatment of childhood epilepsy in Haiti. Epilepsia Open 2020; 5:190-197. [PMID: 32524044 PMCID: PMC7278551 DOI: 10.1002/epi4.12384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/23/2019] [Accepted: 02/13/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The global burden of pediatric epilepsy is disproportionately concentrated in low- and middle-income countries (LMICs). However, little is known about the effectiveness of current treatment programs in this setting. We present the outcomes of children who were assessed and treated at the Clinique D'Épilepsie de Port-au-Prince (CLIDEP), the only pediatric epilepsy referral center in Haiti. METHODS A 10-year retrospective review of children consecutively assessed and treated at CLIDEP was performed. The primary outcome was seizure control following treatment for epilepsy. The secondary outcome was an accurate determination of the diagnosis of epilepsy. A data-driven principle component regression (PCR) analysis was used to identify variables associated with outcomes of interest. RESULTS Of the 812 children referred for evaluation, most children (82%) underwent electroencephalography to investigate a possible epilepsy diagnosis. Very few children (7%) underwent cranial imaging. Although many patients were lost to follow-up (24%), most children who returned to clinic had less frequent seizures (51%) and compliance with medication was relatively high (79%). Using PCR, we identified a patient phenotype that was strongly associated with poor seizure control which had strong contributions from abnormal neurological examination, higher number of antiepileptic drugs, comorbid diagnoses, epileptic encephalopathy or epilepsy syndrome, and developmental delay. Head circumference also contributed to epilepsy outcomes in Haiti with smaller head sizes being associated with a poor seizure outcome. A dissociable phenotype of febrile seizures, suspected structural abnormality, epileptic encephalopathy or epilepsy syndrome, and higher seizure frequency was associated with a diagnosis of epilepsy. SIGNIFICANCE We describe the current landscape of childhood epilepsy in Haiti with an emphasis on diagnosis, treatment and outcomes. The findings provide evidence for the effectiveness of programs aimed at the diagnosis and management of epilepsy in LMICs and may inform the allocation of resources and create more effective referral structures.
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Affiliation(s)
| | | | - Edgar Medawar
- Faculty of MedicineMcGill UniversityMontrealQCCanada
| | - Francois Mathieu
- Division of NeurosurgeryDepartment of SurgeryUniversity of TorontoTorontoONCanada
| | | | - Laureen Hachem
- Division of NeurosurgeryDepartment of SurgeryUniversity of TorontoTorontoONCanada
| | - Aria Fallah
- Department of NeurosurgeryUCLA Mattel Children's HospitalDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Alexander G. Weil
- Faculty of MedicineUniversity of MontrealMontrealQCCanada
- Division of NeurosurgerySte Justine HospitalMontrealQCCanada
| | - George M. Ibrahim
- Division of NeurosurgeryDepartment of SurgeryUniversity of TorontoTorontoONCanada
- Division of NeurosurgeryHospital for Sick ChildrenTorontoONCanada
- Institute of Biomaterials and Biomedical EngineeringUniversity of TorontoTorontoONCanada
- Institute of Medical ScienceUniversity of TorontoTorontoONCanada
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The Gluten Free Diet's Impact on Growth in Children with Celiac Disease in Two Different Countries. Nutrients 2020; 12:nu12061547. [PMID: 32466557 PMCID: PMC7352316 DOI: 10.3390/nu12061547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 01/12/2023] Open
Abstract
The effects of gluten free diet (GFD) on body mass index (BMI) and growth parameters in pediatric patients with celiac disease (CD) and their dependence on different socio-cultural environments are poorly known. We conducted an international retrospective study on celiac patients diagnosed at the University of Verona, Italy, and at the University of Chicago, Chicago, IL, USA, as underweight. A total of 140 celiac children and 140 controls (mean age 8.4 years) were enrolled in Chicago; 125 celiac children and 125 controls (mean age 7.3 years, NS) in Verona. At time of diagnosis, Italian celiac children had a weight slightly lower (p = 0.060) and a BMI z-score significantly (p < 0.001) lower than their American counterparts. On GFD, Italian celiac children showed an increased prevalence of both underweight (19%) as well as overweight (9%), while American children showed a decrease prevalence of overweight/obese. We concluded that while the GFD had a similar impact on growth of celiac children in both countries, the BMI z-score rose more in American than in Italian celiac children. Additionally, in Italy, there was an alarming increase in the proportion of celiac children becoming underweight. We speculate that lifestyle and cultural differences may explain the observed variations.
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Turesky T, Xie W, Kumar S, Sliva DD, Gagoski B, Vaughn J, Zöllei L, Haque R, Kakon SH, Islam N, Petri WA, Nelson CA, Gaab N. Relating anthropometric indicators to brain structure in 2-month-old Bangladeshi infants growing up in poverty: A pilot study. Neuroimage 2020; 210:116540. [PMID: 31945509 PMCID: PMC7068701 DOI: 10.1016/j.neuroimage.2020.116540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/06/2019] [Accepted: 01/10/2020] [Indexed: 01/03/2023] Open
Abstract
Anthropometric indicators, including stunting, underweight, and wasting, have previously been associated with poor neurocognitive outcomes. This link may exist because malnutrition and infection, which are known to affect height and weight, also impact brain structure according to animal models. However, a relationship between anthropometric indicators and brain structural measures has not been tested yet, perhaps because stunting, underweight, and wasting are uncommon in higher-resource settings. Further, with diminished anthropometric growth prevalent in low-resource settings, where biological and psychosocial hazards are most severe, one might expect additional links between measures of poverty, anthropometry, and brain structure. To begin to examine these relationships, we conducted an MRI study in 2-3-month-old infants growing up in the extremely impoverished urban setting of Dhaka, Bangladesh. The sample size was relatively small because the challenges of investigating infant brain structure in a low-resource setting needed to be realized and resolved before introducing a larger cohort. Initially, fifty-four infants underwent T1 sequences using 3T MRI, and resulting structural images were segmented into gray and white matter maps, which were carefully evaluated for accurate tissue labeling by a pediatric neuroradiologist. Gray and white matter volumes from 29 infants (79 ± 10 days-of-age; F/M = 12/17), whose segmentations were of relatively high quality, were submitted to semi-partial correlation analyses with stunting, underweight, and wasting, which were measured using height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) scores. Positive semi-partial correlations (after adjusting for chronological age and sex and correcting for multiple comparisons) were observed between white matter volume and HAZ and WAZ; however, WHZ was not correlated with any measure of brain volume. No associations were observed between income-to-needs or maternal education and brain volumetric measures, suggesting that measures of poverty were not associated with total brain tissue volume in this sample. Overall, these results provide the first link between diminished anthropometric growth and white matter volume in infancy. Challenges of conducting a developmental neuroimaging study in a low-resource country are also described.
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Affiliation(s)
- Ted Turesky
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Wanze Xie
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Swapna Kumar
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Danielle D Sliva
- Department of Neuroscience, Brown University, Providence, RI, United States
| | - Borjan Gagoski
- Department of Radiology, Harvard Medical School, Boston, MA, United States; Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States
| | - Jennifer Vaughn
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Lilla Zöllei
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
| | - Rashidul Haque
- The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Nazrul Islam
- National Institute of Neuroscience and Hospital, Dhaka, Bangladesh
| | - William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Charles A Nelson
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Harvard Graduate School of Education, Cambridge, MA, United States
| | - Nadine Gaab
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Al-Qerem WA. How applicable are GLI 2012 equations to a sample of Middle Eastern school-age children? Pediatr Pulmonol 2020; 55:986-993. [PMID: 32068349 DOI: 10.1002/ppul.24685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/03/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Global Lung Function Initiative attempted to formulate global all-age lung function equations. The suitability of these equations to Middle Eastern children was never evaluated; this study will evaluate these equations in addition to other regional ones. METHODS Spirometry was conducted for 582 (311 boys) healthy 6- to 13-year-old Jordanian children. z scores, predicted values, percent predicted values, and frequency of records below lower limit than normal (LLN) were calculated for each child using the studied equations. RESULTS Although none of the studied equations produced a perfect representation of the study data, the GLI 2012 equations for Caucasians were the most suitable. CONCLUSION GLI 2012 equations for Caucasians are a reasonable fit for Jordanian school-aged children.
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Kahssay M, Woldu E, Gebre A, Reddy S. Determinants of stunting among children aged 6 to 59 months in pastoral community, Afar region, North East Ethiopia: unmatched case control study. BMC Nutr 2020; 6:9. [PMID: 32153979 PMCID: PMC7050729 DOI: 10.1186/s40795-020-00332-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 02/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background Stunting is defined as a child with a height for-age Z-score less than minus two standard deviations. Globally, 162 million less than 5 years were stunted. In Ethiopia, Nationally the prevalence of stunting among under five children was 38.4% and in Afar it is above the national average (41.1%). This study was aimed to identify determinants of stunting among children aged 6 to 59 months in rural Dubti district, Afar region, North East Ethiopia, 2017. Methods Community based unmatched case-control study design was conducted among 322 (161 cases and 161 controls) children aged 6 to 59 months from March 2-30/ 2017. Simple random method was used to select 5 kebelles from 13 kebelles. Training was given for data collectors and supervisors. Data were entered to EPI data version 3.02 and exported to SPSS version 20 for analysis. Binary logistic regression analysis was used and variables with p-value < 0.25 on univariable binary logistic regression analysis were further analyzed on multivariable binary logistic regression analysis and statistical significance was declared at 95% CI. Results Being from a mother with no education (AOR = 4.92, 95%CI (1.94, 12.4), preceding birth interval less than 24 months (AOR = 4.94, 95% (2.17, 11.2), no ANC follow-up (AOR = 2.81, 95% (1.1.46, 5.38), no access to latrine (AOR =3.26, 95% CI (1.54-6.94), children born from short mother < 150 cm (AOR = 3.75, 95%CI (1.54, 9.18), not fed colostrum (AOR = 4.45, 95% CI (1.68, 11.8), breast fed for less than 24 months (AOR = 3.14, 95% CI (1.7, 5.79) and non-exclusive breast feeding (AOR = 6.68, 95% (3.1, 14.52) were determinants of stunting at 95% CI. Conclusion No maternal education, preceding birth interval less than 24 months, no ANC follow-up, no access to latrine, short maternal height, not feeding colostrum, duration of breast feed less than 24 months and non- exclusive breast feeding were determinants of stunting at 95% CI.
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Affiliation(s)
- Molla Kahssay
- Department of Public Health, College of Medical and Health Sciences, Samara University, Semera, Afar Ethiopia
| | - Etsay Woldu
- Department of Public Health, College of Medical and Health Sciences, Samara University, Semera, Afar Ethiopia
| | - Abel Gebre
- Department of Public Health, College of Medical and Health Sciences, Samara University, Semera, Afar Ethiopia
| | - Surender Reddy
- Department of Public Health, College of Medical and Health Sciences, Samara University, Semera, Afar Ethiopia
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Afolabi BM, Afolabi TM, Ogunwale A, Aiyesetenikan A. A 2-month intervention study of preventive clothing against mosquito bites among malnourished and well-nourished children under 5 years of age living on the Atlantic Ocean Coast of Lagos, Southwest Nigeria. Malar J 2020; 19:61. [PMID: 32024519 PMCID: PMC7003332 DOI: 10.1186/s12936-020-3143-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 01/29/2020] [Indexed: 01/31/2023] Open
Abstract
Background Malnutrition is appreciated as a global leading paediatric burden that indirectly or directly contributes to child mortality. In children, malnutrition has profound effects on health and development; and has been associated with poor outcomes in paediatric diseases. However, it is not clear if malnourished children are at an increased risk of having malaria. This study was conducted to evaluate the risk of malaria infection in children with malnutrition. Methods The study design was pre-post. A protective clothing against mosquitoes (pCAM) was given to 102 under-five children in two coastal communities, after screening for malaria parasitaemia. The children’s weight, height and body temperature were measured at recruitment. Blood was also taken at recruitment and monthly for malaria parasitaemia, haemoglobin concentration and random blood sugar. The parents/care-givers were visited daily for 1 month only, after recruitment, to ensure that the children wore the pCAM daily from 5 pm and the children were followed up monthly for 2 months. Results Of the 102 study participants, 60 (24 males and 36 females) were rapid diagnostic test (RDT)-positive at recruitment, indicating 58.8% prevalence of malaria parasitaemia. The prevalence of malnutrition and of stunting were 32.3% (33/102) and 54.9% (56/102), respectively, while 7.8% (8/108) children were wasted. Twenty (60.6%) of the malnourished children and 30 (53.6%) of those stunted were RDT-positive at recruitment. At the first post-intervention screening, only 7 (31.8%) of the malnourished and 13 (28.9%) of those stunted were RDT-positive. Malnourished and stunted children were 2.57 times and 2.31 times more likely to be malaria infected (OR = 2.57, 95% CI 0.97, 6.79; OR = 2.31, 95% CI 1.01, 5.26 respectively). Malnourished females were 2.72 times more likely to be RDT-positive compared to malnourished males (OR = 2.72, 95% CI 0.54, 11.61) and stunted females were 1.73 times more likely to the positive for malaria parasites than stunted males (OR 1.73, 95% CI 0.59, 5.03). The prevalence of anaemia at recruitment decreased from 82.4 to 69.6% after intervention. The mean haemoglobin concentration (g/dl) at recruitment was significantly lower (P < 0.05) than that at 1st and 2nd post-intervention measurements (9.6 ± 1.4, t = − 3.17, P-value = 0.0009 and 10.2 ± 1.3, t = − 2.64, P-value = 0.004, respectively). Mean random blood sugar (mg/dl) of females (91.8 ± 12.7) was significantly lower (t = 2.83, P-value = 0.003) than that of males (98.5 ± 11.2). Conclusion Results from this study suggest a higher risk of malaria infection among malnourished and lower risks among stunted and wasted children. Females were at a higher risk of malnutrition, stunting and wasting than males. Protective clothing against malaria seemed to reduce malaria infection and improve anaemia status.
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Heidari Z, Feizi A, Rezaei S, Kelishadi R. Local growth charts for an Iranian child population aged 2–5 years in comparison with the World Health Organization Child Growth Standards. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [DOI: 10.1186/s43054-019-0014-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There are no national reference charts in Iran for children aged under five. This study aimed to develop representative growth reference charts of height, weight, and BMI for children aged 2–5 years in Isfahan, Iran, and to compare them with the WHO reference curves.
Results
This population-based study has a combination of longitudinal and cross-sectional design. It included 1325 and 761 healthy children, who were born between 2002 and 2015 in Isfahan, central Iran, in longitudinal and cross-sectional phases. Expert health care providers measured the height and weight of children in health centers. The lambda-mu-sigma method was used to construct the age- and sex-specific growth charts of anthropometric measures. The study sample comprised 1029 boys and 1057 girls. The centiles of height, weight, and BMI of boys were higher than that of girls in all age groups. The weight patterns of studied children were close to those of the WHO references in the lower percentiles. However, our study children, especially girls, were lighter compared with WHO standards based on the middle and upper percentiles of the weight distribution. Compared with WHO standards, boys of our study were taller especially at older ages. The percentiles of the BMI for our study samples were considerably lower than WHO standards.
Conclusion
There are differences between our local growth charts for weight, height, and BMI with WHO standards. The local growth standards could be more precise for assessing growth problems in local and national settings. Due to notable differences between our results with WHO standards, future studies are warranted for constructing nationwide growth charts.
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Wallace A, Price A, Fleischer E, Khoury M, Filler G. Estimation of GFR in Patients With Cystic Fibrosis: A Cross-Sectional Study. Can J Kidney Health Dis 2020; 7:2054358119899312. [PMID: 32002189 PMCID: PMC6966245 DOI: 10.1177/2054358119899312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/06/2019] [Indexed: 01/05/2023] Open
Abstract
Background Patients with cystic fibrosis (CF) have frequent infectious complications requiring nephrotoxic medications, necessitating monitoring of renal function. Although adult studies have suggested that cystatin C (CysC)-based estimated glomerular filtration rate (eGFR) may be preferable due to reduced muscle mass of patients with CF, pediatric patients remain understudied. Objective Our objective was to determine which eGFR formula is best for estimating glomerular filtration rate (GFR) in pediatric patients with CF. Methods A total of 17 patients with CF treated with nephrotoxic antibiotics were recruited from the Children's Hospital at London Health Sciences Centre, London, Ontario, Canada. 99Tc DTPA GFR (measured GFR [mGFR]) was measured with 4-point measurements starting at 120 minutes using a 2-compartmental model with Brøchner-Mortensen correction, with simultaneous measurement of creatinine, urea, and CysC. The eGFR was calculated using 16 known equations based on creatinine, urea, CysC, or combinations of these. Primary outcome measures were correlation with mGFR, and agreement within 10% for various eGFR equations. Results Mean mGFR was 136 ± 21 mL/min/1.73 m2. Mean creatinine, CysC, and urea were 38 ± 10 μmol/L, 0.72 ± 0.08 mg/L, and 3.9 ± 1.4 mmol/L, respectively. The 2014 Grubb CysC eGFR had the best correlation coefficient (r = 0.75, P = .0004); however, only 35% were within 10%. The new Schwartz formula with creatinine and urea had the best agreement within 10%, but a relatively low correlation coefficient (r = 0.63, P = .0065, 64% within 10%). Conclusions Our study suggests that none of the eGFR formulae work well in this small cohort of pediatric patients with CF with preserved body composition, possibly due to inflammation causing false elevations of CysC. Based on the small numbers, we cannot conclude which eGFR formula is best.
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Affiliation(s)
- Andrea Wallace
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - April Price
- Division of Paediatric Respirology, Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Erin Fleischer
- Division of Paediatric Respirology, Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Michael Khoury
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Guido Filler
- Division of Paediatric Nephrology, Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Lilibeth Caberto Kidney Clinical Research Unit, Children's Hospital, London Health Sciences Centre, Western University, ON, Canada.,Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Differences between WHO Growth Standards and China Growth Standards in Assessing the Nutritional Status of Children Aged 0-36 Months Old. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010251. [PMID: 31905868 PMCID: PMC6982135 DOI: 10.3390/ijerph17010251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/21/2019] [Accepted: 12/25/2019] [Indexed: 01/01/2023]
Abstract
Background: At present, whether to use the World Health Organization’s (WHO) growth standards or native growth standards to assess the nutritional status in a given population is unclear. This study aimed to compare the differences between the WHO’s growth standards and China’s growth standards in assessing the nutritional status of children aged 0~36 months. Methods: We used z-scores to evaluate the nutritional status of children. The weight-for-age z-scores (WAZs), length/height-for-age z-scores (LAZ/HAZs), and weight-for-length/height z-scores (WLZ/WHZs) were calculated using the WHO’s growth standards and China’s growth standards. MeNemar’s test was used to compare the nutritional status of children. Results: The results in this study showed that there were differences between the WHO’s standards and China’s standards in assessing children’s nutritional status except for stunting and obesity. The prevalence of underweight assessed using China’s standards was higher than when using the WHO’s standards (except when 3 and 36 months old). The prevalence of wasting was significantly higher when assessed using China’s standards than when using the WHO’s standards from 12 to 36 months. The prevalence of overweight was higher when assessed using the WHO’s standards from 3 to 8 months. Conclusions: Both the WHO’s and China’s growth standards are useful measures in assessing children’s nutritional status but with key significant differences. Therefore, caution should be taken in selecting appropriate measures in a given population.
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Gamal Andrawes N, Hashem Fayek M, Salah El-Din N, Atef Mostafa R. Effect of low-dose factor VIII prophylaxis therapy on bone mineral density and 25(OH) vitamin D level in children with severe haemophilia A. Haemophilia 2019; 26:325-332. [PMID: 31884718 DOI: 10.1111/hae.13917] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Decreased bone mineral density (BMD) is a significant morbidity in haemophilia. Vitamin D is important for the bone health of people with haemophilia. Regular factor VIII prophylaxis can prevent bleeding and arthropathy. AIM To determine the 25(OH) vitamin D level in severe haemophilia A patients and correlate it to their Hemophilia Joint Health Score (HJHS) and dual-energy X-ray absorptiometry (DEXA). We also compared the 25(OH) vitamin D and DEXA in haemophilia A and healthy children and in haemophilia A children on prophylaxis versus on-demand therapy. METHODS Fifty severe haemophilia A patients were compared to 50 age-matched healthy boys. Patients were recruited from the Pediatric Hematology Clinic, Ain Shams University from May 2017 to April 2018. Full medical history was taken with emphasis on frequency of bleeding episodes, duration and amplitude of pain assessed by the pain score. Weight, height, body mass index and HJHS were assessed. 25(OH) vit-D3, calcium, phosphorus and alkaline phosphatase were measured. BMD was assessed using Lunar DEXA, paediatric software. RESULTS People with haemophilia had significantly lower 25(OH) vit-D3 (P < .001) and DEXA z-score (P < .001) than controls. Seventy per cent of patients were on factor VIII prophylaxis twice weekly (15U/kg/dose). Significant difference was found regarding DEXA z-score (P = .012), 25(OH) vit-D3 (P = .033) and HJHS (P = .022) among patients on prophylaxis and on-demand therapy. CONCLUSION Severe haemophilia A patients showed significantly lower 25(OH) vit-D3 and DEXA than controls. Hence, vitamin D deficiency should be tested in all people with haemophilia for early diagnosis and treatment. Low-dose prophylaxis in severe haemophilia preserves BMD and increases vitamin D. Further studies are required to evaluate the effect of different prophylaxis protocols on BMD and haemophilic arthropathy.
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Abstract
This study is a contribution for the improvement of healthcare in children and in society generally. This study aims to predict children’s height when they become adults, also known as “target height”, to allow for a better growth assessment and more personalized healthcare. The existing literature describes some existing prediction methods, based on longitudinal population studies and statistical techniques, which with few information resources, are able to produce acceptable results. The challenge of this study is in using a new approach based on machine learning to forecast the target height for children and (eventually) improve the existing height prediction accuracy. The goals of the study were achieved. The extreme gradient boosting regression (XGB) and light gradient boosting machine regression (LightGBM) algorithms achieved considerably better results on the height prediction. The developed model can be usefully applied by pediatricians and other clinical professionals in growth assessment.
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Nutritional deficiency and associated factors among new pulmonary tuberculosis patients of Bale Zone Hospitals, southeast Ethiopia. BMC Res Notes 2019; 12:751. [PMID: 31744538 PMCID: PMC6862861 DOI: 10.1186/s13104-019-4786-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/05/2019] [Indexed: 12/28/2022] Open
Abstract
Objective Tuberculosis remains deadliest communicable diseases accountable for health problem among various individuals annually and is related to malnutrition. Addressing nutritional deficiency in Tuberculosis patients is a crucial side of tuberculosis management programme. Therefore, the aim was to assess the magnitude of nutritional deficiency and associated factors among new pulmonary tuberculosis patients of Bale Zone Hospitals, south-east Ethiopia, 2018. Cross-sectional study design was utilized. Data collection was carried out using structured questionnaires and anthropometric measurements. Body mass index was calculated to see nutritional deficiency. Crude and adjusted odds ratios in conjunction with their corresponding 95% confidence intervals were computed. p-value < 0.05 was thought of to declare a result as statistically associated. Results Prevalence of nutritional deficiency was 63.2%. The mean Body mass index for all listed participants was 17.86 kg/m2. Employment status of the patients, p-value 0.012 (AOR = 1.82; 95% CI 1.14, 2.89) and Khat chewing, p-value 0.02 (AOR = 0.43; 95% CI 0.23, 0.85) were factors independently associated with nutritional deficiency. Prevalence of nutritional deficiency was found to be high. Nutritional support for the impoverished, regular nutritional assessment and dietary counseling are necessary for better treatment outcome and effective Tuberculosis management programme.
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A big-data approach to producing descriptive anthropometric references: a feasibility and validation study of paediatric growth charts. LANCET DIGITAL HEALTH 2019; 1:e413-e423. [PMID: 33323223 DOI: 10.1016/s2589-7500(19)30149-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Both national and WHO growth charts have been found to be poorly calibrated with the physical growth of children in many countries. We aimed to generate new national growth charts for French children in the context of huge datasets of physical growth measurements routinely collected by office-based health practitioners. METHODS We recruited 32 randomly sampled primary care paediatricians and ten volunteer general practitioners from across the French metropolitan territory who used the same electronic medical records software, from which we extracted all physical growth data for the paediatric patients, with anonymisation. We included measurements from all children born from Jan 1, 1990, and aged 1 month to 18 years by Feb 8, 2018, with birthweight greater than 2500 g, to which an automated process of data cleaning developed to detect and delete measurement or transcription errors was applied. Growth charts for weight and height were derived by using generalised additive models for location, scale, and shape with the Box-Cox power exponential distribution. We compared the new charts to WHO growth charts and existing French national growth charts, and validated our charts using growth data from recent national cross-sectional surveys. FINDINGS After data cleaning, we included 1 458 468 height and 1 690 340 weight measurements from 238 102 children. When compared with the existing French national and WHO growth charts, all height SD and weight percentile curves for the new growth charts were distinctly above those for the existing French national growth charts, as early as age 1 month, with an average difference of -0·75 SD for height and -0·50 SD for weight for both sexes. Comparison with national cross-sectional surveys showed satisfactory calibration, with generally good fit for children aged 5-6 years and 10-11 years in height and weight and small differences at age 14-15 years. INTERPRETATION We successfully produced calibrated paediatric growth charts by using a novel big-data approach applied to data routinely collected in clinical practice that could be used in many fields other than anthropometry. FUNDING The French Ministry of Health; Laboratoires Guigoz-General Pediatrics section of the French Society of Pediatrics-Pediatric Epidemiological Research Group; and the French Association for Ambulatory Pediatrics.
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Beard JR, Jotheeswaran AT, Cesari M, Araujo de Carvalho I. The structure and predictive value of intrinsic capacity in a longitudinal study of ageing. BMJ Open 2019; 9:e026119. [PMID: 31678933 PMCID: PMC6830681 DOI: 10.1136/bmjopen-2018-026119] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence. DESIGN Structural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence. SETTINGS Community, United Kingdom. PARTICIPANTS 2560 eligible participants aged over 60 years. MAIN OUTCOME MEASURES Activities of daily living (ADL) and instrumental activities of daily living (IADL). RESULTS One general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and 'vitality'. This structure is consistent with biological theory and the model had a good fit for the data (χ2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome-root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively-and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity. CONCLUSIONS The WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual's subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.
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Affiliation(s)
- John R Beard
- Department of Ageing and Life Course, World Health Organization, Geneve, Switzerland
- University of New South Wales, Sydney, Australia
| | - A T Jotheeswaran
- Department of Ageing and Life Course, World Health Organization, Geneve, Switzerland
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milano, Italy
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Riedlová J, Paulová M, Vignerová J, Brabec M, Sedlak P, Schneidrová D. The Low Prevalence of Overweight and Obesity in Czech Breastfed Infants and Young Children: An Anthropological Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4198. [PMID: 31671517 PMCID: PMC6862631 DOI: 10.3390/ijerph16214198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 11/25/2022]
Abstract
The aim of this study is to evaluate the prevalence of overweight and obesity in a sample of children who were exclusively or predominantly breastfed for at least 6 months compared to Czech references that were constructed based on a representative sample of children, regardless of their mode of feeding. Between 2008 and 2011, a longitudinal study on the growth of breastfed infants was carried out in the Czech Republic. Forty-three GP pediatricians addressed parents at 18-month preventive examinations and collected data on the families' socio-economic conditions and the infants' feeding conditions. The children were measured (length, weight, and head circumference), and anthropometric measurements from 10 previous preventive examinations were obtained from the health records. Out of the collected 1775 questionnaires, 960 children were selected according to the criteria of the WHO Multicentre Growth Reference Study. For the purpose of this study, 799 children who were exclusively or predominantly breastfed for at least 6 months were selected. We found that the proportions of children who were classified as overweight (>90th percentile) or obese (>97th percentile) at 6, 12, and 18-month examinations were far below the proportions of the Czech references. An update of the Czech references and growth charts is highly recommended by GP pediatricians for the valid assessment of growth and nutritional status, including a screening of overweight and obesity in primary preventive health care.
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Affiliation(s)
- Jitka Riedlová
- Department of Anatomy, Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10, Czech Republic.
| | - Markéta Paulová
- Department of Hygiene of Children and Adolescents, National Institute of Public Health, Šrobárova 48, 100 42 Prague 10, Czech Republic.
| | - Jana Vignerová
- National Lactation Centre, Thomayer Hospital, Vídeňská 800, 140 59 Prague 4, Czech Republic.
| | - Marek Brabec
- Institute of Computer Science, Czech Academy of Sciences, Pod Vodárenskou věží 271/2, 182 00 Prague 8, Czech Republic.
| | - Petr Sedlak
- Division of Child Health Promotion, Department of Hygiene, Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10, Czech Republic.
| | - Dagmar Schneidrová
- Division of Child Health Promotion, Department of Hygiene, Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10, Czech Republic.
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Huang JT, Lu XL, Xiao ZH, Zang P, Gong L, Zhou W, Huang P. [Clinical effect of feeding with calorie-enriched formula in children with ventricular septal defect and severe pneumonia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:998-1004. [PMID: 31642434 PMCID: PMC7389736 DOI: 10.7499/j.issn.1008-8830.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/28/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To study the effect of different energy feeding patterns on the nutritional status, clinical course, and outcome of children with congenital heart disease (CHD) and severe pneumonia. METHODS A total of 43 malnourished infants, aged <6 months, who were diagnosed with ventricular septal defect and severe pneumonia and underwent surgical operation from January 1 to December 30, 2017 were enrolled. They were randomly divided into an observation group with 21 infants and a control group with 22 infants. The infants in the observation group were given calorie-enriched formula milk powder (100 kcal/100 mL) after surgery, and those in the control group were given formula milk powder with normal calories (67 kcal/100 mL). The two groups were observed for 3 months to record physical measurements, laboratory markers and nutritional risk screening results. Nutritional status was evaluated for all infants. The two groups were compared in terms of prognosis and adverse events. RESULTS There were no significant differences between the two groups in physical measurements, laboratory markers, nutritional assessment and nutritional risk screening results on admission (P>0.05). At discharge and 1 and 3 months after surgery, the control group had significantly higher degree of malnutrition and level of nutritional risk than the observation group (P<0.05). The analysis of variance with repeated measures showed significant differences in body weight, upper arm circumference, weight-for-age Z-score, height-for-age Z-score, weight-for-height Z-score, and albumin level at different time points and between different groups, and there was an interaction between group factors and time factors (P<0.05). Compared with the control group, the observation group had a significantly lower average daily intake of fluid, a significantly higher average daily intake of energy, and a significantly lower incidence rate of insufficient feeding during hospitalization (P<0.05). Compared with the control group, the observation group had significantly shorter length of hospital stay, duration of mechanical ventilation, and duration of postoperative pyrexia, as well as significantly lower hospital costs (P<0.05). No significant adverse reactions were observed in either group. CONCLUSIONS An appropriate increase in postoperative energy supply for children with CHD can improve the status of malnutrition and clinical outcome.
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Affiliation(s)
- Jiao-Tian Huang
- Department of Critical Care Medicine, Children's Hospital of Hunan Province, Changsha 410007, China.
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130
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Løhmann DJA, Asdahl PH, Abrahamsson J, Ha SY, Jónsson ÓG, Kaspers GJL, Koskenvuo M, Lausen B, De Moerloose B, Palle J, Zeller B, Sung L, Hasle H. Associations between pretherapeutic body mass index, outcome, and cytogenetic abnormalities in pediatric acute myeloid leukemia. Cancer Med 2019; 8:6634-6643. [PMID: 31532076 PMCID: PMC6825997 DOI: 10.1002/cam4.2554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/06/2023] Open
Abstract
Background Associations between body mass index (BMI), outcome, and leukemia‐related factors in children with acute myeloid leukemia (AML) remain unclear. We investigated associations between pretherapeutic BMI, cytogenetic abnormalities, and outcome in a large multinational cohort of children with AML. Methods We included patients, age 2‐17 years, diagnosed with de novo AML from the five Nordic countries (2004‐2016), Hong Kong (2007‐2016), the Netherlands and Belgium (2010‐2016), and Canada and USA (1995‐2012). BMI standard deviations score for age and sex was calculated and categorized according to the World Health Organization. Cumulative incidence functions, Kaplan‐Meier estimator, Cox regression, and logistic regression were used to investigate associations. Results In total, 867 patients were included. The median age was 10 years (range 2‐17 years). At diagnosis, 32 (4%) were underweight, 632 (73%) were healthy weight, 127 (15%) were overweight, and 76 (9%) were obese. There was no difference in relapse risk, treatment‐related mortality or overall mortality across BMI groups. The frequency of t(8;21) and inv(16) increased with increasing BMI. For obese patients, the sex, age, and country adjusted odds ratio of having t(8;21) or inv(16) were 1.9 (95% confidence interval (CI) 1.1‐3.4) and 2.8 (95% CI 1.3‐5.8), respectively, compared to healthy weight patients. Conclusions This study did not confirm previous reports of associations between overweight and increased treatment‐related or overall mortality in children. Obesity was associated with a higher frequency of t(8;21) and inv(16). AML cytogenetics appear to differ by BMI status.
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Affiliation(s)
- Ditte J A Løhmann
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Peter H Asdahl
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Jonas Abrahamsson
- Department of Pediatrics, Institution for Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Shau-Yin Ha
- Department of Pediatrics, Queen Mary Hospital and Hong Kong Pediatric Hematology and Oncology Study Group (HKPHOSG), Hong Kong, China
| | - Ólafur G Jónsson
- Department of Pediatrics, Landspitali University Hospital, Reykjavik, Iceland
| | - Gertjan J L Kaspers
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Dutch Childhood Oncology Group, The Hague, The Netherlands
| | - Minna Koskenvuo
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital and Helsinki University Central Hospital, Helsinki, Finland
| | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Josefine Palle
- Department of Woman's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Bernward Zeller
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Lillian Sung
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus N, Denmark
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Modjadji P, Madiba S. Childhood Undernutrition and Its Predictors in a Rural Health and Demographic Surveillance System Site in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3021. [PMID: 31438531 PMCID: PMC6747220 DOI: 10.3390/ijerph16173021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Overweight and obesity are increasing at an alarming rate in South Africa, while childhood undernutrition remains persistently high. This study determined the magnitude and predictors of stunting and underweight among schoolchildren in the Dikgale and Health Demographic Surveillance System Site, a rural site in South Africa. METHODS A cross sectional study using multistage sampling was conducted among 508 schoolchildren and their mothers. Anthropometric measurements were taken from children and their mothers, while sociodemographic information was obtained from mothers using a questionnaire. The World Health Organization Anthro Plus was used to generate height-for-age and weight-for-age z-scores to indicate stunting and underweight, respectively, among the children. Maternal overweight and obesity were assessed using body mass index. Bivariate and multivariate logistic regression analyses were used to evaluate the predictors of stunting and underweight among schoolchildren. RESULTS Twenty-two percent (22%) of children were stunted and 27% were underweight, while 27.4% of the mothers were overweight and 42.3% were obese. The odds of being stunted were lower in younger children, whereas having a mother who was overweight/obese and had a short stature increased the odds of stunting. Access to water, having a refrigerator, and having a young mother were protective against being underweight. Having a mother who was overweight/obese increased the odds of being underweight. CONCLUSIONS The study showed a high prevalence of stunting and underweight among children, and overweight and obesity among mothers, indicating a household double burden of malnutrition. The age of the child and maternal overweight/obesity and short stature were predictors of stunting and underweight, while having a younger mother and access to water and a refrigerator were protective against being underweight. The need for an evidence-based and feasible nutrition program for schoolchildren, especially those in rural schools, cannot be over-emphasized.
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Affiliation(s)
- Perpetua Modjadji
- School of Health Care Sciences, Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa.
| | - Sphiwe Madiba
- School of Health Care Sciences, Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa 0208, South Africa
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Kim HJ, Jae SY, Choo J, Yoon JK, Kim S, Königstein K, Schmidt‐Trucksäss A, Franklin BA. Mediating effects of exercise capacity on the association between physical activity and health‐related quality of life among adolescents with complex congenital heart disease. Am J Hum Biol 2019; 31:e23297. [DOI: 10.1002/ajhb.23297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/08/2019] [Accepted: 06/28/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hyun Jeong Kim
- Department of Sport ScienceUniversity of Seoul Seoul South Korea
- Department of PediatricsSejong General Hospital Bucheon South Korea
| | - Sae Young Jae
- Department of Sport ScienceUniversity of Seoul Seoul South Korea
| | - Jina Choo
- College of NursingKorea University Seoul South Korea
| | - Ja Kyoung Yoon
- Department of PediatricsSejong General Hospital Bucheon South Korea
| | - Seong‐Ho Kim
- Department of PediatricsSejong General Hospital Bucheon South Korea
| | - Karsten Königstein
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and HealthUniversity of Basel Basel Switzerland
| | - Arno Schmidt‐Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and HealthUniversity of Basel Basel Switzerland
| | - Barry A. Franklin
- Preventive Cardiology and Cardiac RehabilitationWilliam Beaumont Hospital Royal Oak Michigan
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Huey SL, Finkelstein JL, Venkatramanan S, Udipi SA, Ghugre P, Thakker V, Thorat A, Potdar RD, Chopra HV, Kurpad AV, Haas JD, Mehta S. Prevalence and Correlates of Undernutrition in Young Children Living in Urban Slums of Mumbai, India: A Cross Sectional Study. Front Public Health 2019; 7:191. [PMID: 31355176 PMCID: PMC6639755 DOI: 10.3389/fpubh.2019.00191] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/24/2019] [Indexed: 02/04/2023] Open
Abstract
Background: Young children living in urban slums are vulnerable to malnutrition and subsequently poor health outcomes, but data on the correlates of stunting, underweight, wasting, and anemia specifically among 10-18 month-old children in India remain limited. Objective: In this analysis, we sought to describe the prevalence of and examine correlates for different markers of undernutrition, including stunting, underweight, and anemia among 10-18 month-old children living in urban slums, an understudied vulnerable group. Methods: Children and their mothers (n = 323) were screened for anthropometry, demographics, and complete blood counts for hemoglobin concentration between March and November 2017 (Clinicaltrials.gov ID: NCT02233764). Correlates included child and mother's age, sex, birth order, birth weight, illness episodes, hemoglobin concentration, family income, maternal height, and maternal education level. Risk ratios (RR, 95% CI) for binary outcomes (stunting, underweight, wasting and anemia) and mean differences (β, 95% CI) for continuous outcomes (anthropometric Z-scores, hemoglobin concentration) were calculated using multivariate binomial and linear regression (SAS 9.4). Results: The prevalence of stunting was 31.2%, underweight 25.1%, wasting (9.0%), and anemia (76%) among all children. Male children had a higher prevalence of poor growth indices and lower anthropometric Z-scores than females. Male sex, low birthweight, shorter maternal height, report of ≥1 episodes of illness within the past month, older maternal age, and birth order ≥2 were also associated with poor growth and anemia in multivariate models. Correlates of undernutrition were different among females and males. Female children had a 40% (20, 60%) higher risk of anemia associated with diarrhea, and male children who were firstborn had a 20% (0, 70%) lower risk of anemia. Conclusions: These results show that poor growth and anemia among young children is prevalent in urban slums of Mumbai, and that sex of the child may play an important role in informing interventions to address undernutrition.
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Affiliation(s)
- Samantha Lee Huey
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Julia Leigh Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Institute for Nutritional Sciences, Global Health, and Technology (INSIGHT), Cornell University, Ithaca, NY, United States
| | - Sudha Venkatramanan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Shobha A. Udipi
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Padmini Ghugre
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Varsha Thakker
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | - Aparna Thorat
- Department of Nutrition and Food Science, SNDT Women's University, Mumbai, India
| | | | | | - Anura V. Kurpad
- Department of Physiology, St. John's Research Institute, Bangalore, India
| | - Jere Douglas Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Institute for Nutritional Sciences, Global Health, and Technology (INSIGHT), Cornell University, Ithaca, NY, United States
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Leonard D, Buttner P, Thompson F, Makrides M, McDermott R. Anaemia in early childhood among Aboriginal and Torres Strait Islander children of Far North Queensland: a retrospective cohort study. Aust N Z J Public Health 2019; 43:319-327. [PMID: 31180619 DOI: 10.1111/1753-6405.12911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/01/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Early childhood anaemia affects health and neurodevelopment. This study describes anaemia among Aboriginal and Torres Strait Islander children of Far North Queensland. METHODS This retrospective cohort study used health information for children born between 2006 and 2010 and their mothers. We describe the incidence of early childhood anaemia and compare characteristics of children and mothers where the child had anaemia with characteristics of children and mothers where the child did not have anaemia using bivariate and multivariable analysis, by complete case (CC) and with multiple imputed (MI) data. RESULTS Among these (n=708) Aboriginal and Torres Strait Islander children of Far North Queensland, 61.3% (95%CI 57.7%, 64.9%) became anaemic between the ages of six and 23 months. Multivariable analysis showed a lower incidence of anaemia among girls (CC/MI p<0.001) and among children of Torres Strait Islander mothers or both Aboriginal and Torres Strait Islander mothers (CC/MI p<0.001) compared to children of Aboriginal mothers. A higher incidence of anaemia was seen among children of mothers with parity three or more (CC/MI p<0.001); children born by caesarean section (CC/MI p<0.001); and children with rapid early growth (CC/MI p<0.001). CONCLUSION Early childhood anaemia is common among Aboriginal and Torres Strait Islander children of Far North Queensland. Poor nutrition, particularly iron deficiency, and frequent infections are likely causes. Implications for public health: Prevention of early childhood anaemia in 'Close the Gap' initiatives would benefit the Aboriginal and Torres Strait Islander children of Far North Queensland - and elsewhere in northern Australia.
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Affiliation(s)
- Dympna Leonard
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Petra Buttner
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute.,Discipline of Paediatrics, School of Medicine, The University of Adelaide, South Australia
| | - Robyn McDermott
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
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Cruz NRC, Cardoso PC, Frossard TNSV, Ferreira FDO, Brener S, Gomides AFDF, Valente MAS, Velloso-Rodrigues C. Waist circumference as high blood pressure predictor in school age children. CIENCIA & SAUDE COLETIVA 2019; 24:1885-1893. [PMID: 31166521 DOI: 10.1590/1413-81232018245.18012017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/16/2017] [Indexed: 11/22/2022] Open
Abstract
Childhood hypertension is becoming more common with the increasing numbers of child obesity, which has encouraged new studies to identify a good anthropometric marker for high blood pressure levels. The objective this study was to identify the best anthropometric predictor of risk of hypertension in children between 8-10 years of age. The Children were evaluated for socioeconomic status and their blood pressure (BP), weight, height, waist circumference (WC) and percentage of body fat (PBF) were measured. The study included 445 children, of which 50.1% were females. The prevalence of obesity defined by body mass index (BMI) was 14.6%. Increased BP was found in 3.4% and 2.2% of the children, considering the pre-hypertension and hypertension classifications respectively. The arithmetic mean of BP value correlated significantly with BMI, WC and PBF. After height control, the correlations that were maintained significant were between WC and systolic blood pressure (SBP) and between WC and diastolic blood pressure (DBP). The variable with the highest predictive power of the occurrence of hypertension was WC. The results indicate that, in this population of children between 8 and 10 years old, WC is a measurement of higher value in predicting increased BP.
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Affiliation(s)
| | - Pollyanna Costa Cardoso
- Universidade Federal de Juiz de Fora. R. José de Tassis 350, Vila Bretas. 35030-250 Governador Valadares MG Brasil.
| | | | | | - Stela Brener
- Fundação e Centro de Hemoterapia e Hematologia de Minas Gerais. Belo Horizonte MG Brasil
| | | | - Maria Anete Santana Valente
- Universidade Federal de Juiz de Fora. R. José de Tassis 350, Vila Bretas. 35030-250 Governador Valadares MG Brasil.
| | - Cibele Velloso-Rodrigues
- Universidade Federal de Juiz de Fora. R. José de Tassis 350, Vila Bretas. 35030-250 Governador Valadares MG Brasil.
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Frongillo EA, Leroy JL, Lapping K. Appropriate Use of Linear Growth Measures to Assess Impact of Interventions on Child Development and Catch-Up Growth. Adv Nutr 2019; 10:372-379. [PMID: 30805630 PMCID: PMC6520037 DOI: 10.1093/advances/nmy093] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/28/2018] [Accepted: 10/21/2018] [Indexed: 01/19/2023] Open
Abstract
Linear growth is increasingly used as the sole or primary outcome for evaluating interventions, but impact is often not seen. Sometimes there is interest in whether children catch up to where they otherwise would have been had detrimental conditions not occurred, but the literature is confusing because of claims for evidence of catch-up growth based on inappropriate methods. This article examines the use of linear growth measures to evaluate intervention impact and catch-up. Focus on linear growth as a measure of impact has resulted in a lack of demonstrable intervention effects, evaluations that do not use measures responsive to nutrition-sensitive and integrated interventions, insufficient emphasis on adolescent girls and women before conception and children after the first 1000 d, and insufficient investment in developing other measures. Nutrition interventions may benefit children but may not discernibly affect linear growth deficits in immediate or intermediate periods. Interventions intended to affect one domain may have positive or negative impacts on others. Child nutrition and growth are part of early childhood development; the focus should be on improving conditions in which children grow and develop throughout childhood and adolescence because poor conditions in a population affect all children. To assess the impact of nutrition interventions, it is important to use a broad set of measures and indicators of outcomes and immediate and underlying determinants. The 4 criteria for demonstrating catch-up in growth, which are much more stringent than those for demonstrating intervention impact, require demonstration of the following: 1) an inhibiting condition and 2) reduced velocity during 1 period, 3) followed by alleviation of or compensation for the inhibiting condition, and 4) higher-than-normal velocity during a subsequent period. Partial catch-up growth is sometimes possible when constraints are removed, but whether it is beneficial to the child is not clear. Research is needed to develop, refine, and validate measures and indicators for the purposes intended.
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Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC
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137
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Simas LAW, Zanatta LCB, Moreira CA, Borba VZC, Boguszewski CL. Body composition and nutritional and metabolic parameters in postmenopausal women sufficient, insufficient and deficient in vitamin D. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:265-271. [PMID: 31038588 PMCID: PMC10522206 DOI: 10.20945/2359-3997000000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/09/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigated changes in body composition and nutritional and metabolic parameters in a group of postmenopausal women who were classified as sufficient, insufficient and deficient in vitamin D. SUBJECTS AND METHODS A total of 106 postmenopausal women were included in this cross-sectional study and classified according to their serum levels of 25-OH-vitamin D as sufficient (≥ 30 ng/mL; group S), insufficient (20.1 and 29.9 ng/mL; group I) or deficient (≤ 20 ng/mL; group D) in vitamin D. Body composition was measured by dual-energy X-ray absorptiometry (DXA); dietary recall questionnaires were completed; and blood samples were analysed to compare the metabolic and nutritional status of the study groups. RESULTS Eleven (10.4%) of the women were classified in group S, 50 (47.2%) in group I and 45 (42.4%) in group D, with a mean serum level for 25-OH-D of 21.1 ± 7.0 ng/mL in all participants. Body composition did not differ among the groups. Serum levels of 25-OH-D were negatively correlated with serum levels of triglycerides, total cholesterol and LDL cholesterol. CONCLUSIONS Vitamin D insufficiency and deficiency were highly prevalent in our group of postmenopausal women, showing an association with an unfavourable lipid profile.
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Affiliation(s)
- Luisa Amábile Wolpe Simas
- Universidade Federal do ParanáServiço de Endocrinologia e MetabologiaDepartamento de Medicina InternaUniversidade Federal do ParanáCuritibaPRBrasil Serviço de Endocrinologia e Metabologia (SEMPR), Departamento de Medicina Interna , Universidade Federal do Paraná , Curitiba , PR , Brasil
| | - Leila Caroline Bianchet Zanatta
- Universidade Federal do ParanáServiço de Endocrinologia e MetabologiaDepartamento de Medicina InternaUniversidade Federal do ParanáCuritibaPRBrasil Serviço de Endocrinologia e Metabologia (SEMPR), Departamento de Medicina Interna , Universidade Federal do Paraná , Curitiba , PR , Brasil
| | - Carolina Aguiar Moreira
- Universidade Federal do ParanáServiço de Endocrinologia e MetabologiaDepartamento de Medicina InternaUniversidade Federal do ParanáCuritibaPRBrasil Serviço de Endocrinologia e Metabologia (SEMPR), Departamento de Medicina Interna , Universidade Federal do Paraná , Curitiba , PR , Brasil
| | - Victoria Zeghbi Cochenski Borba
- Universidade Federal do ParanáServiço de Endocrinologia e MetabologiaDepartamento de Medicina InternaUniversidade Federal do ParanáCuritibaPRBrasil Serviço de Endocrinologia e Metabologia (SEMPR), Departamento de Medicina Interna , Universidade Federal do Paraná , Curitiba , PR , Brasil
| | - Cesar Luiz Boguszewski
- Universidade Federal do ParanáServiço de Endocrinologia e MetabologiaDepartamento de Medicina InternaUniversidade Federal do ParanáCuritibaPRBrasil Serviço de Endocrinologia e Metabologia (SEMPR), Departamento de Medicina Interna , Universidade Federal do Paraná , Curitiba , PR , Brasil
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138
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Comparison of the effects of different growth standards on infants in Urban Shanghai: a cluster-randomized controlled trial. Chin Med J (Engl) 2019; 132:4-10. [PMID: 30628953 PMCID: PMC6629307 DOI: 10.1097/cm9.0000000000000004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Shanghai growth standards are higher than World Health Organization (WHO) growth standards, which may influence the feeding practices of the caregivers and increase the risk of overweight in these infants. This study aimed to compare the effects of different growth standards on childhood obesity in Shanghai metropolitan area. METHODS This was a cluster-randomized controlled trial conducted in 2 downtown areas with 19 community health service centers in Shanghai from November 2013 to December 2015. Randomization was done at the level of the community. Infants (health newborns) were assessed and monitored by the Shanghai growth standards (S-group) and the 2006 WHO growth standards (W-group), respectively. Measurements were taken at 1.0, 2.0, 4.0, 6.0, 9.0 and 12.0 months of age during follow-up period. Based on the values of length and weight measurements, according to the group's growth standards, doctors provided the caregivers with corresponding clinical consultation. Changes in weight-for-age z-score (WAZ), length-for-age z-score (LAZ), and weight-for length z-score (WLZ) between 2 groups were assessed using mixed regression models. Overweight was compared between 2 group at all follow-up measurements. RESULTS A total of 6509 infants (52.1% were boys) were in the W-group, and 8510 infants (51.4% were boys) were in the S-group. The overweight ratios between two groups were distinct at 9 months of age (3.4% in W-group and 4.3% in S-group) and 12 months of age (2.2% in W-group and 3.8% in S-group), and the differences were statistically significant (P = 0.020 and P < 0.001, respectively). Compared to W-group, the increase in WAZ (coefficient = 0.04, P = 0.004) and WLZ (coefficient = 0.09, P < 0.001) were significantly greater, and the LAZ was lower (coefficient = -0.04, P = 0.047) in S-group (W-group values were used as reference in mixed regression models). CONCLUSION Compared to the Shanghai growth standards, the adoption of WHO 2006 growth standards would reduce the risk of infant overweight in Shanghai metropolitan area up to 1 year of age. TRIAL REGISTRATION NUMBER ChiCTR1800015371, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.
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139
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Giugliani ERJ. Growth in exclusively breastfed infants. J Pediatr (Rio J) 2019; 95 Suppl 1:79-84. [PMID: 30594467 DOI: 10.1016/j.jped.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To address the growth of full-term children in the first 6 months of life in exclusive breastfeeding. SOURCE OF DATA A non-systematic review was carried out by searching the MEDLINE/PubMed, Web of Science, and Cochrane Library databases and the World Health Organization website for articles and documents on the growth of exclusively breastfed infants and their monitoring. Those documents considered to be the most relevant by the author were selected. DATA SYNTHESIS Exclusively breastfeed infants show differentiated growth when compared to formula-fed infants. Weight loss in the first four days of life is due more to loss of fat mass rather than lean mass, including body water, and is usually lower in exclusively breastfed infants. In turn, the time for recovery of the birth weight may be longer in these infants. Formula-fed infants gain weight and increase their BMI more rapidly in the first three to six months of life than infants in exclusive or predominant breastfeeding due to a progressive increase in lean mass. The World Health Organization growth curves, which use the growth pattern of breastfed children as their standard, are used to monitor growth. CONCLUSIONS Exclusively breastfed infants have differentiated growth when compared with formula-fed infants. This should be considered when monitoring the infant's growth. It should be emphasized that the growth pattern currently used as reference is that of the exclusively breastfed infant.
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Affiliation(s)
- Elsa Regina Justo Giugliani
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Pediatria, Porto Alegre, RS, Brazil.
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140
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Giugliani ERJ. Growth in exclusively breastfed infants. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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141
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Koletzko B, Godfrey KM, Poston L, Szajewska H, van Goudoever JB, de Waard M, Brands B, Grivell RM, Deussen AR, Dodd JM, Patro-Golab B, Zalewski BM. Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations. ANNALS OF NUTRITION & METABOLISM 2019; 74:93-106. [PMID: 30673669 PMCID: PMC6397768 DOI: 10.1159/000496471] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND A considerable body of evidence accumulated especially during the last decade, demonstrating that early nutrition and lifestyle have long-term effects on later health and disease ("developmental or metabolic programming"). METHODS Researchers involved in the European Union funded international EarlyNutrition research project consolidated the scientific evidence base and existing recommendations to formulate consensus recommendations on nutrition and lifestyle before and during pregnancy, during infancy and early childhood that take long-term health impact into account. Systematic reviews were performed on published dietary guidelines, standards and recommendations, with special attention to long-term health consequences. In addition, systematic reviews of published systematic reviews on nutritional interventions or exposures in pregnancy and in infants and young children aged up to 3 years that describe effects on subsequent overweight, obesity and body composition were performed. Experts developed consensus recommendations incorporating the wide-ranging expertise from additional 33 stakeholders. FINDINGS Most current recommendations for pregnant women, particularly obese women, and for young children do not take long-term health consequences of early nutrition into account, although the available evidence for relevant consequences of lifestyle, diet and growth patterns in early life on later health and disease risk is strong. INTERPRETATION We present updated recommendations for optimized nutrition before and during pregnancy, during lactation, infancy and toddlerhood, with special reference to later health outcomes. These recommendations are developed for affluent populations, such as women and children in Europe, and should contribute to the primary prevention of obesity and associated non-communicable diseases.
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Affiliation(s)
- Berthold Koletzko
- LMU, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Medical Centre of LMU Munich, München, Germany,
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Lucilla Poston
- Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Hania Szajewska
- Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland
| | | | - Marita de Waard
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Brigitte Brands
- LMU, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Medical Centre of LMU Munich, München, Germany
| | - Rosalie M Grivell
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
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142
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Tung SEH, Mohd Nasir MT, Chin YS, Zalilah MS, Zubaidah JO, Yim HS. Psychological Factors and Cardiovascular Disease Risk Factors as Mediators of the Relationship between Overweight/Obesity and Cognitive Function among School Children in Kuala Lumpur, Malaysia. Child Obes 2019; 15:56-62. [PMID: 30339034 DOI: 10.1089/chi.2018.0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent research suggests that a negative relationship exists between adiposity and cognitive function in children. However, limited information is known on how they are related. This study aimed to examine the mediators of the relationship between overweight/obesity and cognitive function among school children in Kuala Lumpur, Malaysia. METHODS This is a cross-sectional comparison study whereby 225 overweight/obese children matched for age, sex, and ethnicity with 225 normal weight children participated in this study. Body image dissatisfaction, disordered eating, and depressive symptoms were assessed through a self-administered questionnaire. Blood pressure was measured, whereas blood was drawn to determine insulin, high-sensitivity C-reactive protein (hs-CRP), glucose, and lipid profiles. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated using glucose and insulin levels. Wechsler's Intelligence Scale for Children-Fourth Edition (WISC-IV) was used to assess cognitive function in children. Ordinary least square regression analysis was conducted to determine the direct and indirect relationships between weight status and cognitive function. RESULTS A negative relationship was found between overweight/obesity with cognitive function. Overweight/obese children were on average 4.075 units lower in cognitive function scores compared to normal weight children. Such difference was found through mediators, such as body image dissatisfaction, disordered eating, depression, systolic blood pressure, triglycerides, HOMA-IR, and hs-CRP, contributing 22.2% of the variances in cognitive function in children. CONCLUSION Results highlight the important mediators of the relationship between overweight/obesity and cognitive function. Consequently, future interventions should target to improve psychological well-being and reduce cardiovascular disease risk for the prevention of poorer cognitive performance in overweight/obese children.
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Affiliation(s)
- Serene En Hui Tung
- 1 Department of Food Science and Nutrition, Faculty of Applied Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Taib Mohd Nasir
- 2 Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
- 3 Research Center of Excellence, Nutrition and Non-Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Yit Siew Chin
- 2 Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
- 3 Research Center of Excellence, Nutrition and Non-Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Mohd Shariff Zalilah
- 2 Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
- 3 Research Center of Excellence, Nutrition and Non-Communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Jamil Osman Zubaidah
- 4 Division of Psychology, Faculty of Allied Health Sciences, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
| | - Hip Seng Yim
- 1 Department of Food Science and Nutrition, Faculty of Applied Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
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143
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Roy SM, Fields DA, Mitchell JA, Hawkes CP, Kelly A, Wu GD, DeRusso PA, Elovitz MA, Ford E, Drigo D, Zemel BS, McCormack SE. Body Mass Index Is a Better Indicator of Body Composition than Weight-for-Length at Age 1 Month. J Pediatr 2019; 204:77-83.e1. [PMID: 30268397 PMCID: PMC6309630 DOI: 10.1016/j.jpeds.2018.08.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/24/2018] [Accepted: 08/07/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess whether body mass index (BMI) provides a better assessment of measured adiposity at age 1 month compared with weight-for-length (WFL). STUDY DESIGN Participants were healthy term-born infants in the Infant Growth and Microbiome (n = 146) and the Baby Peas (n = 147) studies. Length, weight, and body composition by air displacement plethysmography were measured at 1 month. World Health Organization-based WFL and BMI z-scores were calculated. Within-cohort z-scores of percent fat-Z, fat mass-Z, fat mass/length2-Z, fat mass/length3-Z, fat-free mass-Z, and fat-free mass/length2-Z were calculated. Correlation and multiple linear regression (adjusted for birth weight) analyses tested the associations between body composition outcomes and BMI-Z vs WFL-Z. Quantile regression was used to test the stability of these associations across the distribution of body compositions. RESULTS The sample was 52% female and 56% African American. Accounting for birth weight, both BMI-Z and WFL-Z were strongly associated with fat mass-Z (coefficients 0.56 and 0.35, respectively), FM/L2-Z (0.73 and 0.51), and FM/L3-Z (0.79 and 0.58), with stronger associations for BMI-Z compared with WFL-Z (P < .05). Even after accounting statistically for birth weight, BMI-Z was persistently more strongly associated than WFL-Z with body composition outcomes across the distribution of body composition outcomes. CONCLUSIONS We demonstrate in 2 distinct cohorts that BMI is a better indicator of adiposity in early infancy compared with WFL. Our findings support the preferred use of BMI for growth and nutritional status assessment in infancy.
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Affiliation(s)
- Sani M Roy
- Division of Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX; Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - David A Fields
- Division of Endocrinology and Diabetes, Oklahoma University Health Sciences Center, Oklahoma City, OK
| | - Jonathan A Mitchell
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gary D Wu
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Patricia A DeRusso
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michal A Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eileen Ford
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Danielle Drigo
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shana E McCormack
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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144
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Physical and psychosocial development of Mapuche and nonindigenous Chilean toddlers: A modest role of ethnicity. Dev Psychopathol 2018; 30:1959-1976. [DOI: 10.1017/s0954579418001281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractMapuche represents the largest indigenous group in Chile amounting to nearly 10% of the total population. In a longitudinal cohort of 12,398 children, we analyzed the role of ethnicity in physical and psychosocial development of Mapuche and nonindigenous Chilean toddlers (age 2.5 years), taking into account sociodemographic and caregiver characteristics. As indicated by our univariate analysis, the Mapuche developmental niche was characterized by lower income, lower maternal education, poorer quality of the home environment, longer breastfeeding, and higher parental stress. Physical development showed higher body mass index. Mapuche children showed less externalizing problems. We then analyzed the incremental contribution of ethnicity in a series of hierarchical regressions with the second wave of developmental measurements (age 4.5 years) as outcome variables, showing a significant but modest incremental contribution of ethnicity to the prediction of children's development between 2.5 and 4.5 years of age. Controlling for environmental variables, Mapuche showed less externalizing and internalizing, behavior problems. Socioeconomic status, quality of the home environment, and parenting stress were stronger predictors of socioemotional development than ethnicity per se.
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145
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Ouyang F, Jiang F, Tao F, Xu S, Xia Y, Qiu X, Zhang J. Growth patterns from birth to 24 months in Chinese children: a birth cohorts study across China. BMC Pediatr 2018; 18:344. [PMID: 30396332 PMCID: PMC6217782 DOI: 10.1186/s12887-018-1328-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/25/2018] [Indexed: 12/25/2022] Open
Abstract
Background Assessment of child growth is important in detecting under- and over-growth. We aimed to examine the growth patterns of healthy Chinese infants from birth to 24 months. Methods This study was based on six recent birth cohorts across China, which provided data (from 2015) on 4251 children (2174 boys, 2077 girls) who were born at term to mothers without gestational or preexisting diabetes, chronic hypertension, preeclampsia, or eclampsia. Analyses were performed using 28,298 longitudinal anthropometric measures in 4251 children and the LMS method to generate smoothed Z-score growth curves, which were compared to the WHO growth standards (which are based on data from 2003) and current Chinese growth references (which are based on data from 2005). Results Most (80.3%) of mother had college education or more, and maternal smoking was rare (0.4%). Compared to the WHO longitudinal growth standards for children aged 0 to 2 years, the growth references from this longitudinal study (length-, weight-, head circumference-, BMI-for-age, and weight-for-length) were significantly higher, for boys and girls; Specifically, the median length-, weight-, head circumference-, BMI-for-age, and weight-for-length was on average 0.9 (range 0.2–1.3) cm, 0.51 (range 0.09–0.74) kg, 0.17 (range − 0.24 to 0.37) cm, 0.70 (range 0.01 to 0.92) kg/m2, and 0.43 (range 0.01 to 1.07) kg higher in Chinese boys, and 1.3 (range 0.5–1.9) cm, 0.73 (range 0.10–0.91) kg, 0.45 (range 0.15–0.62) cm, 0.7 (range 0.0 to 1.0) kg/m2, and 0.42 (range 0.00 to 0.64) kg greater in Chinese girls, respectively. Compared to the current China cross-sectional growth references (based on data from a decade ago), growth references from this study were also higher, but the difference was less than that between growth references of this study and WHO growth standards. Conclusions This recent multicenter prospective birth cohort study examined early growth patterns in China. The new growth curves represent the growth patterns of healthy Chinese infants evaluated longitudinally from 0 to 24 months of age, and provide references for monitoring growth in early life in modern China that are more recent than WHO longitudinal growth standards from other countries and previous cross-sectional growth references for China. Electronic supplementary material The online version of this article (10.1186/s12887-018-1328-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fengxiu Ouyang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.
| | - Fan Jiang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.,Department of Developmental and Behavioral Pediatrics, Shanghai Pediatric Transitional Institution, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Shunqing Xu
- Key Laboratory of Environment and Health (HUST), Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430074, Hubei, China
| | - Yankai Xia
- School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510000, China
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, China.
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146
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Ickes SB, Hossain M, Ritter G, Lazarus M, Reynolds K, Nahar B, Ahmed T, Walson J, Denno DM. Systematic Review of Tools and Methods to Measure Appetite in Undernourished Children in the Context of Low- and Middle-Income Countries. Adv Nutr 2018; 9:789-812. [PMID: 30462177 PMCID: PMC6247147 DOI: 10.1093/advances/nmy042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Child undernutrition has multifactorial causes, ranging from food insecurity to etiologies refractory to conventional nutritional approaches, such as infections, environmental enteric dysfunction, and other conditions that lead to systemic inflammation. Poor appetite may be an important symptom of these causes and may be a useful marker of an undernourished child's ability to recover. We conducted a systematic review to characterize the methods and tools to measure appetite among children <5 y old in low- and middle-income countries. A systematic search of 8 databases identified 23 eligible studies published since 1995. Thirteen described methods based on direct feeding observation or quantification of nutrient intake from caregiver report, 16 described tools that assessed caregiver perceptions of appetite, and 6 reported assessments in both categories. Four studies that gauged caregiver perceptions assessed multiple appetite domains, whereas 12 assessed 1 domain-often with a single question. Only 6 studies reported validation processes, the most common of which compared an observed test meal with daily energy intake. No studies reported the use of a method or tool that was validated in multiple cultural or linguistic contexts. Although dietary intake measures and observed feeding tests have shown validity in some contexts, they are resource intensive. Subjective caregiver questionnaires may offer a more efficient appetite evaluation method, but they have been evaluated less consistently. A rigorously developed and validated tool to rapidly assess child appetite is needed and could be best addressed by a questionnaire that leverages the multiple domains of appetite. The application of interventions that target causes of undernutrition that are not amenable to food-based interventions in clinical or research contexts could be facilitated by an efficient appetite screening tool to identify appetite-related causes of undernutrition and to monitor children's response to such interventions.
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Affiliation(s)
- Scott B Ickes
- Departments of Health Services,Global Health,Program in Nutritional Sciences, University of Washington, Seattle, WA,Wheaton College Department of Applied Health Sciences, Wheaton, IL
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Gaelen Ritter
- Program in Nutritional Sciences, University of Washington, Seattle, WA
| | - Monica Lazarus
- Program in Nutritional Sciences, University of Washington, Seattle, WA
| | | | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Tahmeed Ahmed
- Global Health,Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Judd Walson
- Pediatrics,Global Health,Medicine,Epidemiology,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Donna M Denno
- Departments of Health Services,Pediatrics,Global Health,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya,Address correspondence to DMD (e-mail: )
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147
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Early maternal perceived stress and children's BMI: longitudinal impact and influencing factors. BMC Public Health 2018; 18:1211. [PMID: 30376822 PMCID: PMC6208039 DOI: 10.1186/s12889-018-6110-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal perceived stress has been discussed to contribute to the development of childhood overweight. Our aim was to investigate the longitudinal relationship of early maternal perceived stress and BMI z-scores in preschool children (≤ five years). METHODS A longitudinal analysis was conducted in 498 mother-child pairs of the German prospective birth cohort LINA with information on maternal perceived stress during pregnancy, one and two years after birth. BMI z-scores were based on annual measurements of children's weight/height and calculated based on WHO reference data. General estimation equations were applied to evaluate the impact of maternal stress on children's longitudinal BMI z-scores. Potential stressors contributing to the perceived stress of the mother were assessed by linear regression models. Using mediation analyses we evaluated the relationship between stressors, maternal perceived stress, and children's BMI z-score development. RESULTS Postnatal maternal stress during the first year after birth had a positive longitudinal relationship with children's BMI z-scores up to the age of five years. Gender-stratified analyses revealed that only girls showed this positive association while boy's BMI z-scores were unaffected by maternal stress. We identified three neighborhood strains and two socio-demographic factors, which contributed to the maternal perceived stress level. Stressors themselves did not directly affect girl's BMI z-scores but rather mediated their effect through the perceived stress level. CONCLUSIONS While different stressors contribute to maternal stress, the perceived stress level - rather than the stressors themselves - is strongly positively associated with BMI z-score development in girls.
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148
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Aris IM, Rifas-Shiman SL, Li LJ, Yang S, Belfort MB, Thompson J, Hivert MF, Patel R, Martin RM, Kramer MS, Oken E. Association of Weight for Length vs Body Mass Index During the First 2 Years of Life With Cardiometabolic Risk in Early Adolescence. JAMA Netw Open 2018; 1:e182460. [PMID: 30646168 PMCID: PMC6324504 DOI: 10.1001/jamanetworkopen.2018.2460] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/11/2018] [Indexed: 12/17/2022] Open
Abstract
Importance The American Academy of Pediatrics currently recommends weight for length (WFL) for assessment of weight status in children younger than 2 years but body mass index (BMI) for children older than 2 years. However, the clinical implications of using WFL vs BMI in children younger than 2 years as an indicator of future health outcomes remains understudied. Objective To compare associations of overweight based on WFL vs BMI in children younger than 2 years with cardiometabolic outcomes during early adolescence. Design, Setting, and Participants This prospective study of birth cohorts in the United States (Project Viva) and Belarus (Promotion of Breastfeeding Intervention Trial [PROBIT]) performed from June 1, 1996, to November 31, 2002, included 13 666 children younger than 2 years. Main Exposures Overweight defined as Centers for Disease Control and Prevention (CDC) WFL in the 95th percentile or greater, World Health Organization (WHO) WFL in the 97.7th percentile or greater, or WHO BMI in the 97.7th percentile or greater at 6, 12, 18, or 24 months of age. Main Outcomes and Measures Primary outcomes were fat mass index, insulin resistance, metabolic risk score, and obesity during early adolescence. Secondary outcomes were height and BMI z scores, sum of skinfolds, waist circumference, and systolic blood pressure during early adolescence. Results The study included 919 children (mean [SD] age, 12.9 [0.9] years; 460 [50.1%] male; and 598 [65.1%] white) from Project Viva and 12 747 children (mean [SD] age, 11.5 [0.5] years; 6204 [48.7%] male; and 12 747 [100%] white) from PROBIT. During 6 to 24 months of age, in Project Viva, 206 children (22.4%) were overweight at any of the 4 times points according to the CDC WFL, 160 (17.4%) according to WHO WFL, and 161 (17.5%) according to WHO BMI cut points. In PROBIT, 3715 children (29.1%) were overweight at any of the 4 time points according to the CDC WFL, 3069 (24.1%) according to WHO WFL, and 3125 (24.5%) according to WHO BMI cut points. After maternal and child characteristics were adjusted for, being ever overweight (vs never overweight) during 6 to 24 months of age was associated with higher likelihood of adverse cardiometabolic risk markers during early adolescence, but associations did not differ substantially across WFL and BMI cut points in either cohort. For example, for fat mass index in Project Viva, β = 0.9 (95% CI, 0.5-1.4) for the CDC WFL, β = 1.1 (95% CI, 0.6-1.6) for WHO WFL, and β = 1.4 (95% CI, 0.9-1.9) for WHO BMI. For PROBIT, β = 0.5 (95% CI, 0.4-0.6) for the CDC WFL, β = 0.6 (95% CI, 0.5-0.7) for WHO WFL, and β = 0.6 (95% CI, 0.5-0.6) for WHO BMI. Neither growth metric in infancy was superior over the others based on F statistics (Project Viva: 17.1-17.8; PROBIT: 87.1-88.7). Findings were similar for insulin resistance, metabolic risk score, obesity, and secondary outcomes. Conclusions and Relevance Choice of WFL vs BMI to define overweight during the first 2 years of life may not greatly affect the association with cardiometabolic outcomes during early adolescence. The findings appear to have important implications for investigators seeking to use BMI as a growth metric for epidemiologic research and for practitioners monitoring the weight status of children younger than 2 years.
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Affiliation(s)
- Izzuddin M. Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ling-Jun Li
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Division of Obstetrics and Gynecology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Obstetrics and Gynecology Academic Clinical Programme, Duke–National University of Singapore Graduate Medical School, Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Seungmi Yang
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine McGill University, Montreal, Quebec, Canada
| | - Mandy B. Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Thompson
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Diabetes Unit, Massachusetts General Hospital, Boston
| | - Rita Patel
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Richard M. Martin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Michael S. Kramer
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine McGill University, Montreal, Quebec, Canada
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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149
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Growth curves and their associated weight and height factors in children from birth to 4 years old in West Azerbaijan Province, northwest Iran. Arch Pediatr 2018; 25:389-393. [PMID: 30119913 DOI: 10.1016/j.arcped.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/22/2018] [Accepted: 06/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Growth trajectory standards are important components that need to be monitored for suitable child growth. This study examined longitudinal data to identify the factors affecting growth trajectory standards of height and weight for infants. METHODS This study included 566 neonates (286 boys and 280 girls) born in West Azerbaijan Province, northwest Iran, who were followed from birth to 4 years of age. The subjects' weight and height were recorded at birth, 1, 2, 4, 6, 9 months and 1, 1.5, 2, 3, and 4 years of age. In this study, the Lambda-Mu-Sigma (LMS) method was used to construct the growth curves for each measure. The linear mixed model was employed to determine the factors affecting the growth trajectory. RESULTS The study demonstrates that the place of birth, duration of breastfeeding, and infants' gender had a significant effect on the growth trajectory. Nonetheless, other variables did not have any significant effect on growth. Growth curves for significant factors of weight and height (5th, 50th, 95th percentiles) were obtained. There was a rapid increase in the growth curve from birth to 2 years of age, which then remained relatively constant up to 4 years of age. DISCUSSION This paper provides the first local growth trajectory standards of height and weight for infants by analyzing longitudinal measurements in West Azerbaijan province. This study determined the factors affecting the growth trend in both indices. It seems that there was a significant difference in the growth trajectories of infants in subgroups of the effective factor.
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150
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Myatt M, Khara T, Schoenbuchner S, Pietzsch S, Dolan C, Lelijveld N, Briend A. Children who are both wasted and stunted are also underweight and have a high risk of death: a descriptive epidemiology of multiple anthropometric deficits using data from 51 countries. Arch Public Health 2018; 76:28. [PMID: 30026945 PMCID: PMC6047117 DOI: 10.1186/s13690-018-0277-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/05/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Wasting and stunting are common. They are implicated in the deaths of almost two million children each year and account for over 12% of disability-adjusted life years lost in young children. Wasting and stunting tend to be addressed as separate issues despite evidence of common causality and the fact that children may suffer simultaneously from both conditions (WaSt). Questions remain regarding the risks associated with WaSt, which children are most affected, and how best to reach them. METHODS A database of cross-sectional survey datasets containing data for almost 1.8 million children was compiled. This was analysed to determine the intersection between sets of wasted, stunted, and underweight children; the association between being wasted and being stunted; the severity of wasting and stunting in WaSt children; the prevalence of WaSt by age and sex, and to identify weight-for-age z-score and mid-upper arm circumference thresholds for detecting cases of WaSt. An additional analysis of the WHO Growth Standards sought the maximum possible weight-for-age z-score for WaSt children. RESULTS All children who were simultaneously wasted and stunted were also underweight. The maximum possible weight-for-age z-score in these children was below - 2.35. Low WHZ and low HAZ have a joint effect on WAZ which varies with age and sex. WaSt and "multiple anthropometric deficits" (i.e. being simultaneously wasted, stunted, and underweight) are identical conditions. The conditions of being wasted and being stunted are positively associated with each other. WaSt cases have more severe wasting than wasted only cases. WaSt cases have more severe stunting than stunted only cases. WaSt is largely a disease of younger children and of males. Cases of WaSt can be detected with excellent sensitivity and good specificity using weight-for-age. CONCLUSIONS The category "multiple anthropometric deficits" can be abandoned in favour of WaSt. Therapeutic feeding programs should cover WaSt cases given the high mortality risk associated with this condition. Work on treatment effectiveness, duration of treatment, and relapse after cure for WaSt cases should be undertaken. Routine reporting of the prevalence of WaSt should be encouraged. Further work on the aetiology, prevention, case-finding, and treatment of WaSt cases as well as the extent to which current interventions are reaching WaSt cases is required.
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Affiliation(s)
- Mark Myatt
- Brixton Health, Llawryglyn, Powys, Wales, UK
| | | | | | | | | | - Natasha Lelijveld
- Department for Population Health, London School of Hygiene and Tropical Medicine, London, UK
- No Wasted Lives, Action Against Hunger UK, London, UK
| | - André Briend
- School of Medicine, Centre for Child Health Research, University of Tampere, Tampere, Finland
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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