Low dietary diversity is a predictor of child stunting in rural Bangladesh

Open defecation explains differences in nutritional status between Bengali and tribal children in the Chittagong Hill Tracts of Bangladesh

OBJECTIVE

We describe differences in linear growth as measured by height-for-age z-score (HAZ) between children from Bengali and tribal populations in the Chittagong Hill Tracts of Bangladesh and examine factors associated with HAZ in both groups.

DESIGN

We used nutritional surveillance data collected in Bangladesh from 2003 to 2006 to analyze HAZ among 12,006 children aged 6-23 months and conducted multivariate linear regression and Blinder-Oaxaca decomposition to quantify the relative contribution of independent variables to differences in HAZ between Bengali and tribal children.

RESULTS

Mean HAZ was stable for Bengali children (-1.88 in 2003 to -1.90 in 2006) but improved for tribal children (-1.87 in 2003 to -1.68 in 2006). The difference between groups was significant across the study period (p = 0.008). Among Bengali children, HAZ was positively associated with father's schooling (β = 0.221; 95% CI: 0.079-0.363). Among tribal children, HAZ was positively associated with consumption of animal source foods (β = 0.073; 95% CI: 0.051-0.096) and goat ownership (β = 0.240; 95% CI: 0.025-0.454). Results of a likelihood ratio test indicated that distance to a health center was inversely associated with HAZ among tribal children (p < 0.001). Blinder-Oaxaca decomposition demonstrated a difference in pooled coefficients between groups (p = 0.004), explained primarily by differences in coefficients for paternal education (p = 0.001) and village-level prevalence of open defecation (p = 0.004).

CONCLUSIONS

Different responses among Bengali and tribal children to village-level open defecation are an explanatory factor for the difference in HAZ between Bengali and tribal populations. Open defecation may also act a proxy for unmeasured factors such as household environmental conditions and food hygiene.

ABBREVIATIONS

Chittagong Hill Tracts (CHT); height-for-age z-scores (HAZ); Nutrition Surveillance Project (NSP); World Health Organization (WHO).

Childhood growth and neurocognition are associated with distinct sets of metabolites

BACKGROUND

Undernutrition is a serious global problem that contributes to increased child morbidity and mortality, impaired neurocognitive development, and decreased educational and economic attainment. Current interventions are only marginally effective, and identification of associated metabolic pathways can offer new strategies for intervention.

METHODS

Plasma samples were collected at 9 and 36 months from a subset of the PROVIDE child cohort (n = 130). Targeted metabolomics was performed on bile acids, acylcarnitines, amino acids, phosphatidylcholines, and sphingomyelins. Metabolic associations with linear growth and neurocognitive outcomes at four years were evaluated using correlation and penalized-linear regression analysis as well as conditional random forest modeling.

FINDINGS

Different metabolites were associated with growth and neurocognitive outcomes. Improved growth outcomes were associated with higher concentrations of hydroxy-sphingomyelin and essential amino acids and lower levels of acylcarnitines and bile acid conjugation. Neurocognitive scores were largely associated with phosphatidylcholine species and early metabolic indicators of inflammation. All metabolites identified explain ~45% of growth and neurocognitive variation.

INTERPRETATION

Growth outcomes were predominantly associated with metabolites measured early in life (9 months), many of which were biomarkers of insufficient diet, environmental enteric dysfunction, and microbiome disruption. Hydroxy-sphingomyelin was a significant predictor of improved growth. Neurocognitive outcome was predominantly associated with 36 month phosphatidylcholines and inflammatory metabolites, which may serve as important biomarkers of optimal neurodevelopment. The distinct sets of metabolites associated with growth and neurocognition suggest that intervention may require targeted approaches towards distinct metabolic pathways. FUND: Bill & Melinda Gates Foundation (OP1173478); National Institutes of Health (AI043596, CA044579).

Energy and Nutrient Intakes of Rural Nigerian Schoolchildren: Relationship With Dietary Diversity

BACKGROUND

Undernutrition among schoolchildren is a prevalent public health problem which may be due to inadequate energy and nutrient intakes associated with low dietary diversity.

OBJECTIVE

This study assessed dietary diversity scores (DDS), energy and nutrient intakes of schoolchildren (6-15 years), and risks factors of DDS and determined if energy and nutrient intakes were dependent on dietary diversity.

METHODS

The study involved a 2-stage random sampling of 90 schoolchildren. Dietary diversity and nutrient intake data were obtained through a 3-day weighed food intake. Analysis of variance, t test, and χ² with Cochran-Mantel-Haenszel test were used to determine relationships among and between variables; P < .05 was reported as significant.

RESULTS

Few (22.2%) had high DDS with no significant difference (P > .05) between age groups and sex. Children from male headed households were more likely to have medium DDS (odds ratio [OR] = 3.231; 95% confidence interval [CI] = 1.037-10.070) than those from female headed households (P < .05). Low nutrient intakes were observed among 85.6% for niacin, 76.7% for calcium, 72.2% for riboflavin, 54.4% for protein, 32.2% for thiamine, and 15.6% for vitamin C. Among boys, prevalence of inadequate riboflavin intake was significantly (P < .05) higher among 6- to 9-year-olds. Among girls, prevalence of inadequate vitamin A intake was significantly (P < .01) higher among 10 to 15-year-olds. Children with adequate intakes of iron (OR = 0.744, 95% CI = 0.653-0.847) and thiamine (OR = 5.651, 95% CI = 1.214-26.310) were more likely to have high DDS.

CONCLUSION

The schoolchildren had low energy and nutrient intakes. Iron and thiamine, intakes were dependent on DDS.

Nutritional Status, Nutrient Intake, and Food Diversity Among Children With Sickle Cell Anemia

Children with sickle cell anemia (SCA) often exhibit nutritional deficiencies and are at high risk of dying before the age of 5 years. Ensuring adequate nutrition is a critical part of health care for such children. This study aimed to investigate the association between nutritional status, nutrient intake, and food diversity in children with SCA. A descriptive cross-sectional study was conducted on 74 children with SCA, between 24 and 71 months of age. Anthropometric measurements, food and nutrients consumption were determined. The prevalence of low weight, stunting, and overweight/obesity were 16.2%, 35.1%, and 16.2%, respectively. Mean folic acid intake was low (49.05%±51.22%), whereas the intakes of protein (426.71%±171.93%), retinol (292.97%±403.88%), phosphorus (204.55%±151.35%), magnesium (233.02%±151.14%), iron (250.76%±165.81%), and zinc (243.21%±148.40%) were high. The dietary phosphorus/protein ratio was high for 31.1% of the children, and 44.6% of the children had low dietary diversity score. No correlation was found between food diversity, nutrient adequacy, and nutritional status. Despite the adequacy of the intake of most micronutrients, diet quality was inadequate, constituting mainly ultraprocessed foods. Knowing the food consumption pattern of these children enables a more resolute nutritional intervention.

Dietary Diversity among Preschoolers: A Cross-Sectional Study in Poor, Rural, and Ethnic Minority Areas of Central South China

The aim of this study was to document the dietary diversity status of preschool children in poor, rural, and ethnic minority areas of Central South China and examine its associated factors both at home and in preschools. A cross-sectional study including 1328 preschool children aged three or five years from two nationally designated poverty counties in Hunan Province was conducted. A dietary diversity score (DDS) was constructed to measure the dietary patterns based on the 24 h recall method. The mean DDS among the sample children was 5.77 (95% confidence interval: 5.70⁻5.83, range 1 to 9) with a standard deviation of 1.22. Both household characteristics (including the education level of the child's primary caregiver and the nutritional knowledge of the caregiver) and preschool factors (including the nutritional knowledge of the child's preschool principal and teachers, nutritional training to children, and the preschool kitchen manager) were positively associated with children's DDS. The dietary diversity status of children in poor, rural, and ethnic minority areas of Central South China is much lower than that of their peers in other areas. Nutritional education should be provided to caregivers, preschool staff, and children to narrow the gap.

Consumption of Animal-Source Protein is Associated with Improved Height-for-Age z Scores in Rural Malawian Children Aged 12⁻36 Months

Linear growth faltering, caused by insufficient diet, recurrent infections and environmental enteric dysfunction (EED), continues to plague young children in low- and middle-income countries (LMICs). Diets in LMICs are primarily plant based, and thus have poor-quality protein and low levels of essential micronutrients. The aim of this study was to assess the association of the type and protein quality of food consumed with stunting, EED and acute malnutrition in children aged 6⁻36 months in Limera and Masenjere, two rural Southern Malawian communities. This is a secondary analysis of two randomized controlled trials that tested the effects of common bean and cowpea flour on stunting in children aged 6⁻36 months. We used data from two interactive 24-h dietary recalls conducted 12 weeks after enrolment into each trial. Food intakes were compared between the regions using Chi-square and Student's t-test. There were 355 children that participated in the dietary recalls. The diets of children were of poor quality, but the children from Limera consumed more fish (54% vs. 35%, p = 0.009) and more bioavailable protein (26.0 ± 10.3 g/day vs. 23.1 ± 8.1 g/day, p = 0.018, respectively) than children in Masenjere. Food type and protein quality were not associated with any of the outcomes except an association between animal protein consumption and improvement in height-for-age z scores in children aged 12⁻36 months (p = 0.047). These findings support the notion that animal-source food (ASF) consumption in this vulnerable population promotes linear growth.

Dietary diversity and nutritional status among children in rural Burkina Faso

Background

Burkina Faso has a seasonal malnutrition pattern, with higher malnutrition prevalence during the rainy season when crop yields are low. We investigated the association between dietary diversity and nutritional status among children aged 6-59 mo during the low crop yield season in rural Burkina Faso to assess the role of dietary diversity during the lean season on childhood nutritional status.

Methods

Caregivers reported the dietary diversity of the past 7 d, consisting of 11 food groups, summed into a scale. Anthropometric measurements were taken from all children. Height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores were calculated based on 2006 WHO standards. Stunting, wasting and underweight were defined as HAZ, WHZ and WAZ <-2 SD, respectively. Multivariable regression models adjusting for potential confounders including household food insecurity and animal ownership were used to assess the relationship between anthropometric indices and dietary diversity.

Results

Of 251 children enrolled in the study, 20.6% were stunted, 10.0% wasted and 13.9% underweight. Greater dietary diversity was associated with greater HAZ (SD 0.14, 95% CI 0.04 to 0.25) among all children. There was no association between dietary diversity and wasting or mid-upper arm circumference in this study.

Conclusions

Increasing dietary diversity may be an approach to reduce the burden of stunting and chronic malnutrition among young children in regions with seasonal food insecurity.

Women's Empowerment in Agriculture and Dietary Quality Across the Life Course: Evidence from Bangladesh

Using nationally-representative survey data from rural Bangladesh, we examine the relationship between women's empowerment in agriculture and indicators of individual dietary quality. Our findings suggest that women's empowerment is associated with better dietary quality of individuals within the household, but the strength of this association varies across the life course. Women's empowerment is correlated with more diverse diets of children under five, but empowerment measures are not consistently associated with increases in nutrient intake for this age group. Rather, maternal schooling and household socio-economic status play a more important role for younger children. Women's empowerment is positively and significantly associated with adult men's and women's dietary diversity and nutrient intakes. Empowerment does not benefit all individuals within the household equally, with gender bias emerging in adolescence. Variations in the strength of the association between women's empowerment and different individuals' dietary quality across the life course has implications for the design and targeting of interventions to improve dietary quality, particularly of women, children, and adolescent girls.

Dietary diversity determinants and contribution of fish to maternal and under-five nutritional status in Zambia

Background

This study examines socio-economic determinants of food consumption patterns amongst women of reproductive age and children aged 6–59 months from urban poor settlements of Lusaka and their implications for nutritional status. Particular emphasis was placed on the role of fish in their diets and nutritional status.

Methods

A cross-sectional survey design was applied, in which 714 mother-child dyads, with children aged 6–59 months were enrolled. A three-stage randomized cluster sampling approach was applied.

Results

The mean dietary diversity score among children aged 6–23 and 24–59 months was 2.98 (±1.27) and 3.478 (±1.07), respectively. In children aged 6–23 months, there was a significant difference in their nutritional status, based on fish consumption (χ² = 10.979, df = 2, p = 0.004). Children from poorer households consumed mostly small fish (Kapenta). The quantity of fish consumed by children was significantly associated with stunting in both age groups, odds ratio = 0.947 (95% CI: 0.896, 1.000) for children aged 6–23 months and odds ratio = 1.038 (95% CI: 1.006, 1.072) for children aged 24–59 months old. Other significant risk factors for stunting in children aged 6–23 months were the child’s age, mother’s body mass index, access to treated water and child morbidity. Child’s age, mother’s educational level and wealth status were determinants of dietary diversity in children aged 6–59 months as shown by the Poisson regression.

Conclusion

Nutritional status of children aged 6–23 months is associated with fish consumption, with children consuming fish less likely to be stunted. Small fish (Kapenta) is an animal-source food that is particularly important in the diet of children in urban poor households in Zambia and contributes to better nutritional outcomes. As all small fish stem from capture fisheries, sustainable one health environmental integration, monitoring and management strategies are desirable.

The impact of integrated nutrition-sensitive interventions on nutrition and health of children and women in rural Tanzania: study protocol for a cluster-randomized controlled trial

Background

Nutrition-sensitive interventions such as homestead production of diverse, nutrient-rich foods, coupled with behavior change communication, may have positive effects on the nutritional status and health of rural households engaged in agriculture, particularly among women and young children. Engagement of agriculture and health extension workers in these communities may be an effective way of delivering nutrition-sensitive interventions given the dearth of trained health care providers in many developing countries. This study aims to assess the effects of integrated homestead food production, food consumption and women’s empowerment interventions using a multi-sectoral approach on women’s and child’s health and nutrition.

Methods

This is a cluster-randomized community-based prospective study set in Rufiji district, a rural area in Eastern Tanzania. Ten randomly selected villages within the Rufiji Health and Demographic Surveillance Site (HDSS) in Eastern-Tanzania were paired and randomly assigned to the intervention or control arm. The Rufiji HDSS dataset was used to randomly sample households with women of reproductive age and children 6–36 months. The intervention includes provision of small agricultural inputs, garden training support, and nutrition and health counseling. This is delivered by community health workers and agriculture extension workers through home visits and farmer field schools. There are three time points for data collection: baseline, midline, and endline. Primary outcomes are women’s and children’s dietary diversity, maternal and child anemia status and growth (child stunting, child wasting, women’s BMI, and women and child hemoglobin).

Discussion

This integrated agriculture and nutrition intervention among rural farming households is a simple and innovative solution that may contribute to the reduction of undernutrition and disease burden among women and children in developing countries. Engaging already existing workforce in the community may facilitate sustainability of the intervention package.

Trial registration

ClinicalTrials.gov NCT03311698, Retrospectively registered on October 17, 2017.

Prevalence and Determinants of Stunting Among Preschool Children and Its Urban-Rural Disparities in Bangladesh

BACKGROUND

Despite improvements in the reduction of child stunting rates over the last decade, poor nutritional status still remains a public health concern in Bangladesh, where young children are the most vulnerable.

OBJECTIVE

The objective of this study is to capture the prevalence and determinants of childhood stunting and document its urban-rural disparities in the context of Bangladesh.

METHODS

The study used data from the Bangladesh Demographic and Health Survey of 2014. A bivariate analysis was performed to find out the differentials in prevalence of stunting, and multivariate logistic regression was performed to also assess the association of stunting with potential risk factors.

RESULTS

The overall prevalence of stunting was 36.3% and was significantly higher in rural (38.1%) areas than urban (31.2%) areas. In all 3 regression models, significantly higher odds were found among children aged 36 to 47 months compared to 6 to 12 months and among the children from the poorest households. In rural areas, male children were significantly more likely to be stunted (odds ratio = 1.31; 95% confidence interval: 1.12-1.53). Other significant risk factors for childhood stunting were maternal education and body mass index, children suffering from diarrhea, initial breast-feeding, and administrative divisions.

CONCLUSIONS

Disparities exist among urban and rural areas regarding stunting among the children younger than 5 in Bangladesh, which need to be reduced. Public health policies and interventions need to consider the risk factors in urban and rural areas separately.

Evaluating pre-pregnancy dietary diversity vs. dietary quality scores as predictors of gestational diabetes and hypertensive disorders of pregnancy

BACKGROUND

Dietary diversity scores (DDS) are considered as metrics for monitoring the implementation of the UN's Sustainable Development Goals, but they need to be rigorously evaluated.

OBJECTIVE

To examine two DDS, the Food Groups Index (FGI), and the Minimum Dietary Diversity-Women (MDD-W), alongside two dietary quality scores, the Alternate Healthy Eating Index (AHEI-2010) and the Prime Diet Quality Score (PDQS), with risks of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDPs).

DESIGN

The analysis included 21,312 (GDM) and 19,917 (HDPs) singleton births reported in the Nurses' Health Study II cohort (1991-2001), among women without major chronic disease or GDM/HDPs. Scores were derived using prepregnancy diet collected by a comprehensive food frequency questionnaire. Multivariable models were utilized to calculate relative risks (RR) and confidence intervals (95%CIs).

RESULTS

Incident GDM (n = 916) and HDPs (n = 1,421) were reported. The MDD-W and FGI were not associated with risk of GDM or HDPs, but the AHEI-2010 and PDQS were associated with a lower risk of GDM and marginally lower risk of HDP. The RR's of GDM comparing the highest vs. lowest quintiles were 1.00 (95%CI: 0.79, 1.27; p-trend = 0.82) for MDD-W, 0.96 (95%CI: 0.76, 1.22; p-trend = 0.88) for FGI, 0.63 (95%CI: 0.50, 0.81; p-trend <0.0001) for the AHEI-2010 and 0.68 (95%CI: 0.54, 0.86; p-trend = 0.003) for the PDQS. Similarly, the RR's of HDPs were 0.92 (95%CI: 0.75, 1.12, p-trend = 0.94) for MDD-W, 0.97 (95%CI: 0.79, 1.17; p-trend = 0.83) for FGI, 0.84 (95%CI: 0.70, 1.02; p-trend = 0.07) for AHEI-2010 and 0.89 (95%CI: 0.74, 1.09; p-trend = 0.07) for PDQS.

CONCLUSIONS

MDD-W and FGI did not predict the risk of GDM and HDPs. These DDS should not be widely used as metrics for achieving dietary goals in their present form. The Prime Diet Quality Score warrants further testing as a promising measure of a sustainable and healthy diet on a global scale.

Maternal Dietary Diversity and Growth of Children Under 24 Months of Age in Rural Dodoma, Tanzania

Objective:

To identify predictors of maternal dietary diversity in rural Dodoma, Tanzania and assess its association with child growth outcomes.

Methods:

A cross-sectional survey of 361 mothers with children under 24 months of age was conducted in 5 villages in rural Dodoma, Tanzania. Maternal diets were assessed using food frequency questionnaires, and dietary diversity was categorized using Minimum Dietary Diversity for Women (MDD-W) guidelines. Child anthropometric measures were taken to calculate height-for-age z-score (HAZ), weight-for-height z-score (WHZ), and weight-for-age z-score (WAZ). Linear and logistic regressions were used to examine the association between maternal dietary diversity and children’s growth outcomes.

Results:

About 40% of mothers did not consume a diverse diet (MDD-W < 5), and 35% of children were stunted. Household production of greater number of crops was associated with greater MDD-W scores ( P < .01). Greater maternal dietary diversity was associated with significantly greater child WHZ (mean difference = 0.44; 95% confidence interval [CI]: 0.10-0.78; P = .01), WAZ (mean difference = 0.37; 95% CI: 0.08-0.65; P = .01), and reduced risk of wasting (odds ratio = 0.22; 95% CI: 0.07-0.66; P = .01).

Conclusions:

Greater maternal dietary diversity was associated with improved child WHZ and WAZ outcomes. Sustainable interventions to increase maternal dietary diversity may improve WHZ and WAZ in young children in similar settings.

Dietary diversity and associated factors among children aged 6-23 months in Sinan Woreda, Northwest Ethiopia: a cross-sectional study

Background

Child malnutrition accounted by poor dietary diversity is common in developing countries contributing for child morbidity and mortality. It also has an impact on child growth and development. Almost all nutritional related problems are preventable by implementing infant and child feeding strategies. The first two years of life are particularly important to reverse the nutritional problems by achieving dietary diversity feeding.

The study aimed to assess dietary diversity and its associated factors among 6–23 months old children in Sinan Woreda, Northwest Ethiopia.

Methods

We conducted community based cross-sectional study among children aged 6–23 months in Sinan Woreda from February 16 to March 10, 2016. Random sampling technique was used to select 740 samples. Data on children’s dietary diversity of the last 24 h were collected through interview of mothers. Data were entered into EpiData version 3.1 and analysis was performed using SPSS version 20. The bivariate and multivariable logistic regression analyses were done to identify the independent factors associated with sub-optimal dietary diversity among children aged 6–23 months.

Results

Seven hundred thirty six samples were included in the analysis with the response rate of 99%. Optimum dietary diversity was observed in 13% children. The dominant food groups consumed were grains. Availability of media sources at household [Adjusted Odds Ratio (AOR) = 2.77 (1.65–4.68)], availability of cow milk in the household [AOR = 2.39 (1.31–4.35)], women’s involvement in decision-making at household level [AOR = 2.07 (1.02–4.20)], institutional delivery service utilization [AOR = 2.40 (1.24–4.67)], receiving assisted delivery service [AOR = 2.36 (1.12–4.98)], receiving postnatal care [AOR = 2.07 (1.18–3.63)], distance far from the health center [AOR = 3.11 (1.66–5.83)] and meal frequency being four and above [AOR = 3.31 (1.53–7.18)] were associated with dietary diversity.

Conclusion

This study concluded that optimum dietary diversity among children aged 6–23 months in Sinan Woreda is low. Meal frequency is positively associated with dietary diversity. Women involvement at household decision making improves dietary diversity of children. Ensuring maternal health service utilization can contribute for better dietary diversity of children aged 6–23 months. Large scale an interventional based research has to be conducted.

Dietary diversity and associated factors among children of Orthodox Christian mothers/caregivers during the fasting season in Dejen District, North West Ethiopia

Background

Proper feeding practices during early childhood is fundamental for optimal child growth and development. However, scientific evidences on the determinants of dietary diversity are scanty. Particularly, the impact of fasting on children`s dietary diversity is not explored in Ethiopia. The aim of this study was to assess dietary diversity and associated factors among children aged 6–23 months, whose mothers/care-givers were Orthodox Christians during the fasting season (Lent), in Dejen District, North West Ethiopia, 2016.

Methods

A community based cross-sectional study was conducted during the fasting season from March to April, 2016. The study sample were children aged 6–23 months, whose mothers/care-givers were Orthodox Christians. A systematic random sampling technique was used to select a sample of 967 children proportionally from all selected kebeles. Data was entered using Epi data and statistical analysis were done using logistic regression. P-value < 0.05 at 95% confidence interval was taken as statistically significant.

Results

Only 13.6% of children surveyed met the minimum requirement for dietary diversity. Unsatisfactory exposure to media [AOR = 5.22] and low household monthly income [AOR = 2.20] were negatively associated with dietary diversity. As compared to economic related reasons, mothers/caregivers who do not feed diet of animal origin to their children due to fear of utensil contamination for family food preparation were 1.5 times [AOR=1.5; 95% CI (1.05 – 2.53)] less likely to feed the recommended dietary diversity.

Conclusions

The findings of this study revealed that the diet of children in the study area lacked diversity. Promoting mass media and socioeconomic empowerment of women have positive contribution to optimal child feeding practice. Sustained nutrition education to mothers regarding proper infant and young child feeding practice in collaboration with the respective religious leaders is highly recommended.

Seasonality and determinants of child growth velocity and growth deficit in rural southwest Ethiopia

Background

Ethiopia faces cyclic food insecurity that alternates between pre- and post- harvest seasons. Whether seasonal variation in access to food is associated with child growth has not been assessed empirically. Understanding seasonality of child growth velocity and growth deficit helps to improve efforts to track population interventions against malnutrition. The aim of this study was assess child growth velocity, growth deficit, and their determinants in rural southwest Ethiopia.

Method

Data were obtained from four rounds of a longitudinal household survey conducted in ten districts in Oromiya Region and Southern Nations, Nationality and Peoples Region of Ethiopia, in which 1200 households were selected using multi-stage cluster sampling. Households with a child under 5 years were included in the present analyses (round 1 n = 579, round 2 n = 674, round 3 n = 674 and round 4 n = 680). The hierarchical nature of the data was taken into account during the statistical analyses by fitting a linear mixed effects model. A restricted maximum likelihood estimation method was employed in the analyses.

Result

Compared to the post-harvest season, a higher length and weight velocity were observed in pre-harvest season with an average difference of 6.4 cm/year and 0.6 kg/year compared to the post-harvest season. The mean height of children in post-harvest seasons was 5.7 cm below the WHO median reference height. The mean height of children increased an additional 3.3 cm [95% CI (2.94, 3.73)] per year in pre-harvest season compared to the post-harvest season. Similarly, the mean weight of children increased 1.0 kg [95% CI (0.91, 1.11)] per year more in the pre-harvest season compared to the post-harvest season. Children who had a low dietary diversity and were born during the lean season in both seasons had a higher linear growth deficit. Being member of a highly food insecure household was negatively associated with higher weight gain. Having experienced no illness during the previous 2 weeks was positively associated with linear growth and weight gain.

Conclusion

Child growth velocities and child growth deficits were higher in the pre-harvest season and post- harvest season respectively. Low dietary diversity and being part of a highly food insecure household were significantly risk factors for decreased linear growth and weight gain respectively.

Risk factors of stunting among children living in an urban slum of Bangladesh: findings of a prospective cohort study

BACKGROUND

Bangladesh is one of the 20 countries with highest burden of stunting globally. A large portion (around 2.2 million) of the population dwells in the slum areas under severe vulnerable conditions. Children residing in the slums are disproportionately affected with higher burden of undernutrition particularly stunting. In this paper, findings of a prospective cohort study which is part of a larger multi-country study are presented.

METHODS

Two hundred and sixty five children were enrolled and followed since their birth till 24 months of age. Anthropometric measurements, dietary intake and morbidity information were collected monthly. Data from 9 to 12, 15-18 and 21-24 months were collated to analyze and report findings for 12, 18 and 24 months of age. Generalized estimating equation models were constructed to determine risk factors of stunting between 12 and 24 months of age.

RESULT

Approximately, 18% of children were already stunted (LAZ < -2SD) at birth and the proportion increased to 48% at 24 months of age. Exclusive breastfeeding prevalence was only 9.4% following the WHO definition at 6 months. Dietary energy intake as well as intakes of carbohydrate, fat and protein were suboptimal for majority of the children. However, in regression analysis, LAZ at birth (AOR = 0.40, 95% CI: 0.26, 0.61), household with poor asset index (AOR = 2.81, 95% CI: 1.43, 5.52; ref.: average asset index), being male children (AOR = 1.75, 95% CI: 1.04, 2.95; ref.: female) and age (AOR = 2.34, 95% CI: 1.56, 3.52 at 24 months, AOR = 2.13, 95% CI: 1.55, 2.92 at 18 months; ref.: 12 months of age) were the significant predictors of stunting among this population.

CONCLUSION

As the mechanism of stunting begins even before a child is born, strategies must be focused on life course approach and preventive measurement should be initiated during pregnancy. Alongside, government and policymakers have to develop sustainable strategies to improve various social and environmental factors those are closely interrelated with chronic undernutrition particularly concentrating on urban slum areas.

Associations of childhood, maternal and household dietary patterns with childhood stunting in Ethiopia: proposing an alternative and plausible dietary analysis method to dietary diversity scores

BACKGROUND

Identifying dietary patterns that consider the overall eating habits, rather than focusing on individual foods or simple counts of consumed foods, better helps to understand the combined effects of dietary components. Therefore, this study aimed to use dietary patterns, as an alternative method to dietary diversity scores (DDSs), and investigate their associations with childhood stunting in Ethiopia.

METHODS

Mothers and their children aged under 5 years (n = 3788) were recruited using a two-stage random cluster sampling technique in two regions of Ethiopia. Socio-demographic, dietary and anthropometric data were collected. Dietary intake was assessed using standardized dietary diversity tools. Household, maternal and child DDSs were calculated and dietary patterns were identified by tetrachoric (factor) analysis. Multilevel linear and Poisson regression analyses were applied to assess the association of DDSs and dietary patterns with height-for-age z score (HAZ) and stunting, respectively.

RESULTS

The overall prevalence of stunting among children under-five was 38.5% (n = 1459). We identified three dietary patterns each, for households ("fish, meat and miscellaneous", "egg, meat, poultry and legume" and "dairy, vegetable and fruit"), mothers ("plant-based", "egg, meat, poultry and legume" and "dairy, vegetable and fruit" and children ("grain based", "egg, meat, poultry and legume" and "dairy, vegetable and fruit"). Children in the third tertile of the household "dairy, vegetable and fruit" pattern had a 0.16 (β = 0.16; 95% CI: 0.02, 0.30) increase in HAZ compared to those in the first tertile. A 0.22 (β = 0.22; 95% CI: 0.06, 0.39) and 0.19 (β = 0.19; 0.04, 0.33) increase in HAZ was found for those in the third tertiles of "dairy, vegetable and fruit" patterns of children 24-59 months and 6-59 months, respectively. Those children in the second (β = -0.17; 95% CI: -0.31, -0.04) and third (β = -0.16; 95% CI: -0.30, -0.02) tertiles of maternal "egg, meat, poultry and legume" pattern had a significantly lower HAZ compared to those in the first tertile. No significant associations between the household and child "egg, meat, poultry and legume" dietary patterns with HAZ and stunting were found. Statistically non-significant associations were found between household, maternal and child DDSs, and HAZ and stunting.

CONCLUSION

A higher adherence to a "dairy, vegetable and fruit" dietary pattern is associated with increased HAZ and reduced risk of stunting. Dietary pattern analysis methods, using routinely collected dietary data, can be an alternative approach to DDSs in low resource settings, to measure dietary quality and in determining associations of overall dietary intake with stunting.

Assessment of Nutritional Status of Infants Living in Arsenic-Contaminated Areas in Bangladesh and Its Association with Arsenic Exposure

Data is scarce on early life exposure to arsenic and its association with malnutrition during infancy. This study followed the nutritional status of a cohort of 120 infants from birth to 9 months of age in an arsenic contaminated area in Bangladesh. Anthropometric data was collected at 3, 6 and 9 months of the infant's age for nutritional assessment whereas arsenic exposure level was assessed via tube well drinking water arsenic concentration at the initiation of the study. Weight and height measurements were converted to Z-scores of weight for age (WAZ-underweight), height for age (HAZ-stunting), weight for height (WHZ-wasting) for children by comparing with WHO growth standard. Arsenic exposure levels were categorized as <50 μg/L and ≥50 μg/L. Stunting rates (<-2 SD) were 10% at 3 months and 44% at both 6 and 9 months. Wasting rates (<-2 SD) were 23.3% at 3 months and underweight rates (<-2 SD) were 25% and 10% at 3 and 6 months of age, respectively. There was a significant association of stunting with household drinking water arsenic exposure ≥50 μg/L at age of 9 months (p = 0.009). Except for stunting at 9 months of age, we did not find any significant changes in other nutritional indices over time or with levels of household arsenic exposure in this study. Our study suggests no association between household arsenic exposure and under-nutrition during infancy; with limiting factors being small sample size and short follow-up. Difference in stunting at 9 months by arsenic exposure at ≥50 μg/L might be a statistical incongruity. Further longitudinal studies are warranted to establish any association.

Complementary feeding intervention on stunted Guatemalan children: a randomised controlled trial

OBJECTIVE/BACKGROUND

Guatemala's indigenous Maya population has one of the highest rates of childhood stunting in the world. The goal of this study was to examine the impact of an intensive, individualised approach to complementary feeding education for caregivers on feeding practices and growth over usual care.

DESIGN

An individually randomised (1:1 allocation ratio), parallel-group superiority trial, with blinding of study staff collecting outcome data.

SETTING

Rural Maya communities in Guatemala.

PARTICIPANTS

324 children aged 6-24 months with a height-for-age Z score of less than or equal to -2.5 SD were randomised, 161 to the intervention and 163 to usual care.

INTERVENTIONS

Community health workers conducted home visits for 6 months, providing usual care or usual care plus individualised caregiver education.

MAIN OUTCOMES MEASURES

The main outcome was change in length/height-for-age Z score. Secondary outcomes were changes in complementary feeding indicators.

RESULTS

Data were analysed for 296 subjects (intervention 145, usual care 151). There was a non-significant trend to improved growth in the intervention arm (length/height-for-age Z score change difference 0.07(95% CI -0.04 to 0.18)). The intervention led to a 22% improvement in minimum dietary diversity (RR 1.22, 95% CI 1.11 to 1.35) and a 23% improvement in minimal acceptable diet (RR 1.23, 95% CI 1.08 to 1.40) over usual care.

CONCLUSIONS

Complementary feeding outcomes improved in the intervention arm, and a non-significant trend towards improved linear growth was observed. Community health workers in a low-resource rural environment can implement individualised caregiver complementary feeding education with significant improvements in child dietary quality over standard approaches.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02509936. Stage: Results.

Do Infant Feeding Practices Differ Between Grandmothers and Mothers in Rural China? Evidence From Rural Shaanxi Province

The overall goal of this study is to examine whether infant feeding practices differ between mothers and grandmothers in rural China. We randomly sampled 1383 caregivers of infants aged 18 to 30 months living in 351 villages across 174 townships in nationally designated poverty counties in rural areas. Results show that a high fraction of caregivers of 18- to 30-month-old children living in low-income areas of rural China do not regularly engage in positive infant feeding practices. Only 30% of children in our sample achieved adequate dietary diversity. Only 49% of children in our sample were fed meat in the day prior to survey administration. Few caregivers reported giving any vitamin supplements (such as calcium or iron supplements) to their children. We find that 33% of the children were cared for by grandmothers rather than mothers, and that grandmothers feed a less diversified diet to children than do mothers. Most (84%) caregivers rely solely on their own experiences, friends, and family members in shaping their feeding behaviors. Overall infant feeding practices are poor in rural China. Grandmothers engage in poorer feeding practices than do mothers. Grandmothers have improved their feeding practices compared to when their own children were young. Our results suggest shortcomings in the quality of infant feeding practices, at least in part due to an absence of reliable information sources.

Stunting and its determinant factors among children aged 6-59 months in Ethiopia

Background

Though Ethiopia has implemented different nutritional interventions, childhood stunting on which literature is limited continues as a severe public health problem. Thus, this study aimed to investigate stunting and its determinants among children aged 6–59 months in the predominantly rural northwest Ethiopia.

Methods

A community based cross-sectional study was conducted from May to June 2015 at Dabat Health and Demographic Surveillance System (HDSS) site. A total of 1295 mother-child pairs were included for analysis. An ordinal multivariable logistic regression analysis was carried out to identify the determinants of severe stunting. To show the strength of associations, both Crude Odds Ratio (COR) and Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) were estimated. Also, a P-value of <0.05 was used to declare statistical significance in the final model.

Results

The overall prevalence of stunting among children aged 6–59 months was 64.5%, of which about 37.7% and 26.8% were moderately and severely stunted, respectively. Farming occupation of mother [AOR = 1.45; 95% CI: 1.08, 1.93], lack of postnatal vitamin-A supplementation [AOR = 1.54; 95%: 1.19, 2.00], poorer household wealth status [AOR = 2.07; CI: 1.56, 2.75] and accessing family food from farms [AOR = 1.44; 95% CI: 1.09, 1.89] were identified as the key determinants of severe stunting.

Conclusion

In the district, the magnitude of stunting was a critical public health concern. Therefore, emphasis should be given to improving mothers’ postnatal vitamin A supplementation coverage and building knowledge about appropriate child feeding practices among farmer mothers and poorer households.

Hubungan Ketahanan Pangan dan Penyakit Diare dengan Stunting pada Balita 13-48 Bulan di Kelurahan Manyar Sabrangan, Surabaya

 Background: Stunting is an acute malnutrition that is one of the leading causes of death in under-five children in the world and can impact on low quality of life in the future. Household food security and infectious diseases especially diarrhea in under-five children are indicated to be factors that cause the stunting state. Toddlers 13-48 months old are likely have a high risk for disease and its effects. Stunting in under-five children is closely related to food insecurity of the family and diarrheal diseases by the children.Objectives: The purpose of this study was to analyze the association of food security of the family and diarrheal diseases to stunting. Methods: This research was an observational analytic with cross sectional design. The sample was 68 children under-five age 13-48 months in Manyar Sabrangan, Mulyorejo Sub-district, Surabaya. Selection of sample was using simple random sampling with lottery technique. The data were collected by interview method with questionnaire. Food security was accessed by US-HFSSM questionnaire. Spearman correlation test was used in the statistical analysis (α=0.05). Results: The data showed that the percentage of stunting, diarrhea, and household insecurity respectively 30.9%, 19.1%, and 61.8%. There was an association between food insecurity with stunting (p<0.05). There was not an association between diarrhea with stunting (p>0.05). Conclusions: It is necessary for family to have a coping strategy to avoid long-term food insecurity. There is another factor such as a history of food intake that may be able to affect stunting in addition to diarrhea.ABSTRAK Latar Belakang: Stunting merupakan keadaan kekurangan gizi akut yang menjadi salah satu penyebab kematian pada balita di dunia dan dapat berdampak pada kualitas kehidupan yang rendah di masa depan. Ketahanan pangan keluarga dan kejadian penyakit infeksi yang dialami balita terutama diare diindikasikan menjadi faktor yang dapat menyebabkan keadaan stunting. Balita usia 13-48 bulan merupakan kelompok yang rentan terhadap penyakit dan dampaknya. Keadaan stunting erat kaitannya dengan kerawanan pangan keluarga dan penyakit infeksi seperti diare yang dialami balita.Tujuan: Untuk menganalisis hubungan ketahanan pangan keluarga dan penyakit diare dengan keadaan stunting balita.Metode: Penelitian ini merupakan penelitian observasional analitik dengan rancang cross sectional. Sampel dalam penelitian ini adalah 68 balita usia 13-48 bulan di Kelurahan Manyar Sabrangan Kecamatan Mulyorejo Kota Surabaya. Pemilihan sampel menggunakan simple random sampling dengan teknik lotre. Pengambilan data dilakukan dengan metode wawancara dengan kuesioner. Ketahanan pangan diukur dengan menggunakan kuesioner United Stated-Household Food Security Survey Module (US-HFSSM). Analisis statistik dilakukan dengan menggunakan uji korelasi spearman (α=0,05).Hasil: Hasil menunjukkan bahwa sebanyak 30,9% balita mengalami stunting, 19,1% mengalami diare, dan 61,8% berada pada keadaan rawan pangan. Ketahanan pangan keluarga dan keadaan stunting menunjukkan adanya hubungan yang signifikan (p<0,05). Penyakit diare balita dan keadaan stunting tidak menunjukkan adanya hubungan yang signifikan (p>0,05).Kesimpulan: Dibutuhkan coping strategi dalam keluarga untuk mengatasi masalah kerawanan pangan yang terus-menerus. Terdapat faktor lain seperti riwayat asupan makanan yang dapat mempengaruhi stunting selain penyakit diare.

Situation and determinants of the infant and young child feeding (IYCF) indicators in Madagascar: analysis of the 2009 Demographic and Health Survey

BACKGROUND

Studies evaluating child feeding in Madagascar are scarce despite its importance in child growth during the first two years of life. This study assessed the associations between the WHO infant and young child feeding (IYCF) indicators and stunting and identified determinants of inappropriate child feeding practices.

METHODS

The most recent Demographic and Health Survey was used including a total of 1956 infants aged 0-23 months. Logistic regressions were performed for the association between IYCF indicators and stunting and for the determination of risk factors for inappropriate feeding practices.

RESULTS

The rates of initiation of breastfeeding within one hour after birth (77.2%), continued breastfeeding at one year (99.6%) and timely introduction of solid, semi-solid or soft foods at 6-8 months (88.3%) were high. Exclusive breastfeeding under 6 months (48.8%), attaining minimum dietary diversity (22.2%) and consumption of iron-rich foods (19.6%) were relatively low. Higher length-for-age was associated with achieving minimum dietary diversity (p<0.01). The other indicators assessed (early initiation of breastfeeding, exclusive breastfeeding under 6 months, timely introduction of complementary foods and consumption of iron-rich foods) were not associated with stunting. Infants born to mothers who had first given birth at an age younger than 19 were more likely not to be breastfed within one hour after birth, not to be exclusively breastfed and not to have the recommended dietary diversity. Infants whose mothers had low media exposure were at increased risk of being inappropriately fed. Low household wealth also was associated with higher odds of not meeting the minimum dietary diversity.

CONCLUSIONS

Despite almost total continued breastfeeding at one year and early initiation of breastfeeding by more than three-quarter of mothers, minimum dietary diversity scores were still low, confirming the need for more effective programs for improving child feeding practices in Madagascar. Improving dietary diversity in children aged 6-23 months may help reduce stunting. The identified risk factors for inappropriate feeding practices could be used in directing future nutrition sensitive interventions.

Rich Food Biodiversity Amid Low Consumption of Food Items in Kilosa District, Tanzania

Background:

Indigenous foods, which contribute largely to the majority of the households' food basket in rural Tanzanian communities, have not been fully characterized or documented.

Objectives:

The study aimed to document foods available and consumed in Kilosa District, Tanzania, in an attempt to promote, revive use, and build evidence for sustainable utilization of the rich local biodiversity.

Methods:

Data were collected from 307 households in 3 agroecological zones in Kilosa District during the beginning of the rainy season (February-May) and immediately after harvest (September-October). A list of food items was generated, and 24-hour recall was performed. Descriptive statistics were calculated and a student t test statistic was used to compare the means of the Food Biodiversity Score between the agricultural seasons.

Results:

A total of 183 edible food items were reported by households with more reported in the rainy season (n = 82) compared to harvest season (n = 64). The mean number of food items consumed per day during the rainy season was 4.7 (95% CI: 4.5-5.0) compared to 5.9 (95% CI: 5.7-6.1) during harvest season. About 50% of the households mentioned that wild edible foods were less accepted by household members.

Conclusion:

Despite the rich local food biodiversity, households relied on few food items which may be due to limited awareness and knowledge about the biodiversity of foods in the community. It is important to educate communities on the rich and affordable food base available locally to improve their food diversity, income, and nutritional status.

Risk factors of poor complementary feeding practices in Pakistani children aged 6-23 months: A multilevel analysis of the Demographic and Health Survey 2012-2013

Appropriate feeding practices are crucial for survival, growth, and development in childhood. This paper analyzes Pakistan's Demographic and Health Survey 2012-2013 to fill the knowledge gap in risk factors of poor complementary feeding practices in Pakistani children. Multilevel models were applied to fit the multistage cluster sample of 2,827 children aged 6-23 months from 489 communities. Introduction of solid, semi-solid, or soft foods (intro) was achieved in 67% infants aged 6-8 months. Among children aged 6-23 months, the proportion of children meeting minimum meal frequency, dietary diversity (MDD), and acceptable diet criteria were 63%, 22% and 15%, respectively. Consumption of legumes and nuts, flesh foods, and vitamin A-rich fruits and vegetables was low in all children (6-19%), even among children who met the MDD criteria (15-55%). Younger child age, especially between 6 and 11 months and delayed maternal postnatal checkup were significant individual-level risk factors that consistently increased the odds of not meeting all four criteria examined. Fewer antenatal care visits predicted the odds of achieving intro and minimum meal frequency while younger maternal age and household poverty predicted the odds of achieving MDD and minimum acceptable diet. Community-level factors included geographic region and general access to maternal and child health care services. The overall poor quality of children's complementary diets in Pakistani calls for stronger policy and program action to promote the consumption of key nutrient-dense foods while prioritizing interventions for the most vulnerable children and populations.

Infant feeding practices in a South African birth cohort-A longitudinal study

Childhood malnutrition is highly prevalent in low- and middle-income countries. The choices of complementary foods, which are important in infant nutrition, are poorly described in this setting. We investigated infant feeding practices in a South African birth cohort, the Drakenstein Child Health Study. Longitudinal feeding data were collected from March 2012 to March 2015. Feeding practices at birth, 6-10 and 14 weeks and 6, 9, and 12 months, were investigated using food frequency questionnaires. Anthropometry was measured at birth and 12 months. The quality of the diet was analyzed using the World Health Organization infant and young child feeding indicators. Regression models were used to explore associations between feeding and growth outcomes at 1 year. Exclusive breastfeeding for 6 months was low (13%), and 19% of infants were introduced to solid foods before 4 months. There was high daily consumption of processed meat (56%) and inappropriate foods such as fruit juice (82%), soft drinks (54%), and refined sugary foods (51%) at 1 year. Dietary diversity and consumption of iron rich foods were low at 6 months (5% and 3%, respectively) but higher by 12 months (75% and 78%). Longer duration of exclusive breastfeeding was associated with a lower height-for-age z-score at 1 year. Several dietary deficits and a rising trend in the consumption of inappropriate nutritionally poor foods were identified. These findings raise concern about poor dietary practices and the impact on child and long-term health.

Fish and Meat Are Often Withheld From the Diets of Infants 6 to 12 Months in Fish-Farming Households in Rural Bangladesh

BACKGROUND

Fish is a widely available animal-source food in Bangladesh and a rich source of nutrients, yet little is known about practices related to incorporating fish into the diets of infants and young children.

OBJECTIVE

Use dietary diversity data to explore consumption patterns of fish and high-quality food items within the household and examine factors associated with delayed introduction of fish to infants and young children.

METHODS

Cross-sectional survey of 496 households with children <36 months participating in the Aquaculture for Income and Nutrition project in Bangladesh. Data collected included household characteristics, women's dietary diversity score, and minimum dietary diversity score along with data on Infant and Young Child Feeding practices.

RESULTS

Most children (63.4%) met the threshold for minimum dietary diversity. Despite having received extensive nutrition education related to including fish in complementary foods, only half of the caretakers introduced fish at 6 months and the mean age of introduction of small fish was 8.7 months. Meat and fish were not common in infant diets but increased with child age. Concerns about bones were a major barrier to incorporating fish into infant diets.

CONCLUSION

Given its nutrient profile and widespread availability in certain contexts, fish could be an underutilized opportunity to improve nutrition and health outcomes of infants and young children. Further research, including utilizing food processing technologies, is needed to develop appropriate responses to overcome these barriers.

Meal frequency and dietary diversity feeding practices among children 6-23 months of age in Wolaita Sodo town, Southern Ethiopia

BACKGROUND

Child feeding practices are multidimensional, and they change rapidly within short age intervals. Suboptimal complementary feeding practices contribute to a rapid increase in the prevalence of undernutrition in children in the age of 6-23 months. Information on child feeding practices among urban resident is limited in Ethiopia. The aim was to measure minimum meal frequency and dietary diversity and associated factors among children 6-23 months of age in Wolaita Sodo, Ethiopia.

METHODS

A community-based cross-sectional study was carried out to select 623 mothers/caregivers with 6-23 months of children reside in Wolaita Sodo town using systematic sampling from March 02 to 20, 2015. An interviewer-administered questionnaire was used to gather information on socio-demographic, child feeding practices and health-related characteristics. Data were entered to Epi-Data version 3.02 and transported to SPSS version 21 for further analysis. Binary logistic regression was used to see the association between the outcome variables and explanatory variables, and multivariable logistic regression was performed to identify independent predictors of minimum dietary diversity and meal frequency.

RESULTS

The study revealed that the percentage of 6-23 months of children who meet the recommended level of minimum dietary diversity and meal frequency were 27.3 and 68.9%, respectively. Mothers/caregivers who were housewives and government employees feed their children more diversified foods as compared to mothers who were private workers. As compared to children 17-23 months of age, children in the age group of 6-8 and 9-11 months had better probability to meet minimum dietary diversity. Government-employed and illiterate mothers were less likely to feed their children to fulfil the minimum requirement of meal frequency. Children in the age of 9-11 months were also less likely to be fed frequently.

CONCLUSIONS

Even though the study showed better progress as compared to the national prevalence of complementary feeding practices, child feeding practices in the study area were inadequate and not achieving WHO infant and young child feeding recommendations. Strengthening the available strategies and creating new intervention measures to improve socioeconomic status, maternal literacy and occupation opportunity for better practices of child feedings are compulsory actions for the government and policymakers.

Socioeconomic determinants of growth in a longitudinal study in Nepal

Socioeconomic status (SES) is associated with childhood anthropometry, but little is known about how it is associated with tissue growth and body composition. To investigate this, we looked at components of SES at birth with growth in early and mid‐childhood, and body composition in a longitudinal study in Nepal. The exposure variables (material assets, land ownership, and maternal education) were quantified from questionnaire data before birth. Anthropometry data at birth, 2.5 and 8.5 years, were normalized using WHO reference ranges and conditional growth calculated. Associations with child growth and body composition were explored using multiple regression analysis. Complete anthropometry data were available for 793 children. There was a positive association between SES and height‐for‐age and weight‐for‐age, and a reduction in odds of stunting and underweight for each increase in rank of SES variable. Associations tended to be significant when moving from the lower to the upper asset score, from none to secondary education, and no land to >30 dhur (~500 m²). The strongest associations were for maternal secondary education, showing an increase of 0.6–0.7 z scores in height‐for‐age and weight‐for‐age at 2.5 and 8.5 years and 0.3 kg/m² in fat and lean mass compared to no education. There was a positive association with conditional growth in the highest asset score group and secondary maternal education, and generally no association with land ownership. Our results show that SES at birth is important for the growth of children, with a greater association with fat mass. The greatest influence was maternal secondary education.

Simulated effects of home fortification of complementary foods with micronutrient powders on risk of inadequate and excessive intakes in West Gojjam, Ethiopia

Home fortification of complementary foods (CFs) with multiple micronutrient powders (MNPs) is being scaled up in various countries, but little is known about the prevailing complementary feeding practices and the type and nutrient gaps to be filled with MNPs. The present study evaluated the complementary feeding practices of young children and simulated the risk of inadequate and excessive intakes associated with home fortification with MNPs. We have assessed the sociodemographic status, anthropometry, and complementary feeding practices of young children (N = 122) in Mecha district, rural Ethiopia. Using a 2-day, quantitative 24-hr recall, usual intakes of energy, protein, iron, zinc, and calcium were estimated. The risks of inadequate and excessive iron and zinc intakes with or without home fortification scenarios were assessed. The simulations considered intakes from CFs assuming average breast milk contributions and additional nutrients provided by the MNPs. Stunting was highly prevalent (50%) and was associated with a lower dietary diversity (P = .009) and nutrient intakes from the CFs. Median energy, zinc, and calcium intakes were below the estimated needs from CFs; protein needs were met. Median dietary iron intake appeared adequate, but 76%, 95% CI [68%, 84%], of children had inadequate intake (assuming low bioavailability), whereas another 8%, 95% CI: [3%, 13%], had excessive intakes. Simulation of daily and alternative day's fortification with MNP decreased the prevalence of inadequate iron and zinc intake but significantly increased the risk of excessive intakes that remained unacceptably high for iron (>2.5%). Untargeted MNP interventions may lead to excessive intakes, even in settings where poor complementary feeding practices are prevalent.

Differential effects of dietary diversity and maternal characteristics on linear growth of children aged 6-59 months in sub-Saharan Africa: a multi-country analysis

OBJECTIVE

To investigate the differential effects of dietary diversity (DD) and maternal characteristics on child linear growth at different points of the conditional distribution of height-for-age Z-score (HAZ) in sub-Saharan Africa.

DESIGN

Secondary analysis of data from nationally representative cross-sectional samples of singleton children aged 0-59 months, born to mothers aged 15-49 years. The outcome variable was child HAZ. Quantile regression was used to perform the multivariate analysis.

SETTING

The most recent Demographic and Health Surveys from Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC).

SUBJECTS

The present analysis was restricted to children aged 6-59 months (n 31 604).

RESULTS

DD was associated positively with HAZ in the first four quantiles (5th, 10th, 25th and 50th) and the highest quantile (90th) in Nigeria. The largest effect occurred at the very bottom (5th quantile) and the very top (90th quantile) of the conditional HAZ distribution. In DRC, DD was significantly and positively associated with HAZ in the two lower quantiles (5th, 10th). The largest effects of maternal education occurred at the lower end of the conditional HAZ distribution in Ghana, Nigeria and DRC. Maternal BMI and height also had positive effects on HAZ at different points of the conditional distribution of HAZ.

CONCLUSIONS

Our analysis shows that the association between DD and maternal factors and HAZ differs along the conditional HAZ distribution. Intervention measures need to take into account the heterogeneous effect of the determinants of child nutritional status along the different percentiles of the HAZ distribution.

Geophagy Is Associated with Growth Faltering in Children in Rural Bangladesh

OBJECTIVE

To determine the relationship between geophagy (mouthing of dirt, sand, clay, or mud) and growth faltering in young children.

STUDY DESIGN

We examined linear growth as height and weight standardized by age and sex, and weight standardized by height, in a cohort of children aged 6-36 months in rural Mirzapur, Bangladesh. We determined geophagy behavior at baseline through caregiver report. Anthropometric measurements were assessed at baseline and at a 1-year follow-up.

RESULTS

We found that among children not stunted at baseline, those with caregiver-reported geophagy at baseline grew less over 1 year compared with their peers, with a difference in the change of standardized height for age and sex of -0.31 (95% CI, -0.61 to -0.01).

CONCLUSION

These findings show that caregiver-reported geophagy was associated with growth faltering in a pediatric population in rural Bangladesh. Future studies are needed to learn more about this exposure pathway and its relevance to child growth.

Effect of complementary food supplementation on breastfeeding and home diet in rural Bangladeshi children

BACKGROUND

Complementary food supplements (CFSs) can enhance growth where stunting is common, but substitution for the usual diet may reduce observed benefits.

OBJECTIVE

We aimed to characterize dietary diversity from home foods in a CFS efficacy trial and determine whether supplementation reduced breastfeeding frequency or displaced home foods.

DESIGN

In a cluster-randomized controlled trial in rural Bangladesh, children (n = 5499) received, for 1 y starting at age 6 mo, periodic child feeding counseling for mothers (control) or counseling plus 1 of 4 CFSs fed as a daily snack. Breastfeeding status and past 24-h diet were assessed at enrollment and every 3 mo thereafter until 18 mo of age. A 7-food group dietary diversity score (DDS) was calculated from home foods only, and a DDS ≥4 constituted minimum dietary diversity (MDD).

RESULTS

Most children (97%) were breastfed through 18 mo of age, and 24-h breastfeeding frequency did not differ by supplementation group. Child dietary diversity was low; only 51% of children met the MDD by 18 mo. Rice, potatoes, and biscuits (cookies) were the most frequently consumed foods, whereas the legumes, dairy, eggs, and vitamin A-rich fruit and vegetable food groups were each consumed by <50% of children. The odds of meeting the MDD through the consumption of home foods were equal or greater in the supplemented groups compared with the control group at all ages. High socioeconomic status and any maternal education were associated with increased odds of MDD at age 18 mo, whereas child sex and household food security were not associated with MDD.

CONCLUSIONS

In a setting where daily complementary food supplementation improved linear growth, there was no evidence that supplementation displaced breastfeeding or home foods, and the supplementation may have improved dietary diversity. Pathways by which supplementation with fortified foods may enhance dietary diversity, such as an improved appetite and increased body size, need elucidation. This trial was registered at clinicaltrials.gov as NCT01562379.

Plant Protein Intake and Dietary Diversity Are Independently Associated with Nutrient Adequacy in French Adults

BACKGROUND

Plant protein intake, which is favorably associated with the intake of many nutrients, is a marker of a healthy diet. However, the higher nutrient adequacy of diets rich in plant protein may also originate from overarching factors associated with more healthful dietary behaviors, such as a greater dietary diversity.

OBJECTIVE

Our main objective was to determine whether the relation between plant protein intake and nutrient adequacy could be explained, at least in part, by an association with overall dietary diversity.

METHODS

We used data from 1330 adults participating in the French Nutrition and Health Survey [Etude Nationale Nutrition Santé (ENNS); 2006-2007]. With the use of global, integrative approaches, we assessed nutrient adequacy [by using the probabilistic PANDiet (Probability of Adequate Nutrient Intake) scoring system] and overall dietary diversity (by using a 100-point score that accounts for the relative number of subgroups consumed in 7 food groups). Linear multivariate modeling was used for the analysis.

RESULTS

We found a positive association between plant protein (but not total or animal protein) intake and dietary diversity (β = 0.08) and a strong positive association between dietary diversity and nutrient adequacy (β = 0.33). However, the association between plant protein intake and nutrient adequacy was not explained by dietary diversity (r = 0.38 and partial r = 0.36, P < 0.0001). In multivariate analysis, nutrient adequacy was positively associated with dietary diversity (β = 0.44) and plant (β = 0.37) and animal (β = 0.15) protein intakes. Associations persisted after adjustment for potential confounders (total energy, energy density, sex, body mass index, income, occupational status, educational level, region, season, and smoking status).

CONCLUSIONS

Overall dietary diversity is greater in French adults who consume more plant protein. Both plant protein intake and dietary diversity are associated with the nutrient adequacy of the diet. But the plant protein-nutrient adequacy association was not related to the relative overall diversity of the diet.

Anemia and undernutrition among children aged 6-23 months in two agroecological zones of rural Ethiopia

BACKGROUND

Child malnutrition during the first 1,000 days, commencing at conception, can have lifetime consequences. This study assesses the prevalence of anemia and undernutrition among children aged 6-23 months in midland and lowland agroecological zones of rural Ethiopia.

METHODS

Cross-sectional data examining sociodemographic, anthropometry, hemoglobin levels, and meal frequency indicators were collected from 216 children aged 6-23 months and their mothers randomly selected from eight rural kebele (villages).

RESULTS

Of 216 children, 53.7% were anemic, and 39.8%, 26.9%, and 11.6% were stunted, underweight, and wasted, respectively. The prevalence of anemia was higher in the lowland agroecological zone (59.5%) than the midland (47.6%). Among those children who were stunted, underweight, and wasted, 63.5%, 66.7%, and 68.0% were anemic, respectively. Child anemia was significantly associated with the child not achieving minimum meal frequency, sickness during the last 2 weeks before the survey, stunting and low body mass index, and with maternal hemoglobin and handwashing behavior. The prevalence of stunting was higher in the lowland agroecological zone (42.3%) than the midland (36.2%). The predictors of stunting were age and sex of the child, not achieving MMF, maternal body mass index, and age. As maternal height increases, the length for age of the children increases (P=0.003).

CONCLUSION

The overall prevalence of anemia and undernutrition among children aged 6-23 months in these study areas is very high. The prevalence was higher in the lowland agro-ecological zone. Health information strategies focusing on both maternal and children nutrition could be sensible approaches to minimize stunting and anemia.

Dietary diversity, animal source food consumption and linear growth among children aged 1-5 years in Bandung, Indonesia: a longitudinal observational study

Dietary diversity involves adequate intake of macronutrient and micronutrient. The inclusion of animal source foods (ASF) in the diet helps prevent multiple nutrient deficiencies and any resultant, linear growth retardation. The objective of the current study was to assess the relationship between dietary diversity, ASF consumption and height-for-age z-score (HAZ) among children aged 12-59 months old across a 1-year observation. This longitudinal observational study without controls was conducted among four age groups: 12-23 months (n 57), 24-35 months (n 56), 36-47 months (n 58) and 48-59 months (n 56). Anthropometry and dietary intake were measured during each of four visits at 16-20-week intervals. The general characteristics and other observations were only collected at baseline and endline. During the year-long study period, approximately 27 % of the children ate a diverse diet (consumed ≥6 out of 9 food groups) according to ≥3 visits. ASF consumption was high, particularly for eggs, poultry, processed meats and liquid milk. Yet, micronutrient intake inadequacy, especially of Zn, Ca, Fe and vitamin A, was highly prevalent. A multivariate regression analysis showed that the consumption of a diverse diet and ASF was not significantly associated with the HAZ at endline, after controlling for demographic characteristics and the baseline HAZ. The consumption of a diverse diet was significantly associated with Ca intake adequacy. Moreover, ASF consumption was significantly associated with adequate intake of protein and micronutrients, particularly vitamin A, Ca and Zn. Thus, the recommendation is to continue and strengthen the promotion of consuming a diverse diet that includes ASF in supporting the linear growth of young children.

Dietary Diversity Is Positively Associated with Deviation from Expected Height in Rural Nepal

BACKGROUND

Recent research has highlighted the need for additional studies on the nutrition input required to stabilize growth.

OBJECTIVE

Our objective was to examine the association between dietary diversity and conditional growth in children aged 0-89 mo.

METHODS

We analyzed cohort data from 529 mothers and children living in a remote and food-insecure region in the mountains of Nepal. Children were aged 0-59 mo at baseline and were followed up after 9 and 29 mo. Conditional growth was calculated as the deviation from the expected height-for-age difference (HAD) trajectory based on previous measures of HAD and the pattern of growth in the population. Dietary diversity was assessed with the use of a count of the foods consumed from 7 food groups in the previous 7 d. The association between dietary diversity and conditional growth during the 2 follow-up periods (of 9 and 20 mo, respectively) was estimated with the use of ordinary least-squares regressions.

RESULTS

Prevalence of stunting and absolute height deficits was very high and increased over the course of the study. At the last measurement (age range 29-89 mo), 76.5% were stunted and the mean ± SD HAD was -11.7 ± 4.6 cm. Dietary diversity was associated positively with conditional growth in the later (May 2012-December 2013) but not the earlier (July 2011-May 2012) growth period. Children's ages ranged from 0 to 59 mo in July 2011, 9 to 69 mo in May 2012, and 29 to 89 mo in December 2013. After adjustment, increasing the dietary diversity by one food group was associated with a 0.09 cm (95% CI: 0.00, 0.17 cm) increase in conditional growth in the second growth period.

CONCLUSIONS

Increasing dietary diversity for children reduces the risk of stunting and improves growth after growth faltering. Future efforts should be directed at enabling families in food-insecure areas to feed their children a more diverse diet.

Higher Dietary Energy Density is Associated with Stunting but not Overweight and Obesity in a Sample of Urban Malaysian Children

Although diets with high energy density are associated with increased risk of overweight and obesity, it is not known whether such diets are associated with undernutrition. This study assessed the relationship between dietary energy density (ED) and nutritional status of 745 urban 1- to 10-year-old children. Dietary intakes were obtained using food recall and record for two days. Dietary energy density was based on food and caloric beverages. Higher dietary ED was associated with lower intakes of carbohydrate, sugar, vitamins C and D, and calcium but higher fat, fiber, iron, and folate intakes. While intakes of fruits and milk/dairy products decreased, meat, fish, and legume intakes increased with higher dietary ED. Stunting, but not other growth problems, was associated with higher dietary ED. Future studies should confirm the cause-and-effect relationship between higher dietary ED and stunting.

The relationship between agricultural biodiversity, dietary diversity, household food security, and stunting of children in rural Kenya

The study was to determine the role of Dietary diversity (DD), household food security (HFS), and agricultural biodiversity (AB) on stunted growth in children. Two cross-sectional studies were undertaken 6 months apart. Interviews were done with mothers/caregivers and anthropometric measurements of children 24-59 months old. HFS was assessed by household food insecurity access scale (HFIAS). A repeated 24-h recall was used to calculate a dietary diversity score (DDS). Agricultural biodiversity (AB) was calculated by counting the number of edible plants and animals. The study was undertaken in resource-poor households in two rural areas in Kenya. Mothers/Care givers and household with children of 24-59 months of age were the main subjects. The prevalence of underweight [WAZ <-2SD] ranged between 16.7% and 21.6% and stunting [HAZ <-2SD] from 26.3% to 34.7%. Mean DDS ranged from 2.9 to 3.7 and HFIAS ranged from 9.3 to 16.2. AB was between 6.6 and 7.2 items. Households with and without children with stunted growth were significantly different in DDS (P = 0.047) after the rainy season and HFIAS (P = 0.009) in the dry season, but not with AB score (P = 0.486). The mean AB for households with children with stunted growth were lower at 6.8, compared to 7.0 for those with normal growth, however, the difference was insignificant. Data indicate that households with children with stunted growth and those without are significantly different in DDS and HFIAS but not with AB. This suggests some potential in using DDS and HFIAS as proxy measures for stunting.

Nearly half of preschool children are stunted in Dembia district, Northwest Ethiopia: a community based cross-sectional study

Background

Stunting has been the most pressing public health problem throughout the developing countries. It is the major causes of child mortality and global disease burden, where 80 % of this burden is found in developing countries. In the future, stunting alone would result in 22 % of loss in adult income. About 40 % of children under five-years were stunted in Ethiopia. In the country, about 28 % of child mortality is related to undernutrition. Thus, the aim of this study was to determine the prevalence and determinants of stunting among preschool children in Dembia district, Northwest Ethiopia.

Methods

A community based cross–sectional study was carried out in Dembia district, Northwest Ethiopia from January 01 to February 29, 2015. A multi-stage sampling followed by a systematic sampling technique was employed to reach 681 mother-child pairs. A pretested and structured questionnaire was used to collect data. After exporting anthropometric data to ENA/SMART software version 2012, nutritional status (stunting) of a child was determined using the WHO Multicenter Growth Reference Standard. In binary logistic regression, a multivariable analysis was carried out to identify determinants of stunting. The Adjusted Odds Ratio (AOR) with a 95 % confidence interval was computed to assess the strength of the association, and variables with a P-value of <0.05 in multivariable analysis were considered as statistically significant.

Results

A total 681 of mother-child pairs were included in the study. The overall prevalence of stunting was 46 % [95 % CI: 38.7, 53.3 %]. In multivariable analysis, the odds of stunting was higher among children whose families had no latrine [AOR = 1.6, 95 % CI: 1.1, 2.2)]. Likewise, children living in household with more than four family size [AOR =1.4, 95 % CI: 1.1, 1.9)] were more likely to be stunted.

Conclusions

This study confirms that stunting is a very high public health problem in Dembia district. The family size and latrine availability were significantly associated with stunting. Hence, emphasis should be given to improve the latrine coverage and utilization of family planning in the district.

Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey

BACKGROUND

Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India's slow progress in improving childhood survival.

METHODS

Using rounds 2 and 3 (2002-08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states ('Empowered Action Groups').

RESULTS

Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories.

CONCLUSIONS

Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states.

The impact of a conditional cash transfer programme on determinants of child health: evidence from Colombia

OBJECTIVE

Conditional cash transfer (CCT) programmes provide income to low-income families in return for fulfilling specific behavioural conditions. CCT have been shown to improve child health, but there are few systematic studies of their impact on multiple determinants of child health. We examined the impact of a CCT programme in Colombia on: (i) use of preventive health services; (ii) food consumption and dietary diversity; (iii) mother's knowledge, attitudes and practices about caregiving practices; (iv) maternal employment; and (v) women's empowerment.

DESIGN

Secondary analysis of the quasi-experimental evaluation of the Familias en Accion programme. Children and families were assessed in 2002, 2003 and 2005-06. We applied a difference-in-differences approach using logistic or linear regression, separately examining effects for urban and rural areas.

SETTING

Colombia.

SUBJECTS

Children (n 1450) and their families in thirty-one treatment municipalities were compared with children (n 1851) from sixty-five matched control municipalities.

RESULTS

Familias en Accion was associated with a significant increase in the probability of using preventive care services (OR=1·85, 95 % CI 1·03, 3·30) and growth and development check-ups (β=1·36, 95 % CI 0·76, 1·95). It had also a positive impact on dietary diversity and food consumption. No effect was observed on maternal employment, women's empowerment, and knowledge, attitudes and practices about caregiving practices. Overall, Familias en Accion's impact was more marked in rural areas.

CONCLUSION

CCT in Colombia increase contact with preventive care services and improve dietary diversity, but they are less effective in influencing mother's employment decisions, empowerment and knowledge of caregiving practices.