Growth and malnutrition of rural Zimbabwean children (6-17 years of age)

Probiotic Potential, Iron and Zinc Bioaccessibility, and Sensory Quality of Uapaca kirkiana Fruit Jam Fermented with Lactobacillus rhamnosus Yoba

Uapaca kirkiana is an underutilised indigenous fruit tree (IFT) found in the miombo ecological zone in sub-Saharan Africa. Furthermore, sub-Saharan Africa is home to many nutritionally insecure people who suffer from micronutrient deficiency. The incorporation of probiotic strains in jams as a possible way of enhancing mineral accessibility, food quality, and health is limited in Africa. This study monitored the probiotic potential, bioaccessible iron and zinc, and organoleptic properties of U. kirkiana fruit jam fermented with L. rhamnosus yoba. U. kirkiana fruits were collected from semiarid rural areas of Zimbabwe. The L. rhamnosus yoba strain was obtained from the Yoba for Life Foundation, Netherlands. Mineral and biochemical properties of the probiotic jam were analysed using AOAC standard methods. The U. kirkiana fruit tree was ranked first as a food resource by most rural populations in Zimbabwe. The probiotic jam formulation had 55% (wt/vol) U. kirkiana fruit pulp, 43% (wt/vol) sugar, 1.25% (wt/vol) pectin, 0.5% (wt/vol) citric acid, and 0.25% (wt/vol) L. rhamnosus yoba strain. The probiotic jam had 6.2 ± 0.2 log CFU/mL viable L. rhamnosus yoba cells. Iron and zinc content (mg/100 g w.b.) was 4.13 ± 0.22 and 0.68 ± 0.02 with pH 3.45 ± 0.11, respectively. Nutrient content was g/100 g w.b., carbohydrate 66 ± 4.1, fat 0.1 ± 0.01, crude protein 0.2 ± 0.01, ash 0.7 ± 0.02, and crude fiber 0.3 ± 0.01. Bioaccessible iron and zinc were 6.55 ± 0.36% and 16.1 ± 0.50% and increased by 4% and 2% in the probiotic jam, respectively. Mineral bioaccessibility and nutrient content were significantly different (p < 0.05) in jam with 0.25% L. rhamnosus yoba. Jam acceptance rating was 83%. The probiotic jam can be used as a sustainable food containing probiotic with potential nutritional and health benefits.

Evaluation of the nutritional status of rural children living in Zambia

Background

Growth references (growth charts) are used to assess the nutritional and growth status of children. In developed countries, there are growth charts based on the country’s national surveys. However, many developing countries do not have their own growth references, so they usually use WHO and US CDC references. In such cases, it is known that the growth statuses of the subject are underestimated or overestimated. This study sought to accurately assess the growth status of children by developing a local growth chart for children living in the Southern Province of Zambia.

Methods

Anthropometric measurements were conducted on 1135 children aged 2–19 years in the target area. The height and weight data for each sex and age were smoothed using the LMS method, and a percentile curve of height and weight was developed. Based on the US CDC reference, three indicators of undernutrition (stunting, underweight, and thinness) were calculated to determine the proportion of those who are undernourished (z-score < − 2).

Results

The 50th percentile curve of height and weight in the growth chart of the target population was equivalent to the 5–25th percentile curve of the US reference, and the children of Zambia were both small and of low weight. Conversely, although many subjects are small and of low weight, it was found that there were few poor nutritional statuses as judged by BMI. Through comparison with a previous study in the Southern Province of Zambia, a secular change in the growth of children over 20 years was found. Although there was no significant increase in height and weight in the older age group, there was a significant increase in height and weight at an earlier age. This is thought to be due to an increase in the growth rate of children due to improved socioeconomic conditions, women’s education level, and improvement in health care standards.

Conclusions

The subjects were small and of low weight compared to the US population, but the nutritional status was not poor by BMI. The height and weight at an earlier age increased compared to 20 years ago.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40101-020-00244-8.

Age and sex specific variations in body composition in Indian urban Bengali Hindu children, adolescents and young adults aged 7–21 years

Childhood and adolescent obesity is a public health concern worldwide. However, little attention has been paid on status of overweight and body composition of Indian Bengali urban middle and high SES population. The objective was to determine the prevalence of overweight and body composition status by age and sex in children, adolescents and young adults. This cross-sectional study was carried out among 4194 unmarried school and college students (1999 males and 2195 females) aged 7–21 years belonging to the Bengali Hindu Population in Kolkata, India. The survey period was from 1999 to 2011. Anthropometry of participants were measured. Age and sex specific ≥85 percentile of body mass index (BMI) for children (<18 years of age) and BMI ≥23 kg/m2 (≥18 years of age) for adults were used to define overweight. Fat percent, upper arm fat area (UAFA) and upper arm muscle area (UAMA) were estimated. Simple linear regression was performed to check trend of changes with age. The overall prevalence of overweight was 14.8% in both sexes. Mean fat percent was higher in females than males (23.5% vs 13.5% respectively; p<0.001) and it increased by 0.18% (0.02) in males and 0.56% (0.02) in females per year (both p<0.001). UAMA gradually increased with age in both sexes and increasing rate per year was by 2.07 (0.04) cm2 in males and 1.19 (0.04) cm2 in females (both p<0.001). However, UAFA increased by 0.41 (0.03) cm2 and 0.90 (0.03) cm2 every year in males and females respectively (both p<0.001). Sum of biceps, triceps, subscapular and suprailliac skinfolds increased by 1.66 (0.06) mm and 0.5 (0.07) mm per year in females and males respectively (both p<0.001). Overall prevalence of overweight was the same in both sexes but adipose tissue was higher and muscularly was lower in females than males.

Nutritional status and height, weight and BMI centiles of school-aged children and adolescents of 6-18-years from Kinshasa (DRC)

BACKGROUND

The last study to establish centiles of main anthropometric measurements in Kinshasa was conducted over 60 years ago, which questions its current adequacy to describe or monitor growth in this population.

AIM

To assess the nutritional status of school-aged children and adolescents and to estimate centile curves of height, weight and body mass index (BMI).

SUBJECTS AND METHODS

A representative sample of 7541 school-aged children and adolescents (48% boys) aged 6-18 years was measured between 2010-2013. Smooth centiles of height, weight and BMI-for-age were estimated with the LMS method and compared with the WHO 2007 reference. Nutritional status was assessed by comparing measurements of height and BMI against the appropriate WHO cut-offs.

RESULTS

Compared to the WHO reference, percentiles of height and BMI were generally lower. This difference was larger in boys than in girls and increased as they approached adolescence. The prevalence of short stature (< -2 SD) and thinness (< -2 SD) was higher in boys (9.8% and 12%) than in girls (3.4% and 6.1%), but the prevalence of overweight (> 1 SD) was higher in girls (8.6%) than in boys (4.5%).

CONCLUSION

Children from Kinshasa fall below WHO centile references. This study established up-to-date centile curves for height, weight and BMI by age in children and adolescents. These reference curves describe the current status of these anthropometric markers and can be used as a basis for comparison in future studies.

Use of upper arm anthropometry, upper arm muscle area-by-height (UAMAH) and midupper- arm-circumference (MUAC)-for-height as indicators of body composition and nutritional status among children

Upper arm anthropometry has a potential role to provide useful estimations of body composition and nutritional status. Aims of the present cross-sectional study were to assess body composition and nutritional status of rural school-going children using upper arm anthropometric measures such as upper arm muscle area-by-height (UAMAH) and mid-upper arm circumference (MUAC) for-height. The present cross-sectional study was conducted among 1281 children of West Bengal, India (boys 619, girls 662) aged 5-12 years and selected using a stratified random sampling method. Anthropometric measurements of height, weight, MUAC and triceps skinfold (TSF) were recorded. Body composition and nutritional status were assessed using upper arm muscle area (UMA), upper arm fat area (UFA), UAMAH and MUAC-forheight. Age-sex-specific overall adiposity in TSF, UFA, arm fat index and upper-arm fat area estimates were higher among girls than boys (p<0.01), but UMA and upper-arm muscle area estimates were observed to be higher among boys than girls (p<0.05). High prevalence of undernutrition was found among both boys (53.15%) and girls (41.69%) using UAMAH (p<0.01). The overall prevalence of low MUAC-forheight was higher among boys (28.59%) than girls (25.68%) (p>0.05). Upper arm anthropometric measures, UAMAH and MUAC-for-height are useful for assessment of body composition and nutritional status among children.

Culturally based health assumptions in Sub-Saharan African immigrants: Body mass index predicting self-reported health status

This study examined whether Sub-Saharan African adult immigrants maintained cultural preferences for curvier/higher body size post-migration to the United States. Linear and multiple regression analyses were utilized to discern the predicting effects of Sub-Saharan African immigrants' body mass index score on their self-reported health status at two post-migration data collection points. The initial assessment reveals that Sub-Saharan African immigrants' overweight body mass index score predicted better self-reported health status. Four to six years later, higher body mass index score predicted a better self-reported health status and lower dietary acculturation moderated the predicting effect of body mass index on self-reported health status. Limitations of the study and implications for research and practice are explored.

Stature estimation from the femur and tibia in Black South African sub-adults

Stature estimation can play a role in the positive identification of unknown individuals and as such it is routinely assessed during the examination of adult remains. Unfortunately, this is not a standard procedure when dealing with sub-adult remains due to the general lack of standard procedures for the estimation of sub-adult stature. The aim of this study was therefore to derive regression equations for the estimation of stature in black South African sub-adults. Fifty nine black South African sub-adult males and females, aged 10-17 years, voluntarily participated in the study by undergoing a full body Magnetic Resonance Imaging (MRI) scan. Living stature was measured with a stadiometer and the maximum and diaphyseal lengths of the femur and tibia were measured from the MRI scans using the image processing software OsiriX. Pearson's correlation coefficients and linear least square regression analyses were used to assess the correlations between living stature and the measurements and to generate sub-adult stature estimation equations for males, females and a combined sex sample. Measurements of the femur, tibia and the combined measures thereof showed strong statistically significant positive correlations with living stature, while the obtained regression equations were characterized by low standard error of estimates. The strong correlations and low standard error of estimates are comparable to stature estimation models reported for Black South African adults and therefore these variables can be considered good estimators of sub-adult stature which will contribute valuable information to the biological profile of unidentified sub-adult skeletal remains.

Evaluating Crop Area Mapping from MODIS Time-Series as an Assessment Tool for Zimbabwe's "Fast Track Land Reform Programme"

Moderate Resolution Imaging Spectroradiometer (MODIS) data forms the basis for numerous land use and land cover (LULC) mapping and analysis frameworks at regional scale. Compared to other satellite sensors, the spatial, temporal and spectral specifications of MODIS are considered as highly suitable for LULC classifications which support many different aspects of social, environmental and developmental research. The LULC mapping of this study was carried out in the context of the development of an evaluation approach for Zimbabwe’s land reform program. Within the discourse about the success of this program, a lack of spatially explicit methods to produce objective data, such as on the extent of agricultural area, is apparent. We therefore assessed the suitability of moderate spatial and high temporal resolution imagery and phenological parameters to retrieve regional figures about the extent of cropland area in former freehold tenure in a series of 13 years from 2001–2013. Time-series data was processed with TIMESAT and was stratified according to agro-ecological potential zoning of Zimbabwe. Random Forest (RF) classifications were used to produce annual binary crop/non crop maps which were evaluated with high spatial resolution data from other satellite sensors. We assessed the cropland products in former freehold tenure in terms of classification accuracy, inter-annual comparability and heterogeneity. Although general LULC patterns were depicted in classification results and an overall accuracy of over 80% was achieved, user accuracies for rainfed agriculture were limited to below 65%. We conclude that phenological analysis has to be treated with caution when rainfed agriculture and grassland in semi-humid tropical regions have to be separated based on MODIS spectral data and phenological parameters. Because classification results significantly underestimate redistributed commercial farmland in Zimbabwe, we argue that the method cannot be used to produce spatial information on land-use which could be linked to tenure change. Hence capabilities of moderate resolution data are limited to assess Zimbabwe’s land reform. To make use of the unquestionable potential of MODIS time-series analysis, we propose an analysis of plant productivity which allows to link annual growth and production of vegetation to ownership after Zimbabwe’s land reform.

Use of upper-arm anthropometry as measure of body-composition and nutritional assessment in children and adolescents (6-20 years) of Assam, Northeast India

Background

Upper-arm muscle area (UMA), upper-arm fat area (UFA), arm-fat index (AFI), upper-arm fat estimate (UFE) and upper-arm muscle estimate (UME) was introduced for the assessment of body-composition. This cross-sectional study assessed age-sex specific upper-arm composition and nutritional status among children and adolescents.

Methods

The present cross-sectional study was conducted among 1545 (770 boys; 775 girls) Sonowal Kacharis of Dibrugarh District, Assam, Northeast-India, using multi-stage stratified random sampling method. The anthropometric measurements of height, weight, triceps and mid-upper-arm circumference were recorded. The upper-arm composition was assessed using standard equations. Nutritional status was assessed using standard classification of upper-arm muscle-area by height (UAMAH) and thinness (low BMI-for-age).

Results

Age and sex-specific muscularity were found significantly greater among boys than girls (p<0.01), while adiposity was significantly greater among girls (p<0.01), particularly when they approached to puberty. The overall prevalence of low and below-average UAMAH was found to be 16.38% and 22.65% respectively. The overall prevalence of thinness was 23.69% (26.36% boys, 21.03% girls) (p>0.05).

Conclusion

Body-composition and nutritional status of these children and adolescents were found markedly unsatisfactory using upper-arm composition, UAMAH and thinness. The combination of upper-arm composition and conventional anthropometric measures appear to be useful for body-composition and nutritional status assessment.

Upper arm composition and nutritional status of school children and adolescents in Abeokuta, Southwest Nigeria

BACKGROUND

Upper arm composition is a reflection of body protein and calorie reserves. However, there is a paucity of data on upper arm composition of children from African countries, including Nigeria. This study aimed to determine the composition of upper arm and nutritional status of school children in Abeokuta, Nigeria and to compare with international reference standards. The sensitivity and specificity of upper arm muscle area by height (UAMAH) as a nutritional assessment tool was also determined.

METHODS

Five hundred and seventy children aged 5 to 19 years were selected from seven schools using multistage random sampling. Weight, height, mid-upper arm circumference (MUAC) and triceps skin fold thickness (TSF) were measured. Body mass index, upper arm muscle area (UAMA), upper arm fat area (UAFA), fat percentage and UAMAH were derived.

RESULTS

The TSF, UAFA and fat percentage were significantly higher in females than males at each age group. MUAC and UAMA were significantly higher in female children aged 10-14 years, whereas UAMA was significantly higher in male children aged 15-19 years. UAMA and UAFA of the children were lower than those of Americans but similar to those of Zimbabweans, and higher than those of Indians. The sensitivity and specificity of UAMAH for detecting wasting were 80.8% and 63.9%, respectively, whereas the corresponding values for stunting were 32.2% and 58.2%, respectively.

CONCLUSIONS

The school children studied have a combination of poor calorie and protein reserve. UAMAH may be a valuable tool for complete evaluation of the nutritional status of school children.

Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review

BACKGROUND

Prevalence of childhood overweight/obesity has increased considerably in recent years. The transition to higher rates of overweight/obesity has been well documented in high income countries; however, consistent or representative data from lower income countries is scarce. It is therefore pertinent to assess if rates of overweight/obesity are also increasing in lower income countries, to inform public health efforts.

OBJECTIVE

This systematic review aimed to investigate the evidence for an overweight/obesity transition occurring in school-aged children and youth in Sub Saharan Africa.

METHODS

Studies were identified by searching the MEDLINE, Embase, Africa Index Medicus, Global Health, Geobase, and EPPI-Centre electronic databases. Studies that used subjective or objective metrics to assess body composition in apparently healthy or population-based samples of children and youth aged 5 to 17 years were included.

RESULTS

A total of 283 articles met the inclusion criteria, and of these, 68 were used for quantitative synthesis. The four regions (West, Central, East, and South) of Sub Saharan Africa were well represented, though only 11 (3.9%) studies were nationally representative. Quantitative synthesis revealed a trend towards increasing proportions of overweight/obesity over time in school-aged children in this region, as well as a persistent problem of underweight. Weighted averages of overweight/obesity and obesity for the entire time period captured were 10.6% and 2.5% respectively. Body composition measures were found to be higher in girls than boys, and higher in urban living and higher socioeconomic status children compared to rural populations or those of lower socioeconomic status.

CONCLUSIONS

This review provides evidence for an overweight/obesity transition in school-aged children in Sub Saharan Africa. The findings of this review serve to describe the region with respect to the growing concern of childhood overweight/obesity, highlight research gaps, and inform interventions.

PROSPERO REGISTRATION NUMBER

CRD42013004399.

Body fat distribution of children and adolescents in Abeokuta, Southwest Nigeria

Excessive central fat in children and adolescents is a risk factor for cardiovascular and metabolic disorders. This study aimed to compare the body fat distribution patterns of children and adolescents in Abeokuta, Nigeria with international reference standards. Five hundred seventy children aged 5 to 19 years were selected from seven schools using multistage random sampling. Weight, height, triceps and subscapular skinfold thickness (TSF, SSF), and circumference at the waist and hips (WC, HC) were measured. Body mass index (BMI), subscapular:triceps skinfold ratio (STR), waist:hip circumference ratio (WHR), and waist: height ratio (WHtR) were derived. Females had higher mean BMI, TSF, SSF, WC, HC, WHR, and WHtR, while males had significantly higher STR. The mean BMI, WC, TSF, and SSF values were lower for our subjects than for African-American subjects at all ages. On the other hand, in both sexes, STR was higher among Nigerian than African-American subjects up to 12 years old. Thereafter the values were similar. The mean WC was similar to those reported for African-American males up to 8 years, and females up to 7 years of age; thereafter, African-American had higher values. The prevalence of central obesity using WC and WHtR measures was 4.4% and 5.8%, respectively. There is a need to validate each index against serum lipid profiles and other cardiovascular and metabolic risk factors.

Valvulopathies in sub-Saharan African children: patterns, humanitarian interventions and cardiac surgical problems

Despite the high burden of rheumatic fever in sub-Saharan African, there is currently no sustained and comprehensive strategy to control the disease. Consequently in this area the number of patients affected by rheumatic valve disease (RVD), most with a surgical indication, is 10-20 fold higher than in industrialised countries and estimates indicate that more than 50% of African RVD patients will die before age 25. In this paper, we review clinical and management issues of RVD in children in sub-Saharan Africa. Severe heart failure and undergrowth are the prevalent presentation of the illness. Severe mitral regurgitation is the commonest rheumatic valvulopathy observed in the first and second decades. Valve repair, the approach of choice, may be associated with unfavourable outcomes in patients with extreme cardiomegaly. In young people, whenever correct anticoagulation may reasonably be achieved, mechanical mitral prostheses should be preferred, even in females. The early deterioration of biologic mitral prostheses strongly suggests limiting their use to those cases in which correct anticoagulation is not feasible. In most sub-Saharan countries, socioeconomic factors strongly limit access to health services and to cardiac surgery in particular. Efforts to overcome these barriers have resulted in humanitarian projects along two patterns: creation of high tech on site health care structures or transfer of children with complex diseases to receive highly specialised cardiac surgical care abroad. We summarise the experience of our programme that followed the latter approach.

Assessment of the nutritional status of children aged 5-12 years using upper arm composition

BACKGROUND

Upper arm muscle area (UMA) and upper arm fat area (UFA) were introduced for assessment of child nutritional status.

AIM

This cross-sectional study assesses child nutritional status using UMA and UFA. It also evaluates the suitability of upper arm muscle area by height (UAMAH) for assessing child under-nutrition with respect to stunting and wasting.

SUBJECTS AND METHODS

The study was conducted among 1248 children (619 boys; 629 girls) aged 5-12 years belonging to the Bengalee Muslim Population of West Bengal, India. Anthropometric measurements of height, weight, mid-upper arm circumference and triceps skin-fold were recorded. Nutritional status was assessed using UMA, UFA and UAMAH. Percentile curves were derived using the least median square method.

RESULTS

Mean age specific values of UMA, UFA and UAMAH of boys and girls were markedly below the 5th percentile. Using UAMAH, a very high proportion of children (boys, 91.28%; girls, 88.55%) were found to be under-nourished. Prevalence of stunting (boys, 39.74%; girls, 41.49%) and wasting (boys, 19.55%; girls, 15.74%) were also found to be high.

CONCLUSION

The combination of UMA, UFA, UAMAH and conventional nutritional indices appear to be useful for assessment of child under-nutrition.

Effect of Helicobacter pylori infection on growth velocity of school-age Andean children

BACKGROUND

Helicobacter pylori infection affects about half of the world's population and is usually acquired in childhood. The infection has been associated with chronic gastritis, peptic ulcer, and stomach cancer in adulthood. Little is known, however, about its consequences on child health. We examined the effect of H. pylori infection on growth among school-age children in the Colombian Andes by comparing growth velocity in the presence and absence of H. pylori infection.

METHODS

Children who were 4-8 years old in 2004 were followed up in a community where infected children received anti-H. pylori treatment (n = 165) and a comparison community (n = 161) for a mean of 2.5 years. Anthropometry measurements were made every 3 months and H. pylori status ascertained by urea breath test every 6 months. Growth velocities (cm/month) were compared across person-time with and without infection, using mixed models for repeated measures.

RESULTS

In the untreated community, 83% were H. pylori-positive at baseline and 89% were -positive at study end. The corresponding prevalences were 74% and 46%, respectively, in the treated community. Growth velocity in the pretreatment interval was 0.44 (standard deviation [SD] = 0.13) cm/month. Models that adjusted for age, sex, and height estimated that H. pylori-positive children grew on average 0.022 cm/month (95% confidence interval = 0.008 to 0.035) slower than H. pylori-negative children, a result that was not appreciably altered by adjustment for socioenvironmental covariates.

CONCLUSIONS

This study suggests that chronic H. pylori infection is accompanied by slowed growth in school-age Andean children.

Effect of Helicobacter pylori infection on growth velocity of school-age Andean children

BACKGROUND

Helicobacter pylori infection affects about half of the world's population and is usually acquired in childhood. The infection has been associated with chronic gastritis, peptic ulcer, and stomach cancer in adulthood. Little is known, however, about its consequences on child health. We examined the effect of H. pylori infection on growth among school-age children in the Colombian Andes by comparing growth velocity in the presence and absence of H. pylori infection.

METHODS

Children who were 4-8 years old in 2004 were followed up in a community where infected children received anti-H. pylori treatment (n = 165) and a comparison community (n = 161) for a mean of 2.5 years. Anthropometry measurements were made every 3 months and H. pylori status ascertained by urea breath test every 6 months. Growth velocities (cm/month) were compared across person-time with and without infection, using mixed models for repeated measures.

RESULTS

In the untreated community, 83% were H. pylori-positive at baseline and 89% were -positive at study end. The corresponding prevalences were 74% and 46%, respectively, in the treated community. Growth velocity in the pretreatment interval was 0.44 (standard deviation [SD] = 0.13) cm/month. Models that adjusted for age, sex, and height estimated that H. pylori-positive children grew on average 0.022 cm/month (95% confidence interval = 0.008 to 0.035) slower than H. pylori-negative children, a result that was not appreciably altered by adjustment for socioenvironmental covariates.

CONCLUSIONS

This study suggests that chronic H. pylori infection is accompanied by slowed growth in school-age Andean children.

Double burden of nutritional disorders in young Iranian children: findings of a nationwide screening survey

OBJECTIVE

To assess the national prevalence of short stature, underweight, overweight and obesity in 6-year-old Iranian children before school entry.

DESIGN

Cross-sectional nationwide survey.

SETTING

Mandatory national screening programme before entrance to elementary school in 2008 in Iran.

SUBJECTS

All Iranian children entering public and private elementary schools.

RESULTS

The study population comprised 862,433 children (48.4% girls, 77.2% urban resident). Overall, 6.5% of children had short stature, 19.1% were underweight, 12.8% were overweight and 3.4% were obese. There was no significant difference in terms of gender, but considerably larger differences were documented among various provinces.

CONCLUSIONS

The double burden of nutritional disorders among young children warrants a multi-faceted national policy with evidence-based local programmes. Such planning needs a comprehensive surveillance system and centralized data registry for children's growth.