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Gurri FD, Ruiz-García W, Vallejo-Nieto MI, Molina-Rosales DO. Seasonal changes in body composition in children from Maya agriculturalists in central Yucatán, Mexico. Am J Hum Biol 2024:e24121. [PMID: 38938067 DOI: 10.1002/ajhb.24121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/17/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Development policies have aimed to substitute subsistence agriculture for cash crops or other cash generating activities to encourage local farmers to depend on store-bought groceries available year-round instead of seasonal subsistence crops. In this paper, we test the hypothesis that increased dependence on store bought foods has decreased seasonal changes in nutritional status and fat mass in Maya Children from Yucatan, Mexico. METHODS Weight for age (W/A), body mass index (BMI), and tricipital Skinfold z scores in children under the age of 10 years from 14 Maya rural towns with different degrees of development were compared longitudinally between scarcity and abundance seasons using a repeated measures analysis of variance. Height for age (H/A) z scores were also estimated. RESULTS Origin of food consumed corresponded to the town's degree of development. Nutritional status (W/Az) and adiposity, BMI, and tricipital z scores were significantly lower during the scarcity season in every community. W/Az, tricipital skinfold z, and H/Az scores were significantly higher in developed than in traditional towns, yet in both types of town W/Az and H/Az scores were below the WHO standard mean. Tricipital skinfold z score was only below the WHO standard amongst traditional towns during the scarcity season. CONCLUSIONS Increased dependence on store foods failed to eliminate significant losses in body fat during the scarcity season. This failure may be affecting linear growth and promoting a thrifty phenotype that is seen in short and stocky individuals with a tendency to accumulate fat during abundance seasons.
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Affiliation(s)
- Francisco D Gurri
- Environmental Anthropology and Gender Lab, El Colegio de la Frontera Sur (ECOSUR), Campeche, Mexico
| | - Wilma Ruiz-García
- Environmental Anthropology and Gender Lab, El Colegio de la Frontera Sur (ECOSUR), Campeche, Mexico
| | - Mirna I Vallejo-Nieto
- Environmental Anthropology and Gender Lab, El Colegio de la Frontera Sur (ECOSUR), Campeche, Mexico
| | - Dolores O Molina-Rosales
- Environmental Anthropology and Gender Lab, El Colegio de la Frontera Sur (ECOSUR), Campeche, Mexico
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Cliffer IR, Naumova EN, Masters WA, Perumal N, Garanet F, Rogers BL. Peak timing of slowest growth velocity among young children coincides with highest ambient temperatures in Burkina Faso: a longitudinal study. Am J Clin Nutr 2024; 119:393-405. [PMID: 38309828 DOI: 10.1016/j.ajcnut.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Seasonal cycles in climatic factors affect drivers of child growth and contribute to seasonal fluctuations in undernutrition. Current growth seasonality models are limited by categorical definitions of seasons that rely on assumptions about their timing and fail to consider their magnitude. OBJECTIVE We disentangle the relationship between climatic factors and growth indicators, using harmonic regression to determine how child growth is related to peaks in temperature, precipitation, and vegetation. METHODS Longitudinal anthropometric data collected between August 2014 and December 2016 from 5039 Burkinabè children measured monthly from age 6 to 28 mo (108,580 observations) were linked with remotely sensed daily precipitation, vegetation, and maximum air temperature. Our models parsimoniously extract a cyclic signal with multiple potential peaks, to compare the magnitude and timing of seasonal peaks in climatic factors and morbidity with that of nadirs in growth velocity (cm/mo, kg/mo). RESULTS Length and weight velocity were slowest twice a year, coinciding both times with the highest temperatures, and peak fever incidence. Length velocity is slowest 13 d after the first temperature peak in April, and 5 d after the second. Similarly, weight velocity is slowest 13 d before the first temperature peak, and 11 d before the second. The statistical relationship between temperature and anthropometry shows that when the current temperature is higher, weight velocity is lower (β = -0.0048; 95% CI: -0.0059, -0.0038), and length velocity is higher (β = 0.0088; 95% CI: 0.0070, 0.0105). CONCLUSIONS Results suggest that child health and development are more affected by high temperatures than by other aspects of climatic seasonality such as rainfall. Emerging shifts in climatic conditions will pose challenges to optimal growth, highlighting the importance of changes that optimize the timing of nutrition interventions and address environmental growth-limiting conditions. CLINICAL TRIAL REGISTRY Clinicaltrials.gov: NCT02071563.
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Affiliation(s)
- Ilana R Cliffer
- Global Health and Population Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
| | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Nandita Perumal
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia SC, United States
| | - Franck Garanet
- Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Beatrice L Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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3
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Hasan MM, Kader A, Asif CAA, Talukder A. Seasonal variation in the association between household food insecurity and child undernutrition in Bangladesh: Mediating role of child dietary diversity. MATERNAL & CHILD NUTRITION 2023; 19:e13465. [PMID: 36478358 PMCID: PMC10019058 DOI: 10.1111/mcn.13465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
Household food insecurity (HFI) and child dietary diversity (CDD) are variable across seasons. We examined seasonal variation in HFI and child undernutrition association and tested how CDD mediates this association. We analyzed data for 26,353 children aged 6-59 months drawn from nationally representative cross-sectional Food Security and Nutrition Surveillance Project data collected during 2012-2014 in Bangladesh across three seasons annually: Post-Aman harvest (January-April); Monsoon (May-August); and Post-Aus harvest (September-December). Multivariable logistic regression analysis adjusted for individual, maternal, household and geographical characteristics reveals that children of food-insecure households were more likely than food-secure households to be stunted (adjusted odds ratio, AOR: 1.12; 95% confidence interval, CI: 1.02-1.23; p < 0.05), wasted (AOR: 1.21; 95% CI: 1.05-1.39; p < 0.01) and underweight (AOR: 1.16; 95% CI: 1.04-1.3; p < 0.01). CDD mediated 6.1% of the total effect of HFI on underweight. These findings varied across seasons. HFI was associated with greater odds of underweight during Monsoon (AOR: 1.32; 95% CI: 1.08-1.62; p < 0.01) and Post-Aus (AOR: 1.21; 95% CI: 1.06-1.37; p < 0.01) while wasting during Post-Aus (AOR: 1.65; 95% CI: 1.35-2.01; p < 0.001). CDD largely mediated the total effect of HFI on underweight during the Post-Aman in 2012-2014 (23.2%). CDD largely mediated the total effect of HFI on wasting (39.7%) during Post-Aman season in 2014 and on underweight (13.7%) during the same season in 2012. These findings demonstrate that HFI is seasonally associated with child undernutrition and mediated by CDD as well in Bangladesh and seasonality and diversity should be considered while designing appropriate population-level food-based interventions to resolve child undernutrition.
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Affiliation(s)
| | - Abdul Kader
- Helen Keller IntlCountry OfficeDhakaBangladesh
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Subramanian S, Ambade M, Sharma S, Kumar A, Kim R. Prevalence of Zero-Food among infants and young children in India: patterns of change across the States and Union Territories of India, 1993-2021. EClinicalMedicine 2023; 58:101890. [PMID: 37065175 PMCID: PMC10102207 DOI: 10.1016/j.eclinm.2023.101890] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 04/18/2023] Open
Abstract
Background The extent of food deprivation and insecurity among infants and young children-a critical phase for children's current and future health and well-being-in India is unknown. We estimate the prevalence of food deprivation among infants and young children in India and describe its evolution over time at sub-national levels. Methods Data from five National Family Health Surveys (NFHS) conducted in 1993, 1999, 2006, 2016 and 2021 for the 36 states/Union Territories (UTs) of India were used. The study population consisted of the most recent children (6-23 months) born to mothers (aged 15-49 years), who were alive and living with the mother at the time of survey (n = 175,614 after excluding observations that had no responses to the food question). Food deprivation was defined based on the mother's reporting of the child having not eaten any food of substantial calorific content (i.e., any solid/semi-solid/soft/mushy food types, infant formula and powdered/tinned/fresh milk) in the past 24 hours (h), which we labelled as "Zero-Food". In this study, we analyzed Zero-Food in terms of percent prevalence as well as population headcount burden. We calculated the Absolute Change (AC) to quantify the change in the percentage points of Zero-Food across time periods for all-India and by states/UTs. Findings The prevalence of Zero-Food in India marginally declined from 20.0% (95% CI: 19.3%-20.7%) in 1993 to 17.8% (95% CI: 17.5%-18.1%) in 2021. There were considerable differences in the trajectories of change in the prevalence of Zero-Food across states. Chhattisgarh, Mizoram, and Jammu and Kashmir experienced high increase in the prevalence of Zero-Food over this time period, while Nagaland, Odisha, Rajasthan and Madhya Pradesh witnessed a significant decline. In 2021, Uttar Pradesh (27.4%), Chhattisgarh (24.6%), Jharkhand (21%), Rajasthan (19.8%) and Assam (19.4%) were states with the highest prevalence of Zero-Food. As of 2021, the estimated number of Zero-Food children in India was 5,998,138, with the states of Uttar Pradesh (28.4%), Bihar (14.2%), Maharashtra (7.1%), Rajasthan (6.5%), and Madhya Pradesh (6%) accounting for nearly two-thirds of the total Zero-Food children in India. Zero-Food in 2021 was concerningly high among children aged 6-11 months (30.6%) and substantial even among children aged 18-23 months (8.5%). Overall, socioeconomically advantaged groups had lower prevalence of Zero-Food than disadvantaged groups. Interpretation Concerted efforts at the national and state levels are required to further strengthen existing policies, and design and develop new ones to provide affordable food to children in a timely and equitable manner to ensure food security among infants and young children. Funding This study was supported by a grant from the Bill & Melinda Gates Foundation INV-002992.
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Affiliation(s)
- S.V. Subramanian
- Professor of Population Health and Geography, Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Mayanka Ambade
- Post-Doctoral Fellow, Laxmi Mittal and Family South Asia Institute, Harvard University, New Delhi, India
| | - Smriti Sharma
- Program Officer, Mother Infant and Young Child Nutrition, Tata Trusts, Delhi, India
| | - Akhil Kumar
- Affiliate, Center for Geographic Analysis, Harvard University, Cambridge, MA, USA
| | - Rockli Kim
- Assistant Professor, Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
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Dwivedi LK, Bhatia M, Bansal A, Mishra R, P. S, Jana S, Subramanian SV, Unisa S. Role of seasonality variation in prevalence and trend of childhood wasting in India: An empirical analysis using National Family Health Surveys, 2005-2021. Health Sci Rep 2023; 6:e1093. [PMID: 36817627 PMCID: PMC9935817 DOI: 10.1002/hsr2.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 02/19/2023] Open
Abstract
Background Wasting develops over a short period and can be reversed with short-term interventions. The prevalence of wasting typically varies from season to season-becoming higher during the monsoon (June to September) season as compared to the winter (October to January) and summer (February to May) seasons every year in a cyclical fashion. However, to the best of our knowledge, using nationally representative demographic surveys to extensively study the impact of the timing of the survey on the results and trends around wasting has not been done so far. Objectives The goal of this study is to ascertain whether seasonality has an impact on the trend and levels of wasting between NFHS-3 (2005-2006) and NFHS-5 (2019-2021). Methods The analysis was based on data on 51,555, 259,627, and 232,920 children under 5 years included in NFHS-3, NFHS-4, and NFHS-5 respectively. Multivariable logistic regression analysis and the predicted probabilities approach were employed to examine the effect of the months of interview on the prevalence of wasting. The analysis was conducted for 9 states of India which had data for comparable months to compute wasting levels. Results We found that at the national level, wasting increased in India by one per cent from NFHS-3 to NFHS-4 but declined by 2% from NFHS-4 to NFHS-5. The results show that seasonality significantly influenced the prevalence of wasting. It was observed that compared to January, the odds of wasting were particularly higher in summer and monsoon seasons, especially in the month of August across all three rounds, indicating the influence of seasonality in the prevalence of wasting in the country. Discussion The prevalence of wasting in India needs to be interpreted across seasonal changes as seasonality affects many of the variables intrinsically related to child health and nutritional status.
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Affiliation(s)
- Laxmi Kant Dwivedi
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - Mrigesh Bhatia
- Department of Health PolicyLondon School of EconomicsLondonUK
| | - Anjali Bansal
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - Rahul Mishra
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - Shirisha P.
- Department of Humanities and Social SciencesIIT MadrasChennaiIndia
| | - Somnath Jana
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - S. V. Subramanian
- Population Health and GeographyHarvard UniversityBostonMassachusettsUSA
| | - Sayeed Unisa
- Department of Bio‐statistics and EpidemiologyInternational Institute for Population SciencesMumbaiIndia
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Marson M, Saccone D, Vallino E. Total trade, cereals trade and undernourishment: new empirical evidence for developing countries. REVIEW OF WORLD ECONOMICS 2023; 159:299-332. [PMCID: PMC9084271 DOI: 10.1007/s10290-022-00468-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 08/28/2023]
Abstract
While trade policies are considered strategic to shape national food systems and promote food security, the ultimate impact of trade openness on hunger is still highly debated. Using a sample of 81 developing over the period 2001–2016 and principally focusing on the prevalence of undernourishment, this study provides new empirical evidence. Firstly, it estimates the impact of total trade differentiating the effects that pass through changes in real per capita income—i.e. on the economic access to food—from the residual effects that it directly has on the other dimensions of food security. Subsequently, it concentrates on cereals trade, that usually is the most affected by trade restrictions and the most correlated to undernourishment. Finally, it explores the different effects of cereals trade in terms of imports and exports. Three main conclusions emerge: (a) trade openness contributes to lower the prevalence of undernourishment in developing countries and most of this effect is not income-mediated but, rather, passes through the impacts that it directly has on the other dimensions of food security; (b) such impacts are mostly driven by the trade openness of the cereals sector where (c) its import component turns out to play the main role.
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Affiliation(s)
- Marta Marson
- Department of Economics and Statistics “Cognetti de Martiis”, University of Turin, Lungo Dora Siena 100, 10153 Turin, Italy
- OEET-Turin Center on Emerging Economies, Collegio Carlo Alberto, Piazza V. Arbarello 8, 10122 Turin, Italy
| | - Donatella Saccone
- OEET-Turin Center on Emerging Economies, Collegio Carlo Alberto, Piazza V. Arbarello 8, 10122 Turin, Italy
- University of Gastronomic Sciences, Piazza Vittorio Emanuele II, 9, 12042 Pollenzo, Bra, CN Italy
| | - Elena Vallino
- OEET-Turin Center on Emerging Economies, Collegio Carlo Alberto, Piazza V. Arbarello 8, 10122 Turin, Italy
- Department of Cultures, Politics and Society, University of Turin, Lungo Dora Siena 100, 10153 Turin, Italy
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Seasonality and nutrition-sensitive farming in rural Northern Ghana. Food Secur 2022; 15:381-394. [PMID: 37016711 PMCID: PMC10066165 DOI: 10.1007/s12571-022-01325-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/08/2022] [Indexed: 11/25/2022]
Abstract
Abstract
In rural sub-Saharan Africa, where malnutrition in all its forms is rife, the greatest gap between the availability of foods and the foods needed for a nutritious diet are faced during the ‘hunger season’. We investigated what rural households in Northern Ghana would need to grow to ensure year-round availability of a nutrient adequate diet or the income required to fulfil their dietary needs. We applied linear programming to model different scenarios and interventions. Our results provide three major insights. First, considering seasonality is crucial in nutrition-sensitive farming. Ensuring a nutritious diet year-round requires enhanced availability of vegetables and fruits throughout the year. Second, although staple crops do not provide the full range of essential nutrients, increasing their yields allows for a reduction of field size, freeing up space for the production of other foods belonging to a nutritious diet, such as vegetables. Third, small farms are unable to produce sufficient food to cover their needs. They depend on income both from agriculture and other sources, and the availability of types of foods on markets to meet their dietary needs. Our study shows the value of modelling the range of dietary effects from agricultural interventions in a specific context, using a local feasible nutritious diet as a starting point and taking seasonality into account.
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Otero DM, da Rocha Lemos Mendes G, da Silva Lucas AJ, Christ-Ribeiro A, Ribeiro CDF. Exploring alternative protein sources: Evidence from patents and articles focusing on food markets. Food Chem 2022; 394:133486. [PMID: 35759839 DOI: 10.1016/j.foodchem.2022.133486] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/10/2022] [Accepted: 06/12/2022] [Indexed: 11/04/2022]
Abstract
This review considers alternative protein sources through the analysis of food science literature and patents. Data collection was performed from scientific literature and patent documents using the Scopus and National Institute of Industrial Property databases, with a term combination "alternative protein source" and "source* AND protein* AND alternative*". A total of 945 documents were analyzed. The scientific prospection showed that agricultural and biological science was the main application area. The food industry area had the highest number of filed patents. The annual evaluation of published documents demonstrated that this area had been investigated since the 1970s, and the number of articles was twice than that of filled patents. Although protein products are available for sale, animal and vegetable sources replace conventional protein products. Presently, alternative protein sources are already a worldwide trend in the food industry, enabling the development of new products to facilitate their insertion into the consumer market.
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Affiliation(s)
- Deborah Murowaniecki Otero
- Graduate Program in Food, Nutrition, and Health, Nutrition School, Federal University of Bahia, Campus Canela, Salvador, Bahia 40110-907, Brazil; Graduate Program in Food Science, Faculty of Pharmacy, Federal University of Bahia, Campus Ondina, Salvador, Bahia 40170-115, Brazil.
| | - Gabriela da Rocha Lemos Mendes
- Institute of Agricultural Sciences, Federal University of Minas Gerais, Campus Montes Claros, Montes Claros, Minas Gerais 39404-547, Brazil
| | | | - Anelise Christ-Ribeiro
- School of Chemistry and Food, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul 96203-900, Brazil
| | - Camila Duarte Ferreira Ribeiro
- Graduate Program in Food, Nutrition, and Health, Nutrition School, Federal University of Bahia, Campus Canela, Salvador, Bahia 40110-907, Brazil; Graduate Program in Food Science, Faculty of Pharmacy, Federal University of Bahia, Campus Ondina, Salvador, Bahia 40170-115, Brazil
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Nonterah EA, Welaga P, Chatio ST, Kehoe SH, Ofosu W, Ward KA, Godfrey KM, Oduro AR, Newell M. Children born during the hunger season are at a higher risk of severe acute malnutrition: Findings from a Guinea Sahelian ecological zone in Northern Ghana. MATERNAL & CHILD NUTRITION 2022; 18:e13313. [PMID: 35008126 PMCID: PMC8932825 DOI: 10.1111/mcn.13313] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/28/2021] [Accepted: 12/10/2021] [Indexed: 12/13/2022]
Abstract
Heightened food insecurity in the hunger season increases the risk of severe acute malnutrition (SAM) in childhood. This study examined the association of season of birth with SAM in a Guinean Sahelian ecological zone. We analyzed routine health and sociodemographic surveillance data from the Navrongo Health and Socio-demographic Surveillance System collected between 2011 and 2018. January-June, the period of highest food insecurity, was defined as the hunger season. We defined moderate acute malnutrition as child mid-upper arm circumference (MUAC) between 115 mm and 135 mm and SAM as MAUC ≤ 115 mm. We used adjusted logistic regression to quantify the association between the season of birth and SAM in children aged 6-35 months. From the 29,452 children studied, 24% had moderate acute malnutrition. Overall, 1.4% had SAM, with a higher prevalence (1.8%) in the hunger season of birth. Compared with those born October-December, adjusted odds ratios (aOR) and 95% confidence interval (95% CI) for SAM were increased for children born in the hunger season: January-March (1.77 [1.31-2.39]) and April-June (1.92 [1.44-2.56]). Low birth weight, age at an assessment of nutritional status, and ethno-linguistic group were also significantly associated with SAM in adjusted analyses. Our study established that being born in the hunger season is associated with a higher risk of severe acute malnutrition. The result implies improvement in the food supply to pregnant and lactating mothers through sustainable agriculture or food system change targeting the hunger season may reduce the burden of severe acute malnutrition.
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Affiliation(s)
- Engelbert A. Nonterah
- Navrongo Health Research CentreGhana Health ServiceNavrongoGhana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Paul Welaga
- Navrongo Health Research CentreGhana Health ServiceNavrongoGhana
- School of Medicine and DentistryC K Tedam University of Technology and Applied SciencesNavrongoUpper East RegionGhana
| | - Samuel T. Chatio
- Navrongo Health Research CentreGhana Health ServiceNavrongoGhana
| | - Sarah H. Kehoe
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation TrustUniversity of SouthamptonSouthamptonUK
| | - Winfred Ofosu
- Upper East Regional Health Directorate, PMBBolgatangaGhana
| | - Kate A. Ward
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation TrustUniversity of SouthamptonSouthamptonUK
- Global Health Research Institute, School of Health and Human DevelopmentUniversity of SouthamptonSouthamptonUK
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation TrustUniversity of SouthamptonSouthamptonUK
| | - Abraham R. Oduro
- Navrongo Health Research CentreGhana Health ServiceNavrongoGhana
| | - Marie‐Louise Newell
- Department of Human DevelopmentUniversity of SouthamptonSouthamptonUK
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
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Methods for assessing seasonal and annual trends in wasting in Indian surveys (NFHS-3, 4, RSOC & CNNS). PLoS One 2021; 16:e0260301. [PMID: 34807959 PMCID: PMC8608332 DOI: 10.1371/journal.pone.0260301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022] Open
Abstract
Wasting in children under-five is a form of acute malnutrition, a predictor of under-five child mortality and of increased risk of future episodes of stunting and/or wasting. In India, national estimates of wasting are high compared to international standards with one in five children found to be wasted. National surveys are complex logistical operations and most often not planned or implemented in a manner to control for seasonality. Collection of survey data across differing months across states introduces seasonal bias. Cross-sectional surveys are not designed to collect data on seasonality, thus special methods are needed to analyse the effect of data collection by month. We developed regression models to estimate the mean weight for height (WHZ), prevalence of wasting for every month of the year for an average year and an overall weighted survey estimates controlling for the socio-demographic variation of data collection across states and populations over time. National level analyses show the mean WHZ starts at its highest in January, falls to the lowest in June/August and returns towards peak at year end. The prevalence of wasting is lowest in January and doubles by June/August. After accounting for seasonal patterns in data collection across surveys, the trends are significantly different and indicate a stagnant period followed by a decline in wasting. To avoid biased estimates, direct comparisons of acute malnutrition across surveys should not be made unless seasonality bias is appropriately addressed in planning, implementation or analysis. Eliminating the seasonal variation in wasting would reduce the prevalence by half and provide guidance towards further reduction in acute malnutrition.
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11
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Wells JCK, Marphatia AA, Amable G, Siervo M, Friis H, Miranda JJ, Haisma HH, Raubenheimer D. The future of human malnutrition: rebalancing agency for better nutritional health. Global Health 2021; 17:119. [PMID: 34627303 PMCID: PMC8500827 DOI: 10.1186/s12992-021-00767-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 09/15/2021] [Indexed: 01/11/2023] Open
Abstract
The major threat to human societies posed by undernutrition has been recognised for millennia. Despite substantial economic development and scientific innovation, however, progress in addressing this global challenge has been inadequate. Paradoxically, the last half-century also saw the rapid emergence of obesity, first in high-income countries but now also in low- and middle-income countries. Traditionally, these problems were approached separately, but there is increasing recognition that they have common drivers and need integrated responses. The new nutrition reality comprises a global ‘double burden’ of malnutrition, where the challenges of food insecurity, nutritional deficiencies and undernutrition coexist and interact with obesity, sedentary behaviour, unhealthy diets and environments that foster unhealthy behaviour. Beyond immediate efforts to prevent and treat malnutrition, what must change in order to reduce the future burden? Here, we present a conceptual framework that focuses on the deeper structural drivers of malnutrition embedded in society, and their interaction with biological mechanisms of appetite regulation and physiological homeostasis. Building on a review of malnutrition in past societies, our framework brings to the fore the power dynamics that characterise contemporary human food systems at many levels. We focus on the concept of agency, the ability of individuals or organisations to pursue their goals. In globalized food systems, the agency of individuals is directly confronted by the agency of several other types of actor, including corporations, governments and supranational institutions. The intakes of energy and nutrients by individuals are powerfully shaped by this ‘competition of agency’, and we therefore argue that the greatest opportunities to reduce malnutrition lie in rebalancing agency across the competing actors. The effect of the COVID-19 pandemic on food systems and individuals illustrates our conceptual framework. Efforts to improve agency must both drive and respond to complementary efforts to promote and maintain equitable societies and planetary health.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, Population Policy and Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | | | - Gabriel Amable
- Department of Geography, University of Cambridge, Cambridge, UK
| | - Mario Siervo
- School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hinke H Haisma
- Population Research Centre, Department of Demography, University of Groningen, Groningen, the Netherlands
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12
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Saville NM, Cortina-Borja M, De Stavola BL, Pomeroy E, Marphatia A, Reid A, Manandhar DS, Wells JCK. Comprehensive analysis of the association of seasonal variability with maternal and neonatal nutrition in lowland Nepal. Public Health Nutr 2021; 25:1-16. [PMID: 34420531 PMCID: PMC9991647 DOI: 10.1017/s1368980021003633] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/26/2021] [Accepted: 08/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To provide a comprehensive seasonal analysis of pregnant mothers' eating behaviour and maternal/newborn nutritional status in an undernourished population from lowland rural Nepal, where weather patterns, agricultural labour, food availability and disease prevalence vary seasonally. DESIGN Secondary analysis of cluster-randomised Low Birth Weight South Asia Trial data, applying cosinor analysis to predict seasonal patterns. OUTCOMES Maternal mid-upper arm circumference (MUAC), BMI, dietary diversity, meals per day, eating down and food aversion in pregnancy (≥31 weeks' gestation) and neonatal z-scores of length-for-age (LAZ), weight-for-age (WAZ) and head circumference-for-age (HCAZ) and weight-for-length (WLZ). SETTING Rural areas of Dhanusha and Mahottari districts in plains of Nepal. PARTICIPANTS 2831 mothers aged 13-50 and 3330 neonates. RESULTS We found seasonal patterns in newborn anthropometry and pregnant mothers' anthropometry, meal frequency, dietary diversity, food aversion and eating down. Seasonality in intake varied by food group. Offspring anthropometry broadly tracked mothers'. Annual amplitudes in mothers' MUAC and BMI were 0·27 kg/m2 and 0·22 cm, with peaks post-harvest and nadirs in October when food insecurity peaked. Annual LAZ, WAZ and WLZ amplitudes were 0·125, 0·159 and 0·411 z-scores, respectively. Neonates were the shortest but least thin (higher WLZ) in winter (December/January). In the hot season, WLZ was the lowest (May/June) while LAZ was the highest (March and August). HCAZ did not vary significantly. Food aversion and eating down peaked pre-monsoon (April/May). CONCLUSIONS Our analyses revealed complex seasonal patterns in maternal nutrition and neonatal size. Seasonality should be accounted for when designing and evaluating public heath nutrition interventions.
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Affiliation(s)
- Naomi M Saville
- Institute for Global Health (IGH), University College London (UCL), London, UK
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Bianca L De Stavola
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Emma Pomeroy
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | | | - Alice Reid
- Department of Geography, University of Cambridge, Cambridge, UK
| | | | - Jonathan CK Wells
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
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13
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Thorne-Lyman AL, Bevis LEM, Kuo H, Manohar S, Shrestha B, KC A, Klemm RD, Heidkamp RA. Season of Data Collection of Child Dietary Diversity Indicators May Affect Conclusions About Longer-Term Trends in Peru, Senegal, and Nepal. Curr Dev Nutr 2021; 5:nzab095. [PMID: 34466772 PMCID: PMC8397594 DOI: 10.1093/cdn/nzab095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The WHO-UNICEF minimum dietary diversity (MDD) indicator for children aged 6-23 mo is a global monitoring indicator used to track multi-year population-level changes in dietary quality, but the influence of seasonality on MDD estimates remains unclear. OBJECTIVES To examine how seasonality of data collection may influence population-level MDD estimates and inferences about MDD changes over multiple survey years. METHODS We selected countries with 3 or more consecutive years of MDD data collection, including continuous national Demographic Health Surveys in Senegal (2012-2017; n = 12,183) and Peru (2005-2016; n = 35,272) and the Policy and Science for Health, Agriculture, and Nutrition sentinel site seasonal surveys (covering 3 seasons/y) in Nepal (2013-2016; n = 1309). The MDD prevalence (≥5 of 8 food groups) and an 8-item continuous Food Group Score (FGS) and 95% CIs were estimated by month and compared for lean and non-lean seasons using ordinary least squares regression with dummy variables for year. RESULTS The national prevalence of MDD was higher in Peru (75.4%) than in Nepal (39.1%) or in Senegal (15.7%). Children in Peru were 1.8% (coefficient, -0.0179; 95% CI, -0.033 to -0.002) less likely to achieve MDD during the lean season. Similar seasonal magnitudes were observed in Senegal (coefficient, -0.0347; 95% CI, -0.058 to -0.011) and Nepal (coefficient, -0.0133; 95% CI, -0.107 to 0.081). The FGS was about 0.1 item lower during the lean season in all 3 countries. In comparison, MDD increased by an average rate of only 4.2 and 4.4 percentage points per 5 y in Peru and Senegal, respectively. Intakes of specific food groups were stable across months in all countries, with the provitamin A-rich food group exhibiting the most seasonality. CONCLUSIONS The magnitude of seasonal variation in MDD prevalence was smaller than expected but large relative to longer-term changes. If large-scale surveys are not conducted in the same season, biased conclusions about trends are possible.
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Affiliation(s)
- Andrew L Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for a Livable Future, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leah E M Bevis
- Department of Agricultural, Environmental, and Development Economics, The Ohio State University, Columbus, OH, USA
| | - Helen Kuo
- Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Swetha Manohar
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Binod Shrestha
- Policy and Science for Health, Agriculture, and Nutrition Study Team, Johns Hopkins University, Kathmandu, Nepal
| | - Angela KC
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rolf D Klemm
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Hellen Keller International, New York, NY, USA
| | - Rebecca A Heidkamp
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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14
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Locks LM, Patel A, Katz E, Simmons E, Hibberd P. Seasonal trends and maternal characteristics as predictors of maternal undernutrition and low birthweight in Eastern Maharashtra, India. MATERNAL & CHILD NUTRITION 2021; 17:e13087. [PMID: 33006259 PMCID: PMC7988872 DOI: 10.1111/mcn.13087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Abstract
Few studies have assessed whether women and infants in rural and peri-urban communities in South Asia experience seasonal fluctuations in nutritional status; however, a handful of studies have documented seasonal variability in risk factors for undernutrition including food availability, physical activity and infections. We used data from the Maternal and Newborn Health (MNH) registry, a population-based pregnancy and birth registry in Eastern Maharashtra, India, to analyse seasonal trends in birthweight and maternal nutritional status-body mass index (BMI) and haemoglobin-in the first trimester of pregnancy. We plotted monthly and seasonal trends in birthweight, and maternal BMI and haemoglobin, and used multivariable regression models to identify seasonal and maternal characteristics that predicted each outcome. Between October 2014 and January 2018, MNH included 29,253 livebirths with recorded birthweight. BMI was assessed in 15,252 women less than 12 weeks of gestation and haemoglobin in 18,278 women less than 13 weeks of gestation. Maternal characteristics (age, education, parity and height) were significantly associated with nutritional status; however, there were minimal seasonal fluctuations in birthweight or maternal nutrition. There were significant secular trends in maternal haemoglobin; between 2014 and 2018, the prevalence of maternal anaemia decreased from 91% to 79% and moderate or severe anaemia from 53% to 37%. The prevalence of maternal underweight (45.3%) and overweight (9.8%) and low birthweight (19.1%) remained relatively constant over the study period. Our findings highlight that in some rural and peri-urban areas in South Asia, tackling systemic drivers of malnutrition may be more effective than targeted interventions based on season.
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Affiliation(s)
- Lindsey M. Locks
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent CollegeBoston UniversityBostonMassachusettsUSA
- Department of Global Health, School of Public HealthBoston UniversityBostonMassachusettsUSA
| | | | - Elizabeth Katz
- Department of Global Health, School of Public HealthBoston UniversityBostonMassachusettsUSA
| | - Elizabeth Simmons
- Department of Global Health, School of Public HealthBoston UniversityBostonMassachusettsUSA
| | - Patricia Hibberd
- Department of Global Health, School of Public HealthBoston UniversityBostonMassachusettsUSA
- School of MedicineBoston UniversityBostonMassachusettsUSA
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15
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Angela KC, Thorne-Lyman AL, Manohar S, Shrestha B, Klemm R, Adhikari RK, Webb P, West KP. Preschool Child Nutritional Status in Nepal in 2016: A National Profile and 40-Year Comparative Trend. Food Nutr Bull 2020; 41:152-166. [PMID: 32522131 DOI: 10.1177/0379572120916343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preschool child anthropometric status has been assessed nationally in Nepal since 1975, with semi-decadal surveys since 1996, plus several recent, short-interval surveys to track progress toward achieving a World Health Assembly (WHA) goal to reduce stunting to 24% by 2025. OBJECTIVE We report prevalence of preschool child stunting and wasting from a national survey in 2016 and place findings into the context of national trends and alignment for Nepal to attain its WHA 2025 goal. METHODS A representative, midyear Policy and Science for Health, Agriculture and Nutrition (PoSHAN) survey was conducted in 2016 on 5479 children <60 months in 4051 households in 21 village development committees. Child weight and height were measured, and sociodemographic factors were assessed. Data from previous surveys (Nepal Demographic Health Surveys, PoSHAN) were also acquired, and rates of stunting (<-2 height-for-age z score) and wasting (<-2 weight-for-height z score) were compared to current World Health Organization standards. Trends were expressed as average annual rates of reduction (AARR). RESULTS Nationally, in 2016, 34.1% of preschoolers were stunted and 13.7% wasted. Stunting was highest in the Mountains (40.6%) and wasting highest in the Tarai (18.9%). Trend analysis revealed a steady decline (3.8% AARR) in stunting from 2001 to 2013, with virtually no decline from 2013 to 2016. Wasting has been continually high and variable, at ≥8%, since 1975. CONCLUSIONS Following a steady decline in prevalence, preschool child stunting has plateaued at ∼35% in Nepal, while wasting has changed little over time, offering the opportunity to inform, reassess, and adjust, as needed, efforts to reach WHA 2025 goals.
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Affiliation(s)
- K C Angela
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew L Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Swetha Manohar
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Binod Shrestha
- Nutrition Innovation Lab, Johns Hopkins University, Kathmandu, Nepal
| | - Rolf Klemm
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Helen Keller International, New York, NY, USA
| | | | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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