Assessing and Improving Childhood Nutrition and Growth Globally

[Comparison of serum uric acid and liver enzyme levels in adolescents with obesity and with metabolic syndrome]

Introduction

Introduction: a relationship has been observed between elevated levels of liver enzymes and uric acid with the presence of metabolic syndrome (MS) in the pediatric population. Objective: to compare serum liver enzyme and uric acid levels between adolescents with and without MS. Methods: a cross-sectional study was carried out in adolescents with obesity between 10 and 18 years old. Somatometric data, serum insulin, lipid profile, uric acid levels and liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT] and gamma-glutamyl transferase [GGT]) were analyzed. Statistical analysis: Student's t test or the Chi-square test was used to evaluate differences between groups. Results: a total of 1095 adolescents with obesity were included (444 with MS and 651 without MS). The group with MS had a higher BMI (with MS 2.28 vs without MS 2.11 p < 0.001), with no difference in body fat (42.9 % vs 42.9 %, p = 0.978). The MS group had significantly higher levels of AST (34.4 vs. 29.5, p = 0.013), ALT (42.2 vs. 34.6, p = 0.003), and uric acid (6.17 vs. 5.74, p = 0.002). comparison to the group without MS. The proportion of ALT (40.5 % vs 29.5 %, p = 0.029) and altered uric acid (58.1 % vs. 45.6 %, p = 0.019) was higher in the MS group. Conclusions: serum levels of ALT, AST and uric acid in adolescents with obesity and MS were higher compared to those without MS. Altered ALT was a risk factor for SM.

Creating Healthy Environments for Schools: A Comprehensive Approach to Improving Nutrition in Arkansas Public Schools

BACKGROUND

Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition.

METHODS

The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food.

CONCLUSIONS

Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

Theories, determinants, and intervention models and approaches on inequalities of undernutrition amongst under fives: A literature review

Background and Aims

One of the greatest public health problems of the 21st century is undernutrition in children under the age of 5 years (CAUFY). Globally, over 232 million CUAFY are undernourished and approximately 45% of mortality in this population are undernutrition-induced. This paper reviewed and critically explained the factors perpetuating undernutrition in CUAFY in the global space. It further explained the multi-level determinants that influence health inequalities and consequently exacerbate undernutrition amongst CUAFY globally. It also went further to explain the intervention models and approaches that can be used to tackle undernutrition in CUAFY.

Methods/Literature Search Strategy

Demiris et al.'s approach to narrative review was utilized for this paper. Relevant articles on child nutrition were retrieved from multiple credible databases and websites of foremost health organizations. Using an iterative process, multiple combinations of search terms were done by stringing relevant key terms and their synonyms with Boolean Operators. This process was constantly refined to align search results with the study aim. Database search produced relevant and resourceful publications which were utilized to develop this review.

Results

The global burden of undernutrition remains high, especially in Oceania with the highest prevalence of stunting and wasting (41.4% and 12.5%), with Africa and Asia following closely. Malnutrition eradication is a global health issue of high priority as demonstrated by the "Goal 2" of the Sustainable Development Goals (SDGs), and the United Nations (UN) Decade of Action on Nutrition 2016-2025. The review identified no significant positive outcome from previous interventions due to the endemic health inequalities. Determinants of the multi-level health inequalities associated with undernutrition in CUAFY, and probable solutions are explained with theoretical models of health inequalities. A diagonal intervention approach was proposed as a viable solution to ending undernutrition in CUAFY.

Conclusion

The application of relevant theoretical models and context-specific intervention approaches can be utilized by stakeholders to close the existing inequality gaps, thereby reducing undernutrition amongst CUAFY globally.

Interventions for Picky Eaters among Typically Developed Children-A Scoping Review

Picky eating in children is often a major source of concern for many parents and caregivers. Picky eaters (PEs) consume limited foods, demonstrate food aversion, and have a limited food repertoire, which hinders their growth and health. These behaviours are common in children with special health care needs despite the rise in typically developing children. This leads to less attention being given to intervention programmes for typically developing children. Therefore, this scoping review aims to investigate the key concept of an existing intervention programme for PE among typically developing children, primarily on the types and approaches selected. A thorough literature search was conducted on three primary databases (PubMed, Emerald In-sight, and Web of Science) using predefined keywords. The literature was then appraised using the Joanna Briggs Institute's guidelines and protocols, and the PRISMScR checklist. Inclusion and exclusion criteria were also specified in the screening procedure. Results showed that the majority of the interventions in these studies were single-component interventions, with the sensory approach being the type that was most frequently utilised, followed by the nutrition approach and parenting approach. Single and multiple intervention components improved the assessed outcome, with a note that other components may or may not show a similar outcome, as they were not assessed in the single-component intervention. Given the evidence that picky eating is influenced by various factors, a multi-component intervention can provide a substantial impact on future programmes. In addition, defining picky eaters using standardised tools is also essential for a more inclusive subject selection.

Development of the Chinese preschooler dietary index: a tool to assess overall diet quality

BACKGROUND

Diet quality in early childhood has a long-term impact on health outcomes. However, there are scarce dietary indexes for Chinese preschool children, and the existing indexes had limited validity and reliability. This study thus aimed to develop a dietary index for preschool children based on the Chinese Dietary Guideline and Chinese Dietary Reference Intakes and to assess their overall diet quality using the China Health and Nutrition Survey (CHNS).

METHODS

The Chinese Preschooler Dietary Index (CPDI) included 11 components, covering 9 food group components and two nutrient components. The total scores of CPDI ranged from 0 to 90, with a higher score indicating greater diet quality. This study assessed the diet quality of 1742 preschoolers aged two to five years old from CHNS using the CPDI. Dietary intake data were obtained using three-day 24-h diet recalls, and sociodemographic information was also collected. Cochran-Mantel-Haensel (CMH) test was used to explore the association between demographic and CPDI total scores. The principal component analysis, correlation analysis and Cronbach's alpha were used to evaluate the relative reliability and validity of the CPDI. Finally, a stepwise multiple regression analysis was performed to explore potential influencing factors of CPDI.

RESULTS

Among the 1742 CHNS preschool children, more than 70% resided in rural areas and 41.2% of the sample were raised in a low-income family. The mean CPDI score of the preschoolers was 38.8 ± 12.9. Higher diet scores were correlated with higher energy and nutrient intake. Children with higher age (β = 0.93, SE = 0.26, P = 0.0003), raised in a home with higher household income (β = 3.11, SE = 0.27, P < 0.0001) or living in urban areas (β = -4.44, SE = 0.66, P < 0.0001) were associated with higher CPDI scores.

CONCLUSIONS

The CPDI is useful in evaluating the diet quality of preschool children. Based on the CPDI, the diet quality of Chinese preschoolers needs to be improved, especially in rural areas.

Public health interventions tackling childhood obesity at European level: A literature review

Childhood obesity pandemic, a form of malnutrition including undernutrition, and other food-regime associated risks, has universally been on the rise during the chronic period of the past 4-5 decades and is now acknowledged as one of the most "toxic fuel" accounting for poor health in the majority of countries. In order to find remedies to heal this alarming issue, a corpus of European interventions have been brought to light in the recent years. Since the vague influence and effectiveness of these measures / policies is to be further identified, their evaluation screening is underlined as a pivotal necessity. Within this framework this paper aims to critically report on the development and evaluation of the implementation of the European Union, World Health Organization Regional Office for Europe, and European Union countries' national public health policy interventions and action plans in the fight against childhood obesity. Thus, this is a narrative review synthesizing the results -following a qualitative interpretation and analysis- of recent scientific epidemiological research and review studies evidence concerning European public health interventions tackling childhood obesity, through computer-assisted literature search -via PubMed, Scopus, and Google Scholar- scientific databases. According to the literature data, it is concluded that despite the unprecedented public health challenge of addressing childhood obesity, the extent to which related European policies and programs targeting healthy nutrition, increased physical activity, and healthy lifestyle ethos are truly efficacious is still under inquiry.

Evidence of Concurrent Stunting and Obesity among Children under 2 Years from Socio-Economically Disadvantaged Backgrounds in the Era of the Integrated Nutrition Programme in South Africa

In view of persistent stunting and increasing rates of obesity coexisting among children in the era of the Integrated Nutrition Programme, a cross-sectional study was conducted to determined concurrent stunting and obesity (CSO) and related factors using a random sample of child-mother pairs (n = 400) in Mbombela, South Africa. Sociodemographic data was collected using a validated questionnaire, and stunting (≥2SD) and obesity (>3SD) were assessed through respective length-for-age (LAZ) and body mass index (BAZ) z-scores. Using SPSS 26.0, the mean age of children was 8 (4; 11) months, and poor sociodemographic status was observed, in terms of maternal singlehood (73%), no education or attaining primary education only (21%), being unemployed (79%), living in households with a monthly income below R10,000 (≈$617), and poor sanitation (84%). The z-test for a single proportion showed a significant difference between the prevalence of CSO (41%) and non-CSO (69%). Testing for the two hypotheses using the Chi-square test showed no significant difference of CSO between boys (40%) and girls (41%), while CSO was significantly different and high among children aged 6-11 months (55%), compared to those aged 0-5 months (35%) and ≥12 months (30%). Further analysis using hierarchical logistic regression showed significant associations of CSO with employment (AOR = 0.34; 95%CI: 0.14-0.78), maternal education status (AOR = 0.39; 95%CI: 0.14-1.09) and water access (AOR = 2.47; 95%CI: 1.32; 4.63). Evidence-based and multilevel intervention programs aiming to prevent CSO and addressing stunting, while improving weight status in children with social disadvantages, are necessary.

Effect of educational intervention based on health belief model on mothers monitoring growth of 6-12 months child with growth disorders

Background

Maternal education is one of the main ways to improve children's nutritional behaviors and development. The purpose of this study is to investigate the effect of educational intervention based on Health Belief Model (HBM) on mothers monitoring growth of 6–12 months child with growth disorders in Ghirokarzin city, Fars Provonce, Iran.

Methods

This quasi-experimental study was conducted on mothers of 6–12 months children with growth disorders of Ghirokarzin city, Fars province, Iran in 2021–2022. One hundred twenty mothers of 6–12 months child with growth disorders in Ghirokarzin city were selected using random sampling method and were divided into two groups of intervention (60) and control (60). The experimental group received training on the HBM constructs. Both groups completed the questionnaire before and three months after.intervention. A questionnaire beased on Health Belief Model constructs were used to collect information. The data was analyzed with SPSS 22 software using paired t-tests, Chi-square tests, and independent t-tests, with a significance level of 0.05.

Results

Three months after the educational intervention, the experimental group showed a significant increase in terms of knowledge, HBM constructs, weight of the children and feeding behavior.

Conclusion

This study showed the educational intervention based on the HBM improved the knowledge and feeding behavior of mothers and improved Growth Disorders of child. Hence, this model can act as a framework for designing and implementing educational interventions for prevention of growth disorders in children.

Analysis of the Relationship between Nutritional Status and Bone Age and Sexual Development in Children and Adolescents

Purpose

To observe the correlation between nutritional status, bone age, and sexual development in children and adolescents.

Methods

895 children and adolescents who underwent physical examination in the growth and development clinic and height clinic of our hospital from 2019 to 2021 were selected as the research objects. The subjects were divided into emaciation group, normal group, overweight group, and obesity group. The bone age level, bone age assessment, sexual development, and early maturity rate of each group were compared.

Results

The bone age difference (BAD) of the overweight and obesity groups was higher than that of the normal group, and the BAD of the obesity group was higher than that of the emaciation group (P < 0.05). Compared with the normal group, the risk of advancement of bone age in the overweight group increased by 2.674 times (male) and 1.908 times (female), the risk of advancement of bone age in the obesity group increased by 6.376 times (male) and 14.687 times (female), the risk of retardation of bone age in the emaciation group increased by 2.150 times (male) and 3.092 times (female). Whether it was male or female, the sexual development of overweight and obese was higher than that of the normal weight group in the same age group. Among female children, the sexual precocious puberty rate of the overweight + obesity group is higher.

Conclusion

The nutritional status of children and adolescents is closely related to their bone age and sexual development.

Adherence to Optimal Breastfeeding Practices Among HIV-Positive Mothers in Kilimanjaro, Tanzania

Purpose

We sought to assess how HIV-positive mothers enrolled in the PMTCT program adhere to breastfeeding recommendations concerning early initiation of breastfeeding (EIBF), ie, within one hour of birth, pre-lacteal feeds, exclusive breastfeeding until six months (EBF), and continued breastfeeding to one year of age. This study was designed to assess the practices in response to changing recommendations for breastfeeding in HIV, which have differed drastically over the years.

Patients and Methods

We recruited 524 mother-child pairs from 37 PMTCT clinics across Kilimanjaro, Tanzania. The 5 clinics with the highest patient load in each of the 7 districts of Kilimanjaro were chosen, plus the zonal and municipal referral hospitals. The children were below two years of age and currently in the PMTCT program. We administered a questionnaire to assess the mother's practices in feeding the child. We used multiple logistic regression models to determine factors associated with EIBF, EBF, and continued breastfeeding.

Results

EIBF was achieved for 73.1% of babies. Cesarean delivery, low birth weight, and partner disclosure of HIV status were significant risk factors for not achieving EIBF. About 19% of children did not breastfeed exclusively. Of the 247 children ≥12 months old, 43.3% had stopped breastfeeding before 12 months. Counseling on ARV, having had >2 pregnancies while HIV-positive and EBF were associated with breastfeeding until 12 months old. Using ART for more than two years decreased the odds of EBF and continued breastfeeding to 12 months of age.

Conclusion

Adherence to breastfeeding recommendations for HIV-positive women is suboptimal, particularly in aspects of recent changes in recommendations such as continuing breastfeeding for one year. There is a missed opportunity for interventions such as counseling, which has shown to favor adherence. Health education and counseling are needed for providers and mothers to keep them abreast with the frequently changing recommendations.

Multilevel Analysis of the Nutritional and Health Status among Children and Adolescents in Eastern China

We aimed to identify multiple nutritional health problems and the relevant factors among children and adolescents aged 7–17 years. This study was part of the China Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017, conducted in Jiangsu Province in eastern China. After sampling, 3025 school-age children and adolescents were enrolled into this study. Demographic information collections and anthropometric measurements were conducted by trained local Center for Disease Control and Prevention (CDC) staff. Venous blood in the amount of 6 mL was drawn from each participant in the morning and used for testing biochemical and nutritional indicators. Multivariate logistic regression analysis and Poisson regression analysis were used for overnutrition- and undernutrition-related disorders to test relevant personal, parental, and household factors. The prevalence of wasting, overweight, and obesity was 5.5%, 14.8%, and 12.7%, respectively. Metabolic syndrome (MetS) was prevalent among 5.1% of participants. Among the study participants, 29.5% had hyperuricemia. The overall prevalence of high low-density lipoprotein (LDL) and high total cholesterol (TC) of all participants was 4.8% and 7.4%, respectively. 0.9% of the participants had vitamin A deficiency (VAD) and 14.6% had marginal vitamin A deficiency; 25.1% had vitamin D deficiency (VDD) and 54.5% had inadequate vitamin D levels. Anemia was present in 4.0% of all participants. The prevalence of zinc deficiency was 4.8%. Demographic characteristics, behavioral characteristics, parents’ characteristics, and family characteristics were associated with these multiple malnutrition disorders. The double burdens of malnutrition, which includes overnutrition- and undernutrition-related diseases, were prevalent among the school-age children and adolescents in Jiangsu Province in eastern China. There were various factors related to different nutritional problems. Thus, health education focusing on behavior intervention and nutrition education are necessary in containing nutritional problems among children.

Effect of WeChat follow-up education on breastfeeding efficiency of infants after congenital cardiac surgery and parents' satisfaction: A short-term follow-up study

AIM

This study aimed to investigate the impact of WeChat follow-up education on infants' breastfeeding efficiency after congenital cardiac surgery and parents' satisfaction.

METHODS

A prospective study was conducted in a provincial hospital in China. Sixty participants were divided into two groups: 30 participants in the study group received WeChat follow-up health education, and 30 participants in the control group received postoperative routine nursing education for infants after congenital cardiac surgery. The infants' breastfeeding efficiency, parents' satisfaction and relevant clinical data were recorded and analysed.

RESULTS

After the WeChat follow-up intervention, the breastfeeding efficacy score, the parents' satisfaction score and the exclusive breastfeeding rate in the study group were significantly higher than those in the control group (P < 0.05). There was no significant difference in the incidence of feeding intolerance, abdominal distension, dyspeptic diarrhoea, weight gain or recurrent vomiting between the two groups during the 3-month follow-up period.

CONCLUSION

WeChat education can improve infants' breastfeeding efficiency after congenital cardiac surgery and can improve parents' satisfaction and exclusive breastfeeding rate during the short-term follow-up period.

Nutritional status of children and adolescents in three Serbian enclaves in Kosovo and Metohija

Objective

To evaluate nutritional status of children and adolescents living in three Serbian enclaves in Kosovo and Metohija.

Methods

We conducted an observational cross-sectional, population-based study, enrolling children and adolescents who underwent a pediatric screening performed in the three Serbian enclaves of Gračanica, Gornje Kusce and Velika Hoča in Kosovo and Metohija. Children and adolescents (5–19 years) of all ethnic groups were evaluated in one of the three free outpatient medical facilities in rural villages in Kosovo. Body weight and height were measured, height-for-age z- scores (HAZ) and BMI-for-age z-scores (BAZ) indicators were analyzed. The anthropometric indicators HAZ and BAZ distributions were compared between sex and ages using Fisher’s exact test. A two-sample Z-test for proportions was used to detect differences in individual categories of height- and BMI-for-age categories across sexes and age classes.

Results

Three hundred twenty-eight children and adolescents (184 females, 56.1% and 144 males, 43.9%) aged between 5 and 19 years were enrolled in the study. 241/328 participants showed a normal linear growth; with significantly more girls (78.3%) than boys (67.4%) being in the normal category. Similarly, a significant difference in BAZ distribution between sexes was noted, with more females being in the normal BMI category compared to males (63.0% vs 50.0%, respectively). Underweight and severe underweight subjects showed a prevalence of 1.5 and 0.6%, respectively. Overweight and obesity prevalence was 19.5 and 9.1%, respectively, which was comparable to World Health Organization overweight and obesity prevalence data for Serbia.

Conclusions

Prevalence of undernutrition and severe undernutrition in children and adolescents living in three Serbian enclaves in Kosovo and Metohija is small. By contrast, a tendency to an increase in overweight and obesity, especially in the male population, was noted.

Establishing Reference Values for Lean Muscle Mass in the Pediatric Patient

OBJECTIVES

Adults with decreased muscle mass experience worse outcomes and more frequent complications. The effects of sarcopenia on pediatric outcomes are unknown. Our objective was to define reference values for lean muscle mass in a healthy pediatric population to facilitate future studies on the impact of lean muscle mass on pediatric outcomes.

PATIENTS AND METHODS

Bilateral psoas muscle surface area was measured by computed tomography in a healthy pediatric population undergoing evaluation after trauma. Pearson correlation coefficients (PCCs) were calculated for age, weight, height, body mass index (BMI), total psoas muscle area, and psoas muscle index (PMI; defined as psoas muscle area divided by height squared). Quantile regression was used to determine age- and sex-specific percentiles of psoas muscle area and PMI.

RESULTS

Analysis of 494 male and 288 female patients with available imaging (median age: 9.3 years, interquartile range: 5.4-13.4; 63.1% male) was performed. For males, age correlated strongly with total psoas volume (PCC = 0.87), height (0.95), and weight (0.88) and poorly with BMI (0.45). In females, age correlated strongly with total psoas volume (0.88), height (0.92), weight (0.88) and poorly with BMI (0.19). Gender-specific curves and charts were created using output from the quantile regression from reference values of the total psoas muscle area corresponding to the 25th, 50th, and 75th percentiles across all ages.

CONCLUSIONS

We created gender-specific reference charts for total and height-normalized psoas muscle area in healthy children based on age. These results can be used in future studies to establish the effects of sarcopenia in pediatric patients.

Stunting, wasting, overweight and their coexistence among children under 7 years in the context of the social rapidly developing: Findings from a population-based survey in nine cities of China in 2016

The prevalence of stunting, wasting, overweight and their coexistence are various in different populations and they also have changed with social developing and environmental improving. In this paper, we aimed to analyze the prevalence of stunting, wasting, overweight and their coexistence in some developed regions of China. Data were collected in a population-based cross-sectional survey by a multi-stage cluster sampling method in nine cities located in the northern, central, and southern region of China in 2016. Children under seven years (n = 110,491) were measured. WHO growth standards were used to assess the growth status. Stunting, underweight, wasting, overweight and obesity were considered as the primary forms of malnutrition (includes undernutrition and overnutrition) for infant or young children at population-levels. The prevalence of stunting, underweight, wasting, and overweight or obesity were respectively 0.7%, 0.6%, 1.2%, and 7.6%. Most of these children (95.4%) suffered from one form of malnutrition, and only 0.2% of them concurrently stunted and wasted, 0.4% concurrently stunted and overweight, 1.7% concurrently stunted and underweight, 2.3% concurrently underweight and wasted. Among stunted children, 91.2% were appropriate body proportion, and only 2.3% were wasted, 6.5% were overweight or obesity. Among overweight or obese children, only 0.6% were stunted, whereas, 15.8% were high stature and 83.6% were the appropriate ranges of stature. Sex, age, urban/suburban, and region were associated with these primary forms of malnutrition in the multivariate logistic analysis. In conclusion, we found that the coexistence of stunting and overweight was not common at both population-level and individual-level. The situation for undernutrition had significantly improved, and overweight may be the leading public health issue for children under seven years in the nine cities of China.

Early-life Programming of Type 2 Diabetes Mellitus: Understanding the Association between Epigenetics/Genetics and Environmental Factors

Type 2 Diabetes Mellitus is an increasing public health problem that poses a severe social and economic burden affecting both developed and developing countries. Defects in insulin signaling itself are among the earliest indications that an individual is predisposed to the development of insulin resistance and subsequently Type 2 Diabetes Mellitus. To date, however, the underlying molecular mechanisms which result in resistance to the actions of insulin are poorly understood. Furthermore, it has been shown that maternal obesity is associated with an increased risk of obesity and insulin resistance in the offspring. However, the genetic and/or epigenetic modifications within insulin-sensitive tissues such as the liver and skeletal muscle, which contribute to the insulin-resistant phenotype, still remain unknown. More importantly, a lack of in-depth understanding of how the early life environment can have long-lasting effects on health and increased risk of Type 2 Diabetes Mellitus in adulthood poses a major limitation to such efforts. The focus of the current review is thus to discuss recent experimental and human evidence of an epigenetic component associated with components of nutritional programming of Type 2 Diabetes Mellitus, including altered feeding behavior, adipose tissue, and pancreatic beta-cell dysfunction, and transgenerational risk transmission.

Monitoring of the trophological status of children for early detection of alimentary dependent diseases

Food deficits are now a serious problem because they often lead to the development of health disorders and the formation of chronic pathology. The article presents the results of nutritional status assessment including the study of actual nutrition, health, physical development and availability of a number of macro and micronutrients in 493 children aged 3 to 11 years. Early formation of excess body weight and obesity and their relationship with the development of chronic diseases, decrease of physical performance has been proved. Biochemical markers for cardiovascular disease risk in these age groups have been found. The combination of micronutrients deficiency such as calcium, iron, zinc adversely affects the level of health and development of children, which determines the need to introduce a set of preventive measures.

Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso

Stunting prevalence is an indicator of a country’s progress towards United Nations’ Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%–62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress.

Keragaman Pangan dengan Status Kadarzi Keluarga di Wilayah Kerja Posyandu Sidotopo, Surabaya

Background: Indonesia still facing some nutritional problems that hinder its economics development. The government itself has an effort to tackle nutritional problems by establishing  a program known as Keluarga Sadar Gizi (Kadarzi). The family expected to understand and overcome the nutritional problems affecting its members. One of Kadarzi’s five indicator is dietary diversity. Dietary divesity can reflected dietary quality. Therefore, dietary diversity assessment is influential to improve dietary quality. Objectives: The purpose of this study was to analyze the differences in dietary diversity scores among Kadarzi household. Method: The design of the study was cross sectional. Number of sample were 34 mothers who registered in Posyandu settled in Kelurahan Sidotopo, Kecamatan Semampir, Kota Surabaya. Samples were selected using simple random sampling technique. Kadarzi data were collected from KMS book. Dietary diversity was assessed using Individual Dietary Diversity Score (IDDS). The data were analyzed using independent T-test. Result: The result showed that most families were not meeting Kadarzi’s indicator (73%). There were 32.4% family categorized as low dietary diversity, 47.1% family categorized as medium dietary diversity, and 20.6% family categorized as high dietary diversity. There were a difference of dietary diversity score beetwen Kadarzi’s household nor Kadarzi’s household (p<0.001). In Kadarzi’s household the consumption of dark green leafy vegetables, other vitamin A rich fruits and vegetables, anf other fruits and vegetables are higher than non Kadarzi’s household. Conclusions: There was a significant difference in dietary diversity score beetwen Kadarzi’s household and nor Kadarzi’s household. The importance of eating diverse and some references of affordable food choice to meet dietary diversity were needed to share.ABSTRAKLatar belakang: Indonesia masih menghadapi beberapa masalah gizi yang menghambat perkembangan ekonomi. Namun pemerintah memiliki suatu upaya untuk mengatasi permasalahan gizi tersebut dengan membentuk program Keluarga Sadar Gizi (Kadarzi). Pada program ini keluarga diharapkan mampu mengerti dan mengatasi permasalahan gizi anggotanya. Salah dari lima perilaku Kadarzi adalah makan beragam. Makan beragam merupakan salah satu perilaku yang dapat menggambarkan kualitas diet individu. Oleh karena itu penilaian keragaman pangan perlu diketahui untuk mengetahui dan meningkatkan kualitas diet individu. Tujuan: Tujuan penelitian ini adalah untuk menganalisis perbedaan skor keragaman pangan pada keluarga sadar gizi. Metode: Penelitian observasional ini disusun dengan rancang bangun cross sectional. Sejumlah 34 sampel yang merupakan ibu balita yang terdaftar di Posyandu di wilayah Kelurahan Sidotopo, Kecamatan Semampir, Kota Surabaya dipilih menggunakan teknik simple random sampling. Data Kadarzi didapatkan dari observasi kartu menuju sehat (KMS). Keragaman pangan dinilai menggunakan instrumen Individual Dietary Diversity Score (IDDS). Data dianalisis menggunakan independent T-test. Hasil: Sebagian besar keluarga masih belum menerapkan perilaku Kadarzi (73%). Sebanyak 32,4% keluarga termasuk dalam kategori skor keragaman pangan rendah, 47,1% dalam kategori sedang, dan 20,6% dalam kategori tinggi. Terdapat perbedaan skor keragaman pangan antara keluarga yang menerapkan perilaku Kadarzi dan tidak menerapkan perilaku Kadarzi (p<0,001). Pada keluarga yang menerapkan perilaku Kadarzi konsumsi sayuran hijau, sayur dan buah vitamin A, sayur dan buah yang lain lebih tinggi daripada keluarga yang tidak menerapkan Kadarzi. Kesimpulan: Terdapat perbedaan skor keragaman pangan antara keluarga yang menerapkan perilaku Kadarzi dan tidak menerapkan perilaku Kadarzi. Diperlukan pemaparan informasi lebih lanjut mengenai pentingnya makan beragam dan pemilihan makanan yang terjangkau untuk dapat memenuhi konsumsi makan beragam.