Maternal and child undernutrition and overweight in low-income and middle-income countries

Trends in the prevalence of concurrent anaemia and stunting among infants and young children in Rwanda: a cross-sectional study from 2010 to 2020

BACKGROUND

Concurrent anaemia and stunting (CAS) pose severe public health risks in low- and middle-income countries, affecting child health and development.

OBJECTIVES

To determine trends in CAS prevalence and associated factors among infants and young children aged 6-23 months in Rwanda.

METHODS

Analyses of nationally representative samples from the Rwanda Demographic and Health Surveys (RDHS) of 2010, 2014/15, and 2019/20 were conducted. Participants' characteristics, trends, and prevalence of CAS were analysed using frequencies and percentages. Multivariable binary logistic regression analyses were used to assess factors associated with CAS.

RESULTS

The prevalence of CAS among children aged 6-23 months in Rwanda declined from 21.3% in 2010 to 16.9% in 2019/20 (p = 0.005). Significant factors associated with CAS included child's age above 12 months, male sex, small/very small birth size, breastfeeding initiation 1 day post-birth, inadequate minimum acceptable diet, history of cough 2 weeks prior to the survey, multiple births, being from a mother with no or only primary education, mother aged below 20 years, mother with no iron supplementation during pregnancy, maternal anaemia, resident of an eastern province, resident of high altitude areas (>2000 m), low household wealth and unimproved toilet facilities.

CONCLUSIONS

This study reveals persistent CAS among infants and young children in Rwanda. CAS was associated with various child, maternal, and household-related factors. Despite a notable decline in CAS prevalence in Rwanda over the past decade, CAS remains a significant public health issue, requiring targeted interventions.

Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive

Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeria and Vietnam. A&T's SBC approach used interpersonal communication, community mobilization and mass media to address knowledge gaps, strengthen self-efficacy and shift social norms. The initiative used data for design and evaluation and facilitated scale and sustainability through close collaboration with governments and other stakeholders. A&T's approach increased exclusive breastfeeding, minimum meal frequency of children and use of iron and folic acid tablets by pregnant women, but had mixed impacts on early initiation of breastfeeding and maternal and child dietary diversity. Multiple SBC channels and frequent contacts strengthened the impact of SBC on MIYCN practices. Lessons learned included: using existing large-scale platforms for interpersonal communication, improving counselling skills of health workers, delivering timely tailored messages, engaging key influencers to take specific actions, using research to address underlying behavioural concerns and maximize mass media reach and frequency, using simple memorable messages and employing additional channels to reach low media coverage areas. A&T developed and implemented at-scale MIYCN SBC in multiple countries, providing lessons learned about intervention strategies, engagement of influencers and mass media campaign development, which governments and other implementers can adapt and replicate.

Mitigating the Impact of Intergenerational Risk Factors on Stunting: Insights From Seven of the Most Food Insecure Districts in South Africa

A large body of research investigates the determinants of stunting in young children, but few studies have considered which factors are the most important predictors of stunting. We examined the relative importance of predictors of height-for-age z-scores (HAZ) and stunting among children under 5 years of age in seven of the most food-insecure districts in South Africa using data from the Grow Great Community Stunting Survey of 2022. We used dominance analysis and variable importance measures from conditional random forest models to assess the relative importance of predictors. We found that intergenerational and socioeconomic factors-specifically maternal height (HAZ: Coef. 0.02, 95% CI 0.01-0.03; stunting: OR 0.96, 95% CI 0.94-0.98), birth weight (HAZ: Coef. 0.3, 95% CI 0.16-0.43; stunting: OR 0.5, 95% CI 0.35-0.72) and asset-based measures of socioeconomic status (HAZ: Coef. 0.17, 95% CI 0.10-0.24; stunting: OR 0.77, 95% CI 0.67-0.89)-were the most important predictors of HAZ and stunting in these districts. We explored whether any other factors moderated (weakened) the relationship between these intergenerational factors and child height using conditional inference trees and moderation analysis. We found that being on track for vitamin A and deworming, adequate sanitation, a diverse diet and good maternal mental health moderated the effect of birth weight or mother's height. Though impacts are likely to be small relative to the impact of intergenerational risk factors, these moderating factors may provide promising avenues for helping to mitigate the intergenerational transmission of stunting risk in South Africa.

Caregiver Feeding Behaviours and Child Dietary Diversity and Growth in Rural Bangladesh

This study examined relations between caregiver feeding behaviours, child dietary diversity and anthropometry at 24 months of age in rural Bangladesh. Twenty-four hours dietary recall, weight and length data were collected on 4733 children. Factor analysis was applied to an 11-item caregiver feeding behaviours scale administered at 24 months, revealing two constructs: responsive/involved (five items) and forceful (six items); each dichotomised to reflect low and high use. Stunting (length-for-age Z-score < -2), wasting (weight-for-length Z-score < -2) and underweight (weight-for-age Z-score < -2) were defined using international growth reference standards. Associations between feeding behaviours, dietary diversity score (DDS, food groups consumed; range 0-7) and anthropometric indicators were examined using multivariable linear or logistic regression models, adjusting for study design, confounders and intervention arm. Mean (SD) age of children in the study was 24.1 (0.3) months. Mean (SD) DDS was 3.7 (1.4), with 55% of children meeting minimum dietary diversity (MDD, DDS ≥ 4). Stunting, wasting and underweight were 40%, 19% and 42%, respectively. Use of high responsive/involved feeding behaviours (reported in 71% of mothers) was associated with higher DDS (0.09, 95% confidence interval [CI]: 0.001, 0.17) and higher odds of achieving MDD (OR: 1.17; 95% CI: 1.02, 1.33) but not with anthropometric outcomes. Use of high forceful feeding behaviours (reported in 34% of mothers) was associated with lower DDS (-0.12, 95% CI: -0.21 to 0.04), lower odds of achieving MDD (OR: 0.82, 95% CI: 0.72, 0.93), and higher odds of underweight (OR: 1.38, 95% CI: 1.22, 1.56) and wasting (OR: 1.55, 95% CI: 1.33, 1.81). In Bangladesh, responsive/involved feeding was associated with higher child dietary diversity whereas forceful feeding was associated with lower dietary diversity and undernutrition. Future research is needed to understand causality and test the effect of responsive feeding interventions on the promotion of child growth.

Effect of counselling about complementary food flour soaking on nutritional and health status of children 6-23 months, a quasi-experimental study

BACKGROUND

Strategies for achieving improved nutrition in young children in developing countries where plant-based complementary foods are the main source of nutrients can address the challenge of meeting nutritional needs from these foods.

OBJECTIVES

This study aimed to assess the effect of counseling about complementary food flour soaking on nutritional and health status of children 6-23 months.

METHODS

A total of 726 mother-child pairs (intervention n = 363 and control n = 363) were enrolled in this study. Participants in the intervention district received personalized nutritional counseling for six months. Interviewer-administered questionnaires and anthropometric measurements were used to collect data. The data were analyzed using SPSS. The difference in difference regression analysis and the Poisson regression analyses were used to estimate the effect of the interventions on anthropometric Z-score and incidence of disease episodes, respectively. Mean differences and Incidence Rate Ratio were computed as a measure of intervention effects.

RESULT

The results showed that the intervention improved the Weight-for-Age Z score of children by 0.30 (β = 0.30, 95 % CI: 0.15-0.45) and Weight-for-length Z score by 0.47 (β = 0.47, 95 % CI: 0.25-0.69). However, the intervention did not improve Length-for-age and health status.

CONCLUSION

The findings imply the need for strengthening social behavior change communication to improve the complementary feeding practices of mothers in the study area. The trial was registered on ClinicalTrials.gov with a registration number NCT05254717.

Food Insecurity and Nutritional Status Among Pregnant Women Living in Socio-Economic Vulnerability in the Metropolitan Area of Buenos Aires (Argentina)

OBJECTIVE

To analyze food insecurity (FI) in pregnant women from the Metropolitan Area of Buenos Aires (AMBA) and its association with socio-economic variables and nutritional status, as well as to identify dietary patterns in women experiencing moderate and severe FI.

METHODS

Between July 2021 and September 2023, an observational and cross-sectional study was performed. Data from 349 women was recorded in public health centers of disadvantaged urban areas. FI was assessed with the Food Insecurity Experience Scale (FIES), and the nutritional status was evaluated using the body mass index by gestational age. Chi-square, Spearman, and Wilcoxon tests were used to examine associations between FI, nutritional status, socioeconomic conditions, and dietary patterns.

RESULTS

Only 30% of interviewed women were classified as food secure, while 31% experienced moderate FI and 11.5% severe FI. Among socio-economic variables, fewer years of formal education and critical overcrowding were significantly associated with FI. A large part of the sample (68%) had some type of malnutrition (overweight or obesity: 52.7%, undernutrition: 11.2%), which was also significantly associated with FI. Dietary patterns differed between women with moderate and severe FI, with the latter consuming less healthy and more processed foods.

CONCLUSIONS

Our results suggest that women in reproductive ages living in urban areas from the AMBA region have elevated levels of FI, especially moderate FI, even when compared with other vulnerable populations from Latin America. This study confirmed that FI is related to different types of maternal malnutrition, which constitutes a prenatal adversity with diverse potential effects on the offspring.

Effect of lipid-based nutrient supplements on morbidity among children with stunting: secondary analysis of a randomized trial in Uganda

BACKGROUND

Children with stunting are at risk of infections. We assessed the effect of lipid-based nutrient supplement (LNS) on morbidity in children with stunting.

METHODS

This was a secondary analysis of a randomized, 2×2 factorial trial among 12-59 months-old, stunted children in Uganda. Children were randomized to LNS containing milk or soy protein and whey permeate or maltodextrin, or no supplementation, for 12 weeks. The outcomes were caregiver-reported morbidity after 2, 4, 8 and 12 weeks, serum C-reactive protein (S-CRP), α1-acid glycoprotein (S-AGP), and phase-angle (PhA) by bioimpedance.

RESULTS

Of 750 children, mean (SD) age was 32.0 (11.7) months, 55% (n = 412) were male. LNS increased diarrhoea prevalence (18.1% vs 7.3%, P = 0.001) during the first two weeks, but not thereafter. There was no effect of LNS on cough or fever. LNS resulted in greater decline in S-AGP (-0.10 g/L, 95% CI: -0.17, -0.03, P = 0.003) but not S-CRP (25%, 95% CI: -11, 74, P = 0.193), and greater increase in PhA (0.10 degrees, 95% CI: 0.01, 0.18, P = 0.030), explained by greater fat-free mass. Milk compared to soy protein in LNS resulted in higher PhA (0.10 degrees, 95% CI: 0.02, 0.17, P = 0.013), not explained by fat-free mass.

CONCLUSION

LNS supplementation in children with stunting had no effect on morbidity but resulted in a small reduction in sub-acute systemic inflammation. The possible effect of LNS supplementation on inflammation in stunted children requires further evaluation. ( www.isrctn.com : ISRCTN13093195).

Hemoglobin as a mediator between air pollution and growth outcomes in children under 60 months: the moderating role of nutritional supplementation

BACKGROUND

Prior research has yielded incongruent results about the association between air pollutants and offspring hemoglobin levels, as well as between air pollutants and child development. This may be because previous studies have not taken both air pollution and nutrition into account. This study sought to examine the correlations between postnatal exposure to air pollution (PM2.5, PM10, SO2, and CO), offspring hemoglobin levels, stunting, and underweight. Furthermore, we investigated whether hemoglobin levels mediate these connections and assessed the moderating influence of dietary supplementation on hemoglobin levels and growth outcomes.

METHODS

A unified nutrition package intervention study was conducted in western, China between 2016 and 2023. In accordance with WHO guidelines, stunting, underweight, height-for-age z score (HFA), weight-for-age z score (WFA), and anemia status were all defined. A daily average of PM2.5, PM10, SO2, and CO levels was collected from the National Urban Air Quality Real-Time Dissemination Platform ( http://www.cnemc.cn/sssj/ ) of the China Environmental Monitoring General Station. Linear regression and logistic regression models were used to assess the correlation between air pollution and the above indicators. The mediating role of hemoglobin and the moderating effect of nutritional supplementation were also evaluated.

FINDINGS

This study examined the impact of postnatal air pollution exposure on child growth, mediated by hemoglobin levels and moderated by nutritional supplementation (YingYangBao, YYB). Our findings suggest that air pollution negatively affects growth via reduced hemoglobin levels, but extended nutritional supplementation mitigates this effect. A total of 10,766 children under 5 years of age participated in this study. All four air pollutants were associated with reduced hemoglobin levels, but their effects on growth and development were not uniform. Specifically, PM2.5 and PM10 showed stronger negative associations with HFA and WFA, while SO2 and CO had weaker effects. Air pollution had a greater impact on growth outcomes in anemic children compared to non-anemic children. Hemoglobin levels mediated 13.4% of the effect of air pollution on HFA (VAF = 13.4%, Cohen's f² = 0.15). Furthermore, the duration of YYB moderates the effects of air pollution on hemoglobin and HFA. The direct negative effect of air pollution on HFA was attenuated when the duration of use was > 10 months, whereas in the low use group the pollution effect was enhanced (β=-0.0444, 95%CI: -0.0613, -0.03).

CONCLUSION

Postnatal exposure to air pollution (PM2.5, PM10, SO2, CO) increases the risk of stunting, particularly during the critical developmental window of 6-23 months of age. This effect is partially mediated by hemoglobin levels, and YYB can moderate this relationship. These findings highlight the importance of prolonged nutritional interventions in mitigating the adverse effects of air pollution on child growth and development, with significant implications for public health policies targeting air quality and child nutrition in high-pollution regions.

Seasonality of underweight among infants 1-11 months old in Niger: an exploratory analysis of data from a cluster-randomised trial

INTRODUCTION

Malnutrition is a risk factor for child mortality, with around 45% of deaths in children under 5 globally linked to malnutrition. Seasonality of malnutrition has important implications for the timing of child health programme activities, but evidence is mixed on the nature of such patterns. Moreover, the bulk of the existing evidence is focused on wasting and stunting in children 6-59 months, despite increasing evidence that younger children also face a high risk, and that underweight alone is an important predictor of mortality.

METHODS

This study used data from the cluster-randomised AVENIR trial which compared the effect of biannual distribution of azithromycin vs placebo on mortality in children 1-59 months old in Niger. AVENIR included a biannual census conducted on a rolling basis over 2 years. A subset of 133 781 infants aged 1-11 months from 2904 communities were included in this study, and weight-for-age z-score (WAZ) was calculated at each census. The exposure for this analysis is the day of the year weight was captured. Harmonic regression was used to determine primary and secondary peaks and nadirs of WAZ over time.

RESULTS

Overall, the primary peak of WAZ occurred in late February and the primary nadir occurred in mid-May, aligning with a seasonal temperature increase before the rainy season. A secondary peak in August and a secondary nadir in November were also seen, aligning with the postrainy season.

CONCLUSION

The seasonality of WAZ of infants 1-11 months in Niger may have implications for the timing of programmes aiming to decrease malnutrition.

Mass distribution of azithromycin and child mortality among underweight infants in rural Niger: a subgroup analysis of the AVENIR cluster-randomised trial

OBJECTIVE

Azithromycin has been shown to reduce all-cause child mortality. This subgroup analysis investigates azithromycin's mortality impact by underweight status using Azithromycine pour la Vie des Enfants au Niger: Implementation et Recherche (AVENIR) trial data.

DESIGN

The AVENIR trial randomised communities into three arms: azithromycin for children aged 1-59 months, azithromycin for infants aged 1-11 months or placebo. Weight-for-age z-score was used to categorise children into subgroups of either moderate to severe underweight or not and severe underweight or not.

SETTING

2880 communities with a population of less than 2500 people in the Dosso and Tahoua regions of Niger that participated in the AVENIR trial were included.

PARTICIPANTS

97 572 children aged 1-59 months who had weight captured during at least one census participated.

RESULTS

Underweight subgroups had higher overall mortality compared with non-underweight subgroups. IRDs of deaths in children aged 1-11 months comparing communities receiving azithromycin to children 1-59 months of age to placebo were -6.2 deaths per 1000 person-years (95% CI -9.3 to -2.6) overall, -8.0 (95% CI -15.9 to -0.4) in the moderate to severe subgroup and -11.2 (95% CI -26.0 to -2.1) in the severe subgroup. Similar trends were noted in the azithromycin 1-11 month comparison. Malnutrition was not a statistically significant effect modifier for either comparison.

CONCLUSIONS

Although analyses suggest the potential for stronger effects in more severe underweight subgroups, we were unable to demonstrate underweight status as an effect modifier. In fact, azithromycin mass drug administration to children 1-59 months old reduced mortality in all subgroups, and, especially as the number of lives saved would be the highest by treating all subgroups, our results do not support restricting eligibility for this intervention.

TRIAL REGISTRATION NUMBER

clinicaltrials.gov NCT04224987.

Clinical and Epidemiological Profile of Nutritional Anemia and Its Impact on Developmental Outcome Among Children Attending Ruhengeri Referral Hospital

Nutritional anemia is a serious health concern that affects particularly children under 5 years of age and causes problems of physical and mental growth and development. A cross-sectional study determined the rates and risk factors of iron deficiency anemia (IDA) and megaloblastic anemia (MA) and assessed the effect of IDA and MA on developmental outcome at Ruhengeri Referral Hospital from April 2021 to March 2022. The Cochran's formula: n=Z 2PQ/d 2 was used to calculate the sample size of 318 and children aged between 6 and 59 months were purposively selected and included in the study. Venous blood specimens were collected in EDTA and clot activator tubes for complete blood count (CBC) and ferritin, respectively, used Sysmex 500i and Cobas e411 analyzers, respectively. Demographic and clinical information was collected on participants and the data were analyzed by Statistical Package for Social Science (SPSS) Version 20. A p value of less than 0.05 was considered significant at 95% confidence level. Logistic regression analysis and Chi-square test were used to examine the significance of the associations between explanatory and outcome variables. The ratio of male to female participants was 1.7:1 and the age group 12-23 was the most predominant (35.2%). IDA was more prevalent (93.4%) than MA (6.6%). The factors significantly associated with nutritional anemia at 95% confidence level were residence in rural area (OR = 3.896 and CI = 1.504-10.094), number of meal per day (OR = 23.640 and CI = 3.561-156.949), lacking knowledge of nutritional anemia (OR = 3.242 and CI = 1.205-8.723), parity (OR = 0.197 and CI = 0.108-0.360), history of breastfeeding (OR = 0.38 and CI = 0.004-0.904), source of diet (OR = 0.295 and CI = 0.088-0.988), and lack of food supplements (OR = 3.685 and CI = 1.583-8.580). Nutritional anemia was significantly associated with developmental delay (p < 0.0001). Iron deficiency and megaloblastic anemia present a sizeable challenge in the furtherance of primary healthcare outstandingly in young children and are associated with developmental delay. The mothers' education on nutrition and early diagnosis and management of nutritional anemia would reduce the risk of IDA and MA and related morbidity and mortality in the children at risk.

Dietary outcomes of moderately wasted children treated in a food voucher program in Cameroon's Far North: a three-month longitudinal study

BACKGROUND

Many interventions in Cameroon focus on addressing severe wasting rather than targeting moderate wasting, although the latter is more prevalent. The objective of the study was to evaluate dietary outcomes in a program designed to treat moderate wasting using a food voucher program (FVP) tested in the Far North, examining the factors associated with dietary outcomes.

METHODS

A three-month longitudinal study was carried out by an independent team of researchers within the context of a one-year humanitarian project designed to treat children with moderate wasting (middle-upper arm circumference [MUAC] measures 115-125 mm) by providing caretakers with a bi-weekly voucher to redeem for a predefined basket of foods together with essential hygiene and nutrition education. A sample of 474 children were randomly selected from the cohort enrolled in the program for inclusion in the study. Using a pre/post-test design, we evaluate the effect of the receipt of food vouchers on dietary outcomes using as indicators minimum dietary diversity (MDD) for children aged 6-23 months and dietary diversity scores (DDS) for children aged 24-53 months. Mixed logistic and linear regressions were used to identify factors from socio-demographic data and program activities (cooking demonstrations and nutrition education, perception of food safety, food basket sharing, and lasting) associated with these variables. Life table analysis was employed to assess the likelihood of achieving MDD among children aged 6-23 months.

RESULTS

The likelihood of children aged 6-23 months meeting MDD increased from 19.9% at the beginning of the study to 100% after 12 weeks. Among older children, average DDS increased from 3.2 at entry to 5.1 at the two-week mark and remained constant for the duration of the study. A negative perception among caregivers of the safety of redeemed food items was negatively associated with achieving MDD (adjusted RR = 0.50, p = 0.012). The consumption of food basket contents by other family members was negatively associated with DDS (adjusted coef. = 0.33, p = 0.047).

CONCLUSION

The FVP was effective in improving the dietary diversity of MAM children aged between 6 and 59 months in Cameroon's Far North.

Effect of Teté dance on lactation session duration in irritable infants in peru assessed in a randomized controlled trial

 Infant irritability often shortens breastfeeding sessions, contributing to early weaning. The "Teté Dance," inspired by Peruvian Amazonian traditions, combines rhythmic maternal movements with cheerful music to soothe infants and extend feeding sessions. Objective To evaluate the impact of the "Teté Dance" on breastfeeding session duration. Design Single-blind, parallel, randomized controlled trial within a volunteer initiative providing virtual breastfeeding counseling to Peruvian mothers. Infants aged 4-20 weeks (N = 150) with unexplained irritability were randomized (1:1) to the intervention (n = 75) or control (n = 75) groups. The intervention group practiced the Teté Dance, while controls used usual consolation methods. Mothers recorded breastfeeding durations in diaries. The primary outcome was the change in breastfeeding session duration from baseline to 7 days. Staff blinded to group assignments verified entries. Compared to baseline, the intervention group showed a significant increase in breastfeeding session duration after 7 days (36.4 vs. 29.6 min; mean difference + 6.8, 95% CI 4.7-8.9). The "Teté Dance" increased breastfeeding duration by 23%, offering a community-based, low-cost intervention to support lactating mothers. Future studies should explore its long-term effects and applicability in diverse settings.

Feeding Practices in the Introduction of Complementary Feeding and Implications for Future Healthy Eating

BACKGROUND

Complementary feeding (CF) is the process of introducing foods that starts when breast milk or formula alone can no longer meet infant's nutritional requirements. Nevertheless, the goal of introducing solid foods is to supplement, not replace, human milk or infant formula. The timing of introduction of CF is a pivotal issue in paediatrics.

SUMMARY

According to the World Health organization (WHO), ideally CF begins at 6 months of age and continues until 23 months, although breastfeeding may extend beyond this period. In low-resource setting areas due to food and water hygiene issues and less availability of complementary foods (CFs) with good nutritional quality, early CF represents a harm. In the meantime, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and European Food Safety Authority (EFSA) recommend that CF should start between 17 and 26 weeks of age. This indication is provided because an early introduction of CFs before 4 months has harming results for both renal and gastrointestinal function and is inadequate with respect to neurodevelopmental skills. The concern about late introduction after 6 months mainly arises from inadequacy of breast milk in providing critical nutrients, particularly iron. Moreover, accumulating evidence suggests a potential higher risk of food allergies (i.e., peanut) when delaying exposure to allergens, rather than preventing their occurrence.

Maternal balanced energy-protein supplementation reshapes the maternal gut microbiome and enhances carbohydrate metabolism in infants: a randomized controlled trial

Balanced energy-protein (BEP) supplementation during pregnancy and lactation can improve birth outcomes and infant growth, with the gut microbiome as a potential mediator. The MISAME-III randomized controlled trial (ClinicalTrial.gov: NCT03533712) assessed the effect of BEP supplementation, provided during pregnancy and the first six months of lactation, on small-for-gestational age prevalence and length-for-age Z-scores at six months in rural Burkina Faso. Nested within MISAME-III, this sub-study examines the impact of BEP supplementation on maternal and infant gut microbiomes and their mediating role in birth outcomes and infant growth. A total of 152 mother-infant dyads (n = 71 intervention, n = 81 control) were included for metagenomic sequencing, with stool samples collected at the second and third trimesters, and at 1-2 and 5-6 months postpartum. BEP supplementation significantly altered maternal gut microbiome diversity, composition, and function, particularly those with immune-modulatory properties. Pathways linked to lipopolysaccharide biosynthesis were depleted and the species Bacteroides fragilis was enriched in BEP-supplemented mothers. Maternal BEP supplementation also accelerated infant microbiome changes and enhanced carbohydrate metabolism. Causal mediation analyses identified specific taxa mediating the effect of BEP on birth outcomes and infant growth. These findings suggest that maternal supplementation modulates gut microbiome composition and influences early-life development in resource-limited settings.

The impact of hypothetical early life interventions on rapid weight gain during infancy and body mass index at 5 and 8 years in Norway: The Norwegian Mother, Father, and Child Cohort Study (MoBa)

OBJECTIVES

This study examined the impact of hypothetical interventions on (i) early life factors (prenatal and early postnatal) on rapid weight gain during infancy, and (ii) early life factors and child energy balance-related behaviours (EBRB) on children's body mass index (BMI)-for-age at 5 and 8 years.

METHODS

Data from the Norwegian Mother, Father, and Child Cohort Study included participants aged 2 (n = 48 109), 5 (n = 18 810) and 8 (n = 10 830) years. Early life intervention variables were maternal smoking during pregnancy, maternal weight before and during pregnancy, exclusive/partial breastfeeding for 6 months, and introduction of complementary food at 6 months. Child EBRB intervention variables for the 5-year outcome included screen time, fruit and vegetable intake, and sugar-sweetened soft drink intake assessed at 3 years. For the 8-year outcome, interventions included screen time, presence of a television in the child's bedroom, sleep hours and breakfast intake assessed at 5 years. The parametric g-formula was used for analysis.

RESULTS AND CONCLUSIONS

The average population-level difference in rapid weight gain during infancy at 2 years under the intervention targeting the prenatal, early postnatal factors and these factors combined with 95% confidence intervals were -0.012 (-0.017, -0.007), -0.009 (-0.012, -0.005) and -0.020 (-0.025, -0.015), respectively. The average population-level differences in children's BMI-for-age z-score for interventions targeting early life factors, child EBRB and these factors combined were -0.225 (-0.244, -0.207), 0.02 (-0.021, 0.024) and -0.223 (-0.249, -0.196), respectively among 5-year-olds and -0.265 (-0.295, -0.236), -0.020 (-0.029, -0.011) and -0.285 (-0.315, -0.256), respectively among 8-year-olds. Our results suggested joint interventions on early life factors may reduce childhood BMI-for-age z-scores.

Associations Between Personality Traits, Self-Efficacy and Complementary Feeding Behavior Among Infant Caregivers in Western Rural China

The effects of psychological factors on complementary feeding behavior have been widely described, yet the mechanisms underlying the complex relationships among personality traits, self-efficacy, and complementary feeding behavior remain unclear. This cross-sectional study was conducted using a multi-stage cluster sampling process to select caregiver-child dyads in Western rural China. Personality traits, self-efficacy, and complementary feeding behavior were evaluated respectively. Both multiple logistic regression and Bayesian network structure (BNs) were used to explore these associations. A total of 787 caregiver-child dyads were enrolled. Results from multiple logistic regression indicated that caregivers with medium (OR = 2.05, p < 0.001) or high (OR = 1.58, p = 0.04) levels of extraversion, as well as those with high self-efficacy recording complementary feeding (OR = 2.08, p < 0.001), significantly increased the likelihood of meeting the criteria for the Infant and Child Feeding Index (ICFI) qualification. Further, BNs were employed to elucidate the pathways of influence, revealing a direct association between the caregiver's level of extraversion, level of self-efficacy and the ICFI. Additionally, the analysis indicated that a caregiver's openness indirectly influenced the ICFI through its influence on self-efficacy regarding complementary feeding. This is one of few studies exploring associations between personality traits, self-efficacy, and complementary feeding behavior. The study highlights the importance of understanding individual differences in caregiving and suggests that interventions should focus on enhancing caregivers' self-efficacy, rather than solely targeting personality traits.

Estimating double burden of malnutrition among rural and urban children in Amazonia using Bayesian latent models

Background

The double burden of malnutrition (DBM) in the same individual is a neglected public health concern, especially in low- and middle-income countries (LMICs). The DBM is associated with increased risks of non-communicable diseases, childbirth complications, and healthcare costs related to obesity in adulthood. However, evaluating low prevalence outcomes in relatively small populations is challenging using conventional frequentist statistics. Our study used Bayesian latent models to estimate DBM prevalence at the individual-level in small populations located in remote towns and rural communities in the Brazilian Amazon.

Methods

We employed a cross-sectional survey of urban and rural children aged 6-59 months, considering DBM as the coexistence of stunting and overweight in the same individual. We evaluated four river-dependent municipalities, sampling children in randomly selected households in each town and a total of 60 riverine forest-proximate communities. Through Bayesian modeling we estimated the latent double burden of malnutrition (LDBM) and credible intervals (CI).

Results

The exceedance probability of LDBM was used to quantify this form of malnutrition at the population level. Rural prevalence of LDBM was significantly higher in Jutai (3.3%; CI: 1.5% to 6.7%) compared to Maues and Caapiranga. The likelihood that LDBM rural prevalence exceeded 1% was very high in Jutai (99.7%), and Ipixuna (63.2%), and very low (< 2%) in rural communities elsewhere. Exceedance probabilities (at 1%) also varied widely among urban sub-populations, from 6.7% in Maues to 41.2% in Caapiranga. The exceedance probability of LDBM prevalence being above 3.0% was high in rural Jutai (59.7%).

Discussion

Our results have important implications for assessing DBM in vulnerable and marginalized populations, where health and nutritional status are often poorest, and public health efforts remain focused on undernutrition. Our analytical approach could enable more accurate estimation of low prevalence health outcomes, and strengthen DBM monitoring of hard-to-reach populations.

Age Decomposition of Mortality Rates Among Children Younger Than 5 Years in 47 LMICs

Importance

Despite a global decline in the mortality rate of children younger than 5 years (the under-5 mortality rate), neonatal deaths continue to present a substantial challenge. The etiology behind deaths varies between the early and late neonatal periods as well as at later ages.

Objective

To decompose the under-5 mortality rate in 47 low- and middle-income countries into 8 age intervals, providing a comprehensive understanding of varying vulnerability across age groups.

Design, Setting, and Participants

This cross-sectional study used nationally representative data from 47 Demographic and Health Surveys conducted between 2014 and 2023 in low- and middle-income countries, including 1.4 million live births.

Exposure

Age in days, weeks, months, or years.

Main Outcomes and Measures

The under-5 mortality rate was decomposed by age based on a life table approach, using true cohort probabilities for the early and late neonatal periods and synthetic cohort probabilities for other age intervals, to obtain deaths per 1000 live births (ie, the cohort entering the life table) for each age interval.

Results

In the pooled sample of 1 448 001 live births, there were 14 576 deaths in the early neonatal period (age 0 to 6 days); 3400 in the late neonatal period (age 7-27 days); 6760 in the early postneonatal period (age 28 days to 5 months); 4912 in the late postneonatal period (age 6-11 months); and 5145, 3990, 2674, and 1640 at ages 1, 2, 3, and 4 years, respectively. The early neonatal mortality rate accounted for 21.3 (95% CI, 20.5-22.1) deaths per 1000 births from a total under-5 mortality rate of 57.7 (95% CI, 56.2-59.3) deaths per 1000 births. The early neonatal mortality rate was significantly higher than mortality at subsequent ages (eg, median [IQR] mortality rates: early neonatal period, 18.8 [14.3-23.2] deaths per 1000 births; late neonatal period, 4.7 [3.1-5.9] deaths per 1000 births) and much higher when considering the average daily mortality rate. The early neonatal mortality rate accounted for the greatest share of under-5 mortality rate in all but 2 countries. In most countries the lowest mortality rates were observed at age 3 or 4 years. The share of deaths occurring in the late postneonatal period and later was greater in countries with greater under-5 mortality rates.

Conclusions and Relevance

The concentration of mortality in the first week after birth underscores a critical need for enhanced maternal and neonatal health care. Furthermore, early neonatal mortality rates should be routinely reported and included in health targets. In this study, the age of 6 months emerged as an important turning point: high-mortality countries were characterized by a greater concentration of deaths after age 6 months than countries with lower under-5 mortality rate.

Preoperative nutrition intervention program increases cleft surgery eligibility in the low- and middle-income country setting

BACKGROUND

Children with cleft lip and/or palate (CL/P) are highly susceptible to malnutrition, which may restrict surgery eligibility and delay repair. Preoperative nutrition programs for children with unrepaired CL/P are an effective treatment to overcome malnutrition for safe surgical intervention in high-resource settings; however, the effectiveness of such programs has not been demonstrated in the setting of low- and middle-income countries (LMICs). We studied the impact of a preoperative nutrition program on improving nutritional status and achieving surgical eligibility for children with CL/P.

METHODS

A retrospective review of patients treated by the Operation Smile (OS) Durgapur Cleft Centre in India from March 2021 to December 2022 was conducted. Patient gender, weight, age, cleft type, parental demographics, and income were recorded. The patients' malnutrition status was categorized as "mild", "moderate", or "severe" based on the Indian Academy of Pediatrics (IAP). Patient IAP classifications were noted at multiple timepoints, where change in nutrition status overtime served as the primary outcome of this study. Whether the child became eligible for surgery was assessed as a secondary outcome. Descriptive statistics used t-tests for continuous variables and chi-squared tests for categorical variables. P-values < 0.05 were considered significant.

RESULTS

The study included 236 patients who presented for nutritional intervention after being deemed ineligible for surgery. Initial IAP malnutrition classifications were 36.9% (n = 87) mild, 42.8% (n = 101) moderate, and 20.3% (n = 48) severe malnutrition. After intervention, 179 (75.8%) patients improved in IAP nutrition status, 49 (20.7%) maintained baseline status, and only eight (3.4%) declined. Final improvement levels were significantly associated with younger age at intake (p < 0.001) and maternal education background (p = 0.011). At study end, a total of 183 (77.5%) patients were eligible for cleft repair while 53 (22.5%) patients were malnourished and remained enrolled in the program. A total of 162 (68.6%) patients underwent surgery.

CONCLUSION

Malnutrition prevents children with CL/P from receiving surgical care in LMICs. This nutrition intervention enabled 228 (96.6%) patients to improve or maintain baseline nutrition and 183 (77.5%) to become surgically eligible who would not have been eligible otherwise. Preoperative nutrition programs offer a promising solution to addressing malnutrition as a barrier to timely, safe cleft repair in resource-constrained settings.

Maternal anaemia and risk of neonatal and infant mortality in low- and middle-income countries: a secondary analysis of 45 national datasets

BACKGROUND

Anaemia in pregnancy has been recognised worldwide as a growing public health concern and an important cause of adverse neonatal outcomes. However, only a limited number of studies have been done in low-income settings, which have the highest prevalence of anaemia. We aimed to investigate the association between maternal anaemia and neonatal and infant mortality in low- and middle-income countries.

METHODS

Secondary analysis of pooled data from 45 national demographic and health surveys (2010-2020). We included all women between 15 and 49 years old, who had singleton live birth within 1 year preceding the survey, with a valid maternal measurement of haemoglobin. We used logistic regression models to estimate the crude and adjusted OR (aOR) with 95% CIs of the association between maternal anaemia (measured at the time of the survey) and the risk of neonatal and infant mortality.

RESULTS

Among 106 143 women included in our analysis, there were 53 348 (50.5%) women with no anaemia, 24 670 (23.2%) with mild anaemia, 25 937 (24.3%) with moderate anaemia and 2188 (2.0%) with severe anaemia. Overall, there were 2668 (2.5%) neonatal and 3756 (3.5%) infant deaths. Moderate (aOR 1.20; 95% CI 1.06 to 1.35) and severe (aOR 1.89; 95% CI 1.46 to 2.44) maternal anaemia were associated with increased odds of neonatal mortality, respectively. Similar estimates were observed for moderate and severe anaemia and infant mortality. No increased risk was noted for mild anaemia.

INTERPRETATION

Moderate and severe maternal anaemia in low- and middle-income settings are associated with increased risks of neonatal and infant mortality. Future research should examine how targeted interventions for prepregnancy and antenatal treatment of anaemia in reproductive-age women can enhance maternal and child health in low- and middle-income settings.

The eighth annual US DOHAD meeting: promising approaches in epigenetics research of early life exposures

The U.S. Developmental Origins of Health and Disease (DOHaD) meeting is an annual conference of primarily U.S. scientists who study early life programming of health and disease. The eighth annual symposium, entitled "Exploring Translational DOHaD Science: From Cells to Communities" was held at the Rizzo Conference Center in Chapel Hill, North Carolina, from October 14 to 16, 2024. The meeting was organized by US-DOHaD President Danielle Christifano and Vice President Kaela Varberg, and other Society Council Members. This year's meeting had record attendance, with 158 attendees from diverse disciplines, and featured 10 keynote speakers, 11 platform talks, and 84 poster presentations. Four major topics were covered: 1) Early nutrition and developmental outcomes, 2) Prenatal origins of child health, 3) Developmental impacts of toxicant exposures, and 4) Metabolic origins of health. Overall, the presented research highlighted the value of studying epigenetic effects of dietary and toxic exposures early in life. Various strategies emerged to address challenges facing the field, such as harnessing the power of nationwide longitudinal birth cohorts, new methods to integrate epigenetic and environmental data across various levels, and the emerging potential of organoids to identify the causal impact of early life exposures.

Mother's Experiences in Caring for Children with Stunting in Rural Indonesia

INTRODUCTION

Stunting is a major health problem in Indonesia. The aim of this study is to explore the experiences of mothers who take care of stunted children in rural Pamekasan Madura, Indonesia.

METHODS

This research employed a phenomenological approach and conducted in-depth interviews with 11 mothers in rural Pamekasan Madura, Indonesia, using purposive sampling. Data collection took place from June to September 2023.

RESULTS

This study presents Madurese mothers' experiences caring for their children with stunting through two themes and five sub-themes: (a) beliefs passed down for generations: strong ancestral influence on feeding behaviors, traditional food, and traditional health-seeking behavior; and (b) insufficient resources on nutrition: a lack of time and money to provide nutrition-rich food and a lack of nutrition information.

DISCUSSION

Cultural beliefs, a lack of nutrition education, and economic barriers contribute to stunting in children. Our findings guide the design of tailored interventions for preventing stunting in Indonesian families and global communities.

Perspective: Global Burden of Iodine Deficiency: Insights and Projections to 2050 Using XGBoost and SHAP

Iodine deficiency (ID) poses a significant global public health challenge. This study aimed to analyze trends from 1990 to 2021 and project future patterns ≤2050 using the extreme gradient boosting (XGBoost) model, with Shapley additive explanations (SHAP), to identify key factors and inform public health strategies. Data on ID from the Global Burden of Disease (GBD) 2021 study were used to model and predict its burden ≤2050 using XGBoost, with SHAP enhancing model interpretability. In 1990, global incident cases of ID were 7.51 million (age-standardized incidence rate [ASIR]: 126.11/100,000), rising to 8.08 million by 2021 (ASIR: 105.99/100,000, a 15.96% decrease), and projected to reach 8.48 million by 2050 (ASIR: 108.20/100,000). Prevalent cases increased from 146.42 million in 1990 (age-standardized prevalence rate [ASPR]: 2801.80/100,000) to 180.81 million in 2021 (ASPR: 2213.98/100,000, a 20.98% decrease), with 194.51 million expected by 2050 (ASPR: 1900.01/100,000). Disability-adjusted life years (DALYs) dropped from 2.46 million in 1990 (age-standardized disability-adjusted life year rate [ASDR]: 46.19/100,000) to 2.25 million in 2021 (ASDR: 27.67/100,000, a 40.10% decrease) but are projected to rise slightly to 2.51 million by 2050 (ASDR: 25.51/100,000). SHAP analysis identified iodized salt coverage as a key factor, with higher coverage levels associated with reduced ID burden in most countries. Women and people aged 10-30 y had higher incidence rates, although prevalence and DALYs peaked among those aged 20-45 y. Central and Eastern Sub-Saharan Africa and South Asia will continue to bear the highest burden through 2050. The XGBoost+SHAP model identified age, sex, and iodized salt coverage as key factors, with women and younger populations being high-risk groups. Strengthening iodization programs, improving health care access, targeted education, and consistent monitoring of vulnerable populations are essential to mitigate future risks and improve health outcomes.

Suboptimal Refeeding Compensates Stunting in a Mouse Model of Juvenile Malnutrition

BACKGROUND

Early postnatal life is a critical period of rapid growth in mammals, heavily reliant on adequate nutrition. Protein-energy malnutrition (PEM) during this window can lead to stunting and wasting, with lasting health consequences.

OBJECTIVES

This study developed a mouse model of juvenile PEM to assess the effects of refeeding with various diets and interventions on growth recovery, including probiotic supplementation and suboptimal refeeding diets. Outcomes included length and weight catch-up, organ weights, and glucose tolerance.

METHODS

Juvenile male and female C57Bl/6J mice (N = 8 to 11/group) were fed a low-protein diet (LPD, 5% kcal from protein) starting at postnatal day 14 (P14) to which the pups and dams had access. Following weaning, mice were refed an optimal diet (27% kcal from protein) at different times (P28 to P56). Male mice received additional interventions, including supplementation with Lactiplantibacillus plantarum WJL (LpWJL) during refeeding or refeeding with a Western diet (WD), 15.3% kcal from protein, or a modified Western diet (MWD) 7.5% kcal from protein. Statistical analyses used analysis of variance, analysis of covariance, and principal component analysis.

RESULTS

Optimal refeeding restored growth in females (body weight in optimal-fed: 20.5 ± 0.3 g vs. 19.4 ± 0.6 g in P56-refed), but males showed persistent stunting (26.8 ± 0.7 g vs. 21.9 ± 0.9 g; P < 0.05). In males, LpWJL did not enhance growth recovery and exacerbated glucose intolerance in suboptimal refeeding groups. Males refed WD or MWD restored body length but showed impaired glucose metabolism, particularly in mice refed WD, with glycemia 30 min after glucose challenge reaching 20.4 ± 4.0 mM vs. 14.3 ± 3.0 mM in optimal-fed mice (P < 0.05).

CONCLUSIONS

Sex-dependent differences in recovery from PEM were evident, with males showing incomplete growth recovery despite optimal refeeding. Suboptimal diets compensated for stunting but impaired glucose metabolism, and LpWJL did not improve growth outcomes.

Barriers and Facilitators to the Implementation of Government Policies on Infant and Young Child Feeding and Food Fortification in Benin

BackgroundTo prevent micronutrient deficiencies and address the double burden of malnutrition, Benin has implemented Infant and Young Child Feeding (IYCF) and food fortification policies for several years. Despite these efforts, significant micronutrient deficiencies persist, posing a public health problem.ObjectiveThis study aims to identify barriers and facilitators to the implementation of government policies on IYCF and food fortification in Benin.MethodsWe conducted in-depth individual interviews with 23 key national and local stakeholders involved in implementing these policies. The interviews were recorded, transcribed, and analyzed through a deductive and iterative process based on the study's objective.ResultsStakeholders identified several barriers to policy implementation, including low staff motivation, exacerbated by poor personnel management and lack of recognition. Financial resources are insufficient despite organizational support. Training and awareness among health workers and producers are limited outside UNICEF's intervention areas. Traditional eating habits and cultural resistance impede the adoption of new practices. The monitoring system is complex and ill-equipped, hindering quality control of fortified foods. Facilitators include strong political commitment, partnerships with international nongovernmental organizations, and effective intersectoral collaboration. These partnerships have improved training and community awareness, though gaps remain. The involvement of local producers and professional associations also supports food fortification initiatives.ConclusionNutrition policies in Benin face challenges such as low staff motivation and lack of resources. However, strong political commitment and international partnerships present opportunities to overcome these barriers.Plain language titleStudy of Challenges and Solutions to Improve Food Policies for Babies and Children in Benin.

Weight gain among children under five with severe malnutrition in therapeutic feeding programmes: a systematic review and meta-analysis

Background

Globally, some 45 million children under five years of age are wasted (low weight-for-height). Although 2023 World Health Organisation guidelines on their care did not aim to identify optimal weight gain, they did mention 5-10 g/kg/day as a target, which is a change from prior guidelines that recommended 10-15 g/kg/day, when inpatient-only care was the norm. We aimed to inform future policy/programming on weight gain targets.

Methods

For this systematic review and meta-analysis, we searched Embase, Global Health and Medline. The final search was on 23/02/2024. Papers were included if they reported weight gain of children aged 6-59 months with severe malnutrition during inpatient (facility-based), outpatient (home-based), and hybrid treatment (initially inpatient and progressing to outpatient treatment). Summary data were extracted, and quality was assessed using a NICE Quality Appraisal Checklist. Our primary outcome was mean rate of weight gain (g/kg/day) during treatment. We conducted random-effects meta-analysis to describe pooled mean weight gain by programme type. Meta-regression investigated potential associations of weight gain with length of stay and programme outcomes. We registered the study on PROSPERO (CRD42023266472).

Findings

Our search yielded 3173 papers. We reviewed 321 full texts, identifying 126 eligible papers. Of these, 104 papers, including some 240,650 participants, reported weight gain as g/kg/day and were eligible for meta-analysis. Mean rate of weight gain was 8.8 g/kg/day (95% CI: 7.6, 9.9; I2 = 97.8%) across 18 inpatient programmes, 3.4 g/kg/day (95% CI: 2.0, 4.7; I2 = 99.4%) across 12 hybrid programmes, and 3.9 g/kg/day (95% CI: 3.4, 4.4; I2 = 99.7%) across 60 outpatient programmes. We found inconsistent evidence of an association between slower weight gain and higher mortality: there was weak evidence of association after adjusting for programme type (coefficient = -0.4; 95% CI: -0.7, -0.02; p = 0.04; n = 118 programmes). There was high heterogeneity between studies. Details of weight gain calculation methods varied. We found no evidence for publication bias when accounting for programme type (Egger's test p-value = 0.2).

Interpretation

Weight gain in outpatient programmes was markedly slower than in inpatient treatment. Clearer reporting of weight gain and a better understanding of the sequelae of faster/slower recovery is important to set future weight gain targets. Our results set an important baseline for current programmes to benchmark against.

Funding

Medical Research Council/Global Challenges Research Fund, grant number: MR/V000802/1.

Perspective: Can Growth Monitoring and Promotion Accurately Diagnose or Screen for Inadequate Growth of Individual Children? A Critical Review of the Epidemiologic Foundations

Growth monitoring and promotion (GMP), the process of periodic anthropometric measurements to assess the adequacy of individual child growth, is implemented across low-income and middle-income countries. The epidemiologic foundations of GMP (i.e., that GMP can accurately diagnose or screen for inadequate growth) have never been critically reviewed. We first assessed growth patterns of individual healthy children. Using longitudinal data from low-income, middle-income, and high-income countries, we evaluated whether commonly used GMP criteria can be used for diagnosis and screening; i.e., whether they accurately identify current, or predict subsequent, inadequate growth in individual children. The growth of individual healthy children does not track along a specific growth curve, which challenges the notion that growth measurements alone can be used to distinguish between healthy and inadequate growth. We demonstrated that GMP criteria do not provide meaningful diagnostic information and that GMP is not a meaningful screening activity: commonly used GMP criteria are inaccurate predictors of (inadequate) growth later in childhood, and collecting individual children's weight and height does not help to identify who needs support or who will benefit. Our results do not undermine the importance of dedicated programs to diagnose wasting in individual children nor do they challenge the need for well-child care to support parents and to ensure children's optimal nutrition, health, and development. Our findings, however, highlight the need to carefully reconsider the current design of GMP in low-income and middle-income countries.

Worldwide prevalence of the double burden of malnutrition in children and adolescents at the individual level: systematic review and meta-regression

OBJECTIVE

This study aimed to assess the prevalence of the double burden of malnutrition (DBM) at the individual level in children and adolescents through a comprehensive literature review.

SOURCES

Electronic databases, including PubMed, Scopus, and Web of Science, were searched for articles published up until September 9, 2022. Studies reporting individual-level DBM in children and adolescents were included, and meta-regression models were used to investigate potential causes of heterogeneity across studies.

SUMMARY OF THE FINDINGS

Of the 784 articles initially retrieved, 11 met the inclusion criteria. The overweight/obesity prevalence ranges from 8.1 % to 37.0 %, and the undernutrition (stunting, micronutrient deficiency, or anemia) from 4.2 % and 73.0 %. The prevalence of DBM ranged from 1 % to 35.4 %, with the highest rates observed in low- and middle-income countries. Among children, Asia reported the highest DBM prevalence, while in adolescents, Latin America had the highest rates. The review revealed significant variability in DBM prevalence across studies, with a notable increase in research on this topic over the past decade (2013-2022).

CONCLUSION

These findings underscore the concerning global prevalence of the double burden of malnutrition in children and adolescents, particularly in low- and middle-income countries. Standardized definitions and methods are urgently needed to improve comparability, along with further research to identify the specific drivers of DBM and inform effective prevention strategies. CRD42022333424.

Unlocking insights: Using machine learning to identify wasting and risk factors in Egyptian children under 5

INTRODUCTION

Malnutrition, particularly wasting, continues to be a significant public health issue among children under five years in Egypt. Despite global advancements in child health, the prevalence of wasting remains a critical concern. This study employs machine learning techniques to identify and analyze the determinants of wasting in this population.

AIM

To evaluate the prevalence of wasting among children under five years in Egypt and identify key factors associated with wasting using machine learning models.

METHODS

This study is based on secondary data sourced from the Demographic and Health Surveys (DHS), conducted in 2005, 2008, and 2014. Six machine learning classifiers (XGBoost, Logistic Regression, Random Forest, Gradient Boosting, K-Nearest Neighbor, and Decision Tree) were applied to the dataset. The study included children under five years of age, focusing on nutritional status, maternal health, and socio-economic factors. The dataset was cleaned, preprocessed, encoded using one-hot encoding, and split into training (70%) and test (30%) sets. Additionally, k-fold cross-validation and the StandardScaler function from Scikit-learn were used. Performance metrics such as accuracy, precision, recall, F1 score, and ROC-AUC were used to evaluate and compare the algorithms.

RESULTS

It was observed that 76.2% of the children in the dataset have normal nutritional status. Furthermore, 5.2% were found to be suffering from wasting (1.7% experiencing severe wasting and 3.5% moderate wasting), with notable regional disparities. The XGBoost model outperformed other models. Its efficiency metrics include an accuracy of 94.8%, precision of 94.7%, recall of 94.7%, F1 score of 94.7%, and an ROC-AUC of 99.4%. These results indicate that XGBoost was highly effective in predicting wasting.

CONCLUSION

Machine learning techniques, particularly XGBoost, show significant potential for improving the classification of nutritional status and addressing wasting among children in Egypt. However, the limitations in simpler models highlight the need for further research to refine predictive tools and develop targeted interventions. Addressing the identified determinants of wasting can contribute to more effective public health strategies.

The proportion of weight gain due to change in fat mass in infants with vs without rapid growth

BACKGROUND

There is extensive evidence that rapid infant weight gain increases the risk of childhood obesity, but this is normally based on childhood body mass index (BMI) only and whether or not this is because infants with rapid weight gain accrue greater fat mass is unknown.

OBJECTIVE

The primary objective of our study was to test whether the proportion of infant weight gain due to concurrent increases in fat mass is greater in infants with rapid weight gain as compared to those with normal growth.

METHODS

Body composition was assessed by (1) air-displacement plethysmography (ADP) at 0 and 6 months in 342 infants from Australia, India, and South Africa and (2) deuterium dilution (DD) at 3 and 24 months in 555 infants from Brazil, Pakistan, South Africa, and Sri Lanka. Weight gain and length growth were each categorized as slow, normal, or rapid using cut-offs of <-0.67 or >+0.67 Z-scores. Regression was used to estimate and contrast the percentages of weight change due to fat mass change.

RESULTS

Approximately 40% of the average weight gain between 0 and 6 months and 20% of the average weight gain between 3 and 24 months was due to increase in fat mass. In both samples, compared to the normal group, the proportion of weight gain due to fat mass was higher on average among infants with rapid weight gain and lower among infants with slow weight gain, with considerable individual variability. Conversely, slow and rapid length growth was not associated with differential gains in fat mass.

CONCLUSIONS

Pediatricians should monitor infant growth with the understanding that, while crossing upward through the weight centiles generally is accompanied by greater adiposity gains (not just higher BMI), upward crossing through the length centiles is not.

Understanding the relationship between WASH and malnutrition: Analysis of anthropometric data of children attending WASH-supported schools in Ogun State, Nigeria

BackgroundThere has been a growing interest in better understanding the association between water, sanitation, and hygiene (WASH) and malnutrition.AimWe analysed anthropometric data of children attending WASH intervention schools and those from non-intervention schools in Ogun State, Nigeria.MethodsA total of 353 children across six schools (three interventions and three non-interventions) participated in this study. WASH conditions were assessed using WHO standardized tools and anthropometric data of children were analysed in WHO AnthroPlus and R Software.ResultsThe prevalence of stunting was 26.2% in the intervention group, and 29.4% in the control group (p = 0.045). Underweight was lower in the intervention group (3.9% vs. 10.1%) (p = 0.45). However, wasting was higher in the intervention group (32.3% vs. 8.2%) (p = 0.001). Of the variables included in our multivariate model (age, gender, and school category, i.e. intervention/control and class grade), only age was selected, and negatively associated with underweight, stunting and wasting (p = 0.000).ConclusionRegardless of WASH programming status, nutritional outcomes were significantly influenced by age of the children. Children are more likely to have lower z-scores as they grow older.

Unintended impacts of COVID-19 on the epidemiology and burden of paediatric respiratory infections

Acute respiratory infections (ARI), especially lower respiratory infections (LRI), are a leading cause of childhood morbidity and mortality globally. Non-pharmaceutical interventions (NPI) employed during the COVID-19 pandemic have impacted on the epidemiology and burden of paediatric ARI, although accurately describing the full nature of the impact is challenging. For most ARI pathogens, a reduction was observed in the early phase of the pandemic, correlating with the most stringent NPI. In later phases of the pandemic resurgence of disease was observed as NPI eased. This pattern was most striking for seasonal viruses, such as influenza and respiratory syncytial virus. The impact on ARI-associated bacterial disease varied; marked reductions in invasive Streptococcus pneumoniae and Streptococcus pyogenes were observed, followed by a resurgence that correlated with increases in respiratory viral infections. For Corynebacterium diphtheriae,Bordetella pertussis, andMycoplasma pneumoniae, a sustained reduction of disease was observed well into 2022 in most regions. Proposedmechanisms for the varied epidemiological disruption amongst ARI pathogens includedifferential effects of NPI on specific pathogens, population-level immunological effects, and ecological and genetic pathogen adaptations. Additionally, important indirect effects of pandemic restrictions on paediatric respiratory infections have been identified. These occurred as a result of disruptions to routine health services, reductions in vaccination coverage, and disruptions to respiratory infection research and surveillance activities. Impacts have been disproportionately borne by those in low resource settings. We discuss opportunities to leverage pandemic learnings to support improved understanding of the epidemiology of paediatric respiratory infections to inform future prevention and health system strengthening.

Association of Paternal BMI and Diet During Pregnancy with Offspring Birth Measures: The STEPS Study

BACKGROUND/OBJECTIVES

Maternal Body Mass Index (BMI), diet quality, and their associated effects on offspring birth measures are well-established. Emerging evidence, largely from animal studies, has indicated paternal factors can influence offspring birth outcomes. However, this effect is poorly understood in humans. Our aim was to examine the association between paternal BMI and diet quality score and offspring birth measures.

METHODS

Participants from the STEPS (Steps to the healthy development) Study in Southwest Finland were recruited during the first trimester of pregnancy or after delivery. A total of 1586 fathers and their children were included for BMI analysis, and 208 fathers and their children were included for dietary analyses. Paternal BMI was calculated using self-reported weight and height at recruitment, and dietary behaviour was assessed using the Index of Diet Quality (IDQ) at 30 weeks' gestation. Offspring birth weight and length z-scores were calculated using the recently published references specific to the Finnish population. Generalized linear model analyses were carried out to determine associations between paternal factors and offspring z-scores.

RESULTS

The mean paternal BMI was 26 (SD ± 3.5). Over half of the fathers were classed as having an unhealthy diet, classified as poor in adhering to nutrition recommendations including higher intakes of saturated fatty acids, and inadequate intakes of protein, saccharose, fibre, vitamins, and minerals. Paternal BMI was not significantly associated with offspring birth weight (β = 0.00 p = 0.884) or birth length (β = 0.00, p = 0.774) z-scores when adjusted for maternal and other paternal and parental factors. Paternal diet quality score was not associated with offspring birth weight (β = -0.01, p = 0.515) or birth length (β = 0.07 p = 0.291) z-scores.

CONCLUSIONS

This study shows paternal BMI or diet quality at 30 weeks' gestation does not significantly impact offspring birth measures. Given the known impact of nutrition on epigenetics, examining the potential influence of paternal factors at conception on offspring growth is of major importance and should be included in future studies.

Time to recovery from severe acute malnutrition and predictors among children aged 6-59 months at public hospitals: retrospective follow-up study

Severe acute malnutrition is a major cause of illness and death among children under the age of five in Ethiopia. However, there is limited evidence regarding the success of treatment and the length of hospital stays for children with severe acute malnutrition. The objective of this research was to assess the recovery period from severe acute malnutrition and determine potential predictors of recovery. A retrospective follow-up study was conducted. Children aged 6-59 months with severe acute malnutrition who had been treated at the therapeutic feeding unit were selected using a simple random sampling technique. The data was analyzed using Stata v14. Descriptive statistics were used to compute the nature of the variables. Kaplan-Meier with the log-rank test was used to test for the presence of differences in categorical variables. Model goodness of fit and assumptions were checked by the Cox-Snell residual and global tests, respectively. A p-value of 0.25 in the bivariable Cox regression analysis was used for the multivariable Cox regression analysis. Variables with p values less than 0.05 in the multivariable Cox regression were considered significant predictors of recovery time from severe acute malnutrition. In this study, the median recovery time was nine days, with an interquartile range of 7 to 11 days. The incidence rate of recovery was 11.24%. Children who had marasmus, pneumonia at admission, anemia at admission, had not been fully vaccinated, had not received vitamin A, and had not received plumpy'Nut had a statistically significant association with the time to recovery of severe acute malnutrition. Marasmus, pneumonia, and anemia at admission were the predictors that delayed the recovery time of children from their severe acute malnutrition. On the contrary, children who had been given vitamin A and plumpy nuts were the predictors that fastened recovery time. Therefore, special attention should be given to children who have marasmus, comorbidities like pneumonia, and anemia to shorten their recovery time from their severe acute malnutrition status.

Prevalence and associated factors of complementary feeding practices of mothers having children 6-23 months in rural disadvantaged areas, Ben Tre province, Vietnam: a cross-sectional study

BACKGROUND

Appropriate complementary feeding practices (CFPs) play a key role for ensuring optimal health, growth and development for children 6-23 months. The purpose of this study was to determine the prevalence and associated factors of CFPs of mothers or primary caregivers having children 6-23 months in Thanh Phu rural district of Ben Tre province, Vietnam.

METHODS

Three hundred fifty eight child-mother pairs participated in a cross-sectional study. Weight and height of children were measured by trained nutritionists using standard measurement tools and procedure. Mothers or primary caregivers were interviewed about maternal, child, and household characteristics, awareness of the food environment, household food insecurity (HFI), and CFPs using a structured questionnaire. Chi square test, Fisher exact test, t-test, and multivariate logistic regression were used to evaluate associations between CFPs and independent variables.

RESULTS

The percentages of children with appropriate minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were 71.5%, 40.8%, and 31.6%, respectively. MDD was negatively associated with younger child, the child's sickness in the last 2 weeks, caregivers being fathers, not breastfeeding, lower monthly household income, and use of untreated drinking water after controlling for covariates (p < 0.05). Factors associated with poorer MMF included older child, not breastfeeding, and maternal biological status. Conversely, purchasing foods at the street vendors and appropriate MDD was positively associated with better MMF (p < 0.05). Maternal biological status, marital status of mothers, breastfeeding, and HFI were all associated with MAD (p < 0.05).

CONCLUSIONS

These results revealed that inappropriate complementary feeding practices among children aged 6-23 months in rural disadvantaged areas of Southern region remained a significant challenge for nutrition improvement of young children in Vietnam. Child age, HFI, use of untreated drinking water, lower monthly income, mother's marital status, not breastfeeding, and source of purchased foods were associated with poor CFPs. Solutions for improving CFPs for children should address these underlying causes.

Trends and associated factors of animal source foods consumption among children aged 6-23 months in Bangladesh: evidence from four consecutive national surveys

Animal source foods (ASF) are nutrient-dense and essential for the growth and development of children. The Bangladesh Demographic and Health Survey (BDHS) 2022 reported that approximately two-thirds of children aged 6-23 months consumed eggs/flesh foods. However, overall consumption patterns, trends, and factors influencing ASF intake among children in Bangladesh were not well-documented. Therefore, the study aimed to assess the trends and associated factors of ASF consumption among children aged 6-23 months in Bangladesh. A total of 9401 children were extracted from four consecutive BDHS (2011, 2014, 2017/18, and 2022). The Cochran-Armitage test was conducted to assess the trends in ASF consumption, while a two-stage multilevel mixed-effects logistic regression was performed to identify the associated factors. The consumption of ASF significantly increased to 79.1% in 2017/18 from 67% in 2011 but decreased to 73.3% in 2022. ASF consumption was found to be higher among children whose mothers were educated (AOR = 1.60, 95% CI = 1.30-1.98), employed in either agricultural (AOR = 1.27, 95% CI = 1.04-1.54) or non-agricultural (AOR = 1.36, 95% CI = 1.07-1.72) activities, pregnant (AOR = 2.54, 95% CI = 1.66-3.87), had received ANC 1-3 times (AOR = 1.43, 95% CI = 1.20-1.72) or ≥4 times (AOR = 1.59, 95% CI = 1.29-1.95), and was exposed to media (AOR = 1.21, 95% CI = 1.04-1.39). Furthermore, consumption increased with increasing the age of children, and the wealth of their families. However, children who experienced illness were less likely to consume ASF (AOR = 0.76, 95% CI = 0.68-0.86). The recent declines in ASF consumption emphasize the need for targeted interventions to increase ASF consumption among children in Bangladesh.

Importance of postmortem anthropometric evaluation in defining the role of malnutrition as a cause of infant and child deaths in Sub-Saharan Africa and South Asia: a cohort study

OBJECTIVES

To evaluate how postmortem anthropometric malnutrition (PAM) measures align with expert panel attribution of malnutrition as a causal or significant condition in under-5 mortality (U5M).

DESIGN

Cohort study using data from the Child Health and Mortality Prevention Surveillance network, incorporating clinical records, postmortem anthropometrics, minimally invasive tissue sampling, clinical abstraction and verbal autopsy to determine multiple causes of death.

SETTING/PARTICIPANTS

1405 deaths of children aged 1-59 months from six African countries between 2016 and 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

PAM was determined using z-scores from the WHO Child Growth Standards: underweight (weight-for-age<(-2)), wasting (arm circumference-for-age or weight-for-length<(-2)) and stunting (length-for-age <(-2)). Performance metrics (sensitivity (SE), specificity (SP) and positive predictive values (PPV)) were calculated to determine the alignment between PAM and expert panel attribution of malnutrition as a causal or significant condition to death.

RESULTS

Nearly 75% of cases demonstrated moderate-to-severe malnutrition by PAM, while expert panels attributed malnutrition in 41% of cases. Performance metrics varied across anthropometric indices: underweight exhibited the highest SE (89.7%), while wasting based on arm circumference had the highest SP (81.9%) and PPV (76.8%). Discrepancies between PAM classification and expert panel attribution differed significantly by site, age, location of death and preventability of death (p<0.05). Adjusted multivariate regression showed that expert panel attribution was more likely with increasing severity of PAM.

CONCLUSIONS

The proportion of U5M attributable to malnutrition ranged between 41% (expert panel attribution) and 74% (PAM). Variability in classification underscores the need for monitoring and quality improvement measures to address discrepancies. Improved alignment between PAM and panel assessments is essential for accurately identifying malnutrition-related deaths and designing effective interventions to reduce U5M.

Consequences of post-discharge hospitalisation on the growth of young Bangladeshi children hospitalised with diarrhoea: a secondary case-control analysis of Antibiotics for Children with Diarrhea (ABCD) trial

Background

Due to the scarcity of published data on growth among children with severe diarrhoea requiring readmission during post-discharge follow-up, we aimed to investigate the potential impact of post-discharge readmission at day-90 follow-up on growth in diarrheal children aged 2-23 months.

Methods

We performed a secondary analysis using Bangladesh site data from the Antibiotic for Children with Diarrhea (ABCD) trial, a multi-country, randomised, double-blind, placebo-controlled study conducted from July 2017 to July 2019. Children aged 2-23 months who had severe diarrhoea defined as having acute diarrhoea with some/severe dehydration, or severe stunting, or moderate wasting, were admitted to the facility. In this analysis, we classified children who were re-hospitalised within a 90-day post-discharge follow-up period as cases and randomly selected controls who did not require re-hospitalisation, matching them by similar ages and sexes in a 1:3 ratio. We gathered anthropometric data on enrolment and day 90 follow-up. The outcome variables were changes in nutritional indicators height-for-age (ΔHAZ), weight-for-age (ΔWAZ), weight-for-height (ΔWHZ), and mid-upper arm circumference (ΔMUAC). We assessed for growth changes at day 90 post-discharge follow-up using multivariate linear regression.

Results

Among 1431 diarrhoeal children enrolled, we identified 145 cases and 435 controls. In terms of the baseline admission characteristics, the cases were less likely to be immunised (81% vs. 72%; P = 0.031), vomit (11% vs. 22%; P = 0.001), and have dehydrating diarrhoea (26% vs. 36%; P = 0.026) than the controls. After adjusting for potential covariates, the cases had a significant reduction in growth than the controls at 90 days of post-discharge follow-up, according to anthropometric indices: ΔHAZ (β = -0.11; 95% confidence interval (CI) = -0.21, -0.01; P = 0.029), ΔWAZ (β = -0.24; 95% CI = -0.35, -0.14; P < 0.001), ΔWHZ (β = -0.25; 95% CI = -0.39, -0.12; P < 0.001), and ΔMUAC (for children 6-23 months, β = -0.17; 95% CI = -0.29, -0.04; P = 0.011).

Conclusions

Diarrhoeal children aged 2-23 months requiring readmission during the 90-day post-discharge follow-up period had a significant deterioration of ponderal and linear growth, compared with those who did not require readmission. This finding underscores the importance of early identification of children with risks of post-discharge readmission and designing a package of post-discharge trials, including social and nutritional interventions that may help to reduce post-discharge readmissions as well as subsequent growth faltering.

Re-thinking "non-response" to wasting treatment: Exploratory analysis from 14 studies

Children who receive therapeutic feeding for wasting treatment but do not reach the anthropometric definitions of recovery (usually within 12-16 weeks) are categorised as 'non-responders' and considered as treatment failures. We conducted a pooled analysis to explore the growth trajectories of non-responders and the appropriateness of the definition of 'non-response'. We pooled 14 studies of children aged 6-59 months receiving treatment for wasting. We included children classified by their studies as recovered or as non-responders. Observing the pooled data of non-responders' mid-upper arm circumference (MUAC), weight, weight-for-age z-score, weight-for-height z-score and daily weight gain rate, we found that the first quartile differentiated those who did not grow at all versus those that demonstrated some growth. We therefore defined 'low growth non-responders' as < 25th percentile anthropometric gain between admission and exit using the non-responders' pooled study data, and 'high growth non-responders' as ≥ 25th percentile gain. We plotted the growth trajectories of MUAC-, weight- and height-related indices of the recovered, high growth and low growth non-responder groups over time using mixed effects generalised additive models. We compared age, sex and anthropometric characteristics of the three groups and explored predictors of non-response category using a multivariate multinomial logistic regression model. For all outcomes, the high growth non-responders started with a worse anthropometric status compared to those who recovered, but then tracked along a near-parallel growth trajectory. The low growth non-responders showed limited growth throughout treatment. High growth non-responders are better viewed as 'delayed responders' and may need to be kept longer under treatment to recover and reduce the risks from early discharge. Low growth non-responders are the true treatment failures and should be referred for further investigations as quickly as possible. In conclusion, non-responders are not a homogenous group; ~75% of them respond well to treatment and ~25% are treatment failures.

Socioeconomic inequality in the co-occurrence of anemia and stunting among adolescent girls aged 15-19 years in Sub-Saharan African countries: a decomposition analysis

INTRODUCTION

Undernutrition, particularly stunting, and deficiency of micronutrients are prevalent nutrition-related problems in adolescent girls residing in low- and middle-income countries. The coexistence of both kinds of malnutrition typically impacts the most vulnerable people, such as women of reproductive age, and it has a detrimental impact on maternal and child health. Besides, malnutrition and inequality form a vicious cycle that is hard to break without all-encompassing solutions that address every stage of the life cycle. Therefore, this study aimed to assess the presence of socioeconomic inequality in the co-occurrence of anemia and stunting and its contributors in sub-Saharan African countries.

METHODS

A total of 39,712 weighted adolescent girl samples from DHS data SSA countries were included in the study. Erreygers normalized concentration index and its concentration curve were used to assess socioeconomic-related inequality in the co-occurrence of anemia and stunting. Decomposition analysis was performed to identify factors contributing to socioeconomic-related inequality.

RESULTS

The weighted Erreygers normalized concentration index for co-occurrence of anemia and stunting was - 0.046 with Standard error = 0.0043 (P value < 0.0001); indicating that co-occurrence of anemia and stunting was disproportionately concentrated among the poor. The decomposition analysis revealed that wealth index, place of residency, adolescent educational level, and unimproved source of water were the major contributors to the pro-poor socioeconomic inequalities in the co-occurrence of anemia and stunting.

CONCLUSION AND RECOMMENDATION

In this study, there is a pro-poor inequality in the co-occurrence of anemia and stunting. Therefore, it's vital to step up initiatives that improve access to education for adolescent girls, supply of safe water, and boost the economic standing of their country to enhance the level of living status of the population.

Enhancing the Design of Nutrient Clinical Trials for Disease Prevention-A Focus on Vitamin D: A Systematic Review

OBJECTIVES

This systematic review (SR) highlights principles for nutrient clinical trials and explore the diverse physiological functions of vitamin D beyond its traditional role in the musculoskeletal system related to clinical study designs.

BACKGROUND

Thousands of published research articles have investigated the benefits of vitamin D (a nutrient example taken in this SR) beyond the musculoskeletal system, including the immune, pulmonary, and cardiovascular systems; pregnancy; autoimmune disorders; and cancer. They illustrated vitamin D's molecular mechanisms, interactions, and genomic and nongenomic actions.

METHODS

This SR was designed to identify shortcomings in clinical study designs, statistical methods, and data interpretation that led to inconsistent findings in vitamin D-related publications. SR also highlights examples and insights into avoiding study design errors in future clinical studies, including randomized controlled clinical trials (RCTs). The SR adheres to the latest PRISMA statement, guidelines, and the PICOS process.

RESULTS

Inappropriate or flawed study designs were frequent in clinical trials. Major failures discussed here include too short clinical study duration, inadequate or infrequent doses, insufficient statistical power, failure to measure baseline and achieved levels, and recruiting vitamin D-sufficient participants. These design errors have led to misleading interpretations. Thus, conclusions from such studies should not be generalized or used in guidelines, recommendations, or policymaking.

CONCLUSION

Adequately powered epidemiological studies and RCTs with sufficient vitamin D and duration in individuals with vitamin D deficiency reported favorable clinical outcomes, enriching the literature, enabling to understand its physiology and mechanisms. Proper study designs with rigorous methodologies and cautious interpretation of outcomes are crucial in advancing the nutrient field. The principles discussed apply not only to vitamin D, but also other micro-nutrients and nutraceutical research. Adhering to them enhances the credibility and reliability of clinical trials, SRs, and meta-analysis outcomes. The study emphasizes the importance of focused, hypothesis-driven, well-designed, statistically powered RCTs to explore the diverse benefits of nutrients, conducted in index nutrient deficient participants, and avoidance of study design errors. Findings from such studies should be incorporated into clinical practice, policymaking, and public health guidelines, improving the health of the nation and reducing healthcare costs.

Effect of prenatal alcohol consumption on maternal anemia among pregnant women in Gondar town, Northwest Ethiopia: a retrospective cohort study

BACKGROUND

Alcohol consumption during pregnancy can lead to multiple health, social and behavioral problems for both the mother and the offspring. Anemia is one of the major public health concerns and causes of morbidity and mortality among pregnant women with poor maternal and fetal outcomes in developing countries. This study aimed to identify the link between prenatal alcohol consumption and anemia among pregnant women in Gondar town, Northwest Ethiopia.

METHODS

A facility-based retrospective cohort study was conducted among 1669 pregnant women who were booked in for antenatal care in Gondar town. We used a two-stage random sampling technique to recruit and include study participants in the cohort. Data were collected using an interviewer-administered questionnaire. Multivariable analysis was performed to examine the association between reported prenatal alcohol exposure (non-hazardous and hazardous) and anemia in pregnancy using log-binomial regression modeling. The burden of anemia in pregnancy was reported using the adjusted risk ratio (ARR) and population-attributable risk.

RESULTS

The prevalence of anemia during pregnancy was 14.86% (95% CI 13.23 to 16.65%). Hazardous alcohol consumption during pregnancy was significantly associated with anemia in pregnancy (ARR=2.24; 95% CI 1.60, 3.15). The adjusted population-attributable risk of anemia in pregnancy related to hazardous alcohol consumption during pregnancy was 7.68%.

CONCLUSIONS

This study revealed that anemia during pregnancy continues to be a public health concern. Regardless of timing, there is a clear association between prenatal alcohol consumption and anemia during pregnancy that suggests a need for targeted prenatal alcohol use screening, and ongoing intervention for alcoholic pregnant women.

[Association between food insecurity and infant development at age 18 months in the urban area of Pelotas, Rio Grande do Sul State, Brazil]

This study aimed to evaluate the association between household food insecurity and child development at age 18 months in the municipality of Pelotas, Rio Grande do Sul State, Brazil. This longitudinal study was carried out with a population-based sample of 465 mothers and infants from Pelotas. Infants' cognitive, motor, socioemotional, and language developments were assessed by the Bayley Scales of Infant and Toddler Development, third edition. The Brazilian Food Insecurity Scale was used to define food safety/insecurity, which classifies households into four categories: food security or mild, moderate, or severe food insecurity. The results of the adjusted analysis showed that food insecurity only affected motor and socioemotional developments at age 18 months. Each increase in food insecurity score decreased that of motor development by 2.30 points on average (95%CI: -4.31; -0.48) at age 18 months. Similarly, each increase in food insecurity score decreased that of socioemotional development by 4.05 points on average (95%CI: -7.34; -0.76). Results show that food insecurity was associated with lower motor and socioemotional developments at age 18 months and stress the importance of the right to adequate food and to environments that provide stimulating experiences for child development.

Effect of nutritional supplementation with lipid-based therapeutic food on body composition of non-severely malnourished African children aged 6-59 months hospitalized with severe pneumonia

Pneumonia remains an important cause of morbidity and mortality among children in low- and middle-income countries. Poor outcomes are associated with undernutrition. Nutritional supplementation may be beneficial. We examined the effect of supplementation with lipid-based ready-to-use therapeutic food (RUTF) on the body composition of children with severe pneumonia. Non-severely malnourished children (6-59 months) with severe pneumonia enrolled into the Children's Oxygen Administration Strategies and Nutrition trial in Uganda and Kenya, and randomized to receive a diet supplemented with RUTF (500 Kcal/day) for 56 days versus usual diet alone (control) were included. We assessed arm anthropometry and bioimpedance analysis at admission and days 28, 90, and 180 of follow-up. We used mixed effects linear regression to compare body composition between groups. We included 737 participants (369 in intervention; 368 in control group). The median age was 16 months (IQR; 9, 26), and 58.1% were male. Overall, baseline mean arm fat area (AFA), arm muscle area, and arm muscle circumference were 5.8 ± 1.8 cm2, 11.6 ± 2.3 cm2, and 12.3 ± 1.2 cm2, respectively. The mean fat mass and fat-free mass calculated in 116 participants were 5.5 ± 1.5 kg and 5.5 ± 1.5 kg, respectively. There were modest increases in most body composition parameters. RUTF significantly increased AFA at days 28 and 90 but not at day 180 (P-value = .03, .02, and .99, respectively). RUTF did not change other body composition parameters. Despite initial increases in AFA, RUTF did not change the body composition of children with severe pneumonia.

Childhood wasting and associated factors in Africa: evidence from standard demographic and health surveys from 35 countries

INTRODUCTION

Child malnutrition remains a critical public health challenge globally. Childhood wasting, a severe form of malnutrition, indicates acute undernutrition, leading to significant loss of muscle and fat tissue. The World Health Organization's Global Nutrition Target aims to reduce childhood wasting to less than 5% in over half of low- and middle-income countries by 2025. The enduring hunger crisis in Africa is a complex issue that demands our continuous commitment, innovative solutions, and coordinated efforts. This study aims to assess the prevalence and associated factors of childhood wasting in Africa.

METHOD

This study conducted a secondary analysis of demographic and health survey datasets from 2010 to 2022 in 35 African countries. A total of 212,715 children under the age of 5 years were included, using a weighted sample. We employed a mixed-effects model to evaluate the factors associated with childhood wasting. The significance of the fixed effects was assessed using the adjusted odds ratio (AOR) and the corresponding 95% confidence interval.

RESULT

The prevalence of childhood wasting in Africa was estimated to be 7.16% (95% CI: 7.05-7.27). Several factors were significantly associated with childhood wasting, including the child's age, male gender, birth weight, maternal education level, wealth index, lack of antenatal care (ANC) visits, home delivery, multiple gestational births, and rural residence.

CONCLUSION

Childhood wasting in Africa exceeds the global target set for 2025, which aims to reduce it to less than 5%. To address this critical issue, educating mothers without formal education and rural residents about antenatal care visits, institutional delivery, and proper child feeding practices is essential. Moreover, a renewed focus on tackling the multifaceted factors of undernutrition, strengthening health systems, and implementing evidence-based interventions tailored to the local context is crucial for achieving meaningful and sustained reductions in wasting prevalence across the region.

Impact of linear growth-improving interventions on childhood overnutrition at 24 months: a randomized controlled trial

BACKGROUND

Childhood malnutrition, both undernutrition and overnutrition, is a major health concern in many low- and middle-income countries (LMICs). Efforts to reduce early undernutrition could also lead to obesity. In an earlier study, we reported the successful impact of a package of preconception, pregnancy, postnatal, and/or early childhood interventions (health, nutrition, psychosocial support, and water, sanitation, and hygiene) delivered in the first 1000 d, on reducing stunting in low-to-middle-income populations, in comparison with routine care. However, the impact of these interventions on early body composition and subsequent overweight is not known.

OBJECTIVES

The objective of this study was to estimate the effect of a package of interventions directed at preventing stunting in the first 1000 d on body composition at 1 mo and childhood overweight and/or obesity at 24 mo of age.

METHODS

Infant body composition was measured by deuterium dilution at 1 mo of age, along with the prevalence of childhood overweight and/or obesity at 24 mo, defined by a body mass index-for-Age Z (BMIz) score >+2 standard deviation.

RESULTS

Children in the preconception, pregnancy, and early childhood intervention group and those in the pregnancy and early childhood intervention group had higher body mass index z scores than those in routine care. However, the prevalence of overweight and/or obesity was low (ranging from 0.0 to 1.3%). Pregnancy interventions significantly increased neonatal fat-free mass (mean difference 0.1 kg, 95% confidence interval [CI]: 0.01, 0.2). However, there was no significant change in fat mass.

CONCLUSIONS

Comprehensive interventions from preconception to early childhood improve linear growth but do not result in overweight and/or obesity at 24 mo. With better resultant linear and ponderal growth, they converge with the World Health Organization's "double-duty actions for nutrition" for LMIC settings, where childhood overweight and/or obesity is a growing concern. This trial was registered at Clinical Trials Registry - India as CTRI/2017/06/008908.

The impacts of the COVID-19 pandemic on the burden of maternal and neonatal disorders: A counterfactual modeling based on the global burden of disease study (2021)

OBJECTIVES

During the COVID-19 pandemic, global health systems faced unprecedented challenges, as well as in maternal and neonatal health, thus this study aims to clarify the impacts of COVID-19 on maternal and neonatal disorders (MNDs), regional variations, and the role of economic support.

METHODS

We have developed a counterfactual model integrating Autoregressive Integrated Moving Average and Long Short-Term Memory models to forecast the burden of MNDs from 2020 To et al., 2021, which was compared with the actual burden to quantify the specific impact of the COVID-19 pandemic on MNDs.

RESULTS

During the COVID-19 pandemic, the burden of MNDs surpassed predictions, particularly in Russia, where incidence was about 10.20% higher than expected. In Tokelau, neonatal disorders increased by 412.35% in DALYs. The incidence of maternal disorders in Russia has increased by 12.00%, with maternal abortion and miscarriage increasing by 23.08%. The incidence and prevalence of maternal hypertensive disorders, the incidence of hemolytic disease and other neonatal jaundice and neonatal preterm birth accelerated. In low and low-middle Socio-demographic Index countries, mortality rates from maternal abortion and miscarriage, maternal obstructed labor and uterine rupture, neonatal encephalopathy due to birth asphyxia and trauma significantly increased. Similarly, countries with a low economic support index saw higher burden for these conditions, with the burden decreasing as economic support improved.

CONCLUSION

The COVID-19 pandemic has disproportionately increased the burden of MNDs in countries with lower economic support, highlighting the critical need for strengthened global economic support, particularly in low- and middle-income countries.

Mycotoxins and bone growth: a review of the literature on associations between xenobiotic exposure and bone growth and development

Mycotoxins are secondary metabolites of fungi that are known to be associated with linear growth faltering because of their impact on inflammation, intestinal damage, inhibition of protein synthesis, and micronutrient absorption. In this narrative review, we aim to extend this analysis to further explore associations between mycotoxins (aflatoxins, ochratoxins, trichothecenes including deoxynivalenol, T-2 toxin, and fumonisins) and long-bone growth, particularly during the saltatory periods of development. Linear growth is a direct function of skeletal development and long-bone growth. We therefore explored biological pathways and mechanisms of impact of these toxins in both animal and human studies, in addition to the epidemiology literature (post-2020). Given what is known of the effects of individual and combinations of mycotoxins based on the animal literature, we have identified a need for further research and examination of how these toxins and exposures may be studied in humans to elucidate the downstream impact on bone-related biomarkers and anthropometric indices used to identify and predict stunting in population-based studies.