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Miller LC, Neupane S, Joshi N, Lohani M. A multi-sectoral community development intervention has a positive impact on diet quality and growth in school-age children in rural Nepal. MATERNAL & CHILD NUTRITION 2024; 20:e13637. [PMID: 38488300 PMCID: PMC11168361 DOI: 10.1111/mcn.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/26/2023] [Accepted: 02/18/2024] [Indexed: 06/13/2024]
Abstract
Poor diet quality (diet diversity and animal-source food [ASF] consumption) during childhood negatively affects growth, development, behaviour and physiologic function in later life. Relatively less is known about the impact of poor diet on the growth of school-age children compared to children <5 years of age, especially in low/middle-income countries. A better understanding of delivery strategies for effective interventions to improve diet and hence growth in school-age children is needed. A 36-month longitudinal controlled impact evaluation in rural Nepal assessed the nutrition and growth of children <5 years of age in families assigned via community clusters to full package intervention (community development, training in nutrition [during pregnancy and for children <5 years] and livestock husbandry), partial package (training only) or control (no inputs). Concurrent data were collected prospectively (baseline plus additional four rounds) on school-age children (5-8 years at baseline) in these households; the present study analysed findings in the cohort of school-age children seen at all five study visits (n = 341). Diet quality improved more in the full package school-age children compared to those in partial package or control households. full package children consumed more ASF (β +0.40 [CI 0.07,0.73], p < 0.05), more diverse diets (β +0.93 [CI 0.55,1.31], p < 0.001) and had better head circumference z-scores (β +0.21 [CI 0.07,0.35], p < 0.01) than control children. In conclusion, a multi-sectoral community development intervention was associated with improvements in diet and growth of school-age children in rural Nepal even though the intervention focused on the diet of children <5 years of age. The diet and growth of school-age children can be favourably influenced by community-level interventions, even indirectly.
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Affiliation(s)
- Laurie C. Miller
- Department of Pediatrics, Tufts Medical Center and Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Sumanta Neupane
- Nutrition Diet and Health, Division of Poverty, Health, and NutritionInternational Food Policy Research InstituteKathmanduNepal
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Song J, Zhang Y, Li A, Peng J, Zhou C, Cheng X, Wu Y, Zhao W, Zong Z, Wu R, Li H. Prevalence of anemia in patients with rheumatoid arthritis and its association with dietary inflammatory index: A population-based study from NHANES 1999 to 2018. Medicine (Baltimore) 2024; 103:e38471. [PMID: 38905423 PMCID: PMC11191978 DOI: 10.1097/md.0000000000038471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/15/2024] [Indexed: 06/23/2024] Open
Abstract
Anemia is common in patients with rheumatoid arthritis (RA), and it is unknown whether the dietary inflammatory index (DII) is linked to anemia. This study aimed to clarify the prevalence of anemia in RA patients and its association with the DII. The data utilized in this study were collected from the National Health and Nutrition Examination Survey database from 1999 to 2018. The prevalence of anemia in RA patients was estimated by ethnicity, sex, and age. Weighted multivariate logistic regression was utilized to explore the correlation between anemia risk and DII. The most crucial dietary factors related to the risk of anemia in RA patients were screened by stepwise regression. A nomogram model was established according to key dietary factors. A total of 10.25% (confidence interval, 8.58-11.92%) of RA patients will develop anemia, with the lowest prevalence around the age of 60. In addition, higher DII levels were discovered in anemic patients than in nonanemic patients. In multivariate regression models, an important positive association was revealed between anemia and growing quartiles of DII (Q4 vs Q1: odds ratio = 1.98; confidence interval, 1.25-3.15). In the subgroup analysis, the adjusted relation of DII with anemia in females, Mexicans, smokers, nondrinkers, and age groups ≥ 60 years was statistically significant. The same association was observed in the sensitivity analysis. A nomogram model based on stepwise regression screening of key dietary factors showed good discriminatory power to identify anemic risk in RA patients (area under the curve: 0.707). In patients with RA, high DII levels were associated with the risk of anemia. More attention should be given to controlling dietary inflammation to better prevent and treat anemia.
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Affiliation(s)
- Jingjing Song
- Department of Rheumatology and Immunology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Nanchang University School of Ophthalmology & Optometry, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yujun Zhang
- Department of Rheumatology and Immunology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ao Li
- Department of Rheumatology and Immunology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Queen Mary School, Nanchang University, Nanchang, China
| | - Jie Peng
- Department of Rheumatology and Immunology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Chulin Zhou
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Xifu Cheng
- Nanchang University School of Ophthalmology & Optometry, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yang Wu
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Wentao Zhao
- The 3rd Clinical Department of China Medical University, Shenyang, China
| | - Zhen Zong
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rui Wu
- Department of Rheumatology and Immunology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Hui Li
- Department of Rheumatology and Immunology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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Agbaje AO. Waist-circumference-to-height-ratio had better longitudinal agreement with DEXA-measured fat mass than BMI in 7237 children. Pediatr Res 2024:10.1038/s41390-024-03112-8. [PMID: 38443520 DOI: 10.1038/s41390-024-03112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The absolute agreement of surrogate measures of adiposity with dual-energy X-ray absorptiometry (DEXA)-measured body composition was examined. METHODS Over a 15-year follow-up, 7237 (3667 females) nine-year-old children from the Avon Longitudinal Study of Parents and Children (ALSPAC) UK birth cohort were included. Total fat mass (FM) and trunk FM were serially measured with DEXA at ages 9, 11, 15, 17, and 24 years. BMI and waist circumference-to-height ratio (WHtR) were computed. Pearson's correlations, intraclass correlations (ICC), and area under curve (AUC) analyses were conducted. RESULTS Over 15 years, BMI, total FM, and trunk FM, increased but WHtR was relatively stable. WHtR provided a better longitudinal absolute agreement [males ICC 0.84 (95% CI 0.84-0.85); females 0.81 (0.80-0.82)] than BMI [(males (0.65 (0.64-0.66); females 0.72 (0.71-0.73)] with total FM as well as trunk FM from ages 9-24 years. WHtR cut-point for predicting excess total FM (75th-95th percentile) was 0.50-0.53 in males [AUC 0.86-0.94, sensitivity 0.51-0.79 and specificity 0.93-0.95]. WHtR cut-point for predicting excess total FM (75th-95th percentile) was 0.52-0.54 in females [AUC 0.83-0.95, sensitivity 0.38-0.68 and specificity 0.92-0.95]. Results were similar with trunk FM. CONCLUSION WHtR is an inexpensive alternative to BMI for predicting FM in pediatrics. IMPACT Waist circumference-to-height ratio (WHtR) is a better adiposity surrogate measure than body mass index (BMI) in predicting fat mass and discriminating lean mass from childhood through young adulthood. BMI has been used as an inexpensive surrogate measure of adiposity in children for several decades. However, emerging findings suggest that BMI fails to discriminate between fat mass adiposity and lean mass. This is the first-ever longitudinal study in over 7000 children followed up for 15 years that identified WHtR as an inexpensive accurate measure that discriminates fat mass from lean mass that could replace BMI measure of obesity in pediatrics.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Chanyarungrojn PA, Lelijveld N, Crampin A, Nkhwazi L, Geis S, Nyirenda M, Kerac M. Tools for assessing child and adolescent stunting: Lookup tables, growth charts and a novel appropriate-technology "MEIRU" wallchart - a diagnostic accuracy study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001592. [PMID: 37450437 PMCID: PMC10348557 DOI: 10.1371/journal.pgph.0001592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023]
Abstract
Stunting affects 149 million children worldwide and is a form of chronic malnutrition defined by low height-for-age. Surveys and intervention programmes depend on effective assessment and identification of affected individuals. Gold standard assessment is based on height-for-age Z-score (HAZ): HAZ <-2 defines stunting; HAZ <-3 defines severe stunting. However, a major problem for field-based programmes is that Z-scores can be time-intensive and challenging to calculate. We thus developed a novel wallchart that we have coined 'MEIRU wallchart' to easily and accurately identify stunted children and adolescents. Our study aim was to evaluate its performance and acceptability against other methods used in current clinical/field practice. We undertook a non-interventional diagnostic accuracy study in Malawi. We recruited 244 participants aged 8-19 years and determined each individual's stunting status using, in varying order: the MEIRU wallchart, traditional lookup tables, and traditional growth charts. All were compared against 'gold standard' HAZ, calculated using AnthroPlus WHO software. Local community healthcare workers performed all the assessments. The wallchart method was strongly preferred by both participants and staff. It had an overall accuracy of 95.5%(kappa = 0.91) and was faster than lookup tables by an average of 62.5%(41.4sec; p<0.001) per measurement. Lookup tables and growth charts had overall agreements of 59.4%(kappa = 0.36) and 61.9%(kappa = 0.31) respectively. At the HAZ-2 cut-off, the wallchart had a sensitivity of 97.6%(95%CI: 91.5-99.7) and specificity of 96.3%(95%CI: 92.1-98.6). We conclude that the MEIRU wallchart performs well and is acceptable for screening and identification of stunted children/adolescents by community-level health workers. It fulfils key criteria that justify a role in future screening programmes: easy to perform and interpret; acceptable; accurate; sensitive and specific. Potential future uses include: conducting rapid stunting prevalence surveys; identifying affected individuals for interventions. Current field methods, lookup tables and growth charts performed poorly and should be used with caution.
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Affiliation(s)
| | - Natasha Lelijveld
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Emergency Nutrition Network, Oxford, United Kingdom
| | - Amelia Crampin
- MEIRU (Malawi Epidemiology & Intervention Research Unit), Lilongwe, Malawi
- Department of Infectious Disease, London School of Hygiene and Tropical Medicine, Bloomsbury, United Kingdom
- Glasgow University, Scotland, United Kingdom
| | - Lawrence Nkhwazi
- MEIRU (Malawi Epidemiology & Intervention Research Unit), Lilongwe, Malawi
| | - Steffen Geis
- MEIRU (Malawi Epidemiology & Intervention Research Unit), Lilongwe, Malawi
- Department of Infectious Disease, London School of Hygiene and Tropical Medicine, Bloomsbury, United Kingdom
- Infection Prevention and Control Unit, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Moffat Nyirenda
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MEIRU (Malawi Epidemiology & Intervention Research Unit), Lilongwe, Malawi
- MRC Uganda, Entebbe, Uganda
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Getahun GK, Assfaw A, Muhammad EA, Shitemaw T. Prevalence and correlates of stunting and thinness among adolescent students in Lideta subcity, Addis Ababa, Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e065347. [PMID: 37258071 DOI: 10.1136/bmjopen-2022-065347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES To determine the prevalence of stunting and thinness and associated factors among adolescents attending public schools in Lideta subcity, Addis Ababa, Ethiopia, in 2021. DESIGN Cross-sectional. SETTING Public schools in Lideta subcity, Addis Ababa, Ethiopia. ELIGIBILITY Adolescents from grades 5-12 in public schools and students whose parents gave consent for participation. DATA ANALYSIS Bivariate and multivariable logistic regression analyses were used to examine the association between the independent variables and stunting and thinness. Using a 95% CI and adjusted OR (AOR), factors with a p value of less than 0.05 were determined to have a significant association. OUTCOME MEASURES The prevalence of stunting and thinness, as well as the factors associated with stunting and thinness, were secondary outcomes. RESULTS The overall prevalence of stunting and thinness was 7.2% (95% CI: 5.3% to 9.3%) and 9% (95% CI: 6.8% to 11.4%), respectively. Stunting was associated with a larger family size (AOR=3.76; 95% CI: 1.58 to 8.94), low dietary diversity (AOR=2.87; 95% CI: 1.44 to 5.74), food insecurity (AOR=2.81; 95% CI: 1.38 to 5.71) and a lower wealth index (AOR=3.34; 95% CI: 1.51 to 7.41). On the other hand, thinness was associated with maternal education in those who were unable to read and write (AOR=2.5; 95% CI: 1.97 to 8.11), inadequate dietary diversity (AOR=4.81; 95% CI: 2.55 to 9.07) and larger family size (AOR=2.46; 95% CI: 1.14 to 5.29). CONCLUSION Adolescent stunting and thinness were common in Addis Ababa's public schools. Family size, dietary diversity and food security were the main factors associated with both thinness and stunting. Therefore, to solve the problem of adolescent stunting and thinness, the administration of Addis Ababa city should prioritise minimising food insecurity while boosting productivity to enhance adolescent nutritional diversity. Moreover, nutritional education should be strengthened by healthcare providers working at public schools as well as health extension workers.
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Affiliation(s)
- Genanew Kassie Getahun
- Kotebe Metropolitan University, Menelik II Medical and Health Science College, Addis Ababa, Ethiopia
| | - Alebachew Assfaw
- Kotebe Metropolitan University, Menelik II Medical and Health Science College, Addis Ababa, Ethiopia
| | - Esmael Ali Muhammad
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tewoderos Shitemaw
- Kotebe Metropolitan University, Menelik II Medical and Health Science College, Addis Ababa, Ethiopia
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Wu L, Shi Y, Kong C, Zhang J, Chen S. Dietary Inflammatory Index and Its Association with the Prevalence of Coronary Heart Disease among 45,306 US Adults. Nutrients 2022; 14:4553. [PMID: 36364813 PMCID: PMC9656485 DOI: 10.3390/nu14214553] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 07/25/2023] Open
Abstract
Inflammation plays a pivotal in the occurrence and development of coronary heart disease (CHD). We aim to investigate the association between the Dietary Inflammatory Index (DII) and CHD in the present study. In this cross-sectional study, adult participants from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) were enrolled. The social demographic information, lifestyle factors, blood biochemical measurements, dietary information, and CHD status of all the participants were systematically collected. Multivariable logistic regression was adopted to investigate the association between the risk of CHD and the DII. Besides, restricted cubic spline (RCS) analysis was used to explore whether there was a nonlinear association of the DII and CHD. Subgroup analysis stratified by sex, age, race/ethnicity, and BMI was conducted to evaluate the association of the DII and CHD among different populations. A total of 45,306 adults from NHANES (1999-2018) were included. Compared with individuals without CHD, the DIIs of the participants with CHD were significantly elevated. A positive association was observed between the DII and CHD in multivariable logistic analysis after adjusting for age, sex, race/ethnicity, education levels, smoking, drinking, diabetes, hypertension, and body mass index (BMI). Results of RCS analysis suggested a nonlinear relationship between the DII and CHD. In addition, the increment of the DII had a greater impact on female individuals compared with male individuals. The DII is closely associated with the risk of CHD. For better prevention and treatment of CHD, more attention should be paid to controlling dietary inflammation.
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