Relationship between anthropometric indicators and cognitive performance in Southeast Asian school-aged children

The Psychological, Cognitive, and Behavioural Effects of Starvation in Humans: A Scoping Review

BACKGROUND

Research has highlighted the physical complications of starvation, but there is less research examining the psychological effects of starvation in humans.

AIMS

This scoping review synthesises literature on the non-physical effects of starvation in humans.

METHOD

Following PRISMA-ScR guidelines, we searched MEDLINE, PsycINFO, and Global Health for studies published between 1946 and 2023 examining the non-physical effects of starvation in individuals aged 2-79 years, including those who were starved, malnourished, stunted, wasted, underweight, had a restrictive eating disorder, or were raised in famine conditions.

RESULTS

From 16,555 abstracts, 851 articles on the effects of malnutrition were reviewed, and 318 were included. Among these, 35% focused on children and adolescents, 25.5% on adults with comorbid illnesses, 17% on older adults, 13% on those with eating disorders, 6% on adults without comorbidities, and 3.5% on famine survivors. Cognitive impairments were the most frequently reported effects in children. In adults and older adults, depression and anxiety were common, along with reduced cognitive functioning, reduced quality of life, social withdrawal, impaired sleep and impaired sexual functioning. Individuals with eating disorders experienced depression, anxiety, obsessive-compulsive symptoms, emotion regulation difficulties, and cognitive impairment.

CONCLUSIONS

There is extensive evidence showing the detrimental non-physical consequences of starvation in children and adults. These findings should inform research, clinical interventions, and educational materials addressing the effects of insufficient nutrition, including in those with restrictive eating disorders.

Harnessing the power of probiotics to enhance neuroplasticity for neurodevelopment and cognitive function in stunting: a comprehensive review

BACKGROUND

Stunting become a global concern because it's not only affecting physical stature, but also affecting on neurodevelopment and cognitive function. These impacts are resulting in long-term consequences especially for human resources, such as poor-quality labor, decreased productivity due to decreasing of health quality, including immunity and cognitive aspect.

DISCUSSION

This comprehensive review found that based on many studies, there is an altered gut microbiota, or dysbiosis, in stunted children, causing the impairment of brain development through Microbiota-Gut Brain Axis (MGB Axis) mechanism. The administration of probiotics has been known affect MGBA by improving the physical and chemical gut barrier integrity, producing antimicrobial substance to inhibit pathogen, and recovering the healthy gut microbiota. Probiotics, along with healthy gut microbiota, produce SCFAs which have various positive impact on CNS, such as increase neurogenesis, support the development and function of microglia, reduce inflammatory signaling, improve the Blood Brain Barrier's (BBB's) integrity, produce neurotropic factors (e.g. BDNF, GDNF), and promote the formation of new synapse. Probiotics also could induce the production of IGF-1 by intestinal epithelial cells, which functioned as growth factor of multiple body tissues and resulted in improvement of linear growth as well as brain development.

CONCLUSION

These properties of probiotics made it become the promising and feasible new treatment approach for stunting. But since most of the studies in this field are conducted in animal models, it is necessary to translate animal data into human models and do additional study to identify the numerous components in the MGB axis and the effect of probiotics on human.

Association of anthropometric parameters with intelligence quotient in early school-aged children: a cross-sectional study in Iran

BACKGROUND

While the link between body growth indices in the first three years of life and neurodevelopment is well established, the relationship between these indicators and intelligence levels in later stages is not well understood. This study aimed to investigate the association between various anthropometric indices and Intelligence Quotient in early school-aged children.

METHODS

This cross-sectional study recruited healthy students aged 7 to 8 years from four primary schools in Tehran, Iran. Measurements included body weight, height, body mass index, arm circumference, waist circumference, and hip circumference. Intelligence Quotient was assessed using the Raven's Standard Progressive Matrices Test, with scores standardized by age according to the Raven's manual. Separate univariate linear regression analyses evaluated the association between each anthropometric index and children's Intelligence Quotient scores. Multivariate linear regression analyses were then performed to adjust for potential confounding factors, including the child's sex, age, and parental education levels.

RESULTS

A cohort of 160 children (80 females), with a mean age of 7.5 ± 0.6 years, was included in the study. The participants exhibited the following mean anthropometric values: weight 27.7 ± 6.5 kg, height 1.2 ± 0.1 m, body mass index 17.9 ± 3.4 kg/m2, arm circumference 20.7 ± 2.8 cm, waist circumference 56.4 ± 6.4 cm, and hip circumference 68.1 ± 6.6 cm. Their mean Intelligence Quotient score was 106 ± 16.6. In the univariate analysis, children's weight was not significantly associated with Intelligence Quotient score (P-value = 0.153, β = 0.288 [-0.108, 0.684]), while height was negatively associated (P-value = 0.048, β = -31.685 [-63.142, -0.228]) and body mass index showed a positive association (P-value = 0.001, β = 1.265 [0.524, 2.006]). Abdominal circumference was not significantly associated with Intelligence Quotient (P-value = 0.913, β = 0.051 [-0.870, 0.972]), but both waist circumference (P-value = 0.007, β = 0.542 [0.147, 0.937]) and hip circumference (P-value = 0.013, β = 0.484 [0.102, 0.866]) demonstrated significant positive associations with Intelligence Quotient. However, none of the anthropometric indices maintained statistically significant associations with Intelligence Quotient after adjusting for potential confounders (P-values > 0.05).

CONCLUSIONS

This study indicated no strong relationship between various body measurements and intelligence levels in school-aged children after adjusting the analyses for confounders. This suggests that intelligence in these children may be largely shaped by genetic and sociodemographic factors, with minimal influence from physical growth patterns.

Prevalence of Overweight and Obesity and Association with Risk Factors in Secondary School Children in Croatia

BACKGROUND

Childhood and adolescent overweight and obesity represent significant global health concerns. The primary objective of this study was to assess the prevalence and associations of some potential risk factors with overweight and obesity among Croatian adolescents aged 15 to 18.

METHODS

This cross-sectional study included 344 secondary school students from Croatia's Mediterranean region, with data collected through an anonymous questionnaire. The questionnaire gathered sociodemographic information, adherence to the Mediterranean diet of both children and their parents, and the children's dietary habits and physical activity levels.

RESULTS

Weight status data revealed that 2.6% of participants were underweight, 82% had normal weight, 11% were overweight, and 4.4% were classified as obese. The results indicated that boys (p < 0.001), children who skip breakfast (p = 0.031), those with less active lifestyles compared to their peers (p = 0.001), children whose mothers have a higher BMI (p < 0.001), and children from smaller families (p = 0.034) are at greater risk of being overweight or obese.

CONCLUSIONS

This study provides valuable insights into the risk factors associated with overweight and obesity in this age group, which can support the development of targeted strategies for this population.

Association of Chronic Malnutrition, and Not Anemia, with Cognitive Development in Ethiopian Schoolchildren: A Cross-Sectional Study

This study assesses the associations between nutritional status and cognitive development of schoolchildren. A unit increase in height-for-age Z-score was associated with 0.12 SD, 0.08 SD and 0.12 SD increase in standardized digit span, Raven's colored progressive metrics, and performance index of visual search task, respectively. A unit increase in body-mass-index-for-age Z-score was associated with 0.11 SD increase in standardized digit span. Hemoglobin concentration was not associated with any of the cognitive outcomes. Chronic malnutrition was associated with cognitive development in schoolchildren while thinness and hemoglobin concentrations were associated with selected or no cognitive outcomes, respectively.

The nutritional and feeding status of children living in selected residential child care facilities in Zambia: implications for programs and policies

Introduction

This study aimed to estimate the prevalence of undernutrition and risk of feeding difficulties and describe common feeding practices for children from birth to 10 years of age living in residential care in Zambia.

Methods

This was a secondary analysis of de-identified cross-sectional data on 397 children living in 22 residential care facilities in four provinces. Child demographics, anthropometrics, hemoglobin levels, risk for feeding difficulties, and facility-level feeding practices were collected by a trained study team using Count Me In, a digital health app. Interviews with staff were conducted at 15 residential care facilities.

Results

Around half of the study sample were boys (53.4%) and <5 years old (55.4%). Special healthcare needs were reported in 10.3% of the children, with cerebral palsy being the most common (3.5%). Underweight, stunting, wasting (using weight-for-length/height), and anemia were found in 22.4, 28.0, 7.1 and 54.7% of children, respectively, with higher rates in children with special healthcare needs and children <24 months old. Duration of residential care was positively associated with length/height-for-age but not weight-for-age or weight-for-length/height z-scores. A risk for feeding difficulties was found in 41.4 and 26.0% of children with and without special healthcare needs, respectively. Suboptimal bottle-feeding practices, including the use of altered nipples and poor caregiver-infant interactions, were observed for infants <12 months old. Residential care staff reported suboptimal diets in their facilities and gaps in knowledge and resources to meet children's nutritional needs.

Conclusion

These results demonstrate that a large proportion of children living in residential care in Zambia are at high risk for undernutrition and feeding difficulties and contribute to the small body of literature on children living in residential care, both in Zambia and globally. In the context of Zambia's efforts to improve child nutrition and reform its alternative care, these findings can inform programming and policies for children living in residential care to fulfill their rights to health and family care.

Local anthropometric parameters for assessing double burden of malnutrition in South Asian and Southeast Asian countries: a review and retrospective analysis

The double burden of malnutrition (DBM) is a significant public health issue in South and Southeast Asia (SA and SEA). This study aimed to assess the impact of using local and regional ethnicity-specific anthropometric references versus international references on the prevalence of DBM in these regions.A narrative review of DBM prevalence using local versus international standards was conducted. Additionally, deidentified datasets from India and Indonesia were analyzed to evaluate the effectiveness of different growth standards in identifying DBM. Anthropometric Z-scores were compared, and sensitivity, specificity, and positive predictive value (PPV) were calculated.WHO standards had the lowest specificity for identifying short stature in India and Indonesia. BMI-for-age charts using WHO Growth Reference (2007) had lower sensitivity and higher specificity for metabolic risk. Local references showed lower stunting and higher overweight or obesity prevalence. International standards overestimated stunting and underestimated obesity, leading to misclassification and missed cases of metabolic risk.

Funding

None.

Intra-uterine exposure to lower maternal haemoglobin concentration is associated with impaired cognitive function in stunted adolescents: results from a 17-year longitudinal cohort study in Indonesia

The long-term impact of maternal anaemia on cognitive performance remains unknown. Indonesian longitudinal cohort data of 363 paired pregnant mothers and their 10-14-year-old offspring were used to investigate the association between maternal haemoglobin (Hb) concentration and their offspring's cognitive function (assessed by Raven's Progressive Matrices test) during adolescence. The weighted anaemia prevalence was 49.3% in pregnant mothers and 22.2% in adolescents. Adolescents who were stunted, anaemic, or living in a rural area had significantly lower cognitive scores than their counterparts. Maternal Hb was not associated with adolescent cognitive function (β: 0.14; 95%CI: -0.052-0.340). However, the effect of maternal Hb concentration on offspring's cognitive function was modified by stunting status (β, stunted: 0.44; 95%CI: 0.05-0.82; non-stunted: 0.01; 95%CI: -0.02-0.24). This study shows adverse cognitive outcomes at adolescent age are likely multi-causal and can be partially explained by intra-uterine exposure to low maternal Hb concentrations.

Prolonged Egg Supplement Advances Growing Child's Growth and Gut Microbiota

Protein-energy malnutrition still impacts children's growth and development. We investigated the prolonged effects of egg supplementation on growth and microbiota in primary school children. For this study, 8-14-year-old students (51.5% F) in six rural schools in Thailand were randomly assigned into three groups: (1) whole egg (WE), consuming 10 additional eggs/week (n = 238) (n = 238); (2) protein substitute (PS), consuming yolk-free egg substitutes equivalent to 10 eggs/week (n = 200); and (3) control group (C, (n = 197)). The outcomes were measured at week 0, 14, and 35. At the baseline, 17% of the students were underweight, 18% were stunted, and 13% were wasted. At week 35, compared to the C group the weight and height difference increased significantly in the WE group (3.6 ± 23.5 kg, p < 0.001; 5.1 ± 23.2 cm, p < 0.001). No significant differences in weight or height were observed between the PS and C groups. Significant decreases in atherogenic lipoproteins were observed in the WE, but not in PS group. HDL-cholesterol tended to increase in the WE group (0.02 ± 0.59 mmol/L, ns). The bacterial diversity was similar among the groups. The relative abundance of Bifidobacterium increased by 1.28-fold in the WE group compared to the baseline and differential abundance analysis which indicated that Lachnospira increased and Varibaculum decreased significantly. In conclusion, prolonged whole egg supplementation is an effective intervention to improve growth, nutritional biomarkers, and gut microbiota with unaltered adverse effects on blood lipoproteins.

Nutritional status and psychosocial stimulation associated with cognitive development in preschool children: A cross-sectional study at Western Terai, Nepal

Quality education at the age of foundation to produce dynamic manpower is a public concern in developing countries including Nepal. Preschool children do not get proper care and support from their parents due to insufficient knowledge of proper feeding habits, nutrition status and methods of psychosocial stimulation, which may affect their proper cognitive development. This study aimed to identify the factors that influence cognitive development in preschool children aged 3-5 years in Rupandehi district of western Terai, Nepal. In this school based cross-sectional survey, a total of 401 preschool children were selected using a multistage random sampling technique. The study was conducted from 4th February to 12th April, 2021 in Rupandehi district of Nepal. Data on the children's socio-economic and demographic status, level of psychosocial stimulation, nutritional status, and stage of cognitive development were collected through scheduled interviews and direct observation. Stepwise regression analysis was performed to determine the predictors of cognitive development in preschool children. A p-value less than 0.05 considered as statistical significance. Of 401 participants, 44.1% had a normal nutritional status based on height for age Z-score (HAZ). Only 1.2% of primary caregivers provided their children with high levels of psychosocial stimulation, and 49.1% of children had a medium level of cognitive development. Furthermore, cognitive development in preschoolers is positively associated with nutritional status based on the height for age z score (β = 0.280; p<0.0001), psychological stimulation from caregivers (β = 0.184; p<0.0001), and advantageous castes/ethnicity (β = 0.190; p<0.0001), but negatively associated with the child's age (β = - 0.145; p = 0.002) and family type (β = -0.157; p = 0.001). Nutritional status and psychosocial stimulation appear to be major factors affecting cognitive development of preschoolers. Nutritional promotion strategies, as well as techniques for optimal psychosocial stimulation behavior, may play an important role in enhancing preschoolers' cognitive development.

Associations of conflict and migration on childhood cognitive development in Ethiopia: Evidence from a longitudinal study

BACKGROUND

Migration has substantial consequences on the wellness of affected households, thereby exposing children to circumstances that are detrimental for healthy cognitive development. This study evaluates the relationship between conflict and migration during conception or early childhood and childhood cognitive development outcomes among families in Ethiopia. We hypothesized that migration is associated with worse cognitive development outcomes among children and that this association is mediated by educational disparities and caregiver psychological distress.

METHODS

The study used longitudinal data of children enrolled in the Young Lives Study (YLS) conducted in Ethiopia during 2002 (age 1), 2006-2007 (age 5), and 2009-2010 (age 8). We used multivariate linear and logistic regression to analyze the association between migration on cognitive development during middle childhood. Household migration and caregiver psychological distress were measured during round 1, type of education was measured at round 2, and cognitive development was measured at round 3.

RESULTS

Results of the multivariate regression analysis showed that migrant children achieved lower scores on a test of verbal intelligence after controlling for sex, ethnicity, religion, and caregiver distress (β: -8.09; 95% CI: -15.33, -0.85). Results of the mediation analysis show that the type of schooling that children attended, but not caregiver psychological distress, mediated the association between migration and cognitive development. Migrant children were more likely to attend private schools, which buffered the association between migration and lower cognitive development.

CONCLUSIONS

This study suggests that migration is a key determinant of childhood cognitive development among migrated populations. More research is needed to build the evidence base to support interventions for this growing, underserved population.

Tap Water Consumption Is Associated with Schoolchildren’s Cognitive Deficits in Afghanistan

Environmental influence on intelligence quotient (IQ) is poorly understood in developing countries. We conducted the first cross-sectional investigation to assess the role of socio-economic and environmental factors on schoolchildren’s IQ in Jalalabad, Afghanistan. A representative sample of 245 schoolchildren aged 7–15 was randomly selected in five schools. Children’s records included: non-verbal IQ TONI-1 scale, body mass index, socio-economic status, and further environmental indicators (water supply, proximity to a heavy-traffic road, use of surma traditional cosmetics). The mean age of the children was 11.7 years old (±2.0 years), and 70.2% and 29.8% were male and female, respectively. The children’s mean IQ was 83.8 (±12.6). In total, 37 (14.9%) of the children were overweight, 78 (31.5%) were living below the USD 1.25 poverty line, 133 (53.6%) used tap water supply, 76 (30.6%) used surma, and 166 (66.9%) were exposed to heavy road traffic. The children’s IQ was significantly and independently lowered by tap water use (−3.9; 95% CI [−7.1; −0.6]) and by aging (−1.4; 95% CI [−2.2; −0.6]), as revealed in multivariate analysis, independently of gender, socio-economic status, exposure to heavy road traffic, overweight status, and surma use. Lower IQ among older children is possibly attributed to chronic stress experienced by adolescents due to living conditions in Afghanistan. While using tap water prevents fecal peril, it may expose children to toxic elements such as lead which is known to lower their intellectual development.

Nutritional quality of lunch meals and plate waste in school lunch programme in Southern Thailand

Food waste globally affects food security and sustainability. There currently are few studies focusing on food waste in schools. The present study aimed to determine the meal quality and plate waste in school lunch programme in Thailand. This cross-sectional study was conducted in canteens of representing kindergarten and elementary schools in Southern Thailand within their real-life context. The assessment was carried out over five consecutive school days in July–August 2020 for each school, at which two types of menus, including rice with side dish and one-dish meal were served. Waste collection and quantification were conducted by selective aggregate weighing, according to the Food Loss and Waste Protocol. All lunch menus contained excess rice but insufficient meats, fruits, vegetables and eggs, regarding the national lunch standard. For each serving portion, 7–33 % rice, 9–22 % meats, 7–65 % vegetables, 1–19 % fruits and 3–14 % eggs were discarded. Plate waste from rice with side dish menus (10–29 %) was more than one-dish meals (7–17 %). By estimation, each kindergartener generated 71⋅4 g plate waste daily, accounting for the caloric and monetary values of 146 kcal and 0⋅16 US dollar. The amount of plate waste and the respective caloric and monetary losses were less obvious at the elementary school. Plate waste affected the adequacy of food intakes of schoolchildren from lunch meals. The data obtained from the present study will be useful for planning and implementation of school lunch programme in Thailand and countries with similar context.

Gut–brain Axis: Impact of Intestinal Inflammation and Micronutrient Deficiency on Psychomotor Development and Cognitive Functions in Egyptian Children with UndernutritionGut–brain Axis: Impact of Intestinal Inflammation and Micronutrient Deficiency on Psychomotor Development and Cognitive Functions in Egyptian Children with Undernutrition

Cognitive impairment, growth faltering and stunting are pervasive in many countries. mostly causes are unknown. Role of intestinal inflammation in such cases should be minded especially in low- and middle-income countries. We assessed serum markers of inflammation, fecal markers of intestinal inflammation and serum micronutrients in cases with aged 1 to 10 years who suffer from moderate or severe malnutrition “weight-for-age z-score and height-for-age z- Score (WAZ or HAZ) less than -2 SD”. Cognitive abilities were assessed using Wechsler intelligence scale for preschool and school children, Bayley scale III. 55.6% of preschool cases were below average or had mild or moderate intelligence retardation while 24.5% of school cases and 5% of children below 2 years were below average regarding cognitive functions. Cases showed statistically significant reduction of vitamin D, zinc and iron as compared to control. Serum markers of inflammation (alpha 1- glycoprotein (a1-AGP), endotoxin core protein (EndoCAB)) and fecal markers of intestinal inflammation (alpha 1 antitrypsin (AAT) and neopterin (NEOP)) were significant higher in cases than controls. School children showed negative correlation between processing functions and( a1-AGP), positive correlation between perceptual reasoning and serum vitamin A. Children below 2 years, showed negative correlations between motor function and (AAT), (a1-AGP), tumor necrosis factor- alpha (TNF-a) and (EndoCAB), positive correlation between language and serum zinc. In conclusion, our study showed impaired neurocognitive and psychomotor functions in malnourished stunted children. Also, vitamins and minerals deficiency and increased markers of intestinal inflammation were observed in cases compared to healthy control.

Effectiveness of national multicentric school-based health lifestyles intervention among chinese children and adolescents on knowledge, belief, and practice toward obesity at individual, family and schools' levels

BACKGROUND

This study aims to evaluate the effectiveness of the trial of national multicentric school-based health lifestyles intervention toward childhood obesity on the KBP at individual, family and schools' levels.

METHODS

The national trial was a multi-centered, cluster-controlled trial, which was conducted in seven provinces from September 2013 to February 2014, aiming at preventing childhood overweight and obesity. Integrated intervention strategies focused on changing specific practice related to energy intake and expenditure, such as decreasing the consumption of sweetened fizzy drinks, increasing the consumption of vegetables, ensuring proper protein intake, reducing sedentary practice including screen time, and maintaining at least 1 h of moderate to vigorous physical activity. A total of 27,477 children and adolescents in the control group and 30,997 in the intervention group were recruited with a mean follow-up period of 6.7 months. The binomial response mixed-effects model was used for assessing the effects of the national school-based health lifestyles intervention on obesity-related KBP at students individual, parents' and schools' levels.

RESULTS

Children and adolescents in the intervention group mastered better obesity-related knowledge, and they had higher correct response rates to all questions about obesity-related knowledge compared to the control group (P < 0.05). In terms of obesity-related belief, individuals in the intervention group was more motivated than the control group, participants in the intervention group had higher correctness of 71.18, 52.94, and 56.60% than the control group of 68.61, 49.86, and 54.43%, (P < 0.05). In addition, healthier habits of eating breakfast and drinking milk every day were observed in the intervention group. For the beliefs toward obesity, parents of the intervention group had higher correctness than the control group. At the same time except for the fruit consumption, other obesity-related practice in the intervention group were healthier than the control group (P < 0.05). Except for some beliefs and practice, the intervention effect at the parent level was not significant in other aspects.

CONCLUSION

The obesity-related knowledge and beliefs of children and adolescents got improved significantly. However, the effects on the knowledge, beliefs and certain practices of their parents and school administrators failed to reach significance.

Oral Nutritional Supplementation Improves Growth in Children at Malnutrition Risk and with Picky Eating Behaviors

The problem of poor nutrition with impaired growth persists in young children worldwide, including in India, where wasting occurs in 20% of urban children (<5 years). Exacerbating this problem, some children are described by their parent as a picky eater with behaviors such as eating limited food and unwillingness to try new foods. Timely intervention can help prevent nutritional decline and promote growth recovery; oral nutritional supplements (ONS) and dietary counseling (DC) are commonly used. The present study aimed to determine the effects of ONS along with DC on growth in comparison with the effects of DC only. Enrolled children (N = 321) were >24 to ≤48 months old, at malnutrition risk (weight-for-height percentile 3rd to 15th), and described as a picky eater by their parent. Enrollees were randomized to one of the three groups (N = 107 per group): ONS1 + DC; ONS2 + DC; and DC only. From day 1 to day 90, study findings showed significant increases in weight-for-height percentile for ONS1 + DC and for ONS2 + DC interventions, as compared to DC only (p = 0.0086 for both). There was no significant difference between the two ONS groups. Anthropometric measurements (weight and body mass index) also increased significantly over time for the two ONS groups (versus DC only, p < 0.05), while ONS1 + DC significantly improved mid-upper-arm circumference (p < 0.05 versus DC only), as well. ONS groups showed a trend toward greater height gain when compared to DC only group, but the differences were not significant within the study interval. For young Indian children with nutritional risk and picky eating behaviors, our findings showed that a 90-day nutritional intervention with either ONS1 or ONS2, along with DC, promoted catch-up growth more effectively than did DC alone.

Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis

Oral nutritional supplements (ONS) are used to promote catch-up growth in children with undernutrition. We conducted a systematic review and meta-analysis to summarize the evidence of ONS intervention effects on growth for 9-month- to 12-year-old children who were undernourished or at nutritional risk. Eleven randomized controlled trials met the inclusion criteria; trials compared changes in anthropometric measures in children using ONS or ONS + DC (dietary counselling) to measures for those following usual diet or placebo or DC alone. The RCTs included 2287 children without chronic diseases (mean age 5.87 years [SD, 1.35]; 56% boys). At follow-up time points up to 6 months, results showed that children in the ONS intervention group had greater gains in weight (0.423 kg, [95% confidence interval 0.234, 0.613], p < 0.001) and height (0.417 cm [0.059, 0.776], p = 0.022) versus control; greater gains in weight (0.089 kg [0.049, 0.130], p < 0.001) were evident as early as 7–10 days. Longitudinal analyses with repeated measures at 30, 60, and 90 days showed greater gains in weight parameters from 30 days onwards (p < 0.001), a trend towards greater height gains at 90 days (p = 0.056), and significantly greater gains in height-for-age percentiles and Z-scores at 30 and 90 days, respectively (p < 0.05). Similar results were found in subgroup analyses of studies comparing ONS + DC to DC alone. For children with undernutrition, particularly those who were mildly and moderately undernourished, usage of ONS in a nutritional intervention resulted in significantly better growth outcomes when compared to control treatments (usual diet, placebo or DC alone).

Psychosocial health of adolescents in relation to underweight, overweight/obese status: the EU NET ADB survey

BACKGROUND

Both deviations from normal weight, namely, underweight and overweight/obese status, have been inversely associated with psychosocial health in adolescents. This study aimed to examine the relationship between psychosocial health and body mass index (BMI) among adolescents in five European countries, while assessing the effect of sociodemographic variables.

METHODS

A cross-sectional school-based study of adolescents aged 14-17.9 years was conducted in the framework of the European Network for Adolescent Addictive Behavior survey. Self-reported questionnaires from Greece, Iceland, the Netherlands, Romania and Spain were used for the current analysis. Associations between Youth Self-Report (YSR) scales and BMI status were investigated by multiple logistic regression analysis. The effect of sociodemographic variables was also measured.

RESULTS

Τhe sample consisted of 7005 adolescents aged 14-17.9 years. Borderline/clinical scores on some YSR scales were independently associated with overweight/obesity, specifically total problems (OR = 1.52, 95% CI: 1.18-1.96), internalizing ( OR = 1.48, 95% CI: 1.16-1.91), externalizing (OR = 1.36, 95% CI: 1.10-1.68), social (OR = 1.67, 95% CI: 1.19-2.35) and thought problems (OR = 1.62, 95% CI: 1.20-2.20). Among subscales, overweight/obesity specifically correlated with anxiety/depression (OR = 1.83, 95% CI: 1.33-2.51), withdrawal/depression (OR = 1.58, 95% CI: 1.02-2.48) and rule-breaking behavior (OR = 1.55, 95% CI: 1.15-2.08). Underweight was associated with problems on activities (OR = 1.31, 95% CI: 1.01-1.68) and withdrawal/depression (OR = 1.95, 95% CI: 1.27-3.01).

CONCLUSIONS

Lower levels of psychosocial health are associated with both deviations from normal weight. These findings suggest the need for health policies that target health habits and lifestyle, as well as positive attitudes towards the body image, with respect to the different psychosocial characteristics of each body weight status category.

Iron status predicts cognitive test performance of primary school children from Kumasi, Ghana

Background

Good nutritional status of school-aged children is crucial in achieving improved cognition. The objective of this study was to assess the relationship between nutritional status and cognition of school-aged children in the Kumasi metropolis, Ghana.

Methods

389 children were selected from ten government-owned schools. Socio-demographic and anthropometric data were collected. Blood samples were collected and analyzed for nutrients levels. Dietary intakes were assessed using food frequency questionnaire and previous day’s nutrients intake. Cognition test was performed using the Ravens Colored Progressive Matrix (RCPM).

Results

Mean age of participants was 8.9±1.4 years, mean RCPM score was 17.9±5.4. More girls scored RCPM below the 40^th percentile (45.5%) than boys (33.7%), while mother’s level of education significantly associated with RCPM percentiles of the children (p = 0.037). Four dietary patterns were generated from food frequency data, and scores of the second pattern, depicting vegetables, non-fruits, bread and cereals, showed a weak negative correlation (r = -0.132, p = 0.026) with previous day’s dietary zinc intake. Cognitive status did not vary by anthropometric and dietary patterns. More anemic (54.4%) than non-anemic (33.3%) children were below the 40^th RCPM percentile. Mean previous day’s intake for folate (p<0.001), vitamin B₆ (p = 0.018), iron (p<0.001), and zinc (p = 0.001) differed significantly between the cognitive test score percentiles of the children. Spearman rank correlation showed weak positive associations between RCPM score and hemoglobin (r = 0.246, p = 0.003) and serum ferritin (r = 0.176, p = 0.036). Binary regression analysis showed anemic children (aOR = 0.4; 95%CI = 0.2–0.8, p = 0.014), compared with non-anemic had decreased odds, while boys, compared with girls had increased odds (aOR = 2.0 95%CI = 1.0–4.0, p = 0.035) for scoring above the 50^th RCPM percentile.

Conclusions

Iron status, especially hemoglobin levels, correlated with the cognitive performance of school-aged children in the metropolis. Thus nutritional strategies aimed at reducing iron deficiency anemia are needed.

Impacts of a School-Based Intervention That Incorporates Nutrition Education and a Supportive Healthy School Canteen Environment among Primary School Children in Malaysia

In this study, a school nutrition program (SNP) that incorporates nutrition education and a healthy school canteen environment was developed to improve nutrition knowledge among intervention respondents and provide a healthier environment for them to practice healthy eating. In the current study, we evaluated the impacts of the SNP on eating behaviors, physical activity, body mass index-for-age (BAZ), and cognitive performance at pre-intervention, post-intervention, and 3-month follow-up points between intervention and comparison groups. This intervention study involved 523 primary school children (7–11 years old) from six selected schools in Batu Pahat District, Malaysia. Each respondent completed anthropometric and cognitive performance assessments and a set of standardized questionnaire at pre-intervention, post-intervention, and 3-month follow-up points. Multiple linear mixed model analysis was performed to determine the impacts of that SNP after being adjusted for covariates. After the program, the intervention group increased their frequency of breakfast, lunch, and dinner consumption and morning tea snacking and showed more frequent physical activity and better cognitive performance as compared to the comparison group overtime (p < 0.05). At 3-month follow-up, the intervention group showed lower BAZ scores than their comparison counterparts (p < 0.05). The SNP showed positive effects on eating behaviors, physical activity, BAZ, and cognitive performance in school children. Hence, the SNP is highly recommended for all primary school children.

Adolescents' nutritional status and its association with academic performance in South Ethiopia; a facility-based cross-sectional study

BACKGROUND

Adolescence is a particularly vulnerable stages of life in which malnutrition inhibits academic performance through poor growth and development, mental retardation, poor overall cognitive function and poor health status. However, there is a dearth of evidence regarding the association between nutritional status and academic performance among adolescent students. Therefore, this study aimed to determine the association of nutritional status and academic performance among adolescent secondary school students in Wolaita Sodo town, Southern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted among 670 systematically selected adolescents in secondary schools of Wolaita Sodo town from April to June 2019. The academic performance of the adolescents was measured using the mean mark score of two consecutive semesters' results of all subjects. Data were analyzed using Stata software Version 15. Descriptive statistics, binary and multiple linear regression analysis were done. Statistical association of dependent and independent variables was declared at p-value < 0.05.

RESULTS

The mean academic performance of students was 69.21 ± 0.42 (95% CI: 68.34-70.02%). A mean mark score of students increased by 1.89 (β = 1.89; 95%CI: 1.14, 2.64) for a unit increase in BMI for age z-score. Being female decreased a mean mark score by 2.63 (β = - 2.63; 95%CI: - 4.28, - 0.98) and being from a separated parents decreased by 4.73 (β = - 4. 73; 95%CI: - 6.73, - 2.74). A mean mark score of students from the first wealth class decreased by 9.92 (- 9.92; 95%CI: - 12.79, - 7.04) as compared to students from the highest wealth class. Attending private schools increased the mean mark score of students by 4.18 (β = 4.18; 95% CI: 2.46, 5.90).

CONCLUSIONS

Interventions targeted at adolescents' nutritional status should be designed and implemented. The town education office and concerned bodies should launch a school feeding program for public schools. Development and income generation activities should target households in the first wealth status. Schools are recommended to design additional teaching and learning schemes such as tutorial classes for girl students.

Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood

Linear growth failure (stunting) in childhood is the most prevalent form of undernutrition globally. The debate continues as to whether children who become stunted before age 24 months can catch up in growth and cognitive functions later in their lives. The potentially irreparable physical and neurocognitive damage that accompanies stunted growth is a major obstacle to human development. This review aims at evaluation and summarizing the published research covering the different aspects of stunting from childhood to adulthood.

Comparison of a set of cognitive ability screening test for primary school-aged children in Indonesia

BACKGROUND Monitoring children’s intellectual development is important to align their educational needs. This study compared nonverbal intelligence subtest of the cognitive test battery for Individuals with or without intellectual disability (CIID) to measure visual logical reasoning, verbal intelligence subtest (verbal fluency [VF]–animal test) to assess vocabulary and semantic memory, and the modified Indonesian version of Hopkins verbal learning test (IHVLT) to assess learning ability and episodic memory, against the Wechsler intelligence scale for children (WISC) as an alternative cognitive screening tool in school-aged children. METHODS A cross-sectional study was conducted in 145 grade 1–6 elementary school students in Jakarta between March and May 2017. Performance on the CIID subtest, VF, and modified IHVLT was assessed by a pediatrician, and the WISC test was performed by a psychologist. The associations between variables were evaluated using nonparametric Spearman’s rank correlations, regressions, and box plots. RESULTS The correlation between total intelligence quotient (IQ) WISC and CIID was 0.42 (p<0.001) and 0.34 (p<0.001) for both IHVLT and VF. Box plots suggested possible discriminative capacity of CIID but insufficient specificity. However, CIID was associated with stunting (height) and health (weight) independent of age, sex, father’s education, or income. CONCLUSIONS The CIID subtest series, VF, and modified IHVLT correlated with total IQ WISC. However, CIID may be better to test predictors of poor cognitive performance in primary school-aged children than an IQ screening test.

Nutritional status of primary school children: Association with intelligence quotient and academic performance

BACKGROUND

Nutrition plays a pivotal role in brain development throughout life. Sub-optimal intellectual ability and poor school performance are said to be among the long term effects of malnutrition. The aim of this study was to determine the association between nutritional status of the participants, their intelligence quotient (IQ) and academic performance.

METHODS

Children aged 6-12 years who met the inclusion criteria were recruited from the public and private primary schools in the local government area using a proportionate multistage sampling technique. Weight and height were measured using standard protocols and interpreted as normal or abnormal using the World Health Organization AnthroPlus®. IQ was assessed using the Raven's Standard Progressive Matrices and was grouped into optimal and suboptimal. Academic performance was assessed using the past records of class assessment, and was classified into high, average and low academic performance. A semi-structured questionnaire was used to obtain data such as-age, gender, socioeconomic indices and family size of the study participants.

RESULTS

The prevalence of underweight, thinness (wasting), stunting, overweight and obesity were 2.0%, 3.6%, 2.1%, 6.7%, and 4.2%, respectively. Indices of over-nutrition were significantly associated with optimal IQ and good academic performance. There was a trend in the association between wasting and suboptimal intelligence [AOR (95%CI) = 1.5 (1.0-3.0), p = 0.06].

CONCLUSION

Acute and chronic under-nutrition did not adversely affect the IQ and academic performance of the study population. The relationship between over-nutrition, IQ and academic performance disappeared when socio-economic status was controlled for.

Association of anthropometric and nutrition status indicators with cognitive functions in centenarians

BACKGROUND & AIMS

How anthropometric and nutrition status indicators relate to cognitive function in the oldest old adults is an issue that needs to be explored. This study aimed to analyze the association of parameters and nutrition status indicators (waist circumference, BMI, calf circumference, and waist-calf circumference ratio [WCR]) with cognitive functions in centenarians.

METHODS

A cross-sectional observational study was conducted with the full sample of 1002 centenarians from Hainan. The mini-mental state examination (MMSE) was used to identify cognitive impairment. Multiple logistic regression analysis was used to examine the strength of association between each anthropometric index and the risk of cognitive impairment or severe cognitive impairment identified by MMSE. Locally Weighted Scatterplot Smoothing (LOWESS) curve was used to visualize the linear or non-linear relationship of each pair.

RESULTS

The risk of cognitive impairment identified by MMSE for centenarians was reduced by 12% for every 1 cm thickening of the calf circumference (OR = 0.88, 95% CI: 0.81-0.95) and the increase in each unit of WCR increased cognitive impairment the risk by 1.60 times (OR = 2.60, 95% CI: 1.31-5.13) after adjusting for demographic characteristics (i.e., gender, age, ethnicity, marital status, education level, and type of residence) and lifestyle (i.e., smoking, drinking, and exercise) related variables.

CONCLUSIONS

Results suggest that calf circumference is negatively associated with the risk of cognitive impairment identified by MMSE in centenarians. Older adults with lower calf circumference should pay attention to their cognitive function.

Effects of early and recent mercury and lead exposure on the neurodevelopment of children with elevated mercury and/or developmental delays during lactation: A follow-up study

This follow-up study of 82 children investigated the potential impact of early and recent exposure to mercury and lead on their neurodevelopmental performance at 5-8 years of age (2017-2018). Early exposure of these children to mercury, methylmercury, and lead was assessed during lactation at 3-12 months old, as well as their mother's exposure using measurements from a cross-sectional study (2011-2013). Only infants who failed to pass the neurodevelopment screening tools and/or had elevated mercury were included in this study. Urine and hair were sampled during the follow-up study to assess the children's recent exposure to mercury, methylmercury, and lead. Their cognitive performance and visual-motor integration were also measured using the Test of Non-Verbal Intelligence (TONI) and the Beery-Visual-Motor Integration (Beery VMI), respectively. The association between alterations in urinary porphyrins excretion and exposure to metals was analyzed and their influence on the children's neurodevelopment was explored. Linear regression models revealed a significant negative association between the infants' mercury exposure during lactation and the TONI Quotient (β = -0.298, 95%CI = -4.677, -0.414) and Beery VMI Age Equivalent scores at age 5-8 (β = -0.437, 95%CI = -6.383, -1.844). The mothers' blood methylmercury was inversely and significantly associated with their children's TONI Quotient (β = -0.231, 95%CI = -8.184, -0.331). In contrast, the children's Beery VMI Age Equivalent scores were positively and significantly associated with the hair methylmercury of the mothers (β = 0.214, 95%CI = 0.088, 3.899) and their infants (β = 0.256, 95%CI = 0.396, 4.488). These relationships suggest the presence of negative confounding that we did not take into account. Unlike mercury, there was some evidence that lead in breast milk had an inverse relationship with the children's visual-motor coordination skills. Our study did not show a clear association between children's recent exposure to metals and neurodevelopment. However, a significant inverse association was observed between the TONI Quotient and the interaction of hair methylmercury × ∑porphyrins (ß = -0.224, 95%CI = -0.86, -0.049), implying that porphyrins are a sensitive measure of low body-mercury burden. Although lead induced higher ∑porphyrins excretion in urine (β = 0.347, 95%CI = 0.107, 0.525), their interaction did not influence children's neurodevelopmental scores. The interactions between metals and porphyrins might provide insights into their potential contributory role in the pathogenesis associated with neurological disorders or other diseases. Despite the small sample size of the present study, its findings about the association between toxic metal exposure and the high risk of poor neurodevelopmental performance are worrying, particularly at an early age, and additional research is needed using larger sample sizes.

Elevated blood pressure and its relationship with bodyweight and anthropometric measurements among 8-11-year-old Indonesian school children

Objective: Increased prevalence of elevated blood pressure in children and adolescents was associated with increased body weight and measures. Also, prevalence of elevated blood pressure varies between countries. This study is to investigate the prevalence of elevated blood pressure in Indonesian children and its relationship with bodyweight and anthropometric measures. Methods: This cross-sectional study involved 1010 elementary students aged 8 - 12 years (479 girls, 531 boys). The anthropometric measures and blood pressure were assessed. Elevated blood pressure (EBP) was determined if at the 90^th percentile or above for gender, age, and height. Independent t-test, Chi-square, Pearson correlation, and multivariate logistic regression were applied. Significance was determined at p<0.05. Results: Overall prevalence of EBP was 28.8% (35.9% in girls, 22.4% in boys). BMI, waist circumference (WC), waist to height ratio (WHtR), and abdominal skinfold had significant correlation with EBP. Elevated BP was higher in overweight and obesity than in normoweight (60.5% vs 39.5%, p=0.00). In girls, the OR of EBP for overweight and obesity were 2.33 (95% CI 1.40-3.87, p=0.03) and 3.44 (95% CI 1.98-5.99, p=0.00) whereas in boys were 4.26 (95% CI 2.20-8.28, p=0.00) and 8.82 (95% CI 5.10-15.38, p=0.00). Conclusions: Prevalence of EBP in Indonesian school children aged 8 - 11 years was higher and more prevalent in overweight/ obesity and in girls. Anthropometric measures were correlated with EBP.

Outcomes of second-line antiretroviral therapy among children living with HIV: a global cohort analysis

INTRODUCTION

Limited data describe outcomes on second-line antiretroviral therapy (ART) among children globally. Our objective was to contribute data on outcomes among children living with HIV after initiation of second-line ART in the context of routine care within a large global cohort collaboration.

METHODS

Patient-level data from 1993 through 2015 from 11 paediatric HIV cohorts were pooled. Characteristics at switch and through two years of follow-up were summarized for children who switched to second-line ART after starting a standard first-line regimen in North America, Latin America, Europe, Asia, Southern Africa (South Africa & Botswana) and the rest of sub-Saharan Africa (SSA). Cumulative incidences of mortality and loss to follow-up (LTFU) were estimated using a competing risks framework.

RESULTS

Of the 85,389 children on first-line ART, 3,555 (4%) switched to second-line after a median of 2.8 years on ART (IQR: 1.6, 4.7); 69% were from Southern Africa or SSA and 86% of second-line regimens were protease inhibitor-based. At switch, median age was 8.4 years and 50% had a prior AIDS diagnosis. Median follow-up after switch to second-line ranged from 1.8 years in SSA to 5.3 years in North America. Median CD4 counts at switch to second-line ranged from 235 cells/mm3 in SSA to 828 cells/mm3 in North America. Improvements in CD4 counts were observed over two years of follow-up, particularly in regions with lower CD4 counts at second-line switch. Improvements in weight-for-age z-scores were not observed during follow-up. Cumulative incidence of LTFU at two years was <5% in all regions except SSA (7.1%) and Southern Africa (7.4%). Risk of mortality was <3% at two years of follow-up in all regions, except Latin America (4.9%) and SSA (5.5%).

CONCLUSIONS

Children switched to second-line ART experience CD4 count increases as well as low to moderate rates of LTFU and mortality within two years after switch. Severe immune deficiency at time of switch in some settings suggests need for improved recognition and management of treatment failure in children.

Nutrients Essential for Cognitive Function Are Typical Problem Nutrients in the Diets of Myanmar Primary School Children: Findings of a Linear Programming Analysis

BACKGROUND

Good cognitive function is important for school-age children. Although essential fatty acids play a main role in cognitive functions, their intakes are assumed as inadequate among developing countries including Myanmar. However, there is still lack of evidence to show whether they are problem nutrients.

OBJECTIVE

This study aimed to determine the problem nutrients in the diets of Myanmar primary schoolchildren and to formulate food-based recommendations (FBR) to optimize the intake of these micronutrients.

METHODS

A cross-sectional study was conducted at 3 primary schools in Nyaungdon Township of Myanmar. A 1-week dietary intake assessment was done on 7- to 9-year-old (n = 100) primary schoolchildren. A linear programming approach using the World Health Organization Optifood software was used to assess the nutrient intake and develop FBRs.

RESULTS

The prevalence of stunted growth, wasting, and being underweight in the students were 28%, 18%, and 28%, respectively. The intake of calcium, vitamin B₁, folate, iron, omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid was insufficient. Locally available nutrient-dense foods that include water spinach, carp fish, duck egg, garden pea, and shrimp were selected to develop FBR to increase the intake of problem nutrients.

CONCLUSION

The linear programming analysis showed that the primary schoolchildren have difficulty meeting nutrient recommendations given locally available foods, especially iron and essential fatty acids which are important for cognitive performance of schoolchildren.

The association of maternal nutrition and children's pre-primary experience with over-age attendance in secondary school: evidence from lowland Nepal

•Over-age attendance is increasing but remains under-studied in South Asia.•Children fall behind by entering pre-primary or primary late, and by repeating a grade during/after primary school.•Rural location, thin and uneducated mothers predicted late pre-primary entry.•Educational research and interventions need to focus on the earlier time-point of pre-primary.•Improving maternal nutrition and education may ensure timely progression of children in school.

School-based intervention that integrates nutrition education and supportive healthy school food environment among Malaysian primary school children: a study protocol

BACKGROUND

Malnutrition among school children may contribute to adverse health consequences such as non-communicable diseases, poor cognitive performance, psychological distress and poor quality of life that may persist into adulthood. In order to prevent childhood malnutrition, an intervention programme that integrates nutrition education and healthy school food environment is needed to provide nutrition information and reinforce the skills on healthy eating behaviours in schools. This paper describes a study protocol of a school-based intervention programme that integrates nutrition education and healthy school food environment, namely School Nutrition Programme (SNP). The SNP is a primary prevention programme that promotes healthy lifestyle among primary school children in light of the high prevalence of malnutrition in Malaysian children.

METHODS/DESIGN

This quasi-experimental study aimed to evaluate the effectiveness of the SNP between intervention and comparison groups before and after the SNP, and after a 3-month follow-up. The SNP consisted of two main components, whereby three nutrition education sessions were implemented by trained teachers using three standardised modules, and healthy school food environment was implemented by the canteen food handlers with the provision of healthy menu to children during school recess times. Children from intervention group participated in the SNP, in addition to the standard Physical and Health Curriculum. The comparison group attended only the standardised Physical and Health Curriculum and the school canteen food handlers were reminded to follow the standard canteen guidelines from the Ministry of Education Malaysia. The assessment parameters in evaluating the effectiveness of the programme were knowledge, attitude and practice on nutrition, eating behaviours, physical activity, body composition, psychological distress, cognitive performance and health-related quality of life. Assessments were conducted at three time points: pre-intervention, post-intervention and 3-month follow-up.

DISCUSSION

It was hypothesised that the SNP would be effective in promoting healthy lifestyle among school children, and further contributes in preventing malnutrition problem, enhancing cognitive performance and improving health-related quality of life among school children. Findings of the present study can be expanded to other schools in future on ways to improve nutrition education and healthy school food environment.

TRIAL REGISTRATION

UMIN Clinical Trial Registration UMIN000032914 (Date of registration: 7th June 2018, retrospectively registered).

PROTOCOL VERSION

16th September 2019 & Version 4.

Early growth and home environment are associated with cognitive development in the first year of life of Malaysian infants

BACKGROUND

Undernutrition and poor home environment in the first 2 years of life may have long-term effects on cognitive development.

AIMS

To determine the influence of linear growth and home environment towards cognitive development in the first year of life of Malaysian infants.

STUDY DESIGN

Cross-sectional findings at 12-13 months from a prospective cohort study of infants in Malaysia.

SUBJECTS

One hundred fifty-one infants recruited at 2-5 months were visited at home at 12-13 months (M = 12.95, SD = 0.98).

OUTCOME MEASURES

Maternal and infant measures during pregnancy and at birth were obtained from patient health clinic cards. Weight and length of infants were measured at 12-13 months. Home environment and cognitive development were assessed using HOME inventory and Bayley-III, respectively.

RESULTS

About 22.5% of infants experienced stunting and 14.6% had low home environment quality. The mean cognitive score was 94.54 (SD = 12.00). Stunted infants had 7.59 lower cognitive scores than non-stunted infants, while infants with low home environment quality had 12.09 lower cognitive scores than those with high home environment quality. Cognitive scores increased with better home environment quality in both stunted and non-stunted infants, but stunted infants scored lower than non-stunted infants in all conditions.

CONCLUSION

Stunting, a form of chronic undernutrition, and poor home environment may significantly influence cognitive development of infants. Interventions to prevent undernutrition should start as early as during pregnancy and caregivers should be informed on their roles in providing cognitive stimulation within the home environment for their children.

Nutritional status, cognitive achievement, and educational attainment of children aged 8-11 in rural South India

BACKGROUND

Malnutrition among children is one of the most pressing health concerns middle- and low-income countries face today, particularly those in Sub-Saharan Africa and South Asia. Early-life malnutrition has been shown to affect long-term health and income. One hypothesized channel linking early-life malnutrition and long-term outcomes is cognitive development. However, there is limited empirical evidence on the relationship between nutritional status and cognitive achievement in middle childhood.

STUDY DESIGN

As part of the South India Community Health Study (SICHS), we collected educational attainment and anthropometric data from 1,194 children in rural Vellore district of Tamil Nadu, India, and assessed their math and reading skills. We analyzed the relationship between continuous and binary anthropometric measures of nutritional status and three measures of cognitive achievement (reading, math, and grade level), adjusting for potential confounders, using a regression framework.

RESULTS

Lower height-for-age and weight-for-age and their corresponding binary measures (stunting, underweight) were associated with lower reading scores, lower math scores, and lower grade level, with the exception of the association between weight-for-age and reading, which was marginally significant. A stunted child had one-third of a grade disadvantage compared to a non-stunted counterpart, whereas an underweight child had one-fourth of a grade disadvantage compared to a non-underweight counterpart. Lower BMI-for-age was associated with grade level and marginally associated with lower math scores, and its binary measure (thinness) was marginally associated with lower math scores.

CONCLUSIONS

Acute and chronic malnutrition in middle childhood were negatively associated with math scores, reading scores, and educational attainment. Our study provides new evidence that cognitive achievement during middle childhood could be an important mechanism underlying the association between early-life malnutrition and long-term wellbeing.

Low socioeconomic status and severe obesity are linked to poor cognitive performance in Malaysian children

Background

Socioeconomic factors and nutritional status have been associated with childhood cognitive development. However, previous Malaysian studies had been conducted with small populations and had inconsistent results. Thus, this present study aims to determine the association between socioeconomic and nutritional status with cognitive performance in a nationally representative sample of Malaysian children.

Methods

A total of 2406 Malaysian children aged 5 to 12 years, who had participated in the South East Asian Nutrition Surveys (SEANUTS), were included in this study. Cognitive performance [non-verbal intelligence quotient (IQ)] was measured using Raven’s Progressive Matrices, while socioeconomic characteristics were determined using parent-report questionnaires. Body mass index (BMI) was calculated using measured weight and height, while BMI-for-age Z-score (BAZ) and height-for-age Z-score (HAZ) were determined using WHO 2007 growth reference.

Results

Overall, about a third (35.0%) of the children had above average non-verbal IQ (high average: 110–119; superior: ≥120 and above), while only 12.2% were categorized as having low/borderline IQ (< 80). Children with severe obesity (BAZ > 3SD), children from very low household income families and children whose parents had only up to primary level education had the highest prevalence of low/borderline non-verbal IQ, compared to their non-obese and higher socioeconomic counterparts. Parental lack of education was associated with low/borderline/below average IQ [paternal, OR = 2.38 (95%CI 1.22, 4.62); maternal, OR = 2.64 (95%CI 1.32, 5.30)]. Children from the lowest income group were twice as likely to have low/borderline/below average IQ [OR = 2.01 (95%CI 1.16, 3.49)]. Children with severe obesity were twice as likely to have poor non-verbal IQ than children with normal BMI [OR = 2.28 (95%CI 1.23, 4.24)].

Conclusions

Children from disadvantaged backgrounds (that is those from very low income families and those whose parents had primary education or lower) and children with severe obesity are more likely to have poor non-verbal IQ. Further studies to investigate the social and environmental factors linked to cognitive performance will provide deeper insights into the measures that can be taken to improve the cognitive performance of Malaysian children.

Psychological Factors and Cardiovascular Disease Risk Factors as Mediators of the Relationship between Overweight/Obesity and Cognitive Function among School Children in Kuala Lumpur, Malaysia

BACKGROUND

Recent research suggests that a negative relationship exists between adiposity and cognitive function in children. However, limited information is known on how they are related. This study aimed to examine the mediators of the relationship between overweight/obesity and cognitive function among school children in Kuala Lumpur, Malaysia.

METHODS

This is a cross-sectional comparison study whereby 225 overweight/obese children matched for age, sex, and ethnicity with 225 normal weight children participated in this study. Body image dissatisfaction, disordered eating, and depressive symptoms were assessed through a self-administered questionnaire. Blood pressure was measured, whereas blood was drawn to determine insulin, high-sensitivity C-reactive protein (hs-CRP), glucose, and lipid profiles. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated using glucose and insulin levels. Wechsler's Intelligence Scale for Children-Fourth Edition (WISC-IV) was used to assess cognitive function in children. Ordinary least square regression analysis was conducted to determine the direct and indirect relationships between weight status and cognitive function.

RESULTS

A negative relationship was found between overweight/obesity with cognitive function. Overweight/obese children were on average 4.075 units lower in cognitive function scores compared to normal weight children. Such difference was found through mediators, such as body image dissatisfaction, disordered eating, depression, systolic blood pressure, triglycerides, HOMA-IR, and hs-CRP, contributing 22.2% of the variances in cognitive function in children.

CONCLUSION

Results highlight the important mediators of the relationship between overweight/obesity and cognitive function. Consequently, future interventions should target to improve psychological well-being and reduce cardiovascular disease risk for the prevention of poorer cognitive performance in overweight/obese children.

Early undernutrition as a cause of changes in phonological processing skills

ABSTRACT Purpose: to determine whether undernutrition in the first years of life affects the phonological awareness skills, the phonological working memory and the school performance of children. Methods: the participants were children with a history of moderate/severe undernutrition during their first years of life (G1) who achieved nutritional recovery (n = 15). The performance of G1 in different cognitive tasks (phonological awareness at the syllable and phoneme level, phonological working memory - repetition of digits and pseudowords, and reading, writing and arithmetic activities) was compared to that of children with school difficulties (G2) (n = 15) and without school difficulties (G3) (n = 15), all eutrophic ones. Results: the performance of G1 was worse than that of the other two groups in all tasks evaluated (mean score of G1, G2 and G3 and p-values: phonological awareness: 31, 41, 57 - 0.01; repetition of direct order digits: 18, 23, 28 - 0.001; writing: 4, 10, 22 - 0.001; reading: 26, 45, 65-0.001; arithmetic: 4, 7, 11- 0.001). Conclusion: the results demonstrate that undernutrition affected the cognitive development, causing changes in important cognitive skills for the development of written language.

Urban-Rural Differences in Nutritional Status and Dietary Intakes of School-Aged Children in Cambodia

This study aimed to describe the nutritional status and dietary patterns of Cambodian school-aged children compared with those in the South East Asian Nutrition Survey (SEANUTS; Indonesia, Malaysia, Thailand, and Vietnam in 2011) and to clarify the urban-rural differences using data from a nationally representative sample. The survey was conducted in 2014/2015 with a sample of 2020 children aged 6–17 years from 136 randomly selected schools. Standardized anthropometric measurements and a 1-day dietary survey by 24-h recall method were conducted. Extended analyses in the present study revealed that the difference between rural and urban areas was similar to that of the SEANUTS; the overall prevalence of stunting remained high (33.2%). Stunting was more prevalent in children living in rural areas than in those in urban areas (total: 36.4% vs. 20.4%). In contrast, the overall prevalence of overweight and obesity was not as high (3.1%), but was higher among urban children in all age groups compared with those living in rural areas (total: 6.4% vs. 2.3%). Overall, the dietary intake of children did not meet the local recommended dietary allowances, which was similar to the results of the SEANUTS and differed across urban and rural areas.

A multicenter, randomized controlled comparison of three renutrition strategies for the management of moderate acute malnutrition among children aged from 6 to 24 months (the MALINEA project)

BACKGROUND

The aim of this open-label, randomized controlled trial conducted in four African countries (Madagascar, Niger, Central African Republic, and Senegal) is to compare three strategies of renutrition for moderate acute malnutrition (MAM) in children based on modulation of the gut microbiota with enriched flours alone, enriched flours with prebiotics or enriched flours coupled with antibiotic treatment.

METHODS

To be included, children aged between 6 months and 2 years are preselected based on mid-upper-arm circumference (MUAC) and are included based on a weight-for-height Z-score (WHZ) between - 3 and - 2 standard deviations (SD). As per current protocols, children receive renutrition treatment for 12 weeks and are assessed weekly to determine improvement. The primary endpoint is recovery, defined by a WHZ ≥ - 1.5 SD after 12 weeks of treatment. Data collected include clinical and socioeconomic characteristics, side effects, compliance and tolerance to interventions. Metagenomic analysis of gut microbiota is conducted at inclusion, 3 months, and 6 months. The cognitive development of children is evaluated in Senegal using only the Developmental Milestones Checklist II (DMC II) questionnaire at inclusion and at 3, 6, and 9 months. The data will be correlated with renutrition efficacy and metagenomic data.

DISCUSSION

This study will provide new insights for the treatment of MAM, as well as original data on the modulation of gut microbiota during the renutrition process to support (or not) the microbiota hypothesis of malnutrition.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT03474276 Last update 28 May 2018.

Docosahexaenoic acid levels in erythrocytes and their association with the University Selection Test Outcomes in Chile

The aim of this study was to quantitate the relative impact of DHA and AA levels in erythrocytes, anthropometric parameters and socio-economic status of school-age children, of both genders, graduated from high school in Chile, on the scholastic achievement in the University Selection Test (Prueba de Selección Universitaria, PSU) both language scholastic achievement (LSA) and mathematics scholastic achievement (MSA). A representative sample of 671 school-age young graduated from high school in 2013, 550 and 548 of them took the PSU for LSA and MSA, respectively. Only school-age young with high (n = 91) and low (n = 69) SA in both tests were considered. A total of 122 school-age children agreed to participate in the study and were divided as follows: Group 1: high PSU outcome (n = 70; males n = 48) and Group 2: low PSU outcome (n = 52; males n = 23). Data were analyzed by means of SAS software. Independently of gender, DHA, socio-economic status and head circumference-for-age Z-score were the most relevant parameters explaining both LSA (R²= 0.650; p < 0.0001) and MSA outcomes (R²= 0.700; p < 0.0001). These results can be useful for nutrition, health and education planning, in order to protect children starting from an early age and thus increase their school outcomes.

Impact of anthropometric nutritional parameters on the university selection test in Chile: A multifactorial approach

OBJECTIVES

Scholastic achievement (SA) is a multifactorial problem that depends on factors related to the child, the child's family, and the educational system. The aim of this study was to quantify the relative impact of significant variables at the beginning of high school during 2010 (first grade of high school [1 HSG]) on 2013 university selection test (Prueba de Seleccion Universitaria [PSU]) outcomes, both in language scholastic achievement (LSA) and mathematics scholastic achievement (MSA), when students graduated from high school (4 HSG). This was done at the time of university admission with a multicausal approach. The purpose was to confirm the hypothesis that the level of educational establishment SA, intellectual ability, sex, parental schooling levels, and head circumference for age Z-score at the onset of high school are the most relevant parameters associated with 2013 PSU outcomes, both in LSA and MSA.

METHODS

A representative, proportional, and stratified sample of 671 children of both sexes who enrolled in 1 HSG in 2010 (mean age: 14.8 ± 0.6 y) participated in the study. Nutritional, intellectual, brain developmental, cardiovascular risk, socio-to-economic, demographic, and educational variables were quantitated. SA was assessed at 4 HSG with the 2013 PSU tests. Data were analyzed with SAS software.

RESULTS

Educational establishment SA, intellectual ability, maternal schooling, and age Z-score were the most relevant parameters to explain LSA (R² = 0.493; P < 0.0001) and MSA variance in addition to sex (male), but only in MSA (R² = 0.600; P < 0.0001).

CONCLUSIONS

These findings confirm the hypothesis and can be useful to support nutritional, health, and educational planning.

Contribution of early nutrition on the development of malnutrition and allergic diseases in the first year of life: a study protocol for the Mother and Infant Cohort Study (MICOS)

BACKGROUND

Nutrition and environmental factors are essential for the education of the neonatal immune system. Epidemiological evidence has shown that malnutrition and allergic diseases that occur during early childhood share similar protective and risk factors. This paper describes the protocol of the Mother and Infant Cohort Study (MICOS), which aims to determine the contribution of early nutrition to the development of malnutrition and allergic diseases in infants' first year of life.

METHODS

MICOS is a prospective cohort study conducted at selected government health clinics in two states, namely Selangor and Wilayah Persekutuan Kuala Lumpur, Malaysia. Women in their third trimester of pregnancy are recruited into the study and their infants will be followed-up at 3, 6, and 12 months of age. Information on prenatal factors including socio-demographic characteristics, obstetric history, pre-pregnancy body mass index, gestational weight gain, smoking, family history of allergic diseases, maternal dietary intake and sunlight exposure during pregnancy are obtained through face-to-face interviews. Postnatal factors including dietary intake, sun exposure, and anthropometric measurements of the mothers, as well as feeding practices, dietary intake, anthropometric measurements, and development of allergic diseases of the infants are assessed at each follow-up. Blood samples are collected from the mothers in the third trimester to determine 25-hydroxyvitamin D levels as well as from the infants at age 12 months to determine atopic sensitisation.

DISCUSSION

The concept of developmental origins of health and disease (DOHaD) which emphasises on the role of early life environments in shaping future health and disease susceptibility in adulthood has gained a huge interest in recent years. The DOHaD paradigm has influenced many fields of research including malnutrition and allergic diseases. While findings from the developed countries remain controversial, such studies are scarce in developing countries including Malaysia. The present study will determine the cause and effect relationship between early nutrition and the development of malnutrition and allergic diseases in infants' first year of life.

Overweight and obesity in Indonesia: prevalence and risk factors-a literature review

OBJECTIVES

Overweight/obesity is a problem faced by both high- and low- and middle-income countries. This review aimed to report published data on the prevalence of overweight and obesity in Indonesian children, adolescents, and adults, along with the associated risk factors.

STUDY DESIGN

Literature review.

METHODS

We conducted a literature search for articles published in English (through Medline via OvidSP, Scopus, Global Health via OvidSP and Web of Science electronic databases) and Indonesian languages (several websites, direct contact with Indonesian public health researchers, practitioners and Ministry of Health staff) from earliest to March 2016. We screened the results and ensured the quality of included studies with Loney's tools for critically appraising prevalence or incidence studies.

RESULTS

We included 17 papers on the topic which were available in full text and passed the critical appraisal process. The prevalence of overweight/obesity has increased over the past two decades in Indonesian children, adolescents and adults. Prevalence rates are higher in boys than girls among children, but higher in females in the adolescent and adult age groups. The prevalence of overweight/obesity is also higher in those living in urban areas and with higher income or education.

CONCLUSIONS

Overweight/obesity is a serious public health problem in Indonesia with a continuing increase in its prevalence. Interventions at the household level and beyond are needed to successfully lower the prevalence of overweight/obesity in the country.

Newly arrived refugee children with Helicobacter pylori are thinner than their non-infected counterparts

The hypothesis of this study was that those refugee children with Helicobacter pylori are thinner than their non-infected counterparts. This cross-sectional study investigated the height and weight of newly arrived refugee children up to age 19 years, who were screened for H. pylori using a stool antigen test at the Migrant Health Service in Adelaide between August 2010 and October 2013. Of 460 children, 21% were infected with H. pylori. After adjusting for vitamin B12 and iron levels, ethnicity, age and sex, the odds of being thin in the 10- to 19-year-old age group was 4.28-fold higher (95% CI 1.48–12.4) if they were H. pylori positive compared with those who were H. pylori negative. The difference between the two groups is statistically significant (P=0.01). Screening and treatment for H. pylori in the general population in developed countries is not recommended unless there are symptoms such as dyspepsia or risk of peptic ulcer, duodenal ulcer or gastric cancer. Given the findings of this study, a recommendation could be made that newly arrived refugee children who are thin should be tested for H. pylori. Thinness in children may influence their cognitive ability, school performance, physical endurance and hence their ability to successfully settle into their new country.

Nutrition Status of Primary School Students in Two Rural Regions of Guinea-Bissau

BACKGROUND

The nutrition status of primary schoolchildren in Africa has received relatively little attention in comparison to that of younger children. We surveyed primary school students in Guinea-Bissau, a nation that is among the poorest in the world.

OBJECTIVE

Anthropometry and prevalence of anemia and vitamin A deficiency were assessed in schoolchildren participating in International Partnership for Human Development's school feeding program in 2 regions of Guinea-Bissau.

METHODS

A cross-sectional survey of 32 schools in the regions of Cacheu and Oio was conducted in November 2011. Variables included age, gender, weight, height, hemoglobin, and retinol-binding protein concentrations. Z scores for height for age (HAZ), body mass index for age (BAZ), and weight for age were calculated using World Health Organization reference data.

RESULTS

Anthropometric assessment of 4784 students revealed stunting (HAZ < -2) in 15.5%, thinness (BAZ < -2) in 13.2%, and anemia in 42.0%. Stunting, thinness, and anemia were significantly more common in males, in students from Oio, and in older students. Vitamin A deficiency, detected in 21.5% of the population, was the only assessment that did not demonstrate significant differences between genders or regions. About 61.1% of all children had 1 or more indicators of undernutrition.

CONCLUSION

There are substantial rates of stunting, thinness, underweight, anemia, and vitamin A deficiency in primary schoolchildren in Guinea-Bissau, even among those participating in a school lunch program and particularly among males and older students. The results suggest the need for evaluating feeding programs and other methods to improve nutrition status in primary school students, especially in older students.

Overweight and obese infants present lower cognitive and motor development scores than normal-weight peers

AIMS

Compare the cognitive and motor development in overweight/obese infants versus normal-weight peers and investigate the correlation of body weight, body length and body mass index with cognitive and motor development.

METHODS

We conducted a cross-sectional study with 28 overweight/obese infants and 28 normal-weight peers between 6 and 24 months of age. Both groups were evaluated with cognitive and motor scales of the Bayley-III infant development test. The t-test for independent samples was performed to compare the groups, and the Spearman correlation was used to verify the association between variables.

RESULTS

Overweight/obese infants showed lower cognitive and motor composite scores than their normal-weight peers. A significant negative association was found of body weight and body length with cognitive development and of body mass index with motor development.

CONCLUSION

This is the first study that found an effect on both cognitive and motor development in overweight/obese infants when compared with normal-weight peers between 6 and 24 months of age.

Effect of prenatal and postnatal malnutrition on intellectual functioning in early school-aged children in rural western China

The aim of this study was to evaluate the effect of prenatal and postnatal malnutrition on the intellectual functioning of early school-aged children. We followed the offspring of women who had participated in a trial of prenatal supplementation with different combinations of micronutrients and who remained resident in the study field. We measured their intellectual functioning using the Wechsler intelligence scale for children (WISC-IV). Height-for-age, weight-for-age, and body mass index (BMI)-for-age were used as anthropometric nutritional status indices. Four of the 5 composite scores derived from the WISC-IV, except for working memory index (WMI), were significantly lower in low birth weight children after adjusting for confounds. All 5 composite scores, including full-scale intelligence quotient (FSIQ), verbal comprehension index (VCI), WMI, perceptual reasoning index (PRI), and processing speed index (PSI) were significant lower in stunted and underweight children. The differences in the means of WISC-IV test scores were greatest between stunted and nonstunted children. The means for FSIQ, VCI, WMI, PRI, and PSI were as follows: 5.88 (95% confidence interval [CI]: 2.84-8.92), 5.08 (95% CI: 1.12-8.41), 4.71 (95% CI: 1.78-7.66), 6.13 (95% CI: 2.83-9.44), and 5.81 (95% CI: 2.61-9.00). These means were lower in stunted children after adjusting for confounds. Our results suggest the important influences of low birth weight and postnatal malnutrition (stunting, low body weight) on intellectual functioning in early school-aged children.

Persistent Inequalities in Child Undernutrition in Cambodia from 2000 until Today

The study assessed the trends of nutritional status of children under age five in Cambodia over four DHS surveys from 2000 to 2014 and the contribution of socioeconomic and demographic factors to its changes. Undernutrition was a public health problem in all surveys. Despite consistent improvement over the years, stunting still affected 32.5% of children in 2014. Wasting prevalence did not improve since 2005 and affected 9.6% of children under five in 2014. Low wealth and mother education; and rural residence contributed to undernutrition. In 2014; wealth status was the main socioeconomic factor associated with undernutrition and the nutritional status of children was strongly related to that of their mothers. Anemia prevalence was high and after a decrease between 2000 and 2005 remained at 45%. The prevalence of overweight was less than 10% and did not change over the years despite an increasing trend in the richest households of urban areas. Persistent inequalities in child undernutrition call for action, giving priority to the most vulnerable households to ensure availability and access to nutrient-rich foods for women and children through nutrition-sensitive and nutrition-specific programs. The recent increase of overweight in the richest populations must also be considered in Cambodian health policies.

Height for age z score and cognitive function are associated with Academic performance among school children aged 8-11 years old

Background

Academic achievement of school age children can be affected by several factors such as nutritional status, demographics, and socioeconomic factors. Though evidence about the magnitude of malnutrition is well established in Ethiopia, there is a paucity of evidence about the association of nutritional status with academic performance among the nation’s school age children. Hence, this study aimed to determine how nutritional status and cognitive function are associated with academic performance of school children in Goba town, South East Ethiopia.

Methods

An institution based cross-sectional study was conducted among 131 school age students from primary schools in Goba town enrolled during the 2013/2014 academic year. The nutritional status of students was assessed by anthropometric measurement, while the cognitive assessment was measured by the Kaufman Assessment Battery for Children (KABC-II) and Ravens colored progressive matrices (Raven’s CPM) tests. The academic performance of the school children was measured by collecting the preceding semester academic result from the school record. Descriptive statistics, bivariate and multivariable linear regression were used in the statistical analysis.

Results

This study found a statistically significant positive association between all cognitive test scores and average academic performance except for number recall (p = 0.12) and hand movements (p = 0.08). The correlation between all cognitive test scores and mathematics score was found positive and statistically significant (p < 0.05). In the multivariable linear regression model, better wealth index was significantly associated with higher mathematics score (ß = 0.63; 95 % CI: 0.12–0.74). Similarly a unit change in height for age z score resulted in 2.11 unit change in mathematics score (ß = 2.11; 95 % CI: 0.002–4.21). A single unit change of wealth index resulted 0.53 unit changes in average score of all academic subjects among school age children (ß = 0.53; 95 % CI: 0.11–0.95). A single unit change of age resulted 3.23 unit change in average score of all academic subjects among school age children (ß = 3.23; 95 % CI: 1.20–5.27).

Conclusion

Nutritional status (height for age Z score) and wealth could be modifiable factors to improve academic performance of school age children. Moreover, interventions to improve nutrition for mothers and children may be an important contributor to academic success and national economic growth in Ethiopia. Further study with strong design and large sample size is needed.