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Ajeeb TT, Gonzalez E, Solomons NW, Vossenaar M, Koski KG. Human milk microbiome: associations with maternal diet and infant growth. Front Nutr 2024; 11:1341777. [PMID: 38529196 PMCID: PMC10962684 DOI: 10.3389/fnut.2024.1341777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Ingestion of human milk (HM) is identified as a significant factor associated with early infant gut microbial colonization, which has been associated with infant health and development. Maternal diet has been associated with the HM microbiome (HMM). However, a few studies have explored the associations among maternal diet, HMM, and infant growth during the first 6 months of lactation. Methods For this cross-sectional study, Mam-Mayan mother-infant dyads (n = 64) were recruited from 8 rural communities in the Western Highlands of Guatemala at two stages of lactation: early (6-46 days postpartum, n = 29) or late (109-184 days postpartum, n = 35). Recruited mothers had vaginally delivered singleton births, had no subclinical mastitis or antibiotic treatments, and breastfed their infants. Data collected at both stages of lactation included two 24-h recalls, milk samples, and infant growth status indicators: head-circumference-for-age-z-score (HCAZ), length-for-age-z-score (LAZ), and weight-for-age-z-score (WAZ). Infants were divided into subgroups: normal weight (WAZ ≥ -1SD) and mildly underweight (WAZ < -1SD), non-stunted (LAZ ≥ -1.5SD) and mildly stunted (LAZ < -1.5SD), and normal head-circumference (HCAZ ≥ -1SD) and smaller head-circumference (HCAZ < -1SD). HMM was identified using 16S rRNA gene sequencing; amplicon analysis was performed with the high-resolution ANCHOR pipeline, and DESeq2 identified the differentially abundant (DA) HMM at the species-level between infant growth groups (FDR < 0.05) in both early and late lactation. Results Using both cluster and univariate analyses, we identified (a) positive correlations between infant growth clusters and maternal dietary clusters, (b) both positive and negative associations among maternal macronutrient and micronutrient intakes with the HMM at the species level and (c) distinct correlations between HMM DA taxa with maternal nutrient intakes and infant z-scores that differed between breast-fed infants experiencing growth faltering and normal growth in early and late lactation. Conclusion Collectively, these findings provide important evidence of the potential influence of maternal diet on the early-life growth of breastfed infants via modulation of the HMM.
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Affiliation(s)
- Tamara T. Ajeeb
- School of Human Nutrition, McGill University, Montreal, QC, Canada
- Department of Clinical Nutrition, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Emmanuel Gonzalez
- Canadian Centre for Computational Genomics, McGill Genome Centre, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
| | - Noel W. Solomons
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
| | - Marieke Vossenaar
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
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Oh J, Ordoñez ELT, Velasquez E, Mejía M, Grazioso MDP, Rohloff P, Smith BA. Early full-day leg movement kinematics and swaddling patterns in infants in rural Guatemala: A pilot study. PLoS One 2024; 19:e0298652. [PMID: 38422106 PMCID: PMC10903813 DOI: 10.1371/journal.pone.0298652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Tools to accurately assess infants' neurodevelopmental status very early in their lives are limited. Wearable sensors may provide a novel approach for very early assessment of infant neurodevelopmental status. This may be especially relevant in rural and low-resource global settings. METHODS We conducted a longitudinal observational study and used wearable sensors to repeatedly measure the kinematic leg movement characteristics of 41 infants in rural Guatemala three times across full days between birth and 6 months of age. In addition, we collected sociodemographic data, growth data, and caregiver estimates of swaddling behaviors. We used visual analysis and multivariable linear mixed models to evaluate the associations between two leg movement kinematic variables (awake movement rate, peak acceleration per movement) and infant age, swaddling behaviors, growth, and other covariates. RESULTS Multivariable mixed models of sensor data showed age-dependent increases in leg movement rates (2.16 [95% CI 0.80,3.52] movements/awake hour/day of life) and movement acceleration (5.04e-3 m/s2 [95% CI 3.79e-3, 6.27e-3]/day of life). Swaddling time as well as growth status, poverty status and multiple other clinical and sociodemographic variables had no impact on either movement variable. CONCLUSIONS Collecting wearable sensor data on young infants in a rural low-resource setting is feasible and can be used to monitor age-dependent changes in movement kinematics. Future work will evaluate associations between these kinematic variables from sensors and formal developmental measures, such as the Bayley Scales of Infant and Toddler Development.
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Affiliation(s)
- Jinseok Oh
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | | | | | | | | | - Peter Rohloff
- Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Beth A. Smith
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
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Wells JCK, Desoye G, Leon DA. Reconsidering the developmental origins of adult disease paradigm: The 'metabolic coordination of childbirth' hypothesis. Evol Med Public Health 2024; 12:50-66. [PMID: 38380130 PMCID: PMC10878253 DOI: 10.1093/emph/eoae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/18/2023] [Indexed: 02/22/2024] Open
Abstract
In uncomplicated pregnancies, birthweight is inversely associated with adult non-communicable disease (NCD) risk. One proposed mechanism is maternal malnutrition during pregnancy. Another explanation is that shared genes link birthweight with NCDs. Both hypotheses are supported, but evolutionary perspectives address only the environmental pathway. We propose that genetic and environmental associations of birthweight with NCD risk reflect coordinated regulatory systems between mother and foetus, that evolved to reduce risks of obstructed labour. First, the foetus must tailor its growth to maternal metabolic signals, as it cannot predict the size of the birth canal from its own genome. Second, we predict that maternal alleles that promote placental nutrient supply have been selected to constrain foetal growth and gestation length when fetally expressed. Conversely, maternal alleles that increase birth canal size have been selected to promote foetal growth and gestation when fetally expressed. Evidence supports these hypotheses. These regulatory mechanisms may have undergone powerful selection as hominin neonates evolved larger size and encephalisation, since every mother is at risk of gestating a baby excessively for her pelvis. Our perspective can explain the inverse association of birthweight with NCD risk across most of the birthweight range: any constraint of birthweight, through plastic or genetic mechanisms, may reduce the capacity for homeostasis and increase NCD susceptibility. However, maternal obesity and diabetes can overwhelm this coordination system, challenging vaginal delivery while increasing offspring NCD risk. We argue that selection on viable vaginal delivery played an over-arching role in shaping the association of birthweight with NCD risk.
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Affiliation(s)
- Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - David A Leon
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Olson D, Lamb MM, Connery AK, Colbert AM, Calvimontes M, Bauer D, Paniagua-Avila MA, Martínez MA, Arroyave P, Hernandez S, Colborn KL, Roell Y, Waggoner JJ, Natrajan MS, Anderson EJ, Bolaños GA, El Sahly HM, Munoz FM, Asturias EJ. Cumulative Febrile, Respiratory, and Gastrointestinal Illness Among Infants in Rural Guatemala and Association With Neurodevelopmental and Growth Outcomes. Pediatr Infect Dis J 2023; 42:739-744. [PMID: 37343218 PMCID: PMC10527407 DOI: 10.1097/inf.0000000000004006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Infectious disease exposures in early life are increasingly recognized as a risk factor for poor subsequent growth and neurodevelopment. We aimed to evaluate the association between cumulative illness with neurodevelopment and growth outcomes in a birth cohort of Guatemalan infants. METHODS From June 2017 to July 2018, infants 0-3 months of age living in a resource-limited region of rural southwest Guatemala were enrolled and underwent weekly at-home surveillance for caregiver-reported cough, fever, and vomiting/diarrhea. They also underwent anthropometric assessments and neurodevelopmental testing with the Mullen Scales of Early Learning (MSEL) at enrollment, 6 months, and 1 year. RESULTS Of 499 enrolled infants, 430 (86.2%) completed all study procedures and were included in the analysis. At 12-15 months of age, 140 (32.6%) infants had stunting (length-for-age Z [LAZ] score < -2 SD) and 72 (16.7%) had microcephaly (occipital-frontal circumference [OFC] < -2 SD). In multivariable analysis, greater cumulative instances of reported cough illness (beta = -0.08/illness-week, P = 0.06) and febrile illness (beta = -0.36/illness-week, P < 0.001) were marginally or significantly associated with lower MSEL Early Learning Composite (ELC) Score at 12-15 months, respectively; there was no association with any illness (cough, fever, and/or vomiting/diarrhea; P = 0.27) or with cumulative instances of diarrheal/vomiting illness alone ( P = 0.66). No association was shown between cumulative instances of illness and stunting or microcephaly at 12-15 months. CONCLUSIONS These findings highlight the negative cumulative consequences of frequent febrile and respiratory illness on neurodevelopment during infancy. Future studies should explore pathogen-specific illnesses, host response associated with these syndromic illnesses, and their association with neurodevelopment.
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Affiliation(s)
- Daniel Olson
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Molly M. Lamb
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Amy K. Connery
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, USA
| | - Alison M. Colbert
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045, USA
| | - Mirella Calvimontes
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Desiree Bauer
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - M. Alejandra Paniagua-Avila
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St. New York, NY 10032, USA
| | - María Alejandra Martínez
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Paola Arroyave
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Sara Hernandez
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Kathryn L. Colborn
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave #6117, Aurora, CO 80045, USA
| | - Yannik Roell
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
| | - Jesse J. Waggoner
- Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
| | - Muktha S. Natrajan
- Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
| | - Evan J. Anderson
- Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA
| | - Guillermo A. Bolaños
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | - Flor M. Munoz
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Edwin J. Asturias
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health, 13199 East Montview Blvd, Aurora, CO 80045, USA
- Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13001 E 17th Pl, Aurora, CO 80045, USA
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Tola G, Kassa A, Getu M, Dibaba B, Neggesse S. Prevalence of stunting and associated factors among neonates in Shebadino woreda, Sidama region South Ethiopia; a community-based cross-sectional study 2022. BMC Pediatr 2023; 23:276. [PMID: 37264376 DOI: 10.1186/s12887-023-04080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Stunting is a syndrome that begins at conception and leads to severe, irreversible physiological, physical and cognitive damage as an irreversible consequence of nutritional deficiencies and recurrent infections. Although multiple studies have been conducted in Ethiopia to show the magnitude of stunting and factors, all are concentrated on children aged between 6 to 59 months. Therefore, this study was done to determine the prevalence and associated factors of stunting at birth among new-borns. METHODS A community-based cross-sectional study design was employed on 512 neonates in Shebadino Woreda, Sidama Region South Ethiopia 2022. A multistage sampling technique was employed. The data was collected door-to-door using pretested and structured questionnaires, through face-to-face interviews. The collected data were cleaned manually, coded, entered into Epidata version 4.6, and exported to SPSS version 26 software for analysis. Bi-variable analysis was conducted to assess the association of independent variables with the outcome variable. Variables with a p-value < 0.25 in bi-variable logistic regression were further analyzed using multivariable logistic regression. The odds ratio (OR) with 95% CI was used as a measure of association, and variables that had a p-value less than 0.05 in the multivariable logistic regression were considered as significantly associated variables. RESULT The prevalence of stunting in this study was 27.5%: 95% CI 22.6 to 31.9. Factors such as residence (AOR = 4.1, 95% CI: 1.49, 11.25), ANC follow up (AOR = 2.66, 95% CI: 1.34, 5.27), started taking Amessa (AOR = 3.48, 95% CI: 1.27, 9.55) and Sex of the neonate (AOR = 2.15, 95% CI: 1.54, 5.23) were significantly associated with stunting at a p-value of < 0.05. CONCLUSION About 27% of neonates were stunted, which implies, it require a quick public health measurement. New-born who were live in rural area and those who were started traditional medication (Amessa) were more stunted. Besides this, stunting was prevalently observed among a mother who had no ANC follow-up and male neonates. Thus, the regional health bureau and Shebedino woreda health office should increase awareness creation to bring behavioural change at community level to prevent traditional medication usage, ANC follow-up and giving priority for those who live in rural area.
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Affiliation(s)
- Gizu Tola
- Department of Midwifery, College of Health Science, Mettu University, Mettu, Ethiopia.
| | - Andargachew Kassa
- Department of Midwifery, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Melkamu Getu
- Department of Midwifery, Jimma University, Jimma, Ethiopia
| | - Bekem Dibaba
- Department of Midwifery, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Shambel Neggesse
- Department of Midwifery, College of Health Science, Mettu University, Mettu, Ethiopia
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Setiawan AS, Indriyanti R, Suryanti N, Rahayuwati L, Juniarti N. Neonatal stunting and early childhood caries: A mini-review. Front Pediatr 2022; 10:871862. [PMID: 35923789 PMCID: PMC9339654 DOI: 10.3389/fped.2022.871862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
The nutritional status of pregnant women greatly determines their newborn outcome. Deficiencies of several micronutrients are associated with stunting in early childhood, affecting health into adulthood. However, apart from the systemic disease that has been a concern so far, fetal undernutrition can also be associated with dental caries in a child's early life, especially since the primary teeth begin to form during the mother's gestation period. The important thing to underline regarding the intrauterine formation of primary teeth is especially in terms of enamel formation. One of the causes of developmental enamel defects that will contribute to the emergence of early childhood caries is the malnutrition of the pregnant mother. This mini-review aims to understand the linkage mechanism behind neonatal stunting to early childhood caries. This concept is expected to generate further research to help prevent both growth stunting and early childhood caries. In addition, with some evidence-based research, the importance of the first dental visit can be further promoted.
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Affiliation(s)
- Arlette Suzy Setiawan
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Sumedang, Indonesia
| | - Ratna Indriyanti
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Sumedang, Indonesia
| | - Netty Suryanti
- Department of Community Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Sumedang, Indonesia
| | - Laili Rahayuwati
- Department of Community Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Neti Juniarti
- Department of Community Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
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Roegner A, Orozco MN, Jarquin C, Boegel W, Secaira C, Caballeros ME, Al-Saleh L, Rejmánková E. Childhood parasitic infections and gastrointestinal illness in indigenous communities at Lake Atitlán, Guatemala. PeerJ 2021; 9:e12331. [PMID: 34820168 PMCID: PMC8605761 DOI: 10.7717/peerj.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/27/2021] [Indexed: 12/05/2022] Open
Abstract
Lake Atitlán has experienced a decline in water quality resulting from cultural eutrophication. Indigenous Mayans who already face disproportionate health challenges rely directly on the lake water. Our objectives were to: (1) estimate prevalence of shedding of water-borne fecal parasites among children 5 years of age and younger, (2) assess household-reported incidence of gastrointestinal illness in children, and (3) characterize water sources, treatment, and sanitation conditions in households. We hypothesized that household use of untreated lake water results in increased risk of shedding of parasites and gastrointestinal symptoms. A cross-sectional fecal sampling and physical exam of 401 children were conducted along with WASH surveys in partnership with healthcare providers in seven communities. Fecal samples were screened for Giardia lamblia and Cryptosporidium parvum, using a rapid ELISA, with a portion examined by microscope. The prevalence of parasite shedding was 12.2% (9.7% for Giardia; 2.5% for Cryptosporidium). Risk factors for Giardia shedding included age 3 years or older (3.4 odds ratio, z-stat = 2.781 p = 0.0054), low height-for-age z-score (2.3 odds ratio, z-stat = 2.225, p = 0.0216), lack of any household water treatment (2.5 odds ratio, z-stat = 2.492, p < 0.0012), and open access to household latrine (2.04 odds ratio, z-stat = 1.992, p = 0.0464). The majority (77.3%) of households reported water treatment, boiling and gravity fed filters as the most widespread practices. The vast majority of households (92%) reported usage of a latrine, while 40% reported open and shared access beyond their household. An overwhelming majority of households reported diarrhea and fever several times per year or greater, with approximately half reporting vomiting at that frequency. Lake water use was identified as a risk factor for households reporting frequent gastrointestinal symptoms (odds ratio of 2.5, 4.4, and 2.6; z-stat of 3.10, 3.65, and 3.0; p-values of 0.0021, 0.0003, and 0.0028, for diarrhea, vomiting, and fever, respectively) in children 5 years of age and younger. The frequency of gastrointestinal illness with a strong link to lake drinking water cannot be explained by the prevalence of protozoa, and risk from other enteropathogens must be explored. Improving access to water treatment and sanitation practices could substantially reduce the parasite burden faced by developing children in the region.
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Affiliation(s)
- Amber Roegner
- Center For Global Health, University of Oregon, Eugene, OR, United States of America.,Department of Environmental Science and Policy, University of California, Davis, Davis, CA, United States of America
| | - Mónica N Orozco
- Center for Atitlán Studies, Universidad del Valle de Guatemala, Sololá, Sololá, Guatemala
| | - Claudia Jarquin
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | | | - Lujain Al-Saleh
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States of America
| | - Eliška Rejmánková
- Department of Environmental Science and Policy, University of California, Davis, Davis, CA, United States of America
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Gonete AT, Alemu TG, Mekonnen EG, Takele WW. Malnutrition and contributing factors among newborns delivered at the University of Gondar Hospital, Northwest Ethiopia: a cross-sectional study. BMJ Open 2021; 11:e053577. [PMID: 34740934 PMCID: PMC8573658 DOI: 10.1136/bmjopen-2021-053577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of various indicators of malnutrition (stunting, wasting, low birth weight, concurrent stunting and wasting, overweight/obesity and double burden malnutrition) among newborns and to investigate factors associated with these nutritional disorders. METHODS A hospital-based cross-sectional study was conducted from 10 March through to May 2020. A total of 419 newborns were recruited into the study to estimate the prevalence of low birth weight and stunting. After excluding 28 newborns whose length was less than 45 cm, 394 newborn-mother dyads were approached to estimate wasting and overweight/obesity. A systematic random sampling technique was used to select participants. All independent variables were entered into the multivariable logistic regression model and variables that had significant associations were identified based on a p value. RESULTS A very small proportion of the newborns 2.5% (0.9% to 4.1%) were concurrently wasted and stunted. The prevalence rates of low birth weight and wasting were 20.8% (16.8% to 24.6%) and 10.9% (7.82% to 14.01%), respectively. The magnitude of overweight/obesity was 12.7% (9.3% to 15.9%) where 2.8% (1.1% to 4.4%) of newborns have the double burden of malnutrition. Having a father with a primary level of education 2.82 (1.19 to 6.65) and being stunted at birth 3.17 (1.6 to 6.0) were variables that were associated with increased odds of low birth weight. The odds of being overweight/obese are significantly higher among newborns born to mothers who are urban dwellers 0.35 (0.12 to 0.99). CONCLUSIONS The study underscores that malnutrition is a pressing public health concern that demands due emphasis. Fathers' educational status (low level) and being stunted are associated with a high burden of low birth weight. Mothers' residency (being urban) is associated with an elevated risk of overweight/obesity among newborns. Thus, improving the health literacy of fathers and preventing stunting at birth are recommended to mitigate low birth weight.
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Affiliation(s)
- Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, University of Gondar, Gondar, Ethiopia
| | - Eskedar Getie Mekonnen
- Reproductive Health, University of Gondar College of Medicine and Health Sciences, Gondar, Amhara Regional State, Ethiopia
| | - Wubet Worku Takele
- Department of Community Health Nursing, University of Gondar, Gondar, Ethiopia
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Sari K, Sartika RAD. The Effect of the Physical Factors of Parents and Children on Stunting at Birth Among Newborns in Indonesia. J Prev Med Public Health 2021; 54:309-316. [PMID: 34649393 PMCID: PMC8517371 DOI: 10.3961/jpmph.21.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives This study examined stunting at birth and its associations with physical factors of parents and children in Indonesia. Methods This study analyzed secondary data from the national cross-sectional Indonesian Basic Health Survey 2018, conducted across 34 provinces and 514 districts/cities. Birth length data were available for 756 newborns. Univariable, bivariable, and multivariable logistic regression analyses were performed to determine associations between the physical factors of parents and children and stunting at birth. Results In total, 10.2% of children aged 0 months were stunted at birth (10.7% of males and 9.5% of females). Stunting at birth was associated with the mother’s age at first pregnancy, parity, parents’ heights, parents’ ages, and gestational age. Children from mothers with short statures (height <145.0 cm) and fathers with short statures (height <161.9 cm) had an almost 6 times higher likelihood of being stunted at birth (adjusted odds ratio, 5.93; 95% confidence interval, 5.53 to 6.36). A higher maternal age at first pregnancy had a protective effect against stunting. However, other variables (firstborn child, preterm birth, and both parents’ ages being <20 or >35 years) corresponded to a 2-fold higher likelihood of stunting at birth compared to the reference. Conclusions These findings provide evidence that interventions to reduce stunting aimed at pregnant females should also consider the parents’ stature, age, and parity, particularly if it is the first pregnancy and if the parents are short in stature or young. Robust programs to support pregnant females and monitor children’s heights from birth will help prevent intergenerational stunting.
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Affiliation(s)
- Kencana Sari
- Faculty of Public Health, University of Indonesia, Depok, Indonesia.,National Institute of Health Research and Development, Indonesian Ministry of Health, Jakarta, Indonesia
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10
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Bogin B. Fear, violence, inequality, and stunting in Guatemala. Am J Hum Biol 2021; 34:e23627. [PMID: 34125987 DOI: 10.1002/ajhb.23627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Stunting is defined by the public health community as a length- or height-for-age <-2 SD of a growth standard or reference and is claimed to be caused by poor nutrition, repeated infection, and inadequate psychosocial stimulation. MATERIAL AND METHODS Stunting is common at all income levels in middle- and low-income countries. At the higher income levels, stunting is unlikely to be caused by nutrient deficiency or infectious disease. RESULTS In Guatemala, 17% of <5-year-olds in the highest family income quintile are stunted. Guatemala has a history of violence from armed conflict, current-day social and economic inequalities, government corruption, and threat of kidnapping for the wealthiest families. DISCUSSION AND CONCLUSION The high level of persistent violence creates an ecology of fear, an extreme range of inequalities in Social-Economic-Political-Emotional resources, and biosocial stress that inhibits skeletal growth and causes stunting for people of all income levels.
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Affiliation(s)
- Barry Bogin
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK.,UCSD/Salk Center for Academic Research and Training in Anthropogeny (CARTA), University of California San Diego, USA
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Manjong FT, Verla VS, Egbe TO, Nsagha DS. Undernutrition among under-five indigenous Mbororo children in the Foumban and Galim health districts of Cameroon: a cross-sectional study. Pan Afr Med J 2021; 38:352. [PMID: 34367431 PMCID: PMC8308853 DOI: 10.11604/pamj.2021.38.352.25030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/31/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction despite increasing research interest on Indigenous peoples´ health worldwide, the nutritional status of Indigenous children in Cameroon remains unknown. This study was conducted to assess the prevalence of stunting, wasting, and underweight among under-five Indigenous Mbororo children in the Foumban and Galim health districts of the West Region. Methods a cross-sectional study was conducted involving 472 child-caregiver pairs from 16 Mbororo Communities in the Foumban and Galim health districts. Interviewer-administered questionnaires were used for data collection. Anthropometric measurements were collected using standard procedures. Socio-demographic data were analyzed using descriptive statistics. Anthropometric indices: height-for-age, weight-for-height, and weight-for-age - z-scores were analyzed using z-score 06 Stata version 11 and compared with World Health Organization growth reference standards. Ethical approval was obtained from the Faculty of Health Sciences Institutional Review Board of the University of Buea. Results overall prevalence of stunting, wasting and underweight were 55.08% (95% CI: 50.5-59.58), 13.77% (95% CI: 10.65-16.89), and 31.99% (95% CI: 27.76-36.21), respectively. Severe stunting, wasting and underweight were 34.53% (95% CI: 30.22-38.83), 3.18% (95% CI: 1.58-4.76), and 10.59% (95% CI: 7.80-13.37), respectively. Rates of stunting, wasting and underweight for female and male were: 56.88% and 52.71%; 12.38% and 14.72%; and 30.73% and 32.55%, respectively. Stunting, wasting and underweight rates varied with child age. Conclusion the prevalence of undernutrition was high, indicating a serious public health problem and the necessity for strategies to ensure the optimal health of the target population.
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Affiliation(s)
- Florence Titu Manjong
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Department of Pharmacy Technology, St Louis University Institute of Health and Biomedical Sciences, Bamenda, Cameroon
| | - Vincent Siysi Verla
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Thomas Obinchemti Egbe
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Dickson Shey Nsagha
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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12
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Miller AC, Tuiz E, Shaw L, Flood D, Garcia P, Dhaenens E, Thomson DR, Barnoya J, Montano CM, Rohloff P. Population Estimates of GFR and Risk Factors for CKD in Guatemala. Kidney Int Rep 2021; 6:796-805. [PMID: 33732994 PMCID: PMC7938058 DOI: 10.1016/j.ekir.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is an emerging public health priority in Central America. However, data on the prevalence of CKD in Guatemala, Central America's most populous country, are limited, especially for rural communities. METHODS We conducted a population-representative survey of 2 rural agricultural municipalities in Guatemala. We collected anthropometric data, blood pressure, serum and urine creatinine, glycosylated hemoglobin, and urine albumin. Sociodemographic, health, and exposure data were self-reported. RESULTS We enrolled 807 individuals (63% of all eligible, 35% male, mean age 39.5 years). An estimated 4.0% (95% confidence interval [CI] 2.4-6.6) had CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m2. Most individuals with an eGFR below 60 ml/min per 1.73 m2 had diabetes or hypertension. In multivariable analysis, the important factors associated with risk for an eGFR less than 60 ml/min per 1.73 m2 included a history of diabetes or hypertension (adjusted odds ratio [aOR] 11.21; 95% CI 3.28-38.24), underweight (body mass index [BMI] <18.5) (aOR 21.09; 95% CI 2.05-217.0), and an interaction between sugar cane agriculture and poverty (aOR 1.10; 95% CI 1.01-1.19). CONCLUSIONS In this population-based survey, most observed CKD was associated with diabetes and hypertension. These results emphasize the urgent public health need to address the emerging epidemic of diabetes, hypertension, and CKD in rural Guatemala. In addition, the association between CKD and sugar cane in individuals living in poverty provides some circumstantial evidence for existence of CKD of unknown etiology in the study communities, which requires further investigation.
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Affiliation(s)
- Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eva Tuiz
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Leah Shaw
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - David Flood
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Pablo Garcia
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Eloin Dhaenens
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Dana R. Thomson
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | | | | | - Peter Rohloff
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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13
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Krebs NF, Hambidge KM, Westcott JL, Garcés AL, Figueroa L, Tsefu AK, Lokangaka AL, Goudar SS, Dhaded SM, Saleem S, Ali SA, Bose CL, Derman RJ, Goldenberg RL, Thorsten VR, Sridhar A, Chowdhury D, Das A. Growth from Birth Through Six Months for Infants of Mothers in the "Women First" Preconception Maternal Nutrition Trial. J Pediatr 2021; 229:199-206.e4. [PMID: 32956698 PMCID: PMC7855785 DOI: 10.1016/j.jpeds.2020.09.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate whether the fetal linear growth effects of maternal nutrition supplementation would be maintained through 6 months postnatal age. STUDY DESIGN The Women First trial was a multicountry, individually randomized clinical trial that compared the impact of maternal nutrition supplementation initiated preconception (Arm 1) vs at ∼11 weeks of gestation (Arm 2), vs no supplement (Arm 3); the intervention was discontinued at delivery. Trial sites were in Democratic Republic of Congo, Guatemala, India, and Pakistan. Analysis includes 2421 infants born to 2408 randomized women. Primary outcome was the trajectory of length-for-age z scores (LAZ) by arm, based on assessments at birth and 1, 3, and 6 months. We fitted longitudinal models on growth from birth to 6 months using generalized estimating equations; maternal intervention effects were evaluated, adjusting for site and baseline maternal covariates. RESULTS Linear growth for Arms 1 and 2 was statistically greater than for Arm 3 in 3 of the 4 countries, with average pairwise mean differences in LAZ of 0.25 (95% CI 0.15-0.35; P < .001) and 0.19 (95% CI 0.09-0.28; P < .001), respectively. Compared with Arm 3, average overall adjusted relative risks (95% CI) for stunting (LAZ <-2) were lower for Arms 1 and 2: 0.76 (0.66-0.87; P < .001) and 0.77 (0.67-0.88; P < .001), respectively. CONCLUSIONS Improved linear growth in early infancy observed for the 2 intervention arms supports the critical importance of maternal nutrition before conception and in the early phase of gestation. TRIAL REGISTRATION ClinicalTrials.gov: NCT01883193.
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Affiliation(s)
| | | | | | - Ana L. Garcés
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Lester Figueroa
- Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Antoinette K. Tsefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adrien L. Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Shivaprasad S. Goudar
- KLE Academy of Higher Education and Research’s Jawaharlal Nehru Medical College, Belagavi, India
| | - Sangappa M. Dhaded
- KLE Academy of Higher Education and Research’s Jawaharlal Nehru Medical College, Belagavi, India
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14
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Gonete AT, Kassahun B, Mekonnen EG, Takele WW. Stunting at birth and associated factors among newborns delivered at the University of Gondar Comprehensive Specialized Referral Hospital. PLoS One 2021; 16:e0245528. [PMID: 33471862 PMCID: PMC7817059 DOI: 10.1371/journal.pone.0245528] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background Stunting at birth is a chronic form of undernutrition majorly attributable to poor prenatal nutrition, which could persist in children’s later life and impact their physical and cognitive health. Although multiple studies have been conducted in Ethiopia to show the magnitude of stunting and factors, all are concentrated on children aged between 6 to 59 months. Therefore, this study was done to determine the prevalence and associated factors of stunting at birth among newborns delivered at the University of Gondar Comprehensive Specialized Referral Hospital, Northwest, Ethiopia. Methods An institution-based cross-sectional study was conducted from February 26th to April 25th/2020. A systematic random sampling technique was used, to select a total of 422 newborn-mother pairs. The binary logistic regression was employed to identify factors associated with stunting and all independent variables were entered into the multivariable logistic regression model to adjust for confounders. Variables that had significant association were identified based on p-value < 0.05 and the adjusted odds ratio with its respective 95% confidence interval was applied to determine the strength as well as the direction of the association. Results About 30.5% (95% CI: 26.3%, 35.1%) of newborns were stunted at birth. Being male [Adjusted odds ratio (AOR) = 2.9(1.62, 5.21)], newborns conceived in Kiremt(rainy season) [AOR = 2.7(1.49, 4.97)], being low birth weight [AOR = 3.1(1.64, 6.06)] were factors associated with stunting at birth. Likewise, newborns born to short stature mothers [AOR = 2.8(1.21, 6.62)] and chronically malnourished mothers [AOR = 15.3(8.12, 29.1)] were at greater risk of being stunted. Conclusion Just under a third of newborns are stunted at birth, implying a pressing public health problem. Newborns born to chronically malnourished and short stature mothers were more stunted. Besides, stunting was prevalently observed among male neonates, newborns conceived in Kiremet, and being low birth weight. Thus, policymakers and nutrition programmers should work on preventing maternal undernutrition through nutrition education to reduce the burden of low birth weight and stunting. Further, paying due attention to newborns conceived in Kiremet season to improve nutritional status is recommended.
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Affiliation(s)
- Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Bogale Kassahun
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eskedar Getie Mekonnen
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abstract
Background Globally, the prevalence of child stunting has been decreasing over the past decades. However, in low- and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting. Objective To examine the association between breastfeeding (defined as never breastfed, any breastfeeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under -2 standard deviations of the World Health Organization child growth standards' median) in Mexico. Methods Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6-35 months with information on previously identified risk and protective factors for stunting. We conducted fixed- and mixed-effects logistic regression models sequentially controlling for each level of factors. Findings Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breastfeeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models. Conclusions According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.
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16
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Donohue JA, Solomons NW, Hampel D, Shahab-Ferdows S, Orozco MN, Allen LH. Micronutrient supplementation of lactating Guatemalan women acutely increases infants' intake of riboflavin, thiamin, pyridoxal, and cobalamin, but not niacin, in a randomized crossover trial. Am J Clin Nutr 2020; 112:669-682. [PMID: 32649760 PMCID: PMC7690764 DOI: 10.1093/ajcn/nqaa147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maternal supplementation during lactation could increase milk B-vitamin concentrations, but little is known about the kinetics of milk vitamin responses. OBJECTIVES We compared acute effects of maternal lipid-based nutrient supplement (LNS) consumption (n = 22 nutrients, 175%-212% of the RDA intake for the nutrients examined), as a single dose or at spaced intervals during 8 h, on milk concentrations and infant intake from milk of B-vitamins. METHODS This randomized crossover trial in Quetzaltenango, Guatemala included 26 mother-infant dyads 4-6 mo postpartum who were randomly assigned to receive 3 treatments in a random order: bolus 30-g dose of LNS (Bolus); 3 × 10-g doses of LNS (Divided); and no LNS (Control), with control meals. Mothers attended three 8-h visits during which infant milk consumption was measured and milk samples were collected at every feed. Infant intake was assessed as $\mathop \sum \nolimits_{i\ = \ 1}^n ( {{\rm{milk\ volum}}{{\rm{e}}_{{\rm{feed\ }}n}} \times \ {\rm{nutrient\ concentratio}}{{\rm{n}}_{{\rm{feed}}\ n}}} )$ over 8 h. RESULTS Maternal supplementation with the Bolus or Divided dose increased least-squares mean (95% CI) milk and infant intakes of riboflavin [milk: Bolus: 154.4 (138.2, 172.5) μg · min-1 · mL-1; Control: 84.5 (75.8, 94.3) μg · min-1 · mL-1; infant: Bolus: 64.5 (56.1, 74.3) μg; Control: 34.5 (30.0, 39.6) μg], thiamin [milk: Bolus: 10.9 (10.1, 11.7) μg · min-1 · mL-1; Control: 7.7 (7.2, 8.3) μg · min-1 · mL-1; infant: Bolus: 5.1 (4.4, 6.0) μg; Control: 3.4 (2.9, 4.0) μg], and pyridoxal [milk: Bolus: 90.5 (82.8, 98.9) μg · min-1 · mL-1; Control: 60.8 (55.8, 66.3) μg · min-1 · mL-1; infant: Bolus: 39.4 (33.5, 46.4) μg; Control: 25.0 (21.4, 29.2) μg] (all P < 0.001). Only the Bolus dose increased cobalamin in milk [Bolus: 0.054 (0.047, 0.061) μg · min-1 · mL-1; Control: 0.041 (0.035, 0.048) μg · min-1 · mL-1, P = 0.039] and infant cobalamin intake [Bolus: 0.023 (0.020, 0.027) μg; Control: 0.015 (0.013, 0.018) μg, P = 0.001] compared with Control. Niacin was unaffected. CONCLUSIONS Maternal supplementation with LNS as a Bolus or Divided dose was similarly effective at increasing milk riboflavin, thiamin, and pyridoxal and infant intakes, whereas only the Bolus dose increased cobalamin. Niacin was unaffected in 8 h. This trial was registered at clinicaltrials.gov as NCT02464111.
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Affiliation(s)
- Juliana A Donohue
- Present address for JAD: Basics Nutrition Research, 18555 SW Teton Ave., Tualatin, OR 97062, USA
| | - Noel W Solomons
- Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala
| | - Daniela Hampel
- Western Human Nutrition Research Center, Agricultural Research Service, USDA, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Setareh Shahab-Ferdows
- Western Human Nutrition Research Center, Agricultural Research Service, USDA, Davis, CA, USA
| | - Mónica N Orozco
- Center for Atitlán Studies, Universidad del Valle de Guatemala, Sololá, Guatemala
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17
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Hashmi AH, Nyein PB, Pilaseng K, Paw MK, Darakamon MC, Min AM, Charunwatthana P, Nosten F, McGready R, Carrara VI. Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study. BMC Public Health 2019; 19:1586. [PMID: 31779599 PMCID: PMC6883662 DOI: 10.1186/s12889-019-7825-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/21/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study aims to provide a comprehensive understanding of maternal risk factors, infant risk factors and maternal infant feeding practices among refugees and migrants along the Thailand-Myanmar border. METHODS This study employed a mixed-methods approach with two components: (1) cross-sectional survey (n = 390) and (2) focus group discussions (n = 63). Participants were chosen from one of three clinics providing antenatal and delivery services for Karen and Burman refugees and migrants along the border. Participants were pregnant women and mother-infant dyads. RESULTS Refugee and migrant mothers demonstrated high rates of suboptimal breastfeeding and low rates of minimum dietary diversity and acceptable diet. Multivariable regression models showed infant stunting (AOR: 2.08, 95% CI: 1.12, 3.84, p = 0.020) and underweight (AOR: 2.26, 95% CI: 1.17, 4.36, p = 0.015) to have increased odds among migrants, while each 5 cm increase in maternal height had decreased odds of stunting (AOR: 0.50, 95% CI: 0.38, 0.66, p < 0.001) and underweight (AOR: 0.64, 95% CI: 0.48, 0.85, p = 0.002). In addition, small-for-gestational-age adjusted for length of gestation, infant age and gender increased odds of infant's stunting (AOR: 3.42, 95% CI: 1.88, 6.22, p < 0.001) and underweight (AOR: 4.44, 95% CI: 2.36, 8.34, p < 0.001). Using the Integrated Behavioural Model, focus group discussions explained the cross-sectional findings in characterising attitudes, perceived norms, and personal agency as they relate to maternal nutrition, infant malnutrition, and infant feeding practices. CONCLUSIONS Inadequate infant feeding practices are widespread in refugee and migrant communities along the Thailand-Myanmar border. Risk factors particular to maternal nutrition and infant birth should be considered for future programming to reduce the burden of chronic malnutrition in infants.
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Affiliation(s)
- A H Hashmi
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand. .,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - P B Nyein
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - K Pilaseng
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - M K Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - M C Darakamon
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - A M Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - P Charunwatthana
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - F Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX37FZ, UK
| | - R McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX37FZ, UK
| | - V I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand.,Department of Medicine, Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051, Basel, Switzerland
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Andrews-Trevino JY, Webb P, Shively G, Rogers BL, Baral K, Davis D, Paudel K, Pokharel A, Shrestha R, Wang JS, Ghosh S. Relatively Low Maternal Aflatoxin Exposure Is Associated with Small-for-Gestational-Age but Not with Other Birth Outcomes in a Prospective Birth Cohort Study of Nepalese Infants. J Nutr 2019; 149:1818-1825. [PMID: 31198947 DOI: 10.1093/jn/nxz122] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Exposure to aflatoxin has garnered increased attention as a possible contributor to adverse birth outcomes. OBJECTIVE The objective of this study was to investigate the relation of maternal aflatoxin exposure with adverse birth outcomes such as birth weight, birth length, anthropometric z scores, low birth weight (LBW), small-for-gestational-age (SGA), stunting, and preterm birth (PTB). METHODS This study used maternal and newborn data from the AflaCohort Study, an ongoing birth cohort study in Banke, Nepal (n = 1621). Data on aflatoxin B1 (AFB1)-lysine adducts in maternal serum were collected once during pregnancy (at mean ± SD: 136 ± 43 d of gestation). Maternal serum AFB1-lysine adduct concentration was measured via HPLC. Linear and logistic regression analyses were used to determine if maternal aflatoxin exposure was associated with 1) birth weight and length (primary outcomes) and 2) anthropometric z scores, LBW (weight <2.5 kg), SGA (weight <10th percentile for gestational age and sex), stunting at birth (length-for-age z score less than -2), or PTB (born <37 weeks of gestation) (secondary outcomes). RESULTS The geometric mean of maternal serum AFB1-lysine adduct concentration was 1.37 pg/mg albumin (95% CI: 1.30, 1.44 pg/mg albumin). Twenty percent of infants were of LBW and 32% were SGA. Sixteen percent of infants were stunted at birth. In addition, 13% of infants were born preterm. In logistic multivariate regression models, mean maternal serum AFB1-lysine adduct concentrations were significantly associated with SGA (OR: 1.13; 95% CI: 1.00, 1.27; P < 0.05). CONCLUSIONS Findings from this study suggest a small but significant association between serum AFB1-lysine adduct concentrations in pregnant women and SGA. Maternal aflatoxin exposure was not associated with other birth outcomes. These results highlight the need for future research on a threshold level of aflatoxin exposure needed to produce detectable adverse birth outcomes. This trial was registered at clinicaltrials.gov as NCT03312049.
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Affiliation(s)
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Gerald Shively
- Department of Agricultural Economics, Purdue University, West Lafayette, IN, USA
| | - Beatrice L Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Kedar Baral
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Dale Davis
- Helen Keller International-Nepal, Kathmandu, Nepal
| | | | | | - Robin Shrestha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jia-Sheng Wang
- Department of Environmental Health Science, University of Georgia, Athens, GA, USA
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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19
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Hashmi A, Carrara VI, Nyein PB, Darakamon MC, Charunwatthana P, McGready R. The Healthy Baby Flipbook: piloting home-based counseling for refugee mothers to improve infant feeding and water, sanitation, and hygiene (WASH) practices. Glob Health Action 2019; 12:1560115. [PMID: 31154995 PMCID: PMC6338267 DOI: 10.1080/16549716.2018.1560115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Problems in growth and undernutrition manifest in early infancy, with suboptimal breastfeeding and inadequate complementary feeding remaining strong risk factors for chronic undernutrition in infants. No published studies exist on educational interventions to improve infant feeding practices among refugees or displaced persons in low and middle-income (LMIC) settings. The objective of this study was to create and pilot educational materials for home-based counseling of refugee mothers along the Thailand–Myanmar border to improve appropriate infant feeding and water, sanitation, and hygiene (WASH) behaviors. Mothers of infants received counseling on appropriate infant feeding and WASH practices on a monthly basis for a total of six months from infant age three months until nine months. Educational materials were designed to feature a basic script for health workers and photos of locally available, appropriate foods. Of the 20 mothers participating in this pilot, infant feeding and WASH behaviors improved within 1 to 2 months of the first visit, including exclusive breastfeeding, minimum acceptable diet, and safe disposal of infant stool. This pilot demonstrates improvement in maternal infant feeding and WASH practices in a small set of refugee mothers, providing evidence for counseling measures to improve infant health in vulnerable populations.
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Affiliation(s)
- Ahmar Hashmi
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand.,b Department of Family Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Verena I Carrara
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand.,c Department of Medicine , Swiss Tropical and Public Health Institute , Basel , Switzerland
| | - Paw Bay Nyein
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand
| | - Mu Chae Darakamon
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand
| | - Prakaykaew Charunwatthana
- d Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Bangkok , Thailand
| | - Rose McGready
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand.,e Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford , UK
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Scheffler C, Hermanussen M, Bogin B, Liana DS, Taolin F, Cempaka PMVP, Irawan M, Ibbibah LF, Mappapa NK, Payong MKE, Homalessy AV, Takalapeta A, Apriyanti S, Manoeroe MG, Dupe FR, Ratri RRK, Touw SY, K PV, Murtani BJ, Nunuhitu R, Puspitasari R, Riandra IK, Liwan AS, Amandari P, Permatasari AAI, Julia M, Batubara J, Pulungan A. Stunting is not a synonym of malnutrition. Eur J Clin Nutr 2019; 74:377-386. [DOI: 10.1038/s41430-019-0439-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/14/2019] [Accepted: 05/05/2019] [Indexed: 11/09/2022]
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Johnson RK, Lamb M, Anderson H, Pieters-Arroyo M, Anderson BT, Bolaños GA, Asturias EJ. The global school-based student health survey as a tool to guide adolescent health interventions in rural Guatemala. BMC Public Health 2019; 19:226. [PMID: 30795754 PMCID: PMC6387528 DOI: 10.1186/s12889-019-6539-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Adolescents from rural areas in low-middle income countries face increasing physical and mental health challenges that are not well characterized or addressed due to resource limitations. We used the Global School-based Student Health Survey (GSHS) to describe adolescent health behaviors, and to inform prioritization of health promotion efforts in a resource-limited, rural, agricultural region in Guatemala. Methods In July 2015, a group of volunteers administered the GSHS to students from seven schools in four communities in the southwest Trifinio region of Guatemala. Prevalence and predictors of nutritional, mental, and sexual health behaviors were calculated from survey responses, and summarized in region- and school-level reports. Facilitated discussion of survey results with local leadership in January 2016 led to the identification of priorities for school-based health interventions. Results Five hundred fifty-four out of 620 (87%) students aged 12–18 years completed the survey. Prevalence of unhealthy dietary behaviors and body size was high: 61% reported high current soft drink intake, 18% were overweight, and 31% were moderate-severely stunted. In multivariable regression models, being food insecure was marginally associated with being underweight/stunted (OR = 1.95, 95%CI = 0.95–4.0). Boys were more likely than girls to report being sexually active (25% versus 6.4%, p < 0.001). Local school leadership identified food insecurity and sexual education as priority areas for intervention, and made plans for providing breakfast in schools, sexual education curriculum development and teacher training, and continued adolescent health reporting and evaluation. Conclusions The GSHS is a rapid, cost-efficient, useful tool for surveillance of adolescent health behaviors in vulnerable, resource-limited populations. Results of a locally-administered GSHS informed school-based interventions to decrease food insecurity, early sexual initiation, and teen pregnancy in a rural Guatemalan region.
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Affiliation(s)
- Randi K Johnson
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.,Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Molly Lamb
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.,Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Hillary Anderson
- Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | | | - Bradley T Anderson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Guillermo A Bolaños
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Quetzaltenango, Coatepeque, Guatemala
| | - Edwin J Asturias
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. .,Center for Global Health, Colorado School of Public Health, Aurora, CO, USA. .,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. .,Section of Pediatric Infectious Diseases and Jules Amer Chair in Community Pediatrics, Children's Hospital Colorado, Aurora, CO, USA.
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Higher agrobiodiversity is associated with improved dietary diversity, but not child anthropometric status, of Mayan Achí people of Guatemala. Public Health Nutr 2018; 21:2128-2141. [PMID: 29611490 DOI: 10.1017/s1368980018000617] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Child undernutrition remains one of the greatest challenges for public health nutrition in rural areas in developing countries. Interventions aiming to increase and conserve agrobiodiversity seem to be promising alternatives to improve child nutrition. However, the existing literature on these interventions is not conclusive about their effectiveness in combating child undernutrition. We tested the hypothesis that 'higher agrobiodiversity is associated with greater dietary diversity and better anthropometric status' in rural Guatemala.Design/Setting/SubjectsIn the summer of 2016, we conducted a cross-sectional study with a sample of 154 children (6-60 months). We conducted dietary recalls and structured interviews, measured children's weight and height, and visited food production systems (Milpas, home gardens, coffee plantations). Crop species richness, nutritional functional diversity, dietary diversity scores and anthropometric status were calculated. RESULTS Higher food self-sufficiency, nutritional functional diversity and dietary diversity scores were positively correlated with higher crop and animal species richness. Contrarily, remoteness to the local market was negatively correlated with dietary diversity scores. However, higher dietary diversity scores were not correlated with better child anthropometric status. Better child anthropometric status was positively correlated with improved sanitary conditions and maternal education; and negatively correlated with large household size and frequent child morbidity. CONCLUSIONS Agricultural diversification could diversify diets, increase nutrient availability and improve child anthropometry. However, these interventions need to be accompanied by sanitation improvements, family planning, nutritional education and women's empowerment to strengthen their positive effect on diet and nutrition.
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Voth-Gaeddert LE, Stoker M, Cornell D, Oerther DB. What causes childhood stunting among children of San Vicente, Guatemala: Employing complimentary, system-analysis approaches. Int J Hyg Environ Health 2018; 221:391-399. [DOI: 10.1016/j.ijheh.2018.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/01/2018] [Accepted: 01/02/2018] [Indexed: 01/27/2023]
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Islam MM, Sanin KI, Mahfuz M, Ahmed AMS, Mondal D, Haque R, Ahmed T. Risk factors of stunting among children living in an urban slum of Bangladesh: findings of a prospective cohort study. BMC Public Health 2018; 18:197. [PMID: 29378556 PMCID: PMC5789576 DOI: 10.1186/s12889-018-5101-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/19/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bangladesh is one of the 20 countries with highest burden of stunting globally. A large portion (around 2.2 million) of the population dwells in the slum areas under severe vulnerable conditions. Children residing in the slums are disproportionately affected with higher burden of undernutrition particularly stunting. In this paper, findings of a prospective cohort study which is part of a larger multi-country study are presented. METHODS Two hundred and sixty five children were enrolled and followed since their birth till 24 months of age. Anthropometric measurements, dietary intake and morbidity information were collected monthly. Data from 9 to 12, 15-18 and 21-24 months were collated to analyze and report findings for 12, 18 and 24 months of age. Generalized estimating equation models were constructed to determine risk factors of stunting between 12 and 24 months of age. RESULT Approximately, 18% of children were already stunted (LAZ < -2SD) at birth and the proportion increased to 48% at 24 months of age. Exclusive breastfeeding prevalence was only 9.4% following the WHO definition at 6 months. Dietary energy intake as well as intakes of carbohydrate, fat and protein were suboptimal for majority of the children. However, in regression analysis, LAZ at birth (AOR = 0.40, 95% CI: 0.26, 0.61), household with poor asset index (AOR = 2.81, 95% CI: 1.43, 5.52; ref.: average asset index), being male children (AOR = 1.75, 95% CI: 1.04, 2.95; ref.: female) and age (AOR = 2.34, 95% CI: 1.56, 3.52 at 24 months, AOR = 2.13, 95% CI: 1.55, 2.92 at 18 months; ref.: 12 months of age) were the significant predictors of stunting among this population. CONCLUSION As the mechanism of stunting begins even before a child is born, strategies must be focused on life course approach and preventive measurement should be initiated during pregnancy. Alongside, government and policymakers have to develop sustainable strategies to improve various social and environmental factors those are closely interrelated with chronic undernutrition particularly concentrating on urban slum areas.
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Affiliation(s)
- M. Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
| | - Kazi Istiaque Sanin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
| | | | - Dinesh Mondal
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
| | - Rashidul Haque
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212 Bangladesh
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Martinez B, Webb MF, Gonzalez A, Douglas K, Grazioso MDP, Rohloff P. Complementary feeding intervention on stunted Guatemalan children: a randomised controlled trial. BMJ Paediatr Open 2018; 2:e000213. [PMID: 29719876 PMCID: PMC5926563 DOI: 10.1136/bmjpo-2017-000213] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/22/2018] [Accepted: 03/15/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE/BACKGROUND Guatemala's indigenous Maya population has one of the highest rates of childhood stunting in the world. The goal of this study was to examine the impact of an intensive, individualised approach to complementary feeding education for caregivers on feeding practices and growth over usual care. DESIGN An individually randomised (1:1 allocation ratio), parallel-group superiority trial, with blinding of study staff collecting outcome data. SETTING Rural Maya communities in Guatemala. PARTICIPANTS 324 children aged 6-24 months with a height-for-age Z score of less than or equal to -2.5 SD were randomised, 161 to the intervention and 163 to usual care. INTERVENTIONS Community health workers conducted home visits for 6 months, providing usual care or usual care plus individualised caregiver education. MAIN OUTCOMES MEASURES The main outcome was change in length/height-for-age Z score. Secondary outcomes were changes in complementary feeding indicators. RESULTS Data were analysed for 296 subjects (intervention 145, usual care 151). There was a non-significant trend to improved growth in the intervention arm (length/height-for-age Z score change difference 0.07(95% CI -0.04 to 0.18)). The intervention led to a 22% improvement in minimum dietary diversity (RR 1.22, 95% CI 1.11 to 1.35) and a 23% improvement in minimal acceptable diet (RR 1.23, 95% CI 1.08 to 1.40) over usual care. CONCLUSIONS Complementary feeding outcomes improved in the intervention arm, and a non-significant trend towards improved linear growth was observed. Community health workers in a low-resource rural environment can implement individualised caregiver complementary feeding education with significant improvements in child dietary quality over standard approaches. CLINICAL TRIAL REGISTRATION NUMBER NCT02509936. Stage: Results.
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Affiliation(s)
- Boris Martinez
- Wuqu' Kawoq
- Maya Health Alliance, Santiago Sacatepéquez, Guatemala
| | | | - Ana Gonzalez
- Department of Psychology, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Kate Douglas
- Wuqu' Kawoq
- Maya Health Alliance, Santiago Sacatepéquez, Guatemala.,School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, Santiago Sacatepéquez, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Hambidge KM, Krebs NF, Garcés A, Westcott JE, Figueroa L, Goudar SS, Dhaded S, Pasha O, Aziz Ali S, Tshefu A, Lokangaka A, Thorsten VR, Das A, Stolka K, McClure EM, Lander RL, Bose CL, Derman RJ, Goldenberg RL, Bauserman M. Anthropometric indices for non-pregnant women of childbearing age differ widely among four low-middle income populations. BMC Public Health 2017; 18:45. [PMID: 28738791 PMCID: PMC5525260 DOI: 10.1186/s12889-017-4509-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/14/2017] [Indexed: 01/08/2023] Open
Abstract
Background Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC). Methods Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m2) was calculated. Z-scores were determined using WHO reference data. Results A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = 1823); and Thatta, Sindh, Pakistan (n = 2009). Mean age was 23 y and mean parity 1.5. Median (P25-P75) height (cm) ranged from 145.5 (142.2–148.9) in Guatemala to 156.0 (152.0–160.0) in DRC. Median weight (kg) ranged from 44.7 (39.9–50.3) in India to 52.7 (46.9–59.8) in Guatemala. Median BMI ranged from 19.4 (17.6–21.9) in India to 24.9 (22.3–28.0) in Guatemala. Percent stunted (<−2SD height for age z-score) ranged from 13.9% in DRC to 80.5% in Guatemala; % underweight (BMI <18.5) ranged from 1.2% in Guatemala to 37.1% in India; % overweight/obese (OW, BMI ≥25.0) ranged from 5.7% in DRC to 49.3% in Guatemala. For all sites, indicators for higher SES and higher age were associated with BMI. Lower SES women were underweight more frequently and higher SES women were OW more frequently at all sites. Younger women tended to be underweight, while older women tended to be OW. Conclusions Anthropometric data for NPW varied widely among low-income rural populations in four countries located on three different continents. Global comparisons of anthropometric measurements across sites using standard reference data serve to highlight major differences among populations of low-income rural NPW and assist in evaluating the rationale for and the design of optimal intervention trials. Trial registration ClinicalTrials.gov #NCT01883193 (18 June 2013, retrospectively registered)
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Affiliation(s)
| | | | - Ana Garcés
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City, Guatemala
| | | | - Lester Figueroa
- INCAP (Instituto de Nutrición de Centro América y Panamá), Guatemala City, Guatemala
| | | | - Sangappa Dhaded
- KLE University's Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Abhik Das
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | - Carl L Bose
- University of North Carolina, Chapel Hill, NC, USA
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Association of the Familial Coexistence of Child Stunting and Maternal Overweight with Indigenous Women in Guatemala. Matern Child Health J 2017; 21:2102-2113. [DOI: 10.1007/s10995-017-2325-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alfonso-Durruty MP, Valeggia CR. Growth patterns among indigenous Qom children of the Argentine Gran Chaco. Am J Hum Biol 2016; 28:895-904. [DOI: 10.1002/ajhb.22886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/05/2016] [Accepted: 06/05/2016] [Indexed: 01/26/2023] Open
Affiliation(s)
- Marta P. Alfonso-Durruty
- Department of Anthropology, Sociology & Social-Work; Kansas State University; 008 Waters Hall Manhattan Kansas
| | - Claudia R. Valeggia
- Department of Anthropology; Yale University; 10 Sachem St. New Haven Connecticut
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Varela-Silva MI, Bogin B, Sobral JAG, Dickinson F, Monserrat-Revillo S. Deep data science to prevent and treat growth faltering in Maya children. Eur J Clin Nutr 2016; 70:679-80. [PMID: 27094624 PMCID: PMC4908546 DOI: 10.1038/ejcn.2016.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/18/2016] [Accepted: 03/19/2016] [Indexed: 11/09/2022]
Abstract
The Maya people are descended from the indigenous inhabitants of southern Mexico, Guatemala and adjacent regions of Central America. In Guatemala, 50% of infants and children are stunted (very low height-for-age), and some rural Maya regions have >70% children stunted. A large, longitudinal, intergenerational database was created to (1) provide deep data to prevent and treat somatic growth faltering and impaired neurocognitive development, (2) detect key dependencies and predictive relations between highly complex, time-varying, and interacting biological and cultural variables and (3) identify targeted multifactorial intervention strategies for field testing and validation. Contributions to this database included data from the Universidad del Valle de Guatemala Longitudinal Study of Child and Adolescent Development, child growth and intergenerational studies among the Maya in Mexico and studies about Maya migrants in the United States.
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Affiliation(s)
- M I Varela-Silva
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - B Bogin
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - J A G Sobral
- Centro de Investigaciones Educativas, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - F Dickinson
- Department of Human Ecology, Cinvestav-IPN, Mérida, Mexico
| | - S Monserrat-Revillo
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
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Chomat AM, Solomons NW, Koski KG, Wren HM, Vossenaar M, Scott ME. Quantitative Methodologies Reveal a Diversity of Nutrition, Infection/Illness, and Psychosocial Stressors During Pregnancy and Lactation in Rural Mam-Mayan Mother–Infant Dyads From the Western Highlands of Guatemala. Food Nutr Bull 2015; 36:415-40. [DOI: 10.1177/0379572115610944] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: The nature and severity of 3 categories of maternal stressors (nutritional, infectious, and psychosocial) that may impact maternal health and early infant growth are not often considered together. Objectives: To describe quantitative methodologies; assess construct validity of questionnaires; report variability in sociodemographic, obstetric, nutritional, infectious, and psychosocial characteristics; and compare characteristics between pregnancy and lactation and between study cohorts of Mam-Mayan mother–infant dyads. Methods: Grounded in participatory action research and a socioecological framework, this observational study enrolled a longitudinal cohort of 155 women, followed during pregnancy (6-9 months), early (0-6 weeks), and later (4-6 months) postpartum, and 2 cross-sectional cohorts (60 early and 56 later postpartum). Household and social factors; obstetric history; nutritional, infectious, and psychosocial stressors; and infant characteristics were explored. Results: Diet diversity (3.4 ± 1.3) and adult food security (38%) were low. Urinary and gastrointestinal infections were rare (<5%), whereas experience of local idioms of distress was frequent (20%-50%). Participants reported low maternal autonomy (81%), high paternal support (70%), small social support networks (2.7 ± 1.3 individuals), and high trust in family (88%) and community-based institutions (61%-65%) but low trust in government services (6%). Domestic violence was commonly reported (22%). Infant stunting was common (36% early postpartum and 43% later postpartum) despite frequent antenatal care visits (7.5 ± 3.8). Participant engagement with the research team did not influence study outcomes based on comparisons between longitudinal and cross-sectional cohorts. Conclusions: The variability in sociodemographic, nutritional, and psychosocial variables, will allow exploration of factors that promote resilience or increase vulnerability of the mother–infant dyad.
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Affiliation(s)
- Anne Marie Chomat
- McGill University, Montreal, Quebec, Canada
- Tufts University, Boston, MA, USA
| | - Noel W. Solomons
- Tufts University, Boston, MA, USA
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
| | | | | | - Marieke Vossenaar
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
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Soto-Méndez MJ, Romero-Abal ME, Aguilera CM, Rico MC, Solomons NW, Schümann K, Gil A. Associations among Inflammatory Biomarkers in the Circulating, Plasmatic, Salivary and Intraluminal Anatomical Compartments in Apparently Healthy Preschool Children from the Western Highlands of Guatemala. PLoS One 2015; 10:e0129158. [PMID: 26075910 PMCID: PMC4468091 DOI: 10.1371/journal.pone.0129158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/05/2015] [Indexed: 12/22/2022] Open
Abstract
Background Undernutrition and inflammation are related in many ways; for instance, non-hygienic environments are associated with both poor growth and immunostimulation in children. Objective To describe any existing interaction among different inflammation biomarkers measured in the distinct anatomical compartments of whole blood, feces, plasma and saliva. Methods In this descriptive, cross-sectional study, samples of whole blood, feces, plasma and saliva were collected on the 8th and last week of observation among 87 attendees (42 girls and 45 boys) of 3 daycare centers offering a common 40-day rotating menu in Guatemala’s Western Highlands. Analyses included white blood cell count (WBC), fecal calprotectin, and plasmatic and salivary cytokines including IL-1B, IL-6, IL-8, IL-10 and TNF-α. Associations were assessed using Spearman rank-order and goodness-of-fit correlations, as indicated, followed by backwards-elimination multiple regression analyses to determine predictor variables for IL-10 in both anatomical compartments. Results Of a total of 66 cross-tabulations in the Spearman hemi-matrix, 22 (33%) were significantly associated. All 10 paired associations among the salivary cytokines had a significant r value, whereas 7 of 10 possible associations among plasma cytokines were significant. Associations across anatomical compartments, however, were rarely significant. IL-10 in both biological fluids were higher than corresponding reference values. When a multiple regression model was run in order to determine independent predictors for IL-10 in each anatomical compartment separately, IL-6, IL-8 and TNF-α emerged as predictors in plasma (r2 = 0.514) and IL-1B, IL-8 and TNF-α remained as independent predictors in saliva (r2 = 0.762). Significant cross-interactions were seen with WBC, but not with fecal calprotectin. Conclusion Interactions ranged from robust within the same anatomical compartment to limited to nil across distinct anatomical compartments. The prominence of the anti-inflammatory cytokine, IL-10, in both plasma and saliva is consistent with its counter-regulatory role facing a broad front of elevated pro-inflammatory cytokines in the same compartment.
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Affiliation(s)
- María José Soto-Méndez
- Center for the Studies of Sensory Impairment, Aging, and Metabolism–CeSSIAM- Guatemala City, Guatemala
- * E-mail:
| | - María Eugenia Romero-Abal
- Center for the Studies of Sensory Impairment, Aging, and Metabolism–CeSSIAM- Guatemala City, Guatemala
| | - Concepción María Aguilera
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research, University of Granada, Granada, Spain
| | - María Cruz Rico
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research, University of Granada, Granada, Spain
| | - Noel W. Solomons
- Center for the Studies of Sensory Impairment, Aging, and Metabolism–CeSSIAM- Guatemala City, Guatemala
| | - Klaus Schümann
- Molecular Nutrition Unit, ZIEL, Research Center for Nutrition and Food Science, Technische Universität München, Freising, Germany
| | - Angel Gil
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research, University of Granada, Granada, Spain
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