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Jensen CL, Sanga E, Kitt H, PrayGod G, Kunzi H, Setebe T, Filteau S, Webster J, Gladstone M, Olsen MF. Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania. PLoS One 2024; 19:e0285240. [PMID: 38722956 PMCID: PMC11081340 DOI: 10.1371/journal.pone.0285240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a psychosocial stimulation programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on psychosocial stimulation would be helpful, e.g., how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant psychosocial stimulation programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.
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Affiliation(s)
- Cecilie L. Jensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erica Sanga
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Heather Kitt
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - George PrayGod
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Happiness Kunzi
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Theresia Setebe
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melissa Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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2
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Kirolos A, Harawa PP, Chimowa T, Divala O, Freyne B, Jones AG, Lelijveld N, Lissauer S, Maleta K, Gladstone MJ, Kerac M. Long-term outcomes after severe childhood malnutrition in adolescents in Malawi (LOSCM): a prospective observational cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:280-289. [PMID: 38368896 DOI: 10.1016/s2352-4642(23)00339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Research on long-term outcomes of severe childhood malnutrition is scarce. Existing evidence suggests potential associations with cardiometabolic disease and impaired cognition. We aimed to assess outcomes in adolescents who were exposed to severe childhood malnutrition compared with peers not exposed to severe childhood malnutrition. METHODS In Long-term Outcomes after Severe Childhood Malnutrition (LOCSM), we followed up adolescents who had 15 years earlier received treatment for severe childhood malnutrition at Queen Elizabeth Central Hospital in Blantyre, Malawi. Adolescents with previous severe childhood malnutrition included in LOCSM had participated in an earlier follow-up study (ChroSAM) at 7 years after treatment for severe childhood malnutrition, where they were compared to siblings and age-matched children in the community without previous severe childhood malnutrition. We measured anthropometry, body composition, strength, glucose tolerance, cognition, behaviour, and mental health during follow-up visits between Sept 9, 2021, and July 22, 2022, comparing outcomes in adolescents exposed to previous severe childhood malnutrition with unexposed siblings and adolescents from the community assessed previously (for ChroSAM) and newly recruited during current follow-up. We used a linear regression model to adjust for age, sex, disability, HIV, and socioeconomic status. This study is registered with the International Standard Randomised Controlled Trial Number Registry (ISRCTN17238083). FINDINGS We followed up 168 previously malnourished adolescents (median age 17·1 years [IQR 16·5 to 18·0]), alongside 123 siblings (18·2 years [15·0 to 20·5]), and 89 community adolescents (17·1 years [16·3 to 18·1]). Since last measured 8 years previously, mean height-for-age Z (HAZ) scores had improved in previously malnourished adolescents (difference 0·33 [95% CI 0·20 to 0·46]) and siblings (0·32 [0·09 to 0·55]), but not in community adolescents (difference -0·01 [-0·24 to 0·23]). Previously malnourished adolescents had sustained lower HAZ scores compared with siblings (adjusted difference -0·32 [-0·58 to -0·05]) and community adolescents (-0·21 [-0·52 to 0·10]). The adjusted difference in hand-grip strength between previously malnourished adolescents and community adolescents was -2·0 kg (-4·2 to 0·3). For child behaviour checklist internalising symptom scores, the adjusted difference for previously malnourished adolescents was 2·8 (0·0 to 5·5) compared with siblings and 2·1 (-0·1 to 4·3) compared with community adolescents. No evidence of differences between previously malnourished adolescents and unexposed groups were found in any of the other variables measured. INTERPRETATION Catch-up growth into adolescence was modest compared with the rapid improvement seen in childhood, but provides optimism for ongoing recovery of height deficits. We found little evidence of heightened non-communicable disease risk in adolescents exposed to severe childhood malnutrition, although long-term health implications need to be monitored. Further investigation of associated home and environmental factors influencing long-term outcomes is needed to tailor preventive and treatment interventions. FUNDING The Wellcome Trust.
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Affiliation(s)
- Amir Kirolos
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
| | - Philliness P Harawa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Takondwa Chimowa
- Department of Paediatrics, Zomba Central Hospital, Zomba, Malawi
| | - Oscar Divala
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Bridget Freyne
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi; School of Medicine, University College Dublin, Dublin, Ireland
| | - Angus G Jones
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Natasha Lelijveld
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Emergency Nutrition Network, Kidlington, UK
| | - Samantha Lissauer
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Kenneth Maleta
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Melissa J Gladstone
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Centre for Maternal, Adolescent, and Reproductive Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
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3
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Birhanu F, Yitbarek K, Atlantis E, Woldie M, Bobo F. Trends in social determinants of inequality in child undernutrition from the Ethiopian Demographic and Health Surveys, 2005-2016. PLoS One 2024; 19:e0295810. [PMID: 38215079 PMCID: PMC10786372 DOI: 10.1371/journal.pone.0295810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/29/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND While child undernutrition has been eliminated in some middle-income countries, it remains highly prevalent in sub-Sahara African (SSA) and South Asian regions, and is disproportionately concentrated among the poor. In this study, we estimated trends in child undernutrition by social determinants and related risks from wealth inequality in Ethiopia, from 2005 to 2016. METHOD We analyzed data from three consecutive surveys (2005, 2011, and 2016) from the Ethiopian Demographic and Health Survey. First, we estimated trends in the prevalence of childhood undernutrition variables (stunting, underweight, and wasting) and social determinants (household wealth status, education level, place of residence, and administrative regions). Then we assessed evidence of undernutrition by wealth-related inequality with concentration curves (visual) and concentration indeces (quantitative). A multilevel mixed-effect Poisson regression model was used to identify predictors of undernutrition variables expressed as covariate-adjusted rate ratios, with 95% confidence intervals (RRs, 95%CI). RESULT A total of 23,934 mother-child pairs were obtained from the three surveys. The average prevalence decreased by 12.4 percentage points for stunting (from 50.8 to 38.4%, P<0.01), 9.5 percentage points for underweight (33.2% to23.7%, P<0.01), and 2.1 percentage points for wasting (12.2% to10.1%, P<0.01). There was persistent and statistically evidence of wealth inequality in stunting, underweight, and wasting (concentration indeces of -0.2 to -0.04, all P values <0.05). Stunting, underweight, and wasting variables were associated with male sex of the child (RR 0.94, 0.95, 0.85, all P-values <0.01) recent diarrhea (RR 1.18, 1.27, 1.37, all P-values <0.01), secondary education status of the mother (RR 0.66, 0.57, 0.61, all P-values < 0.057), increasing wealth index (richest) (RR 0.73, 0.70, 0.50, all P-values < 0.05), and having no toilet facility (RR 1.16, 1.22, 1.18, all P-values < 0.05). CONCLUSION Despite the decreased burden of stunting and underweight, the prevalence of wasting remained relatively unchanged in Ethiopia from 2005 to 2016. Moreover, wealth-related inequality in child undernutrition increased for most of the child undernutrition indicators during this period. Social determinants of child undernutrition warrant urgent implementation of strategies to reduce their health impacts in SSA.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Sciences, Mizan-Tepi University, Mizan Aman, Southwest Ethiopia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Firew Bobo
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Nienaber A, Conradie C, Manda G, Chimera-Khombe B, Nel E, Milanzi EB, Dolman-Macleod RC, Lombard MJ. Effect of fatty acid profiles in varying recipes of ready-to-use therapeutic foods on neurodevelopmental and clinical outcomes of children (6-59 months) with severe wasting: a systematic review. Nutr Rev 2023:nuad151. [PMID: 38134960 DOI: 10.1093/nutrit/nuad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
CONTEXT In 2020, 13.6 million children under 5 years suffered from severe acute malnutrition (SAM)/wasting. Standard ready-to-use therapeutic foods (RUTFs) improve polyunsaturated fatty acid (PUFA) status but contain suboptimal amounts of omega-3 (n-3) PUFAs with unbalanced n-6-to-n-3 PUFA ratios. OBJECTIVES The aim was to compare the effects of RUTFs with different essential fatty acid contents on PUFA status, neurodevelopmental, and clinical outcomes (mortality, comorbidities, and recovery) of children with severe wasting. DATA SOURCES Twelve databases, trial repositories, and article references with no publication limitations. DATA EXTRACTION Ten studies from randomized, quasi, and cluster-randomized controlled trials providing RUTFs as home treatment to children 6-59 months with SAM/wasting were included. DATA ANALYSIS Plasma phospholipid eicosapentaenoic acid content was higher in children receiving RUTF with altered essential fatty acid contents compared with standard RUTF (0.20 [0.15-0.25], P < 0.00001). Docosahexaenoic acid (DHA) status only improved in children receiving RUTF with added fish oil (0.33 [0.15-0.50], P = 0.0003). The Malawi Developmental Assessment tool (MDAT) global development and problem-solving assessment scores were higher in global assessment and gross motor domains in children receiving added fish oil compared with standard formulation (0.19 [0.0-0.38] and 0.29 [0.03-0.55], respectively). Children receiving high-oleic-acid RUTF (lowering the n-6:n-3 PUFA ratio of the RUTF) with or without fish oil had significantly higher scores in social domains compared with those receiving the standard formulation (0.16 [0.00-0.31] and 0.24 [0.09-0.40]). Significantly higher mortality risk was found in children receiving a standard formulation compared with RUTF with a lower n-6:n-3 PUFA ratio (0.79 [0.67-0.94], P = 0.008). CONCLUSION Although lowering n-6:n-3 PUFA ratios did not increase plasma DHA, it improved specific neurodevelopmental scores and mortality due to lower linoleic acid (high-oleic-acid peanuts), higher alpha-linolenic acid (altered oil), or both. Additional preformed n-3 long-chain PUFAs (fish oil) with RUTF improved the children's DHA status, neurodevelopmental outcomes, and weight-for-height z score. More research is needed regarding cost, availability, stability, acceptability, and the appropriate amount of n-3 long-chain PUFAs required in RUTFs for the best clinical outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022303694.
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Affiliation(s)
- Arista Nienaber
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Cornelia Conradie
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Geoffrey Manda
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Ettienne Nel
- Department of Paediatrics and Child Health, University Stellenbosch, Bellville, Cape Town, South Africa
| | - Edith B Milanzi
- Medical Research Council Clinical Trials, University College London, London, United Kingdom
| | - Robin C Dolman-Macleod
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Martani J Lombard
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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Ayaz A, Nisar I, Muhammad A, Ahmed K, Chand P, Jehan F. Structural Changes in the Brain on Magnetic Resonance Imaging in Malnourished Children: A Scoping Review of the Literature. Pediatr Neurol 2023; 149:151-158. [PMID: 37890309 DOI: 10.1016/j.pediatrneurol.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 06/10/2023] [Accepted: 08/14/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND This review was conducted to summarize the current evidence on the structural findings seen in brain magnetic resonance imaging (MRI) in malnourished children and the effect of optimized nutritional supplementation on brain development as studied through MRI. METHODS A systematic search was carried out in PubMed, Embase, The Cochrane Library, Web of Science (Clarivate Analytics), WHO ICTRP Clinical Trials in Children, and ClinicalTrials.gov using a predefined search criterion for relevant literature from inception to January 2022. The primary outcome of the study was structural changes observed in the brain on MRI. RESULTS The most common abnormal findings on MRI in malnourished infants were cerebral atrophy and dilated ventricles. Furthermore, a higher proportion of breast milk, calorie, and lipid intake in the diet was significantly associated with increased brain volumes; this also increased the likelihood of normal MRI scores at term. When followed till adolescence, it was observed that these infants had increased neonatal weight gain and a higher intelligence quotient when compared with the group. CONCLUSIONS In conclusion, most children with moderate/severe malnutrition had abnormal MRI findings, mostly cerebral atrophy with or without ventricular dilatation. Since none of the studies measured the degree of atrophy or ventricular dilatation, it was not possible to assess the effect of the severity of malnutrition on brain atrophy. A universal measurement or scoring system for assessing the degree of brain atrophy is needed to help correlate the severity of malnutrition with the degree of brain atrophy and monitor the effects of nutritional rehabilitation over time.
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Affiliation(s)
- Ahmed Ayaz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Kheezran Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Prem Chand
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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6
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Jones HJ, Bourke CD, Swann JR, Robertson RC. Malnourished Microbes: Host-Microbiome Interactions in Child Undernutrition. Annu Rev Nutr 2023; 43:327-353. [PMID: 37207356 DOI: 10.1146/annurev-nutr-061121-091234] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Childhood undernutrition is a major global health burden that is only partially resolved by nutritional interventions. Both chronic and acute forms of child undernutrition are characterized by derangements in multiple biological systems including metabolism, immunity, and endocrine systems. A growing body of evidence supports a role of the gut microbiome in mediating these pathways influencing early life growth. Observational studies report alterations in the gut microbiome of undernourished children, while preclinical studies suggest that this can trigger intestinal enteropathy, alter host metabolism, and disrupt immune-mediated resistance against enteropathogens, each of which contribute to poor early life growth. Here, we compile evidence from preclinical and clinical studies and describe the emerging pathophysiological pathways by which the early life gut microbiome influences host metabolism, immunity, intestinal function, endocrine regulation, and other pathways contributing to child undernutrition. We discuss emerging microbiome-directed therapies and consider future research directions to identify and target microbiome-sensitive pathways in child undernutrition.
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Affiliation(s)
- Helen J Jones
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom;
| | - Claire D Bourke
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom;
| | - Jonathan R Swann
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ruairi C Robertson
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom;
- Microenvironment and Immunity Unit, INSERM U1224, Institut Pasteur, Université Paris Cité, Paris, France
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7
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James G, Stephenson K, Callaghan-Gillespie M, Kamara MT, Park HG, Brenna JT, Manary MJ. Docosahexaenoic Acid Stability in Ready-to-Use Therapeutic Food. Foods 2023; 12:foods12020308. [PMID: 36673399 PMCID: PMC9858440 DOI: 10.3390/foods12020308] [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: 12/02/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Ready-to-use therapeutic food (RUTF) is used to treat young children diagnosed with severe acute malnutrition. RUTF with low and balanced linoleic and alpha-linolenic acid, plus omega-3 docosahexaenoic acid (DHA), supports long-term cognitive recovery. DHA is prone to degradation due to peroxidation, possibly exacerbated by the iron inherently in RUTF. Our goals were to prepare benchtop and manufacturing scale of RUTF formulations that include DHA and measure its retention. Twenty-seven RUTF formulas with base ingredients, including oats, high oleic or commodity peanuts, and encapsulated or oil-based DHA at various levels were prepared at benchtop scale, followed by seven months of climate-controlled storage. These pilot samples had similar relative DHA retention. At the manufacturing scale, DHA was added at one of two stages in the process, either at the initial or the final mixing stage. Samples taken at preliminary or later steps show that less than 20% of DHA added at the early stages disappeared prior to packaging for any recipe tested. Overall, our data indicate that most DHA included in RUTF is retained in the final product and that DHA is best retained when added at the latest manufacturing stage.
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Affiliation(s)
- Genevieve James
- Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX 78723, USA
| | - Kevin Stephenson
- Department of Medicine, Washington University, St. Louis, MO 63110, USA
| | | | | | - Hui Gyu Park
- Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX 78723, USA
| | - J. Thomas Brenna
- Dell Pediatric Research Institute, The University of Texas at Austin, Austin, TX 78723, USA
| | - Mark J. Manary
- Department of Pediatrics, Washington University, St. Louis, MO 63110, USA
- Project Peanut Butter, Freetown 47235, Sierra Leone
- Children’s Nutrition Research Center, USDA-Agricultural Research Service, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-(314)-454-2178
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Babikako HM, Bourdon C, Mbale E, Aber P, Birabwa A, Chimoyo J, Voskuijl W, Kazi Z, Massara P, Mukisa J, Mupere E, Nampijja M, Saleem AF, Uebelhoer LS, Bandsma R, Walson JL, Berkley JA, Lancioni C, Gladstone M, van den Heuvel M. Neurodevelopment and Recovery From Wasting. Pediatrics 2022; 150:189663. [PMID: 36193695 DOI: 10.1542/peds.2021-055615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Acute illness with malnutrition is a common indication for hospitalization among children in low- and middle-income countries. We investigated the association between wasting recovery trajectories and neurodevelopmental outcomes in young children 6 months after hospitalization for an acute illness. METHODS Children aged 2 to 23 months were enrolled in a prospective observational cohort of the Childhood Acute Illness & Nutrition Network, in Uganda, Malawi, and Pakistan between January 2017 and January 2019. We grouped children on the basis of their wasting recovery trajectories using change in mid-upper arm circumference for age z-score. Neurodevelopment was assessed with the Malawi Developmental Assessment Tool (MDAT development-for-age z-score [DAZ]) at hospital discharge and after 6 months. RESULTS We included 645 children at hospital discharge (mean age 12.3 months ± 5.5; 55% male); 262 (41%) with severe wasting, 134 (21%) with moderate wasting, and 249 (39%) without wasting. Four recovery trajectories were identified: high-stable, n = 112; wasted-improved, n = 404; severely wasted-greatly improved, n = 48; and severely wasted-not improved, n = 28. The children in the severely wasted-greatly improved group demonstrated a steep positive MDAT-DAZ recovery slope. This effect was most evident in children with both wasting and stunting (interaction wasted-improved × time × stunting: P < .001). After 6 months, the MDAT DAZ in children with wasting recovery did not differ from community children. In children who never recovered from wasting, there remained a significant delay in MDAT DAZ scores. CONCLUSIONS Neurodevelopment recovery occurred in parallel with wasting recovery in children convalescing from acute illness and was influenced by stunting.
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Affiliation(s)
| | - Celine Bourdon
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Translational Medicine
| | - Emmie Mbale
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Peace Aber
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Makerere University, Uganda Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - Annet Birabwa
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Makerere University, Uganda Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - Josephine Chimoyo
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Wieger Voskuijl
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Child Health and Development Center School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda.,Centre for Global Health.,Amsterdam Center for Global health, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Paraskevi Massara
- Translational Medicine.,Department of Nutritional Sciences, Faculty of Medicine
| | - John Mukisa
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Departments of Immunology and Molecular Biology, Pathology.,Baylor College of Medicine, Houston, Texas
| | - Ezekiel Mupere
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Makerere University, Uganda Case Western Reserve University Research Collaboration, Kampala, Uganda.,Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Margaret Nampijja
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,MRC/UVRI & London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda.,African Population and Health Research Center, Nairobi, Kenya
| | - Ali Faisal Saleem
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan
| | - Luke S Uebelhoer
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Robert Bandsma
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Translational Medicine.,Centre for Global Health.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Judd L Walson
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington
| | - James A Berkley
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Christina Lancioni
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Melissa Gladstone
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Women and Children's Health, Institute of Life Course and Clinical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Meta van den Heuvel
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Centre for Global Health.,Division of Pediatrics, Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, University of Toronto, Canada
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Kirolos A, Goyheneix M, Kalmus Eliasz M, Chisala M, Lissauer S, Gladstone M, Kerac M. Neurodevelopmental, cognitive, behavioural and mental health impairments following childhood malnutrition: a systematic review. BMJ Glob Health 2022; 7:e009330. [PMID: 35793839 PMCID: PMC9260807 DOI: 10.1136/bmjgh-2022-009330] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Severe childhood malnutrition impairs growth and development short-term, but current understanding of long-term outcomes is limited. We aimed to identify studies assessing neurodevelopmental, cognitive, behavioural and mental health outcomes following childhood malnutrition. METHODS We systematically searched MEDLINE, EMBASE, Global Health and PsycINFO for studies assessing these outcomes in those exposed to childhood malnutrition in low-income and middle-income settings. We included studies assessing undernutrition measured by low mid-upper arm circumference, weight-for-height, weight-for-age or nutritional oedema. We used guidelines for synthesis of results without meta-analysis to analyse three outcome areas: neurodevelopment, cognition/academic achievement, behaviour/mental health. RESULTS We identified 30 studies, including some long-term cohorts reporting outcomes through to adulthood. There is strong evidence that malnutrition in childhood negatively impacts neurodevelopment based on high-quality studies using validated neurodevelopmental assessment tools. There is also strong evidence that malnutrition impairs academic achievement with agreement across seven studies investigating this outcome. Eight of 11 studies showed an association between childhood malnutrition and impaired cognition. This moderate evidence is limited by some studies failing to measure important confounders such as socioeconomic status. Five of 7 studies found a difference in behavioural assessment scores in those exposed to childhood malnutrition compared with controls but this moderate evidence is similarly limited by unmeasured confounders. Mental health impacts were difficult to ascertain due to few studies with mixed results. CONCLUSIONS Childhood malnutrition is associated with impaired neurodevelopment, academic achievement, cognition and behavioural problems but evidence regarding possible mental health impacts is inconclusive. Future research should explore the interplay of childhood and later-life adversities on these outcomes. While evidence on improving nutritional and clinical therapies to reduce long-term risks is also needed, preventing and eliminating child malnutrition is likely to be the best way of preventing long-term neurocognitive harms. PROSPERO REGISTRATION NUMBER CRD42021260498.
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Affiliation(s)
- Amir Kirolos
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Blantyre, Malawi
| | - Magdalena Goyheneix
- Fundación ACNUR Argentina (Agencia de la ONU para los Refugiados, UNHCR), Buenos Aires, Argentina
| | - Mike Kalmus Eliasz
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Mphatso Chisala
- Malawi Epidemiology and Intervention Research Unit, Lilongwe/Karonga, Malawi
| | - Samantha Lissauer
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Blantyre, Malawi
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Melissa Gladstone
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Marko Kerac
- Centre for Maternal, Child, Adolescent & Reproductive Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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10
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Turesky TK, Shama T, Kakon SH, Haque R, Islam N, Someshwar A, Gagoski B, Petri WA, Nelson CA, Gaab N. Brain morphometry and diminished physical growth in Bangladeshi children growing up in extreme poverty: A longitudinal study. Dev Cogn Neurosci 2021; 52:101029. [PMID: 34801857 PMCID: PMC8605388 DOI: 10.1016/j.dcn.2021.101029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/14/2021] [Accepted: 10/24/2021] [Indexed: 11/25/2022] Open
Abstract
Diminished physical growth is a common marker of malnutrition and it affects approximately 200 million children worldwide. Despite its importance and prevalence, it is not clear whether diminished growth relates to brain development and general cognitive ability. Further, diminished growth is more common in areas of extreme poverty, raising the possibility that it may mediate previously shown links between socioeconomic status (SES) and brain structure. To address these gaps, 79 children growing up in an extremely poor, urban area of Bangladesh underwent MRI at age six years. Structural brain images were submitted to Mindboggle software, a Docker-compliant and high-reproducibility tool for tissue segmentation and regional estimations of volume, surface area, cortical thickness, sulcal depth, and mean curvature. Diminished growth predicted brain morphometry and mediated the link between SES and brain morphometry most consistently for subcortical and white matter subcortical volumes. Meanwhile, brain volume in left pallidum and right ventral diencephalon mediated the relationship between diminished growth and full-scale IQ. These findings offer malnutrition as one possible pathway through which SES affects brain development and general cognitive ability in areas of extreme poverty.
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Affiliation(s)
- Ted K Turesky
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Graduate School of Education, Cambridge, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Talat Shama
- The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Rashidul Haque
- The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nazrul Islam
- National Institute of Neuroscience and Hospital, Dhaka, Bangladesh
| | - Amala Someshwar
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Borjan Gagoski
- Harvard Graduate School of Education, Cambridge, MA, United States; Fetal-Neonatal Neuroimaging and Development Science Center, Boston Children's Hospital, Boston, MA, United States
| | - William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Charles A Nelson
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Graduate School of Education, Cambridge, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Nadine Gaab
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Graduate School of Education, Cambridge, MA, United States; Harvard Medical School, Boston, MA, United States
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11
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Nane D, Hatløy A, Lindtjørn B. A local-ingredients-based supplement is an alternative to corn-soy blends plus for treating moderate acute malnutrition among children aged 6 to 59 months: A randomized controlled non-inferiority trial in Wolaita, Southern Ethiopia. PLoS One 2021; 16:e0258715. [PMID: 34710105 PMCID: PMC8553037 DOI: 10.1371/journal.pone.0258715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Globally, moderate acute malnutrition (MAM) affects approximately 5% of children below five years of age. MAM is a persistent public health problem in Ethiopia. The current approach in Ethiopia for managing MAM is a supplementary feeding program; however, this is only provided to chronically food-insecure areas. The objective of the study was to compare a local-ingredients-based supplement (LIBS) with the standard corn-soy blend plus (CSB+) in treating MAM among children aged 6 to 59 months to test the hypothesis that the recovery rate achieved with LIBS will not be more than 7% worse than that achieved with CSB+. METHODS AND FINDINGS We used an individual randomized controlled non-inferiority trial design with two arms, involving 324 children with MAM aged 6 to 59 months in Wolaita, Southern Ethiopia. One hundred and sixty-two children were randomly assigned to each of the two arms. In the first arm, 125.2 g of LIBS with 8 ml of refined deodorized and cholesterol-free sunflower oil/day was provided. In the second arm, 150 g of CSB+ with 16 ml of refined deodorized and cholesterol-free sunflower oil/day was provided. Each child was provided with a daily ration of either LIBS or CSB+ for 12 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses were done. ITT and PP analyses showed non-inferiority of LIBS compared with CSB+ for recovery rate [ITT risk difference = 4.9% (95% CI: -4.70, 14.50); PP risk difference = 3.7% (95% CI: -5.91, 13.31)]; average weight gain [ITT risk difference = 0.10 g (95% CI: -0.33 g, 0.53 g); PP risk difference = 0.04 g (95% CI: -0.38 g, 0.47 g)]; and recovery time [ITT risk difference = -2.64 days (95% CI: -8.40 days, 3.13 days); PP difference -2.17 days (95% CI: -7.97 days, 3.64 days]. Non-inferiority in MUAC gain and length/height gain was also observed in the LIBS group compared with the CSB+ group. CONCLUSIONS LIBS can be used as an alternative to the standard CSB+ for the treatment of MAM. Thus, the potential of scaling up the use of LIBS should be promoted. TRIAL REGISTRATION Pan-African Clinical Trial Registration number: PACTR201809662822990.
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Affiliation(s)
- Debritu Nane
- School of Public and Environmental Health, Hawassa University, Awassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
- Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Anne Hatløy
- Centre for International Health, University of Bergen, Bergen, Norway
- Fafo Institute for Labour and Social Research, Oslo, Norway
| | - Bernt Lindtjørn
- School of Public and Environmental Health, Hawassa University, Awassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
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12
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Saleem J, Zakar R, Mushtaq F, Bukhari GMJ, Fischer F. Comparative analysis of developmental profile between normal and severe acute malnourished under-five children in Pakistan: a multicentre cross-sectional study. BMJ Open 2021; 11:e048644. [PMID: 34389574 PMCID: PMC8365806 DOI: 10.1136/bmjopen-2021-048644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aims to compare the developmental profile of severe acute malnourished (SAM) and normal under-five children and to find sociodemographic determinants accountable for their developmental disabilities. SETTING We conducted a multi-centre cross-sectional study in three basic health units and one rural health centre in Pakistan. PARTICIPANTS 200 children (SAM and healthy) aged 6-59 months. PRIMARY AND SECONDARY MEASURES We screened for nutritional status and clinical complications. Children underwent for developmental assessment by Denver Development Screening Tool II. A pretested structured questionnaire on sociodemographic characteristics and nutrition was used for collecting data about determinants of developmental delay. RESULTS We observed statistically significant differences in anthropometric measurements among SAM compared with normal nourished in weight, height, mid-upper arm circumference and weight-for-height z-scores. SAM serves as a significant risk factors (p<0.001) for delayed personal or social development (69% vs 11%; OR (95% CI)=18.01 (8.45 to 38.37)), delayed fine motor development (39% vs 8%; OR (95% CI)=7.35 (3.22 to 16.81)), delayed language development (32% vs 8%; OR (95% CI)=5.41 (2.35 to 12.48)), delayed gross motor development (34% vs 10%; OR (95% CI)=4.64 (2.14 to 10.05)) and delayed global development (66% vs 20%; OR (95% CI)=7.77 (4.09 to 14.74)). Applying logistic regression, personal or social development (p<0.001) and language development (p<0.05), under-five siblings was a risk factor, while among gross motor development, mother's educational status (p<0.05) was a significant risk factor for developmental delay. CONCLUSIONS Our analysis indicates that children with malnutrition have a high frequency of developmental delays. Missing maternal education and a higher number of under-five siblings are also potential risk factors for developmental delay.
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Affiliation(s)
- Javeria Saleem
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | | | | | - Florian Fischer
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, University of Applied Sciences Ravensburg-Weingarten, Weingarten, Germany
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13
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Daniel AI, Bwanali M, Tenthani JC, Gladstone M, Voskuijl W, Potani I, Ziwoya F, Chidzalo K, Mbale E, Heath A, Bourdon C, Njirammadzi J, van den Heuvel M, Bandsma RHJ. A Mixed-Methods Cluster-Randomized Controlled Trial of a Hospital-Based Psychosocial Stimulation and Counseling Program for Caregivers and Children with Severe Acute Malnutrition. Curr Dev Nutr 2021; 5:nzab100. [PMID: 34447897 PMCID: PMC8382273 DOI: 10.1093/cdn/nzab100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/17/2021] [Accepted: 07/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Children with severe acute malnutrition (SAM) who require nutritional rehabilitation unit (NRU) treatment often have poor developmental and nutritional outcomes following discharge. The Kusamala Program is a 4-d hospital-based counseling program for caregivers of children with SAM that integrates nutrition, water, sanitation, and hygiene and psychosocial stimulation, aimed at improving these outcomes. OBJECTIVES The aim was to evaluate the effects of the Kusamala Program on child development and nutritional status in children with SAM 6 mo after NRU discharge. The other aim was to qualitatively understand perceptions and experiences of caregivers who participated in the intervention. METHODS A cluster-randomized controlled trial was conducted with caregivers and their children 6-59 mo of age with SAM admitted to the Moyo NRU in Blantyre, Malawi. The primary outcome of the trial was child development according to Malawi Developmental Assessment Tool (MDAT) composite z-scores of gross motor, fine motor, language, and social domains. A qualitative component with focus group discussions and in-depth interviews was also completed with a subset of caregivers who participated in the trial. RESULTS Sixty-eight caregivers and children were enrolled to clusters by week and randomly assigned to the comparison arm and 104 to the intervention arm. There were no differences in child development, with mean MDAT composite z-scores in the comparison arm of -1.2 (95% CI: -2.1, -0.22) and in the intervention arm of -1.1 (95% CI: -1.9, -0.40) (P = 0.93). The qualitative evaluation with 20 caregivers indicated that the 3 modules of the Kusamala Program were appropriate and that they applied many of the lessons learned at home as much as possible. CONCLUSIONS The Kusamala Program did not result in improved developmental or nutritional outcomes, yet it was viewed positively by caregivers according to qualitative results. Future research should evaluate more intensive interventions for caregivers and children with SAM. This trial was registered at www.clinicaltrials.gov as NCT03072433.
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Affiliation(s)
- Allison I Daniel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mike Bwanali
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
| | | | - Melissa Gladstone
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Wieger Voskuijl
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
- Department of Pediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Isabel Potani
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
| | - Frank Ziwoya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
| | - Kate Chidzalo
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
| | - Emmie Mbale
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
- Department of Pediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Anna Heath
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Science, University College London, London, United Kingdom
| | - Celine Bourdon
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
| | - Jenala Njirammadzi
- Department of Pediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Meta van den Heuvel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert H J Bandsma
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
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14
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Wenger MJ, DellaValle DM, Todd LE, Barnett AL, Haas JD. Limited Shared Variance among Measures of Cognitive Performance Used in Nutrition Research: The Need to Prioritize Construct Validity and Biological Mechanisms in Choice of Measures. Curr Dev Nutr 2021; 5:nzab070. [PMID: 34056512 PMCID: PMC8141094 DOI: 10.1093/cdn/nzab070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The literature on correlates of nutrition has seen an increase in studies focused on functional consequences at the levels of neural, perceptual, and cognitive functioning. A range of measurement methodologies have been used in these studies, and investigators and funding agencies have raised the questions of how and if these various methodologies are at all comparable. OBJECTIVE The aim was to determine the extent to which 3 different sets of cognitive measures provide comparable information across 2 subsamples that shared culture and language but differed in terms of socioeconomic status (SES) and academic preparation. METHODS A total of 216 participants were recruited at 2 US universities. Each participant completed 3 sets of cognitive measures: 1 custom-designed set based on well-understood laboratory measures of cognition [cognitive task battery (COGTASKS)] and 2 normed batteries [Cambridge Neuropsychological Test Automated Battery (CANTAB), Weschler Adult Intelligence Scale, fourth edition (WAIS-IV)] designed for assessing general cognitive function. RESULTS The 3 sets differed with respect to the extent to which SES and educational preparation affected the results, with COGTASKS showing no differences due to testing location and WAIS-IV showing substantial differences. There were, at best, weak correlations among tasks sharing the same name or claiming to measure the same construct. CONCLUSIONS Comparability of measures of cognition cannot be assumed, even if measures have the same name or claim to assess the same construct. In selecting and evaluating different measures, construct validity and underlying biological mechanisms need to be at least as important as population norms and the ability to connect with existing literatures.
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Affiliation(s)
- Michael J Wenger
- Department of Psychology, Cellular, and Behavioral Neurobiology, The University of Oklahoma, Norman, OK, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Diane M DellaValle
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- Nutrition Science, King's College, Wilkes-Barre, PA, USA
| | - Lauren E Todd
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Amy L Barnett
- Department of Psychology, Cellular, and Behavioral Neurobiology, The University of Oklahoma, Norman, OK, USA
| | - Jere D Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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15
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Neurodevelopmental effects of childhood malnutrition: A neuroimaging perspective. Neuroimage 2021; 231:117828. [PMID: 33549754 DOI: 10.1016/j.neuroimage.2021.117828] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 02/08/2023] Open
Abstract
Approximately one in five children worldwide suffers from childhood malnutrition and its complications, including increased susceptibility to inflammation and infectious diseases. Due to improved early interventions, most of these children now survive early malnutrition, even in low-resource settings (LRS). However, many continue to exhibit neurodevelopmental deficits, including low IQ, poor school performance, and behavioral problems over their lifetimes. Most studies have relied on neuropsychological tests, school performance, and mental health and behavioral measures. Few studies, in contrast, have assessed brain structure and function, and to date, these have mainly relied on low-cost techniques, including electroencephalography (EEG) and evoked potentials (ERP). The use of more advanced methods of neuroimaging, including magnetic resonance imaging (MRI) and functional near-infrared spectroscopy (fNIRS), has been limited by cost factors and lack of availability of these technologies in developing countries, where malnutrition is nearly ubiquitous. This report summarizes the current state of knowledge and evidence gaps regarding childhood malnutrition and the study of its impact on neurodevelopment. It may help to inform the development of new strategies to improve the identification, classification, and treatment of neurodevelopmental disabilities in underserved populations at the highest risk for childhood malnutrition.
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16
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Impact of food supplements on early child development in children with moderate acute malnutrition: A randomised 2 x 2 x 3 factorial trial in Burkina Faso. PLoS Med 2020; 17:e1003442. [PMID: 33362221 PMCID: PMC7757806 DOI: 10.1371/journal.pmed.1003442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lipid-based nutrient supplements (LNS) and corn-soy blends (CSBs) with varying soy and milk content are used in treatment of moderate acute malnutrition (MAM). We assessed the impact of these supplements on child development. METHODS AND FINDINGS We conducted a randomised 2 × 2 × 3 factorial trial to assess the effectiveness of 12 weeks' supplementation with LNS or CSB, with either soy isolate or dehulled soy, and either 0%, 20%, or 50% of protein from milk, on child development among 6-23-month-old children with MAM. Recruitment took place at 5 health centres in Province du Passoré, Burkina Faso between September 2013 and August 2014. The study was fully blinded with respect to soy quality and milk content, while study participants were not blinded with respect to matrix. This analysis presents secondary trial outcomes: Gross motor, fine motor, and language development were assessed using the Malawi Development Assessment Tool (MDAT). Of 1,609 children enrolled, 54.7% were girls, and median age was 11.3 months (interquartile range [IQR] 8.2-16.0). Twelve weeks follow-up was completed by 1,548 (96.2%), and 24 weeks follow-up was completed by 1,503 (93.4%); follow-up was similar between randomised groups. During the study, 4 children died, and 102 children developed severe acute malnutrition (SAM). There was no difference in adverse events between randomised groups. At 12 weeks, the mean MDAT z-scores in the whole cohort had increased by 0.33 (95% CI: 0.28, 0.37), p < 0.001 for gross motor; 0.26 (0.20, 0.31), p < 0.001 for fine motor; and 0.14 (0.09, 0.20), p < 0.001 for language development. Children had larger improvement in language z-scores if receiving supplements with milk (20%: 0.09 [-0.01, 0.19], p = 0.08 and 50%: 0.11 [0.01, 0.21], p = 0.02), although the difference only reached statistical significance for 50% milk. Post hoc analyses suggested that this effect was specific to boys (interaction p = 0.02). The fine motor z-scores were also improved in children receiving milk, but only when 20% milk was added to CSB (0.18 [0.03, 0.33], p = 0.02). Soy isolate over dehulled soy increased language z-scores by 0.07 (-0.01, 0.15), p = 0.10, although not statistically significant. Post hoc analyses suggested that LNS benefited gross motor development among boys more than did CSB (interaction p = 0.04). Differences between supplement groups did not persist at 24 weeks, but MDAT z-scores continued to increase post-supplementation. The lack of an unsupplemented control group limits us from determining the overall effects of nutritional supplementation for children with MAM. CONCLUSIONS In this study, we found that child development improved during and after supplementation for treatment of MAM. Milk protein was beneficial for language and fine motor development, while suggested benefits related to soy quality and supplement matrix merit further investigation. Supplement-specific effects were not found post-intervention, but z-scores continued to improve, suggesting a sustained overall effect of supplementation. TRIAL REGISTRATION ISRCTN42569496.
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17
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Lelijveld N, Groce N, Patel S, Nnensa T, Chimwezi E, Gladstone M, Mallewa M, Wells J, Seal A, Kerac M. Long-term outcomes for children with disability and severe acute malnutrition in Malawi. BMJ Glob Health 2020; 5:bmjgh-2020-002613. [PMID: 33028697 PMCID: PMC7542612 DOI: 10.1136/bmjgh-2020-002613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Severe acute malnutrition (SAM) and disability are major global health issues. Although they can cause and influence each other, data on their co-existence are sparse. We aimed to describe the prevalence and patterns of disability among a cohort of children with SAM. Methods A longitudinal cohort study in Malawi followed SAM survivors up to 7 years postdischarge. Clinical and anthropometric profiles were compared with sibling and community controls. Disability at original admission was identified clinically; at 7-year follow-up a standardised screening tool called ‘the Washington Group Questionnaire’ was used. Results 60/938 (6.4%) of admissions to SAM treatment had clinically obvious disability at admission. Post-treatment mortality was high, with only 11/60 (18%) surviving till 7-year follow-up. SAM children with a disability at admission had 6.99 (95% CI 3.49 to 14.02; p<0.001) greater risk of dying compared with children without disability. They were also older, less likely to be HIV positive or have oedema and more severely malnourished. Long-term survivors were more stunted, had less catch-up growth, smaller head circumference, weaker hand grip strength and poorer school achievement than non-disabled survivors. The Washington Group Questionnaire confirmed disability in all who had been identified clinically, and identified many who had not been previously flagged. Conclusion Disability is common among children affected by SAM. Those with disability-associated SAM have greatly increased risk of dying even if they survive the initial episode of malnutrition. Survivors have poorer growth, physical strength and school achievement. To enable all children to survive and thrive post-SAM, it is vital to focus more on those with disabilities. SAM treatment programmes should consider using not just clinical assessment but structured assessments to better identify at-risk individuals as well as understand the population of children for which they are developing services.
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Affiliation(s)
- Natasha Lelijveld
- Institute for Global Health, University College London, London, UK .,Clinical Research Programme, Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
| | - Nora Groce
- Department of Epidemiology and Health Care, UCL International Disability Research Centre, London, UK
| | - Seema Patel
- Department of Epidemiology and Health Care, UCL International Disability Research Centre, London, UK
| | - Theresa Nnensa
- Clinical Research Programme, Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
| | - Emmanuel Chimwezi
- Clinical Research Programme, Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
| | - Melissa Gladstone
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Macpherson Mallewa
- Department of Paediatrics and Child Health, University of Malawi College of Medicine, Blantyre, Southern Region, Malawi
| | - Jonathan Wells
- Childhood Nutrition Research Centre, Institute of Child Health, University, London, UK
| | - Andrew Seal
- Institute for Global Health, University College London, London, UK
| | - Marko Kerac
- Clinical Research Programme, Malawi-Liverpool Wellcome Trust, Blantyre, Malawi.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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18
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Khandelwal N, Mandliya J, Nigam K, Patil V, Mathur A, Pathak A. Determinants of motor, language, cognitive, and global developmental delay in children with complicated severe acute malnutrition at the time of discharge: An observational study from Central India. PLoS One 2020; 15:e0233949. [PMID: 32479548 PMCID: PMC7263621 DOI: 10.1371/journal.pone.0233949] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Undernutrition leads to impaired psychosocial and cognitive development. This study explored the developmental status of children with complicated severe acute malnutrition (SAM) and correlated it with various risk factors for SAM. METHODS AND FINDINGS We recruited 100 children with SAM and no other associated significant health issues during the recovery phase of treatment using the Bayley Scales of Infant and Toddler Development III prior to discharge from the nutritional rehabilitation unit in R D Gardi Medical College, Ujjain, Central India. We also assessed composite developmental scores, developmental age equivalents, and average differences in developmental age. Risk factors for developmental delay were identified in children with complicated SAM. The results revealed that 75%, 75%, and 63% of children with SAM exhibited delay in motor (mean score: 78.22), language (mean score: 83.97), and cognitive (mean score: 78.06) domains, respectively. A total of 63% children exhibited delay by an average of 4-7 months in the total developmental age. The proportion of children with delay in motor, language, and cognitive domains was determined. An increased risk of global developmental delay was observedin children with a low birth weight (adjusted odds ratio [aOR]: 18.06, 95%CI: 2.08-156.56; P = 0.009), having working mothers (aOR: 17.54, 95%CI: 3.02-102.59; P = 0.001), weight-for-age less than three standard deviations (aOR: 6.09, 95%CI: 1.08-34.10; P = 0.04), and presence of severe anemia (aOR: 16.34, 95%CI: 2.94-90.73; P = 0.001). CONCLUSIONS The results indicated that children with SAM exhibit developmental delay across all domains. Identifying multiple modifiable risk factors for developmental delay in children with SAM will be helpful in devising early interventional strategies in low-middle income countries; however, the exact timing of such interventions should be investigated.
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Affiliation(s)
| | - Jagdish Mandliya
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain, India
| | - Kamna Nigam
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain, India
| | - Vandana Patil
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain, India
| | - Aditya Mathur
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain, India
| | - Ashish Pathak
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain, India
- Department of Women and Children’s Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
- Global Health—Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- International Centre for Health Research, Ujjain Charitable Trust Hospital and Research Centre, Ujjain, India
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19
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Daniel AI, Chidzalo K, Potani I, Voskuijl W, Gladstone M, van den Heuvel M, Bwanali M, Mbale E, Bandsma RHJ. A quantitative cross-sectional survey of psychosocial stimulation and counselling interventions at nutritional rehabilitation units in Southern Malawi. Malawi Med J 2020; 31:238-243. [PMID: 32128033 PMCID: PMC7036430 DOI: 10.4314/mmj.v31i4.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Inpatient treatment at nutritional rehabilitation units (NRUs) is needed for children who have severe acute malnutrition (SAM) and acute illness, loss of appetite, or severe oedema. World Health Organization guidelines state that nutritional counselling should be done with primary caregivers at NRUs. These recommendations also include psychosocial stimulation interventions to improve developmental outcomes in children with SAM. However, there is limited information about the delivery of these types of interventions for caregivers and children in NRU settings. The primary objective of this research was therefore to obtain data about NRU resources, activities, and protocols relevant to psychosocial stimulation and counselling interventions during inpatient treatment of children with SAM. Methods A cross-sectional survey was administered by interview at all 16 NRUs in seven districts in Southern Malawi. Participants were health workers, nurses, and nutritionists employed at the respective NRUs. Results The response rate was 100% across NRUs. Half of participants said that psychosocial stimulation interventions are conducted at their respective NRUs, yet none of the NRUs have protocols for delivery of these interventions. Furthermore, 7/16 (44%) NRUs have no resources for psychosocial stimulation including play materials. Thirteen of 16 (81%) participants said that they feel this type of intervention is very important and 3/16 (19%) participants said that this somewhat important for children with SAM. All NRUs provide counselling to caregivers about breastfeeding and nutrition; 15/16 (94%) also give counselling about water, sanitation and hygiene. Conclusions Ultimately, results from this survey highlighted that there is a need to invest in comprehensive interventions to improve developmental and nutritional outcomes in these vulnerable children requiring admission to NRUs.
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Affiliation(s)
- Allison I Daniel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Translational Medicine Program.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kate Chidzalo
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi.,The Childhood Acute Illness & Nutrition Network (CHAIN), Blantyre, Malawi
| | - Isabel Potani
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi.,The Childhood Acute Illness & Nutrition Network (CHAIN), Blantyre, Malawi
| | - Wieger Voskuijl
- The Childhood Acute Illness & Nutrition Network (CHAIN), Blantyre, Malawi.,Global Child Health Group, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Melissa Gladstone
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Meta van den Heuvel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,The Childhood Acute Illness & Nutrition Network (CHAIN), Blantyre, Malawi.,Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Mike Bwanali
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi.,The Childhood Acute Illness & Nutrition Network (CHAIN), Blantyre, Malawi
| | - Emmie Mbale
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi.,The Childhood Acute Illness & Nutrition Network (CHAIN), Blantyre, Malawi
| | - Robert H J Bandsma
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Translational Medicine Program.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,The Childhood Acute Illness & Nutrition Network (CHAIN), Blantyre, Malawi.,Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
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20
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Olsen MF, Iuel-Brockdorff AS, Yaméogo CW, Cichon B, Fabiansen C, Filteau S, Phelan K, Ouédraogo A, Wells JC, Briend A, Michaelsen KF, Lauritzen L, Ritz C, Ashorn P, Christensen VB, Gladstone M, Friis H. Early development in children with moderate acute malnutrition: A cross-sectional study in Burkina Faso. MATERNAL AND CHILD NUTRITION 2019; 16:e12928. [PMID: 31823490 PMCID: PMC7083399 DOI: 10.1111/mcn.12928] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022]
Abstract
Malnutrition impairs cognitive, communication, and motor development, but it is not known how nutrition and health are associated with development in children with moderate acute malnutrition (MAM). We aimed to describe motor and language development of children with MAM and explore its nutrition and health-related correlates. This cross-sectional study used baseline data from a nutritional trial in children with MAM aged 6-23 months in Burkina Faso. Motor and language skills were assessed using the Malawi Development Assessment Tool (MDAT). Linear mixed models were used to explore potential correlates of MDAT including socio-economic status, anthropometry, body composition, whole-blood polyunsaturated fatty acids (PUFA), haemoglobin (Hb), iron status, and morbidity. We also assessed child and caregiver participation during MDAT procedures and their associations with correlates and development. MDAT data were available for 1.608 children. Mean (95% CI) MDAT z-scores were -0.39 (-0.45, -0.34) for gross motor, 0.54 (0.48, 0.59) for fine motor, and -0.91 (-0.96, -0.86) for language skills. Children with higher mid-upper arm circumference, weight-for-height, height-for-age, fat-free mass, n-3 PUFAs, Hb, and iron status had better MDAT z-scores, whereas children with more fat mass index, anaemia, illness, and inflammation had poorer z-scores. In addition, children living in larger households or with an unmarried mother had poorer MDAT z-scores. Associations between morbidity and z-scores were largely explained by children's poorer participation during MDAT assessment. The identified factors associated with child development may inform interventions needed to stimulate development during or after management of MAM.
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Affiliation(s)
- Mette F Olsen
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | | | - Charles W Yaméogo
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark.,Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Bernardette Cichon
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Christian Fabiansen
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kevin Phelan
- The Alliance for International Medical Action (ALIMA), Paris, France
| | | | - Jonathan C Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - André Briend
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Per Ashorn
- Centre for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Vibeke B Christensen
- Department of Pediatrics and Adolescent Health, Rigshospitalet, Copenhagen, Denmark.,Medicins Sans Frontieres - Denmark, Copenhagen, Denmark
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
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21
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Acharya Y, Luke N, Haro MF, Rose W, Russell PSS, Oommen AM, Minz S. Nutritional status, cognitive achievement, and educational attainment of children aged 8-11 in rural South India. PLoS One 2019; 14:e0223001. [PMID: 31596845 PMCID: PMC6784908 DOI: 10.1371/journal.pone.0223001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Malnutrition among children is one of the most pressing health concerns middle- and low-income countries face today, particularly those in Sub-Saharan Africa and South Asia. Early-life malnutrition has been shown to affect long-term health and income. One hypothesized channel linking early-life malnutrition and long-term outcomes is cognitive development. However, there is limited empirical evidence on the relationship between nutritional status and cognitive achievement in middle childhood. STUDY DESIGN As part of the South India Community Health Study (SICHS), we collected educational attainment and anthropometric data from 1,194 children in rural Vellore district of Tamil Nadu, India, and assessed their math and reading skills. We analyzed the relationship between continuous and binary anthropometric measures of nutritional status and three measures of cognitive achievement (reading, math, and grade level), adjusting for potential confounders, using a regression framework. RESULTS Lower height-for-age and weight-for-age and their corresponding binary measures (stunting, underweight) were associated with lower reading scores, lower math scores, and lower grade level, with the exception of the association between weight-for-age and reading, which was marginally significant. A stunted child had one-third of a grade disadvantage compared to a non-stunted counterpart, whereas an underweight child had one-fourth of a grade disadvantage compared to a non-underweight counterpart. Lower BMI-for-age was associated with grade level and marginally associated with lower math scores, and its binary measure (thinness) was marginally associated with lower math scores. CONCLUSIONS Acute and chronic malnutrition in middle childhood were negatively associated with math scores, reading scores, and educational attainment. Our study provides new evidence that cognitive achievement during middle childhood could be an important mechanism underlying the association between early-life malnutrition and long-term wellbeing.
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Affiliation(s)
- Yubraj Acharya
- Department of Health Policy and Administration, The Pennsylvania State University, Pennsylvania, United States of America
| | - Nancy Luke
- Department of Sociology and Criminology, The Pennsylvania State University, Pennsylvania, United States of America
| | - Marco Faytong Haro
- Department of Sociology and Criminology, The Pennsylvania State University, Pennsylvania, United States of America
| | - Winsley Rose
- Department of Pediatrics, Christian Medical College, Vellore, India
| | | | - Anu Mary Oommen
- Department of Community Health, Christian Medical College, Vellore, India
| | - Shantidani Minz
- Department of Community Health, Christian Medical College, Vellore, India
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