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Wright CM, Petermann-Rocha F, Bland R, Ashorn P, Zaman S, Ho FK. Weight velocity in addition to latest weight does not improve the identification of wasting, or the prediction of stunting and mortality: a longitudinal analysis using data from Malawi, South Africa, and Pakistan. J Nutr 2024:S0022-3166(24)00350-X. [PMID: 38936551 DOI: 10.1016/j.tjnut.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/28/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND In low/middle-income countries, most nutritional assessments use the latest weights, without reference to growth trajectory. OBJECTIVE This study explores whether velocity, in addition to the latest weight, improves the prediction of wasting, stunting or mortality in the first two years of life. METHODS We analysed a combined data set with weight and height data collected monthly in the first year of 3447 children from Pakistan, Malawi, South Africa, with height and survival recorded till 24 months. The main exposures were weight-for-age z-score (WAZ) at the end of each 2-month period and weight velocity-for-age z-score (WVZ2) across that period. The outcomes were wasting, stunting or all-cause mortality in the next 1-2 months. As a sensitivity analysis, we also used WVZ over 6 months (WVZ6), with matching WAZ. Cox proportional hazard models with repeated growth measures were used to study the association between exposures and mortality. Mixed Poisson models were used for stunting and wasting. RESULTS Children who were already stunted or wasted were most likely to remain so. WVZ2 was associated with a lower risk of subsequent stunting (RR 0.95; 95% CI 0.93-0.96), but added minimal prediction (difference in AUC = 0.004) compared to a model including only WAZ. Similarly, WVZ2 was associated with wasting (RR 0.74; 95% CI 0.72-0.76) but the prediction was only marginally greater than for WAZ (difference in AUC = 0.015). Compared to WAZ, WVZ6 was less predictive for both wasting and stunting. Low WVZ6 (but not WVZ2) was associated with increased mortality (HR 0.75, 95% CI 0.67-0.85), but added marginal only prediction to a model including WAZ alone (difference in C = 0.015). CONCLUSIONS The key anthropometric determinant of impending wasting, stunting, and mortality appears to be how far below the normal range the child's weight is, rather than how they reached that position.
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Affiliation(s)
- Charlotte M Wright
- School of Medicine, Dentistry & Nurising, University of Glasgow, Glasgow, UK.
| | - Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Ruth Bland
- School of Medicine, University of Glasgow, UK
| | - Per Ashorn
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences, Lahore, Pakistan
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Rahut DB, Mishra R, Bera S. Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia. Nutrition 2024; 120:112346. [PMID: 38320385 DOI: 10.1016/j.nut.2023.112346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Child malnutrition, comprising of undernutrition and obesity, is a global concern with severe implications for survival, leading to acute and chronic diseases that adversely affect the productivity of individuals and society. Asia shoulders the greatest burden, with 7 out of 10 undernourished children residing in the region. Despite the decline in global child stunting, particularly in Asia, its prevalence remains significant. In 2017, an estimated 151 million children under five experienced stunting, and an additional 38 million were overweight, with Africa and Asia accounting for 25% and 46% of the global figures, respectively. Therefore, this paper aims to analyze the geospatial and environmental determinants of undernutrition in rural South and Southeast Asia. METHODS To explore the geospatial and environmental determinants of undernutrition (stunting, wasting, and underweight), we use Poisson regression and the data from recent rounds of the Demographic and Health Survey (DHS) from India, Bangladesh, Pakistan, Nepal, Cambodia, and Timor-Leste. RESULTS This study found a high prevalence of stunting, wasting, and underweight among children aged 0 to 59 months in rural areas of South and Southeast Asia, with considerable variation between countries and clusters/primary sampling units. Results show a positive association between child malnutrition and factors such as maternal illiteracy, unsafe drinking water, and dirty cooking fuel in South and Southeast Asia. Children from impoverished households in India, Pakistan, and Cambodia were disproportionately affected. In addition to socio-economic factors, climatic risks such as temperature increase and rainfall variations also emerged as important determinants of child malnutrition in India, Bangladesh, and Timor-Leste. CONCLUSIONS This paper emphasizes the role of environmental and climatic factors on child nutrition, underscoring their significance regardless of socio-economic conditions. As the impacts of climate change continue to intensify, and agrarian societies bear the brunt, these factors will play a critical role in shaping child nutritional outcomes. Thus, amid growing climate change, nutritional security should be prioritized, considering the spatial domain and targeting climate distress areas along with other socio-economic and demographic aspects.
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Affiliation(s)
| | - Raman Mishra
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Subhasis Bera
- International School of Business and Media, Budge Budge, Kolkata, West Bengal, India
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Flaherman VJ, Murungi J, Bale C, Dickinson S, Chen X, Namiiro F, Nankunda J, Pollack LM, Laleau V, Kim MO, Allison DB, Ginsburg AS, Braima de Sa A, Nankabirwa V. Breastfeeding and Once-Daily Small-Volume Formula Supplementation to Prevent Infant Growth Impairment. Pediatrics 2024; 153:e2023062228. [PMID: 38062778 DOI: 10.1542/peds.2023-062228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Randomized controlled trials in Guinea-Bissau and Uganda have revealed that the intensive promotion of exclusive breastfeeding (EBF) impairs growth in early infancy. When newborn growth is impaired, small amounts of formula may be combined with breastfeeding to promote growth. METHODS To determine if breastfeeding combined with once-daily formula supplementation improves growth among at-risk newborns, we conducted a pilot randomized controlled trial in Bissau, Guinea-Bissau and Kampala, Uganda. We randomly assigned 324 healthy breastfeeding newborns who weighed 2000 g to 2499 g at birth or <2600 g at 4 days old to once-daily formula feeding through 30 days as a supplement to frequent breastfeeding followed by EBF from 31 days through 6 months, or to EBF through 6 months. The primary outcome was weight-for-age z score (WAZ) at 30 days. Other outcomes included weight-for-length z score (WLZ), length-for-age z score (LAZ), breastfeeding cessation, adverse events, and serious adverse events through 180 days. RESULTS Daily formula consumption in the intervention group was 31.9 ± 11.8 mL. The random assignment did not impact WAZ, WLZ, LAZ, breastfeeding cessation, adverse events, or serious adverse events through 180 days. In the intervention and control groups, 19 (12%) and 35 (21%) infants, respectively, reported nonformula supplementation in the first 30 days (P = .02). CONCLUSIONS Once-daily formula supplementation for 30 days was well-tolerated, but the small volume consumed did not alter growth through 180 days of age. Further research would be required to determine if larger formula volumes, longer duration of treatment, or more frequent feeding are effective at increasing growth for this at-risk population.
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Affiliation(s)
| | - Joan Murungi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Carlito Bale
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | | | - Xiwei Chen
- School of Public Health, Indiana University, Bloomington, Indiana
| | - Flavia Namiiro
- School of Public Health, Makerere University, Kampala, Uganda
| | - Jolly Nankunda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Lance M Pollack
- School of Medicine, University of California, San Francisco, California
| | - Victoria Laleau
- School of Medicine, University of California, San Francisco, California
| | - Mi-Ok Kim
- School of Medicine, University of California, San Francisco, California
| | - David B Allison
- School of Public Health, Indiana University, Bloomington, Indiana
| | | | | | - Victoria Nankabirwa
- School of Public Health, Makerere University, Kampala, Uganda
- Centre for Intervention Science for Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Flaherman VJ, Nankabirwa V, Ginsburg AS. Promoting Transparent and Equitable Discussion of Controversial Research. J Empir Res Hum Res Ethics 2023; 18:248-249. [PMID: 37437126 DOI: 10.1177/15562646231188573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Affiliation(s)
- Valerie J Flaherman
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Namirembe G, Ghosh S, Ausman LM, Shrestha R, Zaharia S, Bashaasha B, Kabunga N, Agaba E, Mezzano J, Webb P. Child stunting starts in utero: Growth trajectories and determinants in Ugandan infants. MATERNAL & CHILD NUTRITION 2022; 18:e13359. [PMID: 35488408 PMCID: PMC9218325 DOI: 10.1111/mcn.13359] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/20/2022] [Accepted: 03/29/2022] [Indexed: 01/03/2023]
Abstract
Childhood stunting remains a public health burden worldwide. Although many studies have examined early life and in‐utero risk factors; most have been observational and have used analytic techniques that make inferences limited to population means, thereby obscuring important within‐group variations. This study addressed that important gap. Using data from a birth cohort of Ugandan infants (n = 4528), we applied group‐based trajectory modelling to assess diverse patterns of growth among children from birth to 1‐year old. A multinomial regression model was conducted to understand the relationship between risk factors and observed patterns across groups. We found that the onset of stunting occurred before birth and followed four distinct growth patterns: chronically stunted (Group 1), recovery (Group 2), borderline stunted (Group 3) and normal (Group 4). The average length‐for‐age z‐score (LAZ) at birth was −2.6, −3.9, −0.6 and 0.5 for Groups 1–4, respectively. Although both Groups 1 and 2 were stunted at birth, stunting persisted in Group 1 while children in Group 2 recovered by the fourth month. Group 3 exhibited mild stunting while Group 4 was normal. Wasting and underweight were observed in all groups, with the highest prevalence of underweight in Group 1. Wasting gradually increased among children born already stunted (Groups 1 and 2). This showed the importance of distinguishing children by their growth patterns rather than aggregating them and only comparing population averages against global growth standards. The design of nutrition interventions should consider the differential factors and potential for growth gains relative to different risks within each group. In a sample of Ugandan infants, the onset of stunting occurred in utero and set in motion a range of possible growth trajectories for the child after birth. Child growth can be characterised by diverse patterns that suggest temporal variations in children's growth. This provides an opportunity for policymakers to provide specialised and targeted nutrition interventions. Addressing low birth weight, preterm births and small‐for‐gestational‐age is critical to effectively reduce rates of stunting in rural Uganda.
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Affiliation(s)
- Grace Namirembe
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Shibani Ghosh
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Lynne M. Ausman
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Robin Shrestha
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Sonia Zaharia
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Bernard Bashaasha
- Department of Agribusiness and Natural Resource Economics Makerere University Kampala Uganda
| | - Nassul Kabunga
- Department of Agribusiness and Natural Resource Economics Makerere University Kampala Uganda
| | - Edgar Agaba
- Department of Agribusiness and Natural Resource Economics Makerere University Kampala Uganda
| | - Julieta Mezzano
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
| | - Patrick Webb
- Feed the Future Innovation Lab, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
- Feed the Future Innovation Lab for Nutrition Boston Massachusetts USA
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Wu H, Dong C, Xiao W, Wei H, Shao Y, Chen T, Xia Y. Associations between PM 2.5 exposure and infant growth: A mediation analysis of oral microbiota. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 823:153688. [PMID: 35131243 DOI: 10.1016/j.scitotenv.2022.153688] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Previous studies have linked growth retardation with ambient fine particulate matter (PM2.5) exposure. However, few studies explored such association from the perspective of microbiota, such as oral microbiota. We aimed to identify the potential role of oral microbiota in the links between PM2.5 exposure and infant growth. METHODS Baseline information of 335 recruited mother-child pairs was collected by structured questionnaires. Growth indicators (weight, length) of one-year-old infants were abstracted from medical records when they had physical examination and corresponding z scores were calculated. 16S rRNA gene amplicon sequencing was performed to assess oral microbiota of infants and co-abundance groups (CAGs) were further calculated. We assessed PM2.5 levels by inverse distance weighting (IDW). Generalized linear regression and mediation analysis were performed to determine associations between PM2.5 exposure, oral microbiota and growth indicators. RESULTS Per 10 μg m-3 increment of PM2.5 in the period of 10th month-examination was associated with decreased length z score (β = -1.97, 95%CI: -3.83, -0.11). Oral microbiota correlated with weight z score and body mass index (BMI) z score was identified by Spearman correlation analysis. CAG4 was statistically associated with increased weight z score (β = 3.40, 95%CI: 0.29, 6.51) and BMI z score (β = 5.44, 95%CI: 1.00, 9.87). Several bacteria in the level of genus and CAG associated with PM2.5 exposure were additionally identified (P < 0.05). Mediation analysis revealed that PM2.5 in the period of birth-3rd month impacted the z scores of weight and BMI by altering relative abundance of Megasphaera (P < 0.05). CONCLUSION PM2.5 exposure from 10th to 12th month after birth could retard infant linear growth. PM2.5 might impact oral microbiota of one-year-old infants. Growth-related bacteria and CAGs were identified. Megasphaera might function as mediator between PM2.5 exposure during birth-3rd month and infant z scores of weight and BMI.
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Affiliation(s)
- Huaying Wu
- Department of Stomatology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - Chao Dong
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Wenwen Xiao
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Hongcheng Wei
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yunmin Shao
- Department of Stomatology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - Ting Chen
- Department of Science and Technology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China.
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
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