Childhood stunting: a global perspective

Unveiling predictive factors for household-level stunting in India: A machine learning approach using NFHS-5 and satellite-driven data

OBJECTIVES

Childhood stunting remains a significant public health issue in India, affecting approximately 35% of children under 5. Despite extensive research, existing prediction models often fail to incorporate diverse data sources and address the complex interplay of socioeconomic, demographic, and environmental factors. This study bridges this gap by employing machine learning methods to predict stunting at the household level, using data from the National Family Health Survey combined with satellite-driven datasets.

METHODS

We used four machine learning models-random forest regression, support vector machine regression, K-nearest neighbors regression, and regularized linear regression-to examine the impact of various factors on stunting. The random forest regression model demonstrated the highest predictive accuracy and robustness.

RESULTS

The proportion of households below the poverty line and the dependency ratio consistently predicted stunting across all models, underscoring the importance of economic status and household structure. Moreover, the educational level of the household head and environmental variables such as average temperature and leaf area index were significant contributors. Spatial analysis revealed significant geographic clustering of high-stunting districts, notably in central and eastern India, further emphasizing the role of regional socioeconomic and environmental factors. Notably, environmental variables like average temperature and leaf area index emerged as strong predictors of stunting, highlighting how regional climate and vegetation conditions shape nutritional outcomes.

CONCLUSIONS

These findings underline the importance of comprehensive interventions that not only address socioeconomic inequities but also consider environmental factors, such as climate and vegetation, to effectively combat childhood stunting in India.

Prevalence and predictors of stunting in children and adolescents aged 1-18 years with nephrotic syndrome attending Mulago Hospital, Uganda

BACKGROUND

Nephrotic syndrome is the predominant glomerulopathy in children worldwide, particularly in low-income countries. One of the key complications of nephrotic syndrome is stunting. Stunting is the most prevalent form of undernutrition globally; which leads to early and long-term consequences. In this study, we determined the prevalence and predictors of stunting among children and adolescents with nephrotic syndrome at a tertiary nephrology clinic in Uganda.

METHODS

Between February and August 2022, we conducted a cross-sectional study that enrolled children and adolescents aged 1 to 18 years with nephrotic syndrome. Participants had been undergoing steroid treatment for a minimum of three months and were registered at the paediatric renal clinic of Mulago National Referral Hospital in Kampala, Uganda. Medical history, physical examination and anthropometric assessment were conducted on the enrolled children. The World Health Organisation (WHO) growth reference standards were used to evaluate stunting in the enrolled children. Multivariable logistic regression analysis was performed to determine independent predictors of stunting and a p-value < 0.05 was considered statistically significant.

RESULTS

Ninety-four participants were enrolled, with a median age (IQR) at diagnosis of six years (IQR 3-9). Among the participants, 48 (51.1%) were male. The prevalence of stunting was observed in 15 (15.9%) participants (95% confidence interval [CI]: 15.88 - 16.04). Regarding severity, 12 (12.8%) participants were moderately stunted, and 3 (3.2%) were severely stunted. Participants with persistent proteinuria exhibited higher odds of stunting than those without. (OR: 4.11, 95% CI: 1.05 - 15.98, p < 0.041).

CONCLUSIONS

There is a high prevalence of stunting among children with nephrotic syndrome, particularly among those with on-going proteinuria. This underscores the importance of regular growth monitoring and screening for early identification and eventual management of stunting among children receiving care for nephrotic syndrome. Providing nutritional counselling and other interventions is thus crucial in addressing stunting among this specific group of children and adolescents.

Mother's Experiences in Caring for Children with Stunting in Rural Indonesia

INTRODUCTION

Stunting is a major health problem in Indonesia. The aim of this study is to explore the experiences of mothers who take care of stunted children in rural Pamekasan Madura, Indonesia.

METHODS

This research employed a phenomenological approach and conducted in-depth interviews with 11 mothers in rural Pamekasan Madura, Indonesia, using purposive sampling. Data collection took place from June to September 2023.

RESULTS

This study presents Madurese mothers' experiences caring for their children with stunting through two themes and five sub-themes: (a) beliefs passed down for generations: strong ancestral influence on feeding behaviors, traditional food, and traditional health-seeking behavior; and (b) insufficient resources on nutrition: a lack of time and money to provide nutrition-rich food and a lack of nutrition information.

DISCUSSION

Cultural beliefs, a lack of nutrition education, and economic barriers contribute to stunting in children. Our findings guide the design of tailored interventions for preventing stunting in Indonesian families and global communities.

Vitamin K2 deficiency and its association with short stature in children: A cross-sectional study

OBJECTIVES

This study examines the relationship between vitamin K2 (VK2) status and the occurrence of short stature in children.

METHODS

A cross-sectional analysis was conducted between January 2021 and August 2022, involving 235 children with a clinical diagnosis of short stature at the Second Affiliated Hospital of Wenzhou Medical University (short stature group) and 454 children with average height (±1 SD) from the same period (healthy group). Serum VK2 levels were compared between the two groups. Multivariate logistic regression analysis was used to identify factors associated with short stature, and spearman correlation analysis was used to examine the relationship between VK2 status and age.

RESULTS

Children in the short stature group exhibited lower VK2 levels (P = 0.019) and a significantly higher prevalence of VK2 deficiency (P = 0.011) compared to the healthy group. VK2 deficiency was identified as an independent risk factor for short stature (OR = 1.535, 95% CI = 1.061-2.222, P = 0.023) through multivariate logistic regression analysis. Furthermore, an inverse correlation was observed between serum VK2 levels and age in children aged 2 to 15 years (ρ = -0.133, P < 0.001).

CONCLUSIONS

VK2 deficiency may be associated with an increased risk of short stature in children.

Height and weight reference charts for Brazilians with intellectual disabilities aged 7-17

OBJECTIVE

It was to develop smoothed height and weight percentiles for boys and girls with IDs between 7 and 17 years old.

METHODS

The sample consisted of 1,047 young people (645 boys and 402 girls; 7-17 years old) with ID. A total of 4,059 measurements (height: n = 2,041; weight: n = 2,018) were retrospectively obtained from the period between 2013 and 2018. Smoothed height and weight percentiles were developed using the LMS method. Local and global diagnosis of percentiles were evaluated with Q statistics and detrended Q-Q plots.

RESULTS

Percentiles (5, 10, 25, 50, 75, 90, and 95) for height-to-age and weight-to-age were developed with satisfactory modeling in boys and girls between 7 and 17 years old. Boys showed a linear trend in height up to 11 or 12 years old, an increment from 13 to 15 years old and a deceleration from 15 or 16 years old. For the girls, height was linear between the ages of 7 and 11, followed by a deceleration from the age of 12 and without substantial changes from the ages of 15 to 17. Regarding weight, girls showed a linear trend of weight gain until the age of 13 and deceleration at the age of 14 or 15. Boys, however, showed a linear tendency to gain weight from 7 to 17 years old.

CONCLUSION

The height and weight percentiles developed in this study can help monitor the growth of young people with ID.

Exploring Multiple Barriers to Proper Child Feeding Practices in Rural Districts of Ethiopia

Infants' and young children's health and development rely on optimal feeding techniques. Malnutrition is the leading cause of preventable illness and death in infants and early childhood. This impact is mostly significant in low- and middle-income countries, where childhood illness and mortality rates have risen considerably. To explore the barriers to child feeding practices in the rural Gamo zone, south Ethiopia, from primary caregivers and different key individuals' perspectives. A phenomenological qualitative study approach with a purposive sampling technique was carried out to explore the barriers and facilitators of child feeding practices in the study area from August 14 to September 10, 2023. Data was collected from fathers, health extension workers, the health development army, religious leaders, and community elders who reside in rural communities of the Gamo zone. Three focus group discussions, including 8-10 participants per group with females and three with males until data saturation. A total of 51 discussants and 12 key informants participated in the study. The following barriers were identified from the study. Limited income and employment opportunities, lack of property ownership, limited maternal and husband education, and lack of knowledge about proper child feeding practices are among the factors leading to inadequate nutrition for children. Large family sizes, marriage-related factors like polygamy, early marriage, limited freedom of partner choice, and gender inequalities can affect necessary support for appropriate child feeding practices and negatively impact children's nutrition. Moreover, cultural norms, religious beliefs, lack of awareness regarding the husband's income, and lack of support from family members or communities were identified as barriers that influence child feeding practices. The study unveiled three key themes that impede the adoption of appropriate child feeding practices: economic status, demographic conditions, and sociocultural aspects that affect the feeding practices of children. Effective interventions to improve child feeding practices must consider and address these identified barriers.

The Correlation of Calcium and Hemoglobin Level Among Pregnant Women in ≥35 Weeks with the Anthropometry of Newborn Babies

Background

Low birth length and low birth weight can be caused by nutritional deficiencies in pregnant women, including calcium and iron deficiency anemia because it retards fetal growth during pregnancy. This study aimed to explore the correlation between calcium and hemoglobin levels in third-trimester pregnant women with anthropometry of newborn babies.

Methods

This study employed a prospective cohort design, including 120 third-trimester among pregnant women in ≥35 weeks and their newborn aterm babies, using a convenience sampling technique. This study was conducted in March-May 2024. Data on complete blood count tests and calcium levels of the mothers were collected, and anthropometry of newborn including birth length and birth weight was measured. Data were analyzed using univariate, bivariate, and multivariate analysis.

Results

The mean maternal calcium and hemoglobin levels were 2.19 mmol/L (sd 0.135) and 11.55 gr/dL (sd 1.187), respectively. The mean birth weight and median birth length were 3.02 kg (sd 0.374) and newborn's length 48.29 (sd 1.86), respectively. There was a positive correlation between calcium levels (p=0.007; r=0.246), as well as between hemoglobin levels (p=0.006; r=0.25) of pregnant women and the length of newborn babies. Furthermore, hemoglobin level was also correlated with the weight the newborns (p=0.001; r=0.29).

Conclusion

Low calcium level and low hemoglobin level among pregnant women in third trimester tend to have short-born babies. In addition, low hemoglobin level is more likely to have low birth weight. Therefore, it is necessary to monitor the provision of calcium and iron supplements as an alternative, after prioritizing the consumption of natural foods.

Trends and associated factors of animal source foods consumption among children aged 6-23 months in Bangladesh: evidence from four consecutive national surveys

Animal source foods (ASF) are nutrient-dense and essential for the growth and development of children. The Bangladesh Demographic and Health Survey (BDHS) 2022 reported that approximately two-thirds of children aged 6-23 months consumed eggs/flesh foods. However, overall consumption patterns, trends, and factors influencing ASF intake among children in Bangladesh were not well-documented. Therefore, the study aimed to assess the trends and associated factors of ASF consumption among children aged 6-23 months in Bangladesh. A total of 9401 children were extracted from four consecutive BDHS (2011, 2014, 2017/18, and 2022). The Cochran-Armitage test was conducted to assess the trends in ASF consumption, while a two-stage multilevel mixed-effects logistic regression was performed to identify the associated factors. The consumption of ASF significantly increased to 79.1% in 2017/18 from 67% in 2011 but decreased to 73.3% in 2022. ASF consumption was found to be higher among children whose mothers were educated (AOR = 1.60, 95% CI = 1.30-1.98), employed in either agricultural (AOR = 1.27, 95% CI = 1.04-1.54) or non-agricultural (AOR = 1.36, 95% CI = 1.07-1.72) activities, pregnant (AOR = 2.54, 95% CI = 1.66-3.87), had received ANC 1-3 times (AOR = 1.43, 95% CI = 1.20-1.72) or ≥4 times (AOR = 1.59, 95% CI = 1.29-1.95), and was exposed to media (AOR = 1.21, 95% CI = 1.04-1.39). Furthermore, consumption increased with increasing the age of children, and the wealth of their families. However, children who experienced illness were less likely to consume ASF (AOR = 0.76, 95% CI = 0.68-0.86). The recent declines in ASF consumption emphasize the need for targeted interventions to increase ASF consumption among children in Bangladesh.

Trends of wealth-related inequality in stunting and its contributing factors among under-five children in Ethiopia: Decomposing the concentration index using Ethiopian Demographic Health Surveys 2011-2019

BACKGROUND

Childhood stunting is a critical public health agenda that affects physical and cognitive development, leading to long-term health problems. Understanding its wealth related trends and contributing factors is essential for effective prospective interventions. Therefore, this study is aimed to assess the trends of childhood stunting inequality using Ethiopian Demographic Health Surveys (EDHS).

METHODS

This study employed the three consecutive EDHS datasets collected in 2011, 2016, and 2019. Socioeconomic disparity of stunting among under-five children was estimated through concentration index (CIX). Moreover, Wagstaff approach was used to decompose the relative CIX to assess the contribution of explanatory variables for the overall wealth inequality in childhood stunting.

RESULTS

The overall weighted prevalence of childhood stunting in Ethiopia was 40.76% (95%CI: 40.14%, 41.37%). The trend in the magnitude of childhood stunting decreased from 44.52% in 2011 to 37.08% in 2019. The magnitude of childhood stunting was higher (14.30%) among the poorest households than the richest households (4.70%). Moreover, the CIX of wealth inequality decreased from -0.064 in 2011 to -0.089 in 2019. Wealth index(103.38%), place of residence(34.55%), mother's education(26.73%), place of delivery(12.16%) and utilization of recommended antenatal care(12.02%) were high contributor variables in increasing the inequality, whereas administrative regions (-7.15%) and number of under-five children in the household (-4.63%) were variables contributed in the reduction of wealth inequalities in childhood stunting.

CONCLUSION

This study revealed that children in the poorest households were more likely to experience childhood stunting than the children in the richest households. Factors such as wealth index, mothers education, place of residence, place of delivery, number of under-five children in the household were the contributing variables for the childhood stunting inequality. Therefore, the health decision makers better to improve the access and quality of nutritional services for the children in the poorest households in Ethiopia.

Home-based nurturing care practices for children under five with low socioeconomic position in Santo Domingo, Dominican Republic

BACKGROUND

In the Dominican Republic about 14.5% of children do not reach their full potential by age five, with children of low socioeconomic position most affected. The Nurturing Care Framework is an evidence-informed actionable framework to help children thrive, but we must first understand cultural contexts and childrearing practices that contribute to delay. This study applies the Nurturing Care Framework to explore the context of home-based care among young children in the Dominican Republic.

METHODS

We conducted a sociodemographic survey and semi-structured qualitative interview with 25 mothers ages 19-42 (7 under the age of 18 at first birth) with low socioeconomic position and children under five that live in the capital city Santo Domingo. We asked in-depth questions about the Nurturing Care Framework's domains of responsive caregiving and opportunities for early learning. We used consensual coding and deductive thematic analysis to analyze transcriptions, examined convergence and divergence in themes between adolescent and adult mothers, and organized themes using concept mapping.

RESULTS

A few mothers provide responsive caregiving to their child, but they are unaware of its benefit to their child's development. Adolescent mothers expressed lower confidence in their mothering skills. Across age groups, mothers did not see themselves as agents of change in their child's early learning process and allow several hours of videos each day. Mothers provide children opportunities for learning through social interaction, a possible strength among this population. With regards to security and safety, about half of mothers use corporal punishment, all but one of these is an adolescent mother.

CONCLUSION

Findings highlight the need for parenting programs that build on strengths such as child-to-child social interaction and provide parents with opportunities to develop knowledge and skills to provide early learning opportunities. Interventions should target families with low socioeconomic position and adolescent mothers.

Development of the "KARUNI" (young adolescents community) model to prevent stunting: a phenomenological study on adolescents in Gunungkidul regency, Yogyakarta, Indonesia

BACKGROUND

Stunting is a major health problem in developing countries due to chronic malnutrition that impacts physical growth, cognitive ability, and long-term productivity. The focus of stunting prevention is generally aimed at pregnant women and toddlers, while adolescents, especially adolescent girls, are often neglected. In fact, they will be the future mothers who determine the quality of the next generation. Malnutrition and anemia in adolescents increase the risk of giving birth to stunted children. Innovative nutritional intervention programs, such as nutrition education and iron supplements, are needed to break the cycle of stunting, involving adolescents as important targets in prevention. Karuni is a program specifically designed for teenagers aged 12-15 years with the main focus being on empowering teenagers through nutrition education, reproductive health and clean and healthy living behavior as well as involving parents to optimize the program.

METHODS

This study used a phenomenological approach to explore the understanding of adolescent girls aged 12-15 years about the stunting prevention program in Gunungkidul Regency, Indonesia. Data were collected through in-depth interviews and FGDs with adolescents, officials running the Adolescent Health Care (PKPR) program, and related agencies. Data validity was guaranteed by triangulation of sources and NVivo was used for analysis.

RESULTS

The identified five themes related to the adolescent intervention program for stunting prevention: program implementation, achievements, barriers, needs, and KARUNI model design. Program monitoring is important, but faces barriers such as the lack of prioritization and motivation. Cross-sectoral collaboration, innovation, and appropriate media are needed in the implementation of the KARUNI model to increase the effectiveness of the stunting prevention program for adolescents.

CONCLUSIONS

The importance of the role of adolescents in efforts to reduce the prevalence of stunting, especially through collaboration between health centers (Puskesmas) and schools in implementing the PKPR program, providing iron tablets, and health screening.

A high prevalence of stunting was observed among under-five children: A community-based cross-sectional study

BACKGROUND

In low-income countries, stunting remains a major public health problem. It contributes to 50 % of all morbidity and mortality of under-five children and results in diminished mental and physical development.

OBJECTIVES

This study aims to determine the prevalence of stunting and identify the key socio-demographic, clinical, and environmental factors that associated with stunting among children aged 6-59 months in Pawie District, Ethiopia.

METHODS

A community-based cross-sectional study was conducted from March 1st to April 1st, 2019 among 841 children aged 6-59 months. An anthropometric measurement was taken for all children to determine their nutritional status, but demographic, clinical, and associated factor data were obtained through face-to-face interviews with the mother of the child using a structured questionnaire. Before analysis, the data was cleaned thoroughly to check for completeness. Then, enter into Epi Info version 7 and export to SPSS v25 for analyses. Frequencies mean, SD, percentage, and cross-tabulations were used to summarize the descriptive statistics of the data. Bi-variable and multi-variable logistic regression was employed to identify the associated factors of stunting. Lastly, results were presented using tables, charts, graphs, and result statements.

RESULTS

A total of 841 respondents were included in this study, with a 99 % response rate. The prevalence of stunting among children aged 6-59 months was 37.2 % (95 % CI: 33.9-40.4). Of these, half (50.1 %) were female. Child age (AOR = 1.988 [95 % CI: 1.140, 3.465]), maternal education (AOR = 5.164 [95 % CI: 1.207, 22.099]), maternal occupation (AOR: 4.975 [95 % CI: 1.720, 14.385]), episodes of malaria (AOR = 1.900 [95 % CI: 1.262, 2.862]), colostrum feeding (AOR = 2.519 [95 % CI: 1.310, 4.846]), and meal frequency (AOR = 1.857 [95 % CI: 1.084, 3.179]) were factors significantly associated with stunting.

CONCLUSIONS

In this study, a relatively high prevalence of stunting and many factors associated with it were observed. Therefore, confirming food security at the household level and creating awareness among mothers and guardians are the best methods to reverse under-5 stunting.

Determinants of stunting among children under 5 years in Bangladesh: a quantile regression analysis

BACKGROUND

Child undernutrition is a major public health problem in developing countries that contributes to increased incidence of morbidity and mortality. Stunting is a valid and widely acknowledged measure of chronic child malnutrition.

METHODS

This study extracted data of 7778 under-5 children from the 2017-2018 Bangladesh Demographic and Health Survey and aims to explore the relationship between socio-demographic factors and the nutritional status of children under the age of 5. The anthropometric indicator height-for-age z-score (HAZ) was used as the target variable. The quantile regression method was employed to examine the heterogeneous relationship between the covariates and the conditional HAZ distribution across five different quantiles.

RESULTS

This study found that 31.4% of children were severely to moderately stunted and a negative association between children's age and their HAZ. Additionally, children whose mothers had attained at least a secondary education exhibited a positive correlation with their HAZ. Another important factor was the mother's body mass index, which had a two-fold effect on the HAZ. Among the administrative divisions, children from the Sylhet division exhibited a negative association with the HAZ. Additionally, children with a high wealth index exhibited a positive association with the HAZ.

CONCLUSIONS

Collaborative efforts from different organisations, as well as small and large communities in rural and urban areas, are necessary to improve nutritional status of children in Bangladesh.

Mycotoxins and bone growth: a review of the literature on associations between xenobiotic exposure and bone growth and development

Mycotoxins are secondary metabolites of fungi that are known to be associated with linear growth faltering because of their impact on inflammation, intestinal damage, inhibition of protein synthesis, and micronutrient absorption. In this narrative review, we aim to extend this analysis to further explore associations between mycotoxins (aflatoxins, ochratoxins, trichothecenes including deoxynivalenol, T-2 toxin, and fumonisins) and long-bone growth, particularly during the saltatory periods of development. Linear growth is a direct function of skeletal development and long-bone growth. We therefore explored biological pathways and mechanisms of impact of these toxins in both animal and human studies, in addition to the epidemiology literature (post-2020). Given what is known of the effects of individual and combinations of mycotoxins based on the animal literature, we have identified a need for further research and examination of how these toxins and exposures may be studied in humans to elucidate the downstream impact on bone-related biomarkers and anthropometric indices used to identify and predict stunting in population-based studies.

Height development trends among 7-18-year-old school-age children in central plains of China between 2000 and 2019: A serial cross-sectional surveillance study in China

OBJECTIVE

The aim of this study was to analyze changes in height of 7-18-year-old school-age children in China during the year of 2000-2019.

METHODS

We used the survey data from the Chinese National Survey on Students' Constitution and Health in Henan Province for the years 2000, 2005, 2010, 2014, and 2019. Data were categorized into subgroups based on geographic location, gender, and age; mean, standard deviation, and Pearson's correlation coefficient were used to analyze trends in height change among children and adolescents and the correlation between socioeconomic indicators and height change.

RESULTS

The height of children and adolescents in Henan has shown a continuous upward trend. The height difference between urban and rural areas has gradually narrowed but has not disappeared. The correlation of height development trends between neighbouring urban areas was higher than in other areas. The level of medical care was significantly associated with the change in height for both boys (r = 0.950, p = 0.013) and girls (r = 0.897, p = 0.039); GDP per capita (r = 0.940，p = 0.018) was significantly associated with the change in height for boys only.

CONCLUSION

The height of Chinese children and adolescents will continue to maintain a positive growth trend, but we need to pay attention to the health status and nutritional intake of children and adolescents in economically disadvantaged areas in order to narrow the height disparity between different socio-economic groups.

Unveiling subgroup trends of stunting and wasting in Indian children: a serial cross-sectional analysis from National Family Health Surveys 3-5

BACKGROUND

India grapples with a dual burden of child wasting and stunting and stark socio-economic and regional disparities.

OBJECTIVES

We aimed to better understand trends in the prevalence of childhood stunting and wasting, with an emphasis on its disproportionate effects on marginalized populations, by analyzing National Family Health Surveys (NFHS) data from 2005 to 2020.

METHODS

We analyzed trends in the distribution of childhood height-for-age Z (HAZ) and weight-for-height Z (WHZ) scores using anthropometric data from 3 surveys, NFHS 3, 4, and 5. We examined disparities by wealth, caste, tribe, area of residence (rural compared with urban), and sex and mapped trends against India's evolving policy landscape. We also conducted a regression analysis of HAZ and WHZ risk factors.

RESULTS

In the context of an evolving nutrition-centered policy landscape, disparities by level of wealth in both HAZ and WHZ decreased in the study period (HAZ: estimate = 0.27, confidence interval [CI]: 0.16, 0.38; and WHZ: estimate = 0.11, CI: 0.01, 0.22), though there were no improvements in disparities for marginalized castes (HAZ: estimate = 0.07, CI: 0.00, 0.13; and WHZ: estimate = 0.02, CI: -0.04, 0.08). Though they have narrowed, disparities by wealth, caste, tribe, and area of residence persist, with undernutrition at birth, as measured by HAZ and WHZ, a particularly acute problem.

CONCLUSIONS

Although there have been significant reductions in disparities by wealth in mean HAZ and WHZ scores in India, persistent disparities by caste, tribe, and area of residence necessitate reinvestments in targeted interventions. Further, despite this narrowing of disparities and overall progress against stunting, anthropometric scores in early childhood continue to be low in India, especially with regard to wasting, indicating the importance of not only maternal nutrition and care for newborns but more comprehensive efforts to address poverty and other factors that contribute to undernutrition, with a focus on vulnerable populations.

A community-based study to assess the prevalence and predictors of stunting among under-five children in Sheger City, Oromia, Ethiopia

Background

Stunting is a serious public health issue in Ethiopia. However, due to the scarcity of studies, little is known about the prevalence and predictors of stunting among children under the age of five in urban areas, especially those close to the capital city of the country (Addis Ababa). Thus, the aim of this study was to assess the prevalence of stunting and its predictors among children under the age of five in Lega Tafo Lega Dadi, Sheger City, Oromia, Ethiopia.

Methods

A community-based cross-sectional study was conducted on 566 children under the age of five using a systematic random sampling technique. Data were collected through face-to-face interviews, structured questionnaires, and anthropometric measurements. Afterward, the data were entered into EpiData (version 4.7) and exported to SPSS 26 for analysis. Anthropometric indices were calculated using WHO Anthro software (version 3.2.2). Bivariate and multivariable logistic regression analyses were performed to identify candidate variables and associated factors, respectively. An adjusted odds ratio (AOR) and its 95% confidence interval (CI) were used to assess the strength and significance of the association. A p-value of <0.05 was considered statistically significant. The goodness-of-fit for the model was assessed using the Hosmer-Lemeshow test.

Results

The prevalence of stunting was 18.9% (95% CI: 16, 22%) among under-five children in our study setting. Children whose mothers were daily laborers (AOR: 10.3), whose mothers' education level was primary school (AOR: 4.3), whose fathers were daily laborers (AOR: 4), who were born into families with an average birth interval of ≤24 months (AOR: 7.9), who were from families with a size ≥5 (AOR: 7.3), who had a history of diarrhea (AOR: 6.3), who had meals ≤3 times per day (AOR: 13.9), who were underweight (AOR: 2.8), who were breastfed for less than 2 years (AOR: 5.6), who had low dietary diversity (AOR: 6.3), and who experienced food insecurity (AOR: 3.6) were identified as the predictors of stunting in under-five children.

Conclusion

Approximately one-fifth of the under-five children were stunted in the study setting. Family occupational and educational status, average birth interval, family size, a history of diarrhea, meal frequency per day, underweight status, duration of breastfeeding, inadequate dietary diversity, and household food insecurity were all associated with stunting among the under-five children in the study setting.

Socioeconomic disparities in child malnutrition: trends, determinants, and policy implications from the Kenya demographic and health survey (2014 - 2022)

BACKGROUND

Child malnutrition remains a critical public health problem, with socioeconomic factors playing a significant role. Socioeconomic factors include household income, parental education, and access to healthcare, which influence a child's nutritional status. Despite overall progress in reducing under-five child malnutrition in Kenya, disparities persist. This paper analyzes changes, and determinants of child malnutrition, contributions of these determinants to health inequality, and their potential use in the screening for chronic malnutrition in children under five years.

METHODS

We use data from the Kenyan Demographic and Health Survey (KDHS 2014 and 2022) and analyze malnutrition using three indicators: Stunting, underweight, and wasting. The determinants of malnutrition are analyzed using multivariate logistic regression. Trends in socioeconomic inequality are analyzed using concentration indices and visualized using concentration curves. Wagstaff decomposition is used to explore the contributions of determinants to inequality in child malnutrition. We investigate diagnostic utility using sensitivity, specificity, predictive values, and area under the ROC curve.

RESULTS

Socioeconomic inequality in under-five child malnutrition increased between 2014 and 2022, with children from the poorest socioeconomic quintiles being disproportionately affected. A child's age (in months) (Adjusted Odds Ratio [AOR] = 1.01; 95% Confidence Interval [CI]: 1.01 - 1.02), being born to a household in the poorest socioeconomic quintile (AOR = 2.67; 95%CI: 1.92 - 3.72), and sex (male) (AOR = 1.50; 95%CI: 1.35 - 1.67) were associated with an increased risk of stunting. The mother's age, sex of the child (male), and household socioeconomic status (poorest) was associated with an increased risk of being underweight and wasted, whereas residence was associated with an increased risk of wasting alone after adjusting for potential confounders. A household's socioeconomic status was the largest contributing factor to health inequality. Sensitivity, specificity, and AUC values were 67.4% (95% CI: 66.4% - 68.4%), 50.6% (95%CI: 50.0% - 51.1%), and 0.59 (95%CI: 0.58 - 0.60), respectively, when using socioeconomic status as a screening tool for stunting.

CONCLUSION

Socioeconomic disparities are a major barrier to reducing child malnutrition in Kenya, with children from lower socioeconomic quintiles at a greater risk of stunting, underweight, or wasting. This study identifies a child's sex, age, and household socioeconomic status as key predictors of malnutrition, highlighting the need to include these factors in public health interventions. Addressing these disparities with targeted strategies considering immediate health risks and underlying socioeconomic challenges is essential for equitably improving child health outcomes.

The Effects of a Novel Astragalus-Based Extract (Keyfobell Powder (KFB)) on Longitudinal Bone Growth via IGF-1 Upregulation: A Potential Growth Hormone Alternative

BACKGROUND/OBJECTIVES

This study evaluated the effects of a novel Astragalus extract (Keyfobell powder [KFB]) composed of Astragalus membranaceus, red ginseng (Panax ginseng C. A. Meyer), and Cervi Parvum Cornu as a potential growth hormone (GH) alternative. The primary focus was placed on its impact on longitudinal bone growth through the upregulation of circulatory insulin-like growth factor (IGF)-1.

METHODS

We performed in vitro and in vivo experiments using a hypothalamic cell line and Sprague-Dawley (SD) rats. Quantitative RT-PCR was performed to determine growth hormone-releasing hormone (GHRH) and ghrelin mRNA expressions in GT1-7 cells. The treatment groups were administered KFB at various dosages, and the positive controls received recombinant human GH. Body weight, bone length, and density were assessed, along with serum levels of insulin-like growth factor binding protein (IGFBP)-3 and IGF-1.

RESULTS

KFB and somatropin exhibited no cytotoxic effect in GT1-7 cells and increased GHRH and ghrelin mRNA levels in a dose-dependent manner. KFB administration resulted in a significant dose-dependent increase in body weight and bone growth (femur and tibia). Changes in IGF-1 and IGFBP-3 levels were comparable to those observed in the GH-treated group. Based on network pharmacological analysis, multiple compounds in KFB ((20S)-20-hydroxypregn-4-en-3-one, 2-isopropyl-3-methoxypyrazine, caproic acid, daidzein, furfuryl alcohol, lauric acid, octanal, and salicylic acid) may synergistically regulate the PI3K-Akt, Ras, and Rap1 signaling pathways linked to growth control and cartilage formation, leading to a possible increase in height.

CONCLUSIONS

Our results suggest that KFB can function as a GH-mimetic agent that promotes bone growth through IGF-1 upregulation.

Genetic Perception Versus Nutritional Factors: Analyzing the Indigenous Baduy Community's Understanding of Stunting as a Health Issue

This study investigates the challenges and opportunities in addressing public health issues in the context of stunting in the Baduy community. Baduy is a remote indigenous group in Indonesia. The Indonesian government and NGOs such as SRI and Dompet Dhuafa have attempted to abolish stunting. However, factors such as cultural aspects, communication gaps, and logistic problems prevent the optimization of health interventions. Midwives and other health workers have yet to win the community's trust and provide quality services, but the lack of sustainable solutions further worsens their problem. This studyhighlights the urgency of culturally appropriate, long-term strategies that stay within the unique Baduy lifestyle and belief system, including integrating the tribal leaders into health campaigns. This study also seeks to explain the role of modern healthcare in the Baduy community, particularly the functional acceptance of modern medicine due to its effectiveness in treating severe health problems. However, controversies regarding access to healthcare for Indigenous peoples, especially regarding government resources for care in urban centers, reveal broader issues of healthcare equity in Indonesia. The study finds the need to advocate improved and culturally sensitive interventions, particularly in health communication and government support, to ensure sustainable improvements in public health for Indigenous peoples such as the Baduy.

Growth Trajectories of Children Born Preterm and Full-Term With Low Birth Weight to Preschool Ages: A Nationwide Study

CONTEXT

Preterm (PT) and full-term with low birth weight (FT-LBW) children are at a high-risk of poor growth outcomes.

OBJECTIVE

This work aimed to investigate the growth trajectories of PT and FT-LBW children from birth to preschool ages.

METHODS

This study included 1 150 508 infants (PT, 41 454; FT-LBW, 38 250) who underwent the first 3 rounds (4-6, 9-12, and 18-24 months) of the National Health Screening Program for Infants and Children (NHSPIC). Growth measurements were obtained from the NHSPIC database and converted into Z-scores. Growth data at ages 2, 4, and 6 years were measured as outcome variables. The effect of being born small on poor growth outcomes was investigated using a generalized estimating equation and Cox proportional-hazards regression analysis.

RESULTS

The median birth weights of the PT, FT-LBW, and FT groups were 2.3, 2.4, and 3.2 kg, respectively. The incidence of short stature (height Z-score < -2 SD score [SDS]) and failure to thrive (FTT) (body mass index (BMI) Z-score < -2 SDS) was the highest in the FT-LBW group, followed by the PT and FT groups. At age 4 years, the incidence rates were 6.0% vs 5.2% vs 1.9% for short stature and 4.6% vs 3.9% vs 1.7% for FTT. The β estimate of height outcome was lower both in the PT (-0.326 SDS) and FT-LBW (-0.456 SDS) groups.

CONCLUSION

The FT-LBW group was consistently shorter and lighter throughout the preschool period than the PT group, highlighting the significance of growth monitoring in high-risk populations.

Infant and young child feeding practice status and its determinants in UAE: results from the MISC cohort

BACKGROUND

To evaluate breastfeeding and complementary feeding practices and their determinants among infants and young children in the United Arab Emirates using the 2021 WHO/UNICEF IYCF guidelines.

METHODS

The Mother and Infant Study Cohort (MISC), is a prospective study of mothers recruited in their third gestational trimester and followed with their infants up to 18 months of age (n = 167). Data were collected at 3rd trimester, delivery, 2, 6, 12, and 18 months postpartum via questionnaires, review of medical records, anthropometric measurements, and 24-hour dietary recalls of the child's intake at 6, 12, and 18 months. Descriptive statistics and multiple logistic regressions were used to report on feeding practices and their determinants.

RESULTS

Ever breastfeeding, Early initiation of breastfeeding, and exclusive breastfeeding under 6 months were reported by 84.3%, 99.4%, and 32.9% of participants, respectively. Of children, 96.4% consumed solid foods at 6-8 months; 68.7% and 44.7% continued to be breastfed at 12 and 18 months, respectively. Despite improvement with age; several complementary feeding indicators remained suboptimal at 18 months: Minimum Dietary Diversity: 40.4%, Minimum Meal Frequency: 56.7%, Minimum Acceptable Diet: 23.1%, Sugar-Sweetened Beverages, 26.9%, Zero Vegetables and Fruits: 28.8%, Unhealthy Food Consumption: 65.4%. After adjustment, multiparous mothers had higher odds of exclusive breastfeeding, whereas pregnancy complications were associated with lower odds of exclusive breastfeeding. Continued breastfeeding at 18 months was associated with older age among mothers and lower income. Among the factors associated with complementary feeding indicators were higher physical activity and Minimum Dietary Diversity. While Gestational Diabetes Mellitus, Sugar-Sweetened Beverages, and higher education were associated with lower odds of Zero Vegetables and Fruits, and a higher income was associated with lower Unhealthy Food Consumption.

CONCLUSIONS

This study reported good rates of Early initiation of breastfeeding and ever-breastfeeding, yet suboptimal exclusive breastfeeding and complementary feeding. The identified risk factors for inappropriate practices could be used to guide nutrition interventions and public health programs in the United Arab Emirates.

Socio-economic and demographic determinants of undernutrition among 6-59 months old children living in Malawian stunting hotspots: a cross-sectional community study

BACKGROUND

Malnutrition is a global burden, with 171 million under-five children stunted and 45% of child deaths linked to it. Despite high undernutrition such as stunting in Mchinji, Mangochi, and Mzimba, no study has focused on all three hot spots. This study examined socio-economic and demographic determinants of undernutrition among children aged 6-59 months, offering insights to guide targeted interventions in these areas.

METHODS

This cross-sectional study of 1,275 caregiver-child pairs from Mzimba, Mchinji, and Mangochi used multi-stage sampling. Data were analyzed with Stata 17.0, employing descriptive statistics and binary logistic regression to explore associations and identify determinants of malnutrition in children aged 6-59 months based on WHO Z-scores.

RESULTS

The study identified socio-demographic factors influencing wasting, underweight, and stunting among children aged 6-59 months. Wasting was linked to occupation, marital status, household size, religious affiliation, and vaccination, with protective factors including farming (AOR = 0.023), business (AOR = 0.001), being single (AOR = 0.034), and full vaccination (AOR = 0.146), while Muslim affiliation increased odds (AOR = 71.284). Underweight was associated with occupation and household type, with higher risks in business (AOR = 9.408) and single-parent households (AOR = 20.929) but protection in smaller households (AOR = 0.596). Stunting was related to unemployment (AOR = 2.339) and full vaccination (AOR = 1.472). Education and income showed no significant association with stunting.

CONCLUSION

Socio-demographic factors significantly influenced wasting, underweight, and stunting in children, highlighting the need for targeted interventions on livelihoods, vaccination, and household conditions to reduce undernutrition and inform policy and program development.

Current trends in household food insecurity, dietary diversity, and stunting among children under five in Asia: a systematic review

Background

Household food insecurity (HFI) and poor dietary diversity (DD) are major public health challenges in Asia, greatly contributing to stunting among children under five. While previous research has focussed primarily on African regions, this systematic review provides novel insights into the association between HFI, DD, and stunting within the Asian context.

Methods

We searched across six major databases for studies published between 2019 and 2023 exploring the association between HFI, DD, and stunting in children under five across Asia. We then extracted their characteristics, evaluation methods, and outcomes related to stunting for analysis.

Results

From 3215 records, 37 met the inclusion criteria. Most studies were from South Asia (n = 22), followed by Southeast Asia (n = 8), with fewer from West (n = 4), East (n = 2), and Central Asia (n = 1), highlighting geographical research gaps. We found high stunting rates among children under five, especially in South and Southeast Asia. Stunting was strongly linked to HFI and poor DD, suggesting that these factors are critical in addressing malnutrition. Socioeconomic factors, maternal education, and access to clean water also influence stunting outcomes.

Conclusions

Current research on HFI, DD, and stunting in Asia shows substantial variation, with the highest stunting rates in South and Southeast Asia. Limited data from Central and East Asia highlights the need for more comprehensive research in these regions. Addressing HFI and improving DD is critical for reducing stunting and achieving global nutrition targets by 2030.

The Prevalence and Determinants of Undernutrition Among Infants and Children Aged 6 Months to 5 Years in Sub-Saharan African Countries: A Systematic Scoping Review

OBJECTIVE

To explore the prevalence and determinants of undernutrition among infants and children aged 6 months to 5 years in sub-Saharan African countries.

BACKGROUND

Despite substantial progress over the past 20 years, undernutrition has remained an alarming global challenge. Sub-Saharan Africa is the only region where the prevalence of stunting in children younger than 5 years has significantly increased. This study seeks to update the evidence on the prevalence and determinants of childhood undernutrition in this vulnerable region.

METHODS

This systematic scoping review was conducted following the 2018 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Five electronic databases were searched on December 14, 2022, with no date or language restrictions. Primary studies presenting evidence on the prevalence and determinants of childhood undernutrition among infants and children aged 6 months to 5 years were included. Data on the prevalence of stunting, wasting, and underweight, and on determinants of undernutrition were extracted, described, and compared with national survey data.

RESULTS

A total of 59 publications from 11 countries were included, with most studies conducted in Ethiopia (n = 38) and Tanzania (n = 7). Stunting prevalence ranged from 8% to 64%, wasting prevalence ranged from 1% to 58%, and the prevalence of underweight ranged from 2% to 63%. The most frequently reported determinants of undernutrition were the child's age (>24 months), male sex, maternal illiteracy, diarrhea or illness in the past 2 weeks, low household socioeconomic status, or living in a larger household (n > 4 members). Overall, 56% of the included studies reported higher stunting prevalence, 60% reported higher wasting prevalence, and 57% reported a higher prevalence of underweight than reported by relevant national surveys.

CONCLUSION

The prevalence of childhood undernutrition reported by primary studies is often higher than that reported by national surveys. Several immediate and underlying determinants influence childhood undernutrition. Future research should incorporate the findings from primary research to develop holistic, multistrategy approaches to address childhood undernutrition in sub-Saharan African countries.

The Association of Vitamin D, Nerve Growth Factor (NGF), Brain-Derived Neurotrophic Factor (BDNF), and Glial Cell-Derived Neurotrophic Factor (GDNF) with Development in Children

BACKGROUND

Short stature remains a global problem and is associated with vitamin D status. Vitamin D is also a neurosteroid with regard to neurotrophic factors but its role in development is unclear. Therefore, this study analyzed the relationships between vitamin D, NGF, GDNF, and BDNF and developmental status in children with a history of short stature (<2 years).

METHODS

This research is a prospective cross-sectional study conducted in March 2022. The vitamin D, NGF, GDNF, and BDNF levels were measured in stored biological materials from children aged 2-4 years, and their Ages and Stages Questionnaire (ASQ-3) scores were also assessed. The results were analyzed via the chi-square test, Fisher's exact test, Mann-Whitney test for NGF, unpaired t-test, and Spearman rank correlation.

RESULTS

Among the 85 study subjects, 41.2% were short in stature, with 37% having developmental deviation. Male sex (p = 0.038) and low maternal education (p = 0.024) were associated with short stature. The mean vitamin D level was lower (p = 0.041) in children with short stature (27.65 ng/dL). The risk factors associated with short stature were vitamin D levels ≤ 32.7 ng/dL, GDNF levels ≤ 12.99 ng/mL, male sex, and low maternal education. Children with short stature (<2 years old) also demonstrated impaired problem-solving as assessed by the ASQ-3 (p = 0.005). Vitamin D was also associated with gross motor skills (p = 0.035) and personal social development (p = 0.038).

CONCLUSIONS

There was no association of vitamin D with NGF, GDNF, or BDNF levels. Vitamin D levels are associated with short stature and development in children, especially gross motor skills, personal social development, and problem solving.

Suboptimal Refeeding Compensates Stunting in a Mouse Model of Juvenile Malnutrition

BACKGROUND

Early postnatal life is a critical period of rapid growth in mammals, heavily reliant on adequate nutrition. Protein-energy malnutrition (PEM) during this window can lead to stunting and wasting, with lasting health consequences.

OBJECTIVES

This study developed a mouse model of juvenile PEM to assess the effects of refeeding with various diets and interventions on growth recovery, including probiotic supplementation and suboptimal refeeding diets. Outcomes included length and weight catch-up, organ weights, and glucose tolerance.

METHODS

Juvenile male and female C57Bl/6J mice (N = 8 to 11/group) were fed a low-protein diet (LPD, 5% kcal from protein) starting at postnatal day 14 (P14) to which the pups and dams had access. Following weaning, mice were refed an optimal diet (27% kcal from protein) at different times (P28 to P56). Male mice received additional interventions, including supplementation with Lactiplantibacillus plantarum WJL (LpWJL) during refeeding or refeeding with a Western diet (WD), 15.3% kcal from protein, or a modified Western diet (MWD) 7.5% kcal from protein. Statistical analyses used analysis of variance, analysis of covariance, and principal component analysis.

RESULTS

Optimal refeeding restored growth in females (body weight in optimal-fed: 20.5 ± 0.3 g vs. 19.4 ± 0.6 g in P56-refed), but males showed persistent stunting (26.8 ± 0.7 g vs. 21.9 ± 0.9 g; P < 0.05). In males, LpWJL did not enhance growth recovery and exacerbated glucose intolerance in suboptimal refeeding groups. Males refed WD or MWD restored body length but showed impaired glucose metabolism, particularly in mice refed WD, with glycemia 30 min after glucose challenge reaching 20.4 ± 4.0 mM vs. 14.3 ± 3.0 mM in optimal-fed mice (P < 0.05).

CONCLUSIONS

Sex-dependent differences in recovery from PEM were evident, with males showing incomplete growth recovery despite optimal refeeding. Suboptimal diets compensated for stunting but impaired glucose metabolism, and LpWJL did not improve growth outcomes.

Stature and Its Association With Physiological Stress Exposure in a Pediatric Autopsy Sample

INTRODUCTION AND BACKGROUND

Experiencing illnesses or other stressors may disrupt processes of growth and development throughout the different stages of prepubertal development. Stunted stature for age is one potential outcome from such disruption, with both the nature and timing of stressors playing a role in the development of stunting. This study explores whether stress events in utero or during birth, and prepubertal development have an impact on stature, by examining associations between experience of prenatal or birth issues, postnatal stressor exposure by severity, and stature at time-of-death, with the impact of different stress experiences compared.

METHODS

A coronial pediatric dataset of individuals aged 0-20.9 years (280 male, 195 female) who died in the state of New Mexico from years 2011 to 2019 was assessed for presence/absence of stunting associated with physiological stress exposure type whilst controlling for low socioeconomic status (as inferred by housing type) and sex using two multiple logistic regression models for ages < 12, and for ages 12+. Broad postnatal condition categories were then investigated, again controlling for socioeconomic status and sex for these two cohorts. A linear regression model was also used to assess relationships between stunting, physiological stress, low socioeconomic status housing, and age-at-death.

RESULTS AND DISCUSSION

For both groups aged < 12 and 12+, experiencing moderate to severe illness prior to 12 years of age increased the odds of being stunted at death. Only experience of prenatal or birth issues was associated with younger age-at-death, but stunting itself was not, potentially reflecting the prolonged exposure to severe stressors necessary for stunted growth.

Analyzing Patterns of Skeletal Indicators of Developmental Stress Through the Double Lens of Ontogeny and the Life Course Approach in a Contemporary Reference Sample

OBJECTIVES

Skeletal indicators of developmental stress are commonly used to assess health, disease, and patterns of morbidity and mortality in past populations. Incorporating information about individual life history, such as adverse life events, allows for a more thorough understanding of their etiology. This paper adopts the double lens of ontogeny and the life course to analyze indicators of developmental stress in relation to known individual pathologies and developmental patterns of the cranium, vertebrae, and long bones.

MATERIAL AND METHODS

Six skeletal indicators were collected on CT scans or virtual skeletal reconstructions of 1033 contemporary deceased male and female individuals aged between 0 and 20 years from New Mexico: cribra orbitalia, porotic hyperostosis, Harris lines, stunting, vertebral neural canal diameters, and bone mineral density. Autopsy reports provided information on age, sex, disease type, and duration. Polychoric and polyserial correlations, boxplots, balloon plots, factor analyses of mixed data, and cluster analyses were used to explore patterns among indicators, ontogeny, sex, and disease.

RESULTS

The presence and prevalence of indicators varied depending on age and disease: Harris lines, stunted growth, and cribra orbitalia were common in younger age groups and in cases of long-term or respiratory illnesses, while porotic hyperostosis was more prevalent in adolescent and young adult males.

DISCUSSION

Skeletal indicators of developmental stress are most likely associated with the timing of adverse life events in relation to the corresponding ontogenetic patterns, developmental sensitivity to stressors, and developmental plasticity/canalization of the different skeletal elements that bear them.

[Inequalities in the adequacy to consultation calendar for children under 5 years old in the Food and Nutritional Surveillance]

The Ministry of Health recommends a minimum appointment schedule in childcare to monitor growth and development. The objective was to analyze the adequacy of the minimum appointment schedule for children under 5 years of age, with at least one anthropometric follow-up registered with the Food and Nutrition Surveillance System (SISVAN) between 2008 and 2020. The sample size comprised 23,453,620 children under the age of 5, and 103,773,311 records. The indicators analyzed were the average number of appointments and the adequacy of the last scheduled visit. In Brazil, the median number of appointments was three, which is lower than the recommended schedule. For children born after 2008, the adequacy of the last scheduled appointment was 11.8% with inequalities, lower in the North (5.7%) and higher in the South (22.5%). Comparing the federal units, Amapá and Roraima had the lowest frequencies, and Paraíba and Paraná the highest. The adequacy of the last scheduled appointment was higher among municipalities in the top fifth of GDP per capita. SISVAN reveals inequalities in access to health services; the highest level of adequacy with the minimum appointment schedule is in the South and Southeast regions.

Ochratoxin A Status at Birth Is Associated with Reduced Birth Weight and Ponderal Index in Rural Burkina Faso

BACKGROUND

Mycotoxin exposure during pregnancy has been associated with adverse birth outcomes and poor infant growth. We assessed multiple biomarkers and metabolites of exposure to mycotoxins at birth and their associations with birth outcomes and infant growth in 274 newborns in rural Burkina Faso.

METHODS

Whole-blood microsamples were analyzed for mycotoxin concentrations in newborns in the Biospecimen substudy nested in the MIcronutriments pour la SAnté de la Mère et de l'Enfant-III trial using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Unadjusted and adjusted associations between mycotoxin exposure, and birth outcomes and infant growth at 6 mo were estimated using linear regression models for continuous outcomes and linear probability models with robust variance estimation for binary outcomes. Infant growth trajectories from birth to 6 mo were compared by exposure status using mixed-effects models with a random intercept for the individual infant and a random slope for the infant's age.

RESULTS

Ochratoxin A (OTA) exposure was detected in 38.3% of newborns, with other mycotoxins being detected in the range of 0.36% and 4.01%. OTA exposure was significantly associated with adverse birth outcomes, such as lower birth weight [β (95% CI): -0.11 kg (-0.21, 0.00); P = 0.042] and ponderal index [β (95% CI): -0.62 gm/cm3 (-1.19, -0.05); P = 0.034], and a marginally significant lower length growth trajectories during the first 6 mo [β (95% CI): -0.08 cm/mo (-0.15, 0.0); P = 0.057].

CONCLUSIONS

OTA exposure was prevalent among newborns and also associated with lower growth at birth and during the first 6 mo. The results emphasize the importance of nutrition-sensitive strategies to mitigate dietary OTA, as well as adopting food safety measures in Burkina Faso during the fetal period of development.

Associations between extreme weather events and child undernutrition: evidence from sub-Saharan Africa, 2010-2019

BACKGROUND

Extreme weather events, or natural disasters, present a large and increasing threat to human health, infrastructure and food security, including in sub-Saharan Africa (SSA), where the burden of undernutrition is high. However, research about associations between natural disasters and undernutrition in early childhood is limited.

METHODS

We combined anthropometric data of children aged 0-59 months from 51 Demographic and Health Surveys datasets collected from 2010 to 2019 in 30 countries in SSA with information on natural disaster events (flood, drought, other) from the Emergency Events Database database to determine disaster exposure. The analytic sample included 320 479 children. We used generalised estimating equations to predict stunting, wasting and anaemia by disaster exposure and selected covariates.

RESULTS

Almost 20% (19.7%) of children under five were exposed to a natural disaster in the preceding year. In adjusted analysis, children exposed to at least one disaster in the preceding year had a relative risk (RR) of wasting 1.17 times higher than unexposed children (95% CI 1.12, 1.22). Adjusted models examining exposure to drought or flood consistently estimated higher risks of wasting post-disaster (drought RR 1.36, 95% CI 1.26, 1.47; flood RR 1.07, 95% CI 1.02, 1.12). RRs increased when using a 3-month exposure period. However, exposure to natural disaster was not consistently associated with significant differences in RR of stunting or anaemia.

CONCLUSION

Natural disasters are prevalent in SSA. Given the high risk of wasting associated with disaster exposure, policymakers should prioritise interventions to address wasting in post-disaster settings.

Physical growth in the first year of life of Terena Indigenous children living in an urban zone: longitudinal study

The present study aimed to assess the anthropometric nutrition status and physical growth of Terena Indigenous children living in an urban zone of the city of Campo Grande, Mato Grosso do Sul, Brazil, in their first year of life. Children who were born between June 2017 and July 2018 (n = 42) participated in the study. In total, 4.8% of the children presented a low height for age (H/A) in the 12th month of life. According to body mass index (BMI) for age, overweight affected 15.0% of the individuals belonging to the female sex at the age of 12 months, and obesity was observed in 4.8% of the children belonging to both sexes at this same age. Terena Indigenous children's length curve failed to reach the median value recorded for the reference population. Weight and body mass index curves for age, mainly among individuals belonging to the female sex, were often above the reference median value. The Terena growth curves recorded an average linear growth of lower than expected and a weight gain of higher than the reference median. This profile is compatible with the persistence of unfavorable conditions for children's growth and nutrition, as well as with an accelerated process of food and nutritional transition, where the racial dimension of health inequities cannot be disregarded.

Fundamentals of a healthy and sustainable diet

BACKGROUND

A healthy and sustainable diet is a prerequisite for population and planetary health. The evidence of associations between dietary patterns and health outcomes has now been synthesised to inform more than 100 national dietary guidelines. Yet, people select foods, not whole dietary patterns, even in the context of following specific diets such as a Mediterranean diet, presenting challenges to researchers, policymakers and practitioners wanting to translate dietary guideline recommendations into food-level selection guidance for citizens. Understanding the fundamentals that underpin healthy and sustainable diets provides a scientific basis for helping navigate these challenges. This paper's aim is to describe the fundamentals of a healthy and sustainable diet.

RESULTS

The scientific rationale underpinning what is a healthy and sustainable diet is universal. Everyone shares a physiological need for energy and adequate amounts, types and combinations of nutrients. People source their energy and nutrient needs from foods that are themselves sourced from food systems. The physiological need and food systems' sustainability have been shaped through evolutionary and ecological processes, respectively. This physiological need can be met, and food systems' sustainability protected, by following three interlinked dietary principles: (i) Variety - to help achieve a nutritionally adequate diet and help protect the biodiversity of food systems. (ii) Balance - to help reduce risk of diet-related non-communicable diseases and excessive use of finite environmental resources and production of greenhouse gas emissions. (iii) Moderation - to help achieve a healthy body weight and avoid wasting finite environmental resources used in providing food surplus to nutritional requirements.

CONCLUSION

The fundamentals of a healthy and sustainable diet are grounded in evolutionary and ecological processes. They are represented by the dietary principles of variety, balance and moderation and can be applied to inform food-level selection guidance for citizens.

Mitigating the Impact of Intergenerational Risk Factors on Stunting: Insights From Seven of the Most Food Insecure Districts in South Africa

A large body of research investigates the determinants of stunting in young children, but few studies have considered which factors are the most important predictors of stunting. We examined the relative importance of predictors of height-for-age z-scores (HAZ) and stunting among children under 5 years of age in seven of the most food-insecure districts in South Africa using data from the Grow Great Community Stunting Survey of 2022. We used dominance analysis and variable importance measures from conditional random forest models to assess the relative importance of predictors. We found that intergenerational and socioeconomic factors-specifically maternal height (HAZ: Coef. 0.02, 95% CI 0.01-0.03; stunting: OR 0.96, 95% CI 0.94-0.98), birth weight (HAZ: Coef. 0.3, 95% CI 0.16-0.43; stunting: OR 0.5, 95% CI 0.35-0.72) and asset-based measures of socioeconomic status (HAZ: Coef. 0.17, 95% CI 0.10-0.24; stunting: OR 0.77, 95% CI 0.67-0.89)-were the most important predictors of HAZ and stunting in these districts. We explored whether any other factors moderated (weakened) the relationship between these intergenerational factors and child height using conditional inference trees and moderation analysis. We found that being on track for vitamin A and deworming, adequate sanitation, a diverse diet and good maternal mental health moderated the effect of birth weight or mother's height. Though impacts are likely to be small relative to the impact of intergenerational risk factors, these moderating factors may provide promising avenues for helping to mitigate the intergenerational transmission of stunting risk in South Africa.

The Importance of Interprofessional Collaboration (IPC) Guidelines in Stunting Management in Indonesia: A Systematic Review

Background: Indonesia's stunting prevention programs have shown limited effectiveness and scalability. Interprofessional collaboration (IPC) is crucial for preventing and treating pediatric stunting. This study aimed to investigate the roles of primary health centers and IPC in addressing stunting in Indonesia. Methods: A systematic review was conducted, searching PubMed, EMBASE, Web of Science, ProQuest, and Google Scholar for studies up to November 2023. Two reviewers independently screened and included full-text articles that examined IPC and stunting, focusing on prevalence, policy implications, healthcare roles, community roles, preventive measures, and challenges. Results: The review included 52 articles. IPC was found to be critical in reducing stunting prevalence. Training improved the knowledge of health cadres, aiding in the early detection and prevention of stunting. The studies emphasized IPC's positive impact on stunting reduction across various regions. Policymakers are encouraged to adopt a comprehensive strategy involving collaboration, financial support, and effective program implementation. Conclusions: This study highlights IPC as essential in reducing stunting in Indonesia. Integrating stunting management into primary healthcare is recommended, with a call for developing guidelines to standardize and optimize the approach to this public health issue.

Protecting optimal childhood growth: systematic nutritional screening, assessment, and intervention for children at risk of malnutrition in the Kingdom of Saudi Arabia

Background

In 2024, the Kingdom of Saudi Arabia Advisory Board on Pediatric Nutrition (KSA-ABPN) reviewed childhood undernutrition in the Middle East. We sought to foster efficient nutritional care for infants and children at nutritional risk. Severe malnutrition due to starvation is rare in Saudi Arabia, so we focused on early recognition and treatment of children with mild growth impairment that forewarns risk for further nutritional decline. This paper summarizes our findings and introduces a recommended guide for nutritional screening, assessment, and follow-up interventions.

Objective

The KSA-ABPN aimed to build an algorithm with pathways and tools to facilitate up-to-date nutrition-care practices for infants and children. The algorithm is intended to encourage consistent professional training-for and use-of validated tools, adoption of standardized thresholds for intervention, and delivery of nutritional support. Consistent care will increase opportunities for comparative analyses of various treatment strategies and their health and cost outcomes.

Recommendations

We developed a 4-stage algorithm for identifying and caring for children at nutritional risk: (i) screening for clinical risk factors and age-related growth measures, (ii) observation of malnutrition-related physical signs, diet history, and/or laboratory detection of evidence indicating specific nutrient deficiencies, (iii) assessment of the severity of nutritional deficit, and (iv) development of a patient-specific Nutrition Care Plan that includes diet counseling, supplementation, routine monitoring, and follow-up.

Conclusions

By helping professionals identify nutritional risk and specific nutritional deficits in infants and children early in the clinical course, we seek to expand quality nutritional care and ensure that children grow and develop fully.

Associations of bioelectrical impedance and anthropometric variables among populations and within the full spectrum of malnutrition

OBJECTIVES

The aim of this study was to evaluate body composition variability assessed by bioimpedance in relation to nutritional status assessed by anthropometry in children and adolescents living in countries characterized by contrasting nutritional conditions.

METHODS

The sample was comprised of 8614 children (4245 males; 4369 females), aged 3 to 19 years, from Nepal (477 children), Uganda (488 children and adolescents), UK (297 children and adolescents) and US (7352 children and adolescents). Height-for-age (HAZ) and body mass index-for-age (BAZ) z-scores were calculated according to WHO growth references. Specific bioelectrical impedance vector analysis (BIVA) was used to evaluate body composition variability. In each population sample, the relationship of HAZ and BAZ with bioelectrical outcomes was analysed by confidence ellipses and cubic spline regression, controlling for sex and age.

RESULTS

The participants from Uganda and Nepal were more affected by undernutrition, and those from the US and UK by obesity. In all groups, phase angle and specific vector length were weakly associated with HAZ, with null or opposite relationships in the different samples, whereas they were positively associated with BAZ. The stronger association was between vector length, indicative of the relative content of fat mass, and BAZ in the UK and US samples. Confidence ellipses showed that the relationships are more strongly related to phase angle in Nepalese and Ugandan samples.

CONCLUSIONS

Bioelectrical values were more strongly associated with BAZ than HAZ values in all population samples. Variability was more related to markers of muscle mass in Ugandan and Nepalese samples and to indicators of fat mass in UK and US samples. Specific BIVA can give information on the variability of body composition in malnourished individuals.

Estimation of standing height in spina bifida: model development and validation

OBJECTIVE

Childhood standing height has been estimated from arm span-related (heightAS) models. The authors aimed to develop and cross-validate a heightAS model in individuals with spina bifida (SB) and examine the accuracy of existing heightAS models.

METHODS

Participants were individuals with sacral and low-lumbar SB (n = 14) and non-SB (n = 83), 7-16 years old. Arm span, age, sex, and group (SB vs. non-SB) were candidate height predictors. Sequential regression and leave-one-out cross-validation approaches were used for the model development (M1) and cross-validation (M1-M5). Existing models were: an SB-specific model from Polfuss et al. (M2) and non-SB specific models from Gauld et al. (M3), Mulu et al. (M4), and Zverev et al. (M5) studies.

RESULTS

Arm span and group explained 95 % of the variance in height (R2 = 0.95; p < 0.001; SEE = 3.666 cm) and were included in the M1. Mean differences between actual and estimated height were 0.0 cm (M1), 0.4 cm (M2), and 0.5 cm (M5), all not significant (p > 0.05). However, Bland-Altman analysis revealed some variability in the predictability of the models across participants with limits of agreement ranging from 7.4 to 10.9 cm. Considerable errors were observed with M3 (mean diff: -5.58 cm, 95 % CI: -1.6, -20.2 cm), and M4 (mean diff: 10.5 cm, 95 % CI: -13.8, -27.3 cm).

CONCLUSIONS

Models (M1, M2 and M5) may accurately estimate standing height in groups of children with SB. However, due to the wide limits of agreement, caution is recommended when applying these models for individual height estimations.

A 10-year (2014-2023) review of complementary food development in sub-Saharan Africa and the impact on child health

Complementary foods (CFs) commonly consumed by infants and young children (IYC) in sub-Saharan Africa (SSA) are processed using either single or multi-grain ingredients through simple technologies such as fermentation, malting and roasting. Interestingly, CFs (e.g., ogi, kunu, and dabo) are prepared and fed to infants alongside breastmilk until they are completely weaned up to the infant's second birthday. The grains used for preparing CFs can be contaminated with bacterial and chemical contaminants as a result of poor harvesting, handling or storage practices. The stage at which IYC are introduced to CFs is of utmost importance as it aids in addressing malnutrition and improving their overall health and well-being. Complementary feeding practices across SSA are influenced by socio-economic, cultural and geographical factors such that improper introduction can result in dire health consequences including immune suppression, severe foodborne diseases, poor child growth and development, and sometimes death from malnutrition. Malnutrition often occurs from inadequacies of nutrient intakes and assimilation which affect the ability to maintain normal body functions such as growth, learning abilities, resistance to and recovery from diseases. In SSA, IYC malnutrition still poses an enormous concern, therefore indicating the need for intervention strategies such as the promotion of indigenous crops and elevating traditional knowledge and technologies for formulating CFs. This paper clearly highlights the diversity of CFs in SSA, ingredients utilized, processing techniques, contamination by bacteria and chemicals, and demonstrates the consequences of consuming contaminated CFs, and their influence on IYC health as well as approaches to ensuring safety and scaling up indigenous CFs.

Height status matters for risk of mortality in critically ill children

BACKGROUND

Anthropometric measurements are crucial in pediatric critical care, but the impact of height on ICU outcomes is underexplored despite a substantial number of short-for-age children in ICUs. Previous studies suggest that short stature increases the risk of poor clinical outcomes. This study examines the relationship between short stature and ICU outcomes.

METHODS

We conducted a retrospective cohort study using a Japanese nationwide database (the Japanese Intensive Care Patient Database; JIPAD), which included pediatric patients under 16 years admitted to ICUs from April 2015 to March 2020. Height standard deviation scores (SD scores) were calculated based on age and sex. Short-stature patients were defined as height SD score <  - 2. The primary outcome was all-cause ICU mortality, and the secondary outcome was the length of stay in ICU.

RESULTS

Out of 6,377 pediatric patients, 27.2% were classified as having short stature. The ICU mortality rate was significantly higher in the short-stature group compared to the normal-height group (3.6% vs. 1.4%, p < 0.01). Multivariable logistic regression showed that short stature was independently associated with increased ICU mortality (OR = 2.73, 95% CI 1.81-4.11). Additionally, the Fine-Gray subdistribution hazards model indicated that short stature was associated with a lower chance of ICU discharge for each additional day (HR 0.85, 95% CI 0.81-0.90, p < 0.01).

CONCLUSIONS

Short stature is a significant risk factor for increased ICU mortality and prolonged ICU stay in critically ill children. Height should be considered in risk assessments and management strategies in pediatric intensive care to improve outcomes.

Malnutrition in infants aged 6-23 months in China's poorest rural counties from 2016 to 2021: cross sectional study

OBJECTIVES

To assess trends and differences in child malnutrition by population subgroups among infants aged 6-23 months in China's poorest rural counties.

DESIGN

Six consecutive cross sectional surveys were conducted annually.

SETTING

The study was conducted in 116 counties in 19 provinces from 2016 to 2021, representing China's 832 poorest counties.

PARTICIPANTS

A total of 210 088 participants were selected through a multistage cluster sampling procedure; all participants were infants aged 6-23 months.

MAIN OUTCOME MEASURES

Prevalence of anaemia, stunting, wasting, overweight, and growth status in children (measured by length-for-age and weight-for-length z scores).

RESULTS

Four main malnutrition forms were prevalent in 2016: anaemia (prevalence 18.3%), stunting (7.5%), wasting (4.7%), and overweight (3.1%). The prevalence of any two coexisting malnutrition forms was low. All four forms of malnutrition decreased from 2016 to 2021. Anaemia decreased by more than half, with an annual reduction rate of 9.11% (95% confidence interval (CI) 4.83% to 13.20%). Stunting was reduced by over a third, with an annual reduction rate of 10.44% (7.56% to 13.22%), which is faster than the World Health Organization's target of 3.9%. Differences in child growth by county gross domestic product quarters were small and decreased over time, but growth differences related to education persisted. Infants whose mothers completed education up to primary school level had approximately twice the risk of stunting (adjusted rate ratio 2.29 (95% CI 1.87 to 2.81)) and wasting (1.73 (1.40 to 2.13)) compared with children whose mothers had an education level of a college degree or above. Boys had poorer growth and higher anaemia than did girls. For all outcomes, differences related to sex and education were greatest at 6 months of age.

CONCLUSIONS

Education related inequalities in growth of infants persists, with these differences particularly affecting children whose mothers completed education only up to primary school level.

Relationship Between Iron Deficiency Anemia and Stunting in Pediatric Populations in Developing Countries: A Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

Iron deficiency anemia (IDA) and stunting are prevalent global health issues, particularly in developing countries, where previous studies have suggested a potential relationship between them. This systematic review aims to analyze the relationship between iron deficiency anemia and stunting in pediatric populations in developing countries.

METHODS

Literature searches were conducted on PubMed, EMBASE, Cochrane Library, and EBSCO Host. The primary outcome was the association between IDA and stunting. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Effective Public Health Practice Project (EPHPP) for other observational studies. Meta-analysis was performed with a random-effects model and heterogeneity assessment. A Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment was performed to determine the certainty and importance of the study.

RESULTS

Out of 19,095 articles, 15 studies were included in the systematic review, and 4 studies were included in the meta-analysis, encompassing 21,936 subjects aged 0 to 12 years. IDA prevalence ranged from 3.6 to 58.8%, while stunting prevalence varied from 6.6 to 44.5%. Nine articles supported a significant relationship between IDA and stunting, revealing that stunted children had a 1.31-6.785 times higher risk of developing IDA. The odds ratio of children with IDA to be stunted was 2.27 (95% CI = 1.30-3.95). All studies exhibited a moderate risk of bias. GRADE assessment suggested that the evidence's certainty is low but important.

CONCLUSIONS

The high IDA prevalence in developing countries, including Indonesia, is associated with stunting in children, suggesting a synergistic relationship.

Maternal factors promoting normal linear growth of children from impoverished Rwandan households: a cross-sectional study

BACKGROUND

Linear growth faltering remains a pervasive public health concern that affects many children worldwide. This study aimed to investigate possible maternal factors promoting normal linear growth among children aged 6-23 months of age from impoverished Rwandan households.

METHODS

We used a three-stage cluster sampling procedure. The study population consisted of children aged six to 23 months and their mothers who lived in the study districts. A structured questionnaire helped to collect data from 807 selected mother-child dyads. The primary outcome variable was height-for-age Z scores. The main predictors were maternal income-generating activity, maternal education, maternal depression, household decision making, number of ANC visits, use of family planning method, types of family planning, and mode of delivery. We used univariate analysis to establish median, frequencies, and percentages. Furthermore, we used the Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation tests for bivariate analysis. We included in the final model of robust linear regression for multivariate analysis the potential confounding variables identified as significantly associated with the outcome (child age, participation in works for both parents, good handwashing practice, owning a vegetable garden, and the total number of livestock) along with maternal factors.

RESULTS

Maternal factors that promoted normal linear growth of children were the presence of maternal income generation activity (β= 0.640 [0.0269 1.253], p value = 0.041), the participation of the mother in the decision-making process of the household (β=0.147 [0.080 0.214], p-value < 0.001), and the higher frequency of consultations with ANC (β=0.189 [0.025 0.354], p-value = 0.024). Additionally, a combination of household decision-making with the number of ANC visits predicted an increase in the linear growth of the child (β=0.032 [0.019 0.045], p-value < 0.001).

CONCLUSION

Maternal factors such as maternal income-generating activity, maternal participation in household decision making, and increased number of ANC visits were found to promote normal child linear growth. These results contribute valuable information to the formulation of interventions and policies to improve child nutrition and growth in the community studied.

Temporal Trends in the Prevalence of Child Undernutrition in China From 2000 to 2019, With Projections of Prevalence in 2030: Cross-Sectional Analysis

BACKGROUND

Although the problem of malnutrition among children in China has greatly improved in recent years, there is a gap compared to developed countries, and there are differences between provinces. Research on long-term comprehensive trends in child growth failure (CGF) in China is needed for further improvement.

OBJECTIVE

The purpose of this study was to examine trends in stunting, wasting, and underweight among children younger than 5 years in China from 2000 to 2019, and predict CGF till 2030.

METHODS

We conducted a cross-sectional analysis using data from the local burden of disease (LBD) database. Using Joinpoint Regression Software, we examined trends in CGF among children younger than 5 years in China from 2000 to 2019, and predicted the trends of prevalence in 2030, using the Holt-Winters model with trends but without seasonal components. The assessment was performed with Stata 17 (StataCorp). Data were analyzed from October 17, 2023, to November 22, 2023.

RESULTS

In 2019, the prevalences of stunting, wasting, and underweight decreased to 12%, 3%, and 4%, respectively (decreases of 36.9%, 25.0%, and 42.9%, respectively, compared with the values in 2000). The prevalence of CGF decreased rapidly from 2000 to 2010, and the downward trend slowed down after 2010. Most provinces had stagnated processes of trends after 2017. The age group with the highest stunting prevalence was children aged 1 to 4 years, and the highest prevalence of wasting and underweight was noted in early neonatal infants. From 2000 to 2019, the prevalence of CGF declined in all age groups of children. The largest relative decrease in stunting and underweight was noted in children aged 1 to 4 years, and the largest decrease in wasting was noted in early neonatal infants. The prevalences of stunting, wasting, and underweight in China are estimated to decrease to 11.4%, 3.2%, and 4.1%, respectively, by 2030. China has nationally met the World Health Organization's Global Nutrition Targets for 2030 for stunting but not for wasting.

CONCLUSIONS

This study provides data on the prevalence and trends of CGF among children younger than 5 years and reports declines in CGF. There remain areas with slow progress in China. Most units have achieved the goal for stunting prevalence but not wasting prevalence.

Impacts of women's work and childcare on child illness among Bangladeshi Shodagor communities

For decades, women's employment has been seen as crucial for achieving greater autonomy and empowerment for women, and for promoting better health and nutrition outcomes for children, particularly in low- and middle-income countries (LMIC). However, numerous empirical studies of the relationship between women's work and child outcomes have shown mixed results. Our study tests the assumptions of a model that suggests loss of maternal care during working hours may produce negative health outcomes for children. We use longitudinal data collected from traditionally semi-nomadic, boat-dwelling Shodagor families in Matlab, Bangladesh to determine the importance of maternal care as a mechanism influencing the relationship between women's work and child illness. We use Bayesian linear mixed models to assess the influence of occupation and amount of care on average days of child illness per month, and also to examine the role that allomothers play in buffering against potential negative impacts of lost maternal care on child illness. Results show that children who receive more care from mothers experience fewer days of illness, and that availability of high-quality alloparents mediates the relationship between maternal work and child health. These results indicate that both the care and resources provided by mothers influence children's biological outcomes. This has important implications for policy and aid interventions in LMIC, which have been developed to capitalize on an assumed positive relationship between maternal work and child health and nutrition.

Correlates of Body Composition in Children with Stunting: A Cross-sectional Study in Uganda

BACKGROUND

Development of body composition (BC) may be disrupted in children with stunting. Such disruption may affect the later risk of excess adiposity and metabolic health, yet few studies have investigated correlates of BC in children with stunting.

OBJECTIVES

We aimed to investigate nutritional status, infection and inflammation, breastfeeding behaviors, and other factors as correlates of BC in children with stunting.

METHODS

Among Ugandan children with a height-for-age z-score <-2, BC was estimated using bioelectrical impedance analysis and compared with United Kingdom references. We used multiple linear regression analysis to identify correlates of fat mass (FM), fat-free mass (FFM), FM-index (FMI), and FFM index (FFMI) and height, adjusting for gender and age.

RESULTS

In 750 children aged 1-5 y, FMI was 0.46 (95% confidence interval [CI]: 0.38, 0.54] and FFMI 0.18 [95% CI: 0.11, 0.26) z-scores lower than United Kingdom references. Elevated serum α1-acid glycoprotein was associated with 1.14 [0.76, 1.52] cm lower height, 0.50 [0.35, 0.65] kg/m2 less FFMI, and 0.48 [0.31, 0.66] kg/m2 greater FMI. Similar, weaker, associations for elevated serum C-reactive protein were detected. A positive malaria rapid test was associated with 0.64 [0.25, 1.02] cm shorter height, but 0.36 [0.18, 0.54] kg/m2 greater FMI. Anemia (according to hemoglobin) was associated with 0.20 [0.07, 0.33] kg less FFM in proportion to shorter height. Longer breastfeeding duration was associated with 0.03 [0.02, 0.04] kg greater FFM per month, in proportion to greater height.

CONCLUSIONS

These children exhibited deficits in FM and FFM, proportionally to their stunted height, compared with United Kingdom references. Systemic inflammation correlated inversely with linear growth and FFM but positively with fatness, making it a possible target for intervention where fat-free tissue accretion is desirable. Longer breastfeeding may offer protection to lean linear growth, but findings for micronutrients were less clear. Longitudinal studies are warranted to support these findings. The study was registered at www.isrctn.com (Ref. ISRCTN13093195).

Shifting Trend of Protein Consumption in Southeast Asia: Toward Health, Innovation, and Sustainability

Complementing discourse following a February 2023 event on dietary protein needs in Southeast Asia (SEA), this symposium report summarizes the region's protein intake, while simultaneously examining the impact of dietary shift toward complementary and alternative proteins and their health implications. It highlights the importance of protein quality in dietary evaluations, optimal intake, and sustainability, advocating for environmentally conscious protein production and innovation in future foods. Discussion points, expert opinions, national nutrition data, and relevant literature, addressing protein intake and quality, their impact on human health, and various technologies for future foods production, have been included. Despite increased protein supply in SEA, protein requirements, particularly during crucial life stages, are often unmet owing to insufficient focus on protein quality. Factoring in amino acids content and bioaccessibility are crucial for assessing nutritional requirement and sustainability evaluations, rather than solely relying on protein quantity alone. Different food sources of protein also have different key conutrients for health relevance such as vitamin B-12 and ω-3 fatty acids. Innovations in food structure, processing, and technology are key to developing nutritious, sustainable, and appealing future foods, including from complementary and alternative protein sources, while considering safety aspects, especially allergenicity. Addressing protein needs in SEA requires a dual focus on protein quantity and quality, underlining the role of public health policies and guidelines that consider key nutritional differences of animal-source and plant-based proteins. To address regional demands, future food innovations should aim at creating unique yet needful food categories or supplementing current existing sources, rather than mimicking current products.

Spatial variation and risk factors of the dual burden of childhood stunting and underweight in India: a copula geoadditive modelling approach

India has one of the highest burdens of childhood undernutrition in the world. The two principal dimensions of childhood undernutrition, namely stunting and underweight can be significantly associated in a particular population, a fact that is rarely explored in the extant literature. In this study, we apply a copula geoadditive modelling framework on nationally representative data of 104,021 children obtained from the National Family Health Survey 5 to assess the spatial distribution and critical drivers of the dual burden of childhood stunting and underweight in India while accounting for this correlation. Prevalence of stunting, underweight and their co-occurrence among under 5 children were 35.37%, 28.63% and 19.45% respectively with significant positive association between the two (Pearsonian Chi square = 19346, P-value = 0). Some of the factors which were significantly associated with stunting and underweight were child gender (Adjusted Odds Ratio (AOR) = 1.13 (1.12) for stunting (underweight)), birthweight (AOR = 1.46 (1.64) for stunting (underweight)), type of delivery (AOR = 1.12 (1.19) for stunting (underweight)), prenatal checkup (AOR = 0.94 (0.96) for stunting (underweight)) and maternal short-stature (AOR = 2.19 (1.85) for stunting (underweight)). There was significant spatial heterogeneity in the dual burden of stunting and underweight with highest prevalence being observed in eastern and western states while northern and southern states having relatively lower prevalence. Overall, the results are indicative of the inadequacy of a "one-size-fits-all" strategy and underscore the necessity of an interventional framework that addresses the nutritional deficiency of the most susceptible regions and population subgroups of the country.

Landscape Fire Air Pollution as a Mediator in Drought and Childhood Stunting Pathway in Low- and Middle-Income Countries

Drought induces dry hazards, including wildfire, and increased air pollution from wildfire may be a mechanism by which drought increases health risks. We examined whether the drought-wildfire pathway increases the risk of childhood stunting. We analyzed all geocoded children under five across 44 low- and middle-income countries (LMICs). We first conducted mixed-effect regressions to examine the three pairwise associations between standardized precipitation evapotranspiration index (SPEI), fire-sourced PM2.5, and childhood stunting. We then employed a causal mediation analysis to determine whether compounding drought-wildfire (cascading or co-occurring) events significantly impact the drought-stunting pathway. We found that each 1-unit decrease in SPEI exposure was associated with a 2.16% [95% confidence interval (CI): 0.79, 3.49%] increase in stunting risk and 0.57 (95% CI 0.55, 0.59%) μg/m3 increase in fire-sourced PM2.5. Additionally, each 1 μg/m3 increase in 24 month average fire-sourced PM2.5 was associated with an increased risk of 2.46% (95% CI: 2.16, 2.76%) in stunting. Drought-mediated fires accounted for 26.7% (95% CI: 14.5, 36.6%) of the linkage between SPEI and stunting. Our study revealed fire-sourced PM2.5 is a mediator in the drought-stunting pathway in LMICs. To protect child health under increasing drought conditions, personal interventions against wildfire should be considered to enhance climate resilience.