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Abera M, Berhane M, Grijalva-Eternod CS, Abdissa A, Abate N, Hailu E, Barthorp H, Allen E, McGrath M, Girma T, Wells JC, Kerac M, Beaumont E. Maternal mental health and nutritional status of infants aged under 6 months: A secondary analysis of a cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003139. [PMID: 39269974 PMCID: PMC11398659 DOI: 10.1371/journal.pgph.0003139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/13/2024] [Indexed: 09/15/2024]
Abstract
Maternal/caregivers' mental health (MMH) and child nutrition are both poor in low- and middle-income countries. Links between the two are plausible but poorly researched. Our aim was to inform future malnutrition management programmes by better understanding associations between MMH and nutritional status of infants aged under six month (u6m). We conducted a health facility-based cross-sectional survey of 1060 infants in rural Ethiopia, between October 2020 and January 2021. We collected data on: MMH status (main exposure) measured using the Patient Health Questionnaire (PHQ-9) and infant anthropometry indicators (outcome); length for age Z-score (LAZ), weight for age Z-score (WAZ), weight for length Z-score (WLZ), mid upper arm circumference (MUAC), head circumference for age Z-score (HCAZ) and lower leg length (LLL). Analysis of secondary data using linear regression was employed to determine associations between the main exposure and outcome variables. The result showed infants' mean (SD) age was 13.4 (6.2) weeks. The median score for MMH problem was 0 (inter quartile range 0-2) points, and 29.5% and 11.2% reported minimal and mild to severe depression score of 1-4 and 5-27 points, respectively. Mean (SD) LAZ was -0.4 (1.4), WAZ -0.7 (1.3), WLZ -0.5 (1.2), MUAC 12.4 (1.3) cm, HCAZ 0.4 (1.3) and LLL 148 (13.9) mm. In adjusted linear regression analysis, minimal MMH problem was negatively associated with infant LAZ marginally (β = -0.2; 95% CI: -0.4, 0.00; p = 0.05) and LLL (β = -2.0; 95% CI: -3.8, -0.1; p = 0.04), but not with other anthropometric indicators. Statistically significant associations were not found between mild to severe depressive symptoms and infant anthropometric outcomes. In conclusion, only minimal, but not mild, moderate or severe, maternal/caregivers' depressive symptoms are associated with infant anthropometry outcomes in this data set. Whilst there is a plausible relationship between maternal mental health problems and offspring nutritional status, we did not observed this. Possible reasons include: PHQ-9 not suited to our population; and only a small number of participants reporting moderate to severe level of depression. Further research to investigate and understand the relationship and pathways between maternal mental health and offspring nutritional status is required.
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Affiliation(s)
- Mubarek Abera
- Department of Psychiatry, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
- Jimma University Clinical and Nutrition Research Center (JUCAN), Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Jimma University Clinical and Nutrition Research Center (JUCAN), Jimma University, Jimma, Ethiopia
- Department of Pediatrics and Child Health, Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Carlos S Grijalva-Eternod
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- UCL Institute for Global Health, London, United Kingdom
| | - Alemseged Abdissa
- Jimma University Clinical and Nutrition Research Center (JUCAN), Jimma University, Jimma, Ethiopia
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | | | | | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | | | - Tsinuel Girma
- Jimma University Clinical and Nutrition Research Center (JUCAN), Jimma University, Jimma, Ethiopia
- Harvard Chan School of Public Health, Addis Ababa, Ethiopia
| | - Jonathan Ck Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Emma Beaumont
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
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Li C, Ó Gráda C, Lumey LH. Famine mortality and contributions to later-life type 2 diabetes at the population level: a synthesis of findings from Ukrainian, Dutch and Chinese famines. BMJ Glob Health 2024; 9:e015355. [PMID: 39209764 PMCID: PMC11367352 DOI: 10.1136/bmjgh-2024-015355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Since the 1970s, influential literature has been using famines as natural experiments to examine the long-term health impact of prenatal famine exposure at the individual level. Although studies based on various famines have consistently shown that prenatal famine exposure is associated with an increased risk of type 2 diabetes (T2D), no studies have yet quantified the contribution of famines to later-life T2D at the population level. We, therefore, synthesised findings from the famines in Ukraine 1932-1933, the Western Netherlands 1944-1945 and China 1959-1961 to make preliminary estimates of T2D cases attributable to prenatal famine exposure. These famines were selected because they provide the most extensive and reliable data from an epidemiological perspective. We observed a consistent increase in T2D risk among prenatally exposed individuals in these famines, which translated into about 21 000, 400 and 0.9 million additional T2D cases due to prenatal famine exposure in Ukraine, Western Netherlands and China, respectively. The T2D increase related to famine exposure represented only around 1% of prevalent T2D cases in these countries. Our observations highlight the significant increase in later-life T2D risk among individuals with prenatal famine exposure but also the limited contribution of prenatal famine exposure to T2D epidemics at the population level.
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Affiliation(s)
- Chihua Li
- Institute of Chinese Medical Sciences, University of Macau, Macau, Macau SAR
| | | | - L H Lumey
- Columbia University, New York, New York, USA
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Lewis JI, Mbabazi J, Mutumba R, Ritz C, Filteau S, Briend A, Michaelsen KF, Mølgaard C, Wells JC, Mupere E, Friis H, Grenov B. Correlates of Body Composition in Children with Stunting: A Cross-sectional Study in Uganda. J Nutr 2024:S0022-3166(24)00451-6. [PMID: 39111553 DOI: 10.1016/j.tjnut.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/02/2024] [Accepted: 08/01/2024] [Indexed: 08/23/2024] Open
Abstract
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).
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Affiliation(s)
- Jack I Lewis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christian Ritz
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Suzanne Filteau
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, Population Policy and Practice Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ezekiel Mupere
- Department of Pediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
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Liu X, Sun J, Ge B, Pan C, Yan H, Sun X, Peng J, Wang W, Lin Y, Zhang D, Ning F. Association between famine exposure during infancy and childhood and the risk of chronic kidney disease in adulthood. Intern Med J 2024; 54:1310-1319. [PMID: 38465389 DOI: 10.1111/imj.16367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Famine exposure in childhood is proven to be associated with multiple chornic disease in adult but has not been studied with chronic kidney disease (CKD). AIMS This study was conducted to identify the relationship between famine exposure during infancy and childhood - specifically, the Chinese famine of 1959-1961 - and the risk of adult-onset chronic kidney disease (CKD) among Chinese individuals. METHODS This study included 2937 individuals from the Qingdao Diabetes Prevention Program. They were stratified by birth year into infancy-exposed (1956-1958), childhood-exposed (1950-1955) and unexposed (1963-1971) groups. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined as an eGFR of <90 mL/min/1.73 m2. RESULTS The mean eGFR values for the infancy-exposed and childhood-exposed groups were 107.23 ± 12.53 and 103.23 ± 12.44 mL/min/1.73 m2, respectively, both of which were lower than that of the unexposed group (114.82 ± 13.39 mL/min/1.73 m2; P < 0.05). In the crude model, the odds ratio (OR) for CKD was 2.00 (95% confidence interval (CI): 1.39-2.88) in the infancy-exposed group and 2.92 (95% CI: 2.17-3.93) in the childhood-exposed group. Further adjustments for urban/rural residence, body mass index, age, current smoking, type 2 diabetes, systolic blood pressure, diastolic blood pressure and total cholesterol did not significantly alter the association between famine exposure and CKD. The corresponding ORs were 1.71 (95% CI: 1.17-2.50) and 2.48 (95% CI: 1.81-3.40) for the infancy-exposed and childhood-exposed groups respectively. CONCLUSIONS Famine exposure during infancy and childhood is associated with a long-term decline in eGFR and an increased adult-onset CKD risk. Early intervention for high-risk individuals may mitigate the risk of adult-onset CKD.
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Affiliation(s)
- Xiao Liu
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Junhui Sun
- The Second People's Hospital of Jimo, Qingdao, Shandong, China
| | - Bing Ge
- Qingdao Centers for Disease Control and Prevention, Qingdao, Shandong, China
| | - Chi Pan
- Huangdao District Centers for Disease Control and Prevention, Qingdao, Shandong, China
| | - Hongxuan Yan
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Xiaohui Sun
- Qingdao Centers for Disease Control and Prevention, Qingdao, Shandong, China
| | - Jiahui Peng
- Qingdao Centers for Disease Control and Prevention, Qingdao, Shandong, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Yongfeng Lin
- Qingdao Centers for Disease Control and Prevention, Qingdao, Shandong, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Feng Ning
- Qingdao Centers for Disease Control and Prevention, Qingdao, Shandong, China
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Lu J, Ying Z, Xu W, Li L, Liu Y, Han C, Zhang M. Leisure Activity, Childhood Starvation, and Risk of Incident Diabetes in Older Adults: Evidence from a Chinese Nationwide Cohort Study. J Am Med Dir Assoc 2024; 25:105130. [PMID: 38972334 DOI: 10.1016/j.jamda.2024.105130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE This study explores the impact of leisure activity and the association between childhood starvation and the risk of diabetes in older Chinese adults. DESIGN Prospective cohort study based on the Chinese Longitudinal Healthy Longevity Study (CLHLS), a nationwide cohort study in China. SETTING AND PARTICIPANTS A total of 4637 older adults aged ≥65 years, all with documented diabetes history, experiences of childhood starvation, and participation in leisure activities were recruited. METHODS Childhood starvation exposure was assessed via self-reported responses from a structured questionnaire. The leisure activities were measured by 9 distinctive components and categorized into 3 distinct categories: productive activity, recreational activity, and sedentary activity. Diabetes status was determined by self-reported, physician-diagnosed cases during the follow-up period. Nonparametric survival models were employed for analysis. RESULTS Over an average follow-up period of 4.3 years, 215 of 4637 participants (4.6%) reported a confirmed diagnosis of diabetes. Nonparametric survival models showed that those reporting childhood starvation had a higher risk of late-life diabetes [hazard ratio (HR) 1.72, 95% CI 1.21-2.44]. Engaging in productive activity (HR 0.90, 95% CI 0.83-0.99) and recreational activity (HR 0.88, 95% CI 0.77-1.00) was linked with a reduced risk of late-life diabetes. Sedentary activity did not show a significant effect. Further analysis highlighted the interactions effects of leisure activities on diabetes risk across different demographic and historical exposure subgroups. CONCLUSIONS AND IMPLICATIONS Engaging in productive and recreational leisure activities was inversely associated with the risk of diabetes in older adults who experienced childhood starvation. Promoting such activities could be beneficial in mitigating long-term diabetes risk related to early-life nutritional deficiencies.
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Affiliation(s)
- Jiaping Lu
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Zhen Ying
- Ministry of Education Key Laboratory of Metabolism and Molecular Medicine, Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiwei Xu
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lian Li
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yichen Liu
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Chenyu Han
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
| | - Min Zhang
- Department of Endocrinology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
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Rice I, Opondo C, Nyesigomwe L, Ekude D, Magezi J, Kalanzi A, Kerac M, Hayes J, Robello M, Halfman S, DeLacey E. Children with disabilities lack access to nutrition, health and WASH services: A secondary data analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13642. [PMID: 38563355 PMCID: PMC11168356 DOI: 10.1111/mcn.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitation and hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy among households with and without children with disabilities in Uganda. We used cross-sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASH and dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55-0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02-1.22, p = 0.012). The proportion of malnourished children was higher among households with children with disabilities than households without it (6.3% vs. 2.4% p < 0.001). There are concerning gaps in access to NaHS services in Uganda, with households with children with disabilities reporting worse access, particularly for those with low WASH adequacy. Improved and inclusive access to NaHS and WASH needs to be urgently prioritized, especially for children with disabilities.
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Affiliation(s)
- Isabel Rice
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
| | | | | | | | | | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
- London School of Hygiene & Tropical Medicine, Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH)University of LondonLondonUK
| | | | | | | | - Emily DeLacey
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
- London School of Hygiene & Tropical Medicine, Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH)University of LondonLondonUK
- Holt InternationalEugeneOregonUSA
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Mahmud I, Guesdon B, Kerac M, Grijalva‐Eternod CS. Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13635. [PMID: 38433606 PMCID: PMC11168360 DOI: 10.1111/mcn.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
Small and nutritionally at-risk infants aged under 6 months (<6 months) are at high risk of death, but important evidence gaps exist on how to best identify them. We aimed to determine associations between anthropometric deficits and mortality among infants <6 months admitted to inpatient therapeutic care. A secondary analysis of 2002-2008 data included 5034 infants aged <6 months from 12 countries. We estimated the prevalence, concurrence, and severity of wasted, stunted, and underweight, as stand-alone indicators, and using the Composite Index of Anthropometric Failure (CIAF), which combines these indicators into six subgroups of single and multiple anthropometric deficits and into one combined indicator called CIAF. We used logistic regression to examine the association of different anthropometric deficits with in-programme mortality. Among 3692 infants aged <6 months with complete data, 3539 (95.8%) were underweight, 3058 (82.8%) were wasted, 2875 (77.8%) were stunted and 3575 (96.8%) had CIAF. Infants with multiple anthropometric deficits were presented with significantly lower anthropometric indices, that is, they were more severely wasted, stunted and underweight. A total of 141 infants died during inpatient therapeutic care. Among these, severely wasted (116) and severely underweight (138) infants had higher odds of mortality than normal infants (odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.2-2.7, p = 0.009, and OR = 3.3, 95% CI: 0.8-13.6, p = 0.09, respectively). Boys had higher odds of inpatient mortality than girls (OR = 1.40, 95% CI: 1.02-1.92, p = 0.03). Mortality was only observed in infants <6 months presenting multiple anthropometric deficits, although their odds of mortality were not significant, for example, OR = 2.4, 95% CI: 0.5-10.0, p = 0.21 for stunted, wasted and underweight infants <6 months. In conclusion, multiple anthropometric deficits (CIAF) is common among infants <6 months and may be reported in nutrition care programmes and surveys. Both weight-for-length/height z-score and weight-for-age z-score were found to be useful indicators for programme admission and in-programme prognosis. Future work needs to explore which better accounts for admission bias. Boys appear to be most at-risk of dying while receiving malnutrition therapeutic care. Programmes should ensure that all infants receive timely, evidence-based, effective care.
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Affiliation(s)
- Imteaz Mahmud
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Department of Public HealthNorth South UniversityDhakaBangladesh
- The Power of NutritionLondonUK
| | | | - Marko Kerac
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
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Bahwere P, Funnell G, Qarizada AN, Woodhead S, Bengnwi W, Le MT. Effectiveness of a nonweight-based daily dosage of ready-to-use therapeutic food in children suffering from uncomplicated severe acute malnutrition: A nonrandomized, noninferiority analysis of programme data in Afghanistan. MATERNAL & CHILD NUTRITION 2024; 20:e13641. [PMID: 38627974 PMCID: PMC11168373 DOI: 10.1111/mcn.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 06/13/2024]
Abstract
Severe acute malnutrition (SAM) remains a major global public health problem. SAM cases are treated using ready-to-use therapeutic food (RUTF) at a dosage of ∼200 kcal/kg/day per the standard treatment protocol (STD). Emerging evidence on simplifications to the standard protocol, which among other adaptations, includes reducing the daily RUTF dosage, indicates that it is effective and safe for treating children with SAM. In response to a foreseen stock shortage of RUTF, the government of Afghanistan endorsed the temporary use of a modified treatment protocol in which the daily RUTF dosage was prescribed at 1000 kcal/day (irrespective of body weight) until the child achieved moderate acute malnutrition status (weight-for-height z-score ≥ -3 or mid-upper arm circumference [MUAC] ≥ 115 mm), at which point 500 kcal/day was prescribed until cured (modified treatment protocol [MTP]). In this paper, we report the results of this nonweight-based daily RUTF dosage experience. Data of 2042 children with SAM, treated using either the STD protocol (n = 269) or the MTP protocol (n = 1773) from August 2019 to March 2021 in five provinces, were analyzed. The per-protocol analyses confirmed noninferiority of MTP protocol when compared to STD protocol for recovery rate [93.3% vs. 90.2%; ∆ (95% confidence interval, CI) = 3.1 (-0.9; 7.2) %] and length-of-stay [82.6 vs. 75.6 days; ∆ (95% CI) = 6.9 (3.3; 10.5) days], considering the margin of noninferiority of -10% and +14 days, respectively. Weight gain velocity was smaller in the MTP protocol group than in the STD protocol group [3.7 (1.7) vs. 5.2 (2.9) g/kg/day; ∆ (95% CI) = -1.5 (-1.8, -1.2); p < 0.001]. The STD group had a significantly higher mean than the MTP group for absolute MUAC gain [∆ (95% CI) = 1.7 (1.0; 2.3) mm; p < 0.001] and the MUAC velocity [∆ (95% CI) = 0.29 (0.20; 0.37) mm/week; p < 0.001]. Our results confirm the noninferiority of a nonweight-based daily dosage and support the endorsement of this modification as an alternative to the standard protocol in resource-constrained contexts.
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Affiliation(s)
- Paluku Bahwere
- Center for Epidemiology, Biostatistics and Clinical Research (CR2), School of Public HealthUniversité Libre de BruxellesBrusselsBelgium
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Auger N, Paradis G, Healy-Profitós J, Lewin A, Malik M, Potter BJ. Non-cardiac birth defects and long-term risk of cardiovascular hospitalisation. Heart 2024; 110:892-898. [PMID: 38772572 DOI: 10.1136/heartjnl-2023-323632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/04/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Patients with heart defects are at risk of developing cardiovascular disease. Our objective was to determine if non-cardiac birth defects are associated with the risk of cardiovascular hospitalisation. METHODS We conducted a longitudinal cohort study of 1 451 409 parous women in Quebec, Canada. We compared patients with cardiac and non-cardiac birth defects of the urinary, central nervous and other systems against patients without defects between 1989 and 2022. The main outcome was hospitalisation for coronary artery disease, ischaemic stroke and other cardiovascular outcomes during 33 years of follow-up. We computed cardiovascular hospitalisation rates and used Cox proportional hazards regression models to measure the association (HR; 95% CI) between non-cardiac defects and later risk of cardiovascular hospitalisation, adjusted for patient characteristics. RESULTS Women with any birth defect had a higher rate of cardiovascular hospitalisation than women without defects (7.0 vs 3.3 per 1000 person-years). Non-cardiac defects overall were associated with 1.61 times the risk of cardiovascular hospitalisation over time, compared with no defect (95% CI 1.56 to 1.66). Isolated urinary (HR 3.93, 95% CI 3.65 to 4.23), central nervous system (HR 3.33, 95% CI 2.94 to 3.76) and digestive defects (HR 2.39, 95% CI 2.16 to 2.65) were associated with the greatest risk of cardiovascular hospitalisation. These anomalies were associated with cardiovascular hospitalisation whether they presented alone or clustered with other defects. Nevertheless, heart defects were associated with the greatest risk of cardiovascular hospitalisation (HR 10.30, 95% CI 9.86 to 10.75). CONCLUSION The findings suggest that both cardiac and non-cardiac birth defects are associated with an increased risk of developing cardiovascular disease among parous women.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
| | - Antoine Lewin
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Québec, Canada
- Medical Affairs and Innovation, Hema-Quebec, Montreal, Québec, Canada
| | - Mariyam Malik
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
| | - Brian J Potter
- Division of Cardiology, Department of Medicine, University of Montreal Hospital Centre, Montreal, Québec, Canada
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10
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Cheng M, Conley D, Kuipers T, Li C, Ryan CP, Taeubert MJ, Wang S, Wang T, Zhou J, Schmitz LL, Tobi EW, Heijmans B, Lumey LH, Belsky DW. Accelerated biological aging six decades after prenatal famine exposure. Proc Natl Acad Sci U S A 2024; 121:e2319179121. [PMID: 38833467 PMCID: PMC11181019 DOI: 10.1073/pnas.2319179121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/06/2024] [Indexed: 06/06/2024] Open
Abstract
To test the hypothesis that early-life adversity accelerates the pace of biological aging, we analyzed data from the Dutch Hunger Winter Families Study (DHWFS, N = 951). DHWFS is a natural-experiment birth-cohort study of survivors of in-utero exposure to famine conditions caused by the German occupation of the Western Netherlands in Winter 1944 to 1945, matched controls, and their siblings. We conducted DNA methylation analysis of blood samples collected when the survivors were aged 58 to quantify biological aging using the DunedinPACE, GrimAge, and PhenoAge epigenetic clocks. Famine survivors had faster DunedinPACE, as compared with controls. This effect was strongest among women. Results were similar for GrimAge, although effect-sizes were smaller. We observed no differences in PhenoAge between survivors and controls. Famine effects were not accounted for by blood-cell composition and were similar for individuals exposed early and later in gestation. Findings suggest in-utero undernutrition may accelerate biological aging in later life.
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Affiliation(s)
- Mengling Cheng
- Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, LausanneCH 1015, Switzerland
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY10032
| | - Dalton Conley
- Department of Sociology, Princeton University, Mercer, NJ08544
| | - Tom Kuipers
- Department of Biomedical Data Sciences, Leiden University Medical Center, LeidenZC 2333, Netherlands
| | - Chihua Li
- Institute for Social Research, University of Michigan at Ann Arbor, Ann Arbor, MI48106
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY10032
| | - Calen P. Ryan
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY10032
| | - M. Jazmin Taeubert
- Department of Biomedical Data Sciences, Leiden University Medical Center, LeidenZC 2333, Netherlands
| | - Shuang Wang
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY10032
| | - Tian Wang
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY10032
| | - Jiayi Zhou
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY10032
| | - Lauren L. Schmitz
- Center for Demography and Ecology, Robert M. La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, WI53706
| | - Elmar W. Tobi
- Department of Biomedical Data Sciences, Leiden University Medical Center, LeidenZC 2333, Netherlands
| | - Bas Heijmans
- Department of Biomedical Data Sciences, Leiden University Medical Center, LeidenZC 2333, Netherlands
| | - L. H. Lumey
- Department of Biomedical Data Sciences, Leiden University Medical Center, LeidenZC 2333, Netherlands
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY10032
| | - Daniel W. Belsky
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY10032
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY10032
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11
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Salvador C, Nieto R, Kapwata T, Wright CY, Reason C, Gimeno L, Vicedo-Cabrera AM. Analyzing the effects of drought at different time scales on cause-specific mortality in South Africa. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2024; 19:054022. [PMID: 38855580 PMCID: PMC7616071 DOI: 10.1088/1748-9326/ad3bd2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
South Africa (SA) is highly vulnerable to the effects of drought on the environment, economy, and society. However, its effect on human health remains unclear. Understanding the mortality risk associated with different types of droughts in different population groups and by specific causes would help clarify the potential mechanisms involved. The study aims to comprehensively assess the effect of droughts of varying time scales on cause-specific mortality (all; infectious and parasitic; endocrine, nutritional, and metabolic; cardiovascular; respiratory) in SA (from 2009-2016) and identify more vulnerable profiles based on sex and age. We also evaluated the urbanicity and district-level socioeconomic deprivation as potential risk modifiers. We used a two-stage time-series study design, with the weekly standardized precipitation-evapotranspiration index (SPEI) calculated at 1, 6, 12, and 15 months of accumulation to identify droughts of different duration (SPEI1, 6, 12, 15, respectively). We applied a quasi-Poisson regression adjusted by mean temperature to assess the association between each type of drought and weekly mortality in all district municipalities of SA, and then pooled the estimates in a meta-regression model. We reported relative risks (RRs) for one unit increase of drought severity. Overall, we found a positive association between droughts (regardless the time scale) and all causes of death analyzed. The strongest associations were found for the drought events more prolonged (RR [95%CI]: 1.027 [1.018, 1.036] (SPEI1); 1.035 [1.021, 1.050] (SPEI6); 1.033 [1.008, 1.058] (SPEI12); 1.098 [1.068, 1.129] (SPEI15)) and respiratory mortality (RRs varied from 1.037 [1.021, 1.053] (SPEI1) to 1.189 [1.14, 1.241] (SPEI15)). An indication of greater vulnerability was found in younger adults for the shortest droughts, in older adults for medium-term and long-term droughts, and children for very long-term droughts. However, differences were not significant. Further evidence of the relevance of urbanicity and demographic and socioeconomic conditions as potential risk modifiers is needed.
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Affiliation(s)
- Coral Salvador
- Centro de Investigación Marinã, Universidade de Vigo, Environmental Physics Laboratory (EPhysLab), Ourense, Spain
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Raquel Nieto
- Centro de Investigación Marinã, Universidade de Vigo, Environmental Physics Laboratory (EPhysLab), Ourense, Spain
| | - Thandi Kapwata
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg 2090, South Africa
- Department of Environmental Health, University of Johannesburg, Johannesburg 2000, South Africa
| | - Caradee Y Wright
- Environment and Health Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0001, South Africa
| | - Chris Reason
- Oceanography Department, University of Cape Town, Rondebosch 7701, South Africa
| | - Luis Gimeno
- Centro de Investigación Marinã, Universidade de Vigo, Environmental Physics Laboratory (EPhysLab), Ourense, Spain
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
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12
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Dos Reis Araujo T, Alves BL, Dos Santos LMB, Gonçalves LM, Carneiro EM. Association between protein undernutrition and diabetes: Molecular implications in the reduction of insulin secretion. Rev Endocr Metab Disord 2024; 25:259-278. [PMID: 38048021 DOI: 10.1007/s11154-023-09856-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
Undernutrition is still a recurring nutritional problem in low and middle-income countries. It is directly associated with the social and economic sphere, but it can also negatively impact the health of the population. In this sense, it is believed that undernourished individuals may be more susceptible to the development of non-communicable diseases, such as diabetes mellitus, throughout life. This hypothesis was postulated and confirmed until today by several studies that demonstrate that experimental models submitted to protein undernutrition present alterations in glycemic homeostasis linked, in part, to the reduction of insulin secretion. Therefore, understanding the changes that lead to a reduction in the secretion of this hormone is essential to prevent the development of diabetes in undernourished individuals. This narrative review aims to describe the main molecular changes already characterized in pancreatic β cells that will contribute to the reduction of insulin secretion in protein undernutrition. So, it will provide new perspectives and targets for postulation and action of therapeutic strategies to improve glycemic homeostasis during this nutritional deficiency.
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Affiliation(s)
- Thiago Dos Reis Araujo
- Obesity and Comorbidities Research Center (OCRC), Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Carl Von Linnaeus Bloco Z, Campinas, SP, Cep: 13083-864, Brazil
| | - Bruna Lourençoni Alves
- Obesity and Comorbidities Research Center (OCRC), Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Carl Von Linnaeus Bloco Z, Campinas, SP, Cep: 13083-864, Brazil
| | - Lohanna Monali Barreto Dos Santos
- Obesity and Comorbidities Research Center (OCRC), Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Carl Von Linnaeus Bloco Z, Campinas, SP, Cep: 13083-864, Brazil
| | - Luciana Mateus Gonçalves
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Everardo Magalhães Carneiro
- Obesity and Comorbidities Research Center (OCRC), Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Carl Von Linnaeus Bloco Z, Campinas, SP, Cep: 13083-864, Brazil.
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13
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Kirolos A, Harawa PP, Chimowa T, Divala O, Freyne B, Jones AG, Lelijveld N, Lissauer S, Maleta K, Gladstone MJ, Kerac M. Long-term outcomes after severe childhood malnutrition in adolescents in Malawi (LOSCM): a prospective observational cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:280-289. [PMID: 38368896 DOI: 10.1016/s2352-4642(23)00339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Research on long-term outcomes of severe childhood malnutrition is scarce. Existing evidence suggests potential associations with cardiometabolic disease and impaired cognition. We aimed to assess outcomes in adolescents who were exposed to severe childhood malnutrition compared with peers not exposed to severe childhood malnutrition. METHODS In Long-term Outcomes after Severe Childhood Malnutrition (LOCSM), we followed up adolescents who had 15 years earlier received treatment for severe childhood malnutrition at Queen Elizabeth Central Hospital in Blantyre, Malawi. Adolescents with previous severe childhood malnutrition included in LOCSM had participated in an earlier follow-up study (ChroSAM) at 7 years after treatment for severe childhood malnutrition, where they were compared to siblings and age-matched children in the community without previous severe childhood malnutrition. We measured anthropometry, body composition, strength, glucose tolerance, cognition, behaviour, and mental health during follow-up visits between Sept 9, 2021, and July 22, 2022, comparing outcomes in adolescents exposed to previous severe childhood malnutrition with unexposed siblings and adolescents from the community assessed previously (for ChroSAM) and newly recruited during current follow-up. We used a linear regression model to adjust for age, sex, disability, HIV, and socioeconomic status. This study is registered with the International Standard Randomised Controlled Trial Number Registry (ISRCTN17238083). FINDINGS We followed up 168 previously malnourished adolescents (median age 17·1 years [IQR 16·5 to 18·0]), alongside 123 siblings (18·2 years [15·0 to 20·5]), and 89 community adolescents (17·1 years [16·3 to 18·1]). Since last measured 8 years previously, mean height-for-age Z (HAZ) scores had improved in previously malnourished adolescents (difference 0·33 [95% CI 0·20 to 0·46]) and siblings (0·32 [0·09 to 0·55]), but not in community adolescents (difference -0·01 [-0·24 to 0·23]). Previously malnourished adolescents had sustained lower HAZ scores compared with siblings (adjusted difference -0·32 [-0·58 to -0·05]) and community adolescents (-0·21 [-0·52 to 0·10]). The adjusted difference in hand-grip strength between previously malnourished adolescents and community adolescents was -2·0 kg (-4·2 to 0·3). For child behaviour checklist internalising symptom scores, the adjusted difference for previously malnourished adolescents was 2·8 (0·0 to 5·5) compared with siblings and 2·1 (-0·1 to 4·3) compared with community adolescents. No evidence of differences between previously malnourished adolescents and unexposed groups were found in any of the other variables measured. INTERPRETATION Catch-up growth into adolescence was modest compared with the rapid improvement seen in childhood, but provides optimism for ongoing recovery of height deficits. We found little evidence of heightened non-communicable disease risk in adolescents exposed to severe childhood malnutrition, although long-term health implications need to be monitored. Further investigation of associated home and environmental factors influencing long-term outcomes is needed to tailor preventive and treatment interventions. FUNDING The Wellcome Trust.
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Affiliation(s)
- Amir Kirolos
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
| | - Philliness P Harawa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Takondwa Chimowa
- Department of Paediatrics, Zomba Central Hospital, Zomba, Malawi
| | - Oscar Divala
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Bridget Freyne
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi; School of Medicine, University College Dublin, Dublin, Ireland
| | - Angus G Jones
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Natasha Lelijveld
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Emergency Nutrition Network, Kidlington, UK
| | - Samantha Lissauer
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Kenneth Maleta
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Melissa J Gladstone
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Centre for Maternal, Adolescent, and Reproductive Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
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14
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Liu H, Zhang M, Zhang X, Zhao X. Exposure to early-life adversity and long-term trajectories of multimorbidity among older adults in China: analysis of longitudinal data from the China Health and Retirement Longitudinal Study. BMJ Open 2024; 14:e075834. [PMID: 38485180 PMCID: PMC10941172 DOI: 10.1136/bmjopen-2023-075834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES This study aimed to identify long-term distinct trajectories of multimorbidity with ageing from 50 to 85 years among Chinese older adults and examine the relationship between exposure to early-life adversity (ELA; including specific types of adversity and accumulation of different adversities) and these long-term multimorbidity trajectories. DESIGN The group-based trajectory models identified long-term multimorbidity trajectories. Multinomial logistic regression models were used to examine the relationship between ELA and the identified multimorbidity trajectories. SETTING This study used data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) and the 2014 Life History Survey. PARTICIPANTS We used data from 9112 respondents (aged 60 and above) of the 2018 wave of CHARLS. OUTCOME MEASURES Each respondent's history of chronic conditions and experiences of ELA were collected from the 2011-2018 waves of CHARLS and the 2014 Life History Survey. RESULTS Four heterogeneous long-term trajectories of multimorbidity development were identified: 'maintaining-low' (19.1%), 'low onset-rapidly increasing' (23.3%), 'middle onset-moderately increasing' (41.5%) and 'chronically-high' (16.2%). Our findings indicated that the heterogeneity can be explained by ELA experiences. Across various types of different ELA experiences, exposure to food insufficiency (relative risk ratios from 1.372 (95% CI 1.190 to 1.582) to 1.780 (95% CI 1.472 to 2.152)) and parental quarrel/divorce (relative risk ratios from 1.181 (95% CI 1.000 to 1.394) to 1.262 (95% CI 1.038 to 1.536)) had the most prominent associations with health deterioration. The accumulation of more different ELA experiences was associated with a higher relative risk of developing more severe multimorbidity trajectories (relative risk ratio for five to seven ELAs and chronically high trajectory: 7.555, 95% CI 4.993 to 11.431). CONCLUSIONS There are heterogeneous long-term trajectories of multimorbidity in Chinese older adults, and the risk of multimorbidity associated with ELA accumulates over the lifespan. Our findings highlight the role of a supportive early-life family environment in promoting health development across the lifespan, advocating for the integration of life-course approaches to implementing health disparity interventions.
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Affiliation(s)
- Huiying Liu
- Department of Sociology, Central South University, Changsha, China
| | - Mi Zhang
- Department of Sociology, Central South University, Changsha, China
| | - Xinyan Zhang
- Department of Sociology, Central South University, Changsha, China
| | - Xinyi Zhao
- School of Health Humanities, Peking University, Beijing, China
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15
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Olga L, McKenzie K, Kerac M, Boyne M, Badaloo A, Bandsma RHJ, Koulman A, Thompson DS. Weight gain during nutritional rehabilitation post-childhood malnutrition may influence the associations between adulthood desaturases activity and anthro-cardiometabolic risk factors. Clin Nutr 2024; 43:747-755. [PMID: 38330703 DOI: 10.1016/j.clnu.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUNDS & AIMS Childhood malnutrition is a major global health problem with long-term sequelae, including non-communicable diseases (NCDs). Mechanisms are unknown but may involve metabolic programming, resulting from "short-term" solutions to optimise survival by compromising non-priority organs. As key players in lipid metabolism, desaturases have been shown to be predictive of NCDs. We hypothesised that the association between specific desaturase activities and NCD risk determinants (including body composition, serum glucose, insulin levels, and blood pressure) are influenced by childhood post-malnutrition weight gain. METHODS 278 Afro-Caribbean adults with well-documented clinical history of severe malnutrition in childhood were studied. Extensive metabolic analyses including body composition (DXA), fasting serum glucose and lipidomics (n = 101), and fasting serum insulin (n = 83) were performed in malnutrition survivors and matched community controls (n = 90). Established lipid ratios were used as proxies of desaturase activities: CE 16:1/CE 16:0 for stearoyl-CoA desaturase (SCD1), LysoPC 20:4/20:3 for fatty acid desaturase 1 (FADS1), and LysoPC 20:3/18:2 for FADS2. RESULTS Compared to community controls, adult malnutrition survivors (mean ± SD) age 28.3 ± 7.8 and BMI 23.6 ± 5.2 had higher SCD1 and FADS1 activity, (B ± SE) 0.07 ± 0.02 and 0.7 ± 0.08, respectively, but lower FADS2 activities (B ± SE) -0.05 ± 0.01, adjusted for sex and age (p < 0.0005). SCD1 was positively associated with adult BMI and body fat percentage, and negatively associated with lean mass and height. Stratification based on weight gain during nutritional rehabilitation among malnutrition survivors might signal the potential associations between weight gain during that critical period, desaturase activities, and some of adult metabolic parameters, with the lowest tertiles (slowest catch-up weight gain) performing more similarly to controls. CONCLUSIONS In adult survivors of early-life severe acute malnutrition, desaturase activity is associated with markers of NCD risk, especially adiposity. These associations seem to be strengthened by faster weight gain during nutritional rehabilitation.
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Affiliation(s)
- Laurentya Olga
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK.
| | - Kimberley McKenzie
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Boyne
- Department of Medicine, The University of the West Indies, Kingston, Jamaica
| | - Asha Badaloo
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Robert H J Bandsma
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Albert Koulman
- MRC Epidemiology Unit, Wellcome Trust-MRC Institute of Metabolic Science, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK; Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Debbie S Thompson
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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Guo J, Luo S, Su Z, Fu J, Ma J, Zhong X, Zeng C, Huang J, Zhang W, Zhang Z, Zhu H, Li Y. Consumption Patterns of Sugar-Sweetened Beverages and Association with Undernutrition among Children Aged 9-17 Years in Guangzhou, China: A Cross-Sectional Study. Nutrients 2024; 16:650. [PMID: 38474778 DOI: 10.3390/nu16050650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Globally, the high consumption levels of sugar-sweetened beverages (SSBs) and their effect on health have drawn significant attention. This study aimed to identify the consumption patterns of SSBs among children in rural areas of Guangzhou, China, and explore their association with undernutrition. A total of 1864 children aged 9-17 years old were included in this study. Demographics, lifestyle behaviors, and anthropometric and dietary information were collected. Factor analysis was used to identify patterns of SSBs, while nutritional status was assessed using Body Mass Index (BMI). Latent class analysis was used to establish dietary preference models. Log-binomial regression analysis was used to analyze the association between SSBs consumption patterns and undernutrition. The undernutrition prevalence in children was 14.54-19.94% in boys and 9.07% in girls. Three SSB consumption patterns were identified, including the plant protein pattern, dairy-containing pattern, and coffee pattern. Both medium-high (Q3) and the highest (Q4) scores in the dairy-containing pattern were positively associated with the risk of undernutrition, especially in boys. Furthermore, the highest scores in the plant protein pattern and coffee pattern were positively associated with the risk of undernutrition in children aged 9-10 years old. The dairy-containing pattern was a risk factor for undernutrition in children, especially for boys; the plant protein patterns and coffee patterns were risk factors for undernutrition in children aged 9-10 years old. The findings of the study can provide scientific evidence and policy recommendations for improving children's health conditions.
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Affiliation(s)
- Jiaying Guo
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Shiyun Luo
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Zheng Su
- School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Jinhan Fu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jie Ma
- School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Xuexin Zhong
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chunzi Zeng
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Jie Huang
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Weiwei Zhang
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Zhoubin Zhang
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Huilian Zhu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yan Li
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
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17
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Mee N, Abera M, Kerac M. Acceptability and Feasibility of Maternal Mental Health Assessment When Managing Small, Nutritionally At-Risk Infants Aged < 6 Months: A Key Informant Interview Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:209. [PMID: 38397321 PMCID: PMC10887604 DOI: 10.3390/children11020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
Maternal mental health (MMH) conditions and infant malnutrition are both major global public health concerns. Despite a well-established link between the two, many nutrition programmes do not routinely consider MMH. New World Health Organization (WHO) malnutrition guidelines do, however, emphasise MMH. To inform guideline rollout, we aimed to assess the feasibility and acceptability of MMH assessments in nutrition programmes in low-resource settings. Ten semi-structured interviews were conducted with international key informants who work on nutrition programmes or MMH research. Interview transcripts were coded using subthemes derived from the key points discussed. The benefits and risks were highlighted. These included ethical dilemmas of asking about MMH if local treatment services are suboptimal. Commonly reported challenges included governance, staff training and finance. Community and programme staff perceptions of MMH were primarily negative across the different settings. Many points were raised for improvements and innovations in practice, but fundamental developments were related to governance, care pathways, advocacy, training, funding and using existing community networks. Future implementation research is needed to understand whether assessment is safe/beneficial (as it is in other settings) to promote MMH screening. Current service providers in low-resource settings can undertake several steps, as recommended in this paper, to improve the care offered to mothers and infants.
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Affiliation(s)
- Natalie Mee
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
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Tomori C, O'Connor DL, Ververs M, Orta-Aleman D, Paone K, Budhathoki C, Pérez-Escamilla R. Critical research gaps in treating growth faltering in infants under 6 months: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001860. [PMID: 38190356 PMCID: PMC10773941 DOI: 10.1371/journal.pgph.0001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024]
Abstract
In 2020, 149.2 million children worldwide under 5 years suffered from stunting, and 45.4 million experienced wasting. Many infants are born already stunted, while others are at high risk for growth faltering early after birth. Growth faltering is linked to transgenerational impacts of poverty and marginalization. Few interventions address growth faltering in infants under 6 months, despite a likely increasing prevalence due to the negative global economic impacts of the COVID-19 pandemic. Breastfeeding is a critical intervention to alleviate malnutrition and improve child health outcomes, but rarely receives adequate attention in growth faltering interventions. A systematic review and meta-analysis were undertaken to identify and evaluate interventions addressing growth faltering among infants under 6 months that employed supplemental milks. The review was carried out following guidelines from the USA National Academy of Medicine. A total of 10,405 references were identified, and after deduplication 7390 studies were screened for eligibility. Of these, 227 were assessed for full text eligibility and relevance. Two randomized controlled trials were ultimately included, which differed in inclusion criteria and methodology and had few shared outcomes. Both studies had small sample sizes, high attrition and high risk of bias. A Bangladeshi study (n = 153) found significantly higher rates of weight gain for F-100 and diluted F-100 (DF-100) compared with infant formula (IF), while a DRC trial (n = 146) did not find statistically significant differences in rate of weight gain for DF-100 compared with IF offered in the context of broader lactation and relactation support. The meta-analysis of rate of weight gain showed no statistical difference and some evidence of moderate heterogeneity. Few interventions address growth faltering among infants under 6 months. These studies have limited generalizability and have not comprehensively supported lactation. Greater investment is necessary to accelerate research that addresses growth faltering following a new research framework that calls for comprehensive lactation support.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Population, Johns Hopkins University Bloomberg School of Public Health, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Deborah L O'Connor
- Temerty Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Mija Ververs
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Dania Orta-Aleman
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katerina Paone
- Department of Social and Behavioral Health, Yale University School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Chakra Budhathoki
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Health, Yale University School of Public Health, Yale University, New Haven, Connecticut, United States of America
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Thompson DS, McKenzie K, Opondo C, Boyne MS, Lelijveld N, Wells JC, Cole TJ, Anujuo K, Abera M, Berhane M, Koulman A, Wootton SA, Kerac M, Badaloo A. Faster rehabilitation weight gain during childhood is associated with risk of non-communicable disease in adult survivors of severe acute malnutrition. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002698. [PMID: 38127945 PMCID: PMC10734994 DOI: 10.1371/journal.pgph.0002698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
Nutritional rehabilitation during severe acute malnutrition (SAM) aims to quickly restore body size and minimize poor short-term outcomes. We hypothesized that faster weight gain during treatment is associated with greater cardiometabolic risk in adult life. Anthropometry, body composition (DEXA), blood pressure, blood glucose, insulin and lipids were measured in a cohort of adults who were hospitalized as children for SAM between 1963 and 1993. Weight and height measured during hospitalization and at one year post-recovery were abstracted from hospital records. Childhood weight gain during nutritional rehabilitation and weight and height gain one year post-recovery were analysed as continuous variables, quintiles and latent classes in age, sex and minimum weight-for-age z-scores-adjusted regression models against adult measurements. Data for 278 adult SAM survivors who had childhood admission records were analysed. Of these adults, 85 also had data collected 1 year post-hospitalisation. Sixty percent of participants were male, mean (SD) age was 28.2 (7.7) years, mean (SD) BMI was 23.6 (5.2) kg/m2. Mean admission age for SAM was 10.9 months (range 0.3-36.3 months), 77% were wasted (weight-for-height z-scores<-2). Mean rehabilitation weight gain (SD) was 10.1 (3.8) g/kg/day and 61.6 (25.3) g/day. Rehabilitation weight gain > 12.9 g/kg/day was associated with higher adult BMI (difference = 0.5 kg/m2, 95% CI: 0.1-0.9, p = 0.02), waist circumference (difference = 1.4 cm, 95% CI: 0.4-2.4, p = 0.005), fat mass (difference = 1.1 kg, 95% CI: 0.2-2, p = 0.02), fat mass index (difference = 0.32kg/m2, 95% CI: -0.0001-0.6, p = 0.05), and android fat mass (difference = 0.09 kg, 95% CI: 0.01-0.2, p = 0.03). Post-recovery weight gain (g/kg/month) was associated with lean mass (difference = 1.3 kg, 95% CI: 0.3-2.4, p = 0.015) and inversely associated with android-gynoid fat ratio (difference = -0.03, 95% CI: -0.07to-0.001 p = 0.045). Rehabilitation weight gain exceeding 13g/kg/day was associated with adult adiposity in young, normal-weight adult SAM survivors. This challenges existing guidelines for treating malnutrition and warrants further studies aiming at optimising these targets.
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Affiliation(s)
- Debbie S. Thompson
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Kimberley McKenzie
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michael S. Boyne
- Department of Medicine, The University of the West Indies, Kingston, Jamaica
| | - Natasha Lelijveld
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Maternal, Adolescent & Reproductive Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jonathan C. Wells
- Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Tim J. Cole
- Population Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kenneth Anujuo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mubarek Abera
- Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Melkamu Berhane
- Faculty of Medical Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Albert Koulman
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Stephen A. Wootton
- Southampton NIHR Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Maternal, Adolescent & Reproductive Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Asha Badaloo
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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Gholar VM, Christian R. Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities. JBI Evid Implement 2023; 21:374-385. [PMID: 37131273 DOI: 10.1097/xeb.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities. INTRODUCTION Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided. METHODS The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels. RESULTS The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance. CONCLUSION Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.
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Affiliation(s)
- Victoria M Gholar
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
- The Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, MS, USA
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
| | - Robin Christian
- The Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, MS, USA
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
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21
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Hudson LD, Al-Khairulla H, Maicoo M, Borja MC, Rapala A, Viner R, Nicholls D, Taylor A, Muthurangu V, Hughes A. Pulse wave velocity during re-feeding and with weight gain in underweight female adolescents with anorexia nervosa. J Hum Hypertens 2023; 37:1126-1128. [PMID: 37468542 DOI: 10.1038/s41371-023-00848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
Anorexia Nervosa (AN) causes harmful underweight and important cardiovascular acute complications however less is known about longer-term cardiovascular risk. We measured carotid femoral pulse wave velocity (PWV) in a group of underweight young women with AN at baseline and weekly as they were refed and gained weight. PWV decreased over time and was negatively associated with increasing BMI and calorific meal content suggesting potential positive cardiovascular benefits for refeeding and weight gain in AN and supports current consensus for the importance of weight gain in underweight young women with AN.
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Affiliation(s)
| | | | | | | | | | | | - Dasha Nicholls
- Dept Brain Sciences, Imperial College London, London, UK
| | | | | | - Alun Hughes
- UCL Institute of Cardiovascular Science, London, UK
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22
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Sturgeon JP, Njunge JM, Bourke CD, Gonzales GB, Robertson RC, Bwakura-Dangarembizi M, Berkley JA, Kelly P, Prendergast AJ. Inflammation: the driver of poor outcomes among children with severe acute malnutrition? Nutr Rev 2023; 81:1636-1652. [PMID: 36977352 PMCID: PMC10639108 DOI: 10.1093/nutrit/nuad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Severe acute malnutrition (SAM) is the most life-threatening form of undernutrition and underlies at least 10% of all deaths among children younger than 5 years in low-income countries. SAM is a complex, multisystem disease, with physiological perturbations observed in conjunction with the loss of lean mass, including structural and functional changes in many organ systems. Despite the high mortality burden, predominantly due to infections, the underlying pathogenic pathways remain poorly understood. Intestinal and systemic inflammation is heightened in children with SAM. Chronic inflammation and its consequent immunomodulation may explain the increased morbidity and mortality from infections in children with SAM, both during hospitalization and in the longer term after discharge. Recognition of the role of inflammation in SAM is critical in considering new therapeutic targets in this disease, which has not seen a transformational approach to treatment for several decades. This review highlights the central role of inflammation in the wide-ranging pathophysiology of SAM, as well as identifying potential interventions that have biological plausibility based on evidence from other inflammatory syndromes.
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Affiliation(s)
- Jonathan P Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - James M Njunge
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Claire D Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Gerard Bryan Gonzales
- Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Ruairi C Robertson
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | | | - James A Berkley
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Paul Kelly
- is with the Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
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23
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Ahmed KY, Dadi AF, Ogbo FA, Page A, Agho KE, Akalu TY, Baraki AG, Tesema GA, Teshale AB, Alamneh TS, Tessema ZT, Kabthymer RH, Tamirat KS, Ross AG. Population-Modifiable Risk Factors Associated With Childhood Stunting in Sub-Saharan Africa. JAMA Netw Open 2023; 6:e2338321. [PMID: 37851439 PMCID: PMC10585405 DOI: 10.1001/jamanetworkopen.2023.38321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/28/2023] [Indexed: 10/19/2023] Open
Abstract
Importance Identifying modifiable risk factors associated with childhood stunting in sub-Saharan Africa (SSA) is imperative for the development of evidence-based interventions and to achieve the Sustainable Development Goals. Objective To evaluate key modifiable risk factors associated with childhood stunting in SSA. Design, Setting, and Participants This cross-sectional study examined the most recent (2014-2021) Demographic and Health Surveys data for children younger than 5 years from 25 SSA countries. Exposures Modifiable risk factors included history of diarrhea within 2 weeks, consumption of dairy products, maternal body mass index, maternal educational level, antenatal care visits, place of birth, wealth index, type of toilet, and type of cooking fuel. Main Outcomes and Measures Stunting and severe stunting, measured using the height-for-age z score, were the main outcomes. Children who scored below -2.0 SDs or -3.0 SDs were classified as having stunted or severely stunted growth, respectively. Relative risks and 95% CIs were computed using generalized linear latent and mixed models and log-binomial link functions. Population-attributable fractions (PAFs) were calculated using adjusted relative risks and prevalence estimates for key modifiable risk factors. Results This study included 145 900 children from 25 SSA countries. The mean (SD) age of the children was 29.4 (17.3) months, and 50.6% were male. The highest PAFs of severe childhood stunting were observed for mothers lacking a formal education (PAF, 21.9%; 95% CI, 19.0%-24.8%), children lacking consumption of dairy products (PAF, 20.8%; 95% CI, 16.8%-24.9%), unclean cooking fuel (PAF, 9.5%; 95% CI, 2.6%-16.3%), home birth (PAF, 8.3%; 95% CI, 6.3%-10.0%), and low-income household (PAF, 5.8%; 95% CI, 3.4%-8.0%). These 5 modifiable risk factors were associated with 51.6% (95% CI, 40.5%-60.9%) of the severe childhood stunting in SSA. Conclusions and Relevance This cross-sectional study identified 5 modifiable risk factors that were associated with 51.6% of severe childhood stunting in SSA. These factors should be a priority for policy makers when considering future child health interventions to address chronic malnutrition in SSA.
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Affiliation(s)
- Kedir Y. Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | - Abel F. Dadi
- Charles Darwin University, Menzies School of Health Research, Northern Territory, Australia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Felix Akpojene Ogbo
- Riverland Academy of Clinical Excellence, Riverland Mallee Coorong Local Health Network, South Australia Health, Government of South Australia, Berri, South Australia, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Kingsley E. Agho
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adhanom Gebreegziabher Baraki
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Getayeneh Antehunegn Tesema
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Achamyeleh Birhanu Teshale
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tesfa Sewunet Alamneh
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Zemenu Tadesse Tessema
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robel Hussen Kabthymer
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Human Nutrition, School of Public Health, Dilla University, Dilla, Ethiopia
| | - Koku Sisay Tamirat
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Rural Health, Monash University, Warragul, Victoria, Australia
| | - Allen G. Ross
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
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Engler R, McGrath M, Kerac M. Training Packages and Patient Management Tools for Healthcare Staff Working with Small, Nutritionally At-Risk Infants Aged under 6 Months: A Mixed-Methods Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1496. [PMID: 37761457 PMCID: PMC10530104 DOI: 10.3390/children10091496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
Skilled staff are essential for successfully managing child malnutrition, especially when dealing with small, nutritionally at-risk infants aged under 6 months. Training and patient management tools provide healthcare workers with core knowledge, skills, and support. To inform more effective future approaches and support the rollout of new WHO wasting prevention/treatment guidelines, we aimed to map and understand globally available training and patient management tools. In a mixed-methods study, we searched the literature to identify different training packages and management tools and conducted semi-structured key informant interviews with staff working in a variety of internationally organizations and settings. Data were analyzed using a phenomenological approach. We found 14 different training packages targeting different settings, including inpatient, outpatient, and humanitarian contexts. Curricula varied, especially around breastfeeding and maternal assessment, mental health, and nutritional status. Key informants (n = 9) reported gaps regarding counseling skills, time for practice, and how to effectively provide mental health counseling. Training delivery was highly dependent on resources and setting. In conclusion, future training should consider setting-specific needs, opportunities, and limitations. Emphasis on breastfeeding-support skills, mental health support, and counseling skills is needed. Enhanced practical sessions, refresher trainings, and ongoing monitoring and support are vital to ensure sustained high-quality services.
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Affiliation(s)
- Ramona Engler
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (R.E.); (M.M.)
| | - Marie McGrath
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (R.E.); (M.M.)
- Emergency Nutrition Network, Oxford, OX5 2DN, UK
| | - Marko Kerac
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (R.E.); (M.M.)
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Monga M, Sikorski C, de silva H, McGrath M, Kerac M. Identifying underweight in infants and children using growth charts, lookup tables and a novel "MAMI" slide chart: A cross-over diagnostic and acceptability study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002303. [PMID: 37647273 PMCID: PMC10468082 DOI: 10.1371/journal.pgph.0002303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/22/2023] [Indexed: 09/01/2023]
Abstract
Malnutrition is a leading cause of preventable deaths in infants and children. To benefit from treatment and prevention programmes, malnourished children must first be identified. Low weight-for-age is an anthropometric indicator of malnutrition which is gaining much recent attention because it is particularly effective at identifying children at highest risk of death. However, assessing weight-for-age can be challenging. We aimed to evaluate a novel, low-cost weight-for-age slide chart and compare its performance against two traditional methods. We conducted a cross-over diagnostic study comparing a new "MAMI" slide-chart against traditional growth charts and look-up tables. Participants were health and public health professionals working or studying in the UK. Each acted as their own control, using all three methods but in random order. Under timed conditions, they evaluated hypothetical scenarios, arranged in a random sequence. Each tool's diagnostic accuracy and response rate were compared. User preferences were also recorded. Sixty-two participants took part. Diagnostic accuracy was highest for the MAMI chart: 79%(351/445) correct assessments. Accuracy using look-up tables was 70%(308/438). Growth charts performed worst: 61%(217/353) correct (p-value<0.01). The mean number of scenarios (±SD) correctly identified by each participant in 4-minutes was 3.5(±2.19) using growth charts; 4.97(±2.50) using look-up tables; 5.66(±2.69) using MAMI charts (ANOVA, p-value<0.01). This translates to approximately 53, 75 and 85 correct assessments per participant in an hour for the respective tools. No statistically significant differences were found with participants' years of experience or profession type. Most participants, 43/62(69%), preferred the MAMI chart and reported it to be easier and faster to use than traditional tools. We conclude that weight-for-age assessment is quicker and more accurate using the newly-developed MAMI slide chart as opposed to traditional methods. It should be further field tested in other settings since the potential to improve the efficiency and effectiveness of treatment programmes is great.
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Affiliation(s)
- Meenakshi Monga
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Himali de silva
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Cheng M, Sommet N, Kerac M, Jopp DS, Spini D. Exposure to the 1959-1961 Chinese famine and risk of non-communicable diseases in later life: A life course perspective. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002161. [PMID: 37585364 PMCID: PMC10431657 DOI: 10.1371/journal.pgph.0002161] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/20/2023] [Indexed: 08/18/2023]
Abstract
Child undernutrition and later-life non-communicable diseases (NCDs) are major global health issues. Literature suggests that undernutrition/famine exposure in childhood has immediate and long-term adverse health consequences. However, many studies have theoretical and methodological limitations. To add to the literature and overcome some of these limitations, we adopted a life course perspective and used more robust methods. We investigated the association between exposure to the 1959-1961 Chinese famine and later-life NCDs and if this association depends on: life stage at exposure, famine severity, and sex. We conducted a secondary data analysis of a large-scale, nationally representative, longitudinal study-the China Health and Retirement Longitudinal Study (2011-2018, 11,094 participants). We measured famine exposure/severity using self-reported experience, life stage using age at exposure, and health using the number of NCDs. We performed Poisson growth curve models. We obtained three findings. First, compared with unexposed participants, those exposed before age 18 had a higher risk of later-life NCDs, particularly if exposed in-utero (IRR = 1.90, 95% CI [1.70, 2.12], p < .001) and in the "first 1,000 days" of life (IRR = 1.86, 95% CI [1.73, 2.00], p < .001; for 0-6 months group, IRR = 1.95, 95% CI [1.67, 2.29], p < .001). Second, the famine effects among participants moderately and severely exposed were similar (IRR = 1.18, 95% CI [1.09, 1.28], p < .001 and IRR = 1.24, 95% CI [1.17, 1.32], p < .001). Third, the famine effects did not differ between females and males (IRR = 0.98, 95% CI [0.90, 1.07], p = .703). In an individual's life course, in-utero and the "first 1,000 days" are a particularly sensitive time period with marked long-term implications for NCDs if undernutrition/famine is experienced in this period. However, this window remains open until young adulthood. This highlights the need to invest more in preventing and treating child/adolescent undernutrition to tackle later-life NCDs.
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Affiliation(s)
- Mengling Cheng
- Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Sommet
- Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Marko Kerac
- Centre for Maternal Adolescent Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniela S. Jopp
- Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Dario Spini
- Swiss Centre of Expertise in Life Course Research, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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Lelijveld N, Cox S, Anujuo K, Amoah AS, Opondo C, Cole TJ, Wells JCK, Thompson D, McKenzie K, Abera M, Berhane M, Kerac M. Post-malnutrition growth and its associations with child survival and non-communicable disease risk: a secondary analysis of the Malawi 'ChroSAM' cohort. Public Health Nutr 2023; 26:1658-1670. [PMID: 36876519 PMCID: PMC10466107 DOI: 10.1017/s1368980023000411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 01/05/2023] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To explore patterns of post-malnutrition growth (PMGr) during and after treatment for severe malnutrition and describe associations with survival and non-communicable disease (NCD) risk 7 years post-treatment. DESIGN Six indicators of PMGr were derived based on a variety of timepoints, weight, weight-for-age z-score and height-for-age z-score (HAZ). Three categorisation methods included no categorisation, quintiles and latent class analysis (LCA). Associations with mortality risk and seven NCD indicators were analysed. SETTING Secondary data from Blantyre, Malawi between 2006 and 2014. PARTICIPANTS A cohort of 1024 children treated for severe malnutrition (weight-for-length z-score < 70 % median and/or MUAC (mid-upper arm circumference) < 110 mm and/or bilateral oedema) at ages 5-168 months. RESULTS Faster weight gain during treatment (g/d) and after treatment (g/kg/day) was associated with lower risk of death (adjusted OR 0·99, 95 % CI 0·99, 1·00; and adjusted OR 0·91, 95 % CI 0·87, 0·94, respectively). In survivors (mean age 9 years), it was associated with greater hand grip strength (0·02, 95 % CI 0·00, 0·03) and larger HAZ (6·62, 95 % CI 1·31, 11·9), both indicators of better health. However, faster weight gain was also associated with increased waist:hip ratio (0·02, 95 % CI 0·01, 0·03), an indicator of later-life NCD risk. The clearest patterns of association were seen when defining PMGr based on weight gain in g/d during treatment and using the LCA method to describe growth patterns. Weight deficit at admission was a major confounder. CONCLUSIONS A complex pattern of benefits and risks is associated with faster PMGr. Both initial weight deficit and rate of weight gain have important implications for future health.
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Affiliation(s)
- Natasha Lelijveld
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
- Emergency Nutrition Network (ENN), Oxford, UK
- Centre for Maternal, Adolescent & Reproductive Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Sioned Cox
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
| | - Kenneth Anujuo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
| | - Abena S Amoah
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Charles Opondo
- Department of Medical Statistics, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tim J Cole
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jonathan CK Wells
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Debbie Thompson
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Kimberley McKenzie
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | | | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
- Centre for Maternal, Adolescent & Reproductive Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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Souza ACD, Silva DGD, Jezuíno JDS, Ferreira ARO, Ribeiro MVG, Vidigal CB, Moura KF, Erthal RP, Mathias PCDF, Fernandes GSA, Palma-Rigo K, Ceravolo GS. Protein restriction during peripubertal period impairs endothelial aortic function in adult male Wistar rats. J Dev Orig Health Dis 2023; 14:451-458. [PMID: 37198976 DOI: 10.1017/s2040174423000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Protein restriction during early phases of body development, such as intrauterine life can favor the development of vascular disorders. However, it is not known if peripubertal protein restriction can favor vascular dysfunction in adulthood. The present study aimed to evaluated whether a protein restriction diet during peripubertal period favors endothelial dysfunction in adulthood. Male Wistar rats from postnatal day (PND) 30 until 60 received a diet with either 23% protein (CTR group) or with 4% protein (LP group). At PND 120, the thoracic aorta reactivity to phenylephrine, acetylcholine, and sodium nitroprusside was evaluated in the presence or absence of: endothelium, indomethacin, apocynin and tempol. The maximum response (Rmax) and pD2 (-log of the concentration of the drug that causes 50% of the Rmax) were calculated. The lipid peroxidation and catalase activity were also evaluated in the aorta. The data were analyzed by ANOVA (one or two-ways and Tukey's) or independent t-test; the results were expressed as mean ± S.E.M., p < 0.05. The Rmax to phenylephrine in aortic rings with endothelium were increased in LP rats when compared with the Rmax in CTR rats. Apocynin and tempol reduced Rmax to phenylephrine in LP aortic rings but not in CTR. The aortic response to the vasodilators was similar between the groups. Aortic catalase activity was lower and lipid peroxidation was greater in LP compared to CTR rats. Therefore, protein restriction during the peripubertal period causes endothelial dysfunction in adulthood through a mechanism related to oxidative stress.
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Affiliation(s)
- Amanda Cristina de Souza
- Department of Physiological Sciences, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Deborah Gomes da Silva
- Graduation Program of Physiological Sciences, Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
| | - Juliana da Silva Jezuíno
- Department of Physiological Sciences, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Anna Rebeka Oliveira Ferreira
- Department of Cell Biology and Genetics, Center of Biological Sciences, State University of Maringa, Maringa, Brazil
| | - Maiara Vanusa Guedes Ribeiro
- Department of Cell Biology and Genetics, Center of Biological Sciences, State University of Maringa, Maringa, Brazil
| | - Camila Borecki Vidigal
- Department of Physiological Sciences, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Kawane Fabricio Moura
- Graduation Program of Physiological Sciences, Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
| | - Rafaela Pires Erthal
- Department of General Biology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | | | - Glaura Scantamburlo Alves Fernandes
- Graduation Program of Physiological Sciences, Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
- Department of General Biology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Kesia Palma-Rigo
- Department of Cell Biology and Genetics, Center of Biological Sciences, State University of Maringa, Maringa, Brazil
- Adventist College of Parana, Ivatuba, Brazil
| | - Graziela Scalianti Ceravolo
- Department of Physiological Sciences, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
- Graduation Program of Physiological Sciences, Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
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Lee GO, Caulfield LE, Paredes-Olortegui M, Penataro-Yori P, Salas MS, Kosek MN. Nutrient intakes from complementary foods are associated with cardiometabolic biomarkers among undernourished Peruvian children. J Nutr Sci 2023; 12:e80. [PMID: 37528831 PMCID: PMC10388437 DOI: 10.1017/jns.2023.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Relatively little is known about how the diet of chronically undernourished children may impact cardiometabolic biomarkers. The objective of this exploratory study was to characterise relationships between dietary patterns and the cardiometabolic profile of 153 3-5-year-old Peruvian children with a high prevalence of chronic undernutrition. We collected monthly dietary recalls from children when they were 9-24 months old. At 3-5 years, additional dietary recalls were collected, and blood pressure, height, weight, subscapular skinfolds and fasting plasma glucose, insulin and lipid profiles were assessed. Nutrient intakes were expressed as average density per 100 kcals (i) from 9 to 24 months and (ii) at follow-up. The treelet transform and sparse reduced rank regress'ion (RRR) were used to summarize nutrient intake data. Linear regression models were then used to compare these factors to cardiometabolic outcomes and anthropometry. Linear regression models adjusting for subscapular skinfold-for-age Z-scores (SSFZ) were then used to test whether observed relationships were mediated by body composition. 26 % of children were stunted at 3-5 years old. Both treelet transform and sparse RRR-derived child dietary factors are related to protein intake and associated with total cholesterol and SSFZ. Associations between dietary factors and insulin were attenuated after adjusting for SSFZ, suggesting that body composition mediated these relationships. Dietary factors in early childhood, influenced by protein intake, are associated with cholesterol profiles, fasting glucose and body fat in a chronically undernourished population.
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Key Words
- Cardiometabolic biomarkers
- Complementary foods
- HAZ, height-for-age Z-score, based on the WHO reference standard
- HDL-c, high-density lipoprotein cholesterol
- HDLZ, sd of mean HDL-c, based on the distribution of the sample
- HOMA-IR, homeostatic model assessment-insulin resistance
- INZ, sd of insulin, based on the distribution of the sample
- LDC-c, low-density lipoprotein cholesterol
- MAPZ, sd of mean arterial blood pressure, based on the distribution of the sample
- MFP, meat, fish or poultry
- Nutrient intake
- PCA, principal components analysis
- Peru
- RRR, reduced rank regression
- Stunting
- TC, total cholesterol
- TG, triglycerides
- TGZ, sd of triglycerides, based on the distribution of the sample
- WAZ, weight-for-age Z-score, based on the WHO reference standard
- WHZ, weight-for-height Z-score, based on the WHO reference standard
- vLDL-c, very low-density lipoprotein cholesterol
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Affiliation(s)
- Gwenyth O. Lee
- Rutgers Global Health Institute and Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Laura E. Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Pablo Penataro-Yori
- University of Virginia Division of Infectious Diseases and International Health, Charlottesville, VA, USA
| | | | - Margaret N. Kosek
- University of Virginia Division of Infectious Diseases and International Health, Charlottesville, VA, USA
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Littlejohn PT, Bar-Yoseph H, Edwards K, Li H, Ramirez-Contreras CY, Holani R, Metcalfe-Roach A, Fan YM, Yang TMS, Radisavljevic N, Hu X, Johnson JD, Finlay BB. Multiple micronutrient deficiencies alter energy metabolism in host and gut microbiome in an early-life murine model. Front Nutr 2023; 10:1151670. [PMID: 37497061 PMCID: PMC10365968 DOI: 10.3389/fnut.2023.1151670] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Micronutrients perform a wide range of physiological functions essential for growth and development. However, most people still need to meet the estimated average requirement worldwide. Globally, 2 billion people suffer from micronutrient deficiency, most of which are co-occurring deficiencies in children under age five. Despite decades of research, animal models studying multiple micronutrient deficiencies within the early-life period are lacking, which hinders our complete understanding of the long-term health implications and may contribute to the inefficacy of some nutritional interventions. Evidence supporting the Developmental Origins of Health and Disease (DOHaD) theory demonstrates that early-life nutritional deficiencies carry life-long consequences mediated through various mechanisms such as abnormal metabolic programming, stunting, altered body composition, and the gut microbiome. However, this is largely unexplored in the multiple micronutrient deficient host. Methods we developed a preclinical model to examine undernutrition's metabolic and functional impact on the host and gut microbiome early in life. Three-week-old weanling C57BL/6N male mice were fed a low-micronutrient diet deficient in zinc, folate, iron, vitamin A, and vitamin B12 or a control diet for 4-weeks. Results Our results showed that early-life multiple micronutrient deficiencies induced stunting, altered body composition, impaired glucose and insulin tolerance, and altered the levels of other micronutrients not depleted in the diet within the host. In addition, functional metagenomics profiling and a carbohydrate fermentation assay showed an increased microbial preference for simple sugars rather than complex ones, suggestive of a less developed microbiome in the low-micronutrient-fed mice. Moreover, we found that a zinc-only deficient diet was not sufficient to induce these phenotypes, further supporting the importance of studying co-occurring deficiencies. Discussion Together, these findings highlight a previously unappreciated role of early-life multiple micronutrient deficiencies in shaping the metabolic phenome of the host and gut microbiome through altered glucose energy metabolism, which may have implications for metabolic disease later in life in micronutrient-deficient survivors.
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Affiliation(s)
- Paula T. Littlejohn
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Haggai Bar-Yoseph
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - Karlie Edwards
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hong Li
- Life Sciences Institute and Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Ravi Holani
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - Avril Metcalfe-Roach
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Yiyun M. Fan
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Tom Min-Shih Yang
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Nina Radisavljevic
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - Xiaoke Hu
- Life Sciences Institute and Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - James D. Johnson
- Life Sciences Institute and Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - B. Brett Finlay
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
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31
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He X, Shi X, Pan D, Wang H, Zhang X, Pu L, Luo M, Li J. Secular trend of non-communicable chronic disease prevalence throughout the life span who endured Chinese Great Famine (1959-1961). BMC Public Health 2023; 23:1238. [PMID: 37365633 DOI: 10.1186/s12889-023-16142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Famine is a risk factor for non-communicable chronic diseases (NCDs), which account for over 80% of deaths in China. The effect of famine on the prevalence of NCDs in terms of various age groups, time periods and cohorts is currently poorly understood. OBJECTIVE This study aims to explore long-term trends in the impact of China's Great Famine (1959-1961) on NCDs in China. METHODS This study used data from the 2010-2020 China Family Panel Longitudinal Survey across 25 provinces in China. The subjects were aged 18-85 years, and the total number of subjects was 174,894. The prevalence of NCDs was derived from the China Family Panel Studies database (CFPS). An age-period-cohort (APC) model was used to estimate the age, period and cohort effects of NCDs in 2010-2020 and the effect of famine on the risk of NCDs in terms of cohort effects. RESULTS The prevalence of NCDs increased with age. Additionally, the prevalence did not clearly decrease over the survey period. Regarding the cohort effect, people born in the years adjacent to the famine period had a higher risk of NCDs; additionally, females, those born in rural areas, and those who lived in provinces with severe famine and post-famine had a higher likelihood of NCDs. CONCLUSIONS Experiencing famine at an early age or the experience of famine in a close relative's generation (births after the onset of famine) are associated with an increased risk of NCDs. Additionally, more severe famine is associated with a higher risk of NCDs.
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Affiliation(s)
- Xiaoxue He
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Xiaojuan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Degong Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Huihui Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Xue Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Lining Pu
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Mingxiu Luo
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, 75004, Ningxia, China.
| | - Jiangping Li
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China.
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, 750004, Ningxia, Hui Autonomous Region, China.
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32
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Bountogo M, Sié A, Zakane A, Compaoré G, Ouédraogo T, Brogdon J, Lebas E, Nyatigo F, Medvedev MM, Arnold BF, Lietman TM, Oldenburg CE. Infant mortality and growth failure after oral azithromycin among low birthweight and underweight neonates: A subgroup analysis of a randomized controlled trial. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001009. [PMID: 37186577 PMCID: PMC10184901 DOI: 10.1371/journal.pgph.0001009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Low birthweight (birthweight <2500 grams, g) and underweight (weight-for-age Z-score, WAZ, < -2) infants have higher risk of poor outcomes compared to their well-nourished peers. We evaluated the role of azithromycin for reducing mortality and improving growth outcomes in low birthweight and/or underweight infants. METHODS Infants aged 8-27 days of age weighing ≥2500 g at enrollment in Burkina Faso were randomized 1:1 to a single, oral dose of azithromycin (20 mg/kg) or matching placebo. We evaluated mortality and anthropometric outcomes in four subgroups: 1) both low birthweight and underweight at enrollment; 2) low birthweight-only; 3) underweight-only; 4) neither low birthweight nor underweight. FINDINGS Of 21,832 enrolled infants, 21,320 (98%) had birthweight measurements and included in this analysis. Of these, 747 (3%) were both low birthweight and underweight, 972 (5%) were low birthweight-only, 825 (4%) were underweight-only, and 18,776 (88%) were neither low birthweight nor underweight. Infants who were both low birthweight and underweight receiving azithromycin had lower odds of underweight at 6 months compared to placebo (OR 0.65, 95% CI 0.44 to 0.95), but the treatment group by subgroup interaction was not statistically significant (P = 0.06). We did not find evidence of a difference between groups for other outcomes in any subgroup. INTERPRETATION Azithromycin may have some growth-promoting benefits for the highest risk infants, but we were unable to demonstrate a difference in most outcomes in low birthweight and underweight infants. As a secondary analysis of a trial, this study was underpowered for rare outcomes such as mortality. TRIAL REGISTRATION ClinicalTrials.gov NCT03682653.
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Affiliation(s)
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | | | - Jessica Brogdon
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Fanice Nyatigo
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Melissa M. Medvedev
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Benjamin F. Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
| | - Thomas M. Lietman
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Catherine E. Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
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Yan W, Qin C, Tao L, Guo X, Liu Q, Du M, Zhu L, Chen Z, Liang W, Liu M, Liu J. Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study. BMJ 2023; 381:e073043. [PMID: 37164365 PMCID: PMC10170610 DOI: 10.1136/bmj-2022-073043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019. DESIGN Observational study. SETTING 172 countries and territories. DATA SOURCES Databases of the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data. MAIN OUTCOME MEASURES The main outcome was age standardized all cause mortality per 100 000 population in relation to HRH density per 10 000 population, and secondary outcome was age standardized cause specific mortality. The Lorenz curve and the concentration index (CCI) were used to assess trends and inequalities in HRH. RESULTS Globally, the total HRH density per 10 000 population increased, from 56.0 in 1990 to 142.5 in 2019, whereas age standardized all cause mortality per 100 000 population decreased, from 995.5 in 1990 to 743.8 in 2019. The Lorenz curve lay below the equality line and CCI was 0.43 (P<0.05), indicating that the health workforce was more concentrated among countries and territories ranked high on the human development index. The CCI for HRH was stable, at about 0.42-0.43 between 1990 and 2001 and continued to decline (narrowed inequality), from 0.43 in 2001 to 0.38 in 2019 (P<0.001). In the multivariable generalized estimating equation model, a negative association was found between total HRH level and all cause mortality, with the highest levels of HRH as reference (low: incidence risk ratio 1.15, 95% confidence interval 1.00 to 1.32; middle: 1.14, 1.01 to 1.29; high: 1.18, 1.08 to 1.28). A negative association between total HRH density and mortality rate was more pronounced for some types of cause specific mortality, including neglected tropical diseases and malaria, enteric infections, maternal and neonatal disorders, and diabetes and kidney diseases. The risk of death was more likely to be higher in people from countries and territories with a lower density of doctors, dentistry staff, pharmaceutical staff, aides and emergency medical workers, optometrists, psychologists, personal care workers, physiotherapists, and radiographers. CONCLUSIONS Inequalities in HRH have been decreasing over the past 30 years globally but persist. All cause mortality and most types of cause specific mortality were relatively higher in countries and territories with a limited health workforce, especially for several specific HRH types among priority diseases. The findings highlight the importance of strengthening political commitment to develop equity oriented health workforce policies, expanding health financing, and implementing targeted measures to reduce deaths related to inadequate HRH to achieve universal health coverage by 2030.
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Affiliation(s)
- Wenxin Yan
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Chenyuan Qin
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Haidian District, Beijing, China
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Xin Guo
- Department of Institutional Reform, National Health Commission of the People's Republic of China, Xicheng District, Beijing, China
| | - Qiao Liu
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Min Du
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Lin Zhu
- Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA
| | - Zhongdan Chen
- World Health Organization Representative Office for China, Chaoyang District, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, China
- Institute for Healthy China, Tsinghua University, Haidian District, Beijing, China
| | - Min Liu
- School of Public Health, Peking University, Haidian District, Beijing, China
| | - Jue Liu
- School of Public Health, Peking University, Haidian District, Beijing, China
- Institute for Global Health and Development, Peking University, Haidian District, Beijing, China
- Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health, Peking University, Haidian District, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Haidian District, Beijing, China
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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34
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Vitale M, Crossland S, Shinwell J, Stretesky PB, Defeyter MA, Brownlee IA. The Nutritional Quality of Food Provision at UK Government-Funded Holiday Clubs: A Cross-Sectional Analysis of Energy and Nutrient Content. Nutrients 2023; 15:1937. [PMID: 37111156 PMCID: PMC10144653 DOI: 10.3390/nu15081937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
A large proportion of children are at risk of food insecurity during school holidays in the UK. The government-funded Holiday Activities and Food (HAF) programme provides free holiday clubs offering at least one healthy meal/day to eligible children and adolescents. This study aims at evaluating the nutritional quality of food provision at HAF holiday clubs, particularly hot/cold and vegetarian/non-vegetarian meals. Menu variants (n = 2759) from 49 HAF holiday clubs were assessed for adherence to School Food Standards (SFS) and their notional compositional quality, which was scored utilising a novel nutrient-based meal quality index. The median adherence to SFS across all available menus was 70% (IQR 59-79%). Overall, hot variants scored statistically higher menu quality scores than cold variants for both 5-11y (92.3 (80.7-102.7) vs. 80.4 (69.3-90.6)) and 11-18y (73.5 (62.5-85.8) vs. 58.9 (50.0-70.7)) criteria. Cold and hot menu variants tended to score differentially for quality sub-components. These findings highlight areas for potential future improvement in HAF holiday club provision with a tendency for food provision to appear less ideal for attendees for those aged 11-18. Ensuring that children from low-income households have access to a healthy diet is crucial to reduce UK health inequalities.
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Affiliation(s)
- Martina Vitale
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.V.); (S.C.)
| | - Shannon Crossland
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.V.); (S.C.)
| | - Jackie Shinwell
- Healthy Living Lab, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (J.S.); (M.A.D.)
| | - Paul B. Stretesky
- Department of Social Sciences, Northumbria University, Newcastle upon Tyne NE7 7YT, UK;
| | - Margaret Anne Defeyter
- Healthy Living Lab, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (J.S.); (M.A.D.)
| | - Iain Andrew Brownlee
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (M.V.); (S.C.)
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Raza Z, Hussain SF, Foster VS, Wall J, Coffey PJ, Martin JF, Gomes RSM. Exposure to war and conflict: The individual and inherited epigenetic effects on health, with a focus on post-traumatic stress disorder. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1066158. [PMID: 38455905 PMCID: PMC10910933 DOI: 10.3389/fepid.2023.1066158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/03/2023] [Indexed: 03/09/2024]
Abstract
War and conflict are global phenomena, identified as stress-inducing triggers for epigenetic modifications. In this state-of-the-science narrative review based on systematic principles, we summarise existing data to explore the outcomes of these exposures especially in veterans and show that they may result in an increased likelihood of developing gastrointestinal, auditory, metabolic and circadian issues, as well as post-traumatic stress disorder (PTSD). We also note that, despite a potential "healthy soldier effect", both veterans and civilians with PTSD exhibit the altered DNA methylation status in hypothalamic-pituitary-adrenal (HPA) axis regulatory genes such as NR3C1. Genes associated with sleep (PAX8; LHX1) are seen to be differentially methylated in veterans. A limited number of studies also revealed hereditary effects of war exposure across groups: decreased cortisol levels and a heightened (sex-linked) mortality risk in offspring. Future large-scale studies further identifying the heritable risks of war, as well as any potential differences between military and civilian populations, would be valuable to inform future healthcare directives.
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Affiliation(s)
- Zara Raza
- Research & Innovation, Blind Veterans UK, London, United Kingdom
- BRAVO VICTOR, Research & Innovation, London, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | - Syeda F Hussain
- Research & Innovation, Blind Veterans UK, London, United Kingdom
- BRAVO VICTOR, Research & Innovation, London, United Kingdom
| | - Victoria S Foster
- Research & Innovation, Blind Veterans UK, London, United Kingdom
- BRAVO VICTOR, Research & Innovation, London, United Kingdom
- St George's Hospital Medical School, London, United Kingdom
| | - Joseph Wall
- Hull York Medical School, University of York, York, United Kingdom
- Haxby Group Hull, General Practice Surgery, Hull, United Kingdom
| | - Peter J Coffey
- Development, Ageing and Disease, UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - John F Martin
- Centre for Cardiovascular Biology and Medicine, University College London, London, United Kingdom
| | - Renata S M Gomes
- Research & Innovation, Blind Veterans UK, London, United Kingdom
- BRAVO VICTOR, Research & Innovation, London, United Kingdom
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Khara T, Myatt M, Sadler K, Bahwere P, Berkley JA, Black RE, Boyd E, Garenne M, Isanaka S, Lelijveld N, McDonald C, Mertens A, Mwangome M, O’Brien K, Stobaugh H, Taneja S, West KP, Briend A. Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts. Public Health Nutr 2023; 26:1-17. [PMID: 36734049 PMCID: PMC10131149 DOI: 10.1017/s136898002300023x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 11/18/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications. DESIGN A multiple cohort individual data meta-analysis of mortality risk (within 6 months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences were modelled. SETTING Community-based cohort studies in twelve low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread. PARTICIPANTS Children aged 6 to 59 months. RESULTS Of the twelve anthropometric case definitions examined, four (weight-for-age Z-score (WAZ) <-2), (mid-upper arm circumference (MUAC) <125 mm), (MUAC < 115 mm or WAZ < -3) and (WAZ < -3) had the highest informedness in predicting mortality. A combined case definition (MUAC < 115 mm or WAZ < -3) was better at predicting deaths associated with weight-for-height Z-score <-3 and concurrent wasting and stunting (WaSt) than the single WAZ < -3 case definition. After the assessment of all criteria, the combined case definition performed best. The simulated workload for programmes admitting based on MUAC < 115 mm or WAZ < -3, when adjusted with a proxy for required intensity and/or duration of treatment, was 1·87 times larger than programmes admitting on MUAC < 115 mm alone. CONCLUSIONS A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.
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Affiliation(s)
- Tanya Khara
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Mark Myatt
- Brixton Health, Llwyngwril, Gwynedd, Wales, UK
| | - Kate Sadler
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Paluku Bahwere
- Epidemiology, Biostatistics and Clinical Research Centre, School of Public Health, Université libre de Bruxelles
| | - James A Berkley
- Centre for Tropical Medicine & Global Health, University of Oxford, UK
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Erin Boyd
- USAID/Bureau of Humanitarian Assistance, USA
| | - Michel Garenne
- IRD, UMI Résiliences, Paris, France
- Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France
- FERDI, Université d’Auvergne, Clermont-Ferrand, France
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Epicentre, Paris, France
| | - Natasha Lelijveld
- Emergency Nutrition Network, ENN, 2nd Floor, Marlborough House, 69 High St, Kidlington, OX5 2DN, UK
| | - Christine McDonald
- Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, USA
- Department of Nutrition, University of California, Davis, USA
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, USA
| | | | - Kieran O’Brien
- The F.I. Proctor Foundation, University of San Francisco, San Francisco, USA
| | - Heather Stobaugh
- Action Against Hunger USA, New York, NY, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sunita Taneja
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - André Briend
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Medical Technology, Tampere University, Tampere, Finland
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Fredericksberg, Denmark
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Agostoni C, Baglioni M, La Vecchia A, Molari G, Berti C. Interlinkages between Climate Change and Food Systems: The Impact on Child Malnutrition-Narrative Review. Nutrients 2023; 15:416. [PMID: 36678287 PMCID: PMC9865989 DOI: 10.3390/nu15020416] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
The pandemics of obesity, undernutrition, and climate change represent severe threats to child health. They co-occur; interact with each other to produce sequelae at biological, psychological, or social levels; and share common underlying drivers. In this paper, we review the key issues concerning child diet and nutritional status, focusing on the interactions with climate and food systems. Inadequate infant and young child feeding practices, food insecurity, poverty, and limited access to health services are the leading causes of malnutrition across generations. Food system industrialization and globalization lead to a double burden of malnutrition, whereby undernutrition (i.e., stunting, wasting, and deficiencies in micronutrients) coexists with overweight and obesity, as well as to harmful effects on climate. Climate change and the COVID-19 pandemic are worsening child malnutrition, impacting the main underlying causes (i.e., household food security, dietary diversity, nutrient quality, and access to maternal and child health), as well as the social, economic, and political factors determining food security and nutrition (livelihoods, income, infrastructure resources, and political context). Existing interventions have the potential to be further scaled-up to concurrently address undernutrition, overnutrition, and climate change by cross-cutting education, agriculture, food systems, and social safety nets. Several stakeholders must work co-operatively to improve global sustainable nutrition.
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Affiliation(s)
- Carlo Agostoni
- Pediatric Area, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Mattia Baglioni
- Action Contre la Faim (ACF-France), CEDEX, 93558 Montreuil, France
| | - Adriano La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Giulia Molari
- Pediatric Area, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Cristiana Berti
- Pediatric Area, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Kamarudin MS, Shahril MR, Haron H, Kadar M, Safii NS, Hamzaid NH. Interventions for Picky Eaters among Typically Developed Children-A Scoping Review. Nutrients 2023; 15:nu15010242. [PMID: 36615899 PMCID: PMC9824123 DOI: 10.3390/nu15010242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023] Open
Abstract
Picky eating in children is often a major source of concern for many parents and caregivers. Picky eaters (PEs) consume limited foods, demonstrate food aversion, and have a limited food repertoire, which hinders their growth and health. These behaviours are common in children with special health care needs despite the rise in typically developing children. This leads to less attention being given to intervention programmes for typically developing children. Therefore, this scoping review aims to investigate the key concept of an existing intervention programme for PE among typically developing children, primarily on the types and approaches selected. A thorough literature search was conducted on three primary databases (PubMed, Emerald In-sight, and Web of Science) using predefined keywords. The literature was then appraised using the Joanna Briggs Institute's guidelines and protocols, and the PRISMScR checklist. Inclusion and exclusion criteria were also specified in the screening procedure. Results showed that the majority of the interventions in these studies were single-component interventions, with the sensory approach being the type that was most frequently utilised, followed by the nutrition approach and parenting approach. Single and multiple intervention components improved the assessed outcome, with a note that other components may or may not show a similar outcome, as they were not assessed in the single-component intervention. Given the evidence that picky eating is influenced by various factors, a multi-component intervention can provide a substantial impact on future programmes. In addition, defining picky eaters using standardised tools is also essential for a more inclusive subject selection.
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Affiliation(s)
- Mohd Shah Kamarudin
- Center for Rehabilitation & Special Needs Studies (iCaRehab), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Razif Shahril
- Center for Healthy Ageing & Wellness (H-CARE), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hasnah Haron
- Center for Healthy Ageing & Wellness (H-CARE), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Masne Kadar
- Center for Rehabilitation & Special Needs Studies (iCaRehab), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nik Shanita Safii
- Center for Community Health Studies (ReaCH), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nur Hana Hamzaid
- Center for Rehabilitation & Special Needs Studies (iCaRehab), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
- Correspondence:
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Woeltje MM, Evanoff AB, Helmink BA, Culbertson DL, Maleta KM, Manary MJ, Trehan I. Community-based management of acute malnutrition for infants under 6 months of age is safe and effective: analysis of operational data. Public Health Nutr 2023; 26:246-255. [PMID: 34915944 PMCID: PMC11077441 DOI: 10.1017/s1368980021004894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. DESIGN Review of operational acute malnutrition treatment records. SETTING Twenty-one outpatient therapeutic feeding clinics in rural Malawi. PARTICIPANTS Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomised clinical trials. RESULTS A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (seventy-four severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75·4 %) achieved nutritional recovery; in comparison, 56 (75·7 %) of those with severe acute malnutrition 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81·3 %) recovered; in comparison, 241 (85·2 %) of those aged 6-9 months recovered. CONCLUSIONS In a rural Malawian population of infants u6m who had generally already stopped exclusive breast-feeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.
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Affiliation(s)
- Maeve M Woeltje
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, M/S MB.7.520, Seattle, WA98105, USA
- Seattle Children’s Hospital, Seattle, USA
| | | | - Beth A Helmink
- Department of Surgery, Washington University in St. Louis, St Louis, USA
| | | | - Kenneth M Maleta
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mark J Manary
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Pediatrics, Washington University in St. Louis, St Louis, USA
| | - Indi Trehan
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, M/S MB.7.520, Seattle, WA98105, USA
- Seattle Children’s Hospital, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
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40
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van Immerzeel TD, Diagne M, Deme/Ly I, Murungi AE, Diouf S, Kerac M, Grijalva‐Eternod CS, Day LT. Implementing a Care Pathway for small and nutritionally at-risk infants under six months of age: A multi-country stakeholder consultation. MATERNAL & CHILD NUTRITION 2023; 19:e13455. [PMID: 36373777 PMCID: PMC9749585 DOI: 10.1111/mcn.13455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/07/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022]
Abstract
Nutritional vulnerability under the age of 6 months is prevalent in low- and middle-income countries with 20.1% infants underweight, 21.3% wasted and 17.6% stunted in a recent review. A novel Care Pathway for improved management of small and nutritionally at-risk infants under 6 months and their mothers (MAMI) has recently been developed to provide outpatient care at large coverage. We aimed to investigate stakeholders' views on the feasibility of its implementation and to identify barriers and enablers. This was an early stage formative mixed-methods study: an online survey plus in-depth interviews with country-level stakeholders in nutrition and child health from different geographical regions and stakeholder groups. 189 stakeholders from 42 countries responded to the online survey and 14 remote interviews were conducted. Participants expressed an urgent need for improved detection and care for small and nutritionally at-risk infants under 6 months. Whilst they considered the MAMI Care Pathway feasible and relevant, they noted it was largely unknown in their country. The most mentioned implementation barriers were: community-specific needs and health care seeking barriers, health workers' lack of competence in breastfeeding counselling and the absence of a validated anthropometric screening method. Possible enablers for its implementation were: patients' preference for outpatient care, integrating the MAMI care pathway into existing maternal and child health programmes and the possibility of a local pilot project. Adaptation to the local context was considered crucial in further scale-up.
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Affiliation(s)
- Tabitha D. van Immerzeel
- Department for Population Health, Faculty of Epidemiology & Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | | | - Indou Deme/Ly
- University Cheick Anta DiopDakarSenegal
- Centre Hospitalier National D'Enfants Albert RoyerDakarSenegal
| | | | | | - Marko Kerac
- Department for Population Health, Faculty of Epidemiology & Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH)London School of Hygiene & Tropical MedicineLondonUK
| | - Carlos S. Grijalva‐Eternod
- Department for Population Health, Faculty of Epidemiology & Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | - Louise T. Day
- Department for Population Health, Faculty of Epidemiology & Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH)London School of Hygiene & Tropical MedicineLondonUK
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Food abundance in men before puberty predicts a range of cancers in grandsons. Nat Commun 2022; 13:7507. [PMID: 36473854 PMCID: PMC9726939 DOI: 10.1038/s41467-022-35217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Nutritional conditions early in human life may influence phenotypic characteristics in later generations. A male-line transgenerational pathway, triggered by the early environment, has been postulated with support from animal and a small number of human studies. Here we analyse individuals born in Uppsala Sweden 1915-29 with linked data from their children and parents, which enables us to explore the hypothesis that pre-pubertal food abundance may trigger a transgenerational effect on cancer events. We used cancer registry and cause-of-death data to analyse 3422 cancer events in grandchildren (G2) by grandparental (G0) food access. We show that variation in harvests and food access in G0 predicts cancer occurrence in G2 in a specific way: abundance among paternal grandfathers, but not any other grandparent, predicts cancer occurrence in grandsons but not in granddaughters. This male-line response is observed for several groups of cancers, suggesting a general susceptibility, possibly acquired in early embryonic development. We observed no transgenerational influence in the middle generation.
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Trends and patterns of North Korea’s disease burden from 1990 to 2019: Results from Global Burden of Disease study 2019. PLoS One 2022; 17:e0277335. [PMID: 36374924 PMCID: PMC9662722 DOI: 10.1371/journal.pone.0277335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background
Evidence for the trends and patterns of disease burden in North Korea is limited, and in-depth analysis based on several health outcomes for a better understanding remains challenging. Therefore, we aimed to investigate the trends and patterns of disease burden in North Korea between 1990 and 2019.
Methods
We used data from the Global Burden of Diseases (GBD) 2019 study to analyze the North Korean disease burden in comparison with four groups: global, South Korea, low-sociodemographic index (SDI) countries, Central and Eastern Europe, and Central Asia (former socialist countries). We also examined changes in the disease burden between 1990 and 2019 by disease category and age group.
Findings
In 2019, in North Korea, death rates and disability-adjusted life years (DALYs) rates were reduced by 22.2% and 30.7%, respectively, compared to 1990. The rates showed similar trends and patterns to that in former socialist countries. However, these reductions were lower than those of the global rates and rates in low-SDI countries and South Korea. Death rates and DALY rates for under five years dramatically decreased by more than 78%, similar to the trend in South Korea. In contrast, the decline in the death rates and DALY rates of adults was less than those worldwide and in low-SDI countries and South Korea. The burden of diseases among those aged ≥30 years increased largely due to the persistently high burden of non-communicable diseases (NCDs). Cardiovascular diseases, neoplasms, and chronic respiratory diseases were the leading causes of the disease burden in both 1990 and 2019.
Interpretation
North Korea’s disease burden patterns and trends show clear improvements over the past 30 years but suggest that the current challenges of NCDs in the country are very serious. NCDs should be no longer neglected and should be prioritized in public health agendas in North Korea.
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Bernabé-Ortiz A, Quinteros-Reyes C, Carrillo-Larco RM. Double burden of malnutrition as a risk factor for overweight and obesity. Rev Saude Publica 2022; 56:93. [PMID: 36383806 PMCID: PMC9635849 DOI: 10.11606/s1518-8787.2022056004205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/28/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To assess the longitudinal effect of double burden of malnutrition (DBM) on the risk of developing child and adolescent overweight or obesity. METHODS Analysis of the Peruvian Young Lives Study, younger cohort: baseline (2002) and 4 follow-ups (2006-2007, 2009-2010, 2013-2014, and 2016-2017). Outcomes were the incidence of overweight and obesity as defined by the World Health Organization standards. The exposure comprised a variable with 4 categories: non-stunted child with a non-overweight mother (reference group), non-stunted child with an overweight mother, stunted child with a non-overweight mother, and stunted child with an overweight mother (i.e., DBM). Poisson regression models were built to assess the association of interest, and relative risks (RR) and 95%CI were reported. RESULTS Data from 2,034 children; 50.0% were girls and the mean age was 12.0 (3.6) months at baseline. Non-stunted children with an overweight mother had greater risk (RR = 1.64; 95%CI: 1.35-1.99) of developing overweight, compared with the risk for stunted children with a non-overweight mother (RR = 1.38; 95%CI: 1.10-1.72), and for those with DBM (RR = 1.28; 95%CI: 1.02-1.61). When compared with the reference group, obesity risk was greater among non-stunted children with an overweight mother (RR = 2.33; 95%CI: 1.68-3.22), greater among stunted children with a non-overweight mother (RR = 2.59; 95%CI: 1.75-3.84), and greater among those with DBM (RR = 2.14; 95%CI: 1.39-3.28). CONCLUSIONS DBM is a risk factor for childhood overweight and obesity in Peru. Dual-duty policies tackling both undernutrition in children and overweight in mothers are needed to reduce DBM and its future effects in Peru.
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Affiliation(s)
- Antonio Bernabé-Ortiz
- Universidad Peruana Cayetano HerediaCenter of Excellence in Chronic DiseasesLimaPeru Universidad Peruana Cayetano Heredia. Center of Excellence in Chronic Diseases. Lima, Peru,Universidad Científica del SurLimaPeru Universidad Científica del Sur. Lima, Peru
| | - Carmen Quinteros-Reyes
- Universidad Peruana Cayetano HerediaCenter of Excellence in Chronic DiseasesLimaPeru Universidad Peruana Cayetano Heredia. Center of Excellence in Chronic Diseases. Lima, Peru
| | - Rodrigo M. Carrillo-Larco
- Universidad Peruana Cayetano HerediaCenter of Excellence in Chronic DiseasesLimaPeru Universidad Peruana Cayetano Heredia. Center of Excellence in Chronic Diseases. Lima, Peru,Imperial College LondonSchool of Public HealthDepartment of Epidemiology and BiostatisticsLondonUK Imperial College London. School of Public Health. Department of Epidemiology and Biostatistics. London, UK
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Bander A, Murphy-Alford AJ, Owino VO, Loechl CU, Wells JC, Gluning I, Kerac M. Childhood BMI and other measures of body composition as a predictor of cardiometabolic non-communicable diseases in adulthood: a systematic review. Public Health Nutr 2022; 26:1-28. [PMID: 36274635 DOI: 10.1017/s136898002200235x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE There is growing evidence that childhood malnutrition is associated with non-communicable diseases (NCD) in adulthood and that body composition mediates some of this association. This review aims to determine if childhood body composition can be used to predict later-life cardiometabolic NCD and which measures of body composition predicts future NCD. DESIGN Electronic databases were searched for articles where: children aged under 5 years had body composition measured; cardiometabolic health outcomes were measured a minimum of 10 years later. SETTING The databases Embase, Medline and Global Health were searched through July 2020. PARTICIPANTS Children aged under 5 years with a follow-up of minimum 10 years. RESULTS Twenty-nine studies met the inclusion criteria. Though a poor proxy measure of body composition, body mass index (BMI) was commonly reported (n 28, 97 %). 25 % of these studies included an additional measure (ponderal index or skinfold thickness). Few studies adjusted for current body size (n 11, 39 %). CONCLUSIONS Many studies reported that low infant BMI and high childhood BMI were associated with an increased risk of NCD-related outcomes in later life but no conclusions can be made about the exact timing of child malnutrition and consequent impact on NCD. Because studies focussed on BMI rather than direct measures of body composition, nothing can be said about which measures of body composition in childhood are most useful. Future research on child nutrition and long-term outcomes is urgently needed and should include validated body composition assessments as well as standard anthropometric and BMI measurements.
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Affiliation(s)
- Amela Bander
- Department of Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
| | - Alexia J Murphy-Alford
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Victor O Owino
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Cornelia U Loechl
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jonathan Ck Wells
- Population, Policy and Practice Research Teaching Department, University College London, London, UK
| | - Imara Gluning
- Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, LondonWC1E 7HT, UK
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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45
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Dewey KG, Arnold CD, Wessells KR, Prado EL, Abbeddou S, Adu-Afarwuah S, Ali H, Arnold BF, Ashorn P, Ashorn U, Ashraf S, Becquey E, Brown KH, Christian P, Colford JM, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Humphrey JH, Huybregts L, Iannottie LL, Jannat K, Lartey A, Port AL, Leroy JL, Luby SP, Maleta K, Matias SL, Mbuya MNN, Mridha MK, Nkhoma M, Null C, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Prendergast AJ, Ruel M, Shaikh S, Weber AM, Wolff P, Zongrone A, Stewart CP. Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2022; 116:1314-1333. [PMID: 36045000 DOI: 10.1093/ajcn/nqac232] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. OBJECTIVE We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3). METHODS We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models. We used random effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. RESULTS SQ-LNS provision led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation. CONCLUSIONS Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. Registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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Affiliation(s)
- Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, 9000Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Gaibandha-5700, Bangladesh
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sania Ashraf
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.,Helen Keller International, New York, NY, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jean H Humphrey
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | | | - Kaniz Jannat
- School of Health Sciences, Western Sydney University, NSW, Australia
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Agnes Le Port
- Montpellier Interdisciplinary center on Sustainable Agri-food systems (MoISA), French National Research Institute for Sustainable Development (IRD), Montpellier, France
| | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Kenneth Maleta
- Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh.,Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh
| | - Minyanga Nkhoma
- Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh
| | - Harriet Okronipa
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Jean-Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, CA, USA
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Gaibandha-5700, Bangladesh
| | - Ann M Weber
- School of Public Health, Division of Epidemiology, University of Nevada, Reno, USA
| | | | | | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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Anthropometry, body composition and chronic disease risk factors among Zambian school-aged children who experienced severe malnutrition in early childhood. Br J Nutr 2022; 128:453-460. [PMID: 34486967 PMCID: PMC9340851 DOI: 10.1017/s0007114521003457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is limited information as to whether people who experience severe acute malnutrition (SAM) as young children are at increased risk of overweight, high body fat and associated chronic diseases in later life. We followed up, when aged 7-12 years, 100 Zambian children who were hospitalised for SAM before age 2 years and eighty-five neighbourhood controls who had never experienced SAM. We conducted detailed anthropometry, body composition assessment by bioelectrical impedance and deuterium dilution (D2O) and measured blood lipids, Hb and HbA1c. Groups were compared by linear regression following multiple imputation for missing variables. Children with prior SAM were slightly smaller than controls, but differences, controlling for age, sex, socio-economic status and HIV exposure or infection, were significant only for hip circumference, suprailiac skinfold and fat-free mass index by D2O. Blood lipids and HbA1c did not differ between groups, but Hb was lower by 7·8 (95 % CI 0·8, 14·7) g/l and systolic blood pressure was 3·4 (95 % CI 0·4, 6·4) mmHg higher among the prior SAM group. Both anaemia and high HbA1c were common among both groups, indicating a population at risk for the double burden of over- and undernutrition and associated infectious and chronic diseases. The prior SAM children may have been at slightly greater risk than the controls; this was of little clinical significance at this young age, but the children should be followed when older and chronic diseases manifest.
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47
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Kerac M. Diet and development beyond 1000 days: ensuring children thrive as well as survive. Arch Dis Child 2022; 107:701-702. [PMID: 35346921 DOI: 10.1136/archdischild-2022-323780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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48
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Keyata EO, Daselegn A, Oljira A. Dietary diversity and associated factors among preschool children in selected kindergarten school of Horo Guduru Wollega Zone, Oromia Region, Ethiopia. BMC Nutr 2022; 8:71. [PMID: 35906680 PMCID: PMC9335992 DOI: 10.1186/s40795-022-00569-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preschool children are the most vulnerable group because of their high nutritional needs for growth and development. The study assessed dietary diversity scores and associated factors among preschool children in selected kindergarten schools of Horo Guduru Wollega Zone, Western Ethiopia. METHODS The institutional-based cross-sectional study design was conducted on a total 440 of preschool children. A semi-structured questionnaire was used to collect information on the dietary diversity score of preschool children using a 24 h dietary recall method. Binary logistic regression was used to identify variables associated with dietary diversity scores of preschool children. RESULTS The result showed that the majority (87.3%) of preschool children in the selected kindergarten school practiced a low dietary diversity score (less than four food groups). The result obtained from multivariate logistic regression analysis indicated that the age of preschool children [AOR 9.58(2.26-40.60)], sex of child [AOR 3.21(1.71-5.99)], and work of mother [AOR 7.49(2.33-24.07)] were significantly (p < 0.05 associated) with dietary diversity of children. CONCLUSIONS The findings indicated that many preschool children in the study area did not get a minimum dietary diversity score. Therefore, health extension workers must organize community-based behavior change nutritional education for mothers or caregivers to create awareness of preschool child dietary diversity practices.
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Affiliation(s)
- Ebisa Olika Keyata
- Department of Food Science and Nutrition, Faculty of Agriculture, Wollega University, P.O. Box 38, Shambu, Ethiopia.
| | - Abebe Daselegn
- Department of Chemical Engineering, Faculty of Technology, Wollega University, Shambu, Ethiopia
| | - Alemayehu Oljira
- Department of Agricultural Economics, Jimma University College of Agriculture and Veterinary Medicine, P.O. Box: 307, Jimma, Ethiopia
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49
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Gomez-Verjan JC, Esparza-Aguilar M, Martin-Martin V, Salazar-Perez C, Cadena-Trejo C, Gutierrez-Robledo LM, Arroyo P. DNA methylation profile of a rural cohort exposed to early-adversity and malnutrition: An exploratory analysis. Exp Gerontol 2022; 167:111899. [PMID: 35907475 DOI: 10.1016/j.exger.2022.111899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/08/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
Abstract
Barker's hypothesis affirms that undernourishment in early-life induces metabolic reprogramming that compromises organism functions later in life, leading to age-related diseases. We are exposed to environmental and social conditions that impact our life trajectories, leading to ageing phenotypes as we grow. Epigenetic mechanisms constitute the link between both external stimuli and genetic programming. Studies have focused on describing the effect of early adverse events such as trauma, famines, or childhood labor on epigenetic markers in adulthood and the elderly. However, we lack information on epigenetic programming in individuals born in rural communities from underdeveloped countries, exposed to negative influences during fetal and postnatal development, particularly chronic malnutrition. Hence, in this exploratory analysis, we characterize the epigenome of individuals and some parents from Tlaltizapan (a rural community in Mexico originally studied almost 50 years ago) and collect anthropometric data on growth and development, as well on the living conditions of the families. Our results help build a biological hypothesis indicating that most of the epigenetic age measures of the subjects are significantly different among them. Interestingly, the most affected methylated regions correspond to pathways involved in neuronal system development, reproductive behaviour, learning and memory regulation.
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Affiliation(s)
- J C Gomez-Verjan
- Direccion de Investigación, Instituto Nacional de Geriatría, INGER, Mexico City, Mexico.
| | | | | | | | - C Cadena-Trejo
- Direccion de Investigación, Instituto Nacional de Geriatría, INGER, Mexico City, Mexico
| | | | - P Arroyo
- Direccion de Investigación, Instituto Nacional de Geriatría, INGER, Mexico City, Mexico
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50
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Jibat N, Rana R, Negesse A, Abera M, Abdissa A, Girma T, Haile A, Barthorp H, McGrath M, Grijalva-Eternod CS, Kerac M, Berhane M. Carers’ and health workers’ perspectives on malnutrition in infants aged under six months in rural Ethiopia: A qualitative study. PLoS One 2022; 17:e0271733. [PMID: 35862411 PMCID: PMC9302717 DOI: 10.1371/journal.pone.0271733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
Supporting small and nutritionally at-risk (potentially malnourished) infants under six months is a global health priority, albeit with a weak evidence-base. To inform policy and research in this area, we aimed to assess the perceptions and understanding of infant malnutrition and its management among carers, communities, and healthcare workers in rural Ethiopia.
Methods
We conducted in-depth and key-informant interviews, from May-August 2020 in Jimma Zone and Deder District, Ethiopia. We used purposive sampling to recruit the participants. Interviews were transcribed into Amharic or Afaan Oromo and then translated into English. Atlas ti-7 was used to support data analysis. Findings were narrated based on the different themes arising from the interviews.
Results
Carers/community members and healthcare workers reported on five different themes: 1) Perceptions about health and well-being: an ‘ideal infant’ slept well, fed well, was active and looked ‘fat’; 2)Perceptions of feeding: overall knowledge of key recommendations like exclusive breastfeeding was good but practices were suboptimal, notably a cultural practice to give water to young infants; 3)Awareness about malnutrition: a key limitation was knowledge of exactly how to identify small and nutritionally at-risk infants; 4) Reasons for malnutrition: levels of understanding varied and included feeding problems and caregiver’s work pressures resulting in the premature introduction of complementary feeds; 5) Perceptions about identification & treatment: carers prefer treatment close to home but were concerned about the quality of community-based services.
Conclusion
To succeed, research projects that investigate programes that manage small and nutritionally at-risk infants under six months should understand and be responsive to the culture and context in which they operate. They should build on community strengths and tackle misunderstandings and barriers. Interventions beyond just focusing on knowledge and attitude of the carers and health workers are necessary to tackle the challenges around infants under 6 months of age at risk of malnutrition. Moreover, stakeholders beyond the health sector should also be involved in order to support the infants under 6 months and their mothers as some of the key reasons behind the at-risk infants are just beyond the capacity of the health sector or health system. Our list of themes could be used to inform infant nutrition work not just in Ethiopia but also in many others.
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Affiliation(s)
- Nega Jibat
- Department of Sociology, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Ritu Rana
- GOAL Global, Dublin, Ireland
- Indian Institute of Public Health, Gandhinagar, India
| | - Ayenew Negesse
- Department of Human Nutrition, Debre Markos University, Debre Markos, Ethiopia
| | - Mubarek Abera
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Department of Laboratory and Microbiology, Jimma University, Jimma, Ethiopia
- Armaeur Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
- Harvard Chan School of Public Health, Addis Ababa, Ethiopia
| | | | | | | | - Carlos S. Grijalva-Eternod
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UCL Institute for Global Health, London, United Kingdom
| | - Marko Kerac
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melkamu Berhane
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
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