Malnutrition and catch-up growth during childhood and puberty

Combining conventional and smartphone technologies to evaluate the psychomotor status in chronic malnutrition: A cross-sectional pilot study in sub-Saharan Africa

Malnutrition remains a pressing health concern in developing nations, contributing to growth delay (stunting) and psychomotor impairments among the youth. Tanzania has the highest prevalence of stunting, yet the psychomotor status of its population has not been previously studied. To address this gap, we gathered anthropometric, nutritional, and psychomotor data from 211 children with the aim of assessing the reliability of digital tools as indicators of psychomotor performance in relation to the nutritional status. Collected anthropometric measures included middle-upper arm circumference (MUAC), triceps skinfold thickness (TST), and handgrip strength, while psychomotor variables were assessed using digital finger tapping test (DFTT), eye-tracking test (ETT), and nine-hole peg test (9HPT). Statistical analysis revealed significant associations between age and both MUAC and handgrip strength (R = 0.5, p < 0.001). Moreover, DFTT and 9HPT demonstrated a correlation with each other (p = 0.026) and with MUAC, handgrip strength, and age (p < 0.001). Notably, lower stature was independently linked to slower horizontal eye movements (p < 0.001). Findings underscores the crucial link between nutrition and psychomotor skills in Tanzanian children. Digital tests like DFTT, ETT, and the 9HPT show promise for assessing psychomotor performance. Addressing malnutrition requires comprehensive interventions. Future research should explore long-term effects of interventions in resource-limited settings.

Nutrition status and morbidity of Ethiopian children after recovery from severe acute malnutrition: Prospective matched cohort study

After recovery, children with severe acute malnutrition (SAM) remain vulnerable to sub-optimal growth and malnutrition relapse. Although there is an increased interest in understanding these problems, data are scarce, and contextual factors can cause variability. We prospectively followed a cohort of Ethiopian children (215 post-SAM cases and 215 non-wasted controls), monthly for one year. The post-SAM cases were: age 6–59 months at admission into the community management of acute malnutrition (CMAM) program and being successfully discharged from CMAM (MUAC>11.0cm, weight gain of 20%, absence of oedema and clinically stable for two consecutive weeks). The controls were apparently healthy children from same village who had no history of an episode of AM and were matched 1:1 to a post-SAM child by age and sex. The primary outcomes were: cumulative incidence of acute malnutrition; growth trajectory; cumulative incidence of reported common morbidities, and cumulative proportion and incidence of deaths. The burden of common morbidities was higher among post-SAM than controls; post-SAM children had more frequent illness episodes (Incidence Rate Ratio of any illness 1.39, 95% CI: 1.14, 1.71; p<0.001). The prevalence of SAM was consistently higher among post-SAM cases than the control group, having a 14 times higher risk of developing SAM (Incidence Rate Ratio: 14.1; 95% CI: 3.5, 122.5; p<0.001). The divergence in weight and growth trajectory remained the same during the study period. Our results advocate for the design of post-discharge interventions that aim to prevent the reoccurrence of acute malnutrition, reduce morbidity and promote catch-up growth. Research is needed to define the appropriate package of post-discharge interventions.

Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis

Oral nutritional supplements (ONS) are used to promote catch-up growth in children with undernutrition. We conducted a systematic review and meta-analysis to summarize the evidence of ONS intervention effects on growth for 9-month- to 12-year-old children who were undernourished or at nutritional risk. Eleven randomized controlled trials met the inclusion criteria; trials compared changes in anthropometric measures in children using ONS or ONS + DC (dietary counselling) to measures for those following usual diet or placebo or DC alone. The RCTs included 2287 children without chronic diseases (mean age 5.87 years [SD, 1.35]; 56% boys). At follow-up time points up to 6 months, results showed that children in the ONS intervention group had greater gains in weight (0.423 kg, [95% confidence interval 0.234, 0.613], p < 0.001) and height (0.417 cm [0.059, 0.776], p = 0.022) versus control; greater gains in weight (0.089 kg [0.049, 0.130], p < 0.001) were evident as early as 7–10 days. Longitudinal analyses with repeated measures at 30, 60, and 90 days showed greater gains in weight parameters from 30 days onwards (p < 0.001), a trend towards greater height gains at 90 days (p = 0.056), and significantly greater gains in height-for-age percentiles and Z-scores at 30 and 90 days, respectively (p < 0.05). Similar results were found in subgroup analyses of studies comparing ONS + DC to DC alone. For children with undernutrition, particularly those who were mildly and moderately undernourished, usage of ONS in a nutritional intervention resulted in significantly better growth outcomes when compared to control treatments (usual diet, placebo or DC alone).

The exacerbated prevalence of acute malnutrition and growth retardation in Roma children living in camps

Background

Child malnutrition is still a concern in marginalized groups of populations, such as immigrants living in very low socio-economic conditions. Roma children are within the most hard-to-reach populations, susceptible to undernutrition and growth retardation. In the city of Rome (Italy), the Hospital “Bambino Gesù”, in collaboration with the Catholic Association Community of Saint’Egidio, is dedicating free services for the health and nutritional needs of vulnerable people.

Methods

A retrospective analysis was conducted on immigrant children visited at different ages (0–11 years old). Records including nutritional and growth assessment were collected from 2016 up to May 2020. Malnutrition was classified following the WHO 2006 standards. Data for Roma children living in extra-urban camps and non-Roma immigrant children living in urban areas were analyzed, odds ratios and univariate binary regressions were performed to investigate the risk of malnutrition within the two groups.

Results

A sample of 414 children (57% under-five; 51.9% Roma), was included in the database. In the under-five children, underweight accounted for 7.6%, stunting for 11.7%, and wasting for 2.9%. The first year of life was the most crucial for nutritional status. Compared to the counterpart, Roma children accounted for nearly the total rate of malnutrition (wasting 4.8% vs. 1%; stunting 21.4% vs. 2%; underweight 14.2% vs. 1%). Univariate logistic regression confirmed under-five Roma children being at the highest risk of stunting at 12 months (OR: 16.1; CI 2–132; p = 0.01).

When considering the 176 school-aged children, undernutrition affected most Roma children (13% vs 1.9%), followed by stunting (5.8% vs 0.9%). Univariate logistic regression confirmed that Roma school-aged children were more likely to be underweight (OR: 7.8; CI 1.6–37.6; p = 0.01).

Conclusions

Malnutrition in immigrant children is still of high concern in Italy. Its prevalence in Roma children living in extra-urban camps exceeds that of immigrant children living in urban areas and the rates of underweight, stunting and wasting of Roma children living in the Balkans. This exacerbating condition highlights the need of better assisting this fragile population that is at most risk of poverty, food insecurity and social exclusion in Italy, particularly during this pandemic crisis.

Predicting women's height from their socioeconomic status: A machine learning approach

The social determinants of health literature routinely deploy socio-economic status (SES) as a key factor in accounting for women's height-an established indicator of human welfare at the population level-using traditional regression. However, this literature lacks a systematic identification of the predictive power of SES as well as the possible non-linear relationships between the measures of SES (education, occupation, and material wealth) in predicting variation in women's height. This study aims to evaluate this predictive power. We used the Demographic and Health Surveys (DHS) from 66 low- and middle-income countries (women = 1,273,644), sampled between 1994 and 2016. The analysis consisted of training seven machine-learning algorithms of different function classes and assessing their predictive power out-of-sample, vis-à-vis OLS regression. In an OLS framework, SES accounts for 0.7%, R², of the total variance in women's height (from σ_OLSFix² = 31.82 to σ_OLSSES² = 31.57), adjusting for country, community, and sampling year fixed effects. The country-specific variances range from as low as 25.10 units in Egypt to as high as 74.46 units in Sao Tome and Principe. With the same set of SES measures, the best performing learner, a Bayesian neural net, produces a predictive variance of σ_BnnSES² = 31.52. This is a negligible improvement in variance explained by 0.3% (σ_BnnSES²-σ_OLSSES²). Given our selection of algorithms, our findings indicate no relevant non-linear relationships between SES and women's height, and also the predictive limits of SES. We recommend that scholars report both the average effect of SES on health outcomes as well as its contribution to the variance explained. This will improve our understanding of how key social and economic factors affect health, deepening our understanding of the social determinants of health.

Assessing Nutritional Risk Among Infants and Toddlers in Primary Care Practice

Traditionally, nutritional risk has been defined by growth failure, with clinical intervention indicated when a child falls below the third to fifth percentile on growth charts. Although the velocity of linear growth and weight gain during the first years are unparalleled at any other time of life, this period is also unique for other reasons. Nutrition not only supports increased bone length, muscle mass, and tissue growth, but also continued development of several highly metabolic organs such as the gastrointestinal tract, the immune system, the cardiorespiratory system, the kidneys, and the central nervous system. Just as growth depends on consistent nutrients, so too does organ development, especially the brain. The undernourished child may exhibit compromised optimal development and future cognitive performance, irrespective of weight status. It is often challenging in early childhood to ensure that a child is receiving high-quality nutrition. Primary care clinicians are positioned to identify the child with potential nutritional risk and design an appropriate intervention that promotes optimal development. [Pediatr Ann. 2018;47(11):e465-e469.].

Maternal protein malnutrition: effects on prostate development and adult disease

Well-controlled intrauterine development is an essential condition for many aspects of normal adult physiology and health. This process is disrupted by poor maternal nutrition status during pregnancy. Indeed, physiological adaptations occur in the fetus to ensure nutrient supply to the most vital organs at the expense of the others, leading to irreversible consequences in tissue formation and differentiation. Evidence indicates that maternal undernutrition in early life promotes changes in key hormones, such as glucocorticoids, growth hormones, insulin-like growth factors, estrogens and androgens, during fetal development. These alterations can directly or indirectly affect hormone release, hormone receptor expression/distribution, cellular function or tissue organization, and impair tissue growth, differentiation and maturation to exert profound long-term effects on the offspring. Within the male reproductive system, maternal protein malnutrition alters development, structure, and function of the gonads, testes and prostate gland. Consequently, these changes impair the reproductive capacity of the male offspring. Further, permanent alterations in the prostate gland occur at the molecular and cellular level and thereby affect the onset of late life diseases such as prostatitis, hyperplasia and even prostate cancer. This review assembles current thoughts on the concepts and mechanisms behind the developmental origins of health and disease as they relate to protein malnutrition, and highlights the effects of maternal protein malnutrition on rat prostate development and homeostasis. Such insights on developmental trajectories of adult-onset prostate disease may help provide a foundation for future studies in this field.

Adult height, nutrition, and population health

In this review, the potential causes and consequences of adult height, a measure of cumulative net nutrition, in modern populations are summarized. The mechanisms linking adult height and health are examined, with a focus on the role of potential confounders. Evidence across studies indicates that short adult height (reflecting growth retardation) in low- and middle-income countries is driven by environmental conditions, especially net nutrition during early years. Some of the associations of height with health and social outcomes potentially reflect the association between these environmental factors and such outcomes. These conditions are manifested in the substantial differences in adult height that exist between and within countries and over time. This review suggests that adult height is a useful marker of variation in cumulative net nutrition, biological deprivation, and standard of living between and within populations and should be routinely measured. Linkages between adult height and health, within and across generations, suggest that adult height may be a potential tool for monitoring health conditions and that programs focused on offspring outcomes may consider maternal height as a potentially important influence.