Growth in transitional countries: The long-term impact of under-nutrition on health

The effectiveness of an egg-based intervention on improving the nutrition of poor school-age children in China: A quasi-experimental assessment

OBJECTIVES

Although egg-based interventions are effective in alleviating undernutrition for infants and toddlers, little is known regarding their effectiveness for children in remote and poor areas of China. For policy and intervention implications, the aim of this study was to examine the effects of offering one hard-boiled egg per school day to school-age children in less-developed areas of China.

METHODS

This analytical sample included 346 school-age children. Children in the treatment group received one egg per school day. Applying propensity score weighting to the difference-in-difference models, this study examined the effects of the egg intervention on child nutrition status measured in height-for-age Z score (HAZ), weight-for-age Z score (WAZ), and body-mass-index-for-age Z score (BMIZ).

RESULTS

After applying propensity score weighting, the average treatment effect (ATE) and the average treatment effects on the treated (ATT) estimations showed that the increase in HAZ scores from wave 1 to wave 3 for the program participants was 0.28 points higher compared with the increase in HAZ scores from wave 1 to wave 3 for the control group (P < 0.05). The ATE and the ATT estimations showed that the increase in WAZ scores from wave 1 to wave 3 for the program participants was 0.50 and 0.49 points higher compared with the increase in WAZ scores from wave 1 to wave 3 for the control group (P < 0.001). Regarding BMIZ score improvement from wave 1 to wave 3, the program participation had relatively larger effects by 0.57 and 0.55 points based on the ATE and ATT estimations (P < 0.001), respectively.

CONCLUSIONS

The egg intervention can be an effective intervention to improve child development in less-developed areas of China.

Height and health in Roman and Post-Roman Gaul, a life course approach

OBJECTIVE

The present study explores growth and health in Roman (1st-3rd centuries CE) and Post-Roman (4th-7th centuries CE) Gaul, incorporating a life-course approach, to better understand the influence of Roman practices and lifestyles on health, and the impact of cultural change from the Roman to the Post-Roman period.

MATERIALS AND METHODS

The skeletal remains of 844 individuals were analyzed for non-specific signs of physiological stress, including growth disruption (diaphyseal and adult maximum femur length), dental enamel hypoplastic defects (DEH), cribra orbitalia (CO), and periosteal reaction of the tibiae (Tibia PR).

RESULTS

The Gallo-Roman sample demonstrated shorter femoral lengths, and higher rates of DEH and Tibia PR. Post-Roman groups demonstrated longer femoral lengths and higher rates of CO.

CONCLUSIONS

Gallo-Roman individuals may have been more regularly exposed to infectious pathogens throughout childhood, inhibiting opportunities for catch-up growth, resulting in high rates of DEH and shorter femoral lengths ('intermittent stress of low lethality'). This could be the result of overcrowding and insalubrious urban environments. Higher rates of CO in the Post-Roman samples may have been influenced by dietary changes between the periods.

SIGNIFICANCE

The intertwined and often synergistic relationships between early life environment, nutrition and settlement structure is highlighted, helping to further understandings of life experiences during the Roman and Post-Roman periods.

LIMITATIONS

It was not possible to obtain sufficient data from northern regions during the Gallo-Roman period, limiting this analysis.

SUGGESTIONS FOR FURTHER RESEARCH

Further application of life course approaches can reveal subtle patterns in stress indicators.

Pre-pregnancy dietary pattern is associated with newborn size: results from ProcriAr study

Babies born small-for-gestational age (SGA) have an increased risk of mortality, morbidity and adverse functional consequences. Studies suggest that pre-pregnancy maternal diet may influence newborns' size. This study aimed to determine whether maternal pre-pregnancy dietary patterns (DP) are associated with delivering SGA newborns in the ProcriAr Cohort Study, Sao Paulo-Brazil. Pre-pregnancy DP of 299 women were investigated using factor analysis with principal component's estimation, based on intake reported on a validated 110-item FFQ. Newborns were classified as SGA if their weight and/or length, adjusted by gestational age and sex, were below the 10th percentile of the INTERGROWTH-21st standards. Multivariate Poisson regression modelling with robust error variance was performed to examine associations between the different DP (in quintiles) and SGA. In a model adjusted by maternal sociodemographic and health behaviours, women who scored in the highest quintile of the DP 'Snacks, sandwiches, sweets and soft drinks' (in relation to the women who scored in the lowest quintile) were significantly more likely to deliver SGA babies (relative risk 1·92; 95 % CI 1·08, 3·39). This study verified that women's pre-pregnancy dietary behaviour characterised by an energy-dense nutrient-poor food intake was a risk factor for delivering SGA newborns. Investments in education and improved access to healthful food and nutritional information before pregnancy should be prioritised due to their potential positive impact on child health. However, further studies are warranted to identify specific metabolic pathways that may be underlying these associations.

Using syndemic theory to understand food insecurity and diet-related chronic diseases

Syndemic Theory (ST) provides a framework to examine mutually enhancing diseases/health issues under conditions of social inequality and inequity. ST has been used in multiple disciplines to address interacting infectious diseases, noncommunicable diseases, and mental health conditions. The theory has been critiqued for its inability to measure disease interactions and their individual and combined health outcomes. This article reviews literature that strongly suggests a syndemic between food insecurity (FI) and diet-related chronic diseases (DRCDs), and proposes a model to measure the extent of such interaction. The article seeks to: (1) examine the potential syndemic between FI and DRCDs; (2) illustrate how the incorporation of Life History Theory (LHT), into a syndemic framework can help to highlight critical lifeperiods when FI-DRCD interactions result in adverse health outcomes; (3) discuss the use of mixed methods to identify and measure syndemics to enhance the precision and predictive power of ST; and (4) propose an analytical model for the examination of the FI-DRCD syndemic through the life course. The proposed model is more relevant now given the significant increase in FI globally as a result of the ongoing COVID-19 pandemic. The differential impact that the pandemic appears to have among various age groups and by other demographic factors (e.g., race, gender, income) offers an opportunity to examine the potential FI-DRCD syndemic under the lens of LHT.

Determinants of folic acid supplement use outside national recommendations for pregnant women: results from the Growing Up in New Zealand cohort study

OBJECTIVE

To evaluate the sociodemographic and lifestyle factors associated with insufficient and excessive use of folic acid supplements (FAS) among pregnant women.

DESIGN

A pregnancy cohort to which multinomial logistic regression models were applied to identify factors associated with duration and dose of FAS use.

SETTING

The Growing Up in New Zealand child study, which enrolled pregnant women whose children were born in 2009-2010.

SUBJECTS

Pregnant women (n 6822) enrolled into a nationally generalizable cohort.

RESULTS

Ninety-two per cent of pregnant women were not taking FAS according to the national recommendation (4 weeks before until 12 weeks after conception), with 69 % taking insufficient FAS and 57 % extending FAS use past 13 weeks' gestation. The factors associated with extended use differed from those associated with insufficient use. Consistent with published literature, the relative risks of insufficient use were increased for younger women, those with less education, of non-European ethnicities, unemployed, who smoked cigarettes, whose pregnancy was unplanned or who had older children, or were living in more deprived households. In contrast, the relative risks of extended use were increased for women of higher socio-economic status or for whom this was their first pregnancy and decreased for women of Pacific v. European ethnicity.

CONCLUSIONS

In New Zealand, current use of FAS during pregnancy potentially exposes pregnant women and their unborn children to too little or too much folic acid. Further policy development is necessary to reduce current socio-economic inequities in the use of FAS.

Changes in nutritional status among displaced North Korean children living in South Korea

BACKGROUND

As many nations experience the nutrition transition, changes in the nutritional status of children moving from food insecure to food affluent societies has become an important, but infrequently studied, public health issue.

AIM

To determine changes in the nutritional status of North Korean children after relocating to food-affluent South Korea (SK) from food-deficient North Korea (NK) and relationships of current nutritional status with food environment at birth and exposure to food affluent environments.

SUBJECTS AND METHODS

Socioeconomic status, relocation history and anthropometric information were obtained from 70 NK children (6-15 years) living in SK, through questionnaires, interviews and direct measurements.

RESULTS

Following the first 2 years in SK, the height and weight of NK children significantly (p = 0.000) improved, yet they were still shorter (p = 0.000) than SK peers, while the prevalence of obesity was similar to those of SK children. The likelihood of remaining stunted was significantly associated with older age and shorter residency in SK (p < 0.05), but there was no significant association with food security situation at birth.

CONCLUSION

Even a short exposure to food affluent environments improved the nutritional status among children, but linear growth deficits are slow to recover as overall nutritional status remains poor compared to peers without exposures to food insecurity.

Nutritional influences over the life course on lean body mass of individuals in developing countries

The double burden of childhood undernutrition and adult-onset adiposity in transitioning societies poses a significant public health challenge. The development of suboptimal lean body mass (LBM) could partly explain the link between these two forms of malnutrition. This review examines the evidence on both the role of nutrition in “developmental programming” of LBM and the nutritional influences that affect LBM throughout the life course. Studies from developing countries assessing the relationship of early nutrition with later LBM provide important insights. Overall, the evidence is consistent in suggesting a positive association of early nutritional status (indicated by birth weight and growth during first 2 years) with LBM in later life. Evidence on the impact of maternal nutritional supplementation during pregnancy on later LBM is inconsistent. In addition, the role of nutrients (protein, zinc, calcium, vitamin D) that can affect LBM throughout the life course is described. Promoting optimal intakes of these important nutrients throughout the life course is important for reducing childhood undernutrition as well as for improving the LBM of adults.