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Wright CM, Petermann-Rocha F, Bland R, Ashorn P, Zaman S, Ho FK. Weight velocity in addition to latest weight does not improve the identification of wasting, or the prediction of stunting and mortality: a longitudinal analysis using data from Malawi, South Africa, and Pakistan. J Nutr 2024:S0022-3166(24)00350-X. [PMID: 38936551 DOI: 10.1016/j.tjnut.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/28/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND In low/middle-income countries, most nutritional assessments use the latest weights, without reference to growth trajectory. OBJECTIVE This study explores whether velocity, in addition to the latest weight, improves the prediction of wasting, stunting or mortality in the first two years of life. METHODS We analysed a combined data set with weight and height data collected monthly in the first year of 3447 children from Pakistan, Malawi, South Africa, with height and survival recorded till 24 months. The main exposures were weight-for-age z-score (WAZ) at the end of each 2-month period and weight velocity-for-age z-score (WVZ2) across that period. The outcomes were wasting, stunting or all-cause mortality in the next 1-2 months. As a sensitivity analysis, we also used WVZ over 6 months (WVZ6), with matching WAZ. Cox proportional hazard models with repeated growth measures were used to study the association between exposures and mortality. Mixed Poisson models were used for stunting and wasting. RESULTS Children who were already stunted or wasted were most likely to remain so. WVZ2 was associated with a lower risk of subsequent stunting (RR 0.95; 95% CI 0.93-0.96), but added minimal prediction (difference in AUC = 0.004) compared to a model including only WAZ. Similarly, WVZ2 was associated with wasting (RR 0.74; 95% CI 0.72-0.76) but the prediction was only marginally greater than for WAZ (difference in AUC = 0.015). Compared to WAZ, WVZ6 was less predictive for both wasting and stunting. Low WVZ6 (but not WVZ2) was associated with increased mortality (HR 0.75, 95% CI 0.67-0.85), but added marginal only prediction to a model including WAZ alone (difference in C = 0.015). CONCLUSIONS The key anthropometric determinant of impending wasting, stunting, and mortality appears to be how far below the normal range the child's weight is, rather than how they reached that position.
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Affiliation(s)
- Charlotte M Wright
- School of Medicine, Dentistry & Nurising, University of Glasgow, Glasgow, UK.
| | - Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Ruth Bland
- School of Medicine, University of Glasgow, UK
| | - Per Ashorn
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences, Lahore, Pakistan
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Manohar S, Colantuoni E, Thorne-Lyman AL, Shrestha B, Adhikari RK, KC A, Bhattarai A, West KP. Evaluating preschool linear growth velocities: an interim reference illustrated in Nepal. Public Health Nutr 2023; 26:2704-2716. [PMID: 37932904 PMCID: PMC10755438 DOI: 10.1017/s1368980023002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE An annualised linear growth velocity (LGV) reference can identify groups of children at risk of growing poorly. As a single velocity reference for all preschool ages does not exist, we present an interim tool, derived from published, normative growth studies, for detecting growth faltering, illustrating its use in Nepali preschoolers. DESIGN The WHO Child Growth Velocity Standard was adapted to derive 12-month increments and conjoined to the Tanner-Whitehouse Height Velocity Reference data yielding contiguous preschool linear growth annualised velocities. Linear restricted cubic spline regressions were fit to generate sex-specific median and standard normal deviate velocities for ages 0 through 59 months. LGV Z-scores (LGVZ) were constructed, and growth faltering was defined as LGVZ < –2. SETTING Use of the reference was illustrated with data from Nepal’s Tarai region. PARTICIPANTS Children contributing the existing growth references and a cohort of 4276 Nepali children assessed from 2013 to 2016. RESULTS Fitted, smoothed LGV reference curves displayed monotonically decreasing 12-month LGV, exemplified by male/female annual medians of 26·4/25·3, 12·1/12·7, 9·1/9·4, 7·7/7·8 and 7/7 cm/years, starting at 0, 12, 24, 36 and 48 months, respectively. Applying the referent, 31·1 %, 28·6 % and 29·3 % of Nepali children <6, 6–11 and 12–23 months of age, and ∼6 % of children 24–59 months, exhibited growth faltering. Under 24 months, faltering velocities were more prevalent in girls (34·4 %) than boys (25·3 %) (P < 0·05) but comparable (∼6 %) in older preschoolers. CONCLUSIONS A LGV reference, concatenated from extant data, can identify preschool groups at-risk of growth faltering. Application and limitations are discussed.
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Affiliation(s)
- Swetha Manohar
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Global Food Ethics & Policy Program, Johns Hopkins School of Advanced International Studies, Washington, DC20036, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Lucian Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Binod Shrestha
- PoSHAN Study Team, Johns Hopkins University, Patan Dhoka, Lalitpur, Nepal
- Blitz Media Pvt. Ltd., Tripureshwor, Maharajgunj, Kathmandu, Nepal
| | - Ramesh Kant Adhikari
- Global Food Ethics & Policy Program, Johns Hopkins School of Advanced International Studies, Washington, DC20036, USA
| | - Angela KC
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abhigyna Bhattarai
- Department of Child Health, Institute of Medicine, Tribhuvan University, Nepal
- Blitz Media Pvt. Ltd., Tripureshwor, Maharajgunj, Kathmandu, Nepal
| | - Keith Parker West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Liu J, Jin X, Feng Z, Huang J. The association of central and extremity circumference with all-cause mortality and cardiovascular mortality: a cohort study. Front Cardiovasc Med 2023; 10:1251619. [PMID: 37719982 PMCID: PMC10501716 DOI: 10.3389/fcvm.2023.1251619] [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: 07/13/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background Central obesity increases the risk of several diseases, including diabetes, cardiovascular disease (CVD), and cancer. However, the association between extremity obesity and mortality has not been extensively evaluated. The objective of this study was to investigate the quantitative effects of waist circumference (WC), arm circumference (AC), calf circumference (CC), and thigh circumference (TC) on all-cause mortality and CVD mortality. Methods The study used data from the National Health and Nutrition Examination Survey (NHANES) sample survey from 1999 to 2006. A total of 19,735 participants were included in the study. We divided the participants into four groups (Q1-Q4) and used Q1 as a reference to compare the risk of all-cause mortality and CVD mortality in Q2-Q4. COX proportional hazard regression model was used to analyze the relationship between WC, AC, CC and TC on all-cause and CVD mortality. In addition, we conducted a stratified analysis of gender. Results After a mean follow-up of 11.8 years, we observed a total of 3,446 deaths, of which 591 were due to cardiovascular disease. The results showed that for both men and women, compared to the first group, the risk of all-cause mortality was significantly higher in the other three groups of WC and significantly lower in the other three groups of AC, CC, and TC. Similar results were observed after adjusting for confounding factors such as demographics. Conclusions Our results show that all-cause and CVD mortality are positively associated with measures of central obesity and negatively associated with measures of extremity obesity, and that AC, CC, and TC can be used as potential tools to measure prognosis in the general population.
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Affiliation(s)
- Jiajun Liu
- Department of Gynecology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xueshan Jin
- Nephropathy Center, The Affiliated Jiangmen TCM Hospital, Jinan University, Jiangmen, China
| | - Ziyi Feng
- Department of Gynecology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jieming Huang
- Department of Gynecology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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Xiao X, Yu X, Zhu H, Zhai X, Li S, Ma W, Ouyang M, Liu K, Eshak ES, Cao J. Arm Circumference, Arm-to-Waist Ratio in Relation to Cardiovascular and All-Cause Mortality among Patients with Diabetes Mellitus. Nutrients 2023; 15:nu15040961. [PMID: 36839318 PMCID: PMC9959583 DOI: 10.3390/nu15040961] [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: 01/09/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Among patients with diabetes mellitus, limited studies have investigated the relationship between anthropometric parameters and cardiovascular disease (CVD), with all-cause mortality. We examined the associations of arm circumference (AC), arm-to-waist ratio (AC/WC), and CVD, with all-cause mortality among patients with diabetes. This is a cohort study of 5497 diabetic individuals aged 20 or over who were recruited in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014. Cox proportional hazards regression models were used to analyze the associations between AC, AC/WC, and CVD, with all-cause mortality. We also conducted stratified analyses and explored the possible non-linear relation by restricted cubic splines. During a median follow-up of 7.2 years, there were 271 and 1093 cases of CVD and all-cause death. The multivariable adjusted hazard ratios (HRs) with 95% confidence intervals (Cis) of CVD mortality in Q2, Q3, and Q4 groups compared with Q1 group were 0.37 (0.22, 0.62), 0.24 (0.12, 0.48), 0.18 (0.07, 0.46) for AC, and 0.18 (0.07, 0.46), 0.34 (0.20, 0.60), 0.28 (0.15, 0.53) for AC/WC. Similar results were observed in the analysis for all-cause mortality risk. AC and AC/WC were both inversely associated with CVD and all-cause mortality among individuals with diabetes. It is important to pay attention to these anthropometric parameters of diabetic patients.
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Affiliation(s)
- Xinyu Xiao
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Xinyi Yu
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Huiping Zhu
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Xiaobing Zhai
- Center for Artificial Intelligence Driven Drug Discovery, Faculty of Applied Sciences, Macao Polytechnic University, Macau SAR, China
| | - Shiyang Li
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Wenzhi Ma
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Meishou Ouyang
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Osaka, Japan
| | - Keyang Liu
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Osaka, Japan
| | - Ehab S. Eshak
- Department of Public Health, Faculty of Medicine, Minia University, Minia 61511, Egypt
- Advanced Clinical Epidemiology, Medical data Science Unit, Public Health, Department of Social Medicine, Graduate School of Medicine, 2-2 Yamadaoka, Osaka University, Suita-shi 565-0871, Osaka, Japan
- Public Health, School of Health, Calvin University, Grand Rapids, MI 49546, USA
| | - Jinhong Cao
- School of Management, Hubei University of Traditional Chinese Medicine, Wuhan 430065, China
- Research Center for the Development of Traditional Chinese Medicine, Hubei Province Project of Key Research Institute of Humanities and Social Sciences at Universities, Wuhan 430065, China
- Correspondence:
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Wu S, Zhao F, He Y, He T, Duan S, Feng G, Chen Y, Wang X, Szeto IMY, Lin L, Cai L. Association between maternal erythrocyte polyunsaturated fatty acid levels during pregnancy and offspring weight status: A birth cohort study. Front Nutr 2022; 9:978679. [PMID: 36245520 PMCID: PMC9557224 DOI: 10.3389/fnut.2022.978679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background The findings of the association between maternal polyunsaturated fatty acid (PUFA) levels during pregnancy and offspring weight status are controversial. Furthermore, few studies have focused on Asian populations or used erythrocyte membranes as biological markers. We aimed to examine the associations between maternal erythrocyte PUFA and offspring weight status within the first 2 years among the Chinese population. Materials and methods A total of 607 mother-child pairs were recruited from a birth cohort. Maternal erythrocyte n-3 and n-6 PUFA during pregnancy were measured by gas chromatography, and the ratio of PUFA was calculated. Weight- and body mass index (BMI)-for-age z (WAZ and BAZ) scores were calculated for offspring at 1, 3, 6, 8, 12, 18, and 24 months of age. The risk of overweight and obesity was defined by the WHO criterion. The Generalized Estimating Equation (GEE) model was carried out for repeated anthropometric data within 2 years of age. Results Maternal erythrocyte docosapentaenoic acid (DPA, n-3) was inversely associated with offspring BAZ score [tertile 2 vs. tertile 1, β: −0.18 (−0.29, −0.00)]. Higher maternal erythrocyte arachidonic acid (AA) was inversely associated with lower offspring WAZ and BAZ [tertile 3 vs. tertile 1, β: −0.18 (−0.35, −0.02), −0.22 (−0.38, −0.06), respectively]. Furthermore, higher maternal erythrocyte AA [tertile 3 vs. tertile 1, odds ratio [OR]: 0.52 (0.36, 0.75), ptrend < 0.001] and total n-6 PUFA [tertile 3 vs. tertile 1, OR: 0.56 (0.39, 0.81), ptrend = 0.002] were associated with decreased risk of overweight and obesity in offspring. Maternal erythrocyte n-6/n-3 PUFA and AA/eicosapentaenoic acid (EPA) ratios were not associated with offspring weight status. Conclusion Maternal erythrocyte PUFA might influence offspring weight status within 2 years of age in the Chinese population. Further Asian studies are still needed.
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Affiliation(s)
- Shengchi Wu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feng Zhao
- Institute of Nutrition & Health, Qingdao University, Qingdao, China
| | - Yannan He
- Institute of Nutrition & Health, Qingdao University, Qingdao, China
| | - Tingchao He
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot, China
| | - Sufang Duan
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot, China
- Nutrition and Health Research Center, National Center of Technology Innovation for Dairy, Hohhot, China
| | - Gang Feng
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot, China
| | - Yujing Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xin Wang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ignatius Man-Yau Szeto
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
- Nutrition and Health Research Center, National Center of Technology Innovation for Dairy, Hohhot, China
| | - Lizi Lin
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Li Cai,
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Kumar V, Kumar A, Mishra S, Kan P, Ashraf S, Singh S, Blanks KJH, Baiocchi M, Limcaoco M, Ghosh AK, Kumar A, Krishna R, Stevenson DK, Tian L, Darmstadt GL, Darmstadt GL, Elias PM, Ghosh AK, Kan P, Krishna R, Kumar A, Kumar A, Kumar V, Mehrotra H, Mishra S, Patil P, Sahu A, Singh P, Singh S, Singh V, Stevenson DK, Tian L, Yadav R. Effects of emollient therapy with sunflower seed oil on neonatal growth and morbidity in Uttar Pradesh, India: a cluster-randomized, open-label, controlled trial. Am J Clin Nutr 2022; 115:1092-1104. [PMID: 34982820 PMCID: PMC8970981 DOI: 10.1093/ajcn/nqab430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Newborn oil massage is a widespread practice. Vigorous massage with potentially harmful products and forced removal of vernix may disrupt skin barrier integrity. Hospitalized, very-preterm infants treated with sunflower seed oil (SSO) have demonstrated improved growth but community-based data on growth and health outcomes are lacking. OBJECTIVES We aimed to test whether SSO therapy enhances neonatal growth and reduces morbidity at the population level. METHODS We conducted an open-label, controlled trial in rural Uttar Pradesh, India, randomly allocating 276 village clusters equally to comparison (usual care) and intervention comprised of promotion of improved massage practices exclusively with SSO, using intention-to-treat and per-protocol mixed-effects regression analysis. RESULTS We enrolled 13,478 and 13,109 newborn infants in demographically similar intervention and comparison arms, respectively. Adherence to exclusive SSO increased from 22.6% of intervention infants enrolled in the first study quartile to 37.2% in the last quartile. Intervention infants gained significantly more weight, by 0.94 g · kg-1 · d-1 (95% CI: 0.07, 1.82 g · kg-1 · d-1, P = 0.03), than comparison infants by intention-to-treat analysis. Restricted cubic spline regression revealed the largest benefits in weight gain (2-4 g · kg-1 · d-1) occurred in infants weighing <2000 g at birth. Weight gain in intervention infants was higher by 1.31 g · kg-1 · d-1 (95% CI: 0.17, 2.46 g · kg-1 · d-1; P = 0.02) by per-protocol analysis. Morbidities were similar by intention-to-treat analysis but in per-protocol analysis rates of hospitalization and of any illness were reduced by 36% (OR: 0.64; 95% CI: 0.44, 0.94; P = 0.02) and 44% (OR: 0.56; 95% CI: 0.40, 0.77; P < 0.001), respectively, in treated infants. CONCLUSIONS SSO therapy improved neonatal growth, and reduced morbidities when applied exclusively, across the facility-community continuum of care at the population level. Further research is needed to improve demand for recommended therapy inside hospital as well as in community settings, and to confirm these results in other settings.This trial was registered at www.isrctn.com as ISRCTN38965585 and http://ctri.nic.in as CTRI/2014/12/005282.
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Affiliation(s)
| | | | | | - Peiyi Kan
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mika Limcaoco
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - David K Stevenson
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
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Sinaga HT, Achmad N, Manalu M, Perangin-Angin S, Doloksaribu LG. Length Attainment and Stunting Prevalence of Children aged 0–24 Months Living in the Area of Clay Brick Kilns in Pagar Merbau Sub District, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The association of air pollution with children’s health and growth has been proved.
AIM: This study aimed to assess the length attainment and stunting prevalence of children living in the areas of clay brick kiln and non-clay brick kilns.
METHODS: The study was a cross-sectional study conducted from February to December 2020. The location of the study was in Pagar Merbau Subdistrict, Deli Serdang District, North Sumatera Indonesia. Four villages were selected purposively to be the location of study. The total participants were 192 families who have children aged 0–24 years old. To assess the length attainment, the median WHO standard was determined as reference. The growth curve of children was presented in a bubble growth chart. To determine whether the groups were comparable, pair t-tests were applied.
RESULTS: Compared to the median WHO standard, the length attainment of boys aged 18–24 months shorter 1.1–1.9 cm and 0.8–1.9 cm (CBK vs. non-CBK, respectively), whereas for girls shorter 1.5–2.0 cm and 0.8–1.2 cm (CBK vs. non-CBK, respectively). The difference length between non-CBK and CBK children at age 18–24 months is 0.8–1.9 cm. Growth curves of children since born until aged 24 months were around −1SD–0SD. The prevalence of stunting is 18.6% versus 19.8%.
CONCLUSION: The presence of clay brick kilns in villages treated children’s growth. Government should manage the establishment of clay brick kilns in villages. Children cognitive and height of children at school age need to investigate.
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Wang D, Schwinger C, Urassa W, Berhane Y, Strand TA, Fawzi WW. Comparing Attained Weight and Weight Velocity during the First 6 Months in Predicting Child Undernutrition and Mortality. J Nutr 2021; 152:319-330. [PMID: 34549299 PMCID: PMC8754579 DOI: 10.1093/jn/nxab338] [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: 08/15/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The first 6 mo of life are critical for subsequent risk of undernutrition and mortality. The predictive abilities of attained weight at the end of each month and monthly weight velocity for undernutrition and mortality need to be compared. OBJECTIVES This study aimed to examine the predictive abilities of different weight metrics during the first 6 mo of life in predicting undernutrition and mortality. METHODS This study used a cohort of infants in Tanzania. Weight and length were measured monthly from birth to 18 mo of age. Three weight metrics during the first 6 mo of life were considered as predictors, including attained weight-for-age z score (WAZ) at the end of each month, monthly change in WAZ, and monthly weight velocity z score (WVZ). Logistic models were used with undernutrition (at 6 or 12 mo) and mortality (over the first 18 mo) as outcomes. AUC values were compared across metrics. RESULTS For predicting wasting at 6 mo, WVZ (AUC: 0.80) had a greater predictive ability than attained WAZ (AUC: 0.76) and change in WAZ (AUC: 0.71) during the second month of life. After 2 mo, attained WAZ (AUC: 0.81-0.89) had greater predictive abilities than WVZ (AUC: 0.71-0.77) and change in WAZ (AUC: 0.65-0.67). For predicting stunting at 6 mo, attained WAZ (AUC: 0.75-0.79) had consistently greater predictive abilities than WVZ (AUC: 0.56-0.66) and change in WAZ (AUC: 0.50-0.57). The weight metrics had similar abilities in predicting mortality, with the AUC rarely reaching >0.65. CONCLUSIONS Attained weight at the end of each month had greater abilities than monthly weight velocity in the same month in predicting undernutrition. Attained weight remains a useful indicator for identifying infants at greater risk of undernutrition.
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Affiliation(s)
| | - Catherine Schwinger
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Tor A Strand
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA,Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA,Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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9
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Mwangome M, Ngari M, Bahwere P, Kabore P, McGrath M, Berkley JA. Growth monitoring and mortality risk in low birthweight infants: a birth cohort study in Burkina Faso. Gates Open Res 2021; 5:82. [PMID: 38544843 PMCID: PMC10967696 DOI: 10.12688/gatesopenres.13231.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 04/21/2024] Open
Abstract
Background: Wasting and underweight in infancy is an increasingly recognised problem but consensus on optimum assessment is lacking. In particular, there is uncertainty on how to interpret anthropometry among low birth weight (LBW) infants who may be growing normally. This research aimed to determine growth of infants from birth to two months (around age of vaccination) and the mortality risk of underweight LBW infants compared to normal birth weight (NBW) infants at two and six months age. Methods: A secondary analysis of a birth cohort of 1103 infants in Burkina Faso was conducted. Anthropometry was performed monthly from 0 to 12 months. We assessed associations with mortality using Cox proportional hazards models and assessed discriminatory values using area under receiver operating characteristics curves. Results: Eighty-six (7.8%) children died by age one year, 26/86 (30%) and 51/86 (59%) within two and six months, respectively. At age two months, weight gain since birth did not better discriminate mortality risk than current weight-for-age (P=0.72) or mid-upper arm circumference (P=0.21). In total, 227 (21%) LBW infants had increased risk of mortality: adjusted hazards ratio (aHR) 3.30 (95%CI 2.09 to 4.90). Among infants who were underweight at two and six months, LBW infants (64% and 49%, respectively) were not at reduced risk of death compared to NBW infants (aHR 2.63 (95%CI 0.76 to 9.15) and 2.43 (95%CI 0.74 to 7.98), respectively). Conclusion: Assessing weight gain since birth does not offer advantages over immediate anthropometry for discriminating mortality risk. LBW infants who are later identified as underweight require care to help prevent mortality.
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Affiliation(s)
- Martha Mwangome
- The Childhood Acute Illness and Nutrition Network,, CHAIN, Nairobi, P.O Box 43640-00100,, Kenya
- Clinical, KEMRI/Wellcome Trust Research Program, Kilifi, Kilifi, 80108, Kenya
| | - Moses Ngari
- The Childhood Acute Illness and Nutrition Network,, CHAIN, Nairobi, P.O Box 43640-00100,, Kenya
- Clinical, KEMRI/Wellcome Trust Research Program, Kilifi, Kilifi, 80108, Kenya
| | - Paluku Bahwere
- School of Public Health, Center of Research in Epidemiology Biostatistics and Clinical Research,, Université Libre de Bruxelles,, Brussels,, Belgium, Belgium
- Valid International, N/A, 35 Leopold Street, Oxford,, Oxford, OX4 1TW,, UK
| | - Patrick Kabore
- Africa Regional office,, World Health Organisation,, Brazzaville,, Republic of Congo, Congo
| | - Marie McGrath
- Emergency Nutrition Network, 69 High Street, Marlborough House, Kidlington, Oxfordshire, OX5 2DN, UK
| | - James A. Berkley
- Clinical, KEMRI/Wellcome Trust Research Program, Kilifi, Kilifi, 80108, Kenya
- Centre for Clinical Vaccinology & Tropical Medicine, University of Oxford,, Churchill Hospital Old Road,, Headington Oxford, OX3 7LE, UK
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10
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Mwangome M, Ngari M, Bahwere P, Kabore P, McGrath M, Berkley JA. Growth monitoring and mortality risk in low birthweight infants: a birth cohort study in Burkina Faso. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13231.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Wasting and underweight in infancy is an increasingly recognised problem but consensus on optimum assessment is lacking. In particular, there is uncertainty on how to interpret anthropometry among low birth weight (LBW) infants who may be growing normally. This research aimed to determine growth of infants from birth to two months (around age of vaccination) and the mortality risk of underweight LBW infants compared to normal birth weight (NBW) infants at two and six months age. Methods: A secondary analysis of a birth cohort of 1103 infants in Burkina Faso was conducted. Anthropometry was performed monthly from 0 to 12 months. We assessed associations with mortality using Cox proportional hazards models and assessed discriminatory values using area under receiver operating characteristics curves. Results: Eighty-six (7.8%) children died by age one year, 26/86 (30%) and 51/86 (59%) within two and six months, respectively. At age two months, weight gain since birth did not better discriminate mortality risk than current weight-for-age (P=0.72) or mid-upper arm circumference (P=0.21). In total, 227 (21%) LBW infants had increased risk of mortality: adjusted hazards ratio (aHR) 3.30 (95%CI 2.09 to 4.90). Among infants who were underweight at two and six months, LBW infants (64% and 49%, respectively) were not at reduced risk of death compared to NBW infants (aHR 2.63 (95%CI 0.76 to 9.15) and 2.43 (95%CI 0.74 to 7.98), respectively). Conclusion: Assessing weight gain since birth does not offer advantages over immediate anthropometry for discriminating mortality risk. LBW infants who are later identified as underweight require care to help prevent mortality.
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Hruschka DJ. One size does not fit all. How universal standards for normal height can hide deprivation and create false paradoxes. Am J Hum Biol 2020; 33:e23552. [PMID: 33314421 DOI: 10.1002/ajhb.23552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/03/2020] [Accepted: 11/28/2020] [Indexed: 12/28/2022] Open
Abstract
Public health practitioners and social scientists frequently compare height against one-size-fits-all standards of human growth to assess well-being, deprivation, and disease risk. However, underlying differences in height can make some naturally tall populations appear well-off by universal standards, even though they live in severe states of deprivation. In this article, I describe the worldwide extent of these population differences in height and illustrate how using a universal yardstick to compare population height can create puzzling disparities (eg, between South Asia and sub-Saharan Africa) while also underestimating childhood stunting in specific world regions (eg, West Africa and Haiti). I conclude by discussing potential challenges of developing and implementing population-sensitive standards for assessing healthy development.
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Affiliation(s)
- Daniel J Hruschka
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
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Bukari M, Abubakari MM, Majeed M, Abizari AR, Wemakor A, Atosona A. Effect of maternal growth monitoring knowledge on stunting, wasting and underweight among children 0-18 months in Tamale metropolis of Ghana. BMC Res Notes 2020; 13:45. [PMID: 31996253 PMCID: PMC6988331 DOI: 10.1186/s13104-020-4910-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/16/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study sought to assess maternal growth monitoring knowledge and its effect on stunting, wasting and underweight among children 0-18 months in the Tamale Metropolis. An analytical cross-sectional study design, involving 340 mother-child pairs randomly selected from 4 health facilities in the Tamale Metropolis was used. A structured questionnaire was used to collect information on socio-demographic characteristics and maternal growth monitoring knowledge. Weight and length of children were taken to assess nutritional status (stunting, underweight and wasting). Chi square/Fisher's exact test was used to determine the association between maternal growth monitoring knowledge level and child nutritional status. RESULTS The study revealed that 87.6% of mothers had good knowledge on growth monitoring. The prevalence of stunting, underweight and wasting were 9.4%, 25.9% and 17.9% respectively. Bivariate analysis revealed that there is no association between maternal growth monitoring knowledge and stunting (p = 0.781), wasting (p = 0.743) and underweight (p = 0.529) among children 0-18 months in the Tamale Metropolis.
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Affiliation(s)
- Mohammed Bukari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
| | - Muzamil Mohammed Abubakari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
| | - Mohammed Majeed
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
| | - Abdul-Razak Abizari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
| | - Anthony Wemakor
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
| | - Ambrose Atosona
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
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Birungi N, Fadnes LT, Engebretsen IMS, Lie SA, Tumwine JK, Åstrøm AN. Association of maternal HIV-1 severity with dental caries: an observational study of uninfected 5- to 7-yr-old children of HIV-1-infected mothers without severe immune suppression. Eur J Oral Sci 2020; 128:46-54. [PMID: 31994250 DOI: 10.1111/eos.12669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2019] [Indexed: 12/13/2022]
Abstract
Treatment programs to prevent perinatal and postnatal HIV-1 transmission have become available in sub-Saharan Africa, leading to an emerging population of HIV-1 exposed uninfected (HEU) children. Exposure to HIV-1 in utero and during breastfeeding may increase the risk of morbidity and mortality in HEU children. This study estimated the association of the severity of maternal HIV-1 infection as assessed by CD4 count and viral load at baseline (7 d postpartum), with dmft count of their 5- to 7-yr-old HEU offspring. A follow-up study was conducted of HIV-1-infected mother-HEU children pairs (n = 164) from the Ugandan site of the ANRS 12341-PROMISE- PEP trial (ClinicalTrials.gov, number NCT00640263). HIV-1-infected mothers were interviewed and the HEU children were examined for caries using the World Health Organization's survey methods for field conditions and the dmft index. Directed acyclic graphs and negative binomial regression were used for analyses. The prevalence of 1 or more dmft was 48%. Negative binomial regression showed no association between the dmft count and maternal CD4 counts 7 d postpartum but a 10% lower dmft count with longer breastfeeding duration was found. Maternal CD4 count at birth was not associated with the dental caries experience in uninfected children born to women without severe immune suppression, while there appeared to be a protective effect of high viral load and breastfeeding duration.
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Affiliation(s)
- Nancy Birungi
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Bergen Addiction Research Group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - James Kashyugyera Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
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14
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Mark H, Been JV, Sonko B, Faal A, Ngum M, Hasan J, Prentice AM, Unger SA. Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia. BMC Public Health 2019; 19:668. [PMID: 31146716 PMCID: PMC6543667 DOI: 10.1186/s12889-019-6959-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate and timely data on the health of a population are key for evidence-based decision making at both the policy and programmatic level. In many low-income settings, such data are unavailable or outdated. Using an electronic medical records system, we determined the association between nutritional status and severe illness and mortality among young children presenting to a rural primary health care facility in the Gambia. METHODS Clinical data collected over five years (2010-2014) on children aged under 60 months making acute visits to a primary health care clinic in the rural Gambian district of Kiang West were retrospectively extracted from the medical records system. Generalised estimating equation models were used to investigate associations between nutritional status and illness severity, accounting for repeat visits, gender, age and access to transport to the clinic. The Population Attributable Fraction (PAF) was used to determine the proportion of severe illness likely attributable to different grades of malnutrition. RESULTS 3839/5021 (77%) children under 60 months of age living in Kiang West presented acutely to the clinic at least once, yielding 21,278 visits (47% girls, median age 20.2 months (Interquartile Range (IQR) 23.92 months)) and 26,001 diagnoses, 86% being infectious diseases. Severe illness was seen in 4.5% of visits (961/21,278). Wasting was associated with an increased risk of severe illness in a dose-dependent manner, ('WHZ < -1' adjusted Odds Ratio (aOR) 1.68, 95% CI:1.43-1.98, p < 0.001, 'WHZ <-2 and ≥-3' aOR 2.78, 95% CI:2.31-3.36, p < 0.001 and 'WHZ < -3' aOR 7.82, 95% CI:6.40-9.55, p < 0.001) the PAF for wasting (WHZ < -2) was 0.21 (95% CI: 0.18-0.24). Stunting, even in the most severe form (HAZ < -3), was not significantly associated with severe illness (aOR 1.19 95% CI:0.94-1.51) but was associated with a significantly increased risk of death (aOR 6.04 95% CI:1.94-18.78). CONCLUSION In this population-based cohort of young children in rural Gambia, wasting was associated with disease severity in a dose-dependent manner. Further research is needed into strategies to identify and reach these children with effective interventions to improve their nutritional status.
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Affiliation(s)
- Henry Mark
- MRC Unit The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Jasper V. Been
- Division of Neonatology, Department of Paediatrics, and Department of Obstetrics and Gynaecology, Erasmus MC – Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Bakary Sonko
- MRC Unit The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Abdoulie Faal
- MRC Unit The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Mohammed Ngum
- MRC Unit The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Jahid Hasan
- MRC Unit The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Andrew M. Prentice
- MRC Unit The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Stefan A. Unger
- MRC Unit The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Department of Child Life and Health, University of Edinburgh, 20 Sylvan Place, Edinburgh, EH9 1UW UK
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15
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Buonomo E, Germano P, Moramarco S, Rossi R, Malizia A, Scarcella P, Orlando S, Guidotti G, Nielsen-Saines K, Tembo D, Marazzi MC, Palombi L. Early assessment of weight velocity can support frontline health workers in predicting malnutrition in HIV-exposed infants: preliminary results from a DREAM cohort in Malawi. Minerva Pediatr 2019; 72:14-21. [PMID: 30916516 DOI: 10.23736/s0026-4946.19.05417-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children born to HIV-positive mothers are particularly susceptible to malnutrition. Currently, monitoring programs rely on punctual anthropometric measurements to assess child growth. Growth velocities could be an additional tool in identifying critical time windows for prevention and implementation of early intervention for malnutrition. METHODS A retrospective analysis was conducted using data from 817 HIV exposed but uninfected children extracted from DREAM program database. By using the WHO reference for growth standards, patterns of weight velocity for different intervals of assessment from one to 18 months of age were explored. Odds ratios and multinomial logistic regressions between selected weight velocity Z-scores thresholds and successive malnutrition indices (at 6, 12, 18 months of age) were calculated. RESULTS Weight velocity was above the standard mean in the first 3 months, then progressively declined over time. In children with normal nutritional status, significant risks of becoming malnourished (mild malnutrition - underweight [OR 10.8; 95% CI: 4.5-26], chronic malnutrition - stunting [OR 8.3; 95% CI: 2-34.9] and acute malnutrition - wasting [OR 11.7; 95% CI: 1.5-90.5]) started when weight velocity Z-scores <0, at all interval ages. Multinomial regression showed that in the first 6 months, the weight velocity decrements strongly impacted on underweight (OR 17.9; 95% CI: 4-80.7), while the risk of Stunting occurred later at 18 months (OR 8.7; 95% CI: 4.3-17.6), with highest impact at the lowest thresholds. CONCLUSIONS The assessment of weight velocity Z-scores, coupled with the already validated malnutrition indices, can support frontline health workers in early prediction of child malnutrition and performing nutritional counselling in the context of HIV/AIDS and food insecurity.
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Affiliation(s)
- Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy -
| | - Paola Germano
- DREAM Program, Community of Sant'Egidio Catholic Association, Rome, Italy
| | - Stefania Moramarco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Rossi
- Department of Engineering, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Malizia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen UCLA School of Medicine, Los Angeles, CA, USA
| | - Dyna Tembo
- DREAM Program, Community of Sant'Egidio Catholic Association, Blantyre, Malawi
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Environmental Enteropathy, Micronutrient Adequacy, and Length Velocity in Nepalese Children: the MAL-ED Birth Cohort Study. J Pediatr Gastroenterol Nutr 2018; 67:242-249. [PMID: 29620600 DOI: 10.1097/mpg.0000000000001990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Environmental enteropathy (EE) is likely associated with growth retardation in children, but the association between EE and length velocity z score (LVZ) has not been investigated. The objective of the study was to assess associations between fecal markers for intestinal inflammation and LVZ and whether these associations were influenced by micronutrient adequacy among 9 to 24 months old children in Bhaktapur, Nepal. METHODS Data were divided into 5 time slots (9-12, 12-15, 15-18, 18-21, and 21-24 months). Anthropometric measurement and dietary assessment (by 24 hour recall) were performed monthly. Mean nutrient density adequacy was calculated based on nutrient density adequacy of 10 micronutrients (thiamin, riboflavin, niacin, vitamin B6, folate, vitamin C, vitamin A, calcium, iron, and zinc). Anti-1-antitrypsin (AAT), myeloperoxidase (MPO), and neopterin (NEO) were measured in stool samples collected at the beginning of each time slot. An EE score was calculated based on all 3 fecal markers. Associations between AAT, MPO, NEO and EE score and LVZ were assessed by multiple linear regression analyses and Generalized Estimating Equations models. RESULTS Associations between fecal markers and EE score and LVZ were generally weak. EE score and MPO for 3-month and MPO for 6-month growth periods were significantly associated with LVZ from 9 to 24 months. These associations were slightly modified by mean nutrient density adequacy. CONCLUSIONS EE score and MPO were significantly associated with LVZ in 9 to 24 months old Nepali children. Further studies to establish the usefulness of AAT, MPO, and NEO in assessing EE and growth retardation are warranted.
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Leung M, Perumal N, Mesfin E, Krishna A, Yang S, Johnson W, Bassani DG, Roth DE. Metrics of early childhood growth in recent epidemiological research: A scoping review. PLoS One 2018; 13:e0194565. [PMID: 29558499 PMCID: PMC5860780 DOI: 10.1371/journal.pone.0194565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 03/06/2018] [Indexed: 11/18/2022] Open
Abstract
Metrics to quantify child growth vary across studies of the developmental origins of health and disease. We conducted a scoping review of child growth studies in which length/height, weight or body mass index (BMI) was measured at ≥ 2 time points. From a 10% random sample of eligible studies published between Jan 2010-Jun 2016, and all eligible studies from Oct 2015-June 2016, we classified growth metrics based on author-assigned labels (e.g., 'weight gain') and a 'content signature', a numeric code that summarized the metric's conceptual and statistical properties. Heterogeneity was assessed by the number of unique content signatures, and label-to-content concordance. In 122 studies, we found 40 unique metrics of childhood growth. The most common approach to quantifying growth in length, weight or BMI was the calculation of each child's change in z-score. Label-to-content discordance was common due to distinct content signatures carrying the same label, and because of instances in which the same content signature was assigned multiple different labels. In conclusion, the numerous distinct growth metrics and the lack of specificity in the application of metric labels challenge the integration of data and inferences from studies investigating the determinants or consequences of variations in childhood growth.
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Affiliation(s)
- Michael Leung
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Nandita Perumal
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elnathan Mesfin
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aditi Krishna
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Diego G. Bassani
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Daniel E. Roth
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
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18
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Tadesse AW, Tadesse E, Berhane Y, Ekström EC. Choosing Anthropometric Indicators to Monitor the Response to Treatment for Severe Acute Malnutrition in Rural Southern Ethiopia-Empirical Evidence. Nutrients 2017; 9:E1339. [PMID: 29292787 PMCID: PMC5748789 DOI: 10.3390/nu9121339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 11/20/2022] Open
Abstract
The World Health Organization (WHO) recommends the assessment of nutritional recovery using the same anthropometric indicator that was used to diagnose severe acute malnutrition (SAM) in children. However, related empirical evidence from low-income countries is lacking. Non-oedematous children (n = 661) aged 6-59 months admitted to a community-based outpatient therapeutic program for SAM in rural southern Ethiopia were studied. The response to treatment in children admitted to the program based on the mid-upper arm circumference (MUAC) measurement was defined by calculating the gains in average MUAC and weight during the first four weeks of treatment. The children showed significant anthropometric changes only when assessed with the same anthropometric indicator used to define SAM at admission. Children with the lowest MUAC at admission showed a significant gain in MUAC but not weight, and children with the lowest weight-for-height/length (WHZ) showed a significant gain in weight but not MUAC. The response to treatment was largest for children with the lowest anthropometric status at admission in either measurement. MUAC and weight gain are two independent anthropometric measures that can be used to monitor sufficient recovery in children treated for SAM. This study provides empirical evidence from a low-income country to support the recent World Health Organization recommendation.
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Affiliation(s)
- Amare Worku Tadesse
- Department of Women's and Children's Health, International Maternal and Child Health Uppsala University, SE-75185 Uppsala, Sweden.
- Addis Continental Institute of Public Health, P.O. Box 26751/1000 Addis Ababa, Ethiopia.
| | - Elazar Tadesse
- Department of Women's and Children's Health, International Maternal and Child Health Uppsala University, SE-75185 Uppsala, Sweden.
- Addis Continental Institute of Public Health, P.O. Box 26751/1000 Addis Ababa, Ethiopia.
| | - Yemane Berhane
- Addis Continental Institute of Public Health, P.O. Box 26751/1000 Addis Ababa, Ethiopia.
| | - Eva-Charlotte Ekström
- Department of Women's and Children's Health, International Maternal and Child Health Uppsala University, SE-75185 Uppsala, Sweden.
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Wit JM, Himes JH, van Buuren S, Denno DM, Suchdev PS. Practical Application of Linear Growth Measurements in Clinical Research in Low- and Middle-Income Countries. Horm Res Paediatr 2017; 88:79-90. [PMID: 28196362 PMCID: PMC5804842 DOI: 10.1159/000456007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/10/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND/AIMS Childhood stunting is a prevalent problem in low- and middle-income countries and is associated with long-term adverse neurodevelopment and health outcomes. In this review, we define indicators of growth, discuss key challenges in their analysis and application, and offer suggestions for indicator selection in clinical research contexts. METHODS Critical review of the literature. RESULTS Linear growth is commonly expressed as length-for-age or height-for-age z-score (HAZ) in comparison to normative growth standards. Conditional HAZ corrects for regression to the mean where growth changes relate to previous status. In longitudinal studies, growth can be expressed as ΔHAZ at 2 time points. Multilevel modeling is preferable when more measurements per individual child are available over time. Height velocity z-score reference standards are available for children under the age of 2 years. Adjusting for covariates or confounders (e.g., birth weight, gestational age, sex, parental height, maternal education, socioeconomic status) is recommended in growth analyses. CONCLUSION The most suitable indicator(s) for linear growth can be selected based on the number of available measurements per child and the child's age. By following a step-by-step algorithm, growth analyses can be precisely and accurately performed to allow for improved comparability within and between studies.
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Affiliation(s)
- Jan M. Wit
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands,*Jan M. Wit, MD, PhD, Department of Pediatrics, J6S, Leiden University Medical Center, PO Box 9600, NL-2300RC Leiden (The Netherlands), E-Mail
| | - John H. Himes
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stef van Buuren
- Netherlands Organization for Applied Scientific Research TNO, Leiden, the Netherlands,Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, University of Utrecht, Utrecht, the Netherlands
| | - Donna M. Denno
- Department of Pediatrics and Global Health, University of Washington, Seattle, Washington, USA
| | - Parminder S. Suchdev
- Department of Pediatrics and Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
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Schwinger C, Fadnes LT, Shrestha SK, Shrestha PS, Chandyo RK, Shrestha B, Ulak M, Bodhidatta L, Mason C, Strand TA. Predicting Undernutrition at Age 2 Years with Early Attained Weight and Length Compared with Weight and Length Velocity. J Pediatr 2017; 182:127-132.e1. [PMID: 27974166 PMCID: PMC5323241 DOI: 10.1016/j.jpeds.2016.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/12/2016] [Accepted: 11/03/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate the abilities of weight and length velocities vs attained growth measures to predict stunting, wasting, and underweight at age 2 years. STUDY DESIGN We analyzed data from a community-based cohort study (The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development study [MAL-ED] study) in Bhaktapur, Nepal. A total of 240 randomly selected children were enrolled at birth and followed up monthly up to age 24 months. Linear and logistic regression models were used to predict malnutrition at 2 years of age with growth velocity z scores at 0-3, 0-6, 3-6, 6-9, 6-12, and 9-12 months (using the World Health Organization Growth Standards) or attained growth at 0, 3, 6, and 12 months as predictors. RESULTS At age 2 years, 4% of the children were wasted, 13% underweight, and 21% stunted. Children who were malnourished at age 2 years had lower mean growth z scores already at birth and throughout the study period. Anthropometric indicators in infancy were significant predictors for growth at the age of 2 years during most periods and at most ages in infancy. Weight-for-age z score, length-for-age z score, and weight-for-length z score at age 12 months had excellent areas under the curve (91-95) to predict the value of the same indicator at age 24 months. Maximum area under the curve values for weight and length velocity were somewhat lower (70-84). CONCLUSIONS Growth measured at one time point in infancy was better correlated with undernutrition at age 2 years than growth velocity.
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Affiliation(s)
- Catherine Schwinger
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Lars T Fadnes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Sanjaya K Shrestha
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Research Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences, Kathmandu, Nepal
| | | | - Ram Krishna Chandyo
- Department of Child Health, Institute of Medicine, Tribuhvan University, Kathmandu, Nepal
| | - Binob Shrestha
- Research Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences, Kathmandu, Nepal
| | - Manjeswori Ulak
- Department of Child Health, Institute of Medicine, Tribuhvan University, Kathmandu, Nepal
| | - Ladaporn Bodhidatta
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Carl Mason
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Tor A Strand
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
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21
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Low mid-upper arm circumference identifies children with a high risk of death who should be the priority target for treatment. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0101-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Zhang R, Undurraga EA, Zeng W, Reyes-García V, Tanner S, Leonard WR, Behrman JR, Godoy RA. Catch-up growth and growth deficits: Nine-year annual panel child growth for native Amazonians in Bolivia. Ann Hum Biol 2016; 43:304-15. [PMID: 27251215 DOI: 10.1080/03014460.2016.1197312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Childhood growth stunting is negatively associated with cognitive and health outcomes, and is claimed to be irreversible after age 2. AIM To estimate growth rates for children aged 2-7 who were stunted (sex-age standardised z-score [HAZ] <-2), marginally-stunted (-2 ≤ HAZ ≤-1) or not-stunted (HAZ >-1) at baseline and tracked annually until age 11; frequency of movement among height categories; and variation in height predicted by early childhood height. SUBJECTS AND METHODS This study used a 9-year annual panel (2002-2010) from a native Amazonian society of horticulturalists-foragers (Tsimane'; n = 174 girls; 179 boys at baseline). Descriptive statistics and random-effect regressions were used. RESULTS This study found some evidence of catch-up growth in HAZ, but persistent height deficits. Children stunted at baseline improved 1 HAZ unit by age 11 and had higher annual growth rates than non-stunted children. Marginally-stunted boys had a 0.1 HAZ units higher annual growth rate than non-stunted boys. Despite some catch up, ∼ 80% of marginally-stunted children at baseline remained marginally-stunted by age 11. The height deficit increased from age 2 to 11. Modest year-to-year movement was found between height categories. CONCLUSIONS The prevalence of growth faltering among the Tsimane' has declined, but hurdles still substantially lock children into height categories.
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Affiliation(s)
| | - Eduardo A Undurraga
- b Heller School for Social Policy and Management, Brandeis University , Waltham , MA , USA ;,c Center for Intercultural and Indigenous Research, Pontificia Universidad Católica de Chile , Santiago de Chile , Chile
| | - Wu Zeng
- b Heller School for Social Policy and Management, Brandeis University , Waltham , MA , USA
| | - Victoria Reyes-García
- d Institució Catalana de Recerca i Estudis Avançats (ICREA) and Institut de Ciència i Tecnologia Ambientals, Universitat Autònoma de Barcelona , Bellaterra , Spain
| | - Susan Tanner
- e Department of Anthropology , University of Georgia , Athens , GA , USA
| | | | - Jere R Behrman
- g Department of Economics and Population Studies Center , University of Pennsylvania , Philadelphia , PA , USA
| | - Ricardo A Godoy
- b Heller School for Social Policy and Management, Brandeis University , Waltham , MA , USA
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Prentice AM, Nabwera H, Unger S, Moore SE. Growth monitoring and the prognosis of mortality in low-income settings. Am J Clin Nutr 2016; 103:681-2. [PMID: 26888709 DOI: 10.3945/ajcn.115.130013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew M Prentice
- Medical Research Council (MRC) Unit, Banjul, The Gambia; MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom;
| | - Helen Nabwera
- Medical Research Council (MRC) Unit, Banjul, The Gambia; MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stefan Unger
- Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom; and
| | - Sophie E Moore
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
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