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Tran LM, Nguyen PH, Young MF, Martorell R, Ramakrishnan U. The relationships between optimal infant feeding practices and child development and attained height at age 2 years and 6-7 years. MATERNAL & CHILD NUTRITION 2024; 20:e13631. [PMID: 38450914 DOI: 10.1111/mcn.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
Limited evidence exists on the long-term effects of early feeding practices on child growth and development. We examined the relationships between infant feeding practices and child height and development at ages 2 and 6-7 years. We studied 885 mother-child dyads from a randomized controlled trial of preconception supplementation in Vietnam. Early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), breastfeeding (BF) duration and minimum dietary diversity (MDD) were assessed using World Health Organization (WHO) guidelines. Child development was assessed by the Bayley Scales of Infant Development-III at 2 years and the Wechsler Intelligence Scale for Children® - IV at 6-7 years. Child height-for-age z-score (HAZ) was calculated from child height and age. Multivariable regression and structural equation models were used in analyses that controlled for confounding. EIBF and EBF at 6 months occurred in 52% and 62% of children, respectively. Mean breastfeeding duration was 18 months and 83% achieved MDD at 1 year. EIBF was associated with motor (β = 0.13, 95% confidence interval [CI]: 0.00, 0.28) and cognitive development at 2 years (β = 0.12, 95% CI: -0.01, 0.26), which in turn were positively associated with cognitive development at 6-7 years. EBF was directly associated with development at 6-7 years (β = 0.21, 95% CI:0.08, 0.34) whereas motor and cognitive development at 2 years explained 41%-75% of the relationship between EIBF and development at 6-7 years. HAZ at 2 years also mediated 70% of the association between MDD at 1 year and HAZ at 6-7 years. BF duration was not associated with child development and HAZ. Early infant feeding practices, especially EIBF and EBF, have important long-term implications for optimizing child linear growth and cognition as they begin school.
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Affiliation(s)
- Lan Mai Tran
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Phuong H Nguyen
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, District of Columbia, USA
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA
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Rice I, Opondo C, Nyesigomwe L, Ekude D, Magezi J, Kalanzi A, Kerac M, Hayes J, Robello M, Halfman S, DeLacey E. Children with disabilities lack access to nutrition, health and WASH services: A secondary data analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13642. [PMID: 38563355 DOI: 10.1111/mcn.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitation and hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy among households with and without children with disabilities in Uganda. We used cross-sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASH and dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55-0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02-1.22, p = 0.012). The proportion of malnourished children was higher among households with children with disabilities than households without it (6.3% vs. 2.4% p < 0.001). There are concerning gaps in access to NaHS services in Uganda, with households with children with disabilities reporting worse access, particularly for those with low WASH adequacy. Improved and inclusive access to NaHS and WASH needs to be urgently prioritized, especially for children with disabilities.
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Affiliation(s)
- Isabel Rice
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, University of London, London, UK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, University of London, London, UK
| | | | - Daniel Ekude
- Holt International-Uganda Office, Kampala, Uganda
| | | | | | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, University of London, London, UK
- London School of Hygiene & Tropical Medicine, Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), University of London, London, UK
| | | | | | | | - Emily DeLacey
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, University of London, London, UK
- London School of Hygiene & Tropical Medicine, Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), University of London, London, UK
- Holt International, Eugene, Oregon, USA
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3
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Mangusho G, Njogu E, Baingana RK, David-Kigaru DM. Vitamin A-related nutrition knowledge gaps and predictors among caregivers of preschool children in Eastern Uganda: a cross-sectional study. BMC Nutr 2024; 10:85. [PMID: 38863006 DOI: 10.1186/s40795-024-00891-5] [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: 03/30/2023] [Accepted: 05/30/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Vitamin A (VA) remains a core micronutrient as VA Deficiency (VAD) in children has persisted as a public health problem in parts of Africa with adverse effects. Caregivers of children are essential in the control of VAD; however, there is a paucity of data on their knowledge of VA, dietary sources, and VAD. This study sought to assess the level of VA-related nutrition knowledge (VANK) and its predictors among caregivers of preschool children in Eastern Uganda. METHODS A cross-sectional analytical design was used. Both socio-demographic and knowledge and attitude (KA) data were collected using a structured questionnaire partly adapted from the FAO model Knowledge, Attitude and Practice (KAP) questionnaire. A sample size of 256 was used. Caregivers of 24-59 months-old children were selected from Bukwo District in Eastern Uganda using purposive and random sampling methods. Knowledge scores (%) based on responses to ten questions were determined and eventually classified as low (≤ 40%) and moderate or high (˃40%). Descriptive and inferential statistics were computed using SPSS (version 24). Logistic regression was used to identify predictors with p < 0.05 considered significant. RESULTS The study had 247 caregivers with a mean age of 30.9 ± 7.7 years. The majority were female (90%), married, subsistence crop farmers and had primary-level education or lower. The mean VANK score was 18.9 ± 24.7%. Overall, most of the caregivers had low VANK as only about 20% had moderate or high. The proportions that knew the different aspects of VANK were correspondingly small. About half of the caregivers (46.6%) knew VA itself and only 27% knew any of its sources. Those who knew VAD, its causes, signs/symptoms and prevention measures were 31, 22, 13 and 24% respectively. The caregivers' VANK was significantly associated with their overall VA-related attitude, age and level of education. However, education and age were the significant predictors. CONCLUSION Caregivers had very low VANK. They barely knew VA and its food sources or VAD. The main predictors of VANK were caregiver age and level of education. The study recommends education of caregivers about VA for effective VAD control which contributes to achievement of the Sustainable Development Goal (SDG) 2.
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Affiliation(s)
- Gilbert Mangusho
- Department of Nutritional Science & Dietetics, Kyambogo University, P.O Box 1, Kyambogo, Kampala, Uganda.
| | - Eunice Njogu
- Department of Food, Nutrition & Dietetics, Kenyatta University, P.O Box 43844-00100, Nairobi, Kenya
| | - Rhona Kezabu Baingana
- Department of Biochemistry & Sports Science, College of Natural Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
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O'Malley SF, Ambikapathi R, Ghosh S, Galvin L, Jeong J, Mosha D, PrayGod G, Mapendo F, Shively G, Murray-Kolb LE, Gunaratna NS. Contribution of Food from Market Purchases and Home Production to Child Nutrient Intake: Evidence from the EFFECTS Study Baseline Data. J Nutr 2024; 154:1907-1916. [PMID: 38608871 DOI: 10.1016/j.tjnut.2024.04.015] [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: 10/17/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Child undernutrition is prevalent in Tanzania, and households rely primarily on local markets and home production as food sources. However, little is known about the contribution of food market purchases to nutrient intakes among children consuming complementary foods. OBJECTIVES To quantify the relationships between diversity of foods purchased and produced by households and adequate child nutrient intake in Mara, Tanzania. METHODS Cross-sectional baseline dietary and household food source data from the Engaging Fathers for Effective Child Nutrition and Development in Tanzania study were collected from mothers of 586 children aged 9-23 mo clustered in 80 villages in Mara, Tanzania. We conducted mixed effects linear regressions to quantify the association between the diversity of foods consumed at home, from market purchases and home production, and nutrient intake adequacy (based on 24-h food recalls). RESULTS Children had inadequate diets, with fewer than half of children consuming adequate amounts of vitamin A, vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B9 (folate), calcium, iron, and zinc. Breastfeeding was associated with higher overall mean adequacy (b = 0.15-0.19 across models, P < 0.001). Diversity of foods purchased was positively associated with the intake of vitamin B12 and calcium (both P < 0.001); this effect was attenuated among breastfed children. Among nonbreastfed children, production diversity was positively associated with vitamin A intake (b=0.04; P < .05) but not with intake of other nutrients. CONCLUSIONS Both household food purchase and food production diversities were positively associated with children's nutrient intake in rural Mara, Tanzania. Nutrition programming should consider the role of food markets in addition to home food production to improve child diets. This trial was registered at clinicaltrials.gov as NCT03759821, https://clinicaltrials.gov/study/NCT03759821.
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Affiliation(s)
- Savannah F O'Malley
- Department of Public Health, Purdue University, West Lafayette, IN, United States; Department of Nutrition Science, Purdue University, West Lafayette, IN, United States.
| | - Ramya Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, United States; Department of Global Development, Cornell University, Ithaca, NY, United States
| | - Susmita Ghosh
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Lauren Galvin
- Global Communities, Program Quality and Accountability Department, Silver Spring, MD, United States
| | - Joshua Jeong
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Dominic Mosha
- Department of Global Health, BeVera Solutions LLC, Riverdale, GA, United States
| | - George PrayGod
- National Institute for Medical Research, Muhimbili Medical Research Centre, Tanzania
| | - Frank Mapendo
- Africa Academy for Public Health, Research and Program Unit, Tanzania
| | - Gerald Shively
- Department of Agricultural Economics, Purdue University, West Lafayette, IN, United States
| | - Laura E Murray-Kolb
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Nilupa S Gunaratna
- Department of Public Health, Purdue University, West Lafayette, IN, United States
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Kofi Amegah A, Ayinemi R, Sewor C, Fenta HM, Yeboah K, Mohammed SA, Dwomoh D, Annim SK, Stranges S, Kandala NB. Birth weight mediates the association of maternal undernutrition with child undernutrition prevalence in West Africa. Eur J Clin Nutr 2024:10.1038/s41430-024-01453-5. [PMID: 38806645 DOI: 10.1038/s41430-024-01453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Maternal nutritional status before and during pregnancy is an important determinant of foetal health. In West Africa, maternal and child undernutrition remains a major public health problem and it is important to establish the mechanistic pathway linking the two disorders to help address the problem. We therefore assessed the mediating role of low birth weight (LBW) in the relationship of maternal undernutrition with child undernutrition in West Africa. METHODS We included recent (2010-2019) DHS data from thirteen West African countries. Poisson regression model with robust standard errors was used to assess the relationship between maternal undernutrition (body mass index and anaemia) and child undernutrition (stunting, wasting, underweight, and anaemia). Structural equation modelling was used to conduct the mediation analysis. RESULTS Prevalence of stunting, wasting, underweight, and anaemia among under-five children in West Africa was found to be 32.4%, 8.1%, 20.1%, and 71.5%, respectively. We found children of underweight mothers to be more likely to be undernourished (stunted, wasted, and underweight) and anaemic compared to children of normal-weight mothers. Also, children of anaemic mothers were more likely to be stunted and anaemic but not wasted compared with children of non-anaemic mothers. LBW mediated the observed relationships between maternal BMI and childhood stunting (22.6%), and maternal anaemia and childhood stunting (24.9%), wasting (11.7), and anaemia (6.6%). CONCLUSION We found maternal undernutrition to be associated with child undernutrition in West Africa with LBW noted to be a mediator of the observed relationship. We recommend that, to address the child undernutrition problem in West Africa, governments and policymakers must integrate measures to address the burden of LBW.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Roland Ayinemi
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Christian Sewor
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - Kelvin Yeboah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Seidu Awal Mohammed
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Samuel K Annim
- Department of Applied Economics, School of Economics, University of Cape Coast, Cape Coast, Ghana
- Ghana Statistical Service, Head Office Building, P.O. Box GP1098, Finance Close, Accra, Ghana
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Ngianga-Bakwin Kandala
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- University of the Witwatersrand, Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa
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6
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Tharumakunarajah R, Lee A, Hawcutt DB, Harman NL, Sinha IP. The Impact of Malnutrition on the Developing Lung and Long-Term Lung Health: A Narrative Review of Global Literature. Pulm Ther 2024:10.1007/s41030-024-00257-z. [PMID: 38758409 DOI: 10.1007/s41030-024-00257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Worldwide, over 2 billion children under the age of 5 experience stunting, wasting, or are underweight. Malnutrition contributes to 45% of all deaths in this age group (approximately 3.1 million deaths) [1]. Poverty, food insecurity, suboptimal feeding practices, climate change, and conflict are all contributing factors. Malnutrition causes significant respiratory problems, including increased risk of respiratory infections, impaired lung function, and increased risk of subsequent adult respiratory disease, including asthma, COPD, and lung cancer. Childhood malnutrition not only has serious consequences for children's health but it also has numerous consequences on wellbeing and educational attainment. Childhood malnutrition is a complex and multifaceted problem. However, by understanding and addressing the underlying causes, and investing in prevention and treatment programs, it is possible to maximize children's health and wellbeing on a global scale. This narrative review will focus on the impact of childhood malnutrition on lung development, the consequent respiratory disease, and what actions can be taken to reduce the burden of malnutrition on lung health.
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Affiliation(s)
- Ramiyya Tharumakunarajah
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Health Data Science, University of Liverpool, Institute of Population Health, Block F Waterhouse Building, Liverpool, UK
| | - Alice Lee
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Department of Respiratory Paediatrics, Alder Hey Children's Hospital, Liverpool, UK
| | - Daniel B Hawcutt
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, UK
| | - Nicola L Harman
- Health Data Science, University of Liverpool, Institute of Population Health, Block F Waterhouse Building, Liverpool, UK
| | - Ian P Sinha
- Department of Respiratory Paediatrics, Alder Hey Children's Hospital, Liverpool, UK.
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Fivian E, Parida M, Harris-Fry H, Mohanty S, Padhan S, Pradhan R, Das P, Odhiambo G, Prost A, Roopnaraine T, Behera S, James P, Mishra NK, Rath S, Nair N, Rath S, Koniz-Booher P, Danton H, Allen E, Kadiyala S. Feasibility, acceptability and equity of a mobile intervention for Upscaling Participatory Action and Videos for Agriculture and Nutrition (m-UPAVAN) in rural Odisha, India. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003206. [PMID: 38743726 DOI: 10.1371/journal.pgph.0003206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/14/2024] [Indexed: 05/16/2024]
Abstract
Addressing undernutrition requires strategies that remove barriers to health for all. We adapted an intervention from the 'UPAVAN' trial to a mobile intervention (m-UPAVAN) during the COVID-19 pandemic in rural Odisha, India. In UPAVAN, women's groups viewed and discussed participatory videos on nutrition-specific and nutrition-sensitive agricultural (NSA) topics. In m-UPAVAN, weekly videos and audios on the same topics were disseminated via WhatsApp and an interactive voice response system. We assessed feasibility, acceptability, and equity of m-UPAVAN using a convergent parallel mixed-methods design. m-UPAVAN ran from Mar-Sept 2021 in 133 UPAVAN villages. In Feb-Mar 2021, we invited 1000 mothers of children aged 0-23 months to participate in a sociodemographic phone survey. Of those, we randomly sampled 200 mothers each month for five months for phone surveys to monitor progress against targets. Feasibility targets were met if >70% received videos/audios and >50% watched/listened at least once. Acceptability targets were met if >75% of those watching/listening liked the videos/audios and <20% opted out of the intervention. We investigated mothers' experiences of the intervention, including preferences for m-UPAVAN versus UPAVAN, using in-person, semi-structured interviews (n = 38). Of the 810 mothers we reached, 666 provided monitoring data at least once. Among these mothers, feasibility and acceptability targets were achieved. m-UPAVAN engaged whole families, which facilitated family-level discussions around promoted practices. Women valued the ability to access m-UPAVAN content on demand. This advantage did not apply to many mothers with limited phone access. Mothers highlighted that the UPAVAN interventions' in-person participatory approaches and longer videos were more conducive to learning and inclusive, and that mobile approaches provide important complementarity. We conclude that mobile NSA interventions are feasible and acceptable, can engage families, and reinforce learning. However, in-person participatory approaches remain essential for improving equity of NSA interventions. Investments are needed in developing and testing hybrid NSA interventions.
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Affiliation(s)
- Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT), Kendrapara, India
| | | | - Pranay Das
- DCOR Consulting Pvt. Ltd., Bhubaneswar, India
| | - Gladys Odhiambo
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Audrey Prost
- Institute for Global Health, University College London, London, United Kingdom
| | | | | | - Philip James
- Emergency Nutrition Network (ENN), Oxford, United Kingdom
| | - Naba Kishor Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology (VARRAT), Kendrapara, India
| | | | | | | | - Peggy Koniz-Booher
- JSI Research & Training Institute, Inc. Arlington, Virginia, United States of America
| | - Heather Danton
- JSI Research & Training Institute, Inc. Arlington, Virginia, United States of America
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Zavala E, Mohan D, Ali H, Siddiqua TJ, Haque R, Ayesha K, Ahsan KB, Sujan HM, Khaled N, Rahman A, Chakraborty B, Dyer B, Wu LSF, Kalbarczyk A, Erchick DJ, Thorne-Lyman AL, Tumilowicz A, Afsana K, Christian P. Targeting strategies for balanced energy and protein (BEP) supplementation in pregnancy: study protocol for the TARGET-BEP cluster-randomized controlled trial in rural Bangladesh. Trials 2024; 25:315. [PMID: 38741174 DOI: 10.1186/s13063-024-08135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this threshold, however, and a large proportion of undernourished women and those with inadequate gestational weight gain could miss benefiting from BEP. This study compares the effectiveness of individual targeting approaches for supplementation with micronutrient-fortified BEP vs. multiple micronutrient supplements (MMS) alone as control in pregnancy in improving birth outcomes. METHODS The TARGET-BEP study is a four-arm, cluster-randomized controlled trial conducted in rural northwestern Bangladesh. Eligible participants are married women aged 15-35 years old identified early in pregnancy using a community-wide, monthly, urine-test-based pregnancy detection system. Beginning at 12-14 weeks of gestation, women in the study area comprising 240 predefined sectors are randomly assigned to one of four intervention arms, with sector serving as the unit of randomization. The interventions involving daily supplementation through end of pregnancy are as follows: (1) MMS (control); (2) BEP; (3) targeted BEP for those with pre-pregnancy body mass index (BMI) < 18.5 kg/m2 and MMS for others; (4) targeted BEP for those with pre-pregnancy BMI < 18.5 kg/m2, MMS for others, and women with inadequate gestational weight gain switched from MMS to BEP until the end of pregnancy. Primary outcomes include birth weight, low birth weight (< 2500 g), and small for gestational age, defined using the 10th percentile of the INTERGROWTH-21st reference, for live-born infants measured within 72 h of birth. Project-hired local female staff visit pregnant women monthly to deliver the assigned supplements, monitor adherence biweekly, and assess weight regularly during pregnancy. Trained data collectors conduct pregnancy outcome assessment and measure newborn anthropometry in the facility or home depending on the place of birth. DISCUSSION This study will assess the effectiveness of targeted balanced energy and protein supplementation to improve birth outcomes among pregnant women in rural Bangladesh and similar settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05576207. Registered on October 5th, 2022.
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Affiliation(s)
- Eleonor Zavala
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Diwakar Mohan
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | | | | | | | | | - Nazrana Khaled
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Atiya Rahman
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Brian Dyer
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Lee S F Wu
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Anna Kalbarczyk
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Daniel J Erchick
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Andrew L Thorne-Lyman
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Kaosar Afsana
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
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9
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Jugha VT, Anchang JA, Sofeu-Feugaing DD, Taiwe GS, Kimbi HK, Anchang-Kimbi JK. Dietary micronutrients intake and its effect on haemoglobin levels of pregnant women for clinic visit in the Mount Cameroon health area: a cross-sectional study. Front Nutr 2024; 11:1341625. [PMID: 38774262 PMCID: PMC11106498 DOI: 10.3389/fnut.2024.1341625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/10/2024] [Indexed: 05/24/2024] Open
Abstract
Background Nutritional deficiencies and its consequences such as anaemia are frequent among pregnant women residing in under resource settings. Hence, this study sought to investigate specific dietary micronutrient inadequacy and its effect on maternal haemoglobin levels. Methods This institution based cross-sectional survey enrolled 1,014 consenting pregnant women consecutively. Data on socio-demographic, economic and antenatal characteristics were recorded using a structured questionnaire. Minimum dietary diversity for women (MDD-W) was assessed using the 24-h recall method and haemoglobin (Hb) concentration (g/dL) determined using a portable Hb metre. Significant levels between associations was set at p < 0.05. Results Among those enrolled, 40.9% were anaemic while 89.6% had inadequate dietary nutrient intake. In addition, uptake of blood supplements, haem iron, plant and animal-based foods rich in vitamin A were 71.5, 86.2, 35.5 and 12.6%, respectively. Moreover, anaemia prevalence was significantly (p < 0.05) lower in women who took iron-folic acid along with food groups rich in haem iron (38.5%) or both plant and animal vitamin A (29.0%). Besides, mean maternal Hb levels was significantly (p < 0.001) higher in women who consumed haem iron (11.08 ± 1.35) and vitamin A food groups (11.34 ± 1.30) when compared with their counterparts who did not consume haem iron (10.54 ± 1.19) and vitamin A food groups (10.74 ± 1.31). Conclusion Dietary uptake of foods rich in haem-iron and vitamin A significantly improves Hb levels in Cameroonian pregnant women. Our findings underscore the importance of improving maternal nutritional awareness and counselling during antenatal period to reduce the anaemia burden.
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Affiliation(s)
- Vanessa Tita Jugha
- Department of Animal Biology and Conservation, University of Buea, Buea, Cameroon
| | - Juliana Adjem Anchang
- International Centre for Agricultural Research in the Dry Areas, ICARDA, Cairo, Egypt
| | | | | | - Helen Kuokuo Kimbi
- Department of Animal Biology and Conservation, University of Buea, Buea, Cameroon
- Department of Biomedical Sciences, University of Bamenda, Bamenda, Cameroon
- Department of Microbiology and Immunology, College of Medicine, Drexel University, Philadelphia, PA, United States
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10
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Fivian E, Harris-Fry H, Offner C, Zaman M, Shankar B, Allen E, Kadiyala S. The Extent, Range, and Nature of Quantitative Nutrition Research Engaging with Intersectional Inequalities: A Systematic Scoping Review. Adv Nutr 2024; 15:100237. [PMID: 38710327 DOI: 10.1016/j.advnut.2024.100237] [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: 12/08/2023] [Revised: 03/10/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024] Open
Abstract
Addressing malnutrition for all requires understanding inequalities in nutrition outcomes and how they intersect. Intersectionality is increasingly used as a theoretical tool for understanding how social characteristics intersect to shape inequalities in health outcomes. However, little is known about the extent, range, and nature of quantitative nutrition research engaging with intersectional inequalities. This systematic scoping review aimed to address this gap. Between 15 May 2021 and 15 May 2022, we searched 8 databases. Studies eligible for inclusion used any quantitative research methodology and aimed to investigate how social characteristics intersect to influence nutrition outcomes. In total, 55 studies were included, with 85% published since 2015. Studies spanned populations in 14 countries but were concentrated in the United States (n = 35) and India (n = 7), with just 1 in a low-income country (Mozambique). Race or ethnicity and gender were most commonly intersected (n = 20), and body mass index and overweight and/or obesity were the most common outcomes. No studies investigated indicators of infant and young child feeding or micronutrient status. Study designs were mostly cross-sectional (80%); no mixed-method or interventional research was identified. Regression with interaction terms was the most prevalent method (n = 26); 2 of 15 studies using nonlinear models took extra steps to assess interaction on the additive scale, as recommended for understanding intersectionality and assessing public health impacts. Nine studies investigated mechanisms that may explain why intersectional inequalities in nutrition outcomes exist, but intervention-relevant interpretations were mostly limited. We conclude that quantitative nutrition research engaging with intersectionality is gaining traction but is mostly limited to the United States and India. Future research must consider the intersectionality of a wider spectrum of public health nutrition challenges across diverse settings and use more robust and mixed-method research to identify specific interventions for addressing intersectional inequalities in nutrition outcomes. Data systems in nutrition must improve to facilitate this. This review was registered in PROSPERO as CRD42021253339.
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Affiliation(s)
- Emily Fivian
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Helen Harris-Fry
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Offner
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michele Zaman
- Department of Medicine, Queen's University, Ontario, Canada
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, United Kingdom
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Tugume P, Mustafa AS, Walusansa A, Ojelel S, Nyachwo EB, Muhumuza E, Nampeera M, Kabbale F, Ssenku JE. Unravelling taboos and cultural beliefs associated with hidden hunger among pregnant and breast-feeding women in Buyende district Eastern Uganda. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2024; 20:46. [PMID: 38693532 PMCID: PMC11064283 DOI: 10.1186/s13002-024-00682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/29/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Food taboos and cultural beliefs among pregnant and breast-feeding women influence their food consumption patterns and hence the health of women and unborn children. Cognizant of their neglect in programs aimed to ameliorate hidden hunger among pregnant and breast-feeding women in Buyende and other resource-poor communities in sub-Saharan Africa, we opted for a study to unravel them to inform program design. METHODS We documented food taboos and beliefs amongst pregnant and breast-feeding women from six sub-counties of Buyende district in Eastern Uganda. A mixed-methods approach was used, which was comprised of questionnaire interviews with 462 women, eight focus group discussions with 6-10 participants in each and a total of 15 key informant interviews. RESULTS The present study revealed that 129 (27.9%) of the respondents practice food taboos and adhere to cultural beliefs related to their dietary habits during pregnancy and breast-feeding that are fuelling the prevalence of hidden hunger. The most tabooed foods during pregnancy were sugarcane (17.8%), fishes which included lung fish, catfish and the Lake Victoria sardine (Rastrineobola argentea) (15.2%), oranges (6.6%), pineapples (5.9%), eggs (3.3%), chicken (3.3%) and cassava, mangoes and Cleome gynandra (each at 3%). Most foods were avoided for reasons associated with pregnancy and labour complications and undesirable effects on the baby. Most women learnt of the taboos and beliefs from the elders, their own mother, grandparents or mother-in-law, but there was also knowledge transmission in social groups within the community. CONCLUSIONS The taboos and cultural beliefs in the study area render pregnant and breast-feeding women prone to micronutrient deficiency since they are denied consumption of a diversity of nutritious foods. There is a need to educate such women about consumption of nutrient-rich foods like fish, eggs, fruits and vegetables in order to improve their health, that of the unborn and children being breast fed. Additionally, culturally appropriate nutrition education may be a good strategy to eliminate inappropriate food taboos and beliefs with negative impact on the health of pregnant and breast-feeding women.
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Affiliation(s)
- Patience Tugume
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Abubakar Sadik Mustafa
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Abdul Walusansa
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
- Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P. O. Box 7689, Kampala, Uganda
| | - Samuel Ojelel
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Evelyne B Nyachwo
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Emmanuel Muhumuza
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Maria Nampeera
- Department of Health Nutrition, Buyende District Local Government, P. O. Box 87, Kamuli, Uganda
| | - Fredrick Kabbale
- Directorate of Research and Quality Assurance, Busoga University, P. O. Box 154, Iganga, Uganda
- Department of Production, Buyende District Local Government, P. O. Box 87, Kamuli, Uganda
| | - Jamilu E Ssenku
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda.
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12
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Wang D, Shifraw T, Costa JC, Abdelmenan S, Tsegaye S, Berhane Y, Gulema H, Berhane H, Fasil N, Workneh F, Tarekegn W, Wang M, Menzies NA, Worku A, Berhane Y, Fawzi WW. Targeting strategies of antenatal balanced energy and protein supplementation in Addis Ababa, Ethiopia: study protocol for a randomized effectiveness study. Trials 2024; 25:291. [PMID: 38689304 PMCID: PMC11059725 DOI: 10.1186/s13063-024-08002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Antenatal balanced energy and protein (BEP) supplements have well-documented benefits for pregnancy outcomes. However, considerable practical gaps remain in the effective and cost-effective delivery of antenatal BEP supplements at scale in low- and middle-income countries. METHODS A randomized effectiveness study will be conducted in two sub-cities of Addis Ababa, Ethiopia, to evaluate the effectiveness, cost-effectiveness, and implementation of different targeting strategies of antenatal BEP supplements. Pregnant women aged 18 to 49, with a gestational age of 24 weeks or less, and attending antenatal visits in one of the nine study health facilities are eligible for enrollment. In six of the health facilities, participants will be randomized to one of three study arms: control (Arm 1), targeted BEP provision based on baseline nutritional status (Arm 2), and targeted BEP supplementation based on baseline nutritional status and monthly gestational weight gain (GWG) monitoring (Arm 3). In the remaining three facilities, participants will be assigned to universal BEP provision (Arm 4). Participants in Arms 2 and 3 will receive BEP supplements if they have undernutrition at enrollment, as defined by a baseline body mass index less than 18.5 kg/m2 or mid-upper arm circumference less than 23 cm. In Arm 3, in addition to targeting based on baseline undernutrition, regular weight measurements will be used to identify insufficient GWG and inform the initiation of additional BEP supplements. Participants in Arm 4 will receive BEP supplements until the end of pregnancy, regardless of baseline nutritional status or GWG. All participants will receive standard antenatal care, including iron and folic acid supplementation. A total of 5400 pregnant women will be enrolled, with 1350 participants in each arm. Participants will be followed up monthly during their visits to the antenatal facilities until delivery. Maternal and infant health status will be evaluated within 72 h after delivery and at 6 weeks postpartum. The effectiveness and cost-effectiveness of the different BEP targeting strategies in preventing adverse pregnancy outcomes will be compared across arms. Qualitative data will be analyzed to assess the feasibility, acceptability, and implementation of different supplementation strategies. DISCUSSION This study will inform global recommendations and operational guidelines for the effective and cost-effective delivery of antenatal BEP supplements. The targeted approaches have the potential for broader scale-up in Ethiopia and other low-resource settings with a high burden of undernutrition among pregnant women. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT06125860. Registered November 9, 2023.
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Affiliation(s)
- Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 1, Room 1108, Boston, MA, 02115, USA
| | - Tigest Shifraw
- Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Janaina Calu Costa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 1, Room 1108, Boston, MA, 02115, USA
| | - Semira Abdelmenan
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sitota Tsegaye
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yoseph Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Gulema
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Berhane
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Nebiyou Fasil
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Firehiwot Workneh
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Workagegnhu Tarekegn
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 1, Room 1108, Boston, MA, 02115, USA
| | - Alemayehu Worku
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Building 1, Room 1108, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
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13
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Chapman AJ, Ebido CC, Tening RN, Huang Y, Sougou NM, Kolopaking R, Diallo AH, Anggorowati R, Dial FB, Massonnié J, Firoozmand M, Niang CEHA, Harder MK. Creating culturally-informed protocols for a stunting intervention using a situated values-based approach (WeValue InSitu): a double case study in Indonesia and Senegal. BMC Public Health 2024; 24:987. [PMID: 38589810 PMCID: PMC11003100 DOI: 10.1186/s12889-024-18485-y] [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: 09/27/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
International development work involves external partners bringing expertise, resources, and management for local interventions in LMICs, but there is often a gap in understandings of relevant local shared values. There is a widespread need to better design interventions which accommodate relevant elements of local culture, as emphasised by recent discussions in global health research regarding neo-colonialism. One recent innovation is the concept of producing 'cultural protocols' to precede and guide community engagement or intervention design, but without suggestions for generating them. This study explores and demonstrates the potential of an approach taken from another field, named WeValue InSitu, to generate local culturally-informed protocols. WeValue InSitu engages stakeholder groups in meaning-making processes which 'crystallize' their envelope of local shared values, making them communicable to outsiders.Our research context is understanding and reducing child stunting, including developing interventions, carried out at the Senegal and Indonesia sites of the UKRI GCRF Action Against Stunting Hub. Each national research team involves eight health disciplines from micro-nutrition to epigenetics, and extensive collection of samples and questionnaires. Local culturally-informed protocols would be generally valuable to pre-inform engagement and intervention designs. Here we explore generating them by immediately following the group WeValue InSitu crystallization process with specialised focus group discussions exploring: what local life practices potentially have significant influence on the environments affecting child stunting, and which cultural elements do they highlight as relevant. The discussions will be framed by the shared values, and reveal linkages to them. In this study, stakeholder groups like fathers, mothers, teachers, market traders, administrators, farmers and health workers were recruited, totalling 83 participants across 20 groups. Themes found relevant for a culturally-informed protocol for locally-acceptable food interventions included: specific gender roles; social hierarchies; health service access challenges; traditional beliefs around malnutrition; and attitudes to accepting outside help. The concept of a grounded culturally-informed protocol, and the use of WeValue InSitu to generate it, has thus been demonstrated here. Future work to scope out the advantages and limitations compared to deductive culture studies, and to using other formative research methods would now be useful.
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Affiliation(s)
- Annabel J Chapman
- Values & Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, Brighton, UK
| | - Chike C Ebido
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People's Republic of China
- Department of Zoology and Environmental Biology, University of Nigeria, Nsukka, Nigeria
| | - Rahel Neh Tening
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People's Republic of China
| | - Yanyan Huang
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People's Republic of China
| | - Ndèye Marème Sougou
- Preventive Medicine and Public Health, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Risatianti Kolopaking
- Faculty of Psychology, Universitas Islam Negeri Syarif Hidayatullah, Jakarta, Indonesia
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO RECFON) Universitas Indonesia, Jakarta, Indonesia
| | - Amadou H Diallo
- International Research Laboratory (IRL 3189) Environnement santé et sociétés/CNRS/UCAD, Dakar, Senegal
| | - Rita Anggorowati
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO RECFON) Universitas Indonesia, Jakarta, Indonesia
- Department of Medical Records and Health Information, Faculty of Health and Technology, Universitas Bandung, Bandung, Indonesia
| | - Fatou B Dial
- Laboratory of Cultural Anthropology, IFAN, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Jessica Massonnié
- School of Education, Languages and Linguistics, Faculty of Humanities and Social Sciences, University of Portsmouth, Portsmouth, UK
- Department of Learning and Leadership, IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Mahsa Firoozmand
- Values & Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, Brighton, UK
| | | | - Marie K Harder
- Values & Sustainability Research Group, School of Architecture, Technology and Engineering, University of Brighton, Brighton, UK.
- Department of Environmental Science and Engineering, Fudan University, Shanghai, People's Republic of China.
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14
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Chagwena DT, Fernando S, Tavengwa NV, Sithole S, Nyachowe C, Njovo H, Datta K, Brown T, Humphrey JH, Prendergast AJ, Smith LE. Formulation and acceptability of local nutrient-dense foods for young children: A formative study for the Child Health, Agriculture and Integrated Nutrition (CHAIN) Trial in rural Zimbabwe. MATERNAL & CHILD NUTRITION 2024; 20:e13605. [PMID: 38093409 PMCID: PMC10981484 DOI: 10.1111/mcn.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 04/01/2024]
Abstract
Stunting affects almost one-quarter of children globally, leading to reduced human capacity and increased long-term risk of chronic disease. Despite intensive infant and young child feeding (IYCF) interventions, many children do not meet their requirements for essential nutrients. This study aimed to assess the feasibility of implementing an IYCF intervention utilizing nutrient-dense powders from egg, biofortified sugar beans and Moringa oleifera leaf in rural Zimbabwe. A mixed-methods formative study was conducted comprising the following: (i) a recipe formulation trial, (ii) trials of improved practices to assess acceptability of the intervention, and (iii) a participatory message formulation process to develop counselling modules for the IYCF-plus intervention. Twenty-seven mother-baby pairs were recruited between November 2019 and April 2020. Key domains affecting IYCF practices that emerged were time, emotional and physical space, cultural and religious beliefs, indigenous knowledge systems and gender dynamics. Household observations and sensory evaluation indicated high acceptability of the new ingredients. Recipe formulation and participatory message formulation by participants instilled community ownership and served to demystify existing misconceptions about the new food products. Families noted the potential for intervention sustainability because the foods could be grown locally. Supplementing complementary foods with nutrient-dense local food ingredients as powders has the potential to sustainably address nutrient-gaps in the diets of young children living in rural lower- and middle-income countries. Comprehensive IYCF counselling utilizing a gender-lens approach, family support and indigenous knowledge systems or resources are key elements to support positive behaviour change in complementary feeding interventions.
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Affiliation(s)
- Dexter T. Chagwena
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Ministry of Health and Child CareHarareZimbabwe
- School of GeographyQueen Mary University of LondonLondonUK
| | - Shamiso Fernando
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | - Naume V. Tavengwa
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | | | | | | | - Kavita Datta
- School of GeographyQueen Mary University of LondonLondonUK
| | - Tim Brown
- School of GeographyQueen Mary University of LondonLondonUK
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- School of GeographyQueen Mary University of LondonLondonUK
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Laura E. Smith
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Department of Public and Ecosystem HealthCornell UniversityIthacaNew YorkUSA
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15
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Patriota ÉSO, Abrantes LCS, Figueiredo ACMG, Pizato N, Buccini G, Gonçalves VSS. Association between household food insecurity and stunting in children aged 0-59 months: Systematic review and meta-analysis of cohort studies. MATERNAL & CHILD NUTRITION 2024; 20:e13609. [PMID: 38196291 PMCID: PMC10981479 DOI: 10.1111/mcn.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/17/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition-related chronic diseases in adulthood. Our study aimed to systematically review and conduct a meta-analysis of cohort studies investigating the association between HFI and stunting in children aged 0-59 months. Peer-reviewed and grey literature were systematically searched in electronic databases with no language or date restrictions. Two reviewers independently assessed the studies for pre-established eligibility criteria. Data were extracted using a standard protocol. Random-effects meta-analysis models were used, and I2 > 40% indicated high heterogeneity across studies. We used the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of the evidence. Nine cohort studies comprising 46,300 children were included. Approximately 80% (n = 7) of the studies found a positive association between HFI and stunting. Pooled odds ratio was 1.00 (95% confidence interval [CI]: 0.87-1.14; I2: 76.14%). The pooled hazard ratio between moderate and severe HFI and stunting was 1.02 (95% CI: 0.84-1.22; I2: 85.96%). Due to high heterogeneity, the quality of evidence was very low. Individual studies showed an association between HFI and stunting in children aged 0-59 months; however, this association was not sustained in the pooled analysis, possibly because of high heterogeneity across studies.
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Affiliation(s)
- Érika S. O. Patriota
- Graduate Program in Public Health, Faculty of Health SciencesUniversity of BrasíliaBrasiliaDistrito FederalBrazil
| | - Lívia C. S. Abrantes
- Department of Nutrition and HealthGraduate Program in Nutrition Science, Federal University of Viçosa (UFV)ViçosaBrazil
| | - Ana C. M. G. Figueiredo
- Epidemiology Surveillance, Federal District Health State DepartmentBrasíliaFederal DistrictBrazil
| | - Nathalia Pizato
- Graduate Program in Human Nutrition, Faculty of Health SciencesUniversity of BrasíliaBrasiliaDistrito FederalBrazil
| | - Gabriela Buccini
- Department of Social and Behavioral HealthUniversity of NevadaLas VegasUSA
| | - Vivian S. S. Gonçalves
- Graduate Program in Public Health, Faculty of Health SciencesUniversity of BrasíliaBrasiliaDistrito FederalBrazil
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Wu L, Wang J, Lu Y, Huang Y, Zhang X, Ma D, Xiao Y, Cao F. Association of intimate partner violence with offspring growth in 32 low- and middle-income countries: a population-based cross-sectional study. Arch Womens Ment Health 2024; 27:179-190. [PMID: 37947903 DOI: 10.1007/s00737-023-01387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Intimate partner violence (IPV) against women presents a major public health challenge, especially in low-income and middle-income countries (LMICs), and its relationship with poor offspring growth is emerging but remains understudied. This study aimed to explore the impact of maternal exposure to IPV on offspring growth based on different approaches in LMICs. We conducted a population-based cross-sectional study using the most recent Demographic and Health Surveys from 32 LMICs; 81,652 mother-child dyads comprising women aged from 15 to 49 years with children aged 0 to 59 months were included. We applied logistic regression models to explore the independent and cumulative relationship between IPV, including emotional, physical, and sexual IPV, with poor child growth status, including stunting and wasting; 52.6% of mothers were under the age of 30 years with a 36% prevalence of any lifetime exposure to IPV. Maternal exposure to any IPV increased the odds of stunting, but only physical and sexual IPV were independently associated with an increased risk of stunting. Three different types of IPV exhibited a cumulative effect on stunting. Maternal exposure to physical IPV was significantly associated with an increased risk of wasting. Significant associations between maternal exposure to emotional IPV with offspring stunting and physical IPV with wasting were only observed in children aged 0 to 36 months. IPV against women remains high in LMICs and has adverse effects on offspring growth. Policy and program efforts are needed to prioritize the reduction of widespread physical and sexual IPV and to mitigate the impact of such violence.
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Affiliation(s)
- Liuliu Wu
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Juan Wang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital and School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, 310058, People's Republic of China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, 1369 West Wenyi Road, Hangzhou, 311121, People's Republic of China
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, 310058, People's Republic of China
| | - Yan'e Lu
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Yongqi Huang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Xuan Zhang
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Dandan Ma
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Yiping Xiao
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China
| | - Fenglin Cao
- Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, Shandong, 250012, People's Republic of China.
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Sansone NMS, Vitta E, Siqueira BA, Marson FAL. Overview of the Indigenous health of the Yanomami ethnic group in Brazil: A Public Health Emergency. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01978-2. [PMID: 38532175 DOI: 10.1007/s40615-024-01978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The Indigenous population of the Yanomami ethnic group in Brazil is currently facing a public health emergency due to the high number of deaths, mainly of children. Taking that into consideration, this study aims to analyze this crisis impact on the health of this population in the period between 2018 and 2022. METHODS The data presented were collected from the report called Yanomami Mission ("Missão Yanomami") published by the Brazilian Ministry of Health and, from it, a descriptive analysis of the Indigenous individuals' health was carried out for (i) the geographical distribution; ii) the number of deaths; (iii) the child death rate; (iv) the deaths of Indigenous individuals from preventable causes; (v) the causes of preventable diseases related to hygiene and basic sanitation, and the distribution of diarrheal diseases according to age groups; (vi) evaluation of the nutritional classification; vii) the percentage (%) of the complete vaccination scheme, and (viii) the coverage of prenatal appointments of Indigenous pregnant women. RESULTS The report included 31,017 individuals belonging to the Yanomami ethnic group, most of the participants were up to 39 years old (N = 26,377; 85.0%) and men (N = 15,836; 51.1%). During the period described in the report, the number of deaths reached 1285/31,017 (4.1%). When analyzing the deaths, the most representative age groups were those of children under 1 year old (505/1285; 39.9%), from 1 to 4 years old (178/1285; 13.8%), and the elderly from 60 to 79 years old (150/1285; 11.6%). The Indigenous individuals from this ethnic group presented a child death rate ~ 1.5 to 3.5 higher than that of the total Indigenous population in the country. Regarding the child death rate, the neonatal component represented 57.8% of the deaths and, in 2022, 93.0% of the pregnant women had less than six prenatal appointments. This population shows a high number of deaths due to preventable causes (N = 538) and cases of illnesses associated with hygiene and sanitation, for example (N = 35,103 cases/notifications). As for vaccination, the full vaccination scheme targeting children below 5 years old has not been met since 2018. CONCLUSION In the Indigenous population of the Yanomami ethnic group, a high number of deaths was observed, which affected mainly individuals under 1 year old. Among the factors associated with the deaths, mainly in children under 5 years old, most cases have preventable causes, which could be reduced by proper action promoting their health and preventing diseases.
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Affiliation(s)
| | - Eduarda Vitta
- Molecular Biology and Genetics Laboratory, University of São Francisco, Bragança Paulista, São Paulo, Brazil
| | - Bianca Aparecida Siqueira
- Molecular Biology and Genetics Laboratory, University of São Francisco, Bragança Paulista, São Paulo, Brazil
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Korir J, Oldewage-Theron W, Mugambi G, Gichohi-Wainaina WN. Utilising emerging perspectives at the global and regional level to frame multisectoral nutrition governance landscape in Kenya. Public Health Nutr 2024; 27:e99. [PMID: 38504549 PMCID: PMC10993066 DOI: 10.1017/s1368980024000727] [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: 10/24/2023] [Revised: 01/29/2024] [Accepted: 03/12/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE Multisectoral nutrition governance (MNG) is a vital enabling determinant of improved nutrition outcomes. Despite this, it remains to be a complex phenomenon that lacks adequate understanding, especially in developing countries like Kenya. This narrative review aims to discuss the evolution of MNG, the current state of MNG, barriers and challenges, and based on these identify entry points for improvement within the complex governance structure in Kenya. DESIGN The Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to ensure rigorous and transparent identification of literature and interpretation. SETTING Kenya and developing countries with similar contexts. PARTICIPANTS The review included forty-five documents (peer-reviewed articles and grey literature) that reported on MNG in developing countries. RESULTS We acknowledge that MNG is a complex and evolving determinant of better nutrition outcomes. The paper highlights challenges Kenya and other developing countries face such as inadequate leadership, inadequate coordination, insufficient capacity, inadequate monitoring and evaluation systems, and limited financial resources, among others. For Kenya in particular, there is inadequate understanding of what MNG is and how it can be effectively operationalised and tracked. CONCLUSIONS To enhance understanding of MNG in Kenya, a country-specific assessment of MNG processes and impact outcomes using standard tools and defined metrics is vital. Such assessment will generate evidence of progress, successes, and challenges that will compel the government and stakeholders to invest more in multisectoral nutrition approaches to achieve its nutrition goals.
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Affiliation(s)
- Jacob Korir
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX79409, USA
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX79409, USA
| | - Gladys Mugambi
- Division of Health Promotion and Education, Ministry of Health, Nairobi, Kenya
| | - Wanjiku N Gichohi-Wainaina
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX79409, USA
- WorldFish, Jalan Batu Maung, 11960 Bayan Lepas, Penang, Malaysia
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Yang Z, Chang S. Accelerating the progress of low birthweight reduction. Lancet 2024; 403:1003-1005. [PMID: 38430920 DOI: 10.1016/s0140-6736(23)01669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/07/2023] [Indexed: 03/05/2024]
Affiliation(s)
- Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
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20
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de Albuquerque MP, Ibelli PME, Sawaya AL. Child undernutrition in Brazil: the wound that never healed. J Pediatr (Rio J) 2024; 100 Suppl 1:S74-S81. [PMID: 37949430 PMCID: PMC10960182 DOI: 10.1016/j.jped.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE To describe the scenario of child undernutrition in Brazil and its determinants. DATA SOURCE Narrative review of the literature with inclusion of data from population surveys, surveillance and monitoring systems, and active search in favelas and underserved communities carried out by CREN. DATA SYNTHESIS Household surveys carried out from 1974 to 2019 indicate that undernutrition (<5 years) decreased until 2006. Underweight (W/A ≤-2 Z) and stunting (H/A ≤-2 Z) showed a decrease of 17% to 3% and 37% to 7%, respectively. After 2006, there was an increase in underweight of 53% and 76% for wasting (BMI/A ≤-2 Z), with the prevalence of stunting being stagnant at around 7%. Active search data in favelas and underserved communities show that the prevalence of stunting is 11% in those <5 years. In 2021, 30% of the population lived in poverty, 73% of which were black or brown. Stunting in black and brown children <5 years old is, respectively, 9% and 12% higher when compared to white children. Poverty decreased between 2012 and 2015 (27 to 25%), but increased again (2016=26% to 2021=30%), in parallel with food insecurity, which decreased between 2004 and 2013 (12% to 6%), but reached its worst level in the historical series (2022:15%). CONCLUSION Despite advances, Brazil's social protection system was not able to reduce inequalities and the reversal of the trend towards decreasing child undernutrition could be observed from 2006 onwards.
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Affiliation(s)
| | | | - Ana Lydia Sawaya
- Centro de Recuperação e Educação Nutricional, São Paulo, SP, Brazil
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21
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Ferrante G, Piacentini G, Piazza M, Boner AL, Bellanti JA. Addressing global health disparities in the management of RSV infection in infants and children: Strategies for preventing bronchiolitis and post-bronchiolitis recurrent wheezing. Allergy Asthma Proc 2024; 45:84-91. [PMID: 38449013 DOI: 10.2500/aap.2024.45.230089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Background: The topic of equitable access to health care and its impact on exacerbating worldwide inequities in child health not only strikes at the heart of our health-care delivery systems but also deeply resonates with our collective social consciences. Nowhere is this better seen on a global scale than in the burden of illness caused by respiratory syncytial virus (RSV) infection, which extracts the most severe morbidity and mortality in infants and children in low- and middle-income countries (LMIC). This report addresses global health disparities that exist in the management of RSV infection in infants and children, and offers strategies for preventing bronchiolitis and postbronchiolitis recurrent wheezing in LMICs. Methods: A systematic literature review was conducted across the PubMed data bases of RSV infection and the socioeconomic impact of bronchiolitis and postbronchiolitis recurrent wheezing in LMICs. Results: The results of the present study address the many issues that deal with the question if prevention of RSV bronchiolitis can mitigate recurrent wheezing episodes and links RSV risks, downstream effects, prevention, malnutrition, and socioeconomic restraints of developing countries with a call for possible global action. Conclusion: The present study stresses the importance of considering the linkage between malnutrition and disease susceptibility because of the known relationships between undernutrition and greater vulnerability to infectious diseases, including RSV infection. These complex interactions between infectious disease and undernutrition also raise issues on the longer-term sequelae of postbronchiolitis recurrent wheezing. This prompts a discussion on whether industrialized countries should prioritize the provision of newly developed monoclonal antibodies and RSV vaccines to LMICs or whether vital nutritional needs should be a first focus. The resolution of these issues will require research and greater international discourse.
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Affiliation(s)
- Giuliana Ferrante
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Michele Piazza
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
| | - Attilio L Boner
- From the Pediatric Section, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Verona, Italy
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22
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Vosti S, Baker E, Moorthy D, Mazinga M, Dary O. Firm-Level and Public-Sector Costs Make Small-Scale Maize Flour Fortification Challenging in Uganda. Food Nutr Bull 2024; 45:12-23. [PMID: 38214039 DOI: 10.1177/03795721231223052] [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] [Indexed: 01/13/2024]
Abstract
BACKGROUND Maize flour in Uganda is milled by hundreds of enterprises, mostly small- (5-20 metric tons [MT]/day) and micro-scale (<5 MT/day) mills or firms. A mandatory maize flour fortification program exists for medium-scale mills (>20 MT/day) and policymakers are considering including smaller-scale millers. OBJECTIVE We estimated the private and public costs of maize flour fortification at different scales and explored their implications for extending the mandatory fortification to include smaller-scale mills. METHODS We used secondary data on the structure of the maize flour market and primary data on milling and fortification costs to estimate mill and regulatory costs at 3 scales of flour production: micro, small, and medium. RESULTS For micro-, small-, and medium-size operations, respectively, operational costs of fortification were US$13, US$9, and US$7 per metric ton (MT) of maize flour, which represented 20%, 16%, and 16% of annual operating costs, and the ratio of fortification equipment cost to mill equipment costs was higher for micro-scale mills (2.7) than for small- (0.38) and medium-scale (0.54) maize mills. Governmental regulatory costs rise if smaller-scale mills are included due to the increased number of facility inspections. CONCLUSIONS Fortification and regulatory costs increase as production scale decreases. Up-front capital costs of fortification would be daunting for micro- and small-scale mills. Medium-scale mills, which supply social protection programs, might be able to manage fortification costs and other challenges. Decision-makers should consider all costs and cost burdens, and the realities of enforcement capabilities before expanding fortification programs to include smaller-scale operations.
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Affiliation(s)
- Stephen Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA, USA
- Institute for Global Nutrition, UC Davis, Davis, CA, USA
| | - Emily Baker
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally project, Arlington, VA, USA
| | | | | | - Omar Dary
- Nutrition and Environmental Health Division, Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA
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Chaturvedi A, Zhu A, Gadela NV, Prabhakaran D, Jafar TH. Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases. Hypertension 2024; 81:387-399. [PMID: 38152897 PMCID: PMC10863660 DOI: 10.1161/hypertensionaha.123.21354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled blood pressure and cardiovascular disease (CVD) deaths. Despite improvements in high-income countries, disparities persist, notably in the United States, where Black individuals face up to 4× higher CVD mortality than White individuals. Social determinants of health encompass complex, multidimensional factors linked to an individual's birthplace, upbringing, activities, residence, workplaces, socioeconomic and environmental structures, and significantly affect health outcomes, including hypertension and CVD. This review explored how social determinants of health drive disparities in hypertension and related CVD morbidity from a socioecological and life course perspective. We present evidence-based strategies, emphasizing interventions tailored to specific community needs and cross-sector collaboration to address health inequalities rooted in social factors, which are key elements toward achieving the United Nations' Sustainable Development Goal 3.4 for reducing premature CVD mortality by 30% by 2030.
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Affiliation(s)
- Abhishek Chaturvedi
- Georgetown University, MedStar Washington Hospital Center, Washington, DC (A.C.)
| | - Anqi Zhu
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (A.Z., T.H.J.)
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India (D.P.)
- Public Health Foundation of India, Gurugram, India (D.P.)
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (A.Z., T.H.J.)
- Aga Khan University, Karachi, Pakistan (T.H.J.)
- Duke Global Health Institute, Durham, NC (T.H.J.)
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Guo J, Luo S, Su Z, Fu J, Ma J, Zhong X, Zeng C, Huang J, Zhang W, Zhang Z, Zhu H, Li Y. Consumption Patterns of Sugar-Sweetened Beverages and Association with Undernutrition among Children Aged 9-17 Years in Guangzhou, China: A Cross-Sectional Study. Nutrients 2024; 16:650. [PMID: 38474778 DOI: 10.3390/nu16050650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Globally, the high consumption levels of sugar-sweetened beverages (SSBs) and their effect on health have drawn significant attention. This study aimed to identify the consumption patterns of SSBs among children in rural areas of Guangzhou, China, and explore their association with undernutrition. A total of 1864 children aged 9-17 years old were included in this study. Demographics, lifestyle behaviors, and anthropometric and dietary information were collected. Factor analysis was used to identify patterns of SSBs, while nutritional status was assessed using Body Mass Index (BMI). Latent class analysis was used to establish dietary preference models. Log-binomial regression analysis was used to analyze the association between SSBs consumption patterns and undernutrition. The undernutrition prevalence in children was 14.54-19.94% in boys and 9.07% in girls. Three SSB consumption patterns were identified, including the plant protein pattern, dairy-containing pattern, and coffee pattern. Both medium-high (Q3) and the highest (Q4) scores in the dairy-containing pattern were positively associated with the risk of undernutrition, especially in boys. Furthermore, the highest scores in the plant protein pattern and coffee pattern were positively associated with the risk of undernutrition in children aged 9-10 years old. The dairy-containing pattern was a risk factor for undernutrition in children, especially for boys; the plant protein patterns and coffee patterns were risk factors for undernutrition in children aged 9-10 years old. The findings of the study can provide scientific evidence and policy recommendations for improving children's health conditions.
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Affiliation(s)
- Jiaying Guo
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Shiyun Luo
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Zheng Su
- School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Jinhan Fu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jie Ma
- School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Xuexin Zhong
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chunzi Zeng
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Jie Huang
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Weiwei Zhang
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Zhoubin Zhang
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Huilian Zhu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yan Li
- Department of Foodborne Diseases and Food Safety Risk Surveillance, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
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Cardoso MA, Lourenço BH, Matijasevich A, Castro MC, Ferreira MU. Prevalence and correlates of childhood anemia in the MINA-Brazil birth cohort study. Rev Saude Publica 2024; 57Suppl 2:6s. [PMID: 38422335 PMCID: PMC10897962 DOI: 10.11606/s1518-8787.2023057005637] [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: 06/26/2023] [Accepted: 11/08/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study. METHODS Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]). RESULTS The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0-21.0%), 42.6% (38.0-47.2%), and 8.7% (6.3-11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7-45.8%) of the study children were anemic, 38.4% (34.6-42.3%) were iron-deficient, and 26.3 (23.0-29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6-15.2%), 18.1% (15.5-21.1%), and 4.1% (2.8-5.7%), respectively; at five years of age (n = 655), 5.2% (3.6-7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84-2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14-2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17-2.39), malaria since birth (2.25; 1.30-3.87), and iron deficiency (2.15; 1.47-3.15), after adjusting for children's age and household wealth index. CONCLUSIONS Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children.
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Affiliation(s)
- Marly A Cardoso
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, SP, Brasil
| | - Bárbara H. Lourenço
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de NutriçãoSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, SP, Brasil
| | - Alicia Matijasevich
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina PreventivaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
| | - Marcia C Castro
- Harvard T.H. Chan School of Public HealthDepartment of Global Health and PopulationBostonMAUnited States of AmericaHarvard T.H. Chan School of Public Health. Department of Global Health and Population. Boston, MA, United States of America
| | - Marcelo U Ferreira
- Universidade de São PauloInstituto de Ciências BiomédicasDepartamento de ParasitologiaSão PauloSPBrasilUniversidade de São Paulo, Instituto de Ciências Biomédicas. Departamento de Parasitologia. São Paulo, SP, Brasil
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Mulat E, Tamiru D, Abate KH. Impact of indoor Air Pollution on the Linear growth of children in Jimma, Ethiopia. BMC Public Health 2024; 24:488. [PMID: 38365615 PMCID: PMC10870508 DOI: 10.1186/s12889-024-17975-3] [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: 11/01/2023] [Accepted: 02/03/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Stunting in children is the term for reduced linear growth and development, which is frequently brought on by a persistently inadequate diet, recurrent infections and chronic diseases or poor health conditions. Apart from the classic covariates of stunting, which include diet and illness, the relative contribution of household air pollution to chronic nutrition conditions is least studied. Hence, this study is conducted to investigate the impact of household air pollution on the linear growth of under-five children in Jimma town, Ethiopia. METHODS A prospective cohort study was employed to collect data from 280 under-five children who lived in households using solid fuel (exposed group, n = 140) and clean fuel (unexposed group, n = 140). Height-for-age Z scores were compared in both groups over a 12-month follow-up period. The difference in differences estimators were used for comparison of changes in the height-for-age Z scores from baseline to end line in exposed and non-exposed groups. The independent effect of the use of solid fuels on height-for-age Z scores was analyzed through a multivariable linear regression model. Statistical Significances were declared at P < 0.05 and 95% CI level. RESULTS In an unadjusted model (Model 1), compared with the clean fuel type, the mean difference in the height-for-age Z score of children in households using solid fuel was lower by 0.54 (-0.54, 95% CI -0.97, -0.12, P = 0.011). The beta coefficient remained negative after adjusting for age and sex (Model 2 -0.543, 95% CI -1.373, -0.563) and sociodemographic variables (Model 3: -0.543, 95% CI -1.362, -0.575). In the final model (Model 4), which adjusted for wealth quantile, dietary practice, water, sanitation and hygiene status and household food insecurity access scale, the beta coefficient held the same and significant (beta: -0.543, 95% CI -1.357, -0.579, P < 0.001). Higher HAZ scores were observed among female child (β: = 0.48, 95%CI: 0.28, 0.69), Child with father attended higher education (β: = 0.304 95%CI: 0.304, 95% CI 0.19, 0.41) as compared to male gender and those who did not attend a formal education, respectively. In contrast, child living in households with poor hygiene practices had lower HAZ score (β: -0.226, 95% CI: -0.449, -0.003), P < 0.001. CONCLUSIONS Exposure to indoor air pollution was inversely related to linear growth. Furthermore, sex, educational status and hygiene were found relevant predictors of linear growth. In such a setting, there is a need to step up efforts to design and implement public education campaigns regarding the health risks associated with exposure to household air pollution. Promoting improvements to kitchen ventilation and the use of improved cooking stoves, which will help to mitigate the detrimental effects of indoor air pollution on child growth impairment and its long-term effects.
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Affiliation(s)
- Elias Mulat
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Dessalegn Tamiru
- Department of Nutrition and Dietetics, Food and Nutrition Research Institute, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen Abate
- Department of Nutrition and Dietetics, Food and Nutrition Research Institute, Jimma University, Jimma, Ethiopia
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Xu T, Dong C, Shao J, Huo C, Chen Z, Shi Z, Yao T, Gu C, Wei W, Rui D, Li X, Hu Y, Ma J, Niu Q, Yan Y. Global burden of maternal disorders attributable to malnutrition from 1990 to 2019 and predictions to 2035: worsening or improving? Front Nutr 2024; 11:1343772. [PMID: 38425484 PMCID: PMC10902107 DOI: 10.3389/fnut.2024.1343772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Background and aims Maternal malnutrition is a major global public health problem that can lead to serious maternal diseases. This study aimed to analyze and predict the spatio-temporal trends in the burden of maternal disorders attributable to malnutrition, and to provide a basis for scientific improvement of maternal malnutrition and targeted prevention of maternal disorders. Methods Data on maternal disorders attributable to malnutrition, including number of deaths, disability-adjusted life years (DALYs), population attributable fractions (PAFs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) were obtained from the Global Burden of Disease Study 2019 to describe their epidemiological characteristics by age, region, year, and type of disease. A log-linear regression model was used to calculate the annual percentage change (AAPC) of ASMR or ASDR to reflect their temporal trends. Bayesian age-period-cohort model was used to predict the number of deaths and mortality rates to 2035. Results Global number of deaths and DALYs for maternal disorders attributable to malnutrition declined by 42.35 and 41.61% from 1990 to 2019, with an AAPC of -3.09 (95% CI: -3.31, -2.88) and -2.98 (95% CI: -3.20, -2.77) for ASMR and ASDR, respectively. The burden was higher among younger pregnant women (20-29 years) in low and low-middle socio-demographic index (SDI) regions, whereas it was higher among older pregnant women (30-39 years) in high SDI region. Both ASMR and ASDR showed a significant decreasing trend with increasing SDI. Maternal hemorrhage had the highest burden of all diseases. Global deaths are predicted to decline from 42,350 in 2019 to 38,461 in 2035, with the ASMR declining from 1.08 (95% UI: 0.38, 1.79) to 0.89 (95% UI: 0.47, 1.31). Conclusion Maternal malnutrition is improving globally, but in the context of the global food crisis, attention needs to be paid to malnutrition in low SDI regions, especially among young pregnant women, and corresponding measures need to be taken to effectively reduce the burden of disease.
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Affiliation(s)
- Tongtong Xu
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Chenxian Dong
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Jianjiang Shao
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Chaojing Huo
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Zuhai Chen
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Zhengyang Shi
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Teng Yao
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Chenyang Gu
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Wanting Wei
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Dongsheng Rui
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Xinjiang, Shihezi, China
| | - Xiaoju Li
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Xinjiang, Shihezi, China
| | - Yunhua Hu
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Xinjiang, Shihezi, China
| | - Jiaolong Ma
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Xinjiang, Shihezi, China
| | - Qiang Niu
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Xinjiang, Shihezi, China
| | - Yizhong Yan
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Shihezi, Xinjiang, China
- Key Laboratory of Preventive Medicine, Shihezi University, Shihezi, Xinjiang, China
- Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), School of Medicine, Shihezi University, Xinjiang, Shihezi, China
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Birhanu F, Yitbarek K, Bobo FT, Atlantis E, Woldie M. Undernutrition in children under five associated with wealth-related inequality in 24 low- and middle-income countries from 2017 to 2022. Sci Rep 2024; 14:3326. [PMID: 38336795 PMCID: PMC10858243 DOI: 10.1038/s41598-024-53280-0] [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: 05/25/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Undernourishment is a persistent public health problem contributing to increased mortality in children under five in low-income countries, likely exacerbated by socio-economic disparities within communities. This paper aimed to examine the effect of wealth-related inequality on undernutrition in children under five in low, lower-middle, and upper-middle-income countries (LMICs). We analyzed cross-sectional data from the demographic and health survey program collected between 2017 and 2022 from 24 LMICs. Children born within 5 years preceding the survey were included in the analysis. Child undernutrition was the dependent variable (measured by stunting, wasting, and underweight) and country-level wealth-based inequality was the independent variable assessed by concentration index values stratified by the World Bank's income categories. Within country inequality of child undernutrition was determined by concentration index (C) values with 95% confidence intervals (95% CI) and sub-group analysis by place of residence and sex of the child. We then fit bootstrapped meta-regression to check the variation in inequality of child undernutrition across different income category countries. The analysis was controlled by potential confounding variables. From the total sample size of 334,502 children included in the study, 35% were undernourished. Wealth-related inequality in child undernutrition was observed in 11 countries, consistently across income categories. Child undernutrition was highly concentrated among the poor households of Türkiye [C: - 0.26, 95% CI - 0.31 to - 0.20], and Cameroon [C: - 0.19, 95% CI - 0.22 to - 0.17], and relatively it was less concentrated among the poor in Liberia [C: - 0.07, 95% CI - 0.11 to - 0.04], and Gambia [C: - 0.07, 95% CI - 0.11 to - 0.04]. There is no difference in undernutrition associated with inequality between the three broad LMIC categories. The wealth-related inequality in child undernutrition within many of the included countries is still very significant. However, the economic category of countries made no difference in explaining wealth-related inequality in child undernutrition. Inter-sectoral collaboration to fight poverty and render special attention to the disadvantaged population segments would potentially help to address the observed inequity.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Amana, Ethiopia
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia.
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Firew Tekle Bobo
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
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29
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Moore SE. Sex differences in growth and neurocognitive development in infancy and early childhood. Proc Nutr Soc 2024:1-8. [PMID: 38326969 DOI: 10.1017/s0029665124000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Undernutrition in early life remains a significant public health challenge affecting millions of infants and young children globally. Children who are wasted, stunted or underweight are at increased risk of morbidity and mortality. Undernutrition at critical periods also impacts on aspects of neurodevelopment, with longer-term consequences to educational performance and mental health outcomes. Despite consistent evidence highlighting an increased risk of neonatal and infant mortality among boys, a common assumption held across many disciplines is that girls are more vulnerable with respect to early-life exposures. In relation to undernutrition, however, recent evidence indicates the reverse, and in contexts of food insecurity, boys are at increased risk of undernutrition in early life compared to girls, with sex-specific risks for neurodevelopmental deficits. These effects appear independent of social factors that may favour boys, such as gender disparities in infant feeding practices and health-seeking behaviours. The observed vulnerability among boys may therefore be underpinned by biological processes such as differential energy requirements during periods of rapid growth. As boys have greater needs for growth and maintenance, then, in times of nutritional hardship, these needs may not be met resulting in risk of undernutrition and subsequent health consequences. In view of this emerging evidence, a greater understanding of the mechanisms behind this vulnerability among boys is needed and policy considerations to protect boys should be considered. This review will explore sex differences in risk of undernutrition and consider these in the context of existing programmes and policies.
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Affiliation(s)
- Sophie E Moore
- Department of Women and Children's Health, King's College London, LondonSE1 7EH, UK
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30
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Atlas HE, Brander RL, Tickell KD, Bunyige L, Oongo S, McGrath CJ, John-Stewart GC, Richardson BA, Singa BO, Denno DM, Walson JL, Pavlinac PB. Prevalence and Correlates of Stunting among a High-Risk Population of Kenyan Children Recently Hospitalized for Acute Illnesses. Am J Trop Med Hyg 2024; 110:356-363. [PMID: 38150727 PMCID: PMC10859817 DOI: 10.4269/ajtmh.23-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/30/2023] [Indexed: 12/29/2023] Open
Abstract
Stunting (length/height-for-age z-score < -2) is associated with significant morbidity and mortality among children under 5 years of age in sub-Saharan Africa. Children who are stunted and recently hospitalized for acute illness may be at particularly elevated risk for post-discharge mortality. In this cross-sectional analysis, we measured the prevalence of stunting at hospital discharge and identified host, caregiver, and environmental correlates of stunting among children aged 1-59 months in Western Kenya enrolled in the Toto Bora Trial. Child age- and site-adjusted prevalence ratios were estimated using Poisson regression. Of the 1,394 children included in this analysis, 23% were stunted at hospital discharge. Older children (12-23 months and 24-59 months versus 0-5 months) had a higher prevalence of stunting (adjusted prevalence ratio [aPR]: 1.58; 95% CI: 1.04-2.36 and aPR: 1.59; 95% CI: 1.08-2.34, respectively). HIV-exposed, uninfected children (aPR: 1.94; 95% CI: 1.39-2.70), children with HIV infection (aPR: 2.73; 95% CI: 1.45-5.15), and those who were never exclusively breastfed in early life (aPR 2.51; 95% CI: 1.35-4.67) were more likely to be stunted. Caregiver education (primary school or less) and unimproved sanitation (pit latrine without slab floor or open defecation) were associated with increased risk of stunting (aPR: 1.94; 95% CI: 1.54-2.44; aPR: 1.99; 95% CI: 1.20-3.31; aPR: 3.57; 95% CI: 1.77-7.21, respectively). Hospital discharge represents an important opportunity for both identifying and delivering targeted interventions for nutrition-associated poor outcomes among a high-risk population of children.
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Affiliation(s)
- Hannah E Atlas
- Department of Global Health, University of Washington, Seattle, Washington
| | - Rebecca L Brander
- International Food Policy Research Institute, Division of Poverty, Health, and Nutrition, Baltimore, Maryland
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, Seattle, Washington
- Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Lucy Bunyige
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Susan Oongo
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Christine J McGrath
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Grace C John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
- Department of Allergy and Infectious Disease, University of Washington, Seattle, Washington
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Benson O Singa
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Donna M Denno
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
- Department of Health Services, University of Washington, Seattle, Washington
- Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington
- Department of International Health, Johns Hopkins University, Baltimore, Maryland
- Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
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31
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Li J. Less stunted? The impact of Chinese health aid on child nutrition. Soc Sci Med 2024; 342:116559. [PMID: 38183933 DOI: 10.1016/j.socscimed.2024.116559] [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: 07/16/2023] [Revised: 12/06/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024]
Abstract
Despite the increasing recognition of China's role as a global health donor, particularly in Africa, few studies have explored its effectiveness. We geographically matched project-level aid data from AidData with household survey data from Demographic and Health Surveys across eight African countries to examine the effect of Chinese health aid on the nutritional status of children in recipient countries. In addition to adopting a spatiotemporal identification strategy, we also included mother fixed-effects to examine variations among siblings who were exposed to Chinese health aid projects at different times. The empirical results consistently indicated that children living adjacent to Chinese health aid projects had a better nutritional status. The treatment effect of Chinese health aid projects is heterogeneous across household characteristics, types, and sectors of aid projects. Finally, vaccination may serve as a mechanism linking Chinese health aid and child nutrition in the treatment areas of recipient countries.
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Affiliation(s)
- Jia Li
- Yangtze River Institute of International Digital Trade Innovation and Development, Nanjing University of Information Science and Technology, No. 219 Ningliu Road, Pukou District, Nanjing, 210044, China; School of Business, Nanjing University of Information Science and Technology, No. 219 Ningliu Road, Pukou District, Nanjing, 210044, China.
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32
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Conti MV, Itani L, Beretta A, Yaghi K, Filosa A, Monti C, Cena H. An overview of the nutritional status of childbearing age women, children and adolescents living in a rural area of Madagascar: preliminary results of the Tany Vao project. Public Health Nutr 2024; 27:e52. [PMID: 38282033 PMCID: PMC10882536 DOI: 10.1017/s1368980024000259] [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] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To describe the food consumption, nutrition knowledge and nutritional assessment of childbearing age women and their children, living in rural villages in Madagascar. The results presented are related to the Tany Vao research study. DESIGN A cross-sectional pilot study. SETTING The study was carried out in Ampanitosoha village on Nosy Mitsio island in Madagascar. PARTICIPANTS 32 women (14-49 years) and 36 children and adolescents (2-17 years). RESULTS 70 % of the women lacked nutrition knowledge and did not reach the Minimum Dietary Diversity Index for Women cut-off. The median BMI was 21·1 kg/m2 but 55·2 % of the women exceeded the cut-off for waist-to-hip ratio, 51·7 % for waist-to-height ratio and 81·2 % for mid-upper arm circumference (MUAC). Almost all had adequate intake of energy, protein and carbohydrates, while 27·6 % had excessive fat intake and 75·9 % of added sugars. Over half of the women did not meet the micronutrients Reference Daily Intake (RDI). For children, the MUAC z-score was lower for boys than for girls (P-value = 0·041). CONCLUSIONS These results underline the importance of increasing women's nutritional knowledge to promote healthy pregnancy and lactation. Moreover, it is fundamental to provide people living in rural areas with sustainable tools to improve dietary diversity and support long-term health.
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Affiliation(s)
- Maria Vittori Conti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
| | - Leila Itani
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut11072809, Lebanon
| | - Alice Beretta
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
| | - Kassandra Yaghi
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut11072809, Lebanon
| | - Asia Filosa
- Department of Public Health Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Cristina Monti
- Department of Public Health Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100Pavia, Italy
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33
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Heri R, Malqvist M, Yahya-Malima KI, Mselle LT. Dietary diversity and associated factors among women attending antenatal clinics in the coast region of Tanzania. BMC Nutr 2024; 10:16. [PMID: 38254189 PMCID: PMC10801968 DOI: 10.1186/s40795-024-00825-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is crucial for reducing maternal morbidity and mortality, especially in low-resource settings. During antenatal care, women are provided with resources for enhancing their dietary diversity, like nutrition education and counseling. Improved nutrition knowledge influences positive nutritional behavior change, like women's improved dietary diversity, which may increase the likelihood of a healthier pregnancy and delivery experience. OBJECTIVE This study aim was to assess dietary diversity and associated factors among pregnant women attending antenatal care in the Coast region of Tanzania. METHODS The descriptive cross-sectional study design was used to assess dietary diversity and associated factors among 338 pregnant women. A semi-structured questionnaire collected information from pregnant women on social demographic characteristics, nutrition knowledge and dietary diversity. Women were classified as having a varied diet if they had consumed at least five of the ten food groups over the previous twenty-four hours. Multivariable logistic regression analyses were used to identify predictors of dietary diversity in pregnant women. RESULTS Only 28% (95% CI: 23.5-33.1) (n = 95) of pregnant women met the minimum dietary diversity, and 18% (95% CI: 13.8-21.9) (n = 59) were considered to have a high level of nutrition knowledge. Living near a health facility (AOR = 1.77, CI 1.02, 3.06), having high nutrition knowledge (AOR = 2.58, 95% CI: 1.36, 4.89), and being pregnant for the first time (AOR = 2.44, 95% CI: 1.09, 5.44) were associated with adequate dietary diversity. CONCLUSION Pregnant women in the study were found to have low knowledge about nutrition and inadequate dietary diversity intake. The findings underscore the need to improve nutrition knowledge provision in antenatal clinics by emphasizing the importance of a diversified and high-quality diet. Healthcare providers in antenatal care clinics should consistently provide nutrition education and counseling to pregnant women and promote their diversified food consumption. Such knowledge may eventually promote healthier pregnancy and child development by curbing the nutritional deficiencies experienced during pregnancy.
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Affiliation(s)
- Rashidi Heri
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Mats Malqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Khadija I Yahya-Malima
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lilian Teddy Mselle
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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34
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Liu R, Pi L, Leng F, Shen Q. Global disability-adjusted life years and deaths attributable to child and maternal malnutrition from 1990 to 2019. Front Public Health 2024; 12:1323263. [PMID: 38304181 PMCID: PMC10830744 DOI: 10.3389/fpubh.2024.1323263] [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: 10/18/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Background Child and maternal malnutrition (CMM) caused heavy disability-adjusted life years (DALY) and deaths globally. It is crucial to understand the global burden associated with CMM in order to prioritize prevention and control efforts. We performed a comprehensive analysis of the global DALY and deaths attributable to CMM from 1990 to 2019 in this study. Methods The age-standardized CMM related burden including DALY and death from 1990 to 2019 were accessed from the Global Burden of Disease study 2019 (GBD 2019). The changing trend were described by average annual percentage change (AAPC). The relationship between sociodemographic factors and burden attributable to CMM were explored by generalized linear model (GLM). Results Globally, in 2019, the age-standardized DALY and death rates of CMM were 4,425.24/100,000 (95% UI: 3,789.81/100,000-5,249.55/100,000) and 44.72/100,000 (95% UI: 37.83/100,000-53.47/100,000), respectively. The age-standardized DALY rate (AAPC = -2.92, 95% CI: -2.97% to -2.87%) and death rates (AAPC = -3.19, 95% CI: -3.27% to -3.12%) presented significantly declining trends during past 30 years. However, CMM still caused heavy burden in age group of <28 days, Sub-Saharan Africa and low SDI regions. And, low birth weight and short gestation has identified as the primary risk factors globally. The GLM indicated that the highly per capita gross domestic product, per capita current health expenditure, physicians per 1,000 people were contributed to reduce the burden attributable to CMM. Conclusion Although global burden attributable to CMM has significantly declined, it still caused severe health burden annually. To strengthen interventions and address resources allocation in the vulnerable population and regions is necessary.
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Affiliation(s)
- Rong Liu
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Lucheng Pi
- Shenzhen Bao’an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Fangqun Leng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qing Shen
- School of Public Health, Hangzhou Medical College, Hangzhou, China
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35
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Suzuki A, Tani Y, Anzai T, Isumi A, Doi S, Ogawa T, Moriyama K, Fujiwara T. Association between Short Stature at Grade 1 and Permanent Teeth Caries at Grade 6 in Elementary School Children in Japan: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:105. [PMID: 38248567 PMCID: PMC10815877 DOI: 10.3390/ijerph21010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
Short stature in children is a marker of low nutritional status and has been suggested to be associated with dental caries. However, longitudinal studies on this topic are scarce. Data from a longitudinal study of elementary school children in Adachi City, Tokyo, Japan, were analyzed. In 2015, caregivers of children at grade 1 answered questionnaires, and information on dental caries and height measured at school health checkups was merged and followed to grade 6 (N = 3576; follow up rate = 83.3%). The association between short stature at grade 1 (-2.01 standard deviation (SD)--3.00 SD, or <-3.00 SD in height-for-age according to the World Health Organization criteria) and the number of decayed, missing, or filled permanent teeth (DMFT) at grade 6 was examined using multivariable Poisson regression with robust standard error. After adjusting for confounders, children with a short stature at grade 1 had a higher DMFT number at grade 6: the mean ratios (95% confidence interval) were 1.17 (0.89-1.54) and 2.18 (1.03-4.64) for children with a height-for-age -2.01 SD--3.00 SD, and those with a height-for-age < -3.00, respectively. Short stature at grade 1 could be a marker of future dental caries in the permanent teeth at grade 6.
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Grants
- H27-Jyunkankito-ippan-002 Ministry of Health Labour and Welfare
- H29-Seisaku-Shitei-004 Ministry of Health Labour and Welfare
- 16H03276, 16K21669, 17J05974, 17K13245, 19K19310, 19K14029, 19K19309, 19K20109, 19K14172, 19J01614, 19H04879, 20K13945, and 21H04848 Japan Society for the Promotion of Science
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Affiliation(s)
- Ayako Suzuki
- Department of Maxillofacial Orthognathics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; (A.S.); (T.O.); (K.M.)
| | - Yukako Tani
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan;
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo 113-8519, Japan;
| | - Aya Isumi
- Department of Health Policy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; (A.I.); (S.D.)
| | - Satomi Doi
- Department of Health Policy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; (A.I.); (S.D.)
| | - Takuya Ogawa
- Department of Maxillofacial Orthognathics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; (A.S.); (T.O.); (K.M.)
| | - Keiji Moriyama
- Department of Maxillofacial Orthognathics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; (A.S.); (T.O.); (K.M.)
| | - Takeo Fujiwara
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan;
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA
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36
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McKay FH, Vo M, George NA, John P, Kaushal J, van der Pligt P. Cross-cultural food practices and nutrition seeking behaviors among pregnant and postpartum Indian women living in Australia. Health Care Women Int 2024:1-23. [PMID: 38215307 DOI: 10.1080/07399332.2024.2303518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
No research has explored the experiences of Indian women who become pregnant after they migrate to Australia, and how their existing traditions mix with their new environment and subsequently impact eating patterns. Semi-structured interviews were conducted with eleven women of Indian heritage who were living in Australia, and data were thematically analyzed. The researchers identified two main themes were identified (a) foods to eat and which to avoid, and (b) support networks and sources of health information during pregnancy. Women get advice and information from a range of sources and have diverse attitudes and beliefs about cultural food practices. that are both rigid and flexible, as well as traditional and contemporary.
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Affiliation(s)
- Fiona H McKay
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Minnie Vo
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Neetu Abey George
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Preethi John
- Global Business School for Health, University College London, London, UK
| | - Jyotsna Kaushal
- Center for Water Sciences, Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura, Punjab, India
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- Department of Nutrition, Western Health, Footscray, Victoria, Australia
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Checkley W, Thompson LM, Sinharoy SS, Hossen S, Moulton LH, Chang HH, Waller L, Steenland K, Rosa G, Mukeshimana A, Ndagijimana F, McCracken JP, Díaz-Artiga A, Balakrishnan K, Garg SS, Thangavel G, Aravindalochanan V, Hartinger SM, Chiang M, Kirby MA, Papageorghiou AT, Ramakrishnan U, Williams KN, Nicolaou L, Johnson M, Pillarisetti A, Rosenthal J, Underhill LJ, Wang J, Jabbarzadeh S, Chen Y, Dávila-Román VG, Naeher LP, McCollum ED, Peel JL, Clasen TF. Effects of Cooking with Liquefied Petroleum Gas or Biomass on Stunting in Infants. N Engl J Med 2024; 390:44-54. [PMID: 38169489 DOI: 10.1056/nejmoa2302687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Household air pollution is associated with stunted growth in infants. Whether the replacement of biomass fuel (e.g., wood, dung, or agricultural crop waste) with liquefied petroleum gas (LPG) for cooking can reduce the risk of stunting is unknown. METHODS We conducted a randomized trial involving 3200 pregnant women 18 to 34 years of age in four low- and middle-income countries. Women at 9 to less than 20 weeks' gestation were randomly assigned to use a free LPG cookstove with continuous free fuel delivery for 18 months (intervention group) or to continue using a biomass cookstove (control group). The length of each infant was measured at 12 months of age, and personal exposures to fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm) were monitored starting at pregnancy and continuing until the infants were 1 year of age. The primary outcome for which data are presented in the current report - stunting (defined as a length-for-age z score that was more than two standard deviations below the median of a growth standard) at 12 months of age - was one of four primary outcomes of the trial. Intention-to-treat analyses were performed to estimate the relative risk of stunting. RESULTS Adherence to the intervention was high, and the intervention resulted in lower prenatal and postnatal 24-hour personal exposures to fine particulate matter than the control (mean prenatal exposure, 35.0 μg per cubic meter vs. 103.3 μg per cubic meter; mean postnatal exposure, 37.9 μg per cubic meter vs. 109.2 μg per cubic meter). Among 3061 live births, 1171 (76.2%) of the 1536 infants born to women in the intervention group and 1186 (77.8%) of the 1525 infants born to women in the control group had a valid length measurement at 12 months of age. Stunting occurred in 321 of the 1171 infants included in the analysis (27.4%) of the infants born to women in the intervention group and in 299 of the 1186 infants included in the analysis (25.2%) of those born to women in the control group (relative risk, 1.10; 98.75% confidence interval, 0.94 to 1.29; P = 0.12). CONCLUSIONS An intervention strategy starting in pregnancy and aimed at mitigating household air pollution by replacing biomass fuel with LPG for cooking did not reduce the risk of stunting in infants. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foundation; HAPIN ClinicalTrials.gov number, NCT02944682.).
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Affiliation(s)
- William Checkley
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lisa M Thompson
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Sheela S Sinharoy
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Shakir Hossen
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lawrence H Moulton
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Howard H Chang
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lance Waller
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Kyle Steenland
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Ghislaine Rosa
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Alexie Mukeshimana
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Florien Ndagijimana
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - John P McCracken
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Anaité Díaz-Artiga
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Kalpana Balakrishnan
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Sarada S Garg
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Gurusamy Thangavel
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Vigneswari Aravindalochanan
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Stella M Hartinger
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Marilú Chiang
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Miles A Kirby
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Aris T Papageorghiou
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Usha Ramakrishnan
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Kendra N Williams
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Laura Nicolaou
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Michael Johnson
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Ajay Pillarisetti
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Joshua Rosenthal
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Lindsay J Underhill
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Jiantong Wang
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Shirin Jabbarzadeh
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Yunyun Chen
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Victor G Dávila-Román
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Luke P Naeher
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Eric D McCollum
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Jennifer L Peel
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
| | - Thomas F Clasen
- From the Division of Pulmonary and Critical Care (W.C., S.H., K.N.W., L.N.), the Johns Hopkins Center for Global Non-Communicable Disease Research and Training (W.C., S.H., K.N.W., L.N., E.D.M.), the Eudowood Division of Pediatric Respiratory Sciences, School of Medicine (E.D.M.), and the Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health (W.C., L.H.M., E.D.M.), Johns Hopkins University, Baltimore, and Fogarty International Center, National Institutes of Health, Bethesda (J.R.) - both in Maryland; Nell Hodgson Woodruff School of Nursing (L.M.T.) and the Hubert Department of Global Health (S.S.S., U.R.), the Gangarosa Department of Environmental Health (K.S., T.F.C.), and the Department of Biostatistics and Bioinformatics (H.H.C., L.W., J.W., S.J., Y.C.), Rollins School of Public Health, Emory University, Atlanta, and the Departments of Epidemiology and Biostatistics (J.P.M.) and Environmental Health Science (L.P.N.), College of Public Health, University of Georgia, Athens - both in Georgia; the Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London (G.R.), and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford (A.T.P.) - both in the United Kingdom; Eagle Research Center, Kigali, Rwanda (A.M., F.N.); the Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala (J.P.M., A.D.-A.); the Indian Council of Medical Research Center for Advanced Research on Air Quality, Climate, and Health, Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India (K.B., S.S.G., G.T., V.A.); the Latin American Center of Excellence in Climate Change and Health, Universidad Peruana Cayetano Heredia (S.M.H.), and the Biomedical Research Unit, Asociación Benéfica Prisma (M.C.) - both in Lima, Peru; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (M.A.K.); Berkeley Air Monitoring Group (M.J.) and the Division of Environmental Health Sciences, University of California at Berkeley (A.P.) - both in Berkeley; the Cardiovascular Imaging and Clinical Research Core Laboratory, Department of Medicine, Washington University in St. Louis, St. Louis (L.J.U., V.G.D.-R.); and the Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins (J.L.P.)
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Moreira PR, Silveira MB, Neves RO, Nunes LM, Bernardi JR. Estimated energy and nutrient intake in complementary feeding methods in Brazilian infants: randomized clinical trial. Sci Rep 2024; 14:13. [PMID: 38168148 PMCID: PMC10761670 DOI: 10.1038/s41598-023-50415-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
Inadequate nutrient intake during complementary feeding (CF) can affect healthy infant growth and development. A randomized clinical trial was conducted to examine the energy and nutrient intake in Brazilian children randomly assigned to three distinct CF methods. Mother-infant pairs participated in the study, with mothers receiving interventions in one of three CF approaches: (A) strict Parent-Led Weaning (PLW); (B) strict Baby-Led Introduction to Solids (BLISS); and (C) a mixed method. Assessments were made at 5.5 months, nine months, and 12 months of the child's age. Food consumption was measured through 24-h dietary recalls at nine and 12 months, with intake estimates calculated using the Brazilian Food Composition Table. Means or medians of energy and nutrients were compared between groups using ANOVA with Tukey's post hoc test or the Kruskal-Wallis test. A total of 115 infants were evaluated at nine months, and 102 at 12 months. Children in the PLW, BLISS, and mixed method groups exhibited comparable dietary intakes of energy, macronutrients, and micronutrients at both nine and 12 months. Infants following PLW, BLISS, and mixed methods demonstrated similar levels of energy and nutrient intake, underscoring the effectiveness of these strategies in ensuring comparable nutrient intake during the critical phase of CF.Trial registration The trial was registered in the Brazilian Registry of Clinical Trials (ReBEC) with identifier [RBR-229scm U1111-1226-9516], [ https://ensaiosclinicos.gov.br/rg/RBR-229scm ]. The full data of the first registration was on 24/09/2019.
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Affiliation(s)
- Paula Ruffoni Moreira
- Graduate Program in Child and Adolescent Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil.
- Graduate Program of Food, Nutrition, and Health, Department of Nutrition, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Muriele Betencourt Silveira
- Graduate Program of Food, Nutrition, and Health, Department of Nutrition, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Renata Oliveira Neves
- Graduate Program in Child and Adolescent Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil
| | - Leandro Meirelles Nunes
- Graduate Program in Child and Adolescent Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Juliana Rombaldi Bernardi
- Graduate Program in Child and Adolescent Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2400, Porto Alegre, RS, 90035-003, Brazil
- Graduate Program of Food, Nutrition, and Health, Department of Nutrition, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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Hibberd MC, Webber DM, Rodionov DA, Henrissat S, Chen RY, Zhou C, Lynn HM, Wang Y, Chang HW, Lee EM, Lelwala-Guruge J, Kazanov MD, Arzamasov AA, Leyn SA, Lombard V, Terrapon N, Henrissat B, Castillo JJ, Couture G, Bacalzo NP, Chen Y, Lebrilla CB, Mostafa I, Das S, Mahfuz M, Barratt MJ, Osterman AL, Ahmed T, Gordon JI. Bioactive glycans in a microbiome-directed food for children with malnutrition. Nature 2024; 625:157-165. [PMID: 38093016 PMCID: PMC10764277 DOI: 10.1038/s41586-023-06838-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/06/2023] [Indexed: 12/26/2023]
Abstract
Evidence is accumulating that perturbed postnatal development of the gut microbiome contributes to childhood malnutrition1-4. Here we analyse biospecimens from a randomized, controlled trial of a microbiome-directed complementary food (MDCF-2) that produced superior rates of weight gain compared with a calorically more dense conventional ready-to-use supplementary food in 12-18-month-old Bangladeshi children with moderate acute malnutrition4. We reconstructed 1,000 bacterial genomes (metagenome-assembled genomes (MAGs)) from the faecal microbiomes of trial participants, identified 75 MAGs of which the abundances were positively associated with ponderal growth (change in weight-for-length Z score (WLZ)), characterized changes in MAG gene expression as a function of treatment type and WLZ response, and quantified carbohydrate structures in MDCF-2 and faeces. The results reveal that two Prevotella copri MAGs that are positively associated with WLZ are the principal contributors to MDCF-2-induced expression of metabolic pathways involved in utilizing the component glycans of MDCF-2. The predicted specificities of carbohydrate-active enzymes expressed by their polysaccharide-utilization loci are correlated with (1) the in vitro growth of Bangladeshi P. copri strains, possessing varying degrees of polysaccharide-utilization loci and genomic conservation with these MAGs, in defined medium containing different purified glycans representative of those in MDCF-2, and (2) the levels of faecal carbohydrate structures in the trial participants. These associations suggest that identifying bioactive glycan structures in MDCFs metabolized by growth-associated bacterial taxa will help to guide recommendations about their use in children with acute malnutrition and enable the development of additional formulations.
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Affiliation(s)
- Matthew C Hibberd
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Daniel M Webber
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Dmitry A Rodionov
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Suzanne Henrissat
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille University, Marseille, France
| | - Robert Y Chen
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
| | - Cyrus Zhou
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
| | - Hannah M Lynn
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
| | - Yi Wang
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
| | - Hao-Wei Chang
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
| | - Evan M Lee
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
| | - Janaki Lelwala-Guruge
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
| | - Marat D Kazanov
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey
| | - Aleksandr A Arzamasov
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Semen A Leyn
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Vincent Lombard
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille University, Marseille, France
| | - Nicolas Terrapon
- Architecture et Fonction des Macromolécules Biologiques, CNRS, Aix-Marseille University, Marseille, France
| | - Bernard Henrissat
- Department of Biotechnology and Biomedicine (DTU Bioengineering), Technical University of Denmark, Lyngby, Denmark
- Department of Biological Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Juan J Castillo
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | - Garret Couture
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | - Nikita P Bacalzo
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | - Ye Chen
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | - Carlito B Lebrilla
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | - Ishita Mostafa
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Subhasish Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Michael J Barratt
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Andrei L Osterman
- Infectious and Inflammatory Disease Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jeffrey I Gordon
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, MO, USA.
- Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St Louis, MO, USA.
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA.
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40
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Panigrahi P. The neonatal gut microbiome and global health. Gut Microbes 2024; 16:2352175. [PMID: 38743045 PMCID: PMC11095572 DOI: 10.1080/19490976.2024.2352175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
The role of gut microbiome in health, a century-old concept, has been on the center stage of medical research recently. While different body sites, disease conditions, and populations have been targeted, neonatal and early infancy appear to be the most suitable period for such interventions. It is intriguing to note that, unlike traditional use in diarrhea and maintenance of gastrointestinal health, microbiome-mediating therapies have now addressed the most serious medical conditions in young infants such as necrotizing enterocolitis and neonatal sepsis. Unfortunately, almost all new endeavors in this space have been carried out in the Western world leaving behind millions of neonates that can benefit from such manipulations while serving as a large resource for further learning. In this review, an attempt has been made to quantify the global burden of neonatal morbidity and mortality, examples presented on interventions that have failed as a result of drawing from studies conducted in the West, and a case made for manipulating the neonatal gut microbiome to address the biggest killers in early life. A brief comparative analysis has been made to demonstrate the differences in the gut microbiota of North and South and a large clinical trial of synbiotics conducted by our group in a South Asian setting has been presented. Although challenging, the value of conducting such global health research is introduced with an intent to invite medical scientists to engage in well-planned, scientifically robust research endeavors. This can bring about innovation while saving and serving the most vulnerable citizens now and protecting them from the negative health consequences in the later part of their lives, ultimately shaping a resilient and equitable world as pledged by 193 United Nations member countries in 2015.
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Affiliation(s)
- Pinaki Panigrahi
- Department of Pediatrics, Division of Neonatal Perinatal Medicine, International Microbiome Research, Georgetown University Medical Center, Georgetown, WA, USA
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41
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Welch C, Wong CK, Lelijveld N, Kerac M, Wrottesley SV. Adolescent pregnancy is associated with child undernutrition: Systematic review and meta-analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13569. [PMID: 37781871 PMCID: PMC10749999 DOI: 10.1111/mcn.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023]
Abstract
Adolescent pregnancy is associated with poor fetal growth and development which, in turn, increases the risk of childhood wasting and underweight. However, evidence on how young maternal age affects childhood anthropometry beyond the neonatal period is limited. This systematic review and meta-analysis examined associations between adolescent pregnancy and child wasting and underweight and explored potential underlying social and biological factors. Peer-reviewed literature published in English since 1990 was systematically searched. Eligible studies presented data on wasting and/or underweight in children (≤59 months) born to adolescent mothers (10-19, or ≤24 years where applicable) from low- and middle-income countries. Data extraction used a predefined extraction sheet. Both meta-analysis and qualitative synthesis were performed. Of 92 identified studies, 57 were included in the meta-analysis. The meta-analysis showed that children born to adolescent versus adult mothers were at a higher risk of moderate (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.00-1.26 p = 0.04) and severe underweight (OR: 1.21, 95% CI: 1.08-1.35 p < 0.01). Associated risk of wasting was not statistically significant: (OR: 1.05, 95% CI: 0.98-1.12 p = 0.17); severe wasting (OR: 1.16, 95% CI: 0.68-1.96 p = 0.59). These findings were supported by the qualitative synthesis. Evidence on the potential role of biological/social factors was limited, but suggested an intermediary role of maternal nutritional status which warrants further exploration. Particularly in contexts where adolescent pregnancy remains common, interventions to both delay adolescent pregnancy and improve adolescent nutritional status could help reduce the risk of undernutrition in children and contribute to breaking the intergenerational cycle of malnutrition.
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Affiliation(s)
- Caroline Welch
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | - Christopher K. Wong
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | - Natasha Lelijveld
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Emergency Nutrition Network (ENN)OxfordshireUK
| | - Marko Kerac
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
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Flaherman VJ, Murungi J, Bale C, Dickinson S, Chen X, Namiiro F, Nankunda J, Pollack LM, Laleau V, Kim MO, Allison DB, Ginsburg AS, Braima de Sa A, Nankabirwa V. Breastfeeding and Once-Daily Small-Volume Formula Supplementation to Prevent Infant Growth Impairment. Pediatrics 2024; 153:e2023062228. [PMID: 38062778 DOI: 10.1542/peds.2023-062228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Randomized controlled trials in Guinea-Bissau and Uganda have revealed that the intensive promotion of exclusive breastfeeding (EBF) impairs growth in early infancy. When newborn growth is impaired, small amounts of formula may be combined with breastfeeding to promote growth. METHODS To determine if breastfeeding combined with once-daily formula supplementation improves growth among at-risk newborns, we conducted a pilot randomized controlled trial in Bissau, Guinea-Bissau and Kampala, Uganda. We randomly assigned 324 healthy breastfeeding newborns who weighed 2000 g to 2499 g at birth or <2600 g at 4 days old to once-daily formula feeding through 30 days as a supplement to frequent breastfeeding followed by EBF from 31 days through 6 months, or to EBF through 6 months. The primary outcome was weight-for-age z score (WAZ) at 30 days. Other outcomes included weight-for-length z score (WLZ), length-for-age z score (LAZ), breastfeeding cessation, adverse events, and serious adverse events through 180 days. RESULTS Daily formula consumption in the intervention group was 31.9 ± 11.8 mL. The random assignment did not impact WAZ, WLZ, LAZ, breastfeeding cessation, adverse events, or serious adverse events through 180 days. In the intervention and control groups, 19 (12%) and 35 (21%) infants, respectively, reported nonformula supplementation in the first 30 days (P = .02). CONCLUSIONS Once-daily formula supplementation for 30 days was well-tolerated, but the small volume consumed did not alter growth through 180 days of age. Further research would be required to determine if larger formula volumes, longer duration of treatment, or more frequent feeding are effective at increasing growth for this at-risk population.
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Affiliation(s)
| | - Joan Murungi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Carlito Bale
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | | | - Xiwei Chen
- School of Public Health, Indiana University, Bloomington, Indiana
| | - Flavia Namiiro
- School of Public Health, Makerere University, Kampala, Uganda
| | - Jolly Nankunda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Lance M Pollack
- School of Medicine, University of California, San Francisco, California
| | - Victoria Laleau
- School of Medicine, University of California, San Francisco, California
| | - Mi-Ok Kim
- School of Medicine, University of California, San Francisco, California
| | - David B Allison
- School of Public Health, Indiana University, Bloomington, Indiana
| | | | | | - Victoria Nankabirwa
- School of Public Health, Makerere University, Kampala, Uganda
- Centre for Intervention Science for Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Lourenço BH, Castro MC, de Morais Sato P, Neves PAR, Vivanco E, Lima DL, Cardoso MA. Exposure to ultra-processed foods during pregnancy and ultrasound fetal growth parameters. Br J Nutr 2023; 130:2136-2145. [PMID: 37190988 DOI: 10.1017/s0007114523001204] [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] [Indexed: 05/17/2023]
Abstract
Periconceptional maternal ultra-processed food (UPF) consumption impairs embryonic growth. Impacts of exposure to UPF on distinct components of fetal growth in late pregnancy are unknown. We investigated the influence of frequency of UPF consumption during pregnancy on fetal head circumference (HC), abdominal circumference (AC) and femur length (FL). This study included 417 live-born singleton pregnancies prospectively followed-up since the antenatal period in the MINA-Brazil Study, with an available ultrasound scan at >24 gestational weeks. Frequency of food groups consumption in the previous month was categorised as no/monthly, weekly or daily. Ultrasound scans were conducted at 27·8 (sd: 1·7) gestational weeks. HC, AC and FL z-scores were calculated for gestational age using the INTERGROWTH-21st Project standards. Simultaneous-quantile regression models were fitted at the 10th, 50th and 90th percentiles of the distribution of each ultrasound parameter according to UPF consumption, with adjustment for potential confounders. Participants were aged on average 24·7 (sd: 6·5) years, 44·8 % were primiparous, and 26·9 % and 24·9 %, respectively, had weekly and daily UPF consumption. Compared with no/monthly intake, daily UPF consumption impaired HC across its distribution, with significant effect sizes varying from -0·24 to -0·40 z-score. Weekly UPF consumption decreased HC at the 90th percentile by -0·39 z-score (95 % CI: -0·78, -0·01) and FL at the 50th percentile by -0·32 z-score (95 % CI: -0·60, -0·04). No association was noted with AC. Frequency of UPF consumption was negatively associated with skeletal components of fetal growth in late pregnancy. Infant body composition may benefit from healthy food practices since pregnancy.
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Affiliation(s)
- Bárbara Hatzlhoffer Lourenço
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Priscila de Morais Sato
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, BA, Brazil
| | | | - Edwin Vivanco
- Juruá Women's and Children's Hospital, Cruzeiro do Sul, AC, Brazil
| | - Daniel Leal Lima
- Juruá Women's and Children's Hospital, Cruzeiro do Sul, AC, Brazil
| | - Marly Augusto Cardoso
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
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Mostafa I, Hasan SMT, Gazi MA, Alam MA, Fahim SM, Saqeeb KN, Ahmed T. Alteration of stool pH and its association with biomarkers of gut enteropathy among slum-dwelling women of reproductive age in Bangladesh. BMC Womens Health 2023; 23:661. [PMID: 38071298 PMCID: PMC10710701 DOI: 10.1186/s12905-023-02758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Recent evidence suggests that measures of maternal gut enteropathy are associated with unfavorable fetal outcomes. It is, therefore, crucial to identify and treat the features of intestinal enteropathy among reproductive-age women living in areas where enteropathy is highly prevalent. However, there is a lack of non-invasive diagnostic tests to determine EED, making it difficult to identify the disease in field settings. In this study, we tested the potential of fecal pH as a biomarker of gut enteropathy and investigated its relationship with fecal biomarkers of intestinal enteropathy in reproductive-age women living in resource-limited environments. METHODS Data on socio-demographic information, anthropometry, and biological samples were collected from 78 apparently healthy women aged between 20 and 27 years from November 2018 to December 2019. The association of stool pH with two fecal biomarkers of gut enteropathy (i.e., intestinal alkaline phosphatase [IAP] and fecal lipocalin-2 [LCN-2] was investigated using multiple linear regression models after adjusting for relevant covariates. RESULTS In the adjusted models, alkaline stool pH (pH > 7.2) was found to be significantly associated with a decrease in the fecal IAP level by 1.05 unit (95% CI: -1.68, -0.42; p < 0.001) in the log scale, and acidic stool pH (pH < 6) was found to be significantly associated with an increase in the fecal LCN-2 level by 0.89 units (95% CI: 0.12, 1.67; p < 0.025) in the log scale. CONCLUSIONS The study findings demonstrated an association of fecal pH with biomarkers of gut enteropathy indicating its applicability as a simple tool for understanding intestinal enteropathy among reproductive-age women living in resource-limited settings.
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Affiliation(s)
- Ishita Mostafa
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - S M Tafsir Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Amran Gazi
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Ashraful Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shah Mohammad Fahim
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Kazi Nazmus Saqeeb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
- Office of the Executive Director, icddr,b, Dhaka, 1212, Bangladesh
- Department of Global Health, University of Washington, Seattle, WA, 98195, USA
- Department of Public Health Nutrition, James P Grant School of Public Health, BRAC University, Dhaka, 1212, Bangladesh
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Manzo ML, Doudou Halidou M, Dramaix Wilmet M, Donnen P. Trends in malnutrition among children under 5 in Niger: a retrospective analysis of demographic and nutrition surveys comparing 2008-2014 with 2015-2021. Public Health 2023; 225:151-159. [PMID: 37925840 DOI: 10.1016/j.puhe.2023.09.027] [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: 04/26/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES For decades, Niger, a Sahelian country in Africa, has faced serious food and nutrition crises. Policies and strategies have been implemented by the Government, with the support of its partners, to address this public health problem. The current study was conducted to assess trends in malnutrition among children under 5 years of age. By comparing results from 2008 to 2014 with results from 2015 to 2021, this study aimed to check the efficacy of strategies and policies that were implemented to combat malnutrition. STUDY DESIGN Retrospective study. METHODS Data from the annual nutrition survey Standardized Monitoring and Assessment of Relief and Transitions and the Demographic and Health and Multiple Indicator Surveys were used. Meta-analyses were performed on the data as a whole and in each age group by time period. For analysis of age groups, the 95% confidence interval (CI) data were missing, thus an estimate was made from the 'design effect' calculated based on existing CIs. RESULTS Institutional arrangements had not changed from 2008 to 2014 to 2015-2021, and there were very few changes to existing strategies and policies. The prevalence of Global Acute Malnutrition and Global Chronic Malnutrition (GCM) both remained above critical thresholds for each year in both periods. GCM was above the emergency threshold for both periods, indicating that all regions of the country were affected by malnutrition. The most populated regions (40%) of Maradi and Zinder were the most affected by malnutrition. These two regions also had highest incidence of poverty and the least health service coverage. CONCLUSIONS Despite the implementation of various policies and strategies, the nutritional status of children under 5 remains an important public health problem.
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Affiliation(s)
- M L Manzo
- School of Public Health, Université Libre de Bruxelles, Belgium.
| | | | | | - P Donnen
- School of Public Health, Université Libre de Bruxelles, Belgium
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46
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Neufeld LM, Ho E, Obeid R, Tzoulis C, Green M, Huber LG, Stout M, Griffiths JC. Advancing nutrition science to meet evolving global health needs. Eur J Nutr 2023; 62:1-16. [PMID: 38015211 PMCID: PMC10684707 DOI: 10.1007/s00394-023-03276-9] [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: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 11/29/2023]
Abstract
Populations in crisis!A global overview of health challenges and policy efforts within the scope of current nutrition issues, from persistent forms of undernutrition, including micronutrient deficiency, to diet-related chronic diseases. Nutrition science has evolved from a therapeutic and prevention emphasis to include a focus on diets and food systems. Working and consensus definitions are needed, as well as guidance related to healthy diets and the emerging issues that require further research and consensus building. Between nutrient deficiency and chronic disease, nutrition has evolved from focusing exclusively on the extremes of overt nutrient deficiency and chronic disease prevention, to equipping bodies with the ability to cope with physiologic, metabolic, and psychological stress. Just what is 'optimal nutrition', is that a valid public health goal, and what terminology is being provided by the nutrition science community? Nutrition research on 'healthspan', resilience, and intrinsic capacity may provide evidence to support optimal nutrition. Finally, experts provide views on ongoing challenges of achieving consensus or acceptance of the various definitions and interventions for health promotion, and how these can inform government health policies.Nutrition topics that receive particular focus in these proceedings include choline, NAD-replenishment in neurodegenerative diseases, and xanthophyll carotenoids. Choline is a crucial nutrient essential for cellular metabolism, requiring consumption from foods or supplements due to inadequate endogenous synthesis. Maternal choline intake is vital for fetal and infant development to prevent neural tube defects. Neurodegenerative diseases pose a growing health challenge, lacking effective therapies. Nutrition, including NAD-replenishing nutrients, might aid prevention. Emerging research indicates xanthophyll carotenoids enhance vision and cognition, potentially impacting age-related diseases.
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Affiliation(s)
- Lynnette M Neufeld
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Emily Ho
- Linus Pauling Institute and College of Health, Oregon State University, Corvallis, OR, USA
| | - Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital of the Saarland, Homburg, Germany
| | - Charalampos Tzoulis
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, K.G. Jebsen Center for Translational Research in Parkinson's Disease, University of Bergen, Bergen, Norway
| | - Marina Green
- Nutrition Research Centre Ireland, South East Technological University, Waterford, Ireland
| | - Luke G Huber
- Council for Responsible Nutrition, Washington, DC, USA
| | | | - James C Griffiths
- Council for Responsible Nutrition-International, Washington, DC, USA.
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47
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Dewey KG, Arnold CD, Wessells KR, Stewart CP. Lipid-based nutrient supplements for prevention of child undernutrition: when less may be more. Am J Clin Nutr 2023; 118:1133-1144. [PMID: 37742931 DOI: 10.1016/j.ajcnut.2023.09.007] [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: 06/29/2023] [Revised: 08/25/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Both small-quantity and medium-quantity lipid-based nutrient supplements (LNS) have been used for the prevention of child undernutrition. A meta-analysis of 14 trials of small-quantity lipid-based nutrient supplements (SQ-LNS) - no LNS showed effects on length-for-age z-score {LAZ, +0.14 [95% confidence interval (CI): 0.11, 0.16]} and weight-for-length z-score [WLZ, +0.08 (0.06, 0.10)] z-scores, as well as prevalence ratios (95% CI) for stunting [LAZ < -2, 0.88 (0.85, 0.91)] and wasting [WLZ < -2, 0.86 (0.80, 0.93)]. However, little is known about the effects of medium-quantity lipid-based nutrient supplements (MQ-LNS) on growth. OBJECTIVES We aimed to examine the effects of preventive MQ-LNS (∼250-499 kcal/d) provided at ∼6-23 mo of age on growth outcomes - no LNS or provision of SQ-LNS. METHODS We conducted a systematic review of studies of MQ-LNS for prevention, and categorized them as providing <6 mo - ≥6 mo of supplementation; for the latter category, we conducted a meta-analysis, with the main outcomes being change in WLZ and LAZ, and prevalence of wasting and stunting. RESULTS Three studies provided MQ-LNS for 3-5 mo (seasonal) for children 6-36 mo of age, and did not show consistent effects on growth outcomes. Eight studies provided MQ-LNS for 6-18 mo, generally starting at 6 mo of age; in the meta-analysis (max total n = 13,954), MQ-LNS increased WLZ [+0.09 (95% CI: 0.05, 0.13)] and reduced wasting [0.89 (0.81, 0.97)], but had no effect on LAZ [+0.04 (-0.02, 0.11)] or stunting [0.97 (0.92, 1.02)] - no LNS. Two studies directly compared SQ-LNS and MQ-LNS and showed no significant differences in growth outcomes. CONCLUSIONS The current evidence suggests that MQ-LNS offer no added benefits over SQ-LNS, although further studies directly comparing MQ-LNS with SQ-LNS would be useful. One possible explanation is incomplete consumption of the MQ-LNS ration and thus lower than desirable intake of certain nutrients. TRIAL REGISTRATION NUMBER Registry and registry number for systematic reviews or meta-analyses: Registered with PROSPERO as CRD42022382448 on December 18, 2022: =https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022382448.
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Affiliation(s)
- Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States.
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, United States
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48
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Fracassi P, Daget M, Seo S, D'Angeli R. Preventing Child Wasting in Africa's Dryland: An Exploratory Review of the Enabling Environment in 8 Sub-Saharan Countries Using a Food Systems Lens. Food Nutr Bull 2023; 44:S32-S44. [PMID: 37850929 DOI: 10.1177/03795721231188767] [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] [Indexed: 10/19/2023]
Abstract
Persistent child wasting is evident across the Sahel and Horn of Africa, much of which is typically dryland and dependent on agropastoralism. Two events in 2021, the United Nations (UN) Food Systems Summit and the Tokyo Nutrition for Growth Summit, represented a watershed moment for the alignment of food systems and nutrition. Against this backdrop, the costed country operational roadmaps, developed in 22 countries as part of the joint UN Global Action Plan on Child Wasting (UNICEF 2021), recognized the importance of preventing child wasting using a multisectoral approach. We use a food systems lens to assess how current governance mechanisms, policies, and programming priorities in 8 sub-Saharan countries are responsive to the food security and nutritional needs of the most vulnerable people. For governance mechanisms, we draw from a narrative review of joint annual assessments conducted by the Scaling Up Nutrition Movement's national multistakeholder platforms since 2016. For policy frameworks, we analyze recommendations included in operational roadmaps and findings from the review of national multisectoral nutrition plans. For programming priorities, we analyze the typologies of costed interventions in the food and social protection systems. We present how nutrition and healthy diets were factored into national food systems pathways and how Government commitments to Nutrition for Growth integrate food systems and resilience. Results of this exploratory review suggest opportunities offered by the implementation of the country roadmaps should rely on a fundamental understanding of context-specific risks and vulnerabilities embedded in the systems and their dynamics.
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Affiliation(s)
- Patrizia Fracassi
- Food and Agriculture Organization (FAO) of the United Nations, Rome, Italy
| | - Morgane Daget
- Scaling Up Nutrition (SUN) Movement, Geneva, Switzerland
| | - Sangmin Seo
- Food and Agriculture Organization (FAO) of the United Nations, Rome, Italy
| | - Riccardo D'Angeli
- Food and Agriculture Organization (FAO) of the United Nations, Rome, Italy
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Norov B, Cristobal-Maramag C, Van Minh H, Long KQ, Huse O, Nkoroi A, Luvsanjamba M, Phuong DH, Kupka R, Lobstein T, Jewell J, Castro MC, Oliver N, Watson F. Prevention of childhood overweight and obesity in Mongolia, the Philippines and Vietnam: identifying priority actions. Health Promot Int 2023; 38:daad187. [PMID: 38156876 PMCID: PMC10756053 DOI: 10.1093/heapro/daad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Low- and middle-income countries are increasingly faced with a triple burden of malnutrition: endemic underweight, micronutrient deficiencies and rising prevalence of overweight. This study aimed to address existing knowledge gaps and to identify priority policy options in Mongolia, the Philippines and Vietnam. A landscape analysis approach was adopted using methods set out in a UNICEF global toolkit. Quantitative and qualitative data were compiled from a range of global and national sources on childhood overweight and obesity, risk factors and policy responses. Key informant interviews and validation workshops were undertaken with key food and nutrition stakeholders from government and non-government organizations to identify priority policy options for the prevention of overweight and obesity among children. Overweight and obesity among children are increasing in all three countries. Associated risk factors are related to maternal nutrition, birthweight, breastfeeding, as well as diets and physical activity shaped by increasingly obesogenic environments. Key informants identified undefined policy approaches, poor community understanding and food and beverage industry influence as barriers to addressing overweight and obesity. Key policy priorities include restricting the marketing of unhealthy food and beverages, unhealthy food and beverage taxation, introduction of front-of-pack nutrition labels and improving school nutrition environments. Mongolia, the Philippines and Vietnam are all facing an increasing burden of childhood overweight and obesity. Despite differing national contexts, similar environmental factors are driving this rise. A suite of evidence-based policies can effectively be introduced to address obesogenic environments.
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Affiliation(s)
- Bolormaa Norov
- Nutrition Department, National Center for Public Health, Peace Ave 46, Ulaanbaatar 13381, Mongolia
| | - Cherry Cristobal-Maramag
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Hoang Van Minh
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Khương Quỳnh Long
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Oliver Huse
- Deakin University, Geelong Australia, Global Obesity Centre for Preventive Health and Nutrition, Institute for Health Transformation, 1 Gheringhap St 3220
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Alice Nkoroi
- Philippines Country Office, UNICEF, 14th Floor, North Tower, Rockwell Business Center Sheridan, Sheridan Street corner United Street, Highway Hills, Mandaluyong City 1550, Philippines
| | - Munkhjargal Luvsanjamba
- Mongolia Country Office, UNICEF, UN House, United Nations street-14, Ulaanbaatar 14201, Mongolia
| | - Do Hong Phuong
- Vietnam Country Office, UNICEF, The Green One UN House, 304 Kim Ma, Ba Dinh District, Hanoi, Vietnam
| | - Roland Kupka
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Tim Lobstein
- Policy Section, World Obesity Federation, 5th Floor, 38 Chancery Lane, London, WC2A 1EN, UK
- The Boden Initiative, University of Sydney, John Hopkins Dr, Camperdown, Sydney, 2050, NSW, Australia
| | - Jo Jewell
- Nutrition Section, UNICEF, 3 United Nations Plaza, New York, NY 10017, USA
| | - Mary Christine Castro
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Nikka Oliver
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Fiona Watson
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
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50
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Knez M, Stangoulis JCR. Dietary Zn deficiency, the current situation and potential solutions. Nutr Res Rev 2023; 36:199-215. [PMID: 37062532 DOI: 10.1017/s0954422421000342] [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] [Indexed: 11/07/2022]
Abstract
Zinc (Zn) deficiency is a worldwide problem, and this review presents an overview of the magnitude of Zn deficiency with a particular emphasis on present global challenges, current recommendations for Zn intake, and factors that affect dietary requirements. The challenges of monitoring Zn status are clarified together with the discussion of relevant Zn bioaccessibility and bioavailability issues. Modern lifestyle factors that may exacerbate Zn deficiency and new strategies of reducing its effects are presented. Biofortification, as a potentially useful strategy for improving Zn status in sensitive populations, is discussed. The review proposes potential actions that could deliver promising results both in terms of monitoring dietary and physiological Zn status as well as in alleviating dietary Zn deficiency in affected populations.
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Affiliation(s)
- Marija Knez
- College of Science and Engineering, Flinders University, GPO Box 2100, AdelaideSA5001, Australia
- Center of Research Excellence in Nutrition and Metabolism, University of Belgrade, Institute for Medical Research, National Institute of the Republic of Serbia, 11000Belgrade, Serbia
| | - James C R Stangoulis
- College of Science and Engineering, Flinders University, GPO Box 2100, AdelaideSA5001, Australia
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