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Huayta VMR, Pradeilles R, Creed-Kanashiro HM, Rousham E, Delgado D, Pareja R, Landais E, Verdezoto N, Haycraft E, Holdsworth M. Identifying priority double-duty actions to tackle the double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national experts. PLoS One 2024; 19:e0303668. [PMID: 38768151 PMCID: PMC11104715 DOI: 10.1371/journal.pone.0303668] [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: 02/23/2023] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
Multiple forms of malnutrition coexist in infants and young children (IYC) in Peru. The World Health Organization has proposed double-duty actions (DDAs) to simultaneously address undernutrition and overweight/obesity. We assessed current implementation of- and priority for- government-level actions to tackle multiple forms of malnutrition in IYC in Peru. Mapping of current policy activity was undertaken against 47 indicators of good practice for five DDAs (exclusive breastfeeding, complementary feeding, food marketing, maternal nutrition, preschool nutrition; assessed by 27 indicators) and for the enabling policy environment, i.e., 'infrastructure support' (health in all policies, platforms for interactions, financing, monitoring, governance, leadership; assessed by 20 indicators). Interviews with 16 national experts explored views on the level of and barriers to implementation of DDAs and infrastructure support, as well as their prioritisation based on likely impact and feasibility. The level of implementation of actions was categorised into two groups (agenda setting/formulation vs. implementation/evaluation). Mean scores were generated for prioritisation of DDAs and infrastructure support. Deductive qualitative analysis was undertaken to identify barriers that influence policy implementation. Only 5/27 DDA indicators were reported as fully implemented by all national experts (international code that regulates the marketing of breastmilk substitutes, iron supplementation for IYC, micronutrient powders in IYC, iron/folic acid supplementation in pregnant women, paid maternity leave). Only 1/20 infrastructure support indicator (access to nutrition information) was rated as fully implemented by all experts. Barriers to implementing DDAs and infrastructure support included: legal feasibility or lack of regulations, inadequate monitoring/evaluation to ensure enforcement, commercial influences on policymakers, insufficient resources, shifting public health priorities with the COVID-19 pandemic and political instability. The experts prioritised 12 indicators across all five DDAs and eight infrastructure support indicators. Experts highlighted the need to improve implementation of all DDAs and identified ways to strengthen the enabling policy environment.
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Affiliation(s)
| | - Rebecca Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | | | - Emily Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Doris Delgado
- Facultad de Medicina, Departamento de Nutrición, Universidad Nacional Mayor de San Marcos (UNMSM), Lima, Perú
| | | | - Edwige Landais
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Nervo Verdezoto
- School of Computer Science and Informatics, Cardiff University, Cardiff, United Kingdom
| | - Emma Haycraft
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
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Malin AJ, Wang Z, Khan D, McKune SL. The Potential Systemic Role of Diet in Dental Caries Development and Arrest: A Narrative Review. Nutrients 2024; 16:1463. [PMID: 38794700 PMCID: PMC11124059 DOI: 10.3390/nu16101463] [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: 03/21/2024] [Revised: 04/21/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Current conceptualizations of dental caries etiology center primarily on the local role of sugar, starch, or other fermentable carbohydrates on tooth enamel demineralization-a well-established and empirically supported mechanism. However, in addition to this mechanism, studies dating back to the early 1900s point to an important systemic role of diet and nutrition, particularly from pasture-raised animal-source foods (ASF), in dental caries etiology and arrest. Findings from animal and human studies suggest that adherence to a diet high in calcium, phosphorus, fat-soluble vitamins A and D, and antioxidant vitamin C, as well as low in phytates, may contribute to arrest and reversal of dental caries, particularly among children. Furthermore, findings from observational and experimental studies of humans across the life-course suggest that fat-soluble vitamins A, D, and K2 may interact to protect against dental caries progression, even within a diet that regularly contains sugar. While these historic studies have not been revisited in decades, we emphasize the need for them to be reinvestigated and contextualized in the 21st century. Specifically, methodologically rigorous studies are needed to reinvestigate whether historical knowledge of systemic impacts of nutrition on dental health can help to inform current conceptualizations of dental caries etiology, prevention, and arrest.
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Affiliation(s)
- Ashley J. Malin
- College of Public Health and Health Professions, University of Florida, Gainesville, FL 32611, USA; (Z.W.); (D.K.); (S.L.M.)
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Zhilin Wang
- College of Public Health and Health Professions, University of Florida, Gainesville, FL 32611, USA; (Z.W.); (D.K.); (S.L.M.)
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Durdana Khan
- College of Public Health and Health Professions, University of Florida, Gainesville, FL 32611, USA; (Z.W.); (D.K.); (S.L.M.)
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Sarah L. McKune
- College of Public Health and Health Professions, University of Florida, Gainesville, FL 32611, USA; (Z.W.); (D.K.); (S.L.M.)
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Baye K, Yaregal Z. The Global Diet Quality Score predicts diet quality of women of reproductive age in Addis Ababa, Ethiopia. Br J Nutr 2023; 130:1573-1579. [PMID: 36876589 PMCID: PMC10551468 DOI: 10.1017/s0007114523000508] [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: 05/12/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
Improving diet quality is recognised as a double-duty action that can simultaneously address multiple forms of malnutrition. This study aimed to assess diet quality among non-pregnant non-lactating women of reproductive age (WRA) in Addis Ababa, Ethiopia. A 1-d quantitative 24 h recall was conducted among 653 non-pregnant/non-lactating women. Diet quality, assessed using the women dietary diversity score (WDDS), the Global Diet Quality Score (GDQS) and the Nova 4 classification reflecting consumption of ultra-processed foods (UPF), was compared. The proportion that meets the minimum dietary diversity for women (MDD-W) was estimated. The average MDD-W score was 2·6 (sd 0·9), with only 3 % of women meeting the MDD-W (≥ 5 food groups). Consumption of wholegrain and legumes was high, but UPF were also consumed by 9 % of the women. GDQS was positively associated with WDDS, age and skipping breakfast and was negatively associated with eating out of home and UPF consumption (P < 0·05). The multivariate regression model showed that GDQS (total) was not associated with wealth but was significantly associated with both UPF and WDDS (P < 0·001). Unlike UPF and WDDS alone, GDQS was able to predict both nutrient adequacy and unhealthy dietary practices. The diet quality of WRA in Addis Ababa is low in diversity, possibly exposing them to higher risk of nutrient inadequacy and non-communicable diseases as reflected by the low GDQS. Understanding what drives food and dietary choices in urban settings is urgently needed.
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Affiliation(s)
- Kaleab Baye
- College of Natural and Computational Sciences, Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zemenu Yaregal
- College of Natural and Computational Sciences, Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Food Science and Applied Nutrition, Addis Ababa Science and Technology University, P O, Box 16417, Addis Ababa, Ethiopia
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Pradeilles R, Landais E, Pareja R, Eymard‐Duvernay S, Markey O, Holdsworth M, Rousham EK, M. Creed‐Kanashiro H. Exploring the magnitude and drivers of the double burden of malnutrition at maternal and dyad levels in peri-urban Peru: A cross-sectional study of low-income mothers, infants and young children. MATERNAL & CHILD NUTRITION 2023; 19:e13549. [PMID: 37485734 PMCID: PMC10483951 DOI: 10.1111/mcn.13549] [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: 07/21/2022] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
Multiple forms of malnutrition coexist in Peru, especially in peri-urban areas and poor households. We investigated the magnitude of, and the contribution of, dietary and socio-demographic factors to the double burden of malnutrition (DBM) at maternal (i.e., maternal overweight/obesity with anaemia) and dyad (i.e., maternal overweight/obesity with child anaemia) levels. A cross-sectional survey was conducted among low-income mother-child (6-23 months) dyads (n = 244) from peri-urban communities in Peru. Dietary clusters and the minimum dietary diversity score (MDD) were generated for mothers and infants, respectively. A composite indicator using the maternal dietary clusters and the MDD was created to relate to dyad level DBM. Two dietary clusters were found: (i) the 'high variety (i.e., animal-source foods, fruit and vegetables), high sugary foods/beverages' (cluster 1) and (ii) the 'high potato, low fruit and vegetables, low red meat' (cluster 2). DBM prevalence among mothers and dyads was 19.9% and 36.3%, respectively. Logistic regression analyses revealed that the only socio-demographic factor positively associated with maternal DBM was maternal age (aOR/5 years: 1.35 [1.07, 1.71]). Mothers belonging to diet cluster 1 were less likely to experience the DBM (aOR = 0.52 [0.26, 1.03]), although CIs straddled the null. Socio-demographic factors positively associated with dyad level DBM included maternal age (aOR/5 years: 1.41 [1.15, 1.73]), and having ≥ two children under 5 years (aOR = 2.44 [1.23, 4.84]). Diet was not associated with dyad-level DBM. Double-duty actions that tackle the DBM are needed given that one-third of dyads and a fifth of mothers had concurrent overweight/obesity and anaemia.
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Affiliation(s)
- Rebecca Pradeilles
- Centre for Global Health and Human Development School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | - Edwige Landais
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | | | - Sabrina Eymard‐Duvernay
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | - Oonagh Markey
- Centre for Global Health and Human Development School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | - Emily K. Rousham
- Centre for Global Health and Human Development School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
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Xiong J, Yu Z, Huang Y, He T, Yang K, Zhao J. Geriatric Nutritional Risk Index and Risk of Mortality in Critically Ill Patients With Acute Kidney Injury: A Multicenter Cohort Study. J Ren Nutr 2023; 33:639-648. [PMID: 37302721 DOI: 10.1053/j.jrn.2023.06.004] [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: 10/25/2022] [Revised: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES Malnutrition is associated with adverse outcomes in acute or chronic diseases. However, the prediction value of the Geriatric Nutritional Risk Index (GNRI) in critically ill patients with acute kidney injury (AKI) has not been well studied. METHODS Data was extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) and the electronic intensive care unit database. We used two nutritional indicators, the GNRI and the modified Nutrition Risk in Critically ill (NUTRIC) score, to evaluate the relationship between the nutritional status of patients with AKI and prognosis. The outcome is in-hospital mortality and 90-day mortality. The prediction accuracy of GNRI was compared with the NUTRIC score. RESULTS A total of 4,575 participants with AKI were enrolled in this study. The median age of 68 (interquartile range, 56-79) years, and 1,142 (25.0%) patients experienced in-hospital mortality, and 1,238 (27.1%) patients experienced 90-day mortality. Kaplan-Meier survival analysis indicated that lower GNRI levels and high NUTRIC score are associated with lower in-hospital and 90-day survival of patients with AKI (P < .001 by log-rank test). After multivariate adjustment, Cox regression analysis demonstrated a 2-fold increased risk of in-hospital (hazard ratio = 2.019, 95% confidence interval: 1.699-2.400, P < .001) and 90-day (hazard ratio = 2.023, 95% confidence interval: 1.715-2.387, P < .001) mortality in the low GNRI group. Moreover, the multivariate-adjusted Cox model containing GNRI had higher prediction accuracy for the prognosis of patients with AKI than that with NUTRIC score (AUCGNRI model vs. AUCNUTRIC model for in-hospital mortality = 0.738 vs. 0.726, AUCGNRI model vs. AUCNUTRIC model for 90-day mortality = 0.748 vs. 0.726). In addition, the prediction value of GNRI was validated by the electronic intensive care unit database (7,881 patients with AKI) with satisfying performance (AUCGNRI model = 0.680). CONCLUSIONS Our results demonstrated that GNRI is strongly associated with survival in patients in the intensive care unit coexisting with AKI, and the GNRI has a superior predictive value than the NUTRIC score.
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Affiliation(s)
- Jiachuan Xiong
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Zhikai Yu
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Yinghui Huang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Ting He
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Ke Yang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Jinghong Zhao
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China.
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Gaupholm J, Dodd W, Papadopoulos A, Little M. Exploring the double burden of malnutrition at the household level in the Philippines: Analysis of National Nutrition Survey data. PLoS One 2023; 18:e0288402. [PMID: 37459316 PMCID: PMC10351706 DOI: 10.1371/journal.pone.0288402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND In the Philippines, the rising prevalence of obesity and related chronic diseases alongside persistent undernutrition presents a complex public health challenge. Understanding the patterns and dynamics of this 'double burden of malnutrition' (DBM) is crucial for developing effective intervention strategies. However, evidence of the occurrence of undernutrition and overnutrition within the same household is currently lacking. METHODS Using cross-sectional data from the 2013 Philippines National Nutrition Survey this study examined the prevalence of different typologies of household-level DBM from an analytical sample of 5,837 households and 25,417 individuals. Multivariable logistic regression was performed to identify factors associated with overall occurrence of intrahousehold DBM. RESULTS The overall prevalence of double burden households was 56% based on a comprehensive definition. The most common typology of intrahousehold DBM characterized in this study (% of all households) comprised households with at least one adult with overnutrition and at least one separate adult with undernutrition. Household size, wealth quintile, food insecurity, and household dietary diversity were all associated with household-level DBM. Double burden households were also influenced by head of household characteristics, including sex, level of education, employment status, and age. CONCLUSIONS The findings from this study reveal that the coexistence of overnutrition and undernutrition at the household level is a major public health concern in the Philippines. Further comprehensive assessments of household-level manifestations of the DBM are needed to improve our understanding of the trends and drivers of this phenomenon in order to develop better targeted interventions.
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Affiliation(s)
- Josephine Gaupholm
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Matthew Little
- School of Public Health and Social Policy, University of Victoria, Victoria, British Colombia, Canada
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Meshkovska B, Gebremariam MK, Atukunda P, Iversen PO, Wandel M, Lien N. Barriers and facilitators to implementation of nutrition-related actions in school settings in low- and middle-income countries (LMICs): a qualitative systematic review using the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 2023; 4:73. [PMID: 37370179 DOI: 10.1186/s43058-023-00454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) are particularly vulnerable to the double burden of malnutrition: co-existence of underweight, overweight, obesity, and/or diet-related non-communicable diseases. Nutrition-related double-duty actions in school settings have been identified as one of the ways to address this challenge. However, to be able to take full advantage of the potential impact, it is important to understand their implementation as well. The aim of this paper is to systematically review qualitative research on barriers and facilitators to the implementation of nutrition-related actions in the school settings in LMICs. METHODS The following databases were searched: EMBASE, ERIC, MEDLINE, Global Health and PsycInfo (all on Ovid), Scopus (Elsevier), the Web of Science Social Sciences Citation Index, and Global Index Medicus from the World Health Organization. Of the 4253 identified records, 4030 were excluded after the abstract and title screen, leaving 223 for the full-text screen. A final 36 papers were included in this review. The consolidated framework for implementation research (CFIR) was used in the analysis. RESULTS We identified barriers and facilitators to implementation linked to the following CFIR constructs/sub-constructs: design quality and packaging, cost (intervention characteristics); target group needs and resources, cosmopolitanism, external policy and incentives (outer setting); structural characteristics, readiness for implementation (inner setting); knowledge and beliefs (characteristics of individuals) and engaging, executing (process). All identified constructs apart from target group needs and resources, knowledge and beliefs, and engaging were predominantly barriers. Available resources were the most prevalent barriers across studies. CONCLUSION This review identified barriers and facilitators to the implementation of nutrition-related actions based on qualitative articles in the school setting in LMICs, using the CFIR. Schools face continuous challenges in regard to funding and the government sector may have a role to play not only by offering financial assistance, but also through policy-making that would support healthy eating practices on school grounds. REGISTRATION PROSPERO ID: CRD42022296159.
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Affiliation(s)
- Biljana Meshkovska
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway.
| | - Mekdes Kebede Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, Fredrik Holsts hus, 0450, Oslo, Norway
| | - Prudence Atukunda
- Center for Crisis Psychology, University of Bergen, Møllendalsbakken 9, 5009, Bergen, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
- Division of Human Nutrition, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Margareta Wandel
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway
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Pradeilles R, Irache A, Norris T, Chitekwe S, Laillou A, Baye K. Magnitude, trends and drivers of the coexistence of maternal overweight/obesity and childhood undernutrition in Ethiopia: Evidence from Demographic and Health Surveys (2005-2016). MATERNAL & CHILD NUTRITION 2022:e13372. [PMID: 35615766 DOI: 10.1111/mcn.13372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Ethiopia faces a rising problem of overweight and obesity alongside a high prevalence of undernutrition; a double burden of malnutrition (DBM). This study aimed to quantify the magnitude and trends of household-level DBM-defined as the coexistence of maternal overweight/obesity and child undernutrition (i.e., stunting or anaemia)-in Ethiopia between 2005, 2011 and 2016 and understand the potential drivers influencing DBM and the change in DBM over time. Data come from the Ethiopian Demographic and Health Surveys. National and regional prevalence estimates of the DBM were calculated (n = 13,107). Equiplots were produced to display inequalities in the distribution of DBM. Factors associated with DBM were explored using pooled multivariable logistic regression analyses for 2005, 2011 and 2016 (n = 9358). These were also included in a logistic regression decomposition analysis to understand their contribution to the change in DBM between 2005 and 2016 (n = 5285). The prevalence of household-level DBM at the national level was low, with a modest increase from 2.4% in 2005% to 3.5% in 2016. This masks important within-country variability, with substantially higher prevalence in Addis Ababa (22.8%). Factors positively associated with DBM were maternal age (odds ratio [OR] = 1.04 [1.02, 1.06]), urban residence (OR = 3.12 [2.24, 4.36]), wealth (OR = 1.14 [1.06, 1.24]) and the number of children <5 in the household (OR = 1.30 [1.12, 1.49]). Overall, 70.5% of the increase in DBM between 2005 and 2016 was attributed to increased wealth, urban residence and region. Double-duty actions that address multiple forms of malnutrition are urgently needed in urban settings.
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Affiliation(s)
- Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences (SSEHS), Loughborough University, Loughborough, UK
| | - Ana Irache
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tom Norris
- Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Arnaud Laillou
- Nutrition Section, UNICEF Ethiopia, Addis Ababa, Ethiopia
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Research Center for Inclusive Development in Africa (RIDA), Addis Ababa, Ethiopia
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Irenso AA, Letta S, Chemeda AS, Asfaw A, Egata G, Assefa N, Campbell KJ, Laws R. Maternal Time Use Drives Suboptimal Complementary Feeding Practices in the El Niño-Affected Eastern Ethiopia Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073937. [PMID: 35409616 PMCID: PMC8997821 DOI: 10.3390/ijerph19073937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/15/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
Ethiopia is affected by recurrent drought and food-insecurity crises, including El Niño. El Niño started in mid-2014, worsened in 2015, and continued in 2016, leading to a widespread food-insecurity emergency resulting in a surge in the rate of acute malnutrition in infants due to suboptimal feeding practices. This study explored how El Niño influenced complementary feeding practices in the eastern Ethiopia community from March to September 2016. It was an exploratory qualitative study with a basic interpretative qualitative approach. A general inductive approach was used for the analysis. The study involved 11 focus group discussions (FGD) with a total of 76 people, including three with mothers, three with Health Development Army (HDA) leaders, two with fathers, two with traditional birth attendants, and one with religious leaders. El Niño resulted in failed crops and loss of livestock, resulting in reduced dietary diversity and meal frequency. El Niño resulted in suboptimal complementary feeding practices by reducing food access and altering livelihood and coping strategies, reducing the time mothers allocated to child feeding, keeping them away from home, and stressing community health services. The maternal suboptimal time allocation is central to the poor complementary feeding practices. Thus, the women should be supported with climate-resilient livelihood options in their villages, allowing them to feed their children and attend education sessions with HDA leaders.
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Affiliation(s)
- Asnake Ararsa Irenso
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, 221 Burwood Highway, Melbourne, VIC 3125, Australia; (K.J.C.); (R.L.)
- School of Public Health, Haramaya University, Harar P.O. Box 235, Ethiopia
- Correspondence: ; Tel.: +61-420-974-834
| | - Shiferaw Letta
- School of Nursing, Haramaya University, Harar P.O. Box 235, Ethiopia; (S.L.); (A.A.); (N.A.)
| | - Addisu S. Chemeda
- Department of Food Process Engineering and Postharvest Technology, Ambo University, Ambo P.O. Box 19, Ethiopia;
| | - Abiyot Asfaw
- School of Nursing, Haramaya University, Harar P.O. Box 235, Ethiopia; (S.L.); (A.A.); (N.A.)
| | - Gudina Egata
- School of Public Health, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia;
| | - Nega Assefa
- School of Nursing, Haramaya University, Harar P.O. Box 235, Ethiopia; (S.L.); (A.A.); (N.A.)
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, 221 Burwood Highway, Melbourne, VIC 3125, Australia; (K.J.C.); (R.L.)
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, 221 Burwood Highway, Melbourne, VIC 3125, Australia; (K.J.C.); (R.L.)
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Zaba T, Conkle J, Nyawo M, Foote D, Myatt M. Concurrent wasting and stunting among children 6-59 months: an analysis using district-level survey data in Mozambique. BMC Nutr 2022; 8:15. [PMID: 35180886 PMCID: PMC8855563 DOI: 10.1186/s40795-022-00508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background In the past it was believed that wasting and stunting were independent of each other. Recent work has shown that they can occur concurrently in a child and that increases considerably the risk of mortality. Concurrent wasting and stunting (WaSt) is currently defined as WHZ < -2 AND HAZ < -2. Wasting is measured by WHZ and MUAC and evidence shows that they tend to identify different sets of children. Our study aimed to look at the effect of adding MUAC on the prevalence and burden of WaSt, and to assess diagnosis of WaSt with a single measurement. Methods We analyzed population-based anthropometric surveys from 37 districts in Mozambique conducted by the Government of Mozambique between 2017 and 2019. We proposed a new case-definition for WaSt that includes MUAC in acknowledgement of the different children with wasting diagnosed by WHZ and MUAC. We estimated how many WaSt cases are eligible to be included in the existing treatment program in Mozambique by calculating the True Positive and False Positive Values of WaSt using our proposed case-definition against the wasting admission criteria. AUC of ROC curves used for MUAC and WAZ and optimal cut-offs were determined using Youden’s Index. Results Including MUAC in the concurrent WaSt case-definition identified more children with WaSt compared to the original case-definition and more younger children and girls were identified. Using both MUAC and WHZ and enrolling severe and moderate wasting is already picking up most of the WaSt cases: 100% in health facilities and 79.40% with MUAC mass screenings at community level. Cut-off values from the ROC curve for the proposed case-definition were MUAC ≤133 mm and WAZ ≤ 2.145 Z-scores, however, they yielded many false positive values. Conclusion WaSt case-definition should include MUAC. WaSt should commence to be reported in surveys and Mozambique should also start monitoring and treating children with WaSt. A cost-effective approach to identify all children with WaSt without adding too many false positive is needed, as well as understanding how to achieve optimal treatment outcomes within existing programs. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00508-9.
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Affiliation(s)
- Tomás Zaba
- United Nations Children's Fund, 1440 Zimbabwe Avenue, Maputo, Mozambique.
| | - Joel Conkle
- United Nations Children's Fund, 1st Floor UN House, 38-44 Stein St, Klein Windhoek, Namibia
| | - Mara Nyawo
- United Nations Children's Fund, Eastern and Southern Africa Regional Office, PO Box 44145-00100, Nairobi, Kenya
| | - Dorothy Foote
- United Nations Children's Fund, 1440 Zimbabwe Avenue, Maputo, Mozambique
| | - Mark Myatt
- Brixton Health, Cilfach Greigiog, Llwyngwril, Gwynedd, Wales, LL37 2JD 5RJ, UK
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11
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Fuentes-Venado CE, Terán-Pérez G, Espinosa-Hernández VM, Martínez-Herrera E, Segura-Uribe JJ, Mercadillo RE, Pinto-Almazán R, Guerra-Araiza C. Nutritional Status Influences Oxidative Stress and Insulin Resistance in Preschool Children. Metab Syndr Relat Disord 2021; 19:513-523. [PMID: 34314624 DOI: 10.1089/met.2021.0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Child malnutrition represents a major public health problem with physiological, psychological, and social short- and long-term implications. Objective: To compare the influence of nutritional status on oxidative stress (OS) markers in children aged 3-6 years. Methods: Children were categorized into four groups: underweight, normal weight, overweight, and obesity. Glucose (Glu), cholesterol (Chol), high-density lipoproteins, insulin, triacylglycerols (TG), triacylglycerols/glucose (TyG) index, and the homeostasis model assessment of insulin resistance (HOMA-IR) were analyzed. In addition, OS [malondialdehyde (MDA) and 3-nitrotyrosine (3-NT)] and antioxidant defense markers [superoxide dismutase (SOD), catalase (CAT), and the ratio of reduced/oxidized glutathione (GSH/GSSG)] were quantified. Results: Children with obesity showed significantly higher levels of MDA and 3-NT, and increased SOD activity compared with normal weight children. Glu, Chol, TG levels, TyG indexes, HOMA-IR, MDA, 3-NT, and SOD positively correlated with body mass index (BMI) and Centers for Disease Control and Prevention percentiles (CDC PC). However, CAT concentration and the GSH/GSSG ratio correlated negatively with BMI and CDC PC. In children with underweight, we found a positive correlation of TG levels and TyG indexes with BMI, whereas both markers positively correlated with BMI and CDC PC in children with overweight. MDA negatively correlated with BMI in children with underweight, while a positive association was observed in children with overweight. Finally, SOD, CAT, and GSH/GSSG negatively correlated with both BMI and CDC PC in children with overweight. Conclusions: Malnutrition, especially obesity, is associated with metabolic and OS disturbances in preschool children. It is urgent to design strategies to prevent malnutrition in this age group since this stage of development is crucial to potentially avoid future co-morbidities.
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Affiliation(s)
- Claudia Erika Fuentes-Venado
- Doctorado en Ciencias Biológicas y de la Salud-Universidad Autónoma Metropolitana, Mexico City, Mexico.,Servicio de Medicina Física y Rehabilitación, Hospital General de Zona No. 197, Texcoco, Mexico.,Unidad de Investigación Médica en Farmacología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Guadalupe Terán-Pérez
- Clínica de Trastornos del Sueño, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - Victor Manuel Espinosa-Hernández
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico.,Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico
| | - Erick Martínez-Herrera
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico.,Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Julia J Segura-Uribe
- Subdirección de Gestión de la Investigación, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City, Mexico
| | - Roberto E Mercadillo
- Consejo Nacional de Ciencia y Tecnología, Mexico City, Mexico.,Departamento de Biología de la Reproducción, Universidad Autónoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - Rodolfo Pinto-Almazán
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico.,Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Christian Guerra-Araiza
- Servicio de Medicina Física y Rehabilitación, Hospital General de Zona No. 197, Texcoco, Mexico
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12
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Martin SL, Matare CR, Kayanda RA, Owoputi I, Kazoba A, Bezner Kerr R, Nnally L, Khan M, Locklear KH, Dearden KA, Dickin KL. Engaging fathers to improve complementary feeding is acceptable and feasible in the Lake Zone, Tanzania. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13144. [PMID: 34241956 PMCID: PMC8269136 DOI: 10.1111/mcn.13144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/05/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
In Tanzania, suboptimal complementary feeding practices contribute to high stunting rates. Fathers influence complementary feeding practices, and effective strategies are needed to engage them. The objectives of this research were to examine the acceptability and feasibility of (1) tailored complementary feeding recommendations and (2) engaging fathers in complementary feeding. We conducted trials of improved practices with 50 mothers and 40 fathers with children 6-18 months. At visit 1, mothers reported current feeding practices and fathers participated in focus group discussions. At visit 2, mothers and fathers received individual, tailored counselling and chose new practices to try. After 2 weeks, at visit 3, parents were interviewed individually about their experiences. Interview transcripts were analysed thematically. The most frequent feeding issues at visit 1 were the need to thicken porridge, increase dietary diversity, replace sugary snacks and drinks and feed responsively. After counselling, most mothers agreed to try practices to improve diets and fathers agreed to provide informational and instrumental support for complementary feeding, but few agreed to try feeding the child. At follow-up, mothers reported improved child feeding and confirmed fathers' reports of increased involvement. Most fathers purchased or provided funds for recommended foods; some helped with domestic tasks or fed children. Many participants reported improved spousal communication and cooperation. Families were able to practice recommendations to feed family foods, but high food costs and seasonal unavailability were challenges. It was feasible and acceptable to engage fathers in complementary feeding, but additional strategies are needed to address economic and environmental barriers.
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Affiliation(s)
- Stephanie L. Martin
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Cynthia R. Matare
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNYUSA
| | | | - Ibukun Owoputi
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNYUSA
| | | | | | | | - Maliha Khan
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kamryn H. Locklear
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Katherine L. Dickin
- Program in International Nutrition, Division of Nutritional SciencesCornell UniversityIthacaNYUSA
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13
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Minuye M, Getachew P, Laillou A, Chitekwe S, Baye K. Effects of different drying methods and ascorbic acid pretreatment on carotenoids and polyphenols of papaya fruit in Ethiopia. Food Sci Nutr 2021; 9:3346-3353. [PMID: 34136199 PMCID: PMC8194739 DOI: 10.1002/fsn3.2324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/30/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2022] Open
Abstract
Frequent consumption of fruits can prevent nutrient deficiencies and promote health. However, the perishability and unaffordability of fruits had led to very low levels of fruit consumption in low- and middle-income countries (LMICs). The objective of this study was to evaluate the retention of nutrients and bioactive compounds of papaya fruit (Carica papaya L) with/without ascorbic acid pretreatment and drying under different techniques, to then estimate the vitamin A intakes for vulnerable population. Yellow pulp ripped papaya fruits (i.e., >75% level of skin color/stage level 4) (n = 14), with and without ascorbic acid pretreatment were dried using (a) solar drying: open-air, tray driers, and glasshouse; (b) refractance window drying; (c) oven drying; and (d) freeze-drying (control). The fresh fruit had high moisture content (87%) and an acidic pH. The dried papaya had a water activity of 0.5-0.6. The highest TPC, TFC, total carotenoids, and ß-carotene were found in freeze-dried papaya samples, followed by refractance window, and solar glass house (p < .05). The highest retention in total carotenoids (81.5%) and ß-carotene (61.9%) relative to freeze-drying was for the refractance-window; 25 g of dried papaya could contribute to 38% of the retinol equivalents' requirement for young children. Ascorbic acid pretreatment increased the retention of total carotenoids, ß-carotene, TPC, and TFC (p < .05) by (6-11)%, (8-34)%, (7-58)%, and (6-30)%, respectively, for all the drying methods. Refractance window and solar glass house drying can improve diets and constitute a promising food systems' intervention that can increase year-round availability, accessibility, and affordability of vitamin A-rich fruits like papaya.
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Affiliation(s)
- Masresha Minuye
- Center for Food Science and NutritionAddis Ababa UniversityAddis AbabaEthiopia
| | - Paulos Getachew
- Center for Food Science and NutritionAddis Ababa UniversityAddis AbabaEthiopia
| | - Arnaud Laillou
- United Nations Children’s Fund (UNICEF)Addis AbabaEthiopia
| | | | - Kaleab Baye
- Center for Food Science and NutritionAddis Ababa UniversityAddis AbabaEthiopia
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14
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Shu W, Li M, Amaerjiang N, Fan X, Lin S, Segura-Pérez S, Pérez-Escamilla R, Hu Y. A multi-center longitudinal study on responsive breastfeeding in China from the perspective of health equity: research protocol. Int J Equity Health 2021; 20:111. [PMID: 33933082 PMCID: PMC8087879 DOI: 10.1186/s12939-021-01430-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Socio-economic inequities can strongly influence suboptimal infant feeding outcomes. Factors such as lack of knowledge about breastfeeding, low family income, low educational attainment, social and economic status, cultural norms and ethnicity may negatively affect success with offering breastfeeding following a responsive feeding approach (ie. responsive breastfeeding). Such inequities can indeed shorten breastfeeding duration, and negatively affect behavioral and cognitive infant outcomes. In China, there is a dearth of studies focusing on breastfeeding from the responsive and health equity perspective. Objective The aim of this article is to present a protocol of an ongoing longitudinal cohort study investigating factors associated with responsive breastfeeding behaviors, and the child’s behavioral and cognitive development from birth to12 months post-partum in five centers in China. The study seeks to identify breastfeeding barriers and facilitators from a health equity perspective. Methods We are enrolling 700 women and their singleton full term infants in Chongqing, Huizhou and Guangzhou urban and rural areas. The study questionnaires will be administrated within 72 h, 30 days, 3, 6, 9, and 12 months post-partum during the baby’s vaccination visits. We will investigate the difference between urban and rural areas sociodemographic characteristics, breastfeeding knowledge, attitudes and practice, postnatal depression, maternal emotion regulation and parenting stress, and anthropometric and cognitive development indicators of the infants at each time-point. Conclusion Our article illustrates how a cohort study can be designed to understand the barriers and facilitators of responsive breastfeeding taking equity principles into account to help promote infants’ growth and development in China.
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Affiliation(s)
- Wen Shu
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No.10 You'anmenwai Xitoutiao, Fengtai District, Beijing, 100069, China
| | - Menglong Li
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No.10 You'anmenwai Xitoutiao, Fengtai District, Beijing, 100069, China
| | - Nubiya Amaerjiang
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No.10 You'anmenwai Xitoutiao, Fengtai District, Beijing, 100069, China
| | - Xin Fan
- Department of Child Healthcare, Chongqing Health Center for Women and Children, Chongqing, 401147, China
| | - Shunna Lin
- Department of Pediatrics, Tianhe District Maternal and Child Hospital of Guangzhou, Guangzhou, 510620, China
| | - Sofia Segura-Pérez
- Nutrition Unit, Hispanic Health Council, 175 Main St., Hartford, CT, 06106, USA
| | | | - Yifei Hu
- Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, No.10 You'anmenwai Xitoutiao, Fengtai District, Beijing, 100069, China.
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15
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Leocádio PCL, Lopes SC, Dias RP, Alvarez-Leite JI, Guerrant RL, Malva JO, Oriá RB. The Transition From Undernutrition to Overnutrition Under Adverse Environments and Poverty: The Risk for Chronic Diseases. Front Nutr 2021; 8:676044. [PMID: 33968973 PMCID: PMC8102690 DOI: 10.3389/fnut.2021.676044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Paola Caroline L Leocádio
- Laboratory of Atherosclerosis and Nutritional Biochemistry, Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Department of Nutrition, Nursing School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Synara C Lopes
- Laboratory of Tissue Healing, Ontogeny, and Nutrition, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ronaldo P Dias
- Laboratory of Tissue Healing, Ontogeny, and Nutrition, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Jacqueline I Alvarez-Leite
- Laboratory of Atherosclerosis and Nutritional Biochemistry, Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Richard L Guerrant
- Center for Global Health, University of Virginia, Charlottesville, VA, United States
| | - João O Malva
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Reinaldo B Oriá
- Laboratory of Tissue Healing, Ontogeny, and Nutrition, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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16
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Santos MP, Turner B, Chaparro MP. The double burden of malnutrition in Peru: An update with a focus on social inequities. Am J Clin Nutr 2021; 113:865-873. [PMID: 33564875 DOI: 10.1093/ajcn/nqaa387] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The decrease in stunting in Peru is seen as a "success story" in the fight against malnutrition; however, the parallel increase in obesity has often been ignored. OBJECTIVE To investigate trends in the double burden of malnutrition (i.e., the coexistence of stunting and overweight/obesity) in Peru compared with trends in household food expenditures by family socioeconomic status and urban/rural residency. METHODS Using Peruvian nationally representative surveys, we analyzed stunting (children aged 0-5 y) and overweight/obesity (women aged 18-49 y) trends between 1992 and 2017, as well as trends in household energy consumption from healthy and unhealthy foods between 2001 and 2017 by education, income, participation in the Juntos cash-transfer program, and urban/rural residency. Joinpoint software was used for all trends analyses. RESULTS Overall, stunting decreased and obesity increased among all social groups between 1992 and 2017. Inequities in stunting by income and urban/rural residency widened over time. From 1992 to 2017, urban stunting prevalence decreased at an average annual percent change (AAPC) of -4.5% (SE = 0.27%, P < 0.0001), whereas rural stunting prevalence decreased at a lower AAPC of -2.6% (SE = 0.30%, P < 0.0001). On the contrary, inequities in obesity narrowed as obesity prevalence among women from the extremely poor group and those living in rural areas increased at a faster rate than that of their counterparts. Rural obesity prevalence increased at an AAPC of 8.5% (SE = 1.14%, P < 0.0001), whereas urban obesity prevalence increased at an AAPC of 2.0% (SE = 0.25%, P < 0.0001). Increases in energy consumption from unhealthy foods were observed along with decreases in energy consumption from healthy foods in most social groups. CONCLUSION The prevalence of stunting and obesity is high in Peru. The need for multisectoral interventions addressing both ends of the malnutrition spectrum, particularly among disadvantaged groups to avoid further widening of social inequities, is warranted.
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Affiliation(s)
- Maria P Santos
- Department of Biostatistics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Beja Turner
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - M Pia Chaparro
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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17
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Torto NM, Brownell KD. Role of food aid and assistance in addressing the double burden of malnutrition in Ghana: a qualitative policy analysis. BMJ Nutr Prev Health 2021; 3:196-204. [PMID: 33521529 PMCID: PMC7841835 DOI: 10.1136/bmjnph-2020-000136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
Background and aims In many low-income and middle-income countries, the double burden of malnutrition threatens public health and economic progress, urging a re-evaluation of the roles and responsibilities of nutrition actors, both traditional and non-traditional. This study examines the food aid and assistance activities of the United Nations World Food Programme (WFP)-one non-traditional actor in the double burden conversation-and the potential for these activities to reach beyond their traditional mandate on undernutrition to also address overweight and obesity in Ghana. Methods Information on WFP activities in Ghana from 2012 up through its planning into 2023 was extracted from 11 WFP planning, operations and evaluation documents. WFP activities were then judged against the WHO's framework on the determinants of the double burden of malnutrition to determine their potential to address the double burden. Semistructured interviews were also conducted with 17 key informants in the global nutrition landscape to identify challenges that may complicate the role of WFP and other actors in addressing the double burden. Results The analysis demonstrates that WFP activities in Ghana can serve as a platform on which to address the double burden, particularly by targeting the food access, food systems and socioeconomic disadvantage determinants of the double burden. Actors' uncertainty with what role WFP should play in addressing the double burden, insufficient government attention to malnutrition and poor data on overweight and obesity were identified as potential challenges that complicate addressing the double burden. Conclusion The findings suggest that integrating WFP as a partner in the effort to address the double burden in Ghana might help amplify progress. To better address the double burden, WFP might prioritise retrofitting existing activities rather than implementing new interventions.
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Affiliation(s)
- Niisoja M Torto
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Kelly D Brownell
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
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18
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Downs S, Demmler KM. Food environment interventions targeting children and adolescents: A scoping review. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2020. [DOI: 10.1016/j.gfs.2020.100403] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Holdsworth M, Pradeilles R, Tandoh A, Green M, Wanjohi M, Zotor F, Asiki G, Klomegah S, Abdul-Haq Z, Osei-Kwasi H, Akparibo R, Bricas N, Auma C, Griffiths P, Laar A. Unhealthy eating practices of city-dwelling Africans in deprived neighbourhoods: Evidence for policy action from Ghana and Kenya. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2020; 26:100452. [PMID: 33324537 PMCID: PMC7726234 DOI: 10.1016/j.gfs.2020.100452] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/19/2020] [Accepted: 10/08/2020] [Indexed: 01/16/2023]
Abstract
Growing urbanisation in Africa is accompanied by rapid changes in food environments, with potential shifts towards unhealthy food/beverage consumption, including in socio-economically disadvantaged populations. This study investigated how unhealthy food and beverages are embedded in everyday life in deprived areas of two African countries, to identify levers for context relevant policy. Deprived neighbourhoods (Ghana: 2 cities, Kenya: 1 city) were investigated (total = 459 female/male, adolescents/adults aged ≥13 y). A qualitative 24hr dietary recall was used to assess the healthiness of food/beverages in relation to eating practices: time of day and frequency of eating episodes (periodicity), length of eating episodes (tempo), and who people eat with and where (synchronisation). Five measures of the healthiness of food/beverages in relation to promoting a nutrient-rich diet were developed: i. nutrients (energy-dense and nutrient-poor -EDNP/energy-dense and nutrient-rich -EDNR); and ii. unhealthy food types (fried foods, sweet foods, sugar sweetened beverages (SSBs). A structured meal pattern of three main meals a day with limited snacking was evident. There was widespread consumption of unhealthy food/beverages. SSBs were consumed at three-quarters of eating episodes in Kenya (78.5%) and over a third in Ghana (36.2%), with those in Kenya coming primarily from sweet tea/coffee. Consumption of sweet foods peaked at breakfast in both countries. When snacking occurred (more common in Kenya), it was in the afternoon and tended to be accompanied by a SSB. In both countries, fried food was an integral part of all mealtimes, particularly common with the evening meal in Kenya. This includes consumption of nutrient-rich traditional foods/dishes (associated with cultural heritage) that were also energy-dense: (>84% consumed EDNR foods in both countries). The lowest socio-economic groups were more likely to consume unhealthy foods/beverages. Most eating episodes were <30 min (87.1% Ghana; 72.4% Kenya). Families and the home environment were important: >77% of eating episodes were consumed at home and >46% with family, which tended to be energy dense. Eating alone was also common as >42% of eating episodes were taken alone. In these deprived settings, policy action to encourage nutrient-rich diets has the potential to prevent multiple forms of malnutrition, but action is required across several sectors: enhancing financial and physical access to healthier foods that are convenient (can be eaten quickly/alone) through, for example, subsidies and incentives/training for local food vendors. Actions to limit access to unhealthy foods through, for example, fiscal and advertising policies to dis-incentivise unhealthy food consumption and SSBs, especially in Ghana. Introducing or adapting food-based dietary guidelines to incorporate advice on reducing sugar and fat at mealtimes could be accompanied by cooking skills interventions focussing on reducing frying/oil used when preparing meals, including 'traditional' dishes and reducing the sugar content of breakfast.
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Affiliation(s)
- Michelle Holdsworth
- French National Research Institute for Sustainable Development (IRD), NUTRIPASS Unit: IRD-Univ Montpellier-SupAgro, Montpellier, France
- Corresponding author. Joint Research Unit on Food and Nutrition Research in the Global South (UMR NUTRIPASS), French National Research Institute for Sustainable Development (IRD), 911 av. Agropolis, 34394, Cedex 5, Montpellier, France.
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - Akua Tandoh
- School of Public Health, University of Ghana, Accra, Ghana
| | - Mark Green
- School of Environmental Sciences, University of Liverpool, Liverpool, UK
| | - Milkah Wanjohi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Gershim Asiki
- African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Zakia Abdul-Haq
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Robert Akparibo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nicolas Bricas
- French Agricultural Research Centre for International Development (CIRAD), Montpellier, France
| | - Carol Auma
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - Amos Laar
- School of Public Health, University of Ghana, Accra, Ghana
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20
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Laar A, Barnes A, Aryeetey R, Tandoh A, Bash K, Mensah K, Zotor F, Vandevijvere S, Holdsworth M. Implementation of healthy food environment policies to prevent nutrition-related non-communicable diseases in Ghana: National experts' assessment of government action. FOOD POLICY 2020; 93:101907. [PMID: 32565610 PMCID: PMC7299075 DOI: 10.1016/j.foodpol.2020.101907] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 05/15/2023]
Abstract
Nutrition-related non-communicable diseases (NR-NCDs) are a global health problem, increasingly recognised as driven by unhealthy food environments. Yet little is known about government action to implement food environment-relevant policies, particularly in low-and lower-middle income countries. This study assessed government action, implementation gaps, and priorities to improve the food environment in Ghana. Using the Healthy Food-Environment Policy Index (Food-EPI), a panel comprising government and independent experts (n = 19) rated government action to improve the healthiness of food environment in Ghana against international best practices and according to steps within a policy cycle. Forty-three good practice indicators of food environment policy and infrastructure support were used, with ratings informed by systematically collected evidence of action validated by government officials. Following the rating exercise, the expert panel proposed and prioritized actions for government implementation. Three-quarters of all good practice indicators were rated at 'low'/'very little' implementation. Restricting the marketing of breast milk substitutes was the only indicator rated "very high". Of ten policy actions prioritized for implementation, restricting unhealthy food marketing in children's settings and in the media were ranked the highest priority. Providing sufficient funds for nationally-relevant research on nutrition and NCDs was the highest priority infrastructure-support action. Other priority infrastructure-support actions related to leadership, monitoring and evaluation. This study identified gaps in Ghana's implementation of internationally-recommended policies to promote healthy food environments. National stakeholders recommended actions, which will require legislation and leadership. The findings provide a baseline for measuring government progress towards implementing effective policies to prevent NR-NCDs.
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Affiliation(s)
- Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Amy Barnes
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kristin Bash
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, Accra, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public health, University of Health and Allied Sciences Ho, Ghana
| | | | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
- UMR NUTRIPASS, French National Research Institute for Sustainable Development- IRD, Montpellier, France
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Menon S, Peñalvo JL. Actions Targeting the Double Burden of Malnutrition: A Scoping Review. Nutrients 2019; 12:nu12010081. [PMID: 31892187 PMCID: PMC7019596 DOI: 10.3390/nu12010081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 01/28/2023] Open
Abstract
Background: In many developing countries, nutritional and epidemiological transitions are contributing to continuous undernutrition and escalating overnutrition, resulting in coexisting forms of malnutrition often referred as the “double burden of malnutrition” (DBM). This complex phenomenon constitutes an unprecedented challenge to global public health and has been prioritized by international health organizations, prompting governments to swift action. Specifically, five years ago the World Health Organization (WHO) proposed a roadmap to tackle the DBM though so-called “double-duty actions”. The objective of this review was to synthesize the literature on interventions which address the DBM. Methods: We developed a scoping review to identify interventions addressing the DBM. We searched PUBMED for papers reporting interventions until December 2019. Articles examining interventions, government policies, or tools at the individual, household, or community level to address the DBM were included. Results: Seven articles met the inclusion criteria. Three were from sub-Saharan Africa, one was from Southeast Asia, and one was from Central America. Two were modelling studies, with one covering 24 low-income countries and the other focusing on Ghana. Conclusion: Notwithstanding the pressing issue of the DBM, there is a paucity of studies examining double-duty actions despite the attention that it has garnered within the global nutrition community. Whilst nutrient deficiencies may be curbed by poverty reduction measures, for obesity prevention nutrition, education and promotion of physical activity, along with the encouragement of local food production, may be instrumental.
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Affiliation(s)
- Sonia Menon
- Unit of Noncommunicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat, 155 2000 Antwerp, Belgium;
| | - José L. Peñalvo
- Unit of Noncommunicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat, 155 2000 Antwerp, Belgium;
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
- Correspondence: ; Tel.: +32-(0)-3247-6251
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Addressing malnutrition in low- and middle-income countries with double-duty actions –ERRATUM. Proc Nutr Soc 2019; 78:590. [DOI: 10.1017/s002966511800280x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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