Malnutrition and growth

Malnutrition, illness, poverty, and infant growth: A test of a syndemic hypothesis in Nuñoa, Peru

The concept of syndemics provides an important framework for understanding the complex interactions of biological and social conditions. Its use in public health and epidemiological research has increased substantially in the past ten years. Many syndemic analyses rely on the use of a sum score and subsequently fail to demonstrate biological interaction, leading some scholars to question the utility of the syndemic approach. Here, we utilize data from 86 mother/infant pairs from the rural district of Nuñoa, Peru to test a potential syndemic relationship among infection, malnutrition and infant growth. Between 2014 and 2015, surveys were conducted to assess household wealth, sanitation, dietary diversity, and reported illness, while anthropometric measures of mothers and infants were conducted to assess nutritional status via height-for-age and weight-for-height z-scores. Ethnographic insight was used in the selection of key economic variables including the development of an agricultural wealth index. We then assessed whether this constellation of health outcomes met the criteria for a syndemic by performing a quantitative analysis in which we tested for (1) an association between economic marginalization and high-risk environments; (2) the concentration of malnutrition, poor growth, and infection; and (3) biological interaction among these health outcomes. We found that economic measures were associated with pathogenic and nutritional risk, and that these in turn were associated with infectious disease, nutritional status, and growth. However, we did not find evidence that the proposed syndemic met criteria (2) or (3). We conclude that, despite being both socially and biologically plausible, a syndemic of malnutrition, poor growth, and infection did not exist in this context. This analysis moves syndemic research forward by demonstrating that such hypotheses are falsifiable, thus presenting a process by which they may be tested and lending support to the use of syndemic theory as an effective analytic framework.

Spatial prediction of childhood malnutrition across space in Nigeria based on point-referenced data: an SPDE approach

Malnutrition remains a leading cause of child mortality in Nigeria. The spatial analysis based on areal level approaches could, in reality, conceal variations at smaller units. Using point-referenced data from Nigeria Demographic and Health Survey, we quantify the prevalence of malnutrition among under-five children in Nigeria at 1.63 by 1.63 km spatial resolution, and compute the exceedance probability maps for stunting, wasting and underweight at 20% threshold level using the stochastic partial differential equation approach with Bayesian inference based on integrated nested Laplace approximation. Results show divergence prevalence of the malnutrition indicators among children living in neighbouring locations and that the prevalence of stunting and underweight increase with age. The prevalence of stunting was uneven among children living in Kebbi, Zamfara, Sokoto, Kaduna, Kano, Katsina, Bauchi, Gombe and Taraba states with more concentrations in the northern fringes of some of the states. Except for few locations in about three states, the probability is more than 90% that the prevalence of stunting in all parts of the country exceeds 20% but this was not the case for wasting. The findings can assist in location-specific policy formulation and implementations.

Nutritional management and follow up of infants and children with food allergy: Italian Society of Pediatric Nutrition/Italian Society of Pediatric Allergy and Immunology Task Force Position Statement

Although the guidelines on the diagnosis and treatment of food allergy recognize the role of nutrition, there is few literature on the practical issues concerning the nutritional management of children with food allergies. This Consensus Position Statement focuses on the nutritional management and follow-up of infants and children with food allergy.It provides practical advices for the management of children on exclusion diet and it represents an evidence-based consensus on nutritional intervention and follow-up of infants and children with food allergy. Children with food allergies have poor growth compared to non-affected subjects directly proportional to the quantity of foods excluded and the duration of the diet. Nutritional intervention, if properly planned and properly monitored, has proven to be an effective mean to substantiate a recovery in growth. Nutritional intervention depends on the subject's nutritional status at the time of the diagnosis. The assessment of the nutritional status of children with food allergies should follow a diagnostic pathway that involves a series of successive steps, beginning from the collection of a detailed diet-history. It is essential that children following an exclusion diet are followed up regularly. The periodic re-evaluation of the child is needed to assess the nutritional needs, changing with the age, and the compliance to the diet. The follow- up plan should be established on the basis of the age of the child and following the growth pattern.