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Jokhu LA, Syauqy A. Determinants of concurrent wasting and stunting among children 6 to 23 mo in Indonesia. Nutrition 2024; 122:112390. [PMID: 38458063 DOI: 10.1016/j.nut.2024.112390] [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: 11/03/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Concurrent wasting and stunting (WaSt) in a child is a health problem that leads to detrimental effects. However, to our knowledge, there is limited research regarding the prevalence and determinants of WaSt, including in Indonesia. The aim of this study was to analyze the prevalence and determinants of WaSt in children 6 to 23 mo of age. METHODS This cross-sectional study was conducted with data sets from the Indonesia Nutritional Status Survey (INSS). Data was collected between January and December 2021. About 15 641 children, ages 23 mo, were included. A χ2 analysis examined the association between the dependent and independent variables. A multivariate test analyzed the risk for the independent variable to the dependent, seen through the adjusted odds ratio (aOR). RESULTS The prevalence of WaSt was 2.4%. Higher odds for WaSt were seen in the following: • Boys: 2.15 times (95% confidence interval [CI], 1.72-2.68); • Children ages 12 to 23 mo 3.15 times (95% CI, 2.33-4.25); • Those with low birth weight 3.11 times (95% CI, 2.33-4.15) • Those with small birth size: 2 times (95% CI, 1.59-2.54) • Babies born from mothers >35 y of age: 1.5 times (95% CI, 1.19-1.89); • Children who experienced infection: 1.43 times (95% CI, 1.16-1.76); • Children not using the Integrated Health and Nutrition Services (Posyandu): 1.17 times (95% CI; 1.29-2.27); • Children from middle- income families:2.54 times higher odds (95% CI, 1.75-3.7); and • Children from rural areas: 1.37 times (95% CI, 1.1-1.71). CONCLUSION WaSt is associated with multiple factors in Indonesia. Hence, policymakers need to address this problem comprehensively.
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Affiliation(s)
- Lidya Alwina Jokhu
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Ahmad Syauqy
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia.
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Fenta W, Zeru MA. Multilevel bivariate analysis of the association between high-risk fertility behaviors of birth and stunting with associated risk factors in Ethiopia. Front Nutr 2024; 11:1355808. [PMID: 38883857 PMCID: PMC11179432 DOI: 10.3389/fnut.2024.1355808] [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: 12/14/2023] [Accepted: 05/01/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Currently, the linkage between high-risk fertility behavior of birth and the occurrence of stunting among children under the age of 5 continues to be a significant public health problem in developing countries, including Ethiopia. This issue poses a threat to the health and overall wellbeing of under-five children. Thus, the main objective of this study was to examine the association between high-risk fertility behavior of birth and the stunting status of children and associated factors. Methods The data used for this study were extracted from the recent Ethiopian Mini Demographic and Health Survey data in 2019. A total weighted sample of 4,969 under-five children was included in this study, and the relevant data were extracted from those samples. The multilevel bivariate analysis was used to assess the association between high-risk fertility behavior of birth and the stunting status of under-five children in Ethiopia. Results It was found that, out of 4,997 under-five children, 24% of under-five children experienced stunting as a result of high-risk fertility behavior of birth. Our study also revealed an intra-class correlation of 0.2, indicating that 20% of the variability in both high-risk fertility behaviors of birth and stunting can be attributed to differences between communities. Furthermore, there was a statistically significant association between high-risk fertility behavior of birth and the stunting status of children under the age of 5 years [AOR = 8.5, 95% CI: (5.58, 18.70)]. Similarly, the stunting status of birth among boys was 1.36 times greater than the estimated odds of the stunting status of birth among girls [AOR = 1.36, 95% CI: (1.19, 1.55)]. Conclusion This study found that there was a significant statistical association between high-risk fertility behavior of birth and stunting status of under-five children. Specifically, children born to mothers under 18 years and in households with high parity were identified as the main risk factors for child stunting. Furthermore, health-related education, improved access to maternal healthcare, and training interventions were associated with high-risk fertility behavior during birth and child stunting. The study suggests that regular health assessments and early interventions for infants born to mothers with high-risk reproductive characteristics are crucial to reducing the impact of child stunting under 5 years of age.
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Affiliation(s)
- Wondaya Fenta
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melkamu A Zeru
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
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Zaunseder E, Mütze U, Okun JG, Hoffmann GF, Kölker S, Heuveline V, Thiele I. Personalized metabolic whole-body models for newborns and infants predict growth and biomarkers of inherited metabolic diseases. Cell Metab 2024:S1550-4131(24)00182-7. [PMID: 38834070 DOI: 10.1016/j.cmet.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/13/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024]
Abstract
Comprehensive whole-body models (WBMs) accounting for organ-specific dynamics have been developed to simulate adult metabolism, but such models do not exist for infants. Here, we present a resource of 360 organ-resolved, sex-specific models of newborn and infant metabolism (infant-WBMs) spanning the first 180 days of life. These infant-WBMs were parameterized to represent the distinct metabolic characteristics of newborns and infants, including nutrition, energy requirements, and thermoregulation. We demonstrate that the predicted infant growth was consistent with the recommendation by the World Health Organization. We assessed the infant-WBMs' reliability and capabilities for personalization by simulating 10,000 newborns based on their blood metabolome and birth weight. Furthermore, the infant-WBMs accurately predicted changes in known biomarkers over time and metabolic responses to treatment strategies for inherited metabolic diseases. The infant-WBM resource holds promise for personalized medicine, as the infant-WBMs could be a first step to digital metabolic twins for newborn and infant metabolism.
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Affiliation(s)
- Elaine Zaunseder
- School of Medicine, University of Galway, Galway, Ireland; Engineering Mathematics and Computing Lab (EMCL), Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Heidelberg, Germany; Data Mining and Uncertainty Quantification (DMQ), Heidelberg Institute for Theoretical Studies (HITS), Heidelberg, Germany
| | - Ulrike Mütze
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Jürgen G Okun
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Stefan Kölker
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Vincent Heuveline
- School of Medicine, University of Galway, Galway, Ireland; Engineering Mathematics and Computing Lab (EMCL), Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Heidelberg, Germany
| | - Ines Thiele
- School of Medicine, University of Galway, Galway, Ireland; Discipline of Microbiology, University of Galway, Galway, Ireland; Digital Metabolic Twin Centre, University of Galway, Ireland; Ryan Institute, University of Galway, Galway, Ireland; APC Microbiome Ireland, Cork, Ireland.
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Chibuye M, Mende DR, Spijker R, Simuyandi M, Luchen CC, Bosomprah S, Chilengi R, Schultsz C, Harris VC. Systematic review of associations between gut microbiome composition and stunting in under-five children. NPJ Biofilms Microbiomes 2024; 10:46. [PMID: 38782939 PMCID: PMC11116508 DOI: 10.1038/s41522-024-00517-5] [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: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Childhood stunting is associated with impaired cognitive development and increased risk of infections, morbidity, and mortality. The composition of the enteric microbiota may contribute to the pathogenesis of stunting. We systematically reviewed and synthesized data from studies using high-throughput genomic sequencing methods to characterize the gut microbiome in stunted versus non-stunted children under 5 years in LMICs. We included 14 studies from Asia, Africa, and South America. Most studies did not report any significant differences in the alpha diversity, while a significantly higher beta diversity was observed in stunted children in four out of seven studies that reported beta diversity. At the phylum level, inconsistent associations with stunting were observed for Bacillota, Pseudomonadota, and Bacteroidota phyla. No single genus was associated with stunted children across all 14 studies, and some associations were incongruent by specific genera. Nonetheless, stunting was associated with an abundance of pathobionts that could drive inflammation, such as Escherichia/Shigella and Campylobacter, and a reduction of butyrate producers, including Faecalibacterium, Megasphera, Blautia, and increased Ruminoccoccus. An abundance of taxa thought to originate in the oropharynx was also reported in duodenal and fecal samples of stunted children, while metabolic pathways, including purine and pyrimidine biosynthesis, vitamin B biosynthesis, and carbohydrate and amino acid degradation pathways, predicted linear growth. Current studies show that stunted children can have distinct microbial patterns compared to non-stunted children, which could contribute to the pathogenesis of stunting.
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Affiliation(s)
- Mwelwa Chibuye
- Department of Global Health, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Amsterdam Institute of Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniel R Mende
- Amsterdam Institute of Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rene Spijker
- Department of Global Health, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michelo Simuyandi
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chaluma C Luchen
- Department of Global Health, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Samuel Bosomprah
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Roma Chilengi
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- The Zambia National Public Health Institute (ZNPHI), Lusaka, Zambia
| | - Constance Schultsz
- Department of Global Health, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute of Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Vanessa C Harris
- Department of Global Health, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Institute of Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
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Lestari E, Siregar A, Hidayat AK, Yusuf AA. Stunting and its association with education and cognitive outcomes in adulthood: A longitudinal study in Indonesia. PLoS One 2024; 19:e0295380. [PMID: 38709786 PMCID: PMC11073707 DOI: 10.1371/journal.pone.0295380] [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: 10/24/2022] [Accepted: 11/21/2023] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Stunting is associated with adverse outcomes in adulthood. This article specifically aims to analyse the relationship between childhood stunting and education as well as cognitive outcomes for adults in Indonesia. METHODS Pooled data from wave one (1) and two (2) of the Indonesia Family Life Survey (IFLS) in 1993 and 1997 identified a sub-sample of 4,379 children aged 0-5 by their height-for-age (HAZ) to be compared for their differences in educational outcomes and cognitive abilities in 2014. HAZ was used to proxy relative height to determine stunting status based on 2006 WHO child's growth standards. Education and cognitive abilities outcomes include years of schooling, age of school entry, grade repetition, and scores for cognitive and math tests. The study employs estimation models of pooled regressions and instrumental variable (IV) to address problems of endogeneity and bias from omitted variables. RESULTS Stunting and relatively small stature had significant associations with cognitive development, and they worked as intermediaries to cognitive developmental barriers as manifested in reduced educational outcomes. A lack of one SD in HAZ was associated with 0.6 years shortened length of the school, 3% higher chances of dropouts from secondary school, and 0.10-0.23 SD lowered cognitive and numerical scores. Similarly, stunting is associated with decrease cognitive test scores by 0.56-0.8 SD compared to non-stunting, two years less schooling, and 0.4 years of delayed entry to school. As for cognitive abilities, stunting is associated with lower cognitive and numerical abilities by 0.38-0.82 z-scores. CONCLUSION Growth retardation during childhood in Indonesia was associated with lower cognitive abilities, particularly during school age, and this correlation faded as individuals grew up. Subsequently, growth retardation is significantly linked to lower educational outcomes. Impaired growth has implications for reduced lifetime earnings potential mediated by diminished cognitive capacity and lower educational attainment. The finding suggests that development in Indonesia during recent decades has not provided an adequate environment to enable children to achieve their potential educational outcomes.
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Affiliation(s)
- Esta Lestari
- Doctorate in Economics Program, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Research Center for Behavioral and Circular Economics, National Research and Innovation Agency (BRIN), Jakarta, Indonesia
| | - Adiatma Siregar
- Doctorate in Economics Program, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Achmad K. Hidayat
- Doctorate in Economics Program, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Arief A. Yusuf
- Doctorate in Economics Program, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
- SDGs Center, Universitas Padjajaran, Bandung, West Java, Indonesia
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Ehsan L, Coomes D, Kelly P, Greene AR, Ali SA, Mulenga C, Denno DM, VanBuskirk K, Raghib MF, Mahfuz M, Moore SR, Hossain MS, Ahmed T, Sullivan PB, Moskaluk CA, Syed S. Duodenal quantitative mucosal morphometry in children with environmental enteric dysfunction: a cross-sectional multi-country analysis. Am J Clin Nutr 2024:S0002-9165(24)00450-7. [PMID: 38685382 DOI: 10.1016/j.ajcnut.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/08/2024] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Environmental enteric dysfunction (EED), a chronic inflammatory condition of the small intestine, is an important driver of childhood malnutrition globally. Quantifying intestinal morphology in EED allows for exploration of its association with functional and disease outcomes. OBJECTIVE We sought to define morphometric characteristics of childhood EED and determine whether morphology features were associated with disease pathophysiology. METHODS Morphometric measurements and histology were assessed on duodenal biopsy slides for this cross-sectional study from children with EED in Bangladesh, Pakistan, and Zambia (n=69), and those with no pathologic abnormality (NPA; n=8) or celiac disease (n=18) in North America. Immunohistochemistry was also conducted on 46, 8, and 18 biopsy slides, respectively. Linear mixed-effects regression models were used to reveal morphometric differences between EED compared to NPA or celiac disease, and identify associations between morphometry and histology or immunohistochemistry amongst children with EED. RESULTS In duodenal biopsies, median EED villus height (248 μm), crypt depth (299 μm), and villus:crypt (V:C) ratio (0.9) values ranged between those of NPA (396 μm villus height; 246 μm crypt depth; 1.6 V:C ratio) and celiac disease (208 μm villus height; 365 μm crypt depth; 0.5 V:C ratio). Among EED biopsy slides, morphometric assessments were not associated with histologic parameters or immunohistochemical markers, other than pathologist determined subjective semi-quantitative villus architecture. CONCLUSIONS Morphometric analysis of duodenal biopsy slides across geographies identified morphologic features of EED, specifically short villi, elongated crypts, and a smaller V:C ratio relative to NPA slides; although not as severe as in celiac slides. Morphometry did not explain other EED features, suggesting that EED histopathologic processes may be operating independently of morphology. While acknowledging the challenges with obtaining relevant tissue, these data form the basis for further assessments of the role of morphometry in EED.
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Affiliation(s)
- Lubaina Ehsan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA; Department of Pediatric and Adolescent Medicine, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - David Coomes
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Paul Kelly
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK; Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Adam R Greene
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - S Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Chola Mulenga
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Donna M Denno
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Muhammad Faraz Raghib
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Mustafa Mahfuz
- Nutritional and Clinical services Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Sean R Moore
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - M Shabab Hossain
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Peter B Sullivan
- Department of Paediatrics, Children's Hospital, University of Oxford, Oxford, UK
| | | | - Sana Syed
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA; School of Data Science, University of Virginia, Charlottesville, VA, USA.
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Isoyama Y, Nose-Ogura S, Ijitsu MJ, Kruse JGS, Nagai N, Kayaba M, Ogata H, Mangalam M, Kiyono K. Age- and height-dependent bias of underweight and overweight assessment standards for children and adolescents. Front Public Health 2024; 12:1379897. [PMID: 38721543 PMCID: PMC11076850 DOI: 10.3389/fpubh.2024.1379897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/03/2024] [Indexed: 05/15/2024] Open
Abstract
Background Precision in evaluating underweight and overweight status among children and adolescents is paramount for averting health and developmental issues. Existing standards for these assessments have faced scrutiny regarding their validity. This study investigates the age and height dependencies within the international standards set by the International Obesity Task Force (IOTF), relying on body mass index (BMI), and contrasts them with Japanese standards utilizing the percentage of overweight (POW). Method We scrutinized a comprehensive database comprising 7,863,520 children aged 5-17 years, sourced from the School Health Statistics Research initiative conducted by Japan's Ministry of Education, Culture, Sports, Science, and Technology. Employing the quantile regression method, we dissected the structure of weight-for-height distributions across different ages and sexes, quantifying the potentially biased assessments of underweight and overweight status by conventional criteria. Results Applying IOFT criteria for underweight assessment revealed pronounced height dependence in males aged 11-13 and females aged 10-11. Notably, a discernible bias emerged, wherein children in the lower 25th percentile were classified as underweight five times more frequently than those in the upper 25th percentile. Similarly, the overweight assessment displayed robust height dependence in males aged 8-11 and females aged 7-10, with children in the lower 25th percentile for height deemed obese four or five times more frequently than their counterparts in the upper 25th percentile. Furthermore, using the Japanese POW criteria for assessment revealed significant age dependence in addition to considerably underestimating the percentage of underweight and overweight cases under the age of seven. However, the height dependence for the POW criterion was smaller than the BMI criterion, and the difference between height classes was less than 3-fold. Conclusion Our findings underscore the intricacies of age-dependent changes in body composition during the growth process in children, emphasizing the absence of gold standards for assessing underweight and overweight. Careful judgment is crucial in cases of short or tall stature at the same age, surpassing sole reliance on conventional criteria results.
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Affiliation(s)
- Yosuke Isoyama
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Sayaka Nose-Ogura
- Japan High-Performance Sport Center, Department of Sports Medicine and Research, Japan Institute Sports Sciences, Tokyo, Japan
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | | | | | - Narumi Nagai
- School of Human Science and Environment, University of Hyogo, Himeji, Japan
| | - Momoko Kayaba
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hitomi Ogata
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, United States
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
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Kumala Putri DS, Sari K, Utami NH, Djaiman SPH. Influence of maternal and neonatal continuum of care on the risk of intergenerational cycle of stunting: a cross-sectional study. BMJ Open 2024; 14:e081774. [PMID: 38643007 PMCID: PMC11033657 DOI: 10.1136/bmjopen-2023-081774] [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: 11/06/2023] [Accepted: 04/11/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVES This study aimed to analyse the influence of the continuum of care during pregnancy and neonatal periods on the risk of intergenerational cycle of stunting. DESIGN This study was a cross-sectional study, with data analysed from the 2018 Basic Health Research in Indonesia. SETTINGS Basic Health Research 2018 was conducted throughout 513 cities/regencies in 34 provinces in Indonesia. The households were selected through two-stage sampling methods. First, census blocks (CB) were selected using probability proportional to size methods in each urban/rural stratum from each city/regency. Ten households were then selected from each CB using systematic sampling methods. All family members of the selected households were measured and interviewed. PARTICIPANTS This study analyses 31 603 children aged 0-24 months. OUTCOMES MEASURES The dependent variable was the risk of the intergenerational cycle of stunting. Mothers who had a height less than 150.1 cm (short stature mothers) and had children (≤ 24 months of age) with length-for-age Z-score less than -2 Standard Deviation (SD) of the WHO Child Growth Standard (stunted children) were defined as at risk of the intergenerational cycle of stunting. RESULTS Mothers with incomplete maternal and neonatal care visits were 30% more likely to be at risk on the intergenerational cycle of stunting (OR (95% CI): 1.3 (1.00 to 1.63)) after adjusting for economic status. CONCLUSION The continuum of maternal and neonatal healthcare visits could potentially break the intergenerational cycle of stunting, especially in populations where stunted mothers are prevalent.
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Affiliation(s)
- Dwi Sisca Kumala Putri
- Health Research Organization, National Research and Innovation Agency Republic of Indonesia, Bogor, Indonesia
| | - Kencana Sari
- Health Research Organization, National Research and Innovation Agency Republic of Indonesia, Bogor, Indonesia
| | - Nur Handayani Utami
- Health Research Organization, National Research and Innovation Agency Republic of Indonesia, Bogor, Indonesia
| | - Sri Poedji Hastoety Djaiman
- Health Research Organization, National Research and Innovation Agency Republic of Indonesia, Bogor, Indonesia
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Serrano Matos YA, Cano J, Shafiq H, Williams C, Sunny J, Cowardin CA. Colonization during a key developmental window reveals microbiota-dependent shifts in growth and immunity during undernutrition. MICROBIOME 2024; 12:71. [PMID: 38589975 PMCID: PMC11003143 DOI: 10.1186/s40168-024-01783-3] [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: 10/20/2023] [Accepted: 02/28/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Childhood undernutrition is a major global health challenge with devastating lifelong consequences. Linear growth stunting due to undernutrition has been linked to poor health outcomes, and mothers who experience growth stunting in childhood are more likely to give birth to stunted children later in life. Based on these findings, we hypothesized that intergenerational colonization of mice with microbiota from human donors with undernutrition may recapitulate certain immune and growth changes observed in this disorder. RESULTS To test this hypothesis, we developed a gnotobiotic murine model of undernutrition using microbiota from human infants with healthy or stunted growth trajectories. Intergenerational colonization with microbiota derived from children with growth stunting lead to less linear growth and the development of immune features of undernutrition and enteropathy, including intestinal villus blunting, lower liver IGF-1 and accumulation of intraepithelial lymphocytes and plasma cells in the small intestine. In contrast, colonization after weaning lead to fewer host phenotypic changes between these distinct microbial communities. CONCLUSIONS These results are broadly consistent with previous findings demonstrating that exposure of the immune system to microbial products during the weaning phase is a critical determinant of later life immune function. Overall, our results suggest intergenerational colonization with human microbiota samples is a useful approach with which to investigate microbiota-dependent changes in growth and immunity in early life. Murine models that capture the intergenerational and multifactorial nature of undernutrition are critical to understanding the underlying biology of this disorder. Video Abstract.
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Affiliation(s)
- Yadeliz A Serrano Matos
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Jasmine Cano
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Hamna Shafiq
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Claire Williams
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Julee Sunny
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Carrie A Cowardin
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
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Mehta R, Wenndt AJ. Mycotoxins and bone growth: a review of the literature on associations between xenobiotic exposure and bone growth and development. Nutr Rev 2024:nuae032. [PMID: 38578611 DOI: 10.1093/nutrit/nuae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Mycotoxins are secondary metabolites of fungi that are known to be associated with linear growth faltering because of their impact on inflammation, intestinal damage, inhibition of protein synthesis, and micronutrient absorption. In this narrative review, we aim to extend this analysis to further explore associations between mycotoxins (aflatoxins, ochratoxins, trichothecenes including deoxynivalenol, T-2 toxin, and fumonisins) and long-bone growth, particularly during the saltatory periods of development. Linear growth is a direct function of skeletal development and long-bone growth. We therefore explored biological pathways and mechanisms of impact of these toxins in both animal and human studies, in addition to the epidemiology literature (post-2020). Given what is known of the effects of individual and combinations of mycotoxins based on the animal literature, we have identified a need for further research and examination of how these toxins and exposures may be studied in humans to elucidate the downstream impact on bone-related biomarkers and anthropometric indices used to identify and predict stunting in population-based studies.
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Affiliation(s)
- Rukshan Mehta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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11
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Braun L, MacDougall A, Sumner T, Adriano Z, Viegas E, Nalá R, Brown J, Knee J, Cumming O. Associations between Shared Sanitation, Stunting and Diarrhoea in Low-Income, High Density Urban Neighbourhoods of Maputo, Mozambique - a Cross-Sectional Study. Matern Child Health J 2024; 28:775-784. [PMID: 38427278 DOI: 10.1007/s10995-024-03924-4] [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] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Shared sanitation facilities are used by over 500 million people around the world. Most research evidence indicates that shared sanitation conveys higher risk than household sanitation for many adverse health outcomes. However, studies often fail to account for variation between different types of shared facilities. As informal housing development outpaces sanitation infrastructure, it is imperative to understand which components of shared facilities may mitigate the health risks of shared sanitation use. METHODS This cross-sectional study determines whether sanitation improvement or compound hygiene were associated with stunting or diarrhoeal prevalence in children under five living in Maputo, Mozambique who rely on shared sanitation facilities. The study uses logistic and linear multivariable regression analysis to search for associations and control for potential confounding factors. RESULTS 346 children (43.9%) in the study population were stunted. Each unit increase in sanitation score was associated with an approximate decrease of 22% in the odds of stunting (OR: 0.78, CI: 0.66, 0.92), and an increase in height of 0.23 height-for-age z-scores (CI: 0.10, 0.36). There was no evidence that the compound hygiene score was associated with height as measured by stunting (OR: 1.05, CI: 0.87, 1.26) or z-score (-0.06, CI: -0.21, 0.09). Neither sanitation nor compound hygiene score were associated with diarrhoea in the population. CONCLUSIONS Use of an improved shared latrine is associated with decreased odds of stunting. There is no evidence of an association between latrine improvement and diarrhoea. Further investigation is necessary to isolate attributes of shared sanitation facilities that may reduce health risks.
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Affiliation(s)
- Laura Braun
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Amy MacDougall
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Trent Sumner
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, USA
| | | | - Edna Viegas
- Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Rassul Nalá
- Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jackie Knee
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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12
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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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13
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Ahmadi H, Askari M, Suitor K, Bellissimo N, Azadbakht L. The association between different types of amino acid intake and physical growth among children. Clin Nutr ESPEN 2024; 60:165-172. [PMID: 38479905 DOI: 10.1016/j.clnesp.2023.12.143] [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: 10/26/2022] [Revised: 12/07/2023] [Accepted: 12/20/2023] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Restricted linear growth and abnormal weight status are commonly observed among children in low-income countries, possibly due to inadequate protein intake. Considering the role of protein intake and amino acid (AA) synthesis in growth and development, it has been suggested that there may be an association between AA intake and physical growth. We aimed to investigate the association between different types of AA intake and physical growth among children. METHODS A cross-sectional study including 780 six-year-old children referred to 10 health care centers for vaccination between October 2017 and March 2018 was conducted. Anthropometric data was collected using standard methods, and dietary intake was assessed using a validated food-frequency questionnaire (FFQ) in an interview by a trained technician. RESULTS Children in the highest tertile (3rd) of branched-chain amino acids (BCAA) intake had a higher weight-for-age z-score (WAZ) (P = 0.02) and body mass index-for-age z-score (BAZ) (P = 0.001) compared to those in the lowest tertile (1st). Interestingly, BAZ was significantly associated with the highest tertile of acidic AA intake (P = 0.04), while an inverse association was observed between the highest tertile of aromatic AA (phenylalanine and tyrosine) intake and BAZ (P = 0.01) . No significant associations were observed between the highest tertile of sulfuric, aliphatic, or neutral AA and BAZ, height-for-age z-score (HAZ) or WAZ. Further, underweight was associated with the 3rd tertile of aromatic, alcoholic, aliphatic or neutral AA and BCAA intake. Aliphatic and neutral AA intake was also increased the risk of overweight. Finally, stunted growth patterns were associated with the highest tertile of acidic, alcoholic. CONCLUSION Findings presented in this study showed that higher BAZ and WAZ are associated with 3rd tertiles of BCAA intake, but lower BAZ were associated with 3rd tertiles of aromatic AA (phenylalanine and tyrosine) intake. Future research in other populations are needed to confirm these findings.
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Affiliation(s)
- Hedieh Ahmadi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Askari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Katherine Suitor
- Faculty of Community Services, School of Nutrition, Toronto Metropolitan University, Toronto, Canada
| | - Nick Bellissimo
- Faculty of Community Services, School of Nutrition, Toronto Metropolitan University, Toronto, Canada
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Surono IS, Popov I, Verbruggen S, Verhoeven J, Kusumo PD, Venema K. Gut microbiota differences in stunted and normal-lenght children aged 36-45 months in East Nusa Tenggara, Indonesia. PLoS One 2024; 19:e0299349. [PMID: 38551926 PMCID: PMC10980242 DOI: 10.1371/journal.pone.0299349] [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: 08/13/2023] [Accepted: 02/06/2024] [Indexed: 04/01/2024] Open
Abstract
The role of the gut microbiota in energy metabolism of the host has been established, both in overweight/obesity, as well as in undernutrition/stunting. Dysbiosis of the gut microbiota may predispose to stunting. The aim of this study was to compare the gut microbiota composition of stunted Indonesian children and non-stunted children between 36 and 45 months from two sites on the East Nusa Tenggara (ENT) islands. Fecal samples were collected from 100 stunted children and 100 non-stunted children in Kupang and North Kodi. The gut microbiota composition was determined by sequencing amplicons of the V3-V4 region of the 16S rRNA gene. Moreover, fecal SCFA concentrations were analyzed. The microbiota composition was correlated to anthropometric parameters and fecal metabolites. The phyla Bacteroidetes (Bacteroidota; q = 0.014) and Cyanobacteria (q = 0.049) were significantly higher in stunted children. Three taxa at genus levels were consistently significantly higher in stunted children at both sampling sites, namely Lachnoclostridium, Faecalibacterium and Veillonella (q < 7 * 10-4). These and 9 other taxa positively correlated to the z-score length-for-age (zlen), while 11 taxa negatively correlated with zlen. Several taxa also correlated with sanitary parameters, some of which were also significantly different between the two groups. All three fecal SCFA concentrations (acetate, propionate and butyrate) and their total were lower in stunted children compared to non-stunted children, although not significant for butyrate, indicating lower energy-extraction by the gut microbiota. Also, since SCFA have been shown to be involved in gut barrier function, barrier integrity may be affected in the stunted children. It remains to be seen if the three taxa are involved in stunting, or are changed due to e.g. differences in diet, hygiene status, or other factors. The observed differences in this study do not agree with our previous observations in children on Java, Indonesia. There are differences in infrastructure facilities such as clean water and sanitation on ENT and Java, which may contribute to the differences observed. The role of the gut microbiota in stunting therefore requires more in depth studies. Trial registration: the trial was registered at ClinicalTrials.gov with identifier number NCT05119218.
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Affiliation(s)
- Ingrid S. Surono
- Faculty of Engineering, Food Technology Department, Bina Nusantara University, Jakarta, Indonesia
| | - Ilia Popov
- Faculty of Engineering, Food Technology Department, Bina Nusantara University, Jakarta, Indonesia
| | - Sanne Verbruggen
- Centre for Healthy Eating & Food Innovation, Maastricht University—Campus Venlo, Venlo, The Netherlands
| | - Jessica Verhoeven
- Centre for Healthy Eating & Food Innovation, Maastricht University—Campus Venlo, Venlo, The Netherlands
| | - Pratiwi D. Kusumo
- Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
| | - Koen Venema
- Centre for Healthy Eating & Food Innovation, Maastricht University—Campus Venlo, Venlo, The Netherlands
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15
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Singhal A, Singh A, Sharma D, Bose KS. Correlation between maternal and infant vitamin B12 levels in severe malnutrition in infants under 6 months. Ir J Med Sci 2024:10.1007/s11845-024-03662-0. [PMID: 38462591 DOI: 10.1007/s11845-024-03662-0] [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: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Malnutrition poses a significant global health challenge, affecting various age groups, with infants under 6 months being particularly vulnerable. Vitamin B12, an essential micronutrient critical for neurological development, has been identified as a key player in the overall health of both mothers and infants. AIM To find the correlation between serum vitamin B12 levels in infants, 1-6 months of age with severe malnutrition and maternal levels at tertiary care hospitals in western Rajasthan. METHODS The cross-sectional study was conducted in the UNICEF Regional Center of Excellence-supported Nutrition Rehabilitation Center in Rajasthan, India, through simple random sampling. One hundred ten infants with their mothers were enrolled after consent and approval from the Institutional Ethics Committee. RESULTS Severe malnutrition predominantly affected infants aged 1-2 months, with 77% born small for gestational age and 66.4% belonging to the multiple birth order group. Serum vitamin B12 levels showed a significant positive correlation between mothers and infants (p < 0.001), while exclusive breastfeeding correlated positively with age-appropriate milestones (p = 0.033). CONCLUSION The findings emphasize the importance of targeted interventions addressing maternal and infant nutrition, with a focus on ensuring adequate vitamin B12 levels.
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Affiliation(s)
- Arushi Singhal
- Department of Paediatrics, Dr SN Medical College and Hospital, Jodhpur, India
| | - Anurag Singh
- Department of Paediatrics, Dr SN Medical College and Hospital, Jodhpur, India
| | - Damini Sharma
- Department of Paediatrics, Dr SN Medical College and Hospital, Jodhpur, India
| | - Kritanjali Sahu Bose
- Department of Community Medicine, Rajiv Gandhi Medical Collegeand, Chhatrapati Shivaji Medical College, Kalwa, Thane, India.
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16
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Chang B, Zhang W, Wang Y, Zhang Y, Zhong S, Gao P, Wang L, Zhao Z. Uncovering the complexity of childhood undernutrition through strain-level analysis of the gut microbiome. BMC Microbiol 2024; 24:73. [PMID: 38443783 PMCID: PMC10916198 DOI: 10.1186/s12866-024-03211-w] [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: 03/30/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Undernutrition (UN) is a critical public health issue that threatens the lives of children under five in developing countries. While evidence indicates the crucial role of the gut microbiome (GM) in UN pathogenesis, the strain-level inspection and bacterial co-occurrence network investigation in the GM of UN children are lacking. RESULTS This study examines the strain compositions of the GM in 61 undernutrition patients (UN group) and 36 healthy children (HC group) and explores the topological features of GM co-occurrence networks using a complex network strategy. The strain-level annotation reveals that the differentially enriched species between the UN and HC groups are due to discriminated strain compositions. For example, Prevotella copri is mainly composed of P. copri ASM1680343v1 and P. copri ASM345920v1 in the HC group, but it is composed of P. copri ASM346549v1 and P. copri ASM347465v1 in the UN group. In addition, the UN-risk model constructed at the strain level demonstrates higher accuracy (AUC = 0.810) than that at the species level (AUC = 0.743). With complex network analysis, we further discovered that the UN group had a more complex GM co-occurrence network, with more hub bacteria and a higher clustering coefficient but lower information transfer efficiencies. Moreover, the results at the strain level suggested the inaccurate and even false conclusions obtained from species level analysis. CONCLUSIONS Overall, this study highlights the importance of examining the GM at the strain level and investigating bacterial co-occurrence networks to advance our knowledge of UN pathogenesis.
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Affiliation(s)
- Bingmei Chang
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, People's Republic of China
| | - Wenjie Zhang
- Department of Anesthesiology, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Yinan Wang
- Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Yuanzheng Zhang
- Shenzhen Byoryn Technology Co., Ltd, Shenzhen, People's Republic of China
| | - Shilin Zhong
- Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Peng Gao
- BGI-Shenzhen, Beishan Industrial Zone, Shenzhen, People's Republic of China.
| | - Lili Wang
- Department of Anesthesiology, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.
| | - Zicheng Zhao
- Shenzhen Byoryn Technology Co., Ltd, Shenzhen, People's Republic of China.
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17
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Das S, Baffour B, Richardson A. Trends in chronic childhood undernutrition in Bangladesh for small domains. POPULATION STUDIES 2024; 78:43-61. [PMID: 37647268 DOI: 10.1080/00324728.2023.2239772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/24/2023] [Indexed: 09/01/2023]
Abstract
Chronic childhood undernutrition, known as stunting, is an important population health problem with short- and long-term adverse outcomes. Bangladesh has made strides to reduce chronic childhood undernutrition, yet progress is falling short of the 2030 Sustainable Development Goals targets. This study estimates trends in age-specific chronic childhood undernutrition in Bangladesh's 64 districts during 1997-2018, using underlying direct estimates extracted from seven Demographic and Health Surveys in the development of small area time-series models. These models combine cross-sectional, temporal, and spatial data to predict in all districts in both survey and non-survey years. Nationally, there has been a steep decline in stunting from about three in five to one in three children. However, our results highlight significant inequalities in chronic undernutrition, with several districts experiencing less pronounced declines. These differences are more nuanced at the district-by-age level, with only districts in more socio-economically advantaged areas of Bangladesh consistently reporting declines in stunting across all age groups.
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18
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Momo Kadia B, Khouma M, Sow D, Faye B, Ramsteijn AS, Calvo-Urbano B, Jobarteh ML, Ferguson E, Haggarty P, Webster JP, Walker AW, Heffernan C, Allen SJ. Improving gut health and growth in early life: a protocol for an individually randomised, two-arm, open-label, controlled trial of a synbiotic in infants in Kaffrine District, Senegal. BMJ Paediatr Open 2024; 8:e001629. [PMID: 38417919 PMCID: PMC10900337 DOI: 10.1136/bmjpo-2022-001629] [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: 08/02/2022] [Accepted: 10/03/2022] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Infants exposed to enteropathogens through poor sanitation and hygiene can develop a subclinical disorder of the gut called environmental enteric dysfunction (EED), characterised by abnormal intestinal histology and permeability. EED can contribute to stunting through reduced digestion and absorption of nutrients, increased susceptibility to infections, increased systemic inflammation and inhibition of growth hormones. EED can be apparent by age 12 weeks, highlighting the need for early intervention. Modulating the early life gut microbiota using synbiotics may improve resistance against colonisation of the gut by enteropathogens, reduce EED and improve linear growth. METHODS AND ANALYSIS An individually randomised, two-arm, open-label, controlled trial will be conducted in Kaffrine District, Senegal. Infants will be recruited at birth and randomised to either receive a synbiotic containing two Bifidobacterium strains and one Lactobacillus strain, or no intervention, during the first 6 months of life. The impact of the intervention will be evaluated primarily by comparing length-for-age z-score at 12 months of age in infants in the intervention and control arms of the trial. Secondary outcome variables include biomarkers of intestinal inflammation, intestinal integrity and permeability, gut microbiota profiles, presence of enteropathogens, systemic inflammation, growth hormones, epigenetic status and episodes of illness during follow-up to age 24 months. DISCUSSION This trial will contribute to the evidence base on the use of a synbiotic to improve linear growth by preventing or ameliorating EED in a low-resource setting. TRIAL REGISTRATION NUMBER PACTR202102689928613.
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Affiliation(s)
- Benjamin Momo Kadia
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marietou Khouma
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Dakar, Senegal
| | - Doudou Sow
- Service de Parasitologie-Mycologie, UFR Sciences de la Santé, Université Gaston Berger, Saint Louis, Senegal
| | - Babacar Faye
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Beatriz Calvo-Urbano
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
| | - Modou L Jobarteh
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Haggarty
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Joanne P Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
| | - Alan W Walker
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Claire Heffernan
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- London International Development Centre, London, UK
| | - Stephen J Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Davidson TL, Stevenson RJ. Vulnerability of the Hippocampus to Insults: Links to Blood-Brain Barrier Dysfunction. Int J Mol Sci 2024; 25:1991. [PMID: 38396670 PMCID: PMC10888241 DOI: 10.3390/ijms25041991] [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: 01/03/2024] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
The hippocampus is a critical brain substrate for learning and memory; events that harm the hippocampus can seriously impair mental and behavioral functioning. Hippocampal pathophysiologies have been identified as potential causes and effects of a remarkably diverse array of medical diseases, psychological disorders, and environmental sources of damage. It may be that the hippocampus is more vulnerable than other brain areas to insults that are related to these conditions. One purpose of this review is to assess the vulnerability of the hippocampus to the most prevalent types of insults in multiple biomedical domains (i.e., neuroactive pathogens, neurotoxins, neurological conditions, trauma, aging, neurodegenerative disease, acquired brain injury, mental health conditions, endocrine disorders, developmental disabilities, nutrition) and to evaluate whether these insults affect the hippocampus first and more prominently compared to other brain loci. A second purpose is to consider the role of hippocampal blood-brain barrier (BBB) breakdown in either causing or worsening the harmful effects of each insult. Recent research suggests that the hippocampal BBB is more fragile compared to other brain areas and may also be more prone to the disruption of the transport mechanisms that act to maintain the internal milieu. Moreover, a compromised BBB could be a factor that is common to many different types of insults. Our analysis indicates that the hippocampus is more vulnerable to insults compared to other parts of the brain, and that developing interventions that protect the hippocampal BBB may help to prevent or ameliorate the harmful effects of many insults on memory and cognition.
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Affiliation(s)
- Terry L. Davidson
- Department of Neuroscience, Center for Neuroscience and Behavior, American University, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
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Abdulaziz R, Suryanti N, Setiawan AS. A Review on Maternal Parenting, Child's Growth Stunting, and Oral Health. Eur J Dent 2024; 18:26-40. [PMID: 37105223 PMCID: PMC10959610 DOI: 10.1055/s-0043-1764428] [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: 04/29/2023] Open
Abstract
Stunting has gained global attention as one of the most critical problems in public health. As the first and dominant figure in a child's life, the mother is responsible for determining the proper parenting behaviors to apply to maintain the child's physical health. Stunting is often associated with early childhood caries (ECC) and molar incisor hypomineralization, which can be manifested into each other through various mechanisms. Therefore, it is crucial to explore how far maternal parenting behaviors affect stunting and oral health. This study aims to determine which maternal parenting behaviors can affect stunting and oral health. A systematic search was used through PubMed and Google Scholar to search for published articles between 2011 and 2021. The articles analyze maternal parenting behaviors with stunting and poor oral health. Final analysis was used on 21 articles containing 18 cross-sectional studies, 2 cohort studies, and 1 randomized controlled trial. The result implied that the high prevalence of stunting and ECC is the combined result of prolonged breastfeeding practices (7 articles), poor complementary feeding practice (6 articles), high consumption of sugar (5 articles), and poor oral hygiene practices (5 articles). Maternal parenting styles in the aspect of fulfilling nutrition and maintaining oral health affect the occurrence of stunting and ECC in children.
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Affiliation(s)
- Rasyid Abdulaziz
- Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Netty Suryanti
- Department of Community Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Arlette Suzy Setiawan
- Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
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21
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Beatty A, Borkum E, Leith W, Null C, Suriastini W. A cluster randomized controlled trial of a community-based initiative to reduce stunting in rural Indonesia. MATERNAL & CHILD NUTRITION 2024; 20:e13593. [PMID: 38041533 PMCID: PMC10750001 DOI: 10.1111/mcn.13593] [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: 03/11/2023] [Revised: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 12/03/2023]
Abstract
We evaluate the impacts of a $120 million project in Indonesia conducted between 2014 and 2018 that sought to reduce stunting through a combination of (1) community-driven development grants targeted at health and education outcomes, (2) training for health providers on infant and young child feeding and growth monitoring and (3) training for sanitarians on a local variation of community-led total sanitation. This cluster randomized controlled trial involved 95 treatment and 95 control subdistricts across South Sumatra, West Kalimantan, and Central Kalimantan provinces. Overall, we find no significant impacts on stunting, the study's primary outcome measure (0.5 pp; 95% confidence interval [CI]: -3.0 to 4.1 percentage points [pp]), or other longer-term undernutrition outcomes about 1 year after the end of the project. The project had a modest impact on some secondary, more proximal outcomes related to maternal and child nutrition, including the percentage of mothers consuming the recommended number of iron-folic acid pills during pregnancy (8.7 pp; 95% CI: 4.1-13.3 pp), 0-5-month-olds being exclusively breastfed (8.7 pp; 95% CI: 1.8-15.6 pp) and 6-23-month-olds receiving the number of recommended meals per day (8.5 pp; 95% CI: 3.8-13.2 pp). However, there were no significant impacts on other proximal outcomes like the number of pre-natal and post-natal checkups, child dietary diversity, child vitamin A receipt or the incidence of child diarrhoea. Our findings highlight that successfully implementing an integrated package of interventions to reduce child stunting may be challenging in practice. Project design needs to consider implementation reality along with best practice-for example, by piloting the synchronous implementation of multifaceted interventions or phasing them in more gradually over a longer timeframe.
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Kebede T, Bilal SM, Lindtjorn B, Engebretsen IMS. Does livestock ownership predict animal-source food consumption frequency among children aged 6-24 months and their mothers in the rural Dale district, southern Ethiopia? PeerJ 2023; 11:e16518. [PMID: 38107587 PMCID: PMC10725678 DOI: 10.7717/peerj.16518] [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: 04/04/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
Background Animal-source foods are food items that come from animals. Animal-source foods provide a variety of micronutrients that plant-source foods cannot provide to the same extent and without extra precaution. Milk, eggs, poultry, flesh meat and fish are animal-source foods mainly used in Ethiopia. Low animal-source food consumption among children and mothers is a great concern in many low-income settings. This study aimed to describe animal-source food consumption frequencies among children aged 6-24 months and their mothers in rural southern Ethiopia where livestock farming is very common. We also analysed the association between livestock ownership and animal-source food consumption among children and mothers. Methods A community-based cross-sectional study was conducted among 851 randomly selected households with child-mother pairs from August to November 2018. The study was conducted in the rural Dale District, southern Ethiopia. Structured and pre-tested questionnaires were used to collect data on mother and child information, livestock ownership, and animal-source foods consumption frequencies. Ordinal logistic regression analysis was used to describe associations between animal-source foods consumption and livestock ownership. Result Nearly, three-quarters (74.1%) of the households owned cows, and a quarter (25%) had goats or sheep. Dairy, egg and meat consumption among children during the past month was 91.8%, 83.0% and 26.2%, respectively. Likewise, the consumption of dairy, eggs and meat among mothers was 96.0%, 49.5% and 34.0%, respectively. The percentage of children who had not consumed any animal-source foods during the month prior to our survey was 6.6%, and the figure was 2.2% for the mothers. Dairy consumption was 1.8 times higher among children (aOR = 1.8, 95% CI [1.3-2.5]) and 3.0 times higher among mothers (aOR = 3.0, 95% CI [2.2-4.2]) in households that kept cows than in households without cows. The egg consumption frequency was positively associated with hen and goat/sheep ownership for both children and mothers. Meat consumption frequency among children was negatively associated with cow ownership (aOR = 0.66, 95% CI [0.45-0.95]); however, cow ownership was not associated with meat consumption among mothers. Conclusion Dairy products were common animal-source foods consumed by young children and mothers in the study area. However, meat consumption was low among children and mothers. Strategies like promoting the keeping of goats/sheep and hens to improve complementary feeding and mothers' nutrition are warranted in the study area.
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Affiliation(s)
- Tsigereda Kebede
- Centre for International Health, University of Bergen, Bergen, Norway
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Selamawit Mengesha Bilal
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Sidama Regional State Health Bureau, Hawassa, Sidama Region, Ethiopia
| | - Bernt Lindtjorn
- Centre for International Health, University of Bergen, Bergen, Norway
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Taslim NA, Farradisya S, Gunawan WB, Alfatihah A, Barus RIB, Ratri LK, Arnamalia A, Barazani H, Samtiya M, Mayulu N, Kim B, Hardinsyah H, Surya E, Nurkolis F. The interlink between chrono-nutrition and stunting: current insights and future perspectives. Front Nutr 2023; 10:1303969. [PMID: 38192646 PMCID: PMC10773880 DOI: 10.3389/fnut.2023.1303969] [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: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
Stunting is the one factor that is responsible for the irretrievable damage to children's mental and physical health. Stunting imitates chronic undernutrition throughout the most extreme critical stages of growth and development of a child in their early life, and due to that stunted child does not completely develop and are too short for their age. Stunting is mainly linked with brain underdevelopment, along with lifelong damaging consequences, comprising weakened mental and learning capacity, deprived performance in school during childhood, and enhanced risks of nutrition linked to chronic long-lasting ailments, such as diabetes, hypertension, diabesity, and obesity in the future. In this review, the authors mainly summarize the latest studies related to chronic nutrition and how it is related to stunting. Optimal nutrition, particularly during pregnancy and the first 24 months of a child's life, is crucial in preventing stunting. Circadian rhythms play a significant role in maternal and fetal health, affecting outcomes such as premature birth and stunting. Maintaining a balanced diet, avoiding late-night carbohydrate-heavy meals during pregnancy, and promoting breastfeeding align with the body's biological clock, which can benefit newborns in various ways. Providing dedicated spaces for breastfeeding in public places is important to support infant health.
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Affiliation(s)
- Nurpudji Astuti Taslim
- Division of Clinical Nutrition, Faculty of Medicine, Department of Nutrition, Hasanuddin University, Makassar, Indonesia
| | | | - William Ben Gunawan
- Faculty of Medicine, Alumnus of Department of Nutrition Science, Diponegoro University, Semarang, Indonesia
| | - Aulia Alfatihah
- Faculty of Health Science, Department of Nutrition Science, Muhammadiyah University of Surakarta, Surakarta, Indonesia
| | - Ria Irmelin Br Barus
- Faculty of Medicine, Department of Nutrition Science, Diponegoro University, Semarang, Indonesia
| | - Liesty Kurnia Ratri
- Faculty of Medicine, Alumnus of Department of Nutrition Science, Diponegoro University, Semarang, Indonesia
| | - Astri Arnamalia
- Department of Chemistry, State Islamic University of Sunan Kalijaga (UIN Sunan Kalijaga), Yogyakarta, Indonesia
| | - Hero Barazani
- Medical Programme, Faculty of Medicine Universitas Brawijaya, Malang, Indonesia
| | - Mrinal Samtiya
- Department of Nutrition Biology, Central University of Haryana, Haryana, India
| | - Nelly Mayulu
- Faculty of Medicine, Department of Nutrition, Universitas Muhammadiyah Manado, Manado, Indonesia
| | - Bonglee Kim
- Department of Pathology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hardinsyah Hardinsyah
- Senior Professor of Applied Nutrition Division, Faculty of Human Ecology, Department of Community Nutrition, IPB University, Bogor, Indonesia
| | - Ervan Surya
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fahrul Nurkolis
- Faculty of Sciences and Technology, Department of Biological Sciences, State Islamic University of Sunan Kalijaga (UIN Sunan Kalijaga), Yogyakarta, Indonesia
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Rao N, Bala M, Ranganathan N, Anand U, Dhingra S, Costa JC, Weber AM. Trends in the prevalence and social determinants of stunting in India, 2005-2021: findings from three rounds of the National Family Health Survey. BMJ Nutr Prev Health 2023; 6:357-366. [PMID: 38618541 PMCID: PMC11009545 DOI: 10.1136/bmjnph-2023-000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/20/2023] [Indexed: 04/16/2024] Open
Abstract
Objectives To assess social determinants of stunting and the shifts in contributions of socio-demographic factors to national prevalence trends in India between 2005 and 2021. Methods We leveraged data from three rounds of the National Family Health Survey (NFHS-3: 2005-2006, NFHS-4: 2015-2016, NFHS-5: 2019-2021) for 443 038 children under 5 years. Adjusted logistic regression models and a Kitigawa-Oaxaca-Blinder decomposition were deployed to examine how wealth, residence, belonging to a marginalised social group, maternal education and child sex contributed to changes in stunting prevalence. Results The decrease in stunting prevalence was notably slower between NFHS-4 and NFHS-5 (annual average rate of reduction (AARR): 1.33%) than between NFHS-3 and NFHS-4 (AARR: 2.20%). The protective effect of high wealth diminished from 2015 onwards but persisted for high maternal education. However, an intersection of higher household wealth and maternal education mitigated stunting to a greater extent than either factor in isolation. Residence only predicted stunting in 2005-2006 with an urban disadvantage (adjusted OR: 1.18; 95% CI: 1.07 to 1.29). Children from marginalised social groups displayed increased likelihoods of stunting, from 6-16% in 2005-2006 to 11-21% in 2015-2016 and 2020-2021. Being male was associated with 6% and 7% increased odds of stunting in 2015-2016 and 2019-2021, respectively. Increased household wealth (45%) and maternal education (14%) contributed to decreased stunting prevalence between 2005 and 2021. Conclusions Stunting prevalence in India has decreased across social groups. However, social disparities in stunting persist and are exacerbated by intersections of low household wealth, maternal education and being from a marginalised social group. Increased survival must be accompanied by needs-based interventions to support children and mitigate mutually reinforcing sources of inequality.
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Affiliation(s)
- Nirmala Rao
- Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong
| | - Manya Bala
- Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Utkarsh Anand
- School of Economic Sciences, Washington State University, Pullman, Washington, USA
| | | | - Janaina Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ann M Weber
- University of Nevada Reno, Reno, Nevada, USA
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Li S, Nor NM, Kaliappan SR. Long-term effects of child nutritional status on the accumulation of health human capital. SSM Popul Health 2023; 24:101533. [PMID: 37916186 PMCID: PMC10616551 DOI: 10.1016/j.ssmph.2023.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/09/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
Research on the impact of childhood nutrition on adult health and human capital has been extensively studied in developed countries, but research in China on this topic is limited. Nowadays, for children's nutritional status, while significant progress has been made in addressing childhood undernutrition in China, regional disparities persist, conversely, the prevalence of childhood overweight continues to rise. For adults' health human capital, the burden of chronic non-communicable diseases among Chinese residents is gradually increasing, over 50% of Chinese residents are overweight or obese, with obesity being one of the risk factors for other chronic diseases. Therefore, this study uses national representative data from 1991 to 2015 China Health and Nutrition Survey (CHNS), matched with individual information from their childhood, to examine the relationship between childhood nutrition and adult health human capital. Based on the two-way fixed effects models and logit models, the study finds that childhood nutrition status measured by height-for-age z score (HAZ) significantly and continuously has been influencing adult health human capital measured by height, BMI, self-rated health (SRH), whether have been sick in last four weeks (SH). BMI-for-age z score (BMIZ) significantly and continuously influence adult health human capital measured by BMI, blood pressure, and perceived stress (PS). Among that, this study places special emphasis on the long-lasting effects of late childhood and adolescence (ages exceeding 6) on the progressive height accumulation and sustained presence of elevated blood pressure. In conclusion, reducing childhood overweight and promoting linear growth and development throughout the whole childhood can reduce the future burden of disease on the nation.
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Affiliation(s)
- Sa Li
- School of Business and Economics, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
| | - Norashidah Mohamed Nor
- School of Business and Economics, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
| | - Shivee Ranjanee Kaliappan
- School of Business and Economics, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
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Ahmed KT, Karimuzzaman M, Afroz S, Hossain MM, Huq SS, Abdulla F, Rahman A. Trends and long-term variation explaining nutritional determinants of child linear growth: analysis of Bangladesh Demographic and Health Surveys 1996-2018. Public Health Nutr 2023; 26:2758-2770. [PMID: 37886806 PMCID: PMC10755425 DOI: 10.1017/s1368980023002288] [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: 06/26/2021] [Revised: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To examine the height-for-age z-score (HAZ) of 0-35 months' children along with stunting prevalence to identify trends, changes and available nutrition-sensitive and specific determinants that could help explain the long-term variation in child linear growth using successive Bangladesh Demographic and Health Surveys (BDHS) data from 1996 to 2018. DESIGN The BDHS pooled data are used for determining the key outcome variables HAZ, stunting and severe stunting. Trends, kernel-weighted local polynomial smoothing illustrations, pooled multivariable linear probability model (LPM), ordinary least squares method (OLS) and regression decomposition were used. PARTICIPANTS Mothers having 0-35 months' children, the most critical age range for growth faltering. RESULTS The mean HAZ increased by 0·91(±1·53) with 0·041 annual average change, while the percentages of stunting (-26·63 ± 0·54) and severe stunting (-21·12 ± 0·48) showed a reduction with 1·21 and 0·96 average annual changes, respectively. The average HAZ improvement (0·42 ± 1·56) in urban areas was less than the rural areas (1·16 ± 1·44). Similar patterns followed for stunting and severe stunting. The prenatal doctor visits (3064·65 %), birth in a medical facility (1054·32 %), breastfeeding initiation (153·18 %) and asset index (144·73 %) demonstrated a huge change. The findings of OLS, LPM and regression decomposition identified asset index, birth order, paternal and maternal education, bottle-fed, prenatal doctor visit, birth in a medical facility, vaccination, maternal BMI and ever-breastfed as influencing factors to predict the long-term changes of stunting and severe stunting. CONCLUSION The nutrition-sensitive and specific factors identified through regression decomposition describing long-term variation in child linear growth should be focused further to attain the sustainable development goals.
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Affiliation(s)
| | - Md Karimuzzaman
- Department of Statistics, Jahangirnagar University, Savar, Dhaka1342, Bangladesh
- DREXEL Dornsife School of Public Health, DREXEL University, USA
| | - Sabrina Afroz
- Department of Statistics, Jahangirnagar University, Savar, Dhaka1342, Bangladesh
| | - Md Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka1342, Bangladesh
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Syeda Shahanara Huq
- Department of Statistics, Jahangirnagar University, Savar, Dhaka1342, Bangladesh
| | - Faruq Abdulla
- Cancer Care and Research Trust Bangladesh (CCRTB), Dhaka1204, Bangladesh
| | - Azizur Rahman
- School of Computing and Mathematics, Charles Sturt University, Albury, NSW, Australia
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27
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Lye CW, Sivasampu S, Mahmudiono T, Majid HA. A systematic review of the relationship between household food insecurity and childhood undernutrition. J Public Health (Oxf) 2023; 45:e677-e691. [PMID: 37291061 DOI: 10.1093/pubmed/fdad070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/21/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND This systematic review aims to investigate the association between household food insecurity (HFIS) and undernutrition in children under 5 years old, thereby informing policymakers on the vital factors needed to be considered in tailoring an effective strategy to tackle childhood undernutrition and ultimately HFIS. METHODS We performed a systematic review that examined household food insecurity among the undernourished under-five children. PubMed, Cochrane, EBSCO Host, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched from 1 January 2012 to 1 April 2022, for relevant articles. Outcome measures were stunting, underweight or wasting. Of the 2779 abstracts screened, 36 studies that fulfilled the inclusion and exclusion criteria were included. A range of tools had been used to measure HFIS, the most common being Household Food Insecurity Access Scale. HFIS has been found to be significantly associated with undernutrition, particularly stunting and underweight. This is observed proportionately across all national income levels. CONCLUSIONS Sustainable and inclusive economic growth, which aims to reduce income, education and gender inequality, should be a key policy goal in the minimizing food insecurity and childhood undernutrition. Multisectoral interventions are needed to address these issues.
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Affiliation(s)
- Chuan Way Lye
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Sheamini Sivasampu
- Centre for Clinical Outcome Research, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Trias Mahmudiono
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Hazreen Abdul Majid
- The Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- School of Chiropractor, AECC University College, Parkwood Campus, Dorset BH5 2DF, UK
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28
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He P, Shen X, Guo S. Intestinal flora and linear growth in children. Front Pediatr 2023; 11:1252035. [PMID: 38034825 PMCID: PMC10687454 DOI: 10.3389/fped.2023.1252035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
The gut microbiota plays a critical role in human growth and development as well as the regulation of human pathophysiological processes. According to research, the gut microbiota controls the host's growth and development in areas such as nutrition, metabolism, endocrine hormones, and immune modulation. The human gut microbiota has an important role in child and adolescent growth, especially when nutritional conditions are poor. In this review, we focus on recent findings about the gut microbiota's influence on child growth, including the relationship between the gut microbiota and linear growth during pregnancy, infancy, childhood, and adolescence. Furthermore, we also review some mechanisms by which intestinal flora influence the host's linear growth. Although the data supports a link between intestinal flora and linear development in children, our review has limitations that prohibit us from fully verifying the causal relationship between gut flora and linear development in children. Improving the gut microbiota, in conjunction with renutrition techniques, has the potential to ameliorate the growth and development impairments currently associated with chronic illness and malnutrition in children.
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Affiliation(s)
| | | | - Sheng Guo
- Department of Endocrine, Genetics and Metabolism, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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29
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Nisa K, Arisandi R, Ibrahim N, Hardian H. Harnessing the power of probiotics to enhance neuroplasticity for neurodevelopment and cognitive function in stunting: a comprehensive review. Int J Neurosci 2023:1-11. [PMID: 37963096 DOI: 10.1080/00207454.2023.2283690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Stunting become a global concern because it's not only affecting physical stature, but also affecting on neurodevelopment and cognitive function. These impacts are resulting in long-term consequences especially for human resources, such as poor-quality labor, decreased productivity due to decreasing of health quality, including immunity and cognitive aspect. DISCUSSION This comprehensive review found that based on many studies, there is an altered gut microbiota, or dysbiosis, in stunted children, causing the impairment of brain development through Microbiota-Gut Brain Axis (MGB Axis) mechanism. The administration of probiotics has been known affect MGBA by improving the physical and chemical gut barrier integrity, producing antimicrobial substance to inhibit pathogen, and recovering the healthy gut microbiota. Probiotics, along with healthy gut microbiota, produce SCFAs which have various positive impact on CNS, such as increase neurogenesis, support the development and function of microglia, reduce inflammatory signaling, improve the Blood Brain Barrier's (BBB's) integrity, produce neurotropic factors (e.g. BDNF, GDNF), and promote the formation of new synapse. Probiotics also could induce the production of IGF-1 by intestinal epithelial cells, which functioned as growth factor of multiple body tissues and resulted in improvement of linear growth as well as brain development. CONCLUSION These properties of probiotics made it become the promising and feasible new treatment approach for stunting. But since most of the studies in this field are conducted in animal models, it is necessary to translate animal data into human models and do additional study to identify the numerous components in the MGB axis and the effect of probiotics on human.
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Affiliation(s)
- Khairun Nisa
- Department of Physiology, University of Lampung, Bandar Lampung, Indonesia
| | - Rizki Arisandi
- Department of Physiology, University of Lampung, Bandar Lampung, Indonesia
| | - Nurhadi Ibrahim
- Department of Medical Physiology and Biophysics, Universitas Indonesia, Depok, Indonesia
| | - Hardian Hardian
- Department of Physiology, University of Diponegoro, Semarang, Indonesia
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30
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Sturgeon JP, Njunge JM, Bourke CD, Gonzales GB, Robertson RC, Bwakura-Dangarembizi M, Berkley JA, Kelly P, Prendergast AJ. Inflammation: the driver of poor outcomes among children with severe acute malnutrition? Nutr Rev 2023; 81:1636-1652. [PMID: 36977352 PMCID: PMC10639108 DOI: 10.1093/nutrit/nuad030] [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: 03/30/2023] Open
Abstract
Severe acute malnutrition (SAM) is the most life-threatening form of undernutrition and underlies at least 10% of all deaths among children younger than 5 years in low-income countries. SAM is a complex, multisystem disease, with physiological perturbations observed in conjunction with the loss of lean mass, including structural and functional changes in many organ systems. Despite the high mortality burden, predominantly due to infections, the underlying pathogenic pathways remain poorly understood. Intestinal and systemic inflammation is heightened in children with SAM. Chronic inflammation and its consequent immunomodulation may explain the increased morbidity and mortality from infections in children with SAM, both during hospitalization and in the longer term after discharge. Recognition of the role of inflammation in SAM is critical in considering new therapeutic targets in this disease, which has not seen a transformational approach to treatment for several decades. This review highlights the central role of inflammation in the wide-ranging pathophysiology of SAM, as well as identifying potential interventions that have biological plausibility based on evidence from other inflammatory syndromes.
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Affiliation(s)
- Jonathan P Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - James M Njunge
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Claire D Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Gerard Bryan Gonzales
- Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Ruairi C Robertson
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | | | - James A Berkley
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Paul Kelly
- is with the Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
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31
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Picauly I, Adi AAAM, Meiyetriani E, Mading M, Weraman P, Nashriyah SF, Hidayat AT, Boeky DLA, Lobo V, Saleh A, Peni JA. Path analysis model for preventing stunting in dryland area island East Nusa Tenggara Province, Indonesia. PLoS One 2023; 18:e0293797. [PMID: 37917759 PMCID: PMC10621912 DOI: 10.1371/journal.pone.0293797] [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: 08/15/2022] [Accepted: 10/19/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The problem of stunting is still a fundamental problem in Indonesia's human development. East Nusa Tenggara Province is an archipelago dryland area where in 2007-2021 it has contributed to the highest number of stunting children prevalence in Indonesia. This study aims to determine the relationship of variables in individual, household and district level with the prevalence of stunting. METHODS This type of research is observational study with a cross sectional design. This study used individual secondary data from the Indonesian Nutritional Status Survey in 2021 consisting of 7,835 toddlers and National Social Economics Survey 2021. RESULTS This research found that both specific & sensitive intervention programs had an influence in accelerating the decline in stunting prevalence (higher score on Z Score). Results also revealed the positive influence of the food access variable on nutritional intake. The results of the path analysis test showed that sensitive intervention program variables have a positive effect on food access variable and environmental variable (environmental sanitation) such as the habit of open defecation and healthcare. There was significant relationship on disease history, environment and intake to Height for Age (HAZ) score. CONCLUSIONS In conclusion, direct and indirect factors have important roles to prevent stunting. Sensitive and specific intervention program, food access, macro determinants and environment are the indirect indicators which contribute significantly to the stunting. The risk of children under five years old experiencing malnourished nutritional status increases with a history of infectious disease (diarrhea, ARI, worms). The risk of children under five years experiencing malnourished nutritional status decreases with adequate nutritional intake. It is hoped that there will be a special model of stunting control interventions at the individual level and at the family, household and district level that are integrated and of high quality through multisectoral cooperation in the dryland areas of the islands of East Nusa Tenggara Province.
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Affiliation(s)
- Intje Picauly
- Faculty of Public Health, Department of Public Health, University of Nusa Cendana, Kupang City, East Nusa Tenggara, Indonesia
| | | | - Eflita Meiyetriani
- SEAMEO RECFON, Pusat Kajian Gizi Regional, Universitas Indonesia, Jakarta, Indonesia
| | - Majematang Mading
- Lokalitbangkes Waikabubak, Ministry of Health, West Sumba, East Nusa Tenggara, Indonesia
| | - Pius Weraman
- Faculty of Public Health, Department of Public Health, University of Nusa Cendana, Kupang City, East Nusa Tenggara, Indonesia
| | - Siti Fadhilatun Nashriyah
- Department of Biostatistics, Faculty of Public Health, Universitas Indonesia, Depok, Jakarta, Indonesia
| | - Ahmad Thohir Hidayat
- SEAMEO RECFON, Pusat Kajian Gizi Regional, Universitas Indonesia, Jakarta, Indonesia
| | - Daniela L. Adeline Boeky
- Faculty of Public Health, Department of Public Health, University of Nusa Cendana, Kupang City, East Nusa Tenggara, Indonesia
| | - Varry Lobo
- Lokalitbangkes Waikabubak, Ministry of Health, West Sumba, East Nusa Tenggara, Indonesia
| | | | - Jane A. Peni
- Health Polytechnique Kupang, Ministry of Health, Kupang City, East Nusa Tenggara, Indonesia
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Gobena WE, Wotale TW, Lelisho ME, Gezimu W. Prevalence and associated factors of stunting among under-five children in Ethiopia: Application of marginal models analysis of 2016 Ethiopian demographic and health survey data. PLoS One 2023; 18:e0293364. [PMID: 37906602 PMCID: PMC10617690 DOI: 10.1371/journal.pone.0293364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Stunting, short for age, affects the overall growth and development of the children. It occurs due to chronic under nutrition. Stunting vastly occurs in impoverished regions of the world, including Ethiopia. OBJECTIVE This study aimed to investigate the prevalence and correlates of stunting among under-five children in Ethiopia using marginal models. METHODS Data were taken from the 2016 Ethiopian Demographic Health Survey, which is a nationally representative survey of children in the 0-59 month age group. For marginal models, generalized estimating equations and alternating logistic regression models were used for the analysis. RESULTS The prevalence of stunting among the under-five children was 34.91% in the area. The proportion was slightly higher among male (36.01%) than female (33.76%) child. The Alternating Logistic Regression model analysis revealed that the child's age, the mother's education level, the mother's body mass index, the place of residence, the wealth index, and the previous birth interval were found to be significant determinants of childhood stunting, and the result shows that children born with a lower previous birth interval (less than 24 months) were more likely to be stunted than those born within a higher birth interval. Children in rural Ethiopia were more likely to be stunted than children in urban Ethiopia. CONCLUSION This study found that more than one third of children were stunted in the area. The study also determined that child's age, the mother's education, the mother's body mass index, the place of residence, the wealth index, and birth interval influence stunting. Therefore, it is better enhancing the nutritional intervention programs.
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Affiliation(s)
| | - Teramaj Wongel Wotale
- Department of Statistics, College of Natural Science, Mettu University, Mettu, Ethiopia
| | - Mesfin Esayas Lelisho
- Department of Statistics, College of Natural Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Wubishet Gezimu
- Department of Nursing, College of Health Sciences, Mettu University, Mettu, Ethiopia
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Rehman AM, Sekitoleko I, Rukuni R, Webb EL, McHugh G, Bandason T, Moyo B, Ngwira LG, Mukwasi-Kahari C, Gregson CL, Simms V, Filteau S, Ferrand RA. Growth Profiles of Children and Adolescents Living with and without Perinatal HIV Infection in Southern Africa: A Secondary Analysis of Cohort Data. Nutrients 2023; 15:4589. [PMID: 37960240 PMCID: PMC10650589 DOI: 10.3390/nu15214589] [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: 09/11/2023] [Revised: 10/15/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
Impaired linear growth and slower pubertal growth can be associated with perinatal HIV infection. We characterised growth relative to population norms, among the full adolescent period in southern Africa to better understand processes leading to morbidity in adulthood. We conducted a secondary analysis of 945 adolescents aged 8-20 years from urban Malawi and Zimbabwe; we included children with HIV (CWH), an uninfected comparison group from a cohort study, and CWH with co-morbid chronic lung disease (CLD) from a randomised controlled trial. We used latent class analysis of anthropometric Z-scores generated from British 1990 reference equations at two annual time-points, to identify growth trajectory profiles and used multinomial logistic regression to identify factors associated with growth profiles. Growth faltering (one or more of weight-for-age, height-for-age, or BMI-for-age Z-scores < -2) occurred in 38% (116/303) of CWH from the cohort study, 62% (209/336) of CWH with CLD, and 14% (44/306) of HIV-uninfected participants. We identified seven different growth profiles, defined, relatively, as (1) average growth, (2) tall not thin, (3) short not thin, (4) stunted not thin, (5) thin not stunted, (6) thin and stunted and (7) very thin and stunted. Females in profile 3 exhibited the highest body fat percentage, which increased over 1 year. Males at older age and CWH especially those with CLD were more likely to fall into growth profiles 4-7. Improvements in height-for-age Z-scores were observed in profiles 6-7 over 1 year. Interventions to target those with the worst growth faltering and longer-term follow-up to assess the impact on adult health are warranted.
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Affiliation(s)
- Andrea M. Rehman
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK (E.L.W.); (V.S.)
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
| | - Ruramayi Rukuni
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare P.O. Box A178, Zimbabwe (T.B.); (C.M.-K.)
| | - Emily L. Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK (E.L.W.); (V.S.)
| | - Grace McHugh
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare P.O. Box A178, Zimbabwe (T.B.); (C.M.-K.)
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare P.O. Box A178, Zimbabwe (T.B.); (C.M.-K.)
| | - Brewster Moyo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre 312233, Malawi; (B.M.); (L.G.N.)
| | - Lucky Gift Ngwira
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre 312233, Malawi; (B.M.); (L.G.N.)
- Health Economics Policy Unit, Kamuzu University of Health Sciences, Blantyre 312225, Malawi
| | - Cynthia Mukwasi-Kahari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare P.O. Box A178, Zimbabwe (T.B.); (C.M.-K.)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Celia L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK;
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK (E.L.W.); (V.S.)
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare P.O. Box A178, Zimbabwe (T.B.); (C.M.-K.)
| | - Suzanne Filteau
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Rashida A. Ferrand
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare P.O. Box A178, Zimbabwe (T.B.); (C.M.-K.)
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Sahiledengle B, Mwanri L, Blumenberg C, Agho KE. Gender-specific disaggregated analysis of childhood undernutrition in Ethiopia: evidence from 2000-2016 nationwide survey. BMC Public Health 2023; 23:2040. [PMID: 37853384 PMCID: PMC10585928 DOI: 10.1186/s12889-023-16907-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Childhood undernutrition has been investigated extensively in previous literature but gender inequality detailing the burden of undernutrition has not been adequately addressed in scientific papers, especially in Ethiopia, where undernutrition is known to be a public health problem of high significance, necessitating increased efforts to address it and reduce this inequality. This study was carried out to: (1) explore gender differences in the prevalence of stunting, wasting, and underweight, and (2) compare the factors associated with childhood undernutrition between boys and girls in Ethiopia. METHODS The study used a dataset of more than 33,564 children aged under 5 years (boys: 17,078 and girls: 16,486) who were included in the nationally representative Ethiopia Demographic and Health Survey (EDHS) from 2000 to 2016. The outcome variables were anthropometric indices: stunting (height-for-age < -2 standard deviations), wasting (weight-for-height < -2 standard deviations), and underweight (weight-for-age < -2 standard deviations). Gender-specific multilevel analyses were used to examine and compare the factors associated with child undernutrition. RESULTS The overall prevalence of stunting (49.1% for boys vs 45.3% for girls, p < 0.001), wasting (11.9% for boys vs 9.9% for girls, p < 0.001), and underweight (33.1% for boys vs 29.8% for girls, p < 0.001) higher among boys compared to girls. Boys significantly had higher odds of stunting (aOR: 1.31, 95%CI: 1.21-1.42), wasting (aOR: 1.35, 1.23-1.48), and underweight (aOR: 1.38, 95%CI: 1.26-1.50) than girls. The common factors associated with childhood undernutrition for male and female children were the child's age, perceived size of the child at birth, breastfeeding status, maternal stature, maternal education, toilet facility, wealth index, and place of residence. Boys who were perceived by their mothers to be average sized at birth and were born to uneducated mothers had a higher likelihood of experiencing wasting, in contrast to girls. Among boys, birth order (firstborn), household size (1-4), and place of residence (urban) were associated with lower odds of being underweight. Boys living in cities had lower odds of being stunted. While girls born to mothers with no education and worked in agriculture were at a higher odd of being stunted. CONCLUSION Our study revealed that boys were more likely to be malnourished than girls, regardless of their age category, and there were variations in the factors determining undernutrition among boys and girls. The differences in the burden of undernutrition were significant and alarming, positioning Ethiopia to be questioned whether it will meet the set Sustainable Development Goals (SDGs), including SDG 2 of zero hunger by 2030. These findings call for more effort to address malnutrition as a significant public health issue in Ethiopia, and to urgently recognise the need for enhanced interventions that address the gender gap in childhood undernutrition.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide Campus, SA, 5000, Australia
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Causale Consultoria, Pelotas, Brazil
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- School of Medicine, Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, NSW, 2571, Australia
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Namiiro FB, Batte A, Rujumba J, Nabukeera-Barungi N, Kayom VO, Munabi IG, Serunjogi R, Kiguli S. Nutritional status of young children born with low birthweight in a low resource setting: an observational study. BMC Pediatr 2023; 23:520. [PMID: 37858130 PMCID: PMC10585881 DOI: 10.1186/s12887-023-04356-9] [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: 12/07/2022] [Accepted: 10/10/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Every year, an estimated 20 million babies are born with low birthweight and this number is increasing globally. Survivors are at risk of lifelong morbidities like undernutrition. We assessed the growth and nutritional status for children born with low birthweight at Mulago Hospital, Uganda. METHODS We conducted a cross sectional study to describe the nutritional status of children aged between 22 and 38 months and born weighing ≤ 2000 g. Anthropometric measurements; weight for height, height for age and weight for age z-scores were generated based on the World Health Organization standards to define wasting, stunting and underweight respectively. Data was collected using a structured questionnaire and analysis was done using STATA version 14. RESULTS Of the 251 children, 129 (51.4%) were male, mean age was 29.7 months SD 4.5) and maternal mean age was 29.9 (SD 5.3). A total of 101(40.2%) had normal nutritional status. The prevalence of wasting, underweight and stunting were: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively. CONCLUSION Six of ten children born with low birthweight were at risk of undernutrition in early childhood: underweight and stunting were higher than the national prevalence. Targeted interventions are needed for children with very low birth weight.
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Affiliation(s)
- Flaviah B Namiiro
- Department of Paediatrics & Child Health, Mulago National Referral Hospital, Kampala, Uganda.
| | - Anthony Batte
- Child Health and Development Center, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Violet O Kayom
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ian G Munabi
- Department of Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Serunjogi
- Makerere University-John Hopkins University Institute, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Lin J, Feng XL. Exploring the impact of water, sanitation and hygiene (WASH), early adequate feeding and access to health care on urban-rural disparities of child malnutrition in China. MATERNAL & CHILD NUTRITION 2023; 19:e13542. [PMID: 37376961 PMCID: PMC10483939 DOI: 10.1111/mcn.13542] [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: 10/05/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
To explore the effects of UNICEF-suggested modifiable factors, that is, water, sanitation and hygiene (WASH), early adequate feeding and health care on child malnutrition, and to examine the extent to which each factor contributes to urban-rural disparities of child malnutrition in China. Pooling two waves of regionally representative survey data from Jilin, China, in 2013 and 2018, we report on urban-rural relative risks (RRs) in the prevalence of child stunting, wasting and overweight. We employ Poisson regression to examine the effects of urban-rural setting and the three modifiable factors on the prevalence of each malnutrition outcome, that is, stunting, wasting and overweight. We perform mediation analyses to estimate the extent to which each modifiable factor could explain the urban-rural disparities in each malnutrition outcome. The prevalence of stunting, wasting and overweight were 10.9%, 6.3% and 24.7% in urban, and 27.9%, 8.2% and 35.9% in rural Jilin, respectively. The rural to urban crude RR was 2.55 (95% confidence interval [CI]: 1.92-3.39) for stunting, while the corresponding RRs for wasting and overweight were 1.31 (95% CI: 0.84-2.03) and 1.45 (95% CI: 1.20-1.76), respectively. The rural to urban RR for stunting reduced to 2.01 (95% CI: 1.44-2.79) after adjusting for WASH. The mediation analyses show that WASH could mediate 23.96% (95% CI: 4.34-43.58%) of the urban-rural disparities for stunting, while early adequate feeding and health care had no effects. To close the persistent urban-rural gap in child malnutrition, the specific context of rural China suggests that a multi-sectoral approach is warranted that focuses on the sanitation environment and other wider social determinants of health.
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Affiliation(s)
- Junjie Lin
- Department of Health Policy and Management, School of Public HealthPeking UniversityBeijingChina
| | - Xing Lin Feng
- Department of Health Policy and Management, School of Public HealthPeking UniversityBeijingChina
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Tuthill EL, Maltby AE, Odhiambo BC, Akama E, Dawson-Rose C, Cohen CR, Weiser SD. Financial and Food Insecurity are Primary Challenges to Breastfeeding for Women Living with HIV in Western Kenya: A Longitudinal Qualitative Investigation. AIDS Behav 2023; 27:3258-3271. [PMID: 37043052 PMCID: PMC10577374 DOI: 10.1007/s10461-023-04046-8] [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] [Accepted: 03/14/2023] [Indexed: 04/13/2023]
Abstract
Exclusive breastfeeding for the first 6 months and continued breastfeeding for 24 months or longer is recommended for all mothers world-wide, including women living with HIV (WLWH). Given evidence of suboptimal infant feeding and the need to understand context specific barriers, we explored experiences of perinatal WLWH in Kisumu, Kenya. We applied a longitudinal qualitative approach (4 in-depth interviews) with 30 women from pregnancy to 14-18 months postpartum. Cross-sectional profiling led to a narrative description of infant feeding across time. The majority of women breastfed exclusively for 6 months and weaned by 18 months. Severe financial and food insecurity were primary challenges as women worked through when/how to breastfeed or stop breastfeeding in the setting of multiple competing priorities/pressures across time. Financial and food support and increased support for breastfeeding beyond 18 months have the potential to reduce women's stress and uncertainty associated with infant feeding as well as optimize infant health and nutrition in this setting.
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Affiliation(s)
- Emily L Tuthill
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Ann E Maltby
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Belinda C Odhiambo
- Global Programs for Research and Training - Kenya, University of California, San Francisco, CA, USA
| | - Eliud Akama
- Kenya Medical Research Institute- Center for Microbiology Research, Nairobi, Kenya
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Shen H, Zhao H, Jiang Y. Machine Learning Algorithms for Predicting Stunting among Under-Five Children in Papua New Guinea. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1638. [PMID: 37892302 PMCID: PMC10605317 DOI: 10.3390/children10101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Preventing stunting is particularly important for healthy development across the life course. In Papua New Guinea (PNG), the prevalence of stunting in children under five years old has consistently not improved. Therefore, the primary objective of this study was to employ multiple machine learning algorithms to identify the most effective model and key predictors for stunting prediction in children in PNG. The study used data from the 2016-2018 Papua New Guinea Demographic Health Survey, including from 3380 children with complete height-for-age data. The least absolute shrinkage and selection operator (LASSO) and random-forest-recursive feature elimination were used for feature selection. Logistic regression, a conditional decision tree, a support vector machine with a radial basis function kernel, and an extreme gradient boosting machine (XGBoost) were employed to construct the prediction model. The performance of the final model was evaluated using accuracy, precision, recall, F1 score, and area under the curve (AUC). The results of the study showed that LASSO-XGBoost has the best performance for predicting stunting in PNG (AUC: 0.765; 95% CI: 0.714-0.819) with accuracy, precision, recall, and F1 scores of 0.728, 0.715, 0.628, and 0.669, respectively. Combined with the SHAP value method, the optimal prediction model identified living in the Highlands Region, the age of the child, being in the richest family, and having a larger or smaller birth size as the top five important characteristics for predicting stunting. Based on the model, the findings support the necessity of preventing stunting early in life. Emphasizing the nutritional status of vulnerable maternal and child populations in PNG is recommended to promote maternal and child health and overall well-being.
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Affiliation(s)
| | | | - Yi Jiang
- School of Public Health, Chongqing Medical University, Chongqing 400016, China; (H.S.); (H.Z.)
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Mweetwa MN, Haritunians T, Dube S, Chandwe K, Amadi B, Zyambo K, Liu TC, McGovern D, Kelly P. Genetic variation in environmental enteropathy and stunting in Zambian children: A pilot genome wide association study using the H3Africa chip. PLoS One 2023; 18:e0291311. [PMID: 37756315 PMCID: PMC10529557 DOI: 10.1371/journal.pone.0291311] [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: 10/12/2022] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Stunting is known to be heavily influenced by environmental factors, so the genetic contribution has received little attention. Here we report an exploration of genetic influences in stunted Zambian children with environmental enteropathy. METHOD Children with stunting (LAZ < -2) were enrolled and given nutritional therapy. Those that were non-responsive to therapy were designated as cases, and children with good growth (LAZ > -1) from the same community as controls. Blood and stool samples were taken to measure biomarkers of intestinal inflammation, epithelial damage, and microbial translocation. Single nucleotide polymorphism array genotyping was carried out on saliva samples using the H3Africa consortium array. RESULTS Genome wide associations were analysed in 117 cases and 41 controls. While no significant associations with stunting were observed at P<5x10-8, likely due to the small sample size, interesting associations were observed at lower thresholds. SNPs associated with stunting were in genomic regions known to modulate neuronal differentiation and fatty acid biosynthesis. SNPs associated with increased microbial translocation were associated with non-integrin membrane ECM interactions, tight junctions, hemostasis, and G-alpha signalling events. SNPs associated with increased inflammation were associated with, ECM interactions, purine metabolism, axon guidance, and cell motility. SNPs negatively associated with inflammation overlapped genes involved in semaphoring interactions. We explored the existing coeliac disease risk HLA genotypes and found present: DQ2.5 (7.5%), DQ8 (3.5%) and DQ2.2 (3.8%); however, no children were positive for coeliac antibodies. We detected HLA-DRB:1301 and HLA-C:1802 with high odds ratios and P<0.05 in stunted children compared to controls. CONCLUSION Genetic variations associated with stunting and the enteropathy underlying it, include variants associated with multiple pathways relating to gene expression, glycosylation, nerve signalling, and sensing of the nutritional and microbiological milieu.
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Affiliation(s)
- Monica N. Mweetwa
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Physiology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Shishir Dube
- F. Widjaja Foundation Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Kanta Chandwe
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Paediatrics, University of Zambia School of Medicine, Lusaka, Zambia
| | - Beatrice Amadi
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Department of Paediatrics, University of Zambia School of Medicine, Lusaka, Zambia
| | - Kanekwa Zyambo
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Ta-Chiang Liu
- Washington University in St. Louis (WUSTL), St. Louis, Missouri, United States of America
| | - Dermot McGovern
- F. Widjaja Foundation Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
- Washington University in St. Louis (WUSTL), St. Louis, Missouri, United States of America
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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Murphy KN, Boyce LK, Ortiz E, Santos M, Balseca G. Dietary Patterns of Children from the Amazon Region of Ecuador: A Descriptive, Qualitative Investigation. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1568. [PMID: 37761529 PMCID: PMC10528603 DOI: 10.3390/children10091568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Many young children in Ecuador suffer from high rates of malnutrition and stunting that affect their long-term growth and development. Little is known about the dietary patterns of children from the Amazon region who experience some of the highest rates of stunting (height-for-age) within Ecuador. Semi-structured interviews were conducted with 50 mothers of young children living in the Ecuadorian Amazon. In addition to descriptions of overall dietary patterns, three themes emerged from the interviews relating to strengths mothers have in feeding their children healthy diets: knowledge, autonomous and independent children, and supportive and responsive parenting. Five themes were found relating to barriers mothers have in feeding their children healthy diets. The first four themes concerned barriers (lack of knowledge of healthy foods, lack of access to healthy foods, not enough money, and child's health) related to multidimensional poverty. All these influenced the last theme found, namely, how difficult of an eater the child was. The implications of intervention efforts to reduce undernutrition and promote children's development by building on specific family and community strengths and identified barriers are also discussed in this paper.
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Affiliation(s)
- Kristin N. Murphy
- Department of Human Development and Family Studies, Utah State University, Logan, UT 84322, USA;
| | - Lisa K. Boyce
- Department of Human Development and Family Studies, Utah State University, Logan, UT 84322, USA;
| | - Eduardo Ortiz
- Institute for Disability Research, Policy and Practice, Utah State University, Logan, UT 84322, USA;
| | - Marcela Santos
- Facultad de Postgrado, Universidad Casa Grande, Guayaquil 090613, Ecuador
| | - Gloria Balseca
- Facultad de Postgrado, Universidad Casa Grande, Guayaquil 090613, Ecuador
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Benjamin-Chung J, Mertens A, Colford JM, Hubbard AE, van der Laan MJ, Coyle J, Sofrygin O, Cai W, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jilek W, Jung E, Chung EO, Rosete S, Hejazi N, Malenica I, Li H, Hafen R, Subramoney V, Häggström J, Norman T, Brown KH, Christian P, Arnold BF. Early-childhood linear growth faltering in low- and middle-income countries. Nature 2023; 621:550-557. [PMID: 37704719 PMCID: PMC10511325 DOI: 10.1038/s41586-023-06418-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/10/2023] [Indexed: 09/15/2023]
Abstract
Globally, 149 million children under 5 years of age are estimated to be stunted (length more than 2 standard deviations below international growth standards)1,2. Stunting, a form of linear growth faltering, increases the risk of illness, impaired cognitive development and mortality. Global stunting estimates rely on cross-sectional surveys, which cannot provide direct information about the timing of onset or persistence of growth faltering-a key consideration for defining critical windows to deliver preventive interventions. Here we completed a pooled analysis of longitudinal studies in low- and middle-income countries (n = 32 cohorts, 52,640 children, ages 0-24 months), allowing us to identify the typical age of onset of linear growth faltering and to investigate recurrent faltering in early life. The highest incidence of stunting onset occurred from birth to the age of 3 months, with substantially higher stunting at birth in South Asia. From 0 to 15 months, stunting reversal was rare; children who reversed their stunting status frequently relapsed, and relapse rates were substantially higher among children born stunted. Early onset and low reversal rates suggest that improving children's linear growth will require life course interventions for women of childbearing age and a greater emphasis on interventions for children under 6 months of age.
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Affiliation(s)
- Jade Benjamin-Chung
- Department of Epidemiology & Population Health, Stanford University, Stanford, CA, USA.
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
- Chan Zuckerberg Biohub, San Francisco, CA, USA.
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - John M Colford
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Mark J van der Laan
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Jeremy Coyle
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Oleg Sofrygin
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wilson Cai
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anna Nguyen
- Department of Epidemiology & Population Health, Stanford University, Stanford, CA, USA
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nolan N Pokpongkiat
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie Djajadi
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anmol Seth
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wendy Jilek
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther Jung
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther O Chung
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Sonali Rosete
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nima Hejazi
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ivana Malenica
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Haodong Li
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ryan Hafen
- Hafen Consulting, LLC, West Richland, WA, USA
| | | | | | - Thea Norman
- Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
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Reid BM, Georgieff MK. The Interaction between Psychological Stress and Iron Status on Early-Life Neurodevelopmental Outcomes. Nutrients 2023; 15:3798. [PMID: 37686831 PMCID: PMC10490173 DOI: 10.3390/nu15173798] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
This review presents evidence from animal and human studies demonstrating the possible connection and significant impact of poor iron status and psychological distress on neurocognitive development during pregnancy and the neonatal period, with implications for long-term cognition. Stress and iron deficiency are independently prevalent and thus are frequently comorbid. While iron deficiency and early-life stress independently contribute to long-term neurodevelopmental alterations, their combined effects remain underexplored. Psychological stress responses may engage similar pathways as infectious stress, which alters fundamental iron metabolism processes and cause functional tissue-level iron deficiency. Psychological stress, analogous to but to a lesser degree than infectious stress, activates the hypothalamic-pituitary-adrenocortical (HPA) axis and increases proinflammatory cytokines. Chronic or severe stress is associated with dysregulated HPA axis functioning and a proinflammatory state. This dysregulation may disrupt iron absorption and utilization, likely mediated by the IL-6 activation of hepcidin, a molecule that impedes iron absorption and redistributes total body iron. This narrative review highlights suggestive studies investigating the relationship between psychological stress and iron status and outlines hypothesized mechanistic pathways connecting psychological stress exposure and iron metabolism. We examine findings regarding the overlapping impacts of early stress exposure to iron deficiency and children's neurocognitive development. We propose that studying the influence of psychological stress on iron metabolism is crucial for comprehending neurocognitive development in children exposed to prenatal and early postnatal stressors and for children at risk of early iron insufficiency. We recommend future directions for dual-exposure studies exploring iron as a potential mediating pathway between early stress and offspring neurodevelopment, offering opportunities for targeted interventions.
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Affiliation(s)
- Brie M. Reid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02906, USA
| | - Michael K. Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
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Mutumba R, Mbabazi J, Pesu H, Greibe E, Olsen MF, Briend A, Mølgaard C, Ritz C, Mupere E, Filteau S, Friis H, Grenov B. Micronutrient Status and Other Correlates of Hemoglobin among Children with Stunting: A Cross-Sectional Study in Uganda. Nutrients 2023; 15:3785. [PMID: 37686816 PMCID: PMC10489905 DOI: 10.3390/nu15173785] [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: 08/03/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
In low-income countries, undernutrition and infections play a major role in childhood anemia. Stunted children may be at particular risk of anemia. In a cross-sectional study nested in a nutrition trial among 12-59-month-old stunted children in eastern Uganda, we measured hemoglobin (Hb) and markers of iron, cobalamin, folate and vitamin A status. We assessed low micronutrient status, socio-demography, stunting severity, inflammation and malaria as correlates of Hb and anemia using linear and logistic regression analyses, respectively. Of 750 stunted children, the mean ± SD age was 32.0 ± 11.7 months and 55% (n = 412) were male. The mean Hb was 104 ± 15 g/L and 65% had anemia, Hb < 110 g/L. In a multivariable model with age, sex and inflammation, the following were associated with lower Hb: serum ferritin < 12 µg/L (-5.6 g/L, 95% CI: -8.6; -2.6), transferrin receptors > 8.3 mg/L (-6.2 g/L, 95% CI: -8.4; -4.0), plasma folate <20 nmol/L (-4.6 g/L, 95% CI: -8.1;-1.1), cobalamin < 222 pmol/L (-3.0 g/L, 95% CI: -5.4; -0.7) and serum retinol-binding protein < 0.7 µmol/L (-2.0 g/L, 95% CI: -4.1; 0.2). In addition, severe stunting, inflammation and malaria were negative correlates. Anemia is common among stunted children in eastern Uganda; micronutrient deficiencies, inflammation and malaria are associated with low Hb.
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Affiliation(s)
- Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda;
| | - Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda;
| | - Hannah Pesu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
| | - Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark;
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, 5230 Odense M, Denmark;
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda;
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
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Jones HJ, Bourke CD, Swann JR, Robertson RC. Malnourished Microbes: Host-Microbiome Interactions in Child Undernutrition. Annu Rev Nutr 2023; 43:327-353. [PMID: 37207356 DOI: 10.1146/annurev-nutr-061121-091234] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Childhood undernutrition is a major global health burden that is only partially resolved by nutritional interventions. Both chronic and acute forms of child undernutrition are characterized by derangements in multiple biological systems including metabolism, immunity, and endocrine systems. A growing body of evidence supports a role of the gut microbiome in mediating these pathways influencing early life growth. Observational studies report alterations in the gut microbiome of undernourished children, while preclinical studies suggest that this can trigger intestinal enteropathy, alter host metabolism, and disrupt immune-mediated resistance against enteropathogens, each of which contribute to poor early life growth. Here, we compile evidence from preclinical and clinical studies and describe the emerging pathophysiological pathways by which the early life gut microbiome influences host metabolism, immunity, intestinal function, endocrine regulation, and other pathways contributing to child undernutrition. We discuss emerging microbiome-directed therapies and consider future research directions to identify and target microbiome-sensitive pathways in child undernutrition.
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Affiliation(s)
- Helen J Jones
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom;
| | - Claire D Bourke
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom;
| | - Jonathan R Swann
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ruairi C Robertson
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom;
- Microenvironment and Immunity Unit, INSERM U1224, Institut Pasteur, Université Paris Cité, Paris, France
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Tickell KD, Denno DM, Saleem A, Kazi Z, Singa BO, Achieng C, Mutinda C, Richardson BA, Ásbjörnsdóttir KH, Hawes SE, Berkley JA, Walson JL. Plasma proteomic signatures of enteric permeability among hospitalized and community children in Kenya and Pakistan. iScience 2023; 26:107294. [PMID: 37554451 PMCID: PMC10405056 DOI: 10.1016/j.isci.2023.107294] [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: 03/01/2023] [Revised: 05/04/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
We aimed to establish if enteric permeability was associated with similar biological processes in children recovering from hospitalization and relatively healthy children in the community. Extreme gradient boosted models predicting the lactulose-rhamnose ratio (LRR), a biomarker of enteric permeability, using 7,500 plasma proteins and 34 fecal biomarkers of enteric infection among 89 hospitalized and 60 community children aged 2-23 months were built. The R2 values were calculated in test sets. The models performed better among community children (R2: 0.27 [min-max: 0.19, 0.53]) than hospitalized children (R2: 0.07 [min-max: 0.03, 0.11]). In the community, LRR was associated with biomarkers of humoral antimicrobial and cellular lipopolysaccharide responses and inversely associated with anti-inflammatory and innate immunological responses. Among hospitalized children, the selected biomarkers had few shared functions. This suggests enteric permeability among community children was associated with a host response to pathogens, but this association was not observed among hospitalized children.
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Affiliation(s)
- Kirkby D. Tickell
- Department of Global Health, University of Washington, Seattle, WA, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Donna M. Denno
- Department of Global Health, University of Washington, Seattle, WA, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Ali Saleem
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Aga Khan University, Karachi, Pakistan
| | - Zaubina Kazi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Aga Khan University, Karachi, Pakistan
| | - Benson O. Singa
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Catherine Achieng
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Charles Mutinda
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Stephen E. Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - James A. Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, WA, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
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Jana A, Singh A, Adar SD, D'Souza J, Chattopadhyay A. In-utero exposure to multiple air pollutants and childhood undernutrition in India. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023:10.1038/s41370-023-00591-5. [PMID: 37563211 DOI: 10.1038/s41370-023-00591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Several studies have been conducted to understand the impact of socioeconomic and maternal factors on child undernutrition. However, the past literature has not directly examined the joint impacts of fuel use and ambient pollution and have primarily focused on PM2.5. OBJECTIVE This study explored the individual and community-level associations of both indoor (cooking fuel type) and ambient air pollution (PM2.5, NO2 and SO2) during maternal gestation on child undernutrition. METHODS This study analysed stunting, being underweight, and anaemia of children aged 0-59 months (n = 259,627) using the National Family Health Survey. In-utero exposures to ambient PM2.5, NO2, and SO2 were measured using satellite data and self-reported fuel type was a marker of indoor pollution exposure. The study used univariate and bivariate Moran's I, spatial lag model and multivariable logistic regression models after adjusting for other covariates to understand the effect of pollution on in-utero exposure and child health status at the individual and community-levels. RESULTS Higher concentration of indoor and ambient air pollution was found in the Northern and parts of Central regions of India. Estimates of spatial modelling show that each 1 μg/m-3 increase in maternal exposure to ambient PM2.5 across the clusters of India was associated with a 0.11, 9 and 19 percentage points increase in the prevalence of stunting, underweight and anaemia, respectively. The results of multi-pollutant model show that a higher ambient PM2.5 exposure during pregnancy was linked to higher odds of stunting (AOR:1.38; 95% CI:1.32-1.44), underweight (AOR:1.59; 95% CI:1.51-1.67) and anaemia (AOR:1.61; 95% CI:1.52-1.69) in children. Weaker but similar associations were observed for NO2, but not with SO2. Indoor pollution exposure during in-utero periods was also significantly associated with childhood undernutrition and this association was modified by ambient PM2.5 levels, where exposure to both indoor and ambient air pollution had even greater odds of being undernourished. IMPACT STATEMENT Our research on multi-pollutant models has revealed the initial proof of the individual impacts of indoor and outdoor pollution (PM2.5, NO2, and SO2) exposure during fetal development on children's nutrition.
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Affiliation(s)
- Arup Jana
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Akancha Singh
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Sara D Adar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Jennifer D'Souza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Aparajita Chattopadhyay
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India.
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Mutumba R, Pesu H, Mbabazi J, Greibe E, Olsen MF, Briend A, Mølgaard C, Ritz C, Nabukeera-Barungi N, Mupere E, Filteau S, Friis H, Grenov B. Correlates of Iron, Cobalamin, Folate, and Vitamin A Status among Stunted Children: A Cross-Sectional Study in Uganda. Nutrients 2023; 15:3429. [PMID: 37571364 PMCID: PMC10421162 DOI: 10.3390/nu15153429] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Micronutrient deficiencies and stunting are prevalent. We assessed correlates of iron, cobalamin, folate, and vitamin A biomarkers in a cross-sectional study of stunted children aged 12-59 months in eastern Uganda. The biomarkers measured were serum ferritin (S-FE), soluble transferrin receptor (S-TfR), retinol binding protein (S-RBP), plasma cobalamin (P-Cob), methylmalonic acid (P-MMA), and folate (P-Fol). Using linear regression, we assessed socio-demography, stunting severity, malaria rapid test, and inflammation as correlates of micronutrient biomarkers. Of the 750 children, the mean (SD) age was 32.0 (11.7) months, and 45% were girls. Iron stores were depleted (inflammation-corrected S-FE < 12 µg/L) in 43%, and 62% had tissue iron deficiency (S-TfR > 8.3 mg/L). P-Cob was low (<148 pmol/L) and marginal (148-221 pmol/L) in 3% and 20%, and 16% had high P-MMA (>0.75 µmol/L). Inflammation-corrected S-RBP was low (<0.7 µmol/L) in 21% and P-Fol (<14 nmol/L) in 1%. Age 24-59 months was associated with higher S-FE and P-Fol and lower S-TfR. Breastfeeding beyond infancy was associated with lower iron status and cobalamin status, and malaria was associated with lower cobalamin status and tissue iron deficiency (higher S-TfR) despite iron sequestration in stores (higher S-FE). In conclusion, stunted children have iron, cobalamin, and vitamin A deficiencies. Interventions addressing stunting should target co-existing micronutrient deficiencies.
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Affiliation(s)
- Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Hannah Pesu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark;
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - André Briend
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, 33520 Tampere, Finland;
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, 5230 Odense, Denmark;
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
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Amriviana MP, Khairunnisa C, Sasongko TH. Parental stature as a risk factor for stunting in Indonesia: A systematic review and meta-analysis. NARRA J 2023; 3:e144. [PMID: 38450260 PMCID: PMC10914049 DOI: 10.52225/narra.v3i2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 08/28/2023] [Indexed: 03/08/2024]
Abstract
Stunting is defined by height of more than two standard deviations below the World Health Organization's (WHO) child growth standard median. It is a significant nutritional problem in developing countries, where in 2021, Indonesia recorded a stunting prevalence at 24.4%, slightly higher than the global prevalence (22%). Reducing the prevalence of stunting has been the focus of the current administration in the Indonesian government, as delineated in the 2020-2024 National Medium-Term Development Plan. Globally, many studies have addressed parental stature as a risk factor of stunting. However, systematic reviews that summarized and critically appraised the relationship between parental stature and the incidence of stunting in Indonesia was scarce. This systematic review aimed to assess parental stature as a risk factor for stunting among Indonesian toddlers. Studies were searched through PubMed (MEDLINE), Google Scholar and Mendeley. Studies on Indonesian toddlers under five years old living in Indonesia were included. The quality of the included studies was assessed using Joanna Briggs Institute (JBI) critical appraisal tool. Data were extracted using a standardized data extraction form and were analyzed using Cochrane's RevMan 5.3. Twenty-seven prospective and retrospective cohort, case-control and cross-sectional studies were included with a total 4041 children. Out of 27 included studies, eight were found to be of low, seven of moderate and twelve of high quality. The result showed that parental stature was associated with the incidence of stunting among toddlers in Indonesia, either the mother only (odds ratio (OR) 1.92; 95% confidence interval (95%CI: 1.71-2.15), the father only (OR 5.21; 95%CI: 1.71-15.86) or both parents (OR 3.01; 95%CI: 2.41-3.75). However, studies on father and both parental statures suffered from substantial heterogeneity, imprecision and mixed qualities, therefore, they should be cautiously interpreted.
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Affiliation(s)
- Mazaya P. Amriviana
- Department of Public Health, Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Indonesia
| | - Cut Khairunnisa
- Department of Public Health, Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Indonesia
| | - Teguh H. Sasongko
- Department of Physiology, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
- Institute for Research, Development and Innovations, International Medical University, Kuala Lumpur, Malaysia
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Calva-Cruz ODJ, Ovando-Vázquez C, De León-Rodríguez A, Veana F, Espitia-Rangel E, Treviño S, Barba-de la Rosa AP. Dietary Supplementation with Popped Amaranth Modulates the Gut Microbiota in Low Height-for-Age Children: A Nonrandomized Pilot Trial. Foods 2023; 12:2760. [PMID: 37509852 PMCID: PMC10379428 DOI: 10.3390/foods12142760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Amaranth has been recognized as a nutraceutical food because it contains high-quality proteins due to its adequate amino acid composition that covers the recommended requirements for children and adults. Since pre-Hispanic times, amaranth has been consumed as popped grain; the popping process improves its nutritive quality and improves its digestibility. Popped amaranth consumption has been associated with the recovery of malnourished children. However, there is no information on the impact that popped amaranth consumption has on gut microbiota composition. A non-randomized pilot trial was conducted to evaluate the changes in composition, structure, and function of the gut microbiota of stunted children who received four grams of popped amaranth daily for three months. Stool and serum were collected at the beginning and at the end of the trial. Short-chain fatty acids (SCFA) were quantified, and gut bacterial composition was analyzed by 16S rRNA gene sequencing. Biometry and hematology results showed that children had no pathology other than low height-for-age. A decrease in the relative abundance of Alistipes putredinis, Bacteroides coprocola, and Bacteroides stercoris bacteria related to inflammation and colitis, and an increase in the relative abundance of Akkermansia muciniphila and Streptococcus thermophiles bacteria associated with health and longevity, was observed. The results demonstrate that popped amaranth is a nutritious food that helps to combat childhood malnutrition through gut microbiota modulation.
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Affiliation(s)
- Oscar de Jesús Calva-Cruz
- Molecular Biology Division, Instituto Potosino de Investigación Científica y Tecnológica, San Luis Potosí 78216, Mexico
| | - Cesaré Ovando-Vázquez
- CONACYT-Centro Nacional de Supercómputo, Instituto Potosino de Investigación Científica y Tecnológica, San Luis Potosí 78216, Mexico
| | - Antonio De León-Rodríguez
- Molecular Biology Division, Instituto Potosino de Investigación Científica y Tecnológica, San Luis Potosí 78216, Mexico
| | - Fabiola Veana
- Tecnológico Nacional de México, Instituto Tecnológico de Ciudad Valles, Ciudad Valles 79010, Mexico
| | - Eduardo Espitia-Rangel
- Instituto Nacional de Investigaciones Forestales, Agrícolas y Pecuarias, Texcoco 56250, Mexico
| | - Samuel Treviño
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Av. San Claudio S/N, Ciudad Universitaria, Puebla 72000, Mexico
| | - Ana Paulina Barba-de la Rosa
- Molecular Biology Division, Instituto Potosino de Investigación Científica y Tecnológica, San Luis Potosí 78216, Mexico
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Serrano Matos YA, Cano J, Shafiq H, Williams C, Sunny J, Cowardin CA. Colonization during a key developmental window reveals microbiota-dependent shifts in growth and immunity during undernutrition. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.07.547849. [PMID: 37461523 PMCID: PMC10350093 DOI: 10.1101/2023.07.07.547849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Childhood undernutrition is a major global health challenge with devastating lifelong consequences. Linear growth stunting due to undernutrition has been linked to poor outcomes, and mothers who experience stunting are more likely to give birth to stunted children. Murine models that capture the intergenerational and multifactorial nature of undernutrition are critical to understanding the underlying biology of this disorder. Here we report a gnotobiotic mouse model of undernutrition using microbiota from human infants with healthy or stunted growth trajectories. Intergenerational transmission of microbiota from parents to offspring leads to the development of growth and immune features of undernutrition and enteropathy, including reduced linear growth, intestinal villus blunting and accumulation of intraepithelial lymphocytes. In contrast, colonization after weaning reduces sensitivity to detect changes driven by distinct microbial communities. Overall, these results suggest intergenerational colonization is a useful approach with which to investigate microbiota-dependent growth and immunity in early life.
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Affiliation(s)
- Yadeliz A. Serrano Matos
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
- These authors contributed equally
| | - Jasmine Cano
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
- These authors contributed equally
| | - Hamna Shafiq
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
| | - Claire Williams
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
| | - Julee Sunny
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
| | - Carrie A. Cowardin
- Division of Pediatric Gastroenterology & Hepatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
- Senior author
- Lead contact
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