Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood

Global acute malnutrition is associated with geography, season and malaria incidence in the conflict-affected regions of Ouham and Ouham Pendé prefectures, Central African Republic

BACKGROUND

Ongoing conflict between multiple armed groups, including pastoralist herders in the Central African Republic (CAR) causes frequent population displacements, food insecurity and scarcity of healthcare services. The inaccessibility and insecurity of many areas of CAR limit data collection and assessments from national nutritional surveys. Community health workers (CHWs) trained by an international non-governmental organisation, The MENTOR Initiative, deliver basic healthcare to children under 5 years old living in hard-to-reach and conflict-affected areas in eight subprefectures of north-west CAR. Their nutritional status and its associations with geography, malaria, season and conflict are unknown.

METHODS

CHW monthly records (October 2015-August 2021), Armed Conflict Location and Event Data project conflict data and The World Bank Group meteorological data for eight subprefectures of north-west CAR were analysed. Associations between counts of global acute malnutrition (GAM) assessed by mid-upper arm circumference and malaria, season and conflict were investigated using negative binomial regression.

RESULTS

Of the 457,325 consultations with children aged 6-59 months, 6.2% and 0.4% were classified as moderately or severely malnourished, respectively. The negative binomial model demonstrated differences in counts of GAM by subprefecture. Counts of GAM were positively associated with the case rate of severe malaria (IRR = 1.045; 95% CI: 1.04-1.06) and the rainy season (July-September) (IRR = 1.10; 95% CI: 1.03-1.17). Conflict events coded as Battles in ACLED were associated with lower counts of GAM (IRR = 0.78; 95% CI: 0.62-0.97).

CONCLUSIONS

This analysis shows geographical differences in levels of malnutrition in north-west CAR and demonstrates clear associations between malnutrition, season and malaria. It provides evidence that levels of GAM may be underestimated in north-west CAR in areas experiencing conflict. These findings highlight the need for targeted nutritional support to reach children most at risk of malnutrition. CHWs are a proven effective means of delivering essential primary healthcare services in hard-to-reach, conflict-affected areas.

The nutritional and feeding status of children living in selected residential child care facilities in Zambia: implications for programs and policies

Introduction

This study aimed to estimate the prevalence of undernutrition and risk of feeding difficulties and describe common feeding practices for children from birth to 10 years of age living in residential care in Zambia.

Methods

This was a secondary analysis of de-identified cross-sectional data on 397 children living in 22 residential care facilities in four provinces. Child demographics, anthropometrics, hemoglobin levels, risk for feeding difficulties, and facility-level feeding practices were collected by a trained study team using Count Me In, a digital health app. Interviews with staff were conducted at 15 residential care facilities.

Results

Around half of the study sample were boys (53.4%) and <5 years old (55.4%). Special healthcare needs were reported in 10.3% of the children, with cerebral palsy being the most common (3.5%). Underweight, stunting, wasting (using weight-for-length/height), and anemia were found in 22.4, 28.0, 7.1 and 54.7% of children, respectively, with higher rates in children with special healthcare needs and children <24 months old. Duration of residential care was positively associated with length/height-for-age but not weight-for-age or weight-for-length/height z-scores. A risk for feeding difficulties was found in 41.4 and 26.0% of children with and without special healthcare needs, respectively. Suboptimal bottle-feeding practices, including the use of altered nipples and poor caregiver-infant interactions, were observed for infants <12 months old. Residential care staff reported suboptimal diets in their facilities and gaps in knowledge and resources to meet children's nutritional needs.

Conclusion

These results demonstrate that a large proportion of children living in residential care in Zambia are at high risk for undernutrition and feeding difficulties and contribute to the small body of literature on children living in residential care, both in Zambia and globally. In the context of Zambia's efforts to improve child nutrition and reform its alternative care, these findings can inform programming and policies for children living in residential care to fulfill their rights to health and family care.

Assessing fecal contamination from human and environmental sources using Escherichia coli as an indicator in rural eastern Ethiopian households - a study from the EXCAM project

Enteric pathogens are a leading causes of diarrheal deaths in low- and middle-income countries. The Exposure Assessment of Campylobacter Infections in Rural Ethiopia (EXCAM) project, aims to identify potential sources of bacteria in the genus Campylobacter and, more generally, fecal contamination of infants during the first 1.5 years of life using Escherichia coli as indicator. A total of 1,310 samples (i.e., hand rinses from the infant, sibling and mother, drinking and bathing water, food and fomite provided to or touched by the infants, areola swabs, breast milk and soil) were collected from 76 households between May 2021 and June 2022. Samples were assigned to two groups by infant age: TP1 (time point 1), infants between 4 and 8 months of age, and TP2, infants between 11 and 15 months of age. Fluorometric and semi-selective colorimetric approaches were used to quantify E. coli in the field samples. Overall, E. coli was ubiquitous within selected households (56.8% across the study). E. coli was more frequently detected than average (>53%) with high concentration (>2-log CFU) in soil (g) and per pair of hand, while the opposite trend (<33%; <1.5-log CFU) was observed in food provided to the infants (g or ml), per areola, and breast milk (ml; P<0.01). E. coli was frequently detected in fomites touched by the infants, drinking and bathing water (>51%), but at low concentration (<1.5-log CFU). Correlation analysis between E. coli concentration in different sample types suggested that the mother's hands might play a key role in the transmission of E. coli between the environment (i.e., soil, bathing water and fomites) and other family members (i.e., infant and sibling; P<0.04; r2>0.3). Using E. coli as surrogate, our study identified mother (hands and areola) as reservoirs likely to be involved in frequent transmission of fecal contaminants to infants within rural Ethiopian households.

Prevalence of stunting and its correlates among children under 5 in Afghanistan: the potential impact of basic and full vaccination

BACKGROUND

Child stunting is prevalent in low and middle-income countries (LMICs), but an information gap remains regarding its current prevalence, correlates, and the impact of vaccination against this condition in Afghanistan. This study aimed to determine the prevalence and correlates of moderate and severe stunting and the potential impact of basic and full vaccination among children under five in Afghanistan.

METHODS

This is a secondary analysis of the 2022-23 Afghanistan Multiple Indicators Cluster Survey (MICS) including 32,989 children under 5. Descriptive statistics were employed to describe the distribution of independent variables and the prevalence of stunting across them. Chi-square analysis was used to examine the association between each independent variable with stunting. Multinomial logistic regression was used to examine the risk of stunting across different independent variables.

RESULTS

A total of 32,989 children under 5 years old were included in this study. Of those 44.7% were stunted with 21.74% being severely stunted. Children aged 24-35 and 36-47 months faced the highest risk as compared to those aged 1-5 months. The prevalence was lower in female children and they were less likely to experience severe stunting. Stunting was more prevalent in rural areas, with children there 1.16 to 1.23 times more likely to be affected than urban counterparts. Lower wealth correlated with higher stunting. Younger maternal age at birth (≤ 18) correlated with increased stunting risks, particularly in severe cases. Parental education was inversely related to stunting; higher education levels in parents, especially fathers, were associated with lower stunting rates. Households with more than seven children showed a 25% and 44% higher risk of moderate and severe stunting, respectively, compared to families with 1-4 children. Improved sanitation, but not drinking water sources, was linked to reduced stunting in the adjusted model. Vaccination had a protective effect; in the adjusted analysis, basic and full vaccinations significantly lowered the risk of severe stunting by 46% and 41%, respectively.

CONCLUSION

In this nationally representative study, the prevalence of stunting was substantial (44.7%) in Afghan children. Additionally, the findings emphasize the critical factors associated with child stunting and underscore the protective role of vaccination against this condition, which provides policymakers with directions for policy efforts and intervention strategies to reduce child stunting in Afghanistan.

Feeding practices of caregivers with children attending early childhood development centres in Xhariep, South Africa

Background

In low- to middle-income countries, malnutrition is a major contributing factor in children failing to achieve their developmental potential. The prevention of malnutrition requires, among others, nutritious, diverse and safe foods in early childhood.

Aim

The study aimed to determine primary caregivers' choices and motivation for the foods they fed their children.

Setting

The study was conducted among early childhood development centres in the Xhariep District, Free State.

Methods

A qualitative study was undertaken. Twelve participants who met the inclusion criteria were conveniently sampled. Semi-structured interviews were conducted to find out the primary caregivers' choices and motivation for foods they fed their children until data saturation was reached.

Results

The mean age of the participants was 31 years. Nine of the participants relied on social grants as a source of income. The participants reported feeding their children mainly maize porridge, milk, juice, and water. Vegetables and meat were fed to the children once a week. Fruits were fed to the children at the beginning of the month.

Conclusion

The level of education, employment status, and community support influenced the primary caregivers' feeding practices. The content of the diets of their children was insufficient in vegetables and fruit, not only placing the children at risk of undernutrition but also at risk of obesity and micronutrient deficiencies. Primary caregivers ensured their children were fed, although limited foods were offered.

Contribution

This research creates awareness of the level of social progress and access to resources within rural communities in the Xhariep district, and gives the opportunity to extend this research to confirm these findings in other poverty-stricken areas.

Double burden of malnutrition and its socio-demographic determinants among children and adolescents in Malaysia: National Health And Morbidity Survey 2019

INTRODUCTION

Malaysia faces the threat of a double burden of malnutrition where undernutrition and overweight (including obesity) coexist in the same population. This study aimed to determine the anthropometric assessment among children and adolescents aged 5 to 17 years and its association with socio-demographic factors.

METHODS

Data were extracted from the National Health and Morbidity Survey conducted in 2019. This cross-sectional survey applied a two-stage stratified sampling design. Socio-demographic characteristics were obtained. Weight and height were measured, age- and sex-specific standard scores for height and BMI were calculated to establish individual's anthropometric assessment. Having either stunting or thinness was considered undernutrition, while being overweight (including obesity) was considered overnutrition. If someone had undernutrition and/or overnutrition, they were classified as having malnutrition. The prevalence was determined using complex sampling analysis, while the association was assessed through logistic regression. The analysis included a total of 3,185 respondents.

RESULTS

The prevalence of stunting, thinness, overweight and obesity among the respondents aged 5 to 17 years was 12.7%, 10.0%, 15.0% and 14.8%, respectively. The overall prevalence of malnutrition was 48.3%. Respondents residing in rural had 1.35 times more likelihood of experiencing undernutrition [AOR = 1.35, 95% CI (1.04, 1.77)] compared to their urban counterparts. Boys exhibited a greater likelihood of being overweight and obese than girls [AOR = 1.40, 95% CI (1.13, 1.73)]. Respondents aged 10 to 14 years were 1.37 times more likely to be overnutrition than those aged 5 to 9 years old [AOR = 1.37, 95% CI (1.09, 1.73)].

CONCLUSION

There is growing evidence of the increasing prevalence of coexistence of undernutrition along with overweight and obesity among children and adolescents in Malaysia. Moving forward, greater initiatives and efforts are required to formulate strategies for planning and implementing programs and policies to expedite progress in improving nutrition.

Stunting predictors among children aged 0-24 months in Southeast Asia: a scoping review

OBJECTIVE

To identify predictors of stunting among children 0-24 months in Southeast Asia.

METHODS

This scoping review focused on articles with observational study design in English published from 2012 to 2023 from five international databases. The primary keyword used were: "stunting" OR "growth disorder" AND "newborn" AND "predict" AND "Southeast Asia".

RESULTS

Of the 27 articles selected for the final analysis there are thirteen predictors of stunting in seven Southeast Asia countries. The thirteen predictors include the child, mother, home, inadequate complementary feeding, inadequate breastfeeding, inadequate care, poor quality foods, food and water safety, infection, political economy, health and healthcare, water, sanitation, and environment, and social culture factor.

CONCLUSION

All these predictors can lead to stunting in Southeast Asia. To prevent it, health service providers and other related sectors need to carry out health promotion and health prevention according to the predictors found.

Nearly half of HIV-positive children attending public health facilities are suffering from chronic under-nutrition in conflict-affected zones of Southern Ethiopia

Background

In combination with HIV infection, malnutrition is a complicated medical condition with high morbidity and mortality rates in affected children due to a variety of socioeconomic and medical etiological variables. To combat this, information from a range of contexts is required, but there is little evidence, particularly about the nutritional status of under 15 living with HIV in impoverished communities such as conflict affected areas. Therefore, in this study the magnitude and related factors of stunting among under 15 children antiretroviral therapy at public health facilities was assessed.

Methods

An institution-based cross-sectional study was conducted among under 15 children living with HIV in conflict-affected zones of Southern Ethiopia. After providing written informed consent to study participants, data were collected using an interviewer-administered questionnaire and anthropometric measurements. Bivariable and multivariable logistic regression models were used to identify factors associated with nutritional status, using SPSS Version 25.

Results

Of the 401 participants, 197 (49.1%, 95% CI: 0.44, 0.54) had height-for-age z-score ≤ -2. In the multivariable analysis, larger household size (AOR = 1.58, 95% CI: 1.04-2.40), dietary diversity (AOR = 1.78; 95% CI: 1.07-2.96) and having a history of recurrent diarrhea (AOR = 1.96; 95% CI: 1.07-3.59) were significantly associated with chronic under nutrition.

Conclusions

The prevalence found in this study was high when compared with the stunting target set in SDG, which states to end all forms of malnutrition In order to mitigate the negative health effects of diarrhea during HIV therapy, extra attention needs to be paid to facilitate timely detection and on-going monitoring. Nutrition programs in conflict-affected areas need to consider households with larger family sizes and/or routinely having fewer food groups.

Understanding the pubertal, psychosocial, and cognitive developmental trajectories of stunted and non-stunted adolescents: protocol of a multi-site Indonesian cohort study

Background

The prevalence of stunting among Indonesian children aged 5-12 years decreased from 30.7% in 2013 to 23.6% in 2018 but has remained among the highest rates worldwide. Furthermore, Indonesian children were shorter than the standard reported by the World Health Organization and experienced obesity. The Indonesian government has created many programs to reduce stunting in children under the age of 5 years. An early preventive strategy is necessary because stunting can manifest within the initial 1,000 days of life, including during pregnancy. Therefore, a newer perspective, such as that achieved by addressing stunting in adolescents, has been deemed useful, given that adolescents are in their pubertal stage and are undergoing lifestyle changes. This cohort study was designed to measure these factors comprehensively in stunted and non-stunted children as they pass through adolescence.

Methods

For the prospective cohort, 560 individuals will be recruited from DKI Jakarta, DI Yogyakarta, and East Java. The participants will be categorized into stunted and non-stunted groups, then undergo annual examinations in which key objectives, such as weight, height, and body mass index ,will be assessed for the growth profile; waist circumference, middle-upper arm circumference, hand-grip strength, body fat percentage, and food intake will be evaluated in a nutritional assessment; psychosocial and mental issues will be evaluated according to behavioral problems, symptoms of depression, quality of life, sleep patterns, anxiety disorders, and parenting style through the use of specific questionnaires; and pubertal stage will be assessed using a self-report questionnaire. Some cross-sectional data, such as cognitive performance, hair zinc levels, vitamin D levels, bone mineral density, and bone age, will also be included. All the outcomes will be analyzed in accordance with the variable types.

Discussion

This study provides a thorough dataset of Indonesian adolescents encompassing several elements, such as growth, nutrition, psychosocial wellbeing, mental health, and pubertal development, for both stunted and non-stunted individuals. The data acquired from this study can be used to formulate policies to prevent stunting through targeted interventions for adolescents. Finally, a better understanding of adolescent health could lead to improved strategies to decrease the number of stunted individuals in the next Indonesian generation.

Gastrointestinal tolerability of organic infant formula compared to traditional ‎infant formula: A systematic review

BACKGROUND

Infants' nutrition significantly influences their growth, development, and overall well-being. With the increasing demand for organic infant formula driven by the perception of health benefits and growing awareness of natural feeding options, it is crucial to conduct a comparative analysis of the gastrointestinal tolerability between organic and traditional infant formulas.

AIM

To provide a concise and precise analysis of the gastrointestinal tolerability of organic infant formula compared to traditional infant formula. Due to limited direct comparisons, the review synthesizes available literature on each formula type, presenting insights into their potential effects on infants' digestive health.

METHODS

An extensive literature search was conducted, compiling studies on organic and traditional infant formulas, their compositions, and reported effects on gastrointestinal tolerability. We searched academic databases such as PubMed and Google Scholar and specialized ‎nutrition, paediatrics, and infant health journals using relevant keywords till October 1, 2023. ‎.

RESULTS

Although specific comparative studies are scarce and formula heterogeneity is a significant limitation, this systematic review provides an in-depth understanding of organic infant formulas' composition and potential benefits. While scientific evidence directly comparing gastrointestinal tolerability is limited, organic formulas strive to use carefully selected organic ingredients to imitate breast milk composition. Potential benefits include improved lipid profiles, higher methionine content, and decreased antibiotic-resistant bacteria levels. Understanding the gastrointestinal tolerability of organic and traditional infant formulas is crucial for parents and healthcare providers to make informed decisions.

CONCLUSION

Despite limitations in direct comparisons, this systematic review provides insights into the composition and potential benefits of organic infant formulas. It emphasizes the need for further research to elucidate their gastrointestinal effects comprehensively.

Factors related to stunting in children under 2 years old in the Papua, Indonesia: Does the type of residence matter?

OBJECTIVES

To analyze factors related to stunting in Papua region.

METHODS

Secondary data from the 2021 Indonesian National Nutrition Status Survey were used in this study. Samples of 2,937 Papuan children under the age of two were gathered for the study. This study analyzed independent variables (type of residence, mother's age, marriage, mother's education, employment, wealth, child's age, gender, and early breastfeeding initiation (EBFI) with stunting. The relationship was analyzed using logistic regression tests.

RESULTS

Stunting is more common among children in Papua's rural areas than in urban (AOR 1.168, 95% CI, 1.128-1.209). Stunting is more common in children who mother do not work than in mothers who do (AOR 1.174, 95% CI, 1.142- 1.207). Stunting is more common in children aged 12-23 months compared to children <12 months (AOR 3.381, 95% CI, 3.291-3.474). Compared to girls, boys are more likely to become stunted (AOR 1.348, 95% CI, 1,314-1,383). Children under the age of two who do not experience EBFI are at higher risk than those who have (AOR 1.078, 95% CI, 1.050-1.106).

CONCLUSION

There are eight variables associated with stunting, namely residence, age of mother, mother's education, mother's occupation, economic status, child's age, gender, and EBFI. Prioritization of stunting interventions in Papua should be targeted at mothers who living in rural, having low education, and not doing early breastfeeding initiation.

Influence of Sociodemographic Factors on Stunting, Wasting, and Underweight Among Children Under Two Years of Age Born During the COVID-19 Pandemic in Central India: A Cross-Sectional Study

Introduction The adverse effects of the coronavirus disease 2019 (COVID-19) pandemic on maternal and reproductive health extend beyond the immediate morbidity and mortality attributed directly to the disease. Pandemic-induced disruptions in the healthcare, social and economic infrastructures can exacerbate the already high burden of childhood undernutrition in India. Method A cross-sectional study was conducted in a selected district of the central Indian province of Madhya Pradesh. Data was collected from eligible children born during the COVID-19 pandemic (February 2020 to December 2021) who visited a selected tertiary care hospital for routine immunization during the study period. Weight-for-length, weight-for-age, and length-for-age were compared with reference values to obtain corresponding z-scores. Children with z-scores two standard deviations below the reference values were considered wasting, underweight and stunting, respectively. Descriptive statistics were employed to summarise the sociodemographic characteristics of participants. The association of sociodemographic, nutritional, and pregnancy-related factors with the z-scores were assessed via unpaired t-test and ANOVA. Result The studied 147 children were in the age group of nine to 29 months, of which 61 (58.1%) were males. Forty-two (28.6%) were found to be underweight, 22 (14.9%) had wasting and 51 (34.7%) were stunted. These prevalences were comparable to the estimates of the National Family Health Survey 2019-2021 (NFHS-5) for Madhya Pradesh and lower than the NFHS-4 (2015-2016), showing no discernible effect of being born during the pandemic on growth indicators. However, mothers' employment and family income were independent predictors of stunting whereas gestational age at birth, maternal education, and prolonged breastfeeding were all substantially linked with wasting in this study. Conclusion This study adds to the evidence base by reporting the prevalence of stunting, wasting and underweight along with their determinants in central India among children born during the COVID-19 pandemic. Our data did not reflect the expected increase in child malnutrition due to the COVID-19 pandemic-related disruptions in healthcare, social and economic infrastructure. Future research should incorporate the lessons learnt from our study to design a population-based study of under-five children and compare the prevalence of undernutrition in pandemic-born versus non-pandemic-born children.

Co-occurrence of Overweight, Stunting, and Anemia among Adolescents (10-19 Years) in Tanzania Mainland: A School-Based Cross-Sectional Study

Background

Evidence on double and triple burdens of malnutrition among adolescents is an essential key to informing policy design, implementation, and tracking progress of adolescent nutritional programs. Tanzania has a scarcity of studies on the double and triple burden of malnutrition among adolescents.

Objective

The aim of this study was to assess the co-occurrence of malnutrition (overweight, stunting, and anemia) among adolescents (10-19 y) in mainland Tanzania.

Methods

A school-based cross-sectional study was conducted among 44,120 primary school adolescents aged 10 to 19 y in mainland Tanzania. Anthropometric assessments (weight, height, and body mass index), dietary assessments, and hemoglobin levels were used to calculate the single, double, and triple burden of malnutrition. Data were analyzed using Stata software 15. The chi-square test was used to test the association between the nutrition condition and social demographic variables, physical activity, and dietary quality. Log-binomial models were used to determine factors associated with stunting, overweight, and anemia. Multivariable log-binomial models were used to control confounders. All analyses were 2-tailed, and the significance level was set at 5%.

Results

The prevalence of anemia was 34.1%, while stunting and overweight had a prevalence of 32% and 4.2%, respectively. Approximately 41.7%, 13.5%, and 0.3% had single, double, and triple burden malnutrition-related conditions, respectively. Females were found to have a higher risk of being overweight compared with males (relative risk [RR]: 1.33; 95% confidence interval [CI]: 1.21, 1.45), while engaging in moderate to low levels of physical activity was associated with a decreased risk of being overweight. Additionally, residing in urban areas was linked to a decreased risk of stunting (RR: 0.78; 95% CI: 0.75, 0.80) and a 27% lower risk of anemia when compared with participants from rural areas.

Conclusion

The findings from this study suggest that the complex nature of malnutrition among school adolescents warrants consideration when designing policies and interventions to reduce the burden of malnutrition.

Effect of lactoferrin in oral nutrition supplement (ONS) towards IL-6 and IL-10 in failure to thrive children with infection

Background

Growth failure due to infection in children is a major health problem throughout the world. It provokes a systemic immune response, with increased interleukin (IL)-6 and reduced IL-10. Lactoferrin (Lf) is a multifunctional iron-binding protein that can be found in whey protein inside formula milk such as oral nutrition supplement (ONS), which is able to upregulate anti-inflammatory cytokines (IL-10) and modulate pro-inflammatory cytokines. We conducted this study to investigate the effect of Lf supplementation in ONS on IL-6 and IL-10 levels in children with failure to thrive and infection.

Methods

We performed a quasi-experimental pre- and post-study in children aged 12-60 months old with failure to thrive due to infectious illness. The subjects received 400 ml of oral nutritional supplements (ONS, 1 ml equivalent to 1 kcal) each day for 90 days, and their parents received dietary advice and medication based on the underlying illness. Blood was drawn to measure IL-6 and IL-10 before and after the intervention.

Results

There were 75 subjects recruited and divided into group-1 and group-2 based on age. The incidence of undernutrition was 37.33%. Lf in ONS intervention improved body weight and body length. Lf also reduced IL-6, although there was not a significant difference before and after the intervention. However, the IL-6 reduction was significantly higher in subjects with undernutrition compared with subjects with weight faltering. Pre-intervention IL-6 levels were higher in children with stunting than in children with normal stature. There was a greater change in IL-6 in children with severe stunting than in children with normal stature or stunting. IL-10 was significantly reduced after the intervention.

Conclusions

In addition to improving body weight and length, Lf supplementation in ONS improved immune response homeostasis by balancing IL-6 and IL-10 levels and by improving the IL-6/IL-10 ratio.ClinicalTrials.gov number ID: NCT05289674, dated May 3 rd 2022.

The interlink between chrono-nutrition and stunting: current insights and future perspectives

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.

Long-term effects of child nutritional status on the accumulation of health human capital

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.

Severe Acute Malnutrition: The Potential of Non-Peanut, Non-Milk Ready-to-Use Therapeutic Foods

PURPOSE OF REVIEW

This review provides information on the prospect and effectiveness of ready-to-use therapeutic foods (RUTFs) produced locally without the addition of milk and peanut.

RECENT FINDINGS

The foods used in fighting malnutrition in the past decades contributed little to the success of the alleviation program due to their non-effectiveness. Hence, RUTFs are introduced to fight malnutrition. The peanut allergies, the high cost of milk, and the high production cost of peanut RUTF have made its distribution, treatment spread, and accessibility very slow, especially in areas where it is highly needed. There is a need, therefore, for a low-cost RUTF that is acceptable and effective in treating severe acute malnutrition among under-5 children. This review shows both the success and failure of reported studies on the use of non-peanut and non-milk RUTF, including their cost of production as compared to the standard milk and peanut-based RUTF. It was hypothesised that replacing the milk ingredient component with legumes like soybeans can reduce the cost of production of RUTFs while also delivering an effective product in managing and treating severe acute malnutrition (SAM). Consumers generally accept them better because of their familiarity with the raw materials.

Relationships of deworming drug consumption and animal protein intake with stunting

By the end of 2022, the nationwide incidence of stunting remained high, including in Lampung Province, where it was 15.8%, above the target of 14% to be achieved by 2024. Since 2019, stunting has become a national priority due to suspected factors such as low nutrition intake, especially from animal protein sources, high rates of worm infections, and low compliance of under-fives in consuming deworming drugs. Therefore, this research aimed to analyze the relationship between deworming consumption, adequacy of animal protein intake, and stunting incidence in children aged 12-59 months in Bandar Lampung in 2022. This research used an analytic survey with a cross-sectional approach to analyze the relationship between deworming consumption, adequacy of animal protein intake, and stunting in under-fives at two priority stunting handling neighbourhoods in Bandar Lampung, namely Way Gubak and Karang Maritim. The sample consisted of 262 under fives and their mothers who visited the integrated health post in the selected neighbourhoods from November to December 2022, and the data obtained were analyzed using logistic regression. The results revealed a relationship between the consumption of an deworming and varying animal protein consumption with stunting incidence. This indicated a need to promote the importance of consuming deworming and adequate consumption of animal protein with variation to prevent stunting in children in Bandar Lampung.

Stunting and Its Associated Factors among Children Below 5 Years Old on the East Coast of Peninsular Malaysia: Evidence from the National Health and Morbidity Survey

Background

Child malnutrition problems still occur in Malaysia, particularly stunting. This study aimed to determine the proportion of stunting among children below 5 years old and investigate the factors associated with stunting on the East Coast of Peninsular Malaysia.

Methods

This study utilised data from the 2016 National Health and Morbidity Survey (NHMS). Multiple logistic regression was used to determine the factors associated with malnutrition among non-stunted and stunted children.

Results

The proportion of stunting among children below 5 years old in this East Coast region was 26.2%. When divided by state, Kelantan had the highest proportion of stunting, followed by Pahang and Terengganu, at 28.8%, 26.2% and 23.4%, respectively. In this study, the factors associated with stunting were children aged 24 months old-59 months old (adjusted odds ratio [aOR]: 1.52; 95% CI: 1.26, 1.83; P < 0.001), male children (aOR: 1.47; 95% CI: 1.23, 1.76; P < 0.001), Orang Asli children (aOR: 2.84; 95% CI: 1.86, 4.32; P < 0.001), children with low birth weight from 1,500 g to 2,499 g (aOR: 1.86; 95% CI: 1.36, 2.55; P < 0.001) and children from households that practice unsanitary waste disposal (aOR: 1.42; 95% CI: 1.16, 1.74; P = 0.001).

Conclusion

Stunting among children under the age of 5 years old on the East Coast of Peninsular Malaysia remains a public health problem. To reduce the prevalence of stunting in this region, intervention programmes should be intensified. Emphasis should be placed on public health programmes that target the associated factors, such as dietary habits, Orang Asli children, low birth weight and unsanitary waste disposal.

Micronutrients and Nutrition Status of School-Aged Children in Indonesia

Micronutrient deficiencies (MNDs) in school-aged children are still a major health problem in Indonesia. This study was designed to examine the status of micronutrients and their relationship to the nutritional status of children aged 5-12 years since an up-to-date database on the micronutrient status of children aged 5-12 years is needed. Data from the 2018 Indonesian Basic Health Research (Riskesdas) were used in this study, with 2456 subjects for analysis. Micronutrient analysis was carried out, including iron status (ferritin, C reactive protein (CRP)), levels of zinc, vitamin D, calcium, and vitamin A (retinol) in school-aged children (5-12 years). The ELISA measurement was applied to measure CRP, ferritin, and vitamin D. Zinc levels were analysed with atomic absorbance spectroscopy (AAS). Moreover, high-performance liquid chromatography (HPLC) was applied to calculate vitamin A. In addition, stunting and thinness data were also obtained from the Riskesdas study. The results showed that the prevalence of stunting and thinness in school-aged children was 11.4% and 9.2%, respectively, showing that the stunting prevalence in the city was lower than in the village (4.5% vs. 6.9%, P = 0.000, respectively). In addition, the prevalence of MNDs in Indonesian children was 13.4%, 19.7%, 4.2%, 3%, and 12.7% for ferritin, zinc, calcium, vitamin A, and vitamin D, respectively. The mean serum level of vitamin A and zinc was significantly lower in stunted children compared to normal school children (P = 0.010 and P = 0.014). The serum concentration of vitamin D was significantly lower in overweight children compared to thin and normal children (P = 0.000). Serum values of ferritin, zinc, and vitamin A were significantly higher in overweight children compared to thin and normal children (P = 0.000). A poor correlation was observed between the z-score of height-for-age (HAZ) and the levels of zinc (r = 0.089, P = 0.000), vitamin A (r = 0.105, P = 0.000), and vitamin D (-0.073, P = 0.000). In addition, very weak correlations between z-scores of body mass index-for-age (BAZ) and the serum concentrations of ferritin (0.091, P = 0.000), zinc (r = 0.115, P = 0.000), vitamin A (r = 0.137, P = 0.000), and vitamin D (r = -0.112, P = 0.000) were also seen. In conclusion, school-aged children in Indonesia experienced stunting, thinness, and micronutrient deficiency. Furthermore, stunting and thinness were also related to micronutrient deficiencies.

The Influence of Mother's Employment, Family Income, and Expenditure on Stunting Among Children Under Five: A Cross-Sectional Study in Indonesia

Introduction

It is widely acknowledged that the socioeconomic circumstances of a family income are correctly reflected in that family expenditures. The dietary habits of families are influenced by socioeconomic circumstances that may affect stunting. Therefore, this study aims to investigate the household economic predictor stunting (mother's employment, family income, and family expenditure) in children under five.

Methods

This study used a cross-sectional design. Six districts and cities have been chosen as study areas based on the areas with the highest incidence of stunting in West Java, Indonesia. This study conducted specifically from October to December 2018. Data were examined using descriptive statistics (frequency distribution) and a Spearman Rank bivariate test. A logistic regression was employed to determine the elements that serve as predictors of stunting.

Results

A total of 731 women with children under five participated in the study. A bivariate analysis showed that mother's employment had an association with stunting among children under five (p = 0.014). Meanwhile, family income and expenditure are not statistically significant associated with stunting (p > 0.05). A multivariate analysis showed that mother's employment was a stunting predictor with odd ratio (OR) 1.810 (p = 0.017). The OR value means that mothers who do not work have a 1.810 chance for their children to experience stunting compared with mothers who have work. However, family income and expenditure have negative projected values (p = 0.580 and p = 0.398, respectively).

Conclusion

Children under five who are stunted are potentially predictive with mothers' employment, with a chance is higher in mother who do not work. However, family income and expenditure are not predictive of stunting.

Tools for assessing child and adolescent stunting: Lookup tables, growth charts and a novel appropriate-technology "MEIRU" wallchart - a diagnostic accuracy study

Stunting affects 149 million children worldwide and is a form of chronic malnutrition defined by low height-for-age. Surveys and intervention programmes depend on effective assessment and identification of affected individuals. Gold standard assessment is based on height-for-age Z-score (HAZ): HAZ <-2 defines stunting; HAZ <-3 defines severe stunting. However, a major problem for field-based programmes is that Z-scores can be time-intensive and challenging to calculate. We thus developed a novel wallchart that we have coined 'MEIRU wallchart' to easily and accurately identify stunted children and adolescents. Our study aim was to evaluate its performance and acceptability against other methods used in current clinical/field practice. We undertook a non-interventional diagnostic accuracy study in Malawi. We recruited 244 participants aged 8-19 years and determined each individual's stunting status using, in varying order: the MEIRU wallchart, traditional lookup tables, and traditional growth charts. All were compared against 'gold standard' HAZ, calculated using AnthroPlus WHO software. Local community healthcare workers performed all the assessments. The wallchart method was strongly preferred by both participants and staff. It had an overall accuracy of 95.5%(kappa = 0.91) and was faster than lookup tables by an average of 62.5%(41.4sec; p<0.001) per measurement. Lookup tables and growth charts had overall agreements of 59.4%(kappa = 0.36) and 61.9%(kappa = 0.31) respectively. At the HAZ-2 cut-off, the wallchart had a sensitivity of 97.6%(95%CI: 91.5-99.7) and specificity of 96.3%(95%CI: 92.1-98.6). We conclude that the MEIRU wallchart performs well and is acceptable for screening and identification of stunted children/adolescents by community-level health workers. It fulfils key criteria that justify a role in future screening programmes: easy to perform and interpret; acceptable; accurate; sensitive and specific. Potential future uses include: conducting rapid stunting prevalence surveys; identifying affected individuals for interventions. Current field methods, lookup tables and growth charts performed poorly and should be used with caution.

Bi-directional associations between physical activity and growth indicators of pre-school aged children

Physical activity for young children provides a wealth of benefits for health and development. However, little is known about the inter-relationship of physical activity and growth indicators. The aim of this study was to test the bi-directional associations of physical activity and growth indicators in children under five years of age. This prospective study included 1,575 children with data on physical activity and growth indicators at ages 12, 24 and 48 months. Accelerometers were used to measure physical activity. Z-scores for length/height-for-age, weight-for-length/height, weight-for-age and body mass index (BMI)-for-age were calculated. Bi-directional associations between physical activity and growth indicators were evaluated using cross-lagged panels based on Generalized Estimating Equations and cross-lagged structural equation models. Physical activity was consistently associated with lower weight-related growth indicators: BMI-for-age: β=-0.12; Weight-for-age: β=-0.11; Weight-for-length/height: β=-0.12. Higher BMI-for-age indicated lower physical activity (β=-0.06). When the exposure was lagged, the association of physical activity on weight-related growth indicators remained, but weight-related growth indicators showed a negative association on physical activity. A bi-directional association between physical activity and weight-related growth indicators was observed. The magnitude of associations were stronger when physical activity was modelled as exposure. These results reinforce the importance of physical activity since early years.

Assessment of Nutritional Status of Under-Five Children in an Urban Area of South Delhi, India

Introduction Malnutrition among children continues to be a severe public health problem worldwide, whether in a developing country like India or a developed nation. Correct estimation of the problem is a prerequisite to planning the measures to control it. Objective To estimate the prevalence of undernutrition among children under five years of age by utilizing the Composite Index of Anthropometric Failure and the WHO growth charts. Methods From January to March 2020, 1332 children under the age of five years participated in a facility-based, descriptive, cross-sectional study at Fatehpur Beri, Urban Primary Health Center. An anthropometric assessment for each participant was done as per the WHO criteria. The data were entered into a Microsoft Office Excel spreadsheet (Microsoft Corporation, Redmond, WA) and analyzed with WHO Anthro software (WHO, Geneva, Switzerland) and a licensed version of SPSS 21 (IBM Corp., Armonk, NY). Continuous data were expressed using appropriate measures of central tendency, while categorical data were expressed in either frequency or proportions. Results The mean age of the study participants was 23.04 ± 18.24 months, and males (53.3%) were more than (46.7%) females. The prevalence of being underweight was 24.5% (327/1332), of which 24.1% (79/327) of children were severely underweight. Of the total study participants, 27.3% (362/1332) were stunted, and 17.8% (237/1332) were wasted, of which 29.1% (69/237) were severely wasted. The prevalence of anthropometric failure was 45%. Conclusions According to the findings of this study, the prevalence of undernutrition among the study participants was substantial. Furthermore, considering weight for age as the sole criterion may underestimate the true prevalence of malnutrition. The findings have critical implications for future interventions and initiatives among children in India.

Risk Factors for Stunting among Children under Five Years in the Province of East Nusa Tenggara (NTT), Indonesia

In East Nusa Tenggara Province, Indonesia, 42.6% of children under five had stunted growth in 2018, which affects both individual and communal levels. The first step in creating effective interventions is identifying the risk factors for stunting. This study aims to pinpoint the stunting risk factors in East Nusa Tenggara Province, Indonesia, by incorporating secondary data from the 2018 Indonesia Basic Health Research (RISKESDAS). This study implemented a cross-sectional design by utilizing the data of individuals who were successfully visited during the survey. Initial data screening in East Nusa Tenggara Province based on the criteria for children aged 0−59 months and stunting showed as many as 1643. Multivariate logistic regression analysis was performed to evaluate the relationship between children’s characteristics and stunting. There was a significant relationship between age group variables for younger children (aged 12−23, 24−35, and 36−47 months), mothers with low education, and children living in rural areas with the incidence of stunting in children (p-value < 0.05). The dominant factors that caused stunting in this study were the children’s age of 24−35 months (OR = 2.08, 95% CI: 1.12−3.86), mothers with low education (OR = 1.57, 95% CI: 1.18−2.08), and children living in rural areas (OR = 1.39, 95% CI: 1.01−1.91). The highest prevalence of stunting was in the group of children aged 12−23 months (45.2%). To prevent child stunting, the government must intervene for mothers with low education and those living in rural areas. Intervention includes intensive socialization about improving nutritional status during pregnancy and practicing complementary feeding and breastfeeding habits until the child is 24 months old.

Determinants of food preparation and hygiene practices among caregivers of children under two in Western Kenya: a formative research study

INTRODUCTION

Diarrhea is a leading cause of child morbidity and mortality worldwide and is linked to early childhood stunting. Food contamination from improper preparation and hygiene practices is an important transmission pathway for exposure to enteric pathogens. Understanding the barriers and facilitators to hygienic food preparation can inform interventions to improve food hygiene. We explored food preparation and hygiene determinants including food-related handwashing habits, meal preparation, cooking practices, and food storage among caregivers of children under age two in Western Kenya.

METHODS

We used the Capabilities, Opportunities, and Motivations model for Behavior Change (COM-B) framework in tool development and analysis. We conducted 24 focus group discussions with mothers (N = 12), fathers (N = 6), and grandmothers (N = 6); 29 key informant interviews with community stakeholders including implementing partners and religious and community leaders; and 24 household observations. We mapped the qualitative and observational data onto the COM-B framework to understand caregivers' facilitators and barriers to food preparation and hygiene practices.

RESULTS

Facilitators and barriers to food hygiene and preparation practices were found across the COM-B domains. Caregivers had the capability to wash their hands at critical times; wash, cook, and cover food; and clean and dry utensils. Barriers to food hygiene and preparation practices included lack of psychological capability, for instance, caregivers' lack of knowledge of critical times for handwashing, lack of perceived importance of washing some foods before eating, and not knowing the risks of storing food for more than four hours without refrigerating and reheating. Other barriers were opportunity-related, including lack of resources (soap, water, firewood) and an enabling environment (monetary decision-making power, social support). Competing priorities, socio-cultural norms, religion, and time constraints due to work hindered the practice of optimal food hygiene and preparation behaviors.

CONCLUSION

Food hygiene is an underexplored, but potentially critical, behavior to mitigate fecal pathogen exposure for young children. Our study revealed several knowledge and opportunity barriers that could be integrated into interventions to enhance food hygiene.

Impact of Stunting on Development of Children between 1-3 Years of Age

Background

Stunting occurs due to chronic malnutrition and is a major problem for children in developing countries. It is important to evaluate the impact of stunting on the development of children. This study aimed to investigate the impact of stunting on the development of children between 1-3 years of age.

Methods

This cross-sectional study was conducted from July 2020 to March 2021 in Surabaya, Indonesia. A questionnaire and growth assessment were done, following the development measurement to stunted and non-stunted children who met the inclusion and exclusion criteria. Development was measured by the Denver Developmental Screening Test II (DDST-II), and Cognitive Adaptive Test/Clinical Linguistic & Auditory Milestone (CAT/CLAMS) scales.

Results

Three hundred children are included in this study, consisting of 150 stunted and 150 non-stunted children. Stunted children had a higher risk to be suspected of delayed development compared to non-stunted children. The Crude Odd Ratio was 2.98, 4.24, 4.75 with the p-value 0.006, 0.001. and 0.001 respectively. The Adjusted Odd Ratio was 0.34, 0.24, 0.21 with p-value of 0.008, 0.001, and 0.001 respectively.

Conclusion

Stunting is associated with suspected development delay among children 1-3 years of age. Initiatives related to prevention need to be established and nutrition advice needs to be provided.

Household Water Access, Dietary Diversity and Nutritional Status among Preschoolers in Poor, Rural Areas of Central and Western China

Poor child feeding and childhood malnutrition are major public health problems in rural central and western China, with little evidence about their environmental determinants. This study aimed to investigate whether household water access is associated with dietary diversity and nutritional outcomes. We analyzed the cross-sectional data of 3727 children aged 6 to 59 months in rural central and western China, applying multivariate linear and logistic models to estimate the effect of water access on children’s anthropometric indices, hemoglobin, and dietary diversity. We found that unimproved water access was linked to a lower likelihood of achieving dietary diversity (OR = 0.65, 95% CI 0.44 to 0.98, p = 0.039); lower height-for-age z-score (β = −0.34, 95% CI −0.49 to −0.19, p < 0.001) and hemoglobin concentration (β = −2.78, 95% CI −5.16 to −0.41, p = 0.022); higher odds of stunting (OR = 1.50, 95% CI 1.01 to 2.25, p = 0.047) and anemia (OR = 1.34, 95% CI 1.02 to 1.77, p = 0.037). The associations between water access and nutritional outcomes were not explained by dietary diversity and were stronger in children who did not receive iron supplementation. These findings provide evidence for designing water-based nutritional interventions in China.

The Escape from Malnutrition of Chilean Boys and Girls: Height-for-Age Z Scores in Late XIX and XX Centuries

We studied the trends of height-for-age (HAZ) Z scores by socioeconomic status (SES) groups of Chilean boys and girls aged 5-18 born between 1877 and 2001, by performing a meta-analysis of 53 studies reporting height-for-age sample data from which 1258 HAZ score datapoints were calculated using the 2000 reference growth charts for the US of the Centers for Disease Control and Prevention (CDC). We found stagnant mean and median HAZ scores of about -1.55 to -1.75 for the general population, and -2.2 to -2.55 for lower SES groups up to cohorts born in the 1940s. However, we found an upwards structural change in cohorts born after the 1940s, a period in which HAZ scores grew at a pace of about 0.25 to 0.30 HAZ per decade. Since this change happened in a context of moderate Gross Domestic Product (GDP) growth, high and persistent income inequality, and stagnant wages of the working class, we discuss the extent to which our findings are associated with the increase in public social spending and the implementation and expansion of a variety of social policies since the 1940s and early 1950s.

Iodine Deficiency Disorders as a Predictor of Stunting among Primary School Children in the Aseer Region, Southwestern Saudi Arabia

OBJECTIVES

To investigate the present occurrence of stunting and explore the role of iodine deficiency disorders (IDDs) as a predictor of stunting among primary school children in the Aseer Region.

METHODS

In a cross-sectional investigation on school children in the Aseer region, thyroid enlargement was evaluated clinically. Urine was collected to evaluate iodine content.

RESULTS

The present study involved 3046 school-age pupils. The study disclosed a total goiter rate of 24.0% (95% CI: 22.5-25.5%). The median urinary iodine content (UIC) was 17.0 µg/L. A prevalence of stunting (height for age z score of less than -2) of 7.8% (95% CI: 6.9-8.8%) was found. In a logistic regression model, pupils having clinical goiter (aOR = 1.739; 95% CI: 1.222-2.475) and students having UIC of less than 17 µg/L (aOR = 1.934; 95% CI: 1.457-2.571) were considerably related with stunting. In the receiver operating characteristic (ROC) curve, urinary iodine content to forecast stunting was good (AUC = 0.611, 95% CI: 0.594-0.629). The curve recognized the optimum cutoff point of urinary iodine content to be ≤19.0 µg/L. The sensitivity was 59.66% (95% CI: 53.1-66.0) and the specificity was 57.62% (95% CI: 55.8-59.5). Conclusion: The present study showed that stunting among school-aged children presents a mild public health problem. On the other hand, a severe iodine deficiency situation was revealed among school children in the Aseer region. Continuous monitoring of iodine status among school children is therefore necessary. Concerted interventions that blend nutrition-sensitive with nutrition-specific approaches are expected to influence decreasing stunting significantly.