Epidemiological profile of malnutrition status and spatial distribution of children and adolescents living with HIV/AIDS in Tanzania.

OBJECTIVES: To determine the prevalence of malnutrition status, analyse the association between malnutrition status and individual-level factors, and explore the spatial variation among children and adolescents living with HIV/AIDS in Tanzania. METHODS: The study is based on large-scale baseline routine data from the National AIDS Control Programme on people living with HIV from January 2016 to December 2021 in mainland Tanzania. 70,102 children and adolescents aged 5-19 years receiving active antiretroviral therapy were included in the analysis. Nutritional status of participants was assessed by anthropometric measurement. Pearson's Chi-square test was used to describe the association between individual-level factors with all malnutrition outcomes and spatial analysis was used to investigate spatial distribution of malnutrition. The excess risk of malnutrition for each region was calculated while Anselin Local Moran's I and Getis-Ord statistical tools were used to identify significant hot spots regions of malnutrition. RESULTS: The mean age of participants was 11.1 (SD 4.7) years, with 71.7% in the 5-14-year age group and 58.4% being girls. 39.2% were attending care and treatment clinics services at hospital level with public ownership. 53.4% started using ARV at age 5-14 years and 55.5% had already switched to second- or third-line ARV with 61.1% using ARV for less than 3 years. 51.2% were in WHO HIV clinical stage III or IV. The prevalence of malnutrition was 36.0% for stunting, 28.9% for underweight, 13.0% for wasting, and 48.0% for anthropometric failure. Individual-level factors which accounted for a higher proportion of malnutrition based on anthropometric failure were male sex (56.3%), age 5-14 years (50.0%), being unmarried (52.9%), being on second- or third-line ARV treatment (51.4%), ART initiation at age 5-14 years (55.7%), ARV for more than 3 years (49.4%), and stage IV of WHO HIV clinical status (57.8%). There were regional hot spots (p < 0.05): the prevalence rate and excess risk of malnutrition for stunting and anthropometric failure were highest in the southern highlands regions, for underweight in the central regions, and for wasting in the northern regions. CONCLUSIONS: Children and adolescents living with HIV/AIDS in Tanzania suffer from poor nutritional status. Malnutrition does not occur arbitrarily, and the regions identified as hot spots should be given priority for nutritional intervention. Effective nutritional interventions for children living with HIV/AIDS should incorporate multiple approaches by considering unique geographical factors.

Gender-specific association of body fat mass with muscle meat-vegetable intake ratio in Shaanxi, China.

BACKGROUND AND OBJECTIVES: The effects of muscle meat and vegetable intake on body fat mass remain unclear in the general population. This study aimed to investigate the association of body fat mass and fat dis-tribution with a muscle meat-vegetable intake (MMV) ratio. METHODS AND STUDY DESIGN: In total, 29,271 par-ticipants aged 18-80 years were recruited from the Shaanxi cohort of the Regional Ethnic Cohort Study in Northwest China. The associations of muscle meat, vegetable and MMV ratio, as the independent variable, with body mass index (BMI), waist circumference, total body fat percentage (TBF) and visceral fat (VF), as dependent variables were evaluated by gender-specific linear regression models. RESULTS: There was 47.9% of men whose MMV ratio was greater than or equal to 1 and this figure was about 35.7% for women. For men, higher muscle meat intake was associated with higher TBF (standardized coefficient [ß], 0.508; 95% CI, 0.187-0.829), higher vegetable intake was associated with lower VF (ß, -0.109; 95% CI, -0.206 - -0.011), and higher MMV ratio was associated with higher BMI (ß, 0.195; 95% CI, 0.039-0.350) and VF (ß, 0.523; 95% CI, 0.209-0.838). For women, both higher muscle meat consumption and MMV ratio were associated with all fat mass markers, but vegetable intake was not correlated with body fat mass markers. The positive association of MMV on body fat mass was more pronounced in higher MMV ratio group, with both men and women. The intake of pork, mutton and beef was associated positively with fat mass markers but no such as-sociation was observed for poultry or seafood. CONCLUSIONS: An increased intake of muscle meat or a higher MMV ratio was associated with increased body fat, especially among women, and such impact may mainly be attributed to increasing intake of pork, beef and mutton. The dietary MMV ratio could be thus a useful parameter for nutritional intervention.

Associated factors of malnutrition status among children and adolescents living with HIV in Tanzania: Individual-level analysis and marginal effect estimation.

OBJECTIVES: This study aimed to identify individual-level factors that affect malnutrition outcomes among children and adolescents living with HIV/AIDS in Tanzania. METHODS: We used data from the National AIDS Control Programme. 70,102 participants aged 5 to 19 years attending care and treatment clinics between January to December 2021 were included. Nutritional assessments were performed by anthropometric measurement. Logistic regression models were used to evaluate risk factors. We further estimated marginal prevalence and adjusted predictions by marginal effects. Supplementary analysis assessed the accuracy of the final fitted model. RESULTS: Prevalence of malnutrition for stunting, underweight, wasting, and anthropometric failure (CIAF) were 36.0%, 28.9%, 13.0%, and 48.0%, respectively. Several individual-level factors were significant determinants of malnutrition. Boys, participants aged 15-19 years, those switched to second- or third-line antiretroviral therapy (ART), initiated ART at ages of 5-14 years, ART duration less than 3 years, and were in advanced stages of WHO HIV clinical status had increased adjusted odds ratios and marginal prevalence. The larger AUC values for all models implied importance of identified factors accounted for malnutrition. CONCLUSIONS: On long-term ART, nutritional interventions should be context-specific guidelines to improve growth, especially at ART initiation, ART regimen, and ART duration reckoning with age and sex.

Does Serum Uric Acid Mediate Relation between Healthy Lifestyle and Components of Metabolic Syndrome?

A healthy lifestyle is related to metabolic syndrome (MetS), but the mechanism is not fully understood. This study aimed to examine the association of components of MetS with lifestyle in a Chinese population and potential mediation role of serum uric acid (SUA) in the association between lifestyle behaviors and risk of components of MetS. Data were derived from a baseline survey of the Shaanxi urban cohort in the Regional Ethnic Cohort Study in northwest China. The relationship between components of MetS, healthy lifestyle score (HLS), and SUA was investigated by logistic or linear regression. A counterfactual-based mediation analysis was performed to ascertain whether and to what extent SUA mediated the total effect of HLS on components of MetS. Compared to those with 1 or less low-risk lifestyle factors, participants with 4-5 factors had 43.6% lower risk of impaired glucose tolerance (OR = 0.564; 95%CI: 0.408~0.778), 60.8% reduction in risk of high blood pressure (OR = 0.392; 95%CI: 0.321~0.478), 69.4% reduction in risk of hypertriglyceridemia (OR = 0.306; 95%CI: 0.252~0.372), and 47.3% lower risk of low levels of HDL cholesterol (OR = 0.527; 95%CI: 0.434~0.641). SUA mediated 2.95% (95%CI: 1.81~6.16%) of the total effect of HLS on impaired glucose tolerance, 14.68% (95%CI: 12.04~18.85%) on high blood pressure, 17.29% (95%CI: 15.01~20.5%) on hypertriglyceridemia, and 12.83% (95%CI: 10.22~17.48%) on low levels of HDL cholesterol. Increased HLS tends to reduce risk of components of MetS partly by decreasing the SUA level, which could be an important mechanism by which lifestyle influences MetS.

Maternal Dietary Diversity and Birth Weight in Offspring: Evidence from a Chinese Population-Based Study.

Studies on the association between maternal dietary diversity and birth weight in offspring are limited, and the impact of such an adjustable factor on birth weight requires investigation to promote neonatal health. This study used data from a larger-scale population-based survey conducted in northwest China to evaluate the association of maternal dietary diversity with neonatal birth weight with a generalized estimating equation model. The results found that maternal dietary diversity was positively associated with neonate birth weight. Furthermore, a higher minimum dietary diversity for women (MDD-W) score during pregnancy was related to a lower risk of low birth weight (LBW) in offspring. The mothers with the highest MDD-W score had a 38% (OR = 0.62, 95% CI: 0.43-0.89) lower risk of LBW than those with the lowest score. Similarly, the mothers with the highest animal-based food dietary diversity score (DDS) had 39% (OR = 0.61, 95% CI: 0.38-0.98) lower risk of LBW in offspring compared with those with the lowest animal-based food DDS. Moreover, the ratio of animal-based food DDS to non-animal-based food DDS could play an important role in predicting neonate birth weight. In conclusion, increasing maternal dietary diversity would improve birth weight in offspring, especially by increasing the intake of animal-based foods among the Chinese population.

Is Increasing Diet Diversity of Animal-Source Foods Related to Better Health-Related Quality of Life among Chinese Men and Women?

Diet plays a crucial role in regulating individuals' lifestyles and is closely related to health. The intake of animal-sourced foods (ASF) provides the human body with high-quality protein and various micronutrients. This study aimed to investigate whether the diversity of animal foods has a positive impact on the health-related quality of life (HRQoL) among residents. The data came from the Shaanxi baseline survey of the Northwest Chinese Regional Ethnic Cohort Study, which recruited more than 100 thousand participants aged 35 to 74 from five provinces between June 2018 and May 2019. A total of 39,997 participants in Shaanxi (mean age: 50 years; 64% women) were finally included in this current study. The animal source food diet diversity score (ASFDDS) was established based on the frequency of consuming pork, mutton, beef, poultry, seafood, eggs, pure milk, and yogurt. The physical component score (PCS) and mental component score (MCS), ranging from 0 to 100 on the 12-Item Short Form Survey (SF-12), were used to assess participants' HRQoL. Better PCS/MCS was defined as scores higher than the 90th percentile. The results showed that men had a higher intake of ASF and ASFDDS than women. After adjusting for potential confounders, compared with those who never or rarely consumed animal foods, the likelihood of having better PCS and MCS increased by 16% (OR = 1.16, 95%CI: 1.01-1.34) and 24% (OR = 1.24, 95%CI: 1.03-1.448), respectively, in men with an ASFDDS ≥ 2. In women, a 34% increase (OR = l.34, 95%CI: 116-l.54) likelihood for better PCS was observed for an ASFDDS ≥ 2, but no association was observed for MCS. Increasing each specific animal source's food intake was associated with better PCS after adjusting for all covariates. However, for MCS, positive associations were only observed in seafood consumption among men and eggs among women. Restricted cubic splines showed a substantial dose-response association between intake frequency of animal-source foods and PCS, both in men and women. The study suggests that a diverse intake of animal-sourced foods can potentially improve the HRQoL of Chinese adults.