Nutritional status and its associated factors among infants and young children aged 6-23 months in Addis Ababa, Central Ethiopia, 2021: a cross-sectional study.

The aim of this study is to assess nutritional status and associated factors among infants and young children aged 6-23 months in Yeka sub-city, Ethiopia, 2021. An institution-based cross-sectional study was conducted in selected health centres found in the Yeka sub-city from May 2021 to July 2021. In total, 396 systematically selected infants and young children aged 6-23 months attended the selected health centres were included in the study. Data were collected by using a structured questionnaire and anthropometric measurements. A multinomial logistic regression model was used. The overall magnitude of undernutrition and overnutrition among infants and young children were 24.7% and 5.5%, respectively. Dietary diversity score (DDS) ((adjusted odd ratio (AOR) = 5.65; 95% CI = 2.301, 10.87; P value = 0.003), minimum meal frequency (MMF) (AOR = 5.435; 95% CI = 2.097, 11.09; P value = 0.0052), and diarrhoea (AOR = 2.52; 95% CI = 1.007, 6.310; P value = 0.002) were statistically significantly associated factors for nutritional status among infants and young children. Malnutrition (undernutrition and overnutrition) is a public health problem among infants and young children in Yeka sub-city, Ethiopia. DDS, MMF, and diarrhoeal disease were associated with higher odds of undernutrition.

Determinants of Overnutrition among Urban Adults in Yangon, Myanmar.

Background Over 1.9 billion adults who are 18 years old and older were overweight and more than 6.5 million adults were said to be obese. In 2014 National Step Survey of Myanmar stated that there were 16.9% and 5.5% of overweight and obesity in adults. Due to altering lifestyle and urbanization, it is important to detect the nutritional status and its most influencing factors among urban adults in Yangon. Objective To assess the determinants of overnutrition among urban adults in Yangon, Myanmar. Method This is a cross-sectional study with a sample of 453 adults aged 18-62 years and structured questionnaires were used. Overweight and obesity were defined according to the WHO classification for Asian adults. Multivariable logistic regression analysis was used to assess independent factors associated with overnutrition. Result A total of 453 participants were included for analysis. The prevalence of overnutrition was 49.89% (95% CI, 45.28-54.50). In multivariable analysis, being male (AOR = 3.56, 95% CI = 2.09-6.08, being married/divorced/widowed/ separated (AOR = 2.95, 95% CI = 1.82-4.77), family history of overnutrition (AOR = 6.49, 95% CI = 3.72-11.33, history of DM (AOR = 1.79, 95% CI = 1.11-2.89, consumption of starchy vegetables ≥5 days (AOR = 2.05, 95% CI = 1.27-3.30), not meeting the WHO recommended physical activity (AOR = 3.57, 95% CI = 2.24-5.70), and moderate and low perception (AOR = 2.15, 95% CI = 1.21-3.84) were associated with overnutrition. Conclusion We observed high prevalence of overnutrition in this study. Socioeconomic status, health behavior and perception were the factors behind overnutrition. These findings offer important information for establishment of appropriate public health interventions and policies to lessen the burden of overnutrition.

Malnutrition among Children under Age Five in Panama: Results of the ENSPA 2019.

Background: Malnutrition has important short- and long-term consequences in children under age five. Malnutrition encompasses undernutrition, overnutrition, and the coexistence of both of them, known as the double burden of malnutrition (DBM). Objective: The aim of this study was to estimate the prevalence of undernutrition, overnutrition, and the DBM among these children at the national level and by living area in Panama. Methods: Data from the National Health Survey of Panama (ENSPA, Spanish acronym), a population-based, cross-sectional study carried out in 2019 were used. Stunting, wasting, overweight, and obesity were defined according to the cut-off points of the World Health Organization Growth Standards. Undernutrition was defined as being stunted only, wasted only or both; overnutrition was defined as being overweight only or obese only; and the DBM was defined as the co-occurence of stunting and overweight/obesity in the same child. Prevalence and general characteristics at the national level and by living area were weighted. Findings: The prevalence of undernutrition was 15.3% (95% confidence interval (CI) 13.4-17.3) at the national level and 36.6% (CI: 30.1-43.5) in indigenous areas. The prevalence of overnutrition was 10.2% (8.2-12.6) at the national level and 11.9% (CI: 8.5-16.3), 8.4% (CI: 6.5-10.7) and 8.7% (CI: 5.2-14.3) in urban, rural and indigenous areas, respectively. The DBM prevalence was 1.4% (CI: 1.0-2.1) at the national level and 2.7% (CI: 1.4-5.1) in indigenous areas. Conclusions: Undernutrition is still the most prevalent malnutrition condition in our country. Panama has the highest prevalence of overnutrition in Central America. The highest prevalence of undernutrition and DBM was found among children living in indigenous areas.

How much does overnutrition weigh? The environmental and social impacts of Metabolic Food Waste in Italy.

Excess Food Energy Intake (EFEI), namely Metabolic Food Waste (MFW) corresponds to excess calorie intake related to overconsumption of food and is responsible for overweight (OW) and obesity (OB) conditions. Identifying its causes and impacts could be important, so that it can be prevented and reduced, generating health, environmental and societal benefits. Therefore, this research quantifies MFW among OW and OB adult populations (18-75 years) in Italy and its environmental and social implications. Life cycle assessment (LCA) through the Simapro 9.5 software was used and then, the results were monetized according to the Environmental Price Handbook to understand the real environmental cost. Finally, Social LCA (S-LCA) was considered following the Product Social Impact Assessment (PSILCA) guidelines to understand the potential social risks behind the food that ends up on our plates. The results highlight the amount of MFW in Italy is 2696 billion kcal/year corresponding to 1.59 Mtons over-consumed food/year, while the impacts are mainly related to global warming (8.78 Mtons CO2 eq/year, or 2.29 % of the total Italian CO2 emissions), terrestrial ecotoxicity (843,451 tons 1.4-DCB/year), freshwater ecotoxicity (222,483 tons 1.4 DCB eq/year), and land consumption (8 million m2a eq/year), mostly due to the meat, fats and oils and sweets overconsumption. Impacts monetization also shows that MFW could induce an environmental price of € 1340/per capita/year, and finally, the S-LCA reveals how overconsumption of food has the potential to affect gender discrimination, water depletion, trade union, and social discrimination due to the high proportion of labor migrants in the agricultural sector.

Dietary determinants of overnutrition among hypertensive patients in southwest Ethiopia: an ordinal regression model.

Overnutrition is a recognized risk factor for hypertension, but evidence is lacking among hypertensive patients for tailored dietary interventions. This study assessed dietary factors in 331 hypertensive patients in southwest Ethiopia. The data was collected through a questionnaire and analyzed using factor analysis. Body mass index (BMI) was calculated, and a BMI above 25 kg m-2 was considered overnutrition. An ordinal logistic regression model was used to model the data and control confounders. Adjusted odds ratio and p-values were reported. Among the 331 respondents, consumption of cereals and grains (57.0%); roots and tubers (58.5); and legumes (50.0%), while 28.6% drink alcohol, was common. About 29.0% (24.1-34.2) had overnutrition (22%, 17.6-26.6%, overweight and 7.0%, 4.5-10.3%, obesity). While the predicted odds of overnutrition were higher among males (AOR = 2.85; 1.35-6.02), married (AOR = 1.47; 0.69-3.12), illiterates (AOR = 2.09; 1.18-3.72), advanced age (AOR = 1.65; 0.61-4.61), government employees (AOR = 6.83; 1.19-39.2), and urban dwellers (AOR = 4.06; 1.76-9.36), infrequent vegetable consumption (AOR = 1.47; 0.72-2.96) and lower and higher terciles of cereals and animal-source food consumption (AOR = 1.56; 0.72-3.34). Overnutrition among hypertensive patients was significantly high and associated with unhealthy dietary consumption, educational status, residence, and occupation, emphasizing the need for targeted dietary counseling.

Prevalence, determinants, intervention strategies and current gaps in addressing childhood malnutrition in Vietnam: a systematic review.

BACKGROUND: Childhood malnutrition in all forms is a major public health issue worldwide. This review systematically examined the prevalence and determinants and identify the potential interventions and current gap in addressing malnutrition including undernutrition, overnutrition and micronutrient deficiencies (MNDs) in Vietnamese children aged 0-18 years old. METHODS: Embase, Scopus, PubMed, and Web of Science were systematically searched through June 2022 to identify relevant articles published within the past 25 years. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Risk of publication bias was assessed using American Dietetic Association Quality Criteria Checklist. RESULTS: Seventy-two studies that met the inclusion criteria were included. Undernutrition has decreased over time but still 22.4%, 5.2% and 12.2% of children under 5 were stunted, wasted and underweight, respectively. Anaemia, iron, zinc, and vitamin D deficiencies were the more common forms of MNDs, the prevalence varied by age, region, and socioeconomic group. Population-based surveys reported that 11% and 48% of children aged 0-11 years old were iron and vitamin D deficient, respectively. Zinc deficiency affected almost one-quarter of the children and adolescents. Retinol deficiency was of less concern (< 20%). However, more evidence on MNDs prevalence is needed. Overweight and obesity is now on the rise, affecting one-third of school-aged children. The key determinants of undernutrition included living in rural areas, children with low birth weight, and poor socio-economic status, whereas living in urban and affluent areas, having an inactive lifestyle and being a boy were associated with increased risk of overweight and obesity. Nutrition specific intervention studies including supplementation and food fortification consistently showed improvements in anthropometric indices and micronutrient biomarkers. National nutrition-sensitive programmes also provided nutritional benefits for children's growth and eating behaviours, but there is a lack of data on childhood obesity. CONCLUSION: This finding highlights the need for effective double duty actions to simultaneously address different forms of childhood malnutrition in Vietnam. However, evidence on the potential intervention strategies, especially on MNDs and overnutrition are still limited to inform policy decision, thus future research is warranted.

The effect of nutrition-specific and nutrition-sensitive interventions on the double burden of malnutrition in low-income and middle-income countries: a systematic review.

BACKGROUND: Low-income and middle-income countries (LMICs) experiencing nutrition transition face an increasing double burden of malnutrition (DBM). WHO has urged the identification of risks and opportunities in nutrition interventions to mitigate the DBM, but robust evidence is missing. This review summarises the effect of nutrition-specific and nutrition-sensitive interventions on undernutrition and overnutrition in LMICs. METHODS: We searched four major databases and grey literature for publications in English, French, Portuguese, and Spanish from Jan 1, 2000, to Aug 14, 2023. Eligible studies evaluated nutrition-specific or nutrition-sensitive interventions on both undernutrition and overnutrition, employing robust study designs (individually randomised, cluster randomised, and non-randomised trials; interrupted time series; controlled before-after; and prospective cohort studies). Studies were synthesised narratively, and classified as DBM-beneficial, potentially DBM-beneficial, DBM-neutral, potentially DBM-harmful, and DBM-harmful, using vote counting. This review is registered with PROSPERO (CRD42022320131). FINDINGS: We identified 26 studies evaluating 20 nutrition-specific (maternal and child health [MCH] and school-based programmes) and six nutrition-sensitive (conditional cash transfers and other social policies) interventions. Seven of eight MCH interventions providing food-based or nutritional supplements indicated possible DBM-harmful effects, associated with increased maternal or child overweight. Most school-based programmes and MCH interventions that target behavioural change were considered potentially DBM-beneficial. Two studies of conditional cash transfers suggested DBM-beneficial effects in children, whereas one indicated potentially harmful effects on maternal overweight. A study on a family planning service and one on an education reform revealed possible long-term harmful effects on obesity. INTERPRETATION: There is considerable scope to repurpose existing nutrition interventions to reduce the growing burden of the DBM in LMICs. In settings undergoing rapid nutrition transition, specific policy attention is required to ensure that food-based or supplement-based MCH programmes do not unintentionally increase maternal or child overweight. Consistent reporting of undernutrition and overnutrition outcomes in all nutrition interventions is essential to expand the evidence base to identify and promote interventions maximising benefits and minimising harms on the DBM. FUNDING: President's Scholarship (Imperial College London) and National Institute for Health and Care Research. TRANSLATIONS: For the Portuguese, Spanish and French translations of the abstract see Supplementary Materials section.

Prevalence and factors associated with undernutrition and overnutrition among ever-married adolescent girls in Bangladesh: an analysis of national surveys from 2004 to 2017.

Nutritional impairment during adolescence may result in adverse physical and reproductive health outcomes. We investigated the prevalence and determined the factors associated with underweight and overweight/obesity among ever-married adolescent girls in Bangladesh. We used Bangladesh Demographic and Health Surveys data conducted in 2004, 2007, 2011, 2014, and 2017. A total of 7040 ever-married adolescent girls aged 15-19 years were included in this analysis. Prevalence of underweight (body mass index [BMI]<18.5 kg/m2) significantly decreased from 39.53% (95% CI = 36.71, 42.43) to 23.62% (95% CI = 21.35, 26.05) during 2004-2017 (p < 0.001). However, prevalence of overweight/obesity (BMI ≥ 23 kg/m2) significantly increased from 5.9% (95% CI = 4.67, 7.43) to 22.71% (95% CI = 20.39, 25.20) during the same period (p < 0.001). The girls with higher age (OR = 0.94, 95% CI = 0.90, 0.99, p = 0.023), higher level of education (OR = 0.60, 95% CI = 0.43, 0.83, p = 0.002), and richest wealth quintile (OR = 0.78, 95% CI = 0.62, 0.98, p = 0.035) had significantly lower risk of being underweight. Adolescent girls having more than one child (OR = 1.41, 95% CI = 1.15, 1.73, p = 0.001) were more likely to be underweight. Elderly adolescents with better economic status were more at risk of being overweight/obese (OR = 2.57, 95% CI = 1.86, 3.55, p < 0.001). Girls married to skilled/unskilled workers (OR = 0.58, 95% CI = 0.44, 0.77, p < 0.001) and persons involved in small businesses (OR = 0.66, 95% CI = 0.49, 0.89, p = 0.007) had lower risk of having a high BMI. Using contraceptive (OR = 0.8, 95% CI = 0.69, 0.94, p = 0.006) was negatively associated with overweight/obese. Although prevalence of undernutrition among ever-married adolescent girls is declining, the proportion of being overweight/obese is increasing in Bangladesh warranting effective strategies to improve adolescent nutrition.

Overnutrition in adolescents and its associated factors in Dale district schools in Ethiopia: a cross-sectional study.

Background: Adolescence is the critical stage of an individual's growth and development that determines their nutritional status in the future. Adolescent overnutrition has become an increasing public health concern in developing countries like Ethiopia. Objective: This study was designed to determine the magnitude and determinants of overnutrition among school-going adolescents in Dale District of Ethiopia. Methods: An institution-based cross-sectional study was done between November and December 2020. A total of 333 school-going adolescents aged 10-19 years participated in this study. Socio-demographic, lifestyle, physical activity level, dietary energy intake, and height and weight data were collected. Body Mass Index for age Z-score (BAZ) was computed. Binary and multivariable logistic regression models were used to determine the association of outcome variable with explanatory variables, and results were reported using adjusted odds ratio (AOR) with 95% confidence interval. Results: The magnitude of overnutrition was 7.2% (10.8% in the urban versus. 3.6% of rural schools). Overnutrition was positively associated with lack of sufficient play area within the school (AOR = 2.53, 95% CI [1.02-6.26]), being an urban resident (AOR = 3.05, 95% CI [1.12-8.29]), positive energy balance (AOR = 9.47, 95% CI [1.58-56.80]), consuming fast foods within a month before the survey date (AOR = 2.60, 95% CI [1.93-6.83]), having moderate (AOR = 9.28, 95% CI [6.70-71.63]) or low physical activity (PA) (AOR = 7.95, 95% CI [1.12-56.72]), and consuming snack within last one week before the survey date (AOR = 3.32, 95% CI [1.15-9.58]). Conclusion: The magnitude of overnutrition among school-going adolescents was suboptimal. Sedentary lifestyles, excess calorie intake, having inadequate play areas within the school, and having snack and fast foods were determinants for overnutrition in the study area.

Determinants of undernutrition and overnutrition among reproductive-age women in Bangladesh: Trend analysis using spatial modeling.

BACKGROUND: Bangladesh is facing a dual burden of malnutrition, with high rates of undernutrition and increasing rates of overnutrition. The complex scenario of malnutrition in Bangladesh varies across different regions, making it a challenging public health concern to address. OBJECTIVES: This study analyzes the spatial and temporal dependence of underweight and overweight Bangladeshi women of reproductive age. METHODS: Nationally representative cross-sectional data from the Bangladesh Demographic and Health Surveys in 2014 and 2017-18 were utilized to study the changes in weight status in 15-49-year-old women who were either underweight or overweight. A Bayesian geo-additive regression model was used to account for non-linear and linear effects of continuous and categorical covariates and to incorporate spatial effects of geographical divisions. RESULTS: The prevalence of overweight or obese women in rural, city corporations, and other urban areas increased significantly over the four years from 2014 to 2017-18. Women in the categories 'richer' and 'richest' were more likely to be overweight or obese. Women from Sylhet were more likely to be underweight in both survey years; however, the spatial effects were significant for underweight women in Mymensingh for the year 2017-18. Women in Rajshahi and Khulna were more likely to be overweight or obese in 2014, and women from Barishal and Chittagong were more likely to be overweight in the year 2017-18. CONCLUSIONS: Underweight and overweight statuses in women vary unevenly across Bangladesh, with a substantially higher prevalence of overweight or obese women in more urbanized areas. The growing burden of overweight and obesity among Bangladeshi women should be addressed with interventions aimed at those in the reproductive age group.

Exploring the double burden of malnutrition at the household level in the Philippines: Analysis of National Nutrition Survey data.

BACKGROUND: In the Philippines, the rising prevalence of obesity and related chronic diseases alongside persistent undernutrition presents a complex public health challenge. Understanding the patterns and dynamics of this 'double burden of malnutrition' (DBM) is crucial for developing effective intervention strategies. However, evidence of the occurrence of undernutrition and overnutrition within the same household is currently lacking. METHODS: Using cross-sectional data from the 2013 Philippines National Nutrition Survey this study examined the prevalence of different typologies of household-level DBM from an analytical sample of 5,837 households and 25,417 individuals. Multivariable logistic regression was performed to identify factors associated with overall occurrence of intrahousehold DBM. RESULTS: The overall prevalence of double burden households was 56% based on a comprehensive definition. The most common typology of intrahousehold DBM characterized in this study (% of all households) comprised households with at least one adult with overnutrition and at least one separate adult with undernutrition. Household size, wealth quintile, food insecurity, and household dietary diversity were all associated with household-level DBM. Double burden households were also influenced by head of household characteristics, including sex, level of education, employment status, and age. CONCLUSIONS: The findings from this study reveal that the coexistence of overnutrition and undernutrition at the household level is a major public health concern in the Philippines. Further comprehensive assessments of household-level manifestations of the DBM are needed to improve our understanding of the trends and drivers of this phenomenon in order to develop better targeted interventions.

Prevalence of malnutrition & anemia in preschool children; a single center study.

BACKGROUND: Malnutrition including undernutrition, overnutrition, and micronutrient deficiencies are considerable problems worldwide, with variable burdens among different communities. Its complications include physical and cognitive impairment, with the probability of irreversible lifelong consequences. We aimed to assess the prevalence of undernutrition, overweight, obesity, and anemia in preschoolers, being a risk group for developmental adverse events. METHODS: We recruited 505 healthy preschool children, with a male: female ratio of 1.05:1. Children with chronic diseases were excluded. We used anthropometry and complete blood count to screen for malnutrition and anemia. RESULTS: The mean age of the study group was 3.8 ± 1.4 years (1.02-7). The screening results were average in 228 (45.1%) children, while 277 (54.9%) children had either abnormal anthropometry, anemia, or both. We observed undernutrition in 48 (9.5%) children; among them, 33 (6.6%) were underweight, 33 (6.6%) wasted, and 15 (3%) were stunted, with no significant difference between children aged below or above five. We identified overnutrition in 125 (24.8%); 43 (8.5%) were overweight, 12 (2.4%) were obese, and 70 (13.9%) had a high body mass index Z score, not qualifying the definition of overweight. Anemia was diagnosed in 141 (27.9%) children and was significantly more frequent among older children without gender discrimination. About 10% (50 children) had both anemia and abnormal anthropometry. The frequency of abnormal anthropometry was comparable between children with anemia and those with normal hemoglobin. CONCLUSION: Malnutrition and anemia in preschoolers are still a heavy burden affecting about half of our study group, with an upward trend towards the overnutrition side. Anemia is still a moderate public health problem in preschoolers.

The double burden of malnutrition among women of reproductive age and preschool children in low- and middle-income countries: A scoping review and thematic analysis of literature.

The aim of this review was to map the literature on the double burden of malnutrition (DBM) among women of reproductive age (WRA) and preschool children in low- and middle-income countries (LMICs). The study aimed to provide an understanding of how DBM construct has been defined in the current literature and to elucidate plausible mechanisms underlying DBM development and its common risk factor among the two subgroups. We systematically searched for literature from the following databases: EMBASE, CINAHL, MEDLINE, LILACS, Scopus and ProQuest Dissertations & Thesis Global and identified articles that specifically reported on the coexistence of undernutrition and overnutrition sequalae at the population, household, or individual levels among WRA and preschool children in LMICs. A thematic analysis using the Braun and Clarke approach was conducted on excerpts from the articles to reveal emerging themes underlying the occurrence of DBM from the included studies. Of the initial 15 112 articles found, 720 met the inclusion criteria. Anthropometric measures for overnutrition and undernutrition including body mass index for WRA and height-for-age, weight-for-age, and weight-for-height Z-scores for preschool children were frequently used indicators for defining DBM across all levels of assessment. In fewer cases, DBM was defined by the pairing of cardiometabolic risk factors (e.g., hypertension) as measures for overnutrition and micronutrient deficiency (e.g., iron deficiency) as measures for undernutrition. The following themes emerged as plausible mechanisms for DBM development: nutrition transition, breastfeeding, diet behavior, biological mechanism, and statistical artifact. Factors such as child age, child sex, maternal age, maternal education, maternal occupation, household food security, household wealth, urbanicity, and economic development were commonly associated with most of the DBM phenotypes. Our review findings showed that the understanding of the DBM in current literature is very ambiguous. There is need for future research to better understand the DBM construct and its etiology.

Exploring Overnutrition, Overweight, and Obesity in the Hospital Setting-A Point Prevalence Study.

Malnutrition is an international healthcare concern associated with poor patient outcomes, increased length of stay, and healthcare costs. Although malnutrition includes both under and overnutrition, there is a large body of evidence that describes the impacts of undernutrition with limited data on overnutrition in hospitalized patients. Obesity itself is a modifiable risk factor associated with hospital-associated complications. However, there is limited reporting of the prevalence of obesity in hospitals. This one-day cross-sectional study (n = 513) captures the prevalence of both under and overnutrition in a hospitalized population and explores dietetic care provided compared to the Nutrition Care Process Model for hospitalized patients who have obesity. The main findings were: (1) the largest proportion of patients were in the overweight and obese classifications (57.3%, n = 294/513); 5.3% of these patients had severe obesity (class III); (2) patients who were overweight and obese had lower malnutrition risk profiles as well as the prevalence of malnutrition; (3) 24.1% of patients who had obesity (n = 34/141) were receiving dietetic intervention; (4) 70.6% (n = 24/34) did not have a nutrition diagnosis that followed the Nutrition Care Process Model. Study results provide valuable clinical insight into the prevalence of overnutrition and opportunities to improve nutrition care for this vulnerable patient group.

Quantification of Urbanization Using Night-Time Light Intensity in Relation to Women's Overnutrition in Bangladesh.

Urbanization is accelerating in developing countries, which are simultaneously experiencing a rise in the prevalence of overnutrition (i.e., overweight and obesity), specifically among women. Since urbanization is a dynamic process, a continuous measure may better represent it when examining its association with overnutrition. However, most previous research has used a rural-urban dichotomy-based urbanization measure. This study utilized satellite-based night-time light intensity (NTLI) data to measure urbanization and evaluate its association with body weight in reproductive-aged (15-49) women in Bangladesh. Multilevel models estimated the association between residential area NTLI and women's body mass index (BMI) or overnutrition status using data from the latest Bangladesh Demographic and Health Survey (BDHS 2017-18). Higher area-level NTLI was associated with a higher BMI and increased odds of being overweight and obese in women. Living in areas with moderate NTL intensities was not linked with women's BMI measures, whereas living in areas with high NTL intensities was associated with a higher BMI or higher odds of being overweight and obese. The predictive nature of NTLI suggests that it could be used to study the relationship between urbanization and overnutrition prevalence in Bangladesh, though more longitudinal research is needed. This research emphasizes the necessity for preventive efforts to offset the expected public health implications of urbanization.

Comparison of Weight for Height and BMI for Age for Estimating Overnutrition Burden in Under-Five Populations With High Stunting Prevalence.

BACKGROUND: Overnourished under-five children are anthro-pometrically classified as either being at possible risk of over-weight, overweight or obese and defined so, when either weight for height or body mass index for age (BMI-for-age) are >1SD to 2SD, >2SD to 3SD and >3SD, respectively of the analogous World Health Organization standards. AIM: To compare weight for height and BMI for age definitions for quantifying overnutrition burden. METHODS: Theoretical consequences of ignoring age were evaluated by comparing, at varying height for age z-scores, the age- and sex-specific cutoffs of BMI that would define overnutrition with these two metrics. Overnutrition prevalence was then compared in simulated populations (short, intermediate and tall) and real-life datasets from India. RESULTS: In short (-2SD) children, the BMI cutoffs with weight for height criteria were lower in comparison to BMI for age till 7-8 months, but higher at later ages. In National Family Health Survey-4, India dataset (short population), overnutrition (>1SD) prevalence with weight for height was higher from 0-0.5 years (exclusive breastfeeding age), but lower at subsequent ages. The prevalence difference (weight for height - BMI for age) in 0.5-5 years was -2.26% (6.57% vs 8.83%); this attenuated in 0-5 years (-1.55%; 7.23% vs 8.78%). The discrepancy was maxi-mal for stunted children and was lower in girls. A similar pattern, of lower magnitude, was observed for overweight (>2SD) com-parison. In intermediate and tall populations, there were no meaningful differences. CONCLUSION: The two definitions produce cutoffs, and hence estimates of overnutrition, that differ with the age, sex, and height of under-five children. The relative invariance, with age and height, of BMI for age, favors its use.

School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines.

BACKGROUND: The impacts of multicomponent school water, sanitation, and hygiene (WaSH) interventions on children's health are unclear. We conducted a cluster-randomized controlled trial to test the effects of a school WaSH intervention on children's malnutrition, dehydration, health literacy (HL), and handwashing (HW) in Metro Manila, Philippines. METHODS: The trial lasted from June 2017 to March 2018 and included children, in grades 5, 6, 7, and 10, from 15 schools. At baseline 756 children were enrolled. Seventy-eight children in two clusters were purposively assigned to the control group (CG); 13 clusters were randomly assigned to one of three intervention groups: low-intensity health education (LIHE; two schools, n = 116 children), medium-intensity health education (MIHE; seven schools, n = 356 children), and high-intensity health education (HIHE; four schools, n = 206 children). The intervention consisted of health education (HE), WaSH policy workshops, provision of hygiene supplies, and WaSH facilities repairs. Outcomes were: height-for-age and body mass index-for-age Z scores (HAZ, BAZ); stunting, undernutrition, overnutrition, dehydration prevalence; HL and HW scores. We used anthropometry to measure children's physical growth, urine test strips to measure dehydration, questionnaires to measure HL, and observation to measure HW practice. The same measurements were used during baseline and endline. We used multilevel mixed-effects logistic and linear regression models to assess intervention effects. RESULTS: None of the interventions reduced undernutrition prevalence or improved HAZ, BAZ, or overall HL scores. Low-intensity HE reduced stunting (adjusted odds ratio [aOR] 0.95; 95% CI 0.93 to 0.96), while low- (aOR 0.57; 95% CI 0.34 to 0.96) and high-intensity HE (aOR 0.63; 95% CI 0.42 to 0.93) reduced overnutrition. Medium- (adjusted incidence rate ratio [aIRR] 0.02; 95% CI 0.01 to 0.04) and high-intensity HE (aIRR 0.01; 95% CI 0.00 to 0.16) reduced severe dehydration. Medium- (aOR 3.18; 95% CI 1.34 to 7.55) and high-intensity HE (aOR 3.89; 95% CI 3.74 to 4.05) increased observed HW after using the toilet/urinal. CONCLUSION: Increasing the intensity of HE reduced prevalence of stunting, overnutrition, and severe dehydration and increased prevalence of observed HW. Data may be relevant for school WaSH interventions in the Global South. Interventions may have been more effective if adherence was higher, exposure to interventions longer, parents/caregivers were more involved, or household WaSH was addressed. TRIAL REGISTRATION NUMBER: DRKS00021623.

Does maternal overnutrition carry child undernutrition in India?

BACKGROUND AND OBJECTIVES: Studies in low-and middle-income countries where nutrition transition is underway provides mixed evidence of double burden of maternal overnutrition and child undernutrition among mother-child pairs. Shifting dietary pattern and rapid increase in overweight/obesity among adults with persistent child undernutrition indicate that India is experiencing nutrition transition and double burden of malnutrition. Hence, the study explores the presence of and the factors associated with mother-child dyads of over- and undernutrition in India. METHODS AND MATERIALS: The study uses National Family Health Survey 2015-16 data. The analytic sample consists of 28,817 weighted mother-child pairs where an overweight/obese mother is paired with an undernourished child. The nutritional status of children is defined according to WHO 2006 child growth standards as underweight (i.e., low weight-for-age), stunting (i.e., low height-for-age) and wasting (i.e., low weight-for-height). Maternal overweight/obesity (i.e., BMI ≥ 25 kg/m2) is defined using adult BMI criterion. Descriptive, bivariate, and adjusted multivariable logistic regression analysis are conducted. RESULTS: Of the overweight/obese mothers, 21.3%, 26.5%, and 14% have underweight, stunted, and wasted children respectively. In adjusted models, maternal short stature (aOR: 2.94, 95% CI: 2.30-3.75), age of child (aOR: 3.29, 95% CI: 2.76-3.92), and poorest wealth status (aOR: 2.01, 95% CI: 1.59-2.54) are significant predictors of overweight/obese mothers and stunted child pairs. Similarly, poor wealth status (aOR: 1.68, 95% CI:1.32-2.14), maternal stature (aOR: 2.70, 95% CI: 2.08-3.52), and child aged 2-5 years (aOR: 1.77, 95% CI:1.51-2.08) are also significantly associated with higher occurrence of overweight/obese mother and-underweight child pairs. CONCLUSION: Findings of the study are consistent with the phase of nutrition transition and double burden of malnutrition. The paper concludes with suggestions to improve the socioeconomic condition, more strategic nutrition specific investments and policy interventions to eliminate all forms of malnutrition for achieving SDGs.

Prevalencia de malnutrición por exceso en niños, niñas y adolescentes en pandemia, en centro médico de la Escuela de Medicina de la Universidad de Tarapaca / Prevalence of malnutrition due to excess in children, girls and adolescents during pandemic, in a medical center of the School of Medicine of the University of Tarapacá

INTRODUCCIÓN: La malnutrición por exceso afecta aproximadamente a 337 millones de niños, niñas y adolescentes en el mundo. Entre los aspectos multifactoriales asociados a la obesidad, destaca el contexto Pandemia por COVID-19, el cual ha aumentado las cifras de obesidad infantil. Por otro lado, la obesidad es considerada un factor de riesgo para desarrollar de forma grave la enfermedad por COVID-19. Este estudio busca analizar el efecto de la pandemia en los índices de malnutrición por exceso en los niños, niñas y adolescentes atendidos en el centro médico de la carrera de medicina de la Universidad de Tarapacá durante el año 2021 y compararlos con estudios previos realizados en Chile. METODOLOGÍA: La investigación tiene un enfoque analítico, transversal, retrospectivo y observacional. El estudio se basó en la revisión de fichas clínicas de 1094 pacientes entre 2 y 17 años atendidos en el Centro Médico de la Escuela de Medicina de la Universidad de Tarapacá en la ciudad de Arica. Los datos obtenidos fueron almacenados en plantilla Excel para ser ingresados en un programa estadístico. RESULTADOS: Del total de 1094 fichas analizadas, 611 pacientes (55,8%) se encontraron en un estado nutricional concordante con malnutrición por exceso, predominando en el sexo masculino (54,7%) y a mayor edad mayor malnutrición por exceso, encontrando mayor prevalencia de obesidad y obesidad severa en los(las) adolescentes. DISCUSIÓN: La malnutrición por exceso ha adquirido las características de epidemia y es un problema frecuente de los países en vías de desarrollo, convirtiéndose en un problema de salud pública. En este estudio se demuestra un aumento en los niveles de malnutrición por exceso durante el año 2021, comparando los resultados obtenidos en relación a la realidad nacional y regional en los años 2019 y 2020.

INTRODUCTION: Malnutrition due to excess affects approximately 337 million children and adolescents in the world. Among the multifactorial aspects associated with obesity, the COVID-19 Pandemic context stands out, which has warned the figures of childhood obesity. On the other hand, obesity is considered a risk factor for severely developing COVID-19 disease. This study seeks to analyze the effect of the pandemic on the rates of malnutrition due to excess in children and adolescents treated at the medical center of the University of Tarapacá during the year 2021 and compare them with previous studies carried out in Chile. METHODOLOGY: The research has an analytical, cross-sectional, retrospective and observational approach. The study was based on the review of clinical records of 1094 patients between 2 and 17 years of age treated at the Medical Center of the School of Medicine of the University of Tarapacá in the city of Arica. The data obtained was stored in an Excel template to be entered into a statistical program. RESULTS: Of the total of 1094 records analyzed, 611 patients (55.8%) were found to be in a nutritional state consistent with malnutrition due to excess, predominating in males (54.7%) and at older ages, finding a higher prevalence of obesity and severe obesity in adolescents. DISCUSSION: Malnutrition due to excess has acquired the characteristics of an epidemic and is a frequent problem in developing countries, becoming a public health problem. This study demonstrates an increase in the levels of malnutrition by excess during the year 2021, comparing the results obtained in relation to the national and regional reality in the years 2019 and 2020.

Overnutrition in Indian Children: Challenges and Opportunities.

Global and Indian data indicate that children from all the segments of population face dual nutrition burden and related health consequences. Long-term cohort studies have shown that both the under- and overnutrition are risk factors for overnutrition and non-communicable diseases in adult life. Halting the rise in overnutrition is one of the Sustainable Development Goal (SDG) targets to be achieved by 2030. With the development and inclusion of body mass index (BMI)-for-age in the WHO child growth standards, it has become possible to assess over- and undernutrition in short-statured children. In India, the Annual Health Survey (AHS) (2014) and the District Level Household Survey 4 (DLHS4) (2013) undertook measurement of height/length and weight (AHS 557016 and DLHS4 295663) in the 0-18-year of school-age children from selected households. Prevalence of overnutrition in 0-18-year children was calculated from these two surveys by using the WHO standards for BMI-for-age (BMI-for-age z scores (BAZ) > +2 in 0-5 and BAZ > +1 in 5-18-year children) as well as uniform norms of either > +1 or > +2 BAZ across 0-18-year children. An attempt was made to explore the policy and program implications of using different norms for assessing overnutrition in preschool and school age children in the Indian context. Body mass index-for-age curve for the 0-18-year Indian children was calculated and compared with the WHO BMI-for-age curve. Across 0-18-year children, the mean BMI-for-age of Indian boys and girls was lower than the mean of the WHO standards, but the trajectory followed was similar. Therefore, Indian high-risk under- and overnourished children can be monitored by using the WHO BMI-for-age curve. Irrespective of the cutoff used for BMI-for-age, prevalence of overnutrition was higher in preschool as compared to school-age children. Overnourished school-age children outnumbered preschool children, especially if the WHO cutoffs were used. The school health system may find it difficult to implement programs that aimed at detection and management of large number of overnourished children. If uniform norm of BAZ > +1 was used, prevalence of overnutrition in preschool children was high and almost similar to undernutrition. Currently, nutrition programs for preschool children are focused on undernutrition and they may find it difficult to manage program focused on overnutrition in large number of children. If the uniform norm of BAZ > +2 was used, both the prevalence of overnutrition and number of children requiring intervention were relatively low in all the age groups. The existing preschool and school nutrition programs can take up an integrated program aimed at early detection and effective management of both the under- (BAZ < -2) and overnutrition (BAZ > +2) in 0-18-year children and strive to achieve the SDG targets.