How do children with severe underweight and wasting respond to treatment? A pooled secondary data analysis to inform future intervention studies.

Children with weight-for-age z-score (WAZ) <-3 have a high risk of death, yet this indicator is not widely used in nutrition treatment programming. This pooled secondary data analysis of children aged 6-59 months aimed to examine the prevalence, treatment outcomes, and growth trajectories of children with WAZ <-3 versus children with WAZ ≥-3 receiving outpatient treatment for wasting and/or nutritional oedema, to inform future protocols. Binary treatment outcomes between WAZ <-3 and WAZ ≥-3 admissions were compared using logistic regression. Recovery was defined as attaining mid-upper-arm circumference ≥12.5 cm and weight-for-height z-score ≥-2, without oedema, within a period of 17 weeks of admission. Data from 24,829 children from 9 countries drawn from 13 datasets were included. 55% of wasted children had WAZ <-3. Children admitted with WAZ <-3 compared to those with WAZ ≥-3 had lower recovery rates (28.3% vs. 48.7%), higher risk of death (1.8% vs. 0.7%), and higher risk of transfer to inpatient care (6.2% vs. 3.8%). Growth trajectories showed that children with WAZ <-3 had markedly lower anthropometry at the start and end of care, however, their patterns of anthropometric gains were very similar to those with WAZ ≥-3. If moderately wasted children with WAZ <-3 were treated in therapeutic programmes alongside severely wasted children, we estimate caseloads would increase by 32%. Our findings suggest that wasted children with WAZ <-3 are an especially vulnerable group and those with moderate wasting and WAZ <-3 likely require a higher intensity of nutritional support than is currently recommended. Longer or improved treatment may be necessary, and the timeline and definition of recovery likely need review.

Growth management and prevalence of underweight of indigenous children (Orang Asli) in Peninsular Malaysia: a clinical audit.

BACKGROUND: Most indigenous people (Orang Asli in Peninsular Malaysia) live in poverty, and their children are at risk of growth problems due to nutrition deficiency. Routine health and growth assessments are essential to identify these children. This clinical audit aimed to determine the growth management of indigenous children and the prevalence of underweight among these children in Perak state, Malaysia. METHODS: A clinical audit was conducted in 2016 after obtaining consensus from stakeholders for audit criteria, forms, and procedures. All weight-for-age growth charts of Orang Asli children aged 2 and below were sampled for retrospective audit. This audit excluded children who required special needs. Growth charts were examined against audit criteria: (i) quality of growth chart plotting (charts were not plotted, incompletely plotted, or incorrectly plotted), (ii) presence of underweight, and (iii) appropriateness of action taken (appropriate or inappropriate action) according to local standard operating policies. Eligible auditors were first trained using simulated growth charts. RESULTS: Out of 1329 growth charts audited, 797 (60%) growth charts were correctly plotted, 527 (39.7%) were incompletely or incorrectly plotted, and five (0.3%) were not plotted. Overall, 40.0% of the growth chart was plotted incorrectly or completely not plotted. 550 (41.4%) children were found to be underweight, and 71.5% of them received inappropriate care management. Where growth charts were correctly plotted, 283 children were identified with underweight problems, and 194 (68.6%) of them received inappropriate care. For growth charts that were plotted incompletely or incorrectly, 267 children were identified as having underweight problems, and 199 (74.5%) received inappropriate care. The growth status of 265 (19.9%) children was unable to be determined due to incomplete plotting. CONCLUSION: Approximately 40% of indigenous Orang Asli children aged 2 years and under were underweight, and most of them received inappropriate care.

Early within-person weight gain and variability during inpatient treatment for anorexia nervosa: Age-dependent effects on treatment outcome.

OBJECTIVE: Early weight gain during inpatient treatment for anorexia nervosa (AN) is a dynamic process characterised by within-person variability that may be age-dependent. We examined whether age moderates the effect of within-person weight gain and variability on treatment outcome. METHOD: Within-person level estimates of N = 2881 underweight adolescents and adults with AN for daily average weight gain (linear slope) and variability (root mean squared errors) were obtained using random-effects modelling. Between-person level regression analyses were calculated to assess effects on weight, eating disorder psychopathology and attaining normal body weight (body mass index [BMI]: 18.5-25 kg/m2 ). RESULTS: Higher weight gain during first 2 weeks of inpatient treatment predicted higher weight, lower drive for thinness and lower body dissatisfaction at discharge, but not lower bulimic symptoms. Moreover, it predicted a higher probability of discharge weight within normal range. Younger age was associated with stronger effects of early weight gain on weight, drive for thinness and body dissatisfaction at discharge. Weight variability was not associated with any outcome. CONCLUSIONS: Age moderated effects of early weight gain on treatment outcomes, with larger effects for younger patients. Weight variability alone did not influence treatment across age and should be of lesser clinical concern during early inpatient treatment.

Evaluation of Very Integrated Program: Health Promotion for Patients With Alcohol and Drug Addiction-A Randomized Trial.

BACKGROUND: Compared to the general population, patients with alcohol and drug addiction have an increased risk of additional hazardous lifestyles and suffer from more chronic diseases, adding to their already significantly higher morbidity and mortality. The objective of this study was to test the efficacy of the Very Integrated Program (VIP) on treatment and health outcomes for patients diagnosed with alcohol and drug addiction. METHODS: Parallel randomized clinical trial with intervention as add-on to addiction care as usual. A total of 322 patients aged 18 years or older were identified, and the study requirements were fulfilled by 219 patients, 7 of whom participated in a pilot. The intervention was a 6-week intensive, tailored, educational program that included motivational interviewing, a smoking cessation program, dietary and physical activity counseling, and patient education. The main outcome measures were substance-free days, time to relapse, and treatment adherence assessed after 6 weeks and 12 months. Secondary outcomes were lifestyle factors, symptoms of comorbidity, and quality of life. Missing data were imputed conservatively by using data closest to the follow-up date and baseline values in patients with no follow-up. RESULTS: The 212 patients (intervention, n = 113; control, n = 99) were randomized, and 202 had complete data for primary outcomes. After 6 weeks, there were no significant differences between the groups regarding primary or secondary outcomes. At the 12-month follow-up, the patients in the control group had significantly more total substance-free days (139 days; ranging 0 to 365 vs. 265; 0 to 366, p = 0.021)-specifically among the patients with drug addiction-and higher physical and mental quality of life (45 vs. 58, p = 0.049 and 54 vs. 66, p = 0.037), but not in the per-protocol analysis (60 vs. 46, p = 0.52 and 70 vs. 66, p = 0.74). The sensitivity analyses did not support significant differences between the groups. CONCLUSION: Overall, adding VIP intervention did not improve outcome of the alcohol or drug addiction care or the lifestyle compared to the addiction care alone. This patient group is still in need of effective programs, and new intervention research is required to develop that.

Dynamic changes in white matter microstructure in anorexia nervosa: findings from a longitudinal study.

BACKGROUND: Gray matter (GM) 'pseudoatrophy' is well-documented in patients with anorexia nervosa (AN), but changes in white matter (WM) are less well understood. Here we investigated the dynamics of microstructural WM brain changes in AN patients during short-term weight restoration in a combined longitudinal and cross-sectional study design. METHODS: Diffusion-weighted images were acquired in young AN patients before (acAN-Tp1, n = 56) and after (acAN-Tp2, n = 44) short-term weight restoration as well as in age-matched healthy controls (HC, n = 60). Images were processed using Tract-Based-Spatial-Statistics to compare fractional anisotropy (FA) across groups and timepoints. RESULTS: In the cross-sectional comparison, FA was significantly reduced in the callosal body in acAN-Tp1 compared with HC, while no differences were found between acAN-Tp2 and HC. In the longitudinal arm, FA increased with weight gain in acAN-Tp2 relative to acAN-Tp1 in large parts of the callosal body and the fornix, while it decreased in the right corticospinal tract. CONCLUSIONS: Our findings reveal that dynamic, bidirectional changes in WM microstructure in young underweight patients with AN can be reversed with brief weight restoration therapy. These results parallel those previously observed in GM and suggest that alterations in WM in non-chronic AN are also state-dependent and rapidly reversible with successful intervention.

Hospital course of underweight youth with ARFID treated with a meal-based behavioral protocol in an inpatient-partial hospitalization program for eating disorders.

OBJECTIVE: Information on nutritional rehabilitation for underweight patients with avoidant/restrictive food intake disorder (ARFID) is scarce. This study characterized hospitalized youth with ARFID treated in an inpatient (IP)-partial hospitalization behavioral eating disorders (EDs) program employing an exclusively meal-based rapid refeeding protocol and compared weight restoration outcomes to those of patients with anorexia nervosa (AN). METHOD: Data from retrospective chart review of consecutive underweight admissions (N = 275; age 11-26 years) with ARFID (n = 27) were compared to those with AN (n = 248) on clinical features, reason for discharge, and weight restoration variables. For patients with ARFID, presenting phenomenology was further characterized by detailed chart review. RESULTS: At admission, 53% of patients with ARFID were vomiting regularly. The predominant ARFID subtype was ARFID-aversive, with close to a third being mixed subtype. Gastrointestinal (GI) symptomatology (81.5%) was the most commonly endorsed reason for restriction. A third had undergone unsuccessful parenteral or enteral tube feeding. Patients with ARFID were more likely male, had higher admission BMI, and slower IP weight gain (1.36 kg /week vs 1.92) compared to patients with AN. Fewer patients with ARFID transitioned to the partial hospitalization program, although the proportion discharged for clinical improvement did not differ and both groups had a mean program discharge BMI >18.5. DISCUSSION: GI symptoms appear a common contributor to restrictive eating amongst hospitalized youth with ARFID. Despite a slightly lower rate of IP weight gain, clinical improvement and weight restoration at discharge were similar for patients with ARFID compared to AN.

Weight management among school-aged children and adolescents: a quantitative assessment in a Ghanaian municipality.

BACKGROUND: Childhood and adolescent overweight, obesity and underweight have become an issue of grave concern to both the developed and developing countries in context of global burden of non-communicable diseases. Unhealthy weight status is a significant public health issue for developing countries, of which Ghana is not excluded. This study evaluated the prevalence of overweight, obesity and underweight and its related factors among school-aged children and adolescents. METHODS: A total of 1004 participants were randomly selected from six schools. A structured questionnaire on demography and socioeconomic status of students' parents/guardians was completed by the selected students. Anthropometric parameters were measured, and body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. BMI-for-age z-scores were used to categorize anthropometric data of the children as underweight, normal, overweight or obese. A cut-off value of > 0.50 was used to define obesity by WHtR. RESULTS: Overweight prevalence of 13.8% and 12.6 was observed among basic school and high school students respectively based on BMI classification. Obesity prevalence of 8.8% was found in basic school students and 8.9% among high school students. Underweight was observed in 114 (11.3%) basic school students and 86 (8.6%) high school students. There was a difference in sex prevalence in unhealthy weight-behaviours; with more girls being overweight (19.4% vs 7.6%, p < 0.001) and obese (10.2% vs. 7.3%, p = 0.177) compared to boys. High WHtR found in 10.5% of basic students and 5.0% of high school students, with a statistical difference. Overweight/obesity was significantly associated with taking snacks before bed among basic school students [aOR = 10.45(5.95-18)] and high school students [aOR = 10.23(5.95-18.37)] respectively. Watching TV [aOR = 0.39(0.22-0.70)], sleeping during leisure periods [aOR = 0.43(0.23-0.81)] and bicycling as a means of transport [aOR = 0.37(0.19-0.72)] to school was protective of obesity among basic school students. CONCLUSION: High prevalence of unhealthy weight-related behaviours was observed among school-aged children in the Bekwai Municipality. Snacking before bed was a major factor promoting obesity among school-aged children while leisure behaviours such as TV watching, and sleeping were protective of obesity. Therefore, it is recommended to promote and support healthy eating habits among school-aged children which are likely beneficial in reducing the risk of childhood unhealthy weight-related behaviours.

Outpatient CBT for Underweight Patients with Eating Disorders: Effectiveness Within a National Health Service (NHS) Eating Disorders Service.

BACKGROUND: Underweight eating disorders (EDs) are notoriously difficult to treat, although a growing evidence base suggests that outpatient cognitive behaviour therapy for EDs (CBT-ED) can be effective for a large proportion of individuals. AIMS: To investigate the effectiveness of CBT-ED for underweight EDs in a 'real-world' settings. METHOD: Sixty-three adults with underweight EDs (anorexia nervosa or atypical anorexia nervosa) began outpatient CBT-ED in a National Health Service setting. RESULTS: Fifty-four per cent completed treatment, for whom significant changes were observed on measures of ED symptoms, psychological distress and psychosocial impairment. There was also a large effect on body weight at end-of-treatment. CONCLUSIONS: The results suggest that good outcomes can be achieved by the majority of those who complete treatment, although treatment non-completion remains a significant barrier to recovery. Future studies should focus on improving treatment retention, as evidence suggests that CBT-ED in 'real-world' settings is effective.

Underweight among rural Indian adults: burden, and predictors of incidence and recovery.

OBJECTIVE: To study the magnitude and predictors of underweight, incident underweight and recovery from underweight among rural Indian adults. DESIGN: Prospective cohort study. Each participant's BMI was measured in 2008 and 2012 and categorized as underweight (BMI<18·5 kg/m2), normal (BMI=18·5-22·9 kg/m2) or overweight/obese (BMI ≥23·0 kg/m2). Incident underweight was defined as a transition from normal weight or overweight/obese in 2008 to underweight in 2012, and recovery from underweight as a transition from underweight in 2008 to normal weight in 2012. Bivariate and multivariable logistic regression analyses were employed. SETTING: The Birbhum Health and Demographic Surveillance System, West Bengal, India. SUBJECTS: Predominantly rural individuals (n 6732) aged ≥18 years enrolled in 2008 were followed up in 2012. RESULTS: In 2008, the prevalence of underweight was 46·5 %. From 2008 to 2012, 25·8 % of underweight persons transitioned to normal BMI, 12·9 % of normal-weight persons became underweight and 0·1 % of overweight/obese persons became underweight. Multivariable models reveal that people aged 25-49 years, educated and wealthier people, and non-smokers had lower odds of underweight in 2008 and lower odds of incident underweight. Odds of recovery from underweight were lower among people aged ≥36 years and higher among educated (Grade 6 or higher) individuals. CONCLUSIONS: The current study highlights a high incidence of underweight and important risk factors and modifiable predictors of underweight in rural India, which may inform the design of local nutrition interventions.

Visceral, general, abdominal adiposity and atherogenic index of plasma in relatively lean hemodialysis patients.

BACKGROUND: Obesity is a well-established risk factor for atherosclerosis. However, it is unknown which measure of adiposity best relates to atherosclerosis in relatively lean maintenance hemodialysis (MHD) patients. We aimed to explore and compare the associations between different adiposity indices reflecting general, abdominal, visceral adiposity and arteriosclerosis risk with atherogenic index of plasma(AIP) in relatively lean MHD patients. METHODS: We conducted a multicenter, cross-sectional study in Guizhou Province, Southwest China. General/abdominal adiposity indices like body mass index (BMI), waist circumference(WC), waist-height ratio(WHtR), conicity index (Ci) and visceral obesity indices including visceral adiposity index (VAI), lipid accumulation product (LAP) and the hypertriglyceridemic waist phenotype (HW phenotype) were recorded. Univariate and multivariate linear regression models were used. RESULTS: All adiposity indices correlated positively with AIP in univariate analysis both in men and women except for Ci. After adjustment for age and traditional atherosclerosis risk factors, BMI, WC, WHtR, VAI and LAP still had associations with AIP both in men (ß = 0.265, 0.153, 0.16, 0.788 and 0.74, respectively, all P < 0.001) and women (ß = 0.34,0.199, 0.21, 0.83 and 0.74, respectively, all P < 0.001). After further adjustment for BMI, associations between AIP and VAI, LAP remained significant, but associations between WC, WHtR and AIP disappeared. CONCLUSIONS: The HW phenotype, VAI, and LAP, validated and convenient markers of visceral obesity, were superior to classical anthropometric general/ abdominal adiposity indices for atherosclerosis risk assessment, especially in relatively lean MHD patients aged 40 years or older.

[Facets of Body Image Disorder: A Differential Analysis of the TEK-KJ (Test for the Detection of Body Disorder in Children and Adolescents) for the Direct Measurement of Haptic-Perceptual Parts]. / Facetten der Körperbildstörung: eine differenzielle Analyse des TEK-KJ (Test zur Erfassung der Körperbildstörung bei Kindern und Jugendlichen) zur direkten Messung haptisch-perzeptiver Anteile.

There is presently a lack of instruments that measure the haptic-perceptive component of body-image distortion ­ a central criterion for the eating disorders anorexia nervosa and bulimia nervosa. We present a differential analysis for the Test for Body Image Distortion in Children and Adolescents (BID-CA, German: TEK-KJ) using a large child and adolescents sample, including for the first time male participants. We analyze convergent validity with the Contour Drawing Rating Scale (CDRS) as well as differences between children and adolescents from different type of schools and different BMI percentile groups. The sample size was N = 1,654 pupils (873 females and 781 males) with an average age of 13.35 years (SD = 0.76). We calculated a substantial convergent validity with the CDRS. Significant differences between children and adolescents from different type of schools and different BMI percentile groups were detected, with increased values for children and adolescents attending high school and underweight participants. The TEK-KJ seems to be an appropriate additional instrument for detecting the haptic-perceptive component of body-image distortion. The normative data presented improves the standardization of this instrument.

Exercise training improves fat metabolism independent of total energy expenditure in sedentary overweight men, but does not restore lean metabolic phenotype.

BACKGROUND: Obesity is a dietary fat storage disease. Although exercise prevents weight gain, effects of chronic training on dietary fat oxidation remains understudied in overweight adults. OBJECTIVE: We tested whether 2 months of training at current guidelines increase dietary fat oxidation in sedentary overweight adults like in sedentary lean adults. DESIGN: Sedentary lean (n=10) and overweight (n=9) men trained on a cycle ergometer at 50% VO2peak, 1 h day-1, four times per week, for 2 months while energy balance was clamped. Metabolic fate of [d31]palmitate and [1-13C]oleate mixed in standard meals, total substrate use, total energy expenditure (TEE), activity energy expenditure (AEE) and key muscle proteins/enzymes were measured before and at the end of the intervention. RESULTS: Conversely to lean subjects, TEE and AEE did not increase in overweight participants due to a spontaneous decrease in non-training AEE. Despite this compensatory behavior, aerobic fitness, insulin sensitivity and fat oxidation were improved by exercise training. The latter was not explained by changes in dietary fat trafficking but more likely by a coordinated response at the muscle level enhancing fat uptake, acylation and oxidation (FABPpm, CD36, FATP1, ACSL1, CPT1, mtGPAT). ACSL1 fold change positively correlated with total fasting (R2=0.59, P<0.0001) and post-prandial (R2=0.49, P=0.0006) fat oxidation whereas mtGPAT fold change negatively correlated with dietary palmitate oxidation (R2=0.40, P=0.009), suggesting modified fat trafficking between oxidation and storage within the muscle. However, for most of the measured parameters the post-training values observed in overweight adults remained lower than the pre-training values observed in the lean subjects. CONCLUSION: Independent of energy balance and TEE, exercise training at current recommendations improved fitness and fat oxidation in overweight adults. However the improved metabolic phenotype of overweight adults was not as healthy as the one of their lean counterparts before the 2-month training, likely due to the spontaneous reduction in non-training AEE.

Acute effects of exercise on appetite, ad libitum energy intake and appetite-regulatory hormones in lean and overweight/obese men and women.

BACKGROUND: Acute exercise does not elicit compensatory changes in appetite parameters in lean individuals; however, less is known about responses in overweight individuals. This study compared the acute effects of moderate-intensity exercise on appetite, energy intake and appetite-regulatory hormones in lean and overweight/obese individuals. METHODS: Forty-seven healthy lean (n=22, 11 females; mean (s.d.) 37.5 (15.2) years; 22.4 (1.5) kg m-2) and overweight/obese (n=25, 11 females; 45.0 (12.4) years, 29.2 (2.9) kg m-2) individuals completed two, 8 h trials (exercise and control). In the exercise trial, participants completed 60 min treadmill exercise (59 (4)% peak oxygen uptake) at 0-1 h and rested thereafter while participants rested throughout the control trial. Appetite ratings and concentrations of acylated ghrelin, peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) were measured at predetermined intervals. Standardised meals were consumed at 1.5 and 4 h and an ad libitum buffet meal was provided at 7 h. RESULTS: Exercise suppressed appetite (95% confidence interval (CI) -3.1 to -0.5 mm, P=0.01), and elevated delta PYY (95% CI 10 to 17 pg ml-1, P<0.001) and GLP-1 (95% CI 7 to 10 pmol l-1, P<0.001) concentrations. Delta acylated ghrelin concentrations (95% CI -5 to 3 pg ml-1, P=0.76) and ad libitum energy intake (95% CI -391 to 346 kJ, P=0.90) were similar between trials. Subjective and hormonal appetite parameters and ad libitum energy intake were similar between lean and overweight/obese individuals (P⩾0.27). The exercise-induced elevation in delta GLP-1 was greater in overweight/obese individuals (trial-by-group interaction P=0.01), whereas lean individuals exhibited a greater exercise-induced increase in delta PYY (trial-by-group interaction P<0.001). CONCLUSIONS: Acute moderate-intensity exercise transiently suppressed appetite and increased PYY and GLP-1 in the hours after exercise without stimulating compensatory changes in appetite in lean or overweight/obese individuals. These findings underscore the ability of exercise to induce a short-term energy deficit without any compensatory effects on appetite regardless of weight status.

Determinants of physical activity frequency and provider advice during pregnancy.

BACKGROUND: Our aims were to (1) describe the frequency of physical activity and prenatal healthcare provider advice about physical activity during pregnancy and (2) examine determinants and correlates of 3rd trimester physical activity and receipt of physical activity advice. METHODS: We analyzed data from the 2008 Pregnancy Risk Assessment Monitoring System. We studied 2669 women from North Carolina and Colorado with data on physical activity frequency in the 3 months prior to pregnancy and during the 3rd trimester and 1584 women from Oklahoma with data on provider advice regarding physical activity during pregnancy. Respondents reported physical activity, defined as 30 min or more of exercise/physical activity (excluding vocationally related activity), in in these categories: <1 day/week, 1-4 days/week, and ≥5 days/week. We defined adherence to American College of Obstetrics & Gynecology (ACOG) criteria as physical activity ≥5 days/week in the 3rd trimester. We performed logistic regression analyses weighted for sampling and adjusted for socio-demographic factors. RESULTS: Forty-two percent of women in North Carolina and Colorado reported 3rd trimester physical activity <1 day/week, 42% 1-4 days/week, 9% ≥5 days/week; 7% reported being told not to exercise. Seventy-two percent of women in Oklahoma reported receiving physical activity advice from a prenatal care provider. Low activity frequency (<1 day/week) prior to pregnancy was strongly associated with low likelihood of ACOG guideline adherence in the 3rd trimester (aOR 0.10, 95% CU 0.04, 0.30 vs. 1-4 days/week). Underweight women were more likely to adhere to ACOG guidelines than normal weight women (aOR 2.27, 95% CI 1.36, 3.79). Overweight women were more likely to receive physical activity advice (aOR 2.9, 95% CI 1.3, 6.3 vs. normal weight), but obese women were not (aOR 0.65, 95% CI 0.4, 1.2). CONCLUSIONS: Few women meet ACOG guideline criteria for physical activity during pregnancy. Improving physical activity and weight status prior to pregnancy may improve activity levels during pregnancy. Nearly one third did not receive advice about physical activity during prenatal care. Obese women were no more likely to receive advice than their normal weight counterparts, indicating the need for targeted physical activity counseling in this population.

Fifteen minute consultation: A structured approach to the management of children and adolescents with medically unstable anorexia nervosa.

Assessing and managing children who are underweight is an integral part of paediatric practice. Young people with anorexia nervosa (AN) are mainly cared for in the community by specialist eating disorder services. However, increasing numbers require admission to paediatric wards with medical instability due to the complications of starvation. Despite recommendations published in the junior MARSIPAN report in 2012, many paediatricians still feel poorly equipped to care for these high-risk patients. This article aims to provide a safe and structured approach to the assessment and management of children and adolescents with medically unstable AN.

Health effects of 'Juntos', a conditional cash transfer programme in Peru.

In some countries, conditional cash transfer (CCT) programmes show an impact on maternal and child health. Juntos, the CCT programme in Peru, has been evaluated several times operationally, but seldom for maternal and child health outcomes. The objective of this study is to evaluate the impact of Juntos on children under 6 years, pregnant women and mothers of children under 17 years. Outcomes evaluated included (1) anaemia in women and children; (2) acute malnutrition in children; (3) post-partum complications in mothers; and (4) underweight and overweight in mothers. We identified Juntos eligible respondents from the Demographic and Health Surveys of Peru for years 2007 to 2013. Propensity score matching was used to identify comparable treatment and control groups, including eligible respondents enrolled in Juntos vs. those not enrolled in Juntos (individual-level analysis), as well as eligible respondents living in Juntos districts vs. those not residing in Juntos districts (district-level analysis). We then used generalized linear models to estimate prevalence ratios. Individual level analysis showed that Juntos reduced underweight in women (PR:0.39, 95%CI:0.18 - 0.85) and anaemia in children (PR:0.93, 95%CI:0.86 - 1.00). In the district level analysis, the programme was associated with a reduction of overweight in women (PR:0.94, 95%CI:0.90 - 0.98) and acute malnutrition in children (PR:0.49, 95%CI:0.32 - 0.73), but an increase in the prevalence of anaemia in children (PR:1.09, 95%CI:1.01 - 1.17). We found that Juntos had an effect on maternal and child health indicators, but further studies are required to overcome some limitations encountered here.

["Pro Ana": Psychodynamic References for Anorexia Nervosa]. / "Pro Ana": Hinweise für ein psychodynamisches Störungsverständnis von Anorexia nervosa.

"Pro Ana": Psychodynamic References for Anorexia Nervosa The internet-based phenomenon "Pro Ana" refers to the eating disorder anorexia nervosa in a positive way. To understand what the phenomenon "Pro Ana" represents, the websites are used as a starting point of the current analysis. Based on these results, similarities and differences between "Pro Ana" and the eating disorder anorexia nervosa are discussed. Furthermore psychodynamic references for anorexia nervosa are derived and finally their importance for treatment motivation will be considered.

Preserved white matter microstructure in young patients with anorexia nervosa?

A massive but reversible reduction of cortical thickness and subcortical gray matter (GM) volumes in Anorexia Nervosa (AN) has been recently reported. However, the literature on alterations in white matter (WM) volume and microstructure changes in both acutely underweight AN (acAN) and after recovery (recAN) is sparse and results are inconclusive. Here, T1-weighted and diffusion-weighted MRI data in a sizable sample of young and medication-free acAN (n = 35), recAN (n = 32), and age-matched female healthy controls (HC, n = 62) were obtained. For analysis, a well-validated global probabilistic tractography reconstruction algorithm including rigorous motion correction implemented in FreeSurfer: TRACULA (TRActs Constrained by UnderLying Anatomy) were used. Additionally, a clustering algorithm and a multivariate pattern classification technique to WM metrics to predict group membership were applied. No group differences in either WM volume or WM microstructure were detected with standard analysis procedures either in acAN or recAN relative to HC after controlling for the number of performed statistical tests. These findings were not affected by age, IQ, or psychiatric symptoms. While cluster analysis was unsuccessful at discriminating between groups, multivariate pattern classification showed some ability to separate acAN from HC (but not recAN from HC). However, these results were not compatible with a straightforward hypothesis of impaired WM microstructure. The current findings suggest that WM integrity is largely preserved in non-chronic AN. This finding stands in contrast to findings in GM, but may help to explain the relatively intact cognitive performance of young patients with AN and provide the basis for the fast recovery of GM structures. Hum Brain Mapp 37:4069-4083, 2016. © 2016 Wiley Periodicals, Inc.

Recovery in Young Children with Weight Faltering: Child and Household Risk Factors.

OBJECTIVE: To examine whether weight recovery among children with weight faltering varied by enrollment age and child and household risk factors. STUDY DESIGN: Observational, conducted in an interdisciplinary specialty practice with a skill-building mealtime behavior intervention, including coaching with video-recorded interactions. Eligibility included age 6-36 months with weight/age

Interventions for managing weight change following paediatric acquired brain injury: a systematic review.

OBJECTIVE: To systematically review literature reporting interventions for weight change following paediatric acquired brain injury (ABI). METHOD: A systematic search of the literature was conducted using advanced search techniques. The retrieval identified 1562 papers, of which 30 were relevant. The total number of paediatric participants was 759. RESULTS: There is a paucity of higher quality evidence to support the use of weight change interventions following paediatric ABI. Substantial variation in screening, outcome measures, intervention, and reporting were demonstrated. Some support was found for the use of hypothalamic-sparing surgery as a method to prevent obesity following craniopharyngioma resection. INTERPRETATION: There is a need for further study in this area to inform clinical and research practice; recommendations are given.