Association between Dietary Practices and Growth Trajectories in Preschool Children.

OBJECTIVES: To estimate the association of dietary practices with early life weight among children born in 2001 in the U.S. METHODS: The Early Childhood Longitudinal Study (ECLS-B) is a population-based cohort followed from 9 months to Kindergarten entry (n~5000). We employed an auto-regressive cross-lagged model to assess the impacts of dietary practices on weight stability over time. We calculated age- and sex-standardized BMI z-scores using WHO growth curves. RESULTS: BMI z-scores had a stable increase over time. Later age of solid food introduction was associated with lower BMI z-score at age 2y [-0.03(-0.05,-0.004)]; having dinners more times per week with family at age 2y was associated with higher BMI z-score at 4y [0.03(0.01,0.05)]. These changes, of <0.05 BMI z-score, are small. Children with higher birthweight were introduced to solid foods at younger ages [-0.39 months(-0.45,-0.32)] and were breast fed longer [0.13 months(0.04,0.22)]. For girls, having dinner at a regular time at ages 2y and 4y was associated with lower BMI at ages 4y and 5y. CONCLUSIONS: Dietary practices in early childhood affect weight trajectories. However, these effects are small and are largely overshadowed by prior weight. Children's weight in infancy is associated with subsequent dietary practices but also small effects.

Experiences of victimization before resettlement and chronic disease among foreign-born people in the United States.

Stressful experiences are common among migrants and may have health implications. With the only US nationally representative data set on migration, the New Immigrant Survey, we used survey-adjusted descriptive and multivariate regression methods to examine whether victimization prior to resettlement was associated with obesity, cardiovascular disease, diabetes, arthritis, cancer, and chronic lung disease. Among foreign-born people who obtained lawful permanent residence in the US in 2003-04, 6.7 per cent reported victimization before arriving in the US. Those who had experienced victimization more often suffered from chronic conditions than people without such experiences: they were 32 per cent more likely to suffer from at least one chronic condition (p < 0.05), especially cancer (4.36, p < 0.05), arthritis (1.77, p < 0.01), and cardiovascular disease (odds ratio 1.32, p < 0.05). These relationships were in part mediated by differences in healthcare access after arriving in the US between those who had experienced victimization and those who had not. Victimization may have consequences for integration and later-life chronic disease.

A retrospective review on the histopathological pattern of childhood malignant solid tumors in Ethiopia.

In low- and middle-income countries (LMICs), malignancies remain underreported due to lack of quality data. This study outlines the histopathological pattern of pediatric solid malignancies in children aged 0-15 years at the largest referral hospital in Ethiopia. A total of 432 solid malignancies were evaluated. The most common malignancies were lymphoma (21.8%), retinoblastoma (19.4%), and Wilms tumor (13.9%). Burkitt lymphoma accounted for 2.1%, despite being the most reported pediatric malignancy in sub-Saharan Africa in published literature. Definitive diagnosis could not be made in 7% of cases, related to the lack of confirmatory testing. The study highlights the need for improvement in diagnostic capabilities in LMICs.

Unhealthy weight among young children in the Middle East and North African region.

OBJECTIVE: To understand early-life growth in the Middle East and North Africa (MENA) region, and how it has changed over time, we estimated the prevalence of wasting and overweight at ages under 5 years. DESIGN: Cross-sectional data from twenty-nine Demographic and Health Surveys with direct anthropometric data and parent-reported demographic information were examined. The study utilised the WHO Child Growth Standards to classify overweight (weight-for-height z-score ≥ 2 sd above the median), wasting (weight-for-height z-score ≤ 2 sd below the median) and unhealthy weight defined as either wasting or overweight. SETTING: Nationally representative for nine of the MENA countries (Armenia, Azerbaijan, Egypt, Jordan, Mauritania, Morocco, Tunisia, Turkey and Yemen). PARTICIPANTS: Children under age 5 from nine MENA countries between 1987 and 2016 (n 155 961). RESULTS: Across the region, at the most recent time point, between 7·3 and 23·6 % of children experienced unhealthy weight (Jordan - 7·3 %, Egypt -23·6 %); 1·7 and 16·6 % had wasting (Turkey, Yemen) and 2·0 and 15·0 % had overweight (Yemen, Egypt). Overweight was more common than wasting in all countries except Yemen and Mauritania. Between 1987 and 2016, the prevalence of unhealthy weight in the region increased (10·0-18·4 %) due to increases in both wasting and overweight. Boys had a higher prevalence of unhealthy weight than girls. CONCLUSION: Undernutrition continues to be a problem in some countries in the MENA region, and overnutrition is emerging as a health concern in many countries in the region. Countries in the region must advance programmes that reduce undernutrition while not overlooking or inadvertently promoting overnutrition.

Household hardships and responses to COVID-19 pandemic-related shocks in Eastern Ethiopia.

BACKGROUND: COVID-19 resulted in enormous disruption to life around the world. To quell disease spread, governments implemented lockdowns that likely created hardships for households. To improve knowledge of consequences, we examine how the pandemic period was associated with household hardships and assess factors associated with these hardships. METHODS: We conducted a cross-sectional study using quasi-Poisson regression to examine factors associated with household hardships. Data were collected between August and September of 2021 from a random sample of 880 households living within a Health and Demographic Surveillance System (HDSS) located in the Harari Region and the District of Kersa, both in Eastern Ethiopia. RESULTS: Having a head of household with no education, residing in a rural area, larger household size, lower income and/or wealth, and community responses to COVID-19, including lockdowns and travel restrictions, were independently associated with experiencing household hardships. CONCLUSIONS: Our results identify characteristics of groups at-risk for household hardships during the pandemic; these findings may inform efforts to mitigate the consequences of COVID-19 and future disease outbreaks.

Body Mass Index Trajectories From Childhood to Adulthood and Age at Onset of Overweight and Obesity: The Influence of Parents' Weight Status.

We investigated the influence of parents' weight status on their children's growth trajectories and its association with age at onset of overweight and obesity. We used 16,396 height and weight records from 3,284 youths from the Panel Study of Income Dynamics, followed across childhood into adulthood (United States, 1997-2017). Across age groups, we modeled body mass index trajectories (ages 5-32 years) according to parents' weight status, using mixed-effect models to estimate age at onset of overweight and obesity and proportion with obesity from childhood to adulthood. There were large differences in growth patterns according to parents' weight status: Children of parents with obesity had, on average, overweight at age 6 (95% confidence interval (CI): 5, 7) and steep growth trajectories until age 12; children of normal-weight parents had slower increases in body mass index, reaching overweight on average at age 25 (95% CI: 24, 27). By age 30, 30% (95% CI: 28, 31) of youths had obesity. Differences in early-life growth persisted into adulthood: 48% (95% CI: 45, 52) of adult children of parents with obesity had obesity versus 16% (95% CI: 14, 19) of those of normal-weight parents. Trajectories to unhealthy weight were heavily influenced by parents' weight status, especially before age 12, children of parents with obesity having overweight 19 earlier in life than children of normal-weight parents.

Food Choices in the Context of Globalizing Food Options among Adolescents in Rural Southern India.

Changes in food choice often accompany globalization and economic growth. These changes have not been well documented in rural settings and among young people. To advance research on food choice, we demonstrate adolescents' selection of local vs.non-local foods in a rural area of India where globalization is just reaching. A representative sample of 237 school-going adolescents in a village in Southern India completed a survey in 2019 to understand how adolescents decide among foods traditional to the area and foods arriving from other parts of the country and the world. Adolescents most frequently consumed local foods but also occasionally consumed non-local items. In hypothetical scenarios, 81% of the adolescents reported being most interested in substituting local foods with non-local foods if they were to have more money. Among the few who currently consumed non-local snacks and drinks, very few would be willing to replace them with local alternatives, particularly if they were to have more money (snacks: 10% and drinks: 5% respectively). Overall, adolescents were most interested in switching to non-local items when considering fruits, vegetables and snacks. As India faces the dual burden of undernutrition and overnutrition, understanding the changing food environment may help inform efforts to improve nutrition.

Development of a temporally harmonized asset index: evidence from across 50 years of follow up of a birth cohort in Guatemala.

BACKGROUND: Asset-based indices are widely-used proxy measures of wealth in low and middle-income countries (LMIC). The stability of these indices within households over time is not known. METHODS: We develop a harmonized household asset index using Principal Component Analysis for the participants (n = 2392) of INCAP Longitudinal Study, Guatemala using data from six waves of follow-up over the period of 1965-2018. We estimate its cross-sectional association with parental schooling (in 1967-75) and attained schooling (in 2015-18) of cohort members. We study how patterns of cross-sectional loadings change over time and between urban-rural settings. We assess its robustness to omission of assets or study waves and alternate specifications of factor extraction procedure (exploratory factor analysis, multiple correspondence analysis). RESULTS: The harmonized index constructed using 8 assets and 11 housing characteristics explained 32.4% of the variance. Most households increased in absolute wealth over time with median wealth (25th percentile, 75th percentile; households) increasing from - 3.74 (- 4.42, - 3.07; 547) in 1967 to 2.08 (1.41, 2.67; 1145) in 2017-18. Ownership of television, electricity, quality of flooring and sanitary installation explained the largest proportion of variance. The index is positively associated with measures of schooling (maternal: r = 0.16; paternal: r = 0.10; attained: r = 0.35, all p < 0.001). In 2015-18, house ownership versus housing characteristics and ownership of electronic goods differentiate households in urban and rural areas respectively. The index is robust for omission of assets or study waves, indicator categorization and factor extraction method. CONCLUSION: A temporally harmonized asset index constructed from consistently administered surveys in a cohort setting over time may allow study of associations of life-course social mobility with human capital outcomes in LMIC contexts. The approach permits exploration of trends in household wealth of the sample over a follow-up period against repeated cross-sectional surveys which permit the estimation of only the mean trajectory.

Adolescent physical activity, sedentary behavior and sleep in relation to body composition at age 18 years in urban South Africa, Birth-to-Twenty+ Cohort.

BACKGROUND: Adolescence is marked by a decline in physical activity, rapid physical growth and changes in body composition, which have been linked to body composition. Prospective data on these associations are rare, particularly in Africa. AIM: The aim of this study was to examine the association of longitudinal patterns across adolescent in physical activity, sedentary behavior and sleep, with anthropometry and body composition at age 18 years in urban South Africa. METHODS: We analyzed data from the Birth-to-Twenty Plus Cohort (Bt20+), a longitudinal study of children born in 1990 in Soweto-Johannesburg, South Africa. We used general linear models to investigate the association of adolescent (ages 12 to 18 years) longitudinal trends in physical activity, sedentary behavior and schoolnight sleep and overall physical activity patterns, with body mass index (BMI), waist circumference, fat mass index (FMI), lean mass index (LMI) and percent body fat at age 18 years. RESULTS: The final study sample included 1337 participants with anthropometric measurements (52% female) and 958 participants with body composition measurements (53% female). Males who were consistently more active and consistently walked to school over adolescence had lower waist circumference (B = - 2.0, 95% CI: - 3.9 to - 0.2), FMI (B = - 0.8, 95%: CI: - 1.2 to - 0.1) and percent body fat (B = -2.9, 95% CI: - 4.9 to - 0.9) at age 18 years than those who decreased activity and did not walk to school. Consistently-sedentary females had higher waist circumference than those whose sedentary behavior increased over adolescence (B = 5.4, 95% CI: 0.2 to 10.6). Males who reported sleeping 9 h or more per night on schoolnights had significantly lower BMI (B = -1.0, 95% CI: - 1.4 to- 0.5), and percent body fat (B = -1.5, 95%CI - 2.8 to - 0.1) than those who reported sleeping 8 h or less per night. CONCLUSION: Patterns of adolescent physical activity, sedentary behavior and sleep are related to young-adult body composition in urban South Africa. These modifiable behaviors may be paths for public health interventions to curb overweight and obesity in many low- or middle-income countries.

Health and Demographic Surveillance Systems Within the Child Health and Mortality Prevention Surveillance Network.

Health and demographic surveillance systems (HDSSs) provide a foundation for characterizing and defining priorities and strategies for improving population health. The Child Health and Mortality Prevention Surveillance (CHAMPS) project aims to inform policy to prevent child deaths through generating causes of death from surveillance data combined with innovative diagnostic and laboratory methods. Six of the 7 sites that constitute the CHAMPS network have active HDSSs: Mozambique, Mali, Ethiopia, Kenya, Bangladesh, and South Africa; the seventh, in Sierra Leone, is in the early planning stages. This article describes the network of CHAMPS HDSSs and their role in the CHAMPS project. To generate actionable health and demographic data to prevent child deaths, the network depends on reliable demographic surveillance, and the HDSSs play this crucial role.