Effects of an exclusive breastfeeding intervention for six months on growth patterns of 4-5 year old children in Uganda: the cluster-randomised PROMISE EBF trial.

BACKGROUND: Breastfeeding promotion is regarded as one of the most effective interventions to improve child health, and could reduce under-5-mortality by 8 % globally. Few studies have assessed the health outcomes beyond infancy of interventions promoting exclusive breastfeeding. METHODS: This study assessed growth in under-five children who participated in a cluster-randomised trial in Eastern Uganda (ClinicalTrials.gov.no.NCT00397150). In the intervention arm, peer counsellors promoted exclusive breastfeeding during the first 6 months of infancy. There were no interventions after 6 months of age. Mother-infant pairs were interviewed at visits scheduled at 3, 6, 12 and 24 weeks after birth and follow-up visits at 2 and 5 years, with 765 included in the analyses. RESULTS: The mean length/height-for-age and weight-for-age-z-score (HAZ, WAZ) decreased with increasing age in both the intervention and control arms. At the three weeks visit, HAZ in the intervention was -0.45 (-0.68;-0.21) and -0.32 (-0.56;-0.07) in the control arm. At the 2 year follow-up, the mean HAZ in the intervention was -1.85 (95 % CI -1.97;-1.73) compared to -1.61 (-1.87;-1.34) in the control. Similarly, at the 5 year follow-up, the mean HAZ in the intervention was -1.78 (-2.08;-1.47) compared to -1.53 (-1.79;-1.28) in the control arm. At the 2 year follow-up visit, 139 (45 %) were stunted (HAZ<-2) in the intervention compared to 109 (37 %) in the control arm, odds ratio (OR) 1.7 (1.1;2.4). Underweight (WAZ<-2) was also more common in the intervention arm than in the control at the five years follow-up (OR 1.7 (1.0;2.8)), with a mean WAZ of -1.28 (-1.47;-1.08) and -1.06 (-1.19;-0.92) in the intervention and control arm, respectively. CONCLUSION: While stunting was widespread at 2 and 5 years of age in both arms, it was more common in the intervention arm. It is questionable whether community-based support from lay people with short training and focussing only on exclusive breastfeeding, is an appropriate strategy to improve child health and development. TRIAL REGISTRATION: ClinicalTrials.gov.no. NCT00397150 . Registered 7th of November 2006.

Ready-to-use food-allocation policy to reduce the effects of childhood undernutrition in developing countries.

Several aid groups have proposed strategies for allocating ready-to-use (therapeutic and supplementary) foods to children in developing countries. Analysis is needed to investigate whether there are better alternatives. We use a longitudinal dataset of 5,657 children from Bwamanda to construct a bivariate time-series model that tracks each child's height-for-age z score (HAZ) and weight-for-height z score (WHZ) throughout the first 5 y of life. Our optimization model chooses which individual children should receive ready-to-use therapeutic or supplementary food based on a child's sex, age, HAZ, and WHZ, to minimize the mean number of disability-adjusted life years (DALYs) per child during 6-60 mo of age [which includes childhood mortality calculated from a logistic regression and the lifelong effects of stunting (i.e., low HAZ)] subject to a budget constraint. Compared with the strategies proposed by the aid groups, which do not use HAZ information, the simple strategy arising from our analysis [which prioritizes children according to low values of a linear combination of HAZ, WHZ, and age and allocates the entire budget to therapeutic (i.e., 500 kcal/d) food for the prioritized children] reduces the number of DALYs by 9% (for the same budget) or alternatively incurs the same number of DALYs with a 61% reduction in cost. Whereas our qualitative conclusions appear to be robust, the quantitative results derived from our analysis should be treated with caution because of the lack of reliable data on the impact of supplementary food on HAZ and WHZ, the application of our model to a single cohort of children and the inclusion and exclusion errors related to imperfect food targeting.

The social context of severe child malnutrition: a qualitative household case study from a rural area of the Democratic Republic of Congo.

INTRODUCTION: The magnitude of child malnutrition including severe child malnutrition is especially high in the rural areas of the Democratic Republic of Congo (the DRC). The aim of this qualitative study is to describe the social context of malnutrition in a rural part of the DRC and explore how some households succeed in ensuring that their children are well-nourished while others do not. METHODOLOGY: This study is based on participant observation, key informant interviews, group discussions and in-depth interviews with four households with malnourished children and four with well-nourished children. We apply social field theory to link individual child nutritional outcomes to processes at local level and to the wider socio-economic environment. FINDINGS: We identified four social fields that have implications for food security and child nutritional outcomes: 1) household size and composition which determined vulnerability to child malnutrition, 2) inter-household cooperation in the form of 'gbisa work party' which buffered scarcity of labour in peak seasons and facilitated capital accumulation, 3) the village associated with usufruct rights to land, and 4) the local NGO providing access to agricultural support, clean drinking water and health care. CONCLUSIONS: Households that participated in inter-household cooperation were able to improve food and nutrition security. Children living in households with high pressure on productive members were at danger of food insecurity and malnutrition. Nutrition interventions need to involve local institutions for inter-household cooperation and address the problem of social inequalities in service provision. They should have special focus on households with few resources in the form of land, labour and capital.

Population-based survey of overweight and obesity and the associated factors in peri-urban and rural Eastern Uganda.

BACKGROUND: In sub-Saharan Africa (SSA), the rising prevalence of overweight, obesity and non-communicable diseases co-exists with the high burden of under-nutrition. The paucity of data on adulthood overweight and obesity, disaggregated by socio-demographic characteristics and in rural settings in SSA calls for research. We determined the prevalence of underweight, overweight/obesity and associated factors among adults in peri-urban and rural Uganda. METHODS: A cross-sectional study of 1210 randomly selected adults aged ≥ 18 years was conducted in Iganga-Mayuge Health and Demographic Surveillance Site in eastern Uganda in 2013. Height, weight and socio-demographic variables were assessed. Overweight was defined as BMI = 25.0-29.99 kg/m(2), obesity ≥ 30 kg/m(2) and overweight/obesity ≥ 25 kg/m(2). Logistic regression was used to identify factors associated with overweight/obesity. RESULTS: Of the participants, 7 % were underweight (8.1 % of men; 5.9 % of women, p = 0.99); 17.8 % were overweight (12.4 % of men; 23.1 % of women, p < 0.001); and 7 % were obese (2.0 % of men; 12.7 % of women, p < 0.001). Overweight prevalence was 15.8 % and 23.8 % among rural and peri-urban adults, respectively (p < 0.001). Obesity prevalence was 3.9 % and 17.8 % among rural and peri-urban adults, respectively (p < 0.001). Factors associated with overweight/obesity were: being female, adjusted odds ratio (AOR) 4.3 (95 % confidence interval (PloS one 8:e75640, 20013) 3.2-5.9); peri-urban residence AOR 2.6 (1.9-3.6); being in age group 35-44, AOR 3.1 (1.8-5.3); 45-54 AOR 4.1 (2.3-7.3); 55-64 AOR 2.6 (1.4-5.0); ≥ 65 years AOR 3.1 (1.6-6.0); and having socio-economic status (SES) in the third AOR 2.8 (1.7-4.6), fourth 2.5 (1.5-4.2) and fifth 2.7 (1.6-4.4) quintile. CONCLUSIONS: Overweight/obesity was prevalent among adults. Overweight/obese was associated with being female, being aged 35 years and older, residing in a peri-urban area and having a higher SES. The time has come to develop interventions to prevent and control overweight/obesity.

HIV infection, viral load, low birth weight, and nevirapine are independent influences on growth velocity in HIV-exposed South African infants.

Data from a prospective multisite cohort study were used to examine the effect of HIV exposure, untreated HIV infection, and single-dose nevirapine on infant growth velocity. The 2009 WHO growth velocity standards constitute a new tool for this type of investigation and are in need of functional validation. In period 1 (3-24 wk), 65 HIV-infected, 502 HIV-exposed uninfected (HEU), and 216 HIV-unexposed infants were included. In period 2 (25-36 wk), 31 infants moved from the HEU group to the HIV-infected group. We compared weight velocity Z-scores (WVZ) and length velocity Z-scores (LVZ) by HIV group and assessed their independent influences. In period 1, mean WVZ (95% CI) was significantly (P < 0.001) lower in infected [-0.87 (-1.77, 0.04)] than HEU [0.81 (0.67, 0.94)] and unexposed [0.55 (0.33, 0.78)] infants. LVZ showed similar associations. In both periods, sick infants and those exposed to higher maternal viral loads had lower WVZ. Higher mean LVZ was associated with low birth weight. Infants that had received nevirapine had higher LVZ. In conclusion, HIV infection and not exposure was associated with low WVZ and LVZ in period 1. Eliminating infant HIV infection is a critical component in averting HIV-related poor growth patterns in infants in the first 6 mo of life.

Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation.

OBJECTIVE: To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea. DESIGN: We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence. SETTING: Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources. SUBJECTS: The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. RESULTS: In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels. CONCLUSIONS: This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

Incidence and course of child malnutrition according to clinical or anthropometrical assessment: a longitudinal study from rural DR Congo.

BACKGROUND: Longitudinal studies describing incidence and natural course of malnutrition are scarce. Studies defining malnutrition clinically [moderate clinical malnutrition (McM) marasmus, kwashiorkor] rather than anthropometrically are rare. Our aim was to address incidence and course of malnutrition among pre-schoolers and to compare patterns and course of clinically and anthropometrically defined malnutrition. METHODS: Using a historical, longitudinal study from Bwamanda, DR Congo, we studied incidence of clinical versus anthropometrical malnutrition in 5,657 preschool children followed 3-monthly during 15 months. RESULTS: Incidence rates were highest in the rainy season for all indices except McM. Incidence rates of McM and marasmus tended to be higher for boys than for girls in the dry season. Malnutrition rates increased from the 0-5 to the 6 - 11 months age category. McM and marasmus had in general a higher incidence at all ages than their anthropometrical counterparts, moderate and severe wasting. Shifts back to normal nutritional status within 3 months were more frequent for clinical than for anthropometrical malnutrition (62.2-80.3% compared to 3.4-66.4.5%). Only a minority of moderately stunted (30.9%) and severely stunted children (3.4%) shifted back to normal status. Alteration from severe to mild malnutrition was more characteristic for anthropometrically than for clinically defined malnutrition. CONCLUSIONS: Our data on age distribution of incidence and course of malnutrition underline the importance of early life intervention to ward off malnutrition. In principle, looking at incidence may yield different findings from those obtained by looking at prevalence, since incidence and prevalence differ approximately differ by a factor "duration". Our findings show the occurrence dynamics of general malnutrition, demonstrating that patterns can differ according to nutritional assessment method. They suggest the importance of applying a mix of clinical and anthropometric methods for assessing malnutrition instead of just one method. Functional validity of characterization of aspects of individual nutritional status by single anthropometric scores or by simple clinical classification remain issues for further investigation.

Child mortality as predicted by nutritional status and recent weight velocity in children under two in rural Africa.

WHO has released prescriptive child growth standards for, among others, BMI-for-age (BMI-FA), mid-upper arm circumference-for-age, and weight velocity. The ability of these indices to predict child mortality remains understudied, although growth velocity prognostic value underlies current growth monitoring programs. The study aims were first to assess, in children under 2, the independent and combined ability of these indices and of stunting to predict all-cause mortality within 3 mo, and second, the comparative abilities of weight-for-length (WFL) and BMI-FA to predict short-term (<3 mo) mortality. We used anthropometry and survival data from 2402 children aged between 0 and 24 mo in a rural area of the Democratic Republic of Congo with high malnutrition and mortality rates and limited nutritional rehabilitation. Analyses used Cox proportional hazard models and receiver operating characteristic curves. Univariate analysis and age-adjusted analysis showed predictive ability of all indices. Multivariate analysis without age adjustment showed that only very low weight velocity [HR = 3.82 (95%CI = 1.91, 7.63); P < 0.001] was independently predictive. With age adjustment, very low weight velocity [HR = 3.61 (95%CI = 1.80, 7.25); P < 0.001] was again solely retained as an independent predictor. There was no evidence for a difference in predictive ability between WFL and BMI-FA. This paper shows the value of attained BMI-FA, a marker of wasting status, and recent weight velocity, a marker of the wasting process, in predicting child death using the WHO child growth standards. WFL and BMI-FA appear equivalent as predictors.

Clinical and contextual determinants of anthropometric failure at baseline and longitudinal improvements after starting antiretroviral treatment among South African children.

OBJECTIVES: To describe baseline nutritional anthropometry and its determinants in a cohort of children commencing HAART, and subsequent longitudinal anthropometric trajectories over 2 years. METHODS: Prospective observational study in a prepubertal cohort of children commencing HAART in Durban, South Africa. RESULTS: Among 151 children with a median baseline age of 61.3 months (IQR 29.6, 90.1), prevalence of stunting was 54% (95% CI 46, 62) and of underweight, 37% (95% CI 29, 45). There was high prevalence of preceding respiratory and diarrhoeal comorbidities, which were associated with poorer anthropometry. There were significant improvements in height, weight and mid-upper-arm circumference z-scores after initiation of HAART regardless of preceding comorbidities. Stunted children remained shorter on average after 24 months, but younger children had better catch-up. Children who eventually died had persistently worse anthropometry. Children who were exposed to improved programs for prevention of mother-to-child transmission (PMTCT) were younger and had more severe growth impairments at baseline. CONCLUSION: Anthropometric status of children on HAART is influenced by age, preceding comorbidities, and by programmatic factors. With improved PMTCT programs, infants who would previously have died in infancy are now surviving to commence HAART. Poor outcomes are preceded by persistent anthropometric failure on HAART reaffirming the need for growth velocity monitoring.

Target weight gain for moderately wasted children during supplementation interventions--a population-based approach.

OBJECTIVE: In malnourished populations, the weight-for-height Z-score (WHZ) distribution is shifted to the left. The aim of nutrition interventions should be to restore a normal WHZ distribution for the whole population. The present paper examines the WHZ change needed by each individual to achieve this objective. DESIGN: We developed a mathematical model of required individual change in WHZ as a function of characteristics of the initial population to restore a normal distribution. This model was then tested by simulating WHZ change needed to restore a normal WHZ distribution in a test population. SETTING: A rural area of Democratic Republic of the Congo with a high prevalence of undernutrition. SUBJECTS: Children under 5 years of age. RESULTS: To restore a normal distribution for the whole population, the WHZ of all children should be shifted. The desired WHZ change of each individual should be higher when the individual's initial WHZ is low, when the mean WHZ of the whole population is low and, for the most wasted individual, when the variance of WHZ and WHZ change in the population are high. Using the suggested model in a simulation on the test population resulted in a WHZ distribution close to the growth standard. CONCLUSIONS: To restore a normal WHZ distribution in wasted populations, nutritional programmes should cover the whole population with a higher weight gain in areas where mean WHZ is low.

Sociodemographic, lifestyle, mental health and dietary factors associated with direction of misreporting of energy intake.

OBJECTIVE: To estimate the extent of under- and over-reporting, to examine associations with misreporting and sociodemographic and lifestyle characteristics and mental health status and to identify differential reporting in micro- and macronutrient intake and quality of diet. DESIGN: A health and lifestyle questionnaire and a semi-quantitative FFQ were completed as part of the 2007 Survey of Lifestyle, Attitudes and Nutrition. Energy intake (EI) and intake of micro- and macronutrients were determined by applying locally adapted conversion software. A dietary score was constructed to identify healthier diets. Accuracy of reported EI was estimated using the Goldberg method. ANOVA, χ2 tests and logistic regression were used to examine associations. SETTING: Residential households in Ireland. SUBJECTS: A nationally representative sample of 7521 adults aged 18 years or older. RESULTS: Overall, 33·2 % of participants were under-reporters while 11·9 % were over-reporters. After adjustment, there was an increased odds of under-reporting among obese men (OR = 2·01, 95 % CI 1·46, 2·77) and women (OR = 1·68, 95 % CI 1·23, 2·30) compared to participants with a healthy BMI. Older age, low socio-economic status and overweight/obesity reduced the odds of over-reporting. Among under-reporters, the percentage of EI from fat was lower and overall diet was healthier compared to accurate and over-reporters. The reported usage of salt, fried food consumption and snacking varied significantly by levels of misreporting. CONCLUSIONS: Patterns in differential reporting were evident across sociodemographic, lifestyle and mental health factors and diet quality. Consideration should be given to how misreporting affects nutrient analysis to ensure sound nutritional policy.

Challenging the role of social norms regarding body weight as an explanation for weight, height, and BMI misreporting biases: development and application of a new approach to examining misreporting and misclassification bias in surveys.

BACKGROUND: Cultural pressures to be thin and tall are postulated to cause people to misreport their body weight and height towards more socially normative (i.e., desirable) values, but a paucity of direct evidence supports this idea. We developed a novel non-linear approach to examining weight, height, and BMI misreporting biases and used this approach to examine the association between socially non-normative weight and misreporting biases in adults. METHODS: The Survey of Lifestyles, Attitudes, and Nutrition 2007 (SLÁN 2007), a nationally representative survey of the Republic of Ireland (N = 1942 analyzed) was used. Self-reported weight (height) was classified as under-reported by ≥ 2.0 kg (2.0 cm), over-reported by ≥ 2.0 kg (2.0 cm), or accurately reported within 2.0 kg (2.0 cm) to account for technical errors of measurement and short-term fluctuations in measured weight (height). A simulation strategy was used to define self-report-based BMI as under-estimated by more than 1.40 kg/m2, over-estimated by more than 1.40 kg/m2, or accurately estimated within 1.40 kg/m2. Patterns of biases in self-reported weight, height, and BMI were explored. Logistic regression was used to identify factors associated with mis-estimated BMI and to calculate adjusted odds ratios (AOR) and 99% confidence intervals (99%CI). RESULTS: The patterns of bias contributing the most to BMI mis-estimation were consistently, in decreasing order of influence, (1) under-reported weight combined with over-reported height, (2) under-reported weight with accurately reported height, and (3) accurately reported weight with over-reported height. Average bias in self-report-based BMI was -1.34 kg/m2 overall and -0.49, -1.33, and -2.66 kg/m2 in normal, overweight, and obese categories, respectively. Despite the increasing degree of bias with progressively higher BMI categories, persons describing themselves as too heavy were, within any given BMI category, less likely to have under-estimated BMI (AOR 0.5, 99%CI: 0.3-0.8, P < 0.001), to be misclassified in a lower BMI category (AOR 0.3, 99%CI: 0.2-0.5, P < 0.001), to under-report weight (AOR 0.5, 99%CI: 0.3-0.7, P < 0.001), and to over-report height (OR 0.7, 99%CI: 0.6-1.0, P = 0.007). CONCLUSIONS: A novel non-linear approach to examining weight, height, and BMI misreporting biases was developed. Perceiving oneself as too heavy appears to reduce rather than exacerbate weight, height, and BMI misreporting biases.

Post-partum weight change patterns in the WHO Multicentre Growth Reference Study.

The interplay of factors that affect post-partum loss or retention of weight gained during pregnancy is not fully understood. The objective of this paper is to describe patterns of weight change in the six sites of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) and explore variables that explain variation in weight change within and between sites. Mothers of 1743 breastfed children enrolled in the MGRS had weights measured at days 7, 14, 28 and 42 post-partum, monthly from 2 to 12 months and bimonthly thereafter until 24 months post-partum. Height, maternal age, parity and employment status were recorded and breastfeeding was monitored throughout the follow-up. Weight change patterns varied significantly among sites. Ghanaian and Omani mothers lost little or gained weight post-partum. In Brazil, India, Norway and USA, mothers on average lost weight during the first year followed by stabilization in the second year. Lactation intensity and duration explained little of the variation in weight change patterns. In most sites, obese mothers tended to lose less weight than normal-weight mothers. In Brazil and Oman, primiparous mothers lost about 1 kg more than multiparous mothers in the first 6 months. In India and Ghana, multiparous mothers lost about 0.6 kg more than primiparas in the second 6 months. Culturally defined mother-care practices probably play a role in weight change patterns among lactating women. This hypothesis should stimulate investigation into gestational weight gain and post-partum losses in different ethnocultural contexts.

Effect on longitudinal growth and anemia of zinc or multiple micronutrients added to vitamin A: a randomized controlled trial in children aged 6-24 months.

BACKGROUND: The benefits of zinc or multiple micronutrient supplementations in African children are uncertain. African children may differ from other populations of children in developing countries because of differences in the prevalence of zinc deficiency, low birth weight and preterm delivery, recurrent or chronic infections such as HIV, or the quality of complementary diets and genetic polymorphisms affecting iron metabolism.The aim of this study was to ascertain whether adding zinc or multiple micronutrients to vitamin A supplementation improves longitudinal growth or reduces prevalence of anemia in children aged 6-24 months. METHODS: Randomized, controlled double-blinded trial of prophylactic micronutrient supplementation to children aged 6-24 months. Children in three cohorts - 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers, and 187 uninfected children born to HIV-uninfected mothers - were separately randomly assigned to receive daily vitamin A (VA) [n = 124], vitamin A plus zinc (VAZ) [n = 123], or multiple micronutrients that included vitamin A and zinc (MM) [n = 126]. RESULTS: Among all children there were no significant differences between intervention arms in length-for-age Z scores (LAZ) changes over 18 months. Among stunted children (LAZ below -2) [n = 62], those receiving MM had a 0.7 Z-score improvement in LAZ versus declines of 0.3 in VAZ and 0.2 in VA (P = 0.029 when comparing effects of treatment over time). In the 154 HIV-uninfected children, MM ameliorated the effect of repeated diarrhea on growth. Among those experiencing more than six episodes, those receiving MM had no decline in LAZ compared to 0.5 and 0.6 Z-score declines in children receiving VAZ and VA respectively (P = 0.06 for treatment by time interaction). After 12 months, there was 24% reduction in proportion of children with anemia (hemoglobin below 11 g/dL) in MM arm (P = 0.001), 11% in VAZ (P = 0.131) and 18% in VA (P = 0.019). Although the within arm changes were significant; the between-group differences were not significant. CONCLUSIONS: Daily multiple micronutrient supplementation combined with vitamin A was beneficial in improving growth among children with stunting, compared to vitamin A alone or to vitamin A plus zinc. Effects on anemia require further study. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, number. NCT00156832.

Prevalence of the metabolic syndrome and its components in relation to socioeconomic status among Jamaican young adults: a cross-sectional study.

BACKGROUND: The metabolic syndrome has a high prevalence in many countries and has been associated with socioeconomic status (SES). This study aimed to estimate the prevalence of the metabolic syndrome and its components among Jamaican young adults and evaluate its association with parental SES. METHODS: A subset of the participants from the 1986 Jamaica Birth Cohort was evaluated at ages 18-20 years between 2005 and 2007. Trained research nurses obtained blood pressure and anthropometric measurements and collected a venous blood sample for measurement of lipids and glucose. Prevalence of the metabolic syndrome and its components were estimated using the 2009 Consensus Criteria from the International Diabetes Federation, National Heart Lung and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity. SES was assessed by questionnaire using occupation of household head, highest education of parent/guardian, and housing tenure of parent/guardian. Analysis yielded means and proportions for metabolic syndrome variables and covariates. Associations with levels of SES variables were obtained using analysis of variance. Multivariable analysis was conducted using logistic regression models. RESULTS: Data from 839 participants (378 males; 461 females) were analyzed. Prevalence of the metabolic syndrome was 1.2% (95% confidence interval [95%CI] 0.5%-1.9%). Prevalence was higher in females (1.7% vs. 0.5%). Prevalence of the components [male: female] were: central obesity, 16.0% [5.3:24.7]; elevated blood pressure, 6.7% [10.8:3.3]; elevated glucose, 1.2% [2.1:0.4]; low HDL, 46.8% [28.8:61.6]; high triglycerides, 0.6% [0.5:0.6]. There were no significant differences in the prevalence of the metabolic syndrome for any of the SES measures used possibly due to lack of statistical power. Prevalence of central obesity was inversely associated with occupation (highly skilled 12.4%, skilled 13.5%, semi-skilled/unskilled 21.8%, p = 0.013) and education (tertiary 12.5%, secondary 14.1%, primary/all-age 28.4%, p = 0.002). In sex-specific multivariate logistic regression adjusted for hip circumference, central obesity remained associated with occupation and education for women only. CONCLUSION: Prevalence of the metabolic syndrome is low, but central obesity and low HDL are present in 16% and 47% of Jamaican youth, respectively. Central obesity is inversely associated with occupation and education in females.

Incidence and duration of severe wasting in two African populations.

OBJECTIVE: The present study aimed to compare two situations of endemic malnutrition among <5-year-old African children and to estimate the incidence, the duration and the case fatality of severe wasting episodes. DESIGN: Secondary analysis of longitudinal studies, conducted several years ago, which allowed incidence and duration to be calculated from transition rates. The first site was Niakhar in Senegal, an area under demographic surveillance, where we followed a cohort of children in 1983-5. The second site was Bwamanda in the Democratic Republic of Congo, where we followed a cohort of children in 1989-92. Both studies enrolled about 5,000 children, who were followed by routine visits and systematic anthropometric assessment, every 6 months in the first case and every 3 months in the second case. RESULTS: Niakhar had less stunting, more wasting and higher death rates than Bwamanda. Differences in cause-specific mortality included more diarrhoeal diseases, more marasmus, but less malaria and severe anaemia in Niakhar. Severe wasting had a higher incidence, a higher prevalence and a more marked age profile in Niakhar. However, despite the differences, the estimated mean durations of episodes of severe wasting, calculated by multi-state life table, were similar in the two studies (7.5 months). Noteworthy were the differences in the prevalence and incidence of severe wasting depending on the anthropometric indicator (weight-for-height Z-score

Fast-food and sweetened beverage consumption: association with overweight and high waist circumference in adolescents.

OBJECTIVE: Overweight and obesity have increased to epidemic proportions among adolescents and are associated with chronic non-communicable diseases and excess mortality in adulthood. The association of overweight/obesity with poor dietary habits has not been studied in adolescents in middle-income developing countries. The present study aimed to estimate the prevalence of overweight, obesity and high waist circumference (WC) in 15-19-year-old Jamaican adolescents and to investigate the association with fast-food and sweetened beverage consumption. DESIGN: The study enrolled 1317 (598 male, 719 female) adolescents aged 15-19 years using multistage, nationally representative sampling. Age-specific prevalence calculation used internal Z-score lines connecting with the WHO adult cut-off points. Logistic regression was used to examine the association of overweight or high WC with fast-food and sweetened beverage consumption, adjusting for potential confounders. RESULTS: The overall prevalence of overweight, obesity and high WC was approximately 15 %, 6 % and 10 %, respectively. Prevalence estimated using internal Z-scores was similar to that using the International Obesity Taskforce cut-off points. Obesity (8.0 % in females, 3.3 % in males) and high WC (16.2 % in females, 1.7 % in males) were significantly more prevalent in females when using internal Z-score cut-offs. High WC was associated with the absence of fruit consumption (P = 0.043) and overweight with high sweetened beverage consumption (P = 0.018). CONCLUSION: Overweight occurs frequently among Jamaican 15-19-year-olds and is associated with increased consumption of sweetened beverages. High WC is more prevalent among females and is related to low consumption of fruits and vegetables. Measures to reduce the consumption of sweetened beverages and increase fruit intake may reduce the prevalence of excess body fat among adolescents.

HIV infection is associated with decreased dietary diversity in South African children.

Little is known about dietary diversity of children residing in areas of high HIV prevalence. This study examined dietary diversity in 381 children ages 6-24 mo in rural South Africa. Twenty-eight (7.3%) children and 170 mothers (44.6%) were HIV infected. Home visits were conducted weekly and a detailed history of dietary intake obtained. A dietary diversity score was computed based on the weekly consumption of 8 food classes. Low dietary diversity was defined as falling within the lowest quartile of the diversity scale. There were 22,772 child weeks of observation: 1369 for HIV-infected children, 8876 for HIV-uninfected children born to HIV-infected mothers, and 12,527 for HIV-uninfected children born to HIV-uninfected mothers. Low dietary diversity was more common in HIV-infected children [crude odds ratio (OR), 2.59; 95% CI, 1.52 to 4.41) compared with children born to HIV-uninfected mothers. In a multiple logistic regression analysis adjusting for socioeconomic and health status, HIV-infected children had lower dietary diversity (conditional OR, 1.76; 95% CI, 1.06 to 2.94) than HIV-uninfected children. HIV-infected children consumed less in 6 of 8 food classes compared with HIV-uninfected children, with the 2 exceptions being breast milk and formula milk. In rural South Africa, HIV-infected children's diets are significantly less diverse than those of HIV-uninfected children. This may be a factor contributing to increased morbidity and poorer survival in these children.

Correction to: Effects of early feeding on growth velocity and overweight/obesity in a cohort of HIV unexposed South African infants and children.

[This corrects the article DOI: 10.1186/s13006-015-0041-x.].