Prevalence and Correlates of Double and Triple Burden of Malnutrition Among Children and Adolescents in India: The Comprehensive National Nutrition Survey.

BACKGROUND: Limited information on the co-prevalence of undernutrition, micronutrient deficiencies, overnutrition, and abnormal levels of noncommunicable disease biomarkers at the same time in children and adolescents in India hinders efforts to comprehensively address their health. OBJECTIVES: This study aimed to examine the prevalence and correlates of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) among children and adolescents (5-19 y) to inform policies and programs. METHODS: A total of 17,599 children (5-9 y) and 16,184 adolescents (10-19 y) with available biomarker data from the Comprehensive National Nutrition Survey were included. Malnutrition was defined based on either undernutrition based on anthropometry, overnutrition/abnormal metabolic markers, and anemia/micronutrient deficiency. DBM was defined as the coexistence of any 2 forms of malnutrition. DBM+ was defined as the coexistence of undernutrition and/or micronutrient deficiency along with overnutrition. TBM was defined as having the coexistence of all 3 forms of malnutrition. The prevalence of DBM, DBM+, and TBM was estimated accounting for probabilistic selection. We used mixed-effect binomial regression to determine correlates of DBM/TBM in children and adolescents separately. RESULTS: The prevalence of DBM, DBM+, and TBM was 50.8%, 37.2%, and 14.4%, respectively, in children and 53.4%, 36.1%, and 12.7%, respectively, in adolescents. The prevalence of DBM+ was significantly higher in girls compared to in boys in the 5-9 y age group. In children, being in a disadvantaged caste group, having a lower wealth index, having inadequate diet diversity, having no maternal schooling, and having a recent history of acute illness were associated with DBM. In adolescents, being in a disadvantaged caste group, maternal occupation, and lower paternal age were correlated with DBM. A similar set of variables was associated with TBM in both age groups. CONCLUSIONS: The prevalence of DBM and TBM is substantial in children and adolescents in India and varies across states. Socioeconomic factors and acute illness were the main correlates for DBM and TBM.

Iodine intake in the Swiss population 100 years after the introduction of iodised salt: a cross-sectional national study in children and pregnant women.

PURPOSE: The Swiss voluntary salt iodisation programme has successfully prevented iodine deficiency for 100 years, but dietary habits are changing and today only one-third of processed foods contain iodised salt. We aimed to monitor the current iodine status in children and pregnant women. METHODS: We conducted a nationwide cross-sectional study in children (6-12 years) and pregnant women and measured the urinary iodine concentration (UIC) in spot urine samples. We estimated the iodine intake using UIC and urinary creatinine concentration (UCC) and determined the prevalence of intakes below the average requirement (AR) using the SPADE method. We measured dried blood spot (DBS) thyroglobulin (Tg), TSH and total T4 in pregnant women. RESULTS: The median UIC was 127 µg/L (bootstrapped 95% CI 119, 140, n = 362) in children and 97 µg/L (bootstrapped 95% CI 90, 106, n = 473) in pregnant women. The estimated prevalence of inadequate iodine intake (< 65 µg/day) was 5.4% (bootstrapped 95% CI 0.0, 14.6) in children. Half (47%) of the women consumed iodine-containing multivitamin and mineral supplements (≥ 150 µg/day). Compared to non-users, users had higher median UIC (129 vs. 81 µg/L, P < 0.001), lower prevalence of inadequacy (< 160 µg/day; 0.2 vs. 31%) and lower DBS-Tg (23 vs. 29 µg/L, P < 0.001). All women were euthyroid. CONCLUSIONS: The Swiss diet and current salt fortification provides adequate iodine intake in children, but not in all pregnant women. Iodine supplements cover the dietary gap in pregnancy but are not universally consumed. Therefore, improved use of iodised salt in processed foods is desired to ensure adequate iodine intake in all population groups. This trial was registered at clinicaltrials.gov as NCT04524013.

Reactance inversion in moderate to severe persistent asthma: low birth weight, prematurity effect, and bronchodilator response.

INTRODUCTION: Reactance inversion (RI) has been associated with impaired peripheral airway function in persistent asthma. However, there is little to no data about the difference between asthmatic children with and without RI. This study aimed to detect clinical and lung function differences in moderate-severe asthmatic children with and without RI. METHODS: This study was conducted between 2021 and 2022 in asthmatic school-age children. Impulse oscillometry (IOS) and spirometry were performed according to ATS/ERS standards. RESULTS: A total of 62 patients, with a mean age of 8.4 years, 54.8% were males and were divided into three groups: group 1 (32.3%) with no RI, group 2 (27.4%) with RI but disappearing after bronchodilator test and group 3 (40.3%) with persistent RI after bronchodilator test. Children in groups 2 and 3 had significantly lower birth weights than in group 1. Group 2 had lower gestational age compared to group 1. FEV1 and FEF25-75 of forced vital capacity were significantly lower in groups 2 and 3. In group 3, R5, AX, R5-20, and R5-R20/R5 ratios were significantly higher. Bronchodilator responses (BDR) in X5c, AX, and R5-R20 were significantly different between groups and lower in group 3. CONCLUSION: RI is frequently found in children with moderate-severe persistent asthma, particularly in those with a history of prematurity or low birth weight. In some patients, RI disappears after the bronchodilator test; however, it, persists in those with the worst pulmonary function. RI could be a small airway dysfunction marker.

Learning to read may help promote attention by increasing the volume of the left middle frontal gyrus and enhancing its connectivity to the ventral attention network.

Attention and reading are essential skills for successful schooling and in adult life. While previous studies have documented that attention development supports reading acquisition, whether and how learning to read may improve attention among school-age children and the brain structural and functional development that may be involved remain unknown. In this prospective longitudinal study, we examined bidirectional and longitudinal predictions between attention and reading development and the neural mediators of attention and reading development among school-age children using cross-lagged panel modeling. The results showed that better baseline reading performance significantly predicted better attention performance one year later after controlling for baseline attention performance. In contrast, after controlling for baseline reading performance, attention did not significantly predict reading performance one year later, while more attention problems also significantly predicted worse reading performance. Both the increasing gray matter volume of the left middle frontal gyrus and the increasing connectivity between the left middle frontal gyrus and the ventral attention network mediated the above significant longitudinal predictions. This study, directly revealed that reading skills may predict the development of important cognitive functions, such as attention, in school-age children. Therefore, learning to read is not only a challenge for school-age children but is also an important way to optimize attention and brain development.

Understanding health behaviors that modify the risk for obesity in ADHD.

OBJECTIVE: Research provides support for the associated risk of inadequate sleep duration, limited physical activity, and excessive media use in attention-deficit/hyperactivity disorder (ADHD) and obesity. The present study aims to (1) examine the association between ADHD and overweight or obese status (OW/OB); (2) comprehensively examine sleep duration, physical activity, and media use as potential moderators of OW/OB; and (3) examine the moderating effects of these health behaviors cross-sectionally by comparing medicated youth with ADHD, unmedicated youth with ADHD, and youth without ADHD. METHODS: Data were acquired from the 2018 and 2019 National Survey of Children's Health, a nationally representative survey of caregivers conducted across the United States. The current study used data for youth 11-17 years old with a final sample size of 26,644. Hours of sleep, physical activity, and media use per day were dichotomized based on national recommendation guidelines for each health behavior (i.e., either meeting or not meeting guidelines). RESULTS: The OW/OB prevalence rate was 7% greater among unmedicated youth with ADHD than among medicated youth with ADHD. Medicated youth with ADHD and peers without ADHD had similar OW/OB rates. Among medicated youth with ADHD, physical activity, sleep duration, and media use did not contribute to OW/OB risk after controlling for family poverty level. However, among unmedicated youth with ADHD, meeting sleep duration guidelines was linked to a lower OW/OB risk. CONCLUSION: Overall, findings suggest that clinical providers and parents may wish to prioritize improved sleep duration in the management of OW/OB risk in youth with ADHD.

Optimism, pessimism, and physical health among youth: a scoping review.

OBJECTIVE: High levels of optimism (and low levels of pessimism) are associated with improved physical health in adults. However, relatively less is known about these relations in youth. The present study aimed to review the literature investigating optimism, pessimism, and physical health in children and adolescents from populations with and without health conditions. METHODS: We conducted a scoping review up until February 2024. Studies were included if they sampled youth (average age ≤18 years) and treated optimism or pessimism as predictors of health behaviors or outcomes. Data on study and sample characteristics, health outcome, optimism construct, and findings were extracted from eligible papers and results were synthesized. RESULTS: Sixty studies were retained. Most studies were conducted in North America, with adolescents, and used cross-sectional designs and self-reported measures of health. Measures of optimism and pessimism differed across studies. Roughly one-third of studies sampled medical populations. Health categories included substance use, diet and physical activity, sexual health practices, medical adherence, other health behaviors, cardiometabolic health, subjective health/health-related quality of life, pain, sleep, and oral health. Generally, we observed adaptive associations between optimism and health. Higher optimism and lower pessimism were most consistently associated with lower rates of substance use and lower cardiometabolic risk. CONCLUSIONS: The presence of optimism or the absence of pessimism appears to be associated with various adaptive health outcomes among youth with and without health conditions. Developmental, methodological, and clinical considerations for future research are discussed, such as conducting longitudinal studies with objective measures of health and psychometrically validated instruments.

Exploring Differences in Physical Health in Young Children With and Without ADHD.

OBJECTIVE: To assess differences in child physical health outcomes and metrices associated with obesity in a sample of predominantly Hispanic/Latinx young children with and without attention-deficit/hyperactivity disorder (ADHD). METHODS: Participants included 127 children diagnosed with ADHD and 96 typically developing (TD) children between 4 and 7 years of age. Objective measures of children's body composition, fitness, and physical activity were conducted. Parents of children completed food recalls to assess their child's dietary intake, diet quality was calculated based on the Healthy Eating Index-2015, and parents completed a survey about their family's health habits. RESULTS: Logistic regression revealed that those with ADHD were more likely to be classified as having an overweight or obese (Ov/O) body mass index (BMI). Linear regression analyses indicated that children with ADHD performed worse on a fitness test and consumed more calories relative to TD children. Moderation analyses indicated that sex differences in steps were prominent in our TD sample, but not among those with ADHD. CONCLUSIONS: Young children with ADHD are at greater risk for having an Ov/O BMI, being less fit, and eating a greater intake of calories compared to TD children.

Perceived acceptability and appropriateness of a web-based program targeting risk for anxiety in young children and their parents.

OBJECTIVE: This mixed-methods study examined perceived acceptability and appropriateness of a novel digital mental health program targeting anxiety risk (i.e., perfectionism or error sensitivity) in 5-to-7-year-old children and their parents. METHODS: Parent-child dyads participated in a modular, web-based cognitive-behavioral program targeting negative overreactions to making mistakes. The program, "Making Mistakes", consisted of a 6-month series of short video clips, journaling activities, and weekly reminders, and modules were delivered to caregivers and children separately. 86 dyads completed self-report measures, 18 of whom participated in semi-structured interviews, following completion of the primary program module. A standard thematic analysis was used to elucidate themes from the parent and child interview content. RESULTS: Our quantitative and qualitative results were generally aligned. Children and parents viewed the novel digital mental health program as acceptable and appropriate, favoring the cognitive behavioral strategies such as modeling positive reactions to mistakes, responding positively to child mistakes, and emphasizing effort over outcome. Participants also provided helpful feedback related to program content, delivery, and engagement, as well as suggestions to enhance the program. CONCLUSIONS: Findings have implications for design and content features of parent-based and dyad-based programs, as well as digital mental health programs focused on reducing anxiety risk.

Hot and cool executive function in the development of behavioral problems in grade school.

Despite the well-established link between children's executive function and behavioral adjustment, it remains unclear whether the hot and cool aspects of executive function are uniquely associated with children's behavioral problems. Using longitudinal data spanning in the grade school (N = 1,140), this study aimed to examine whether hot and cool executive function skills may be uniquely related to the development of behavioral problems. Hot and cool executive function skills were measured with tasks, standardized tests, and questionnaires at 54 months and in the first grade, respectively. Internalizing and externalizing problems were evaluated by teachers using questionnaires throughout the grade school. The results indicated that, independent of each other, hot and cool executive function skills were uniquely and negatively related to the development of internalizing and externalizing problems over time at the between-individual level, adjusting for within-individual fluctuations. Moreover, internalizing and externalizing problems were positively related at the between-individual level across the grade school. Findings provide needed evidence to clarify the relations between hot and cool executive function and children's behavioral problems, emphasizing the importance of both aspects of executive function in understanding the development of behavioral problems in school-age children.

Impact of wearing dual-focus soft contact lenses on myopia progression: a one-year randomized clinical trial in Chinese school-age children.

BACKGROUND: Myopia is prevalent in China; however, trials involving Chinese children wearing dual-focus soft contact lenses (DFSCL) are limited. Thus, the purpose of this study is to investigate the efficacy of DFSCL among Chinese school-age children. METHODS: Sixty-four children aged 8-12 years with spherical equivalent refraction (SER) between - 0.75D and - 4.00D were recruited in this randomized controlled clinical study. The control group (32 subjects) wore single-vision spectacles (SVS), while the DFSCL group (32 subjects) wore daily disposable + 2.00 D defocus MiSight DFSCL. Follow-up examinations were performed every 3 months to compare the axial length (AL) growth and SER change between the groups for a period of 12 months by using the independent samples t-test or the Mann-Whitney U test. Statistical differences with a P < 0.05, when compared to the control group, are considered indicative of an effective intervention. Multivariate analysis and regression analysis were used to eliminate the effects of confounding factors on the results. RESULTS: A total of 58 subjects, with 30 in the SVS group and 28 in the DFSCL group, completed the follow-up. After adjusting for baseline age, gender, AL and SER, AL growth was 0.33 ± 0.02 mm in the SVS group and 0.23 ± 0.03 mm in the DFSCL group (P = 0.004). SER change was - 0.53 ± 0.06 in the SVS group and - 0.44 ± 0.06 in the DFSCL group (P = 0.308). In the DFSCL group, AL and SER increased 0.11 mm and 0.09 D less than in the SVS group, respectively. Moreover, initial wear of DFSCL may cause occasional blurriness in near vision, and prolonged wear may lead to increased ocular discomfort symptoms such as dryness, itchiness, and foreign body sensation. CONCLUSION: MiSight DFSCL showed a reduction in AL growth during the first three months of wear. However, no significant benefits were observed during the subsequent nine months. No significant differences in the changes of SER were found. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2200064731. Registered 15 October 2022, http://www.chictr.org.cn/.

Children's evaluations of culturally diverse lunchbox foods.

Previous research indicates that children make ingroup-outgroup judgments based on notions of food conventionality and that ethnic minority children have been teased or bullied for bringing non-conventional foods to school. This series of three studies experimentally investigated U.S. school-age children's evaluations of culturally diverse lunchbox foods. Study 1 examined an online sample of children aged 5 to 12 years and their evaluations of foods from four cultures (mainstream American, Chinese, Indian, and Mexican) on the taste, smell, and messiness of the food, the appropriateness of bringing the food to school, and whether "cool kids" eat the food. Compared with the mainstream American lunchbox, children rated the Chinese, Indian, and Mexican lunchboxes as less tasty, more messy, and less likely that cool kids would bring those foods to school. In Studies 2 and 3, we examined children's behavioral choices in a hypothetical cafeteria. In both studies, we found that the match between children's own lunch preferences and what was displayed in the mainstream American lunchbox was the only predictor of children's choice to sit at the table with the American lunchbox. Individual variables (e.g., child age, food pickiness) and contextual variables (e.g., neighborhood diversity) did not predict children's table choices. This research highlights children's understanding of familiarity and conventionality of foods and the social consequences of their behavioral choices.

A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. OBJECTIVE: The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. METHODS: This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. RESULTS: Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants' average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (ß=-12.203, 95% CI -17.882 to -6.523; P<.001), owing to lower scores on the subscales Inattention (ß=-3.966, 95% CI -6.285 to -1.647; P<.001), Hyperactivity/Impulsivity (ß=-5.735, 95% CI -8.334 to -3.137; P<.001), and Oppositional Defiant Disorder (ß=-2.995, 95% CI -4.857 to -1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (ß=-6.312, 95% CI -10.973 to -1.650; P=.006) and Global Executive Composite (ß=-5.952, 95% CI -10.214 to -1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. CONCLUSIONS: This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806.

Different time courses of maturation for learning and generalization following auditory training in children.

OBJECTIVE: We recently demonstrated that learning abilities among school-age children vary following frequency discrimination (FD) training, with some exhibiting mature adult-like learning while others performing poorly (non-adult-like learners). This study tested the hypothesis that children's post-training generalisation is related to their learning maturity. Additionally, it investigated how training duration influences children's generalisation, considering the observed decrease with increased training in adults. DESIGN: Generalisation to the untrained ear and untrained 2000 Hz frequency was assessed following single-session or nine-session 1000 Hz FD training, using an adaptive forced-choice procedure. Two additional groups served as controls for the untrained frequency. STUDY SAMPLE: Fifty-four children aged 7-9 years and 59 adults aged 18-30 years. RESULTS: (1) Only adult-like learners generalised their learning gains across frequency or ear, albeit less efficiently than adults; (2) As training duration increased children experienced reduced generalisation, similar to adults; (3) Children's performance in the untrained tasks correlated strongly with their trained task performance after the first training session. CONCLUSIONS: Auditory skill learning and its generalisation do not necessarily mature contemporaneously, although mature learning is a prerequisite for mature generalisation. Furthermore, in children, as in adults, more practice makes rather specific experts. These findings should be considered when designing training programs.

Recognition of Dynamic Emotional Expressions in Children and Adults and Its Associations with Empathy.

This present study investigates emotion recognition in children and adults and its association with EQ and motor empathy. Overall, 58 children (33 5-6-year-olds, 25 7-9-year-olds) and 61 adults (24 young adults, 37 parents) participated in this study. Each participant received an EQ questionnaire and completed the dynamic emotion expression recognition task, where participants were asked to identify four basic emotions (happy, sad, fearful, and angry) from neutral to fully expressed states, and the motor empathy task, where participants' facial muscle activity was recorded. The results showed that "happy" was the easiest expression for all ages; 5- to 6-year-old children performed equally well as adults. The accuracies for "fearful," "angry," and "sad" expressions were significantly lower in children than in adults. For motor empathy, 7- to 9-year-old children exhibited the highest level of facial muscle activity, while the young adults showed the lowest engagement. Importantly, individual EQ scores positively correlated with the motor empathy index in adults but not in children. In sum, our study echoes the previous literature, showing that the identification of negative emotions is still difficult for children aged 5-9 but that this improves in late childhood. Our results also suggest that stronger facial mimicry responses are positively related to a higher level of empathy in adults.

Assessment of attention-deficit / hyperactivity disorder signs among Palestinian school-age children.

PURPOSE: The study aimed to identify the prevalence of Attention-Deficit / Hyperactivity Disorder (ADHD) signs exhibited in Palestinian school-age students while comparing their sociodemographic characteristics. DESIGN AND METHODS: A cross-sectional descriptive correlation study was conducted. The study included children aged 6-12 in West Bank schools, without a previous ADHD diagnoses or other neurodevelopmental disorders. This study used a parent questionnaire with three sections: child's sociodemographic data, parents' data, and Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), which has a Cronbach's alpha values of 0.94 for total ADHD. All collected data were analyzed using SPSS version 25, with confidence interval of 95 %. RESULTS: A total 487 school-aged children participated in the study (46.4 % females and 53.6 % males). The results showed that 8.7 % of the children exhibited ADHD signs, with ADHD-I being the most prevalent subtype (3.3 %). Significant associations were found between ADHD signs and the following factors: males (P = 0.003); children with lower academic averages (less than 79.9 %) (P = 0.000); children speaking only one language (P = 0.002); children of mothers exposed to tobacco during pregnancy (P = 0.004); children whose mothers faced complications during pregnancy (P = 0.000); children whose mothers were 19 years old or younger at childbirth scores (P = 0.05); and children with relatives having ADHD (P = 0.000). No significant associations were found with variables such as child's age, birth weight, gestational age, number of countries lived in, school class, place of residency, parents' marital status, educational level, employment status, average income, number of children, or child's birth order. A moderate negative correlation was found between ADHD signs and poor academic performance (r = -0.169, P = 0.000). CONCLUSION: The study found a significant prevalence of ADHD signs in Palestinian school-age children (8.7 %), with ADHD-I having the highest prevalence. Risk factors included gender, languages, maternal exposure to tobacco, maternal complications, mother's age, and relatives with ADHD. Early detection is crucial to mitigate its impact on academic performance. PRACTICE IMPLICATIONS: Nurses play a crucial role in managing ADHD in school-aged children. They conduct educational programs, early screening programs, and work with a multidisciplinary team to evaluate and monitor suspected ADHD cases. They also advocate for research and policy development to improve ADHD care and outcomes. This ensures children receive necessary treatment and support services.

The lived experience of mothers caring for school-age children with Pompe disease: A qualitative study.

PURPOSE: To explore the lived experiences of mothers caring for school-age children with Pompe disease. DESIGN AND METHODS: A qualitative study using a descriptive phenomenology approach. Semi-structured interviews were conducted from October to December 2022 with 10 mothers of school-age children diagnosed with Pompe disease, which were identified through the Taiwan Pompe Disease Association. Colaizzi's phenomenological method was employed for data analysis. RESULTS: The study identified five themes in the caregiving experiences of mothers: 1. unwavering parenting beliefs; 2. child-centric approach; 3. focus on peer relationships and coping strategies; 4. integration of learning, treatment, and rehabilitation; and 5. embracing and navigating life's challenges. Mothers balanced education, treatment, and rehabilitation for their children with Pompe disease, offering perspectives into the caregiving experience. CONCLUSIONS: This study highlights the complex experiences of mothers caring for children with Pompe disease, emphasizing the importance of comprehensive support. PRACTICE IMPLICATIONS: Insights into the perspectives of mothers can aid health-care professionals in understanding the challenges faced by families with children diagnosed with Pompe disease and can enable the development of strategies for providing comprehensive psychological support to improve mental health outcomes for these children and their families. Increased awareness among health-care professionals and in the society leads to an informed and empathetic approach to addressing the unique challenges faced by children with Pompe disease and their families.

Nutritional status of school-age children (5-19 years) in South Asia: A scoping review.

Information on malnutrition for school-age children and adolescents (5-19 years) in South Asia is fragmented and inconsistent, which limits the prioritization of nutrition policies, programmes and research for this age group. This scoping review aimed to synthesize existing evidence on the burden of malnutrition for children and adolescents aged 5-19 years in South Asia, and on interventions to improve their nutritional status. Cochrane Library, EMBASE, Medline and Google Scholar were systematically searched for articles published between January 2016 and November 2022. Eligible studies reported the prevalence of undernutrition, overweight/obesity, micronutrient deficiencies and unhealthy dietary intakes, and interventions that aimed to address these in South Asia. In total, 296 articles met our inclusion criteria. Evidence revealed widespread, yet heterogeneous, prevalence of undernutrition among South Asian children and adolescents: thinness (1.9%-88.8%), wasting (3%-48%), underweight (9.5%-84.4%) and stunting (3.7%-71.7%). A triple burden of malnutrition was evident: the prevalence of overweight and obesity ranged from 0.2% to 73% and 0% to 38% (with rapidly rising trends), respectively, alongside persistent micronutrient deficiencies. Diets often failed to meet nutritional requirements and high levels of fast-food consumption were reported. Education, fortification, supplementation and school feeding programmes demonstrated beneficial effects on nutritional status. Comprehensive and regular monitoring of all forms of malnutrition among children and adolescents, across all countries in South Asia is required. Further, more large-scale intervention research is needed to ensure policy and programmes effectively target and address malnutrition among children and adolescents in South Asia.

The use of differing verb types in the oral narratives of school-age children.

The aim of this project was to examine age-related use of action, metacognitive, and metalinguistic verbs because factors related to verb transparency are thought to impact word learning. Performance on fictional, oral narratives elicited using a single-episode picture was evaluated for 84 children with typical language (TL) and 38 age-matched children with a Developmental Language Disorder (DLD) ranging in age from 5;1 to 14;4 years of age. Narrative samples were transcribed and coded for occurrences of action verbs (AV), metacognitive verbs (MCV), and metalinguistic verbs (MLV). The total number of verbs used and the number of different verbs produced in each category were examined across ages, as was the difference in verb usage patterns across language ability groups. A statistically significant increase in the overall use of action, MCV, and MLV with age was observed. TL children used a wider variety of each verb type as compared to those with DLD. Age-related progression for verb use was observed in the fictional narrative generation task by both groups of children. However, despite similar rates of total verb use, children with DLD produced fewer different verbs in the three categories. These findings indicate the total number of verbs used is similar in children with TL and DLD, but there is a difference in the number of different verbs used in functional tasks such as narratives for children with DLD. These results also indicate a need for ongoing examination of the factors not only impacting verb acquisition but also use in communication tasks.

A comparison of narrative abilities in Malay school-age typically developing children and children with developmental language disorder.

Research on narrative skills in the Malay language is scarce for both typically developing (TD) and children with Developmental Language Disorders (DLD). This study examines the differences in narrative abilities of Malay-speaking school-age children with and without DLD. Fifteen Malay-speaking TD children and 15 children with DLD told four stories elicited using the Multilingual Assessment Instrument for Narrative (MAIN). Group comparisons were conducted in narrative production (story retelling and story generation) as well as in comprehension. We also examined the differences in both groups' story complexity (e.g. the combination of goals (G), attempts (A) and outcomes (O)). General microstructure features such as the total number of words (TNW), total number of sentences (TNS) and total number of different words (NDW) were also investigated. TD children outperformed children with DLD in both narrative production and comprehension performances. TD children constructed a higher combination of G, A, and O components than children with DLD. Children with DLD frequently produced G, A, and O in isolation in comparison to TD children. In language productivity and lexical complexity, TD children had a significantly higher frequency in TNW and NDW than children with DLD, resulting in longer narratives and higher uses of different words than children with DLD. Distinct differences are found in the narrative profile of TD children and children with DLD. The results are relatively consistent with the findings of similar studies that utilised and adapted the MAIN in other languages. Clinical implications and recommendations are discussed.

[Relationship between dietary risk factors and sedentary recreational screen time among school-age children in grades 4-6 in Baise City from 2018 to 2019].

OBJECTIVE: To explore the relationship between dietary risk factors and sedentary recreational screen time of adolescents. METHODS: A total of 6363 pupils of Grades 4-6 from 6 primary schools in Baise were recruited with cluster-sampling method from Sep.2018 to Nov.2019. Participants were asked to report the average duration of watching television, digital devices use, intakes of sugar-sweetened beverage(SSB), snacks, fast-food, soymilk/milk product, skipping breakfast, and frequency of fruit/vegetable. We performed multivariable logistic regression to estimate OR and 95%CI for the relations between duration of sedentary recreational screen time and dietary risk factors, accounting for complex survey sampling and adjusting for potential confounders. RESULTS: (1)Both prolonged watching television and leisure-time digital devices use were associated with high intakes of SSBs, snacks, and low intakes of fruits and vegetables. And compared with <2 h/d, two kinds of screen-time(>4 h/d) was associated with significantly higher odds for intakes of fast food(watching television: OR=2.551;leisure-time digital devices use: OR=3.024), and frequent breakfast skipping(watching television: OR=1.646;leisure-time digital devices use: OR=1.674). (2)Compared with the reference groups(<2 h/d), participants spending more time per day on sedentary recreational screen time were more likely to drink sugar-sweetened beverages(OR=1.717-3.272), consume snacks(OR=1.626-3.154)and less likely to consume fruit/vegetable(OR=1.526-2.251). Compared to ≤2 h/d, estimated ORs of high intakes of fast food were 2.118 for>3 h/d of screen time, and 2.357 for >4 h/d. CONCLUSION: Increased television viewing and digital devices use in adolescence of Grades 4-6 is associated with higher odds of consumption of sweetened beverages, snacks and lower odds of fruit consumption in Baise.