Oral nutritional supplementation with dietary counseling improves linear catch-up growth and health outcomes in children with or at risk of undernutrition: a randomized controlled trial.

Introduction: Childhood undernutrition is associated with increased morbidity, mortality and a high socio-economic burden. Methods: Supporting Pediatric GRowth and Health OUTcomes (SPROUT) is a randomized, controlled trial evaluating the effects of an oral nutritional supplement (ONS) with dietary counseling (DC; n = 164) compared to a DC-only group who continued consuming their habitual milk (n = 166; NCT05239208). Children aged 24-60 months who were at risk or with undernutrition, as defined by weight-for-age [WAZ] < -1 and height-for-age [HAZ] < -1 according to the WHO Growth Standards, and who also met the criterion of weight-for-height [WHZ] < 0, were enrolled in Vietnam. Results: ONS + DC had a larger WAZ increase at day 120 (primary endpoint) vs. DC (least squares mean, LSM (SE): 0.30 (0.02) vs. 0.13 (0.02); p < 0.001), and larger improvements in all weight, BMI and weight-for-height indices at day 30 and 120 (all p < 0.01). Height gain was larger in ONS + DC in all indices, including height-for-age difference [HAD; cm: 0.56 (0.07) vs. 0.10 (0.07); p < 0.001], at day 120. ONS + DC had larger arm muscle but not arm fat indices, higher parent-rated appetite, physical activity and energy levels, longer night sleep, fewer and shorter awakenings, and better sleep quality than DC. Conclusion: Adding ONS to DC, compared to DC-alone, improves growth in weight and height, linear catch-up growth, and health outcomes in children with or at risk of undernutrition.

Factors affecting nutritional status among children aged below five years in Rwanda's Western and Southern Provinces.

BACKGROUND: The state of a child's nutrition is a critical indicator of their overall health and wellbeing. Public health still faces challenges from undernutrition, especially in developing nations across the globe. In Rwanda, around 33% of children aged under five years suffer from chronic undernutrition. Many factors, such as poverty, illiteracy, poor WASH practices, improper child feeding practices, and insufficient healthcare, are the leading causes of undernutrition. The study aims to assess infant and young child feeding practices, WASH, food security, and their association with the nutritional status of children under five years in Rwanda's Western and Southern provinces. METHODS: A community-based cross-sectional study design was applied to study factors affecting the nutritional status of children under five years in 439 households in the Karongi, Nyabihu, and Nyamagabe districts of Rwanda. The study assessed anemia, stunting, underweight, and wasting indicators, and collected data was analyzed using SPSS version 25. RESULTS: The study findings indicate that among the children surveyed, 29.2% (128) were identified as stunted, 5.9% (26) were underweight, 2.3% (10) suffered from wasting, and 20.9% (31) had anemia. Factors associated with these conditions included larger household size [AOR = 2.108; 95% CI (1.016-4.371)], positively associated with stunting. Additionally, children from households where the head was above 60 years old were more likely to exhibit stunting [AOR = 4.809; 95% CI (1.513, 15.283)]. Furthermore, a high household dietary diversity score was positively linked to being underweight [AOR = 6.061; 95% CI (1.535,23.942)]. CONCLUSION: Household characteristics like size, dietary diversity, and the age of the household head affect children's nutritional status. Improving these conditions would enhance children's nutritional status.

A study to assess the nutritional status and dietary gap among pulmonary tuberculosis patients in Raipur city.

Background: Undernutrition raises the likelihood of progressing from tuberculosis (TB) infection to active TB illness and causes weight loss. Proper food and nutrition are important in the treatment of tuberculosis patients. Active tuberculosis necessitates a substantial energy expenditure. The Tuberculosis treatment guidelines neglect the nutritional supplementation part of Tuberculosis management. The study aims to determine the factors affecting the nutritional status of pulmonary Tuberculosis patients. Material and Methods: A hospital-based cross-sectional study was conducted from December 2021 to January 2022 among the patients newly diagnosed and above 18 years of age coming to DOTS Centre (DMC) of Pt J.N.M. Medical College, Raipur. Total 120 subjects were selected by consecutive sampling method. Data was analyzed using SPSS version 24, and P value <0.05 was considered statistically significant. Result: Among 120 study subjects, malnourished was 54.16% (BMI <18.50 kg/m2), normal was 35% (BMI 18.50-24.99 kg/m2), overweight was 6.67% (BMI 25-29.99 kg/m2), and obese were 4.17% (BMI 30-34.99 kg/m2). Among 120 study subjects, the maximum number of them (96.3%) had a dietary gap in their diets which was equal in two groups of 1-50% calorie deficit and 51-100% calorie deficit. Conclusion: A high proportion of tuberculosis patients were undernourished, and even a very distal factor for undernutrition became proximal for tuberculosis patients. To control tuberculosis and to end the tuberculosis disease, an improvement in the nutritional status of the patient should be our priority. By knowing the importance of nutrition in TB patients, the primary care physicians can decrease the morbidity and mortality in TB patients.

Nutritional status and dietary intake among Nigerian adolescent: a systematic review.

INTRODUCTION: The prevailing nutritional conditions and the triple challenge of malnutrition faced by adolescents have adverse consequences for both the present and future generations' health and nutrition. Summarizing the available research on the nutritional status and dietary habits of adolescents in Nigeria is crucial. OBJECTIVE: This study aims to systematically evaluate available literature on the nutritional status of adolescent aged 10 to 19years in Nigeria. METHODOLOGY: A systematic search using PRISMA guideline was conducted. Three electronic databases were searched i.e., PubMed, Web of Science and Scopus using specific terms and keywords for online articles published between 2013 and 2023. After applying specified inclusion and exclusion criteria, 51 articles were selected for data extraction, synthesis and quality assessment. RESULTS: Of the 51 included studies, 78.4% were conducted in the Southern Nigeria, 11.8% in the Northern Nigeria and 9.8% included both regions. The prevalence of overweight ranged between 0.8 and 31% and obesity ranged between 0.1 and 14%. The prevalence of thinness, stunting and underweight ranged between 3 and 31%, 0.4 to 41.6%, 0.3 to 73.3% respectively. The review also identified an inadequate intake of essential nutrients including iron, zinc, calcium, vitamin A, C, D, niacin, thiamin, riboflavin, cobalamin, and folate, with vitamin A deficiency prevalence ranges from 44 to 96%. The dietary patterns were characterized by a high consumption of cereals grains and starchy foods, low animal proteins, fast-food with soft drinks, and limited consumption of fruits and vegetables along with meal skipping. CONCLUSION: These findings portray a complex picture of the nutritional challenges faced by this demographic group, highlighting both undernutrition and overnutrition, poor eating behaviour and micronutrient deficiency as significant concerns. The review revealed regional disparities in research representation, with a concentration of studies in Southern Nigeria. This highlights the importance of directing research efforts toward the northern regions, where the prevalence of nutritional issues is equally severe, but less studied. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42023481095.

Perinatal intervention strategies providing food with micronutrients to pregnant and breastfeeding women in low- and middle-income countries: A scoping review.

In resource-constrained settings, pregnant and breastfeeding women and girls (PBW/G) are particularly vulnerable to undernutrition. Micronutrient-fortified balanced energy protein (BEP) supplementation may be provided to boost maternal nutritional status and improve birth and infant outcomes. We conducted a scoping review of the published literature to determine the impact of BEP and other related nutrition interventions that provided fortified food or cash along with a minimum of 3 micronutrients on maternal, birth, and infant/child outcomes in low- and middle-income countries. We conducted a PubMed search using pre-defined keywords and controlled vocabulary search terms. All titles and abstracts were reviewed for eligibility by two independent reviewers, and data were extracted according to outcome type. We identified 149 eligible research articles that reported on a total of 21 trials and/or programme evaluations which assessed the health impact of one or more products (fortified lipid-based nutrient supplement [LNS, n = 12], fortified blended flours [n = 5], milk-based beverages [n = 2], and local food/snacks [n = 3]) that provided 118-750 kcal/day and varying levels of protein and micronutrients. Only one of these programme evaluations assessed the impact of the provision of cash and fortified food. Effects on maternal outcomes such as gestational weight gain and duration of gestation were promising but inconsistent. Birth outcomes were reported in 15 studies, and the effects on birthweight and birth length were generally positive. Seven studies demonstrated sustained benefits on infant and child growth out of the 15 studies that reported at least one of these outcomes, although data were sparse. Additional research is needed to investigate issues of dose, cost-effectiveness, and incorporation into multi-component interventions.

Effect of preconception multiple micronutrients vs. iron-folic acid supplementation on maternal and birth outcomes among women from developing countries: a systematic review and meta-analysis.

Background: Maternal malnutrition affects the somatic growth of the fetus and subsequent adverse events during infancy and childhood period. Though trials have been conducted on multiple micronutrient (MMN) supplements initiated during the preconception period, there is no collated evidence on this. Materials and methods: We performed a systematic review of published trials with the application of Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The searches were conducted until 30 September 2023. Meta-analysis was performed using Review Manager 5 software. The primary objective was to compare the effect of preconception MMN vs. iron-folic acid (IFA) supplementation on newborn anthropometric parameters at birth. Results: Of the 11,832 total citations retrieved, 12 studies with data from 11,391 participants [Intervention = 5,767; Control = 5,624] were included. For the primary outcome, there was no significant difference in the birth weight [MD, 35.61 (95% CI, -7.83 to 79.06), p = 0.11], birth length [MD, 0.19 (95% CI, -0.03 to 0.42), p = 0.09], and head circumference [MD, -0.25 (95% CI, -0.64 to -0.14), p = 0.22] between the MMN and control groups. For all the secondary outcomes [except for small for gestational age (SGA) and low birth weight (LBW)], the difference between the MMN and control groups was not significant. The GRADE evidence generated for all the outcomes varied from "very low to moderate certainty." Conclusion: A "very low certainty" of evidence suggests that MMN supplementation may not be better than routine IFA supplementation in improving newborn anthropometric parameters (weight, length, and head circumference). The adverse events resulting from the supplementation were not significant. We need better quality uniformly designed RCTs before any firm recommendation can be made.Systematic review registration: identifier (CRD42019144878: https://www.crd.york.ac.uk/prospero/#searchadvanced).

Household food insecurity, dietary diversity with undernutrition among children younger than five years in Indian subcontinent-a narrative review.

The emerging predictors of childhood undernutrition include household food insecurity (HFI) and inadequate diet diversity (DD). Geographical, socio-cultural, economic, and demographic factors contribute to HFI. Earlier, HFI was often considered an outcome of hunger and poverty leading to undernutrition. The increasing availability of data related to childhood DD and its direct association with undernutrition indicates that DD could mediate the relationship between HFI and undernutrition. This narrative review examined the association of HFI and/or DD with undernutrition in children younger than 5 years in the Indian subcontinent; and the current programmes and policies. The current evidence showed a possible association between HFI and DD either independently or together with childhood undernutrition. Until now, nutrition-specific interventions to address moderate and severe forms of undernutrition were focused, with a limited attention on nutrition-sensitive approaches to improve HFI and DD. Interventions which improve HFI and DD may be included in the existing programmes and would help address the undernutrition in children younger than 5 years.

Effect of quality and quantity of diet on nutritional status of under-five children residing in the rural area: A longitudinal study.

Introduction: Variety and adequacy of intake of food are required to meet the nutritional needs of the children. Due to poverty/illiteracy, poor families depend on a single food group that is, cereals. Due to the pandemic also, the nutrition of the growing children is affected. Objective: To know the effect of quantity and quality of diet on the nutritional status of under-five children. Methodology: This study had 270 children aged between 1 and 4 years registered at Anganwadi as study participants. Information on sociodemographic variables, quantity of calories and proteins consumed, quality of diet, and anthropometry of children was collected. Percentages and paired t-tests were used to find the difference between nutritional status and diet at different intervals, which was found to be statistically significant (P < 0.05). Results: In our study, we found that as the quantity and quality of diet improved nutritional status, especially weight for age, body mass index (BMI) for age Z score also improved. There was a significant difference between calories consumed at the baseline, 6 months and 1 year with P < 0.05. Protein intake was significant between baseline and six months with P < 0.005. Conclusion: Our study found a high percentage of undernutrition and wasting in the under-five population when diet was not sufficient in quality and quantity. As the quality and quantity of diet improved nutritional status also improved.

Dietary Supplementation with Rumen-Protected Arginine or N-Carbamylglutamate Enhances Fetal Liver Development in Nutrient-Restricted Pregnant Hu Ewes.

This study was conducted in nutrient-restricted pregnant Hu ewes to determine whether rumen-protected arginine (RP-Arg) or N-carbamylglutamate (NCG) supplementation affects fetal liver growth and development. From 35 d to 110 d of gestation, 32 Hu ewes were randomly divided into four groups: a control group (100% of the National Research Council (NRC) requirements), a nutrient-restricted group (50% of the NRC requirements), and two treatment groups (ARG and NCG, 50% of the NRC requirements, supplemented with 20 g/day RP-Arg or 5 g/day NCG, respectively). Fetal body weights, fetal liver growth performance, the capability of antioxidation, and the expression of the mRNA and proteins of apoptosis-related genes in the fetal liver were determined and analyzed at 110 d of gestation. The dry matter, water, fat, protein, and ash components of the fetal livers in the RG group were found to be lower than in the CG group, and these components were significantly higher in the NCG group than in the RG group (p < 0.05). A decrease in DNA, RNA, and protein concentrations and contents, as well as in protein/DNA ratios, was observed in the RG group in comparison to the CG group (p < 0.05). Compared with the RG group, the NCG group had higher concentrations of DNA, RNA, and protein, as well as higher protein/DNA ratios (p < 0.05). The RG group had lower concentrations of cholinesterase, nitric oxide, nitric oxide synthase, superoxide dismutase, alanine aminotransferase, and total protein than the CG group (p < 0.05). The RG group had higher levels of glutathione peroxidase, maleic dialdehyde, and aspartate aminotransferase than the CG group (p < 0.05). In the RG group, the mRNA and protein expression of p53 and Bax was significantly increased (p < 0.05) compared with the CG group, and the gene expression of FasL and Bcl-2, the ratio of Bcl-2 to Bax, and the protein expression of Bcl-2 in the RG group were lower (p < 0.05) than in the CG group. It appears that RP-Arg and NCG supplementation during pregnancy could influence fetal liver growth and development. A nutrition-based therapeutic intervention to alleviate reduced fetal growth can be developed based on this study, which has demonstrated that maternal undernutrition during pregnancy induces the maldevelopment of the fetal liver.

Integrative Approach of Treating Early Undernutrition with an Enriched Black Corn Chip, Study on a Murine Model.

Undernutrition (UN) increases child vulnerability to illness and mortality. Caused by a low amount and/or poor quality of food intake, it impacts physical, cognitive, and social development. Modern types of food consumption have given highly processed food a higher cultural value compared to minimally processed food. OBJECTIVE: The objective of this study was to evaluate the effect on growth, metabolism, physical activity (PA), memory, inflammation, and toxicity of an enriched black corn chip (BC) made with endemic ingredients on post-weaned UN mice. METHODS: A chip was made with a mixture of black corn, fava beans, amaranth, and nopal cactus. To probe the effects of UN, UN was induced in 3wo post-weaned male C57Bl/6j mice through a low-protein diet (LPD-50% of the regular requirement of protein) for 3w. Then, the BC was introduced to the animals' diet (17%) for 5w; murinometric parameters were measured, as were postprandial glucose response, PA, and short-term memory. Histological analysis was conducted on the liver and kidneys to measure toxicity. Gene expression related to energy balance, thermogenesis, and inflammation was measured in adipose and hypothalamic tissues. RESULTS: Treatment with the BC significantly improved mouse growth, even with a low protein intake, as evidenced by a significant increase in body weight, tail length, cerebral growth, memory improvement, physical activation, normalized energy expenditure (thermogenesis), and orexigenic peptides (AGRP and NPY). It decreased anorexigenic peptides (POMC), and there was no tissue toxicity. CONCLUSIONS: BC treatment, even with persistent low protein intake, is a promising strategy against UN, as it showed efficacy in correcting growth deficiency, cognitive impairment, and metabolic problems linked to treatment by adjusting energy expenditure, which led to the promotion of energy intake and regulation of thermogenesis, all by using low-cost, accessible, and endemic ingredients.

A case-control study to investigate determinants of undernutrition in community-dwelling children.

PURPOSE: This study aimed to examine determinants of undernutrition among children under 2 years of age. DESIGN AND METHODS: A matched case-control study design was conducted to recruit 300 mothers comprising 100 mothers with an undernourished child (case group) and 200 mothers with a healthy child (control group). Measurements consisted of demographic characteristics of children data, mother's data, household data, mother's knowledge of child undernutrition, mother's knowledge of nutrition, complementary feeding practices, and undernutrition parameters of the children. A conditional logistic regression was used to identify determinants of undernutrition. The risk of undernutrition was estimated by odds ratios (ORs) and 95% confidence intervals (CIs). Statistical significance was defined as any p value of <.05. RESULTS: Findings showed that mother's knowledge of undernutrition (AOR: 0.95; 95% CI: 0.91-0.98), mother's knowledge of nutrition (AOR: 0.90; 95% CI: 0.85-0.96), and mother's knowledge (AOR: 0.78; 95% CI: 0.67-0.91) and behavior of complementary feeding practices (AOR: 0.97; 95% CI: 0.94-0.99) were significant determinants of undernutrition (p < .05). PRACTICE IMPLICATIONS: Mothers with high scores on knowledge of undernutrition, knowledge of nutrition, and knowledge and behaviors of complementary feeding practices would benefit the children under 2 years to reduce the risk of undernutrition. Healthcare professionals (i.e., pediatric nurses and community health nurses) should provide early assessment of knowledge related to undernutrition, nutrition, and complementary feeding practices for mothers with children under 2 years.

Development and Acceptability of Shelf-Stable Microbiota Directed Complementary Food Formulations.

BACKGROUND: A randomized controlled trial in Bangladeshi children aged 12 to 18 months with moderate acute malnutrition found that dietary supplementation with the microbiota-directed complementary food (MDCF-2) significantly improved weight gain and repaired gut microbiota compared to the ready-to-use supplementary food. However, the MDCF-2 formulation was made daily from locally available ingredients and the need for a packaged, nutritionally compliant, and organoleptically acceptable MDCF-2 prototype was essential for future large-scale clinical studies. OBJECTIVE: The study aimed to develop and assess the acceptability of 3 alternative foil-packaged formulations of MDCF-2 in comparison to current MDCF-2. METHODS: Of the 3 packaged formulations, the Jumpstart version was provided in 2 sachets, the other 2 formulations were provided in a retort-stable foil pouch extended by sterilization, and microbiological growth was monitored over 10 months. The acceptability study included 40 children aged 8 to 12 months living in an urban slum in Dhaka, and the organoleptic properties were assessed using a 7-point hedonic scale. RESULTS: In the 100 g distributed over the 2 sessions, children consumed 82.5 ± 7.84 g (mean ± SD) of kitchen-prepared MDCF-2, 85.4 ± 7.15 g of the "Jumpstart" MDCF-2 formulation, 85.4 ± 8.70 g of the MDCF-2 with green banana powder, and 86.2 ± 4.26 g of the MDCF-2 with sweet potato formulation. The "Jumpstart" MDCF-2 and MDCF-2 with sweet potato achieved the highest overall acceptability scores on the hedonic scale; although none of the shelf-stable formulations were significantly different from the kitchen-prepared MDCF-2. CONCLUSIONS: Packaged, shelf-stable prototypes of MDCF-2 exhibited comparable acceptability among Bangladeshi children aged 8 to 12 months to the original freshly prepared formulation.

Plain language titleDevelopment and Acceptability of Shelf-Stable Microbiota-Directed Complementary FoodsPlain language summaryCountries around the world are making progress in fighting malnutrition, but it may be challenging to achieve the global nutrition targets for undernourished children by 2025 at the current rate. To address this problem, we need special types of food that can help children grow, develop properly, and sustain their growth. Children with moderate acute malnutrition have imbalanced gut bacteria. By providing them with the right nutrition, we can restore the healthy bacteria in their gut using a special food called microbiota-directed complementary food (MDCF). Currently, this food is made daily in the icddr, b established field kitchen, which follows standard production measures to control the quality of MDCF preparation, but we need to create stable prototypes that can be stored and used in different settings. This study was designed to develop shelf-stable new formulations in industrial settings and check their acceptability among children with moderate acute malnutrition. The shelf life of the food was extended using a sterilization method, and its microbiological safety was monitored for a year. The actual consumption and acceptability of these foods were evaluated and all these formulations were acceptable by the children and their mother. The children consumed all 4 food formulations in substantial quantities, with consumption rates exceeding 80% for each formulation. This study showed positive results in Bangladesh, but more research is needed to see if these formulations work well in other geographies and over longer periods.

Associations of micronutrients and lipids with prediabetes and glycemic parameters in adolescent girls of the rural DERVAN cohort (DERVAN-9).

Background: We investigated the associations of micronutrients and lipids with prediabetes, glycemic parameters, and glycemic indices among the adolescent girls of the DERVAN (aDolescent and prEconception health peRspectiVe of Adult Non-communicable diseases) cohort study from rural India. Methods: We recruited 1,520 adolescent girls aged 16-18 years. We measured glycemic parameters (glucose, insulin and HbA1C), lipids (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides), and micronutrients (vitamin B12, folate, and vitamin D). Prediabetes was defined using American Diabetes Association criteria (fasting glucose ≥100 mg/dL or HbA1C ≥5.7%). Glycemic indices (insulin resistance, insulin sensitivity, and ß cell function) were calculated using the homeostasis model. Associations of prediabetes, glycemic parameters and glycemic indices with micronutrients and lipids were analyzed by multiple logistic regressions. Results: The median age and Body Mass Index (BMI) were 16.6 years and 17.6 kg/m2, respectively. Overall, 58% of girls had a low BMI. Median vitamin B12, folate, and vitamin D concentrations were 249.0 pg/mL, 6.1 ng/mL, and 14.2 ng/mL, respectively. The deficiencies observed were 32.1% for vitamin B12, 11.8% for folate, and 33.0% for vitamin D. Median total cholesterol, LDL, HDL, and triglyceride concentrations were 148.0 mg/dL, 81.5 mg/dL, 50.8 mg/dL, and 61.5 mg/dL, respectively. Elevated total cholesterol, LDL, and triglycerides were observed in 4.8, 4.0, and 3.8%, respectively, while low HDL was observed in 12.8%. Prediabetes was observed in 39.7% of the girls. Among lipids, total cholesterol and LDL were higher in girls with prediabetes (p < 0.01 for both). In a multivariate model containing cholesterol and vitamin B12/folate/vitamin D, prediabetes was associated with high cholesterol. Prediabetes was also associated with high LDL, independent of folate and vitamin D. Poor insulin secretion was high in those with low vitamin B12. Elevated insulin resistance was associated with low HDL. The likelihood of high insulin sensitivity was reduced in those with high triglycerides. The likelihood of poor ß cell function was high in those with high LDL. Statistical interactions between micronutrients and lipids for prediabetes and glycemic outcomes were not significant. Conclusion: There was a substantial deficiency of micronutrients and an absence of dyslipidemia. Our results indicate the need for lipid and micronutrient-based interventions in adolescence to improve glycemic outcomes. Maintaining adequate storage of not only micronutrients but also lipids in adolescent girls is likely to reduce diabetes risk in adulthood.

Association among Household Wealth, Maternal Employment, and Undernutrition in Children under Three Years of Age in Pakistan.

BACKGROUND: There is an abundance of studies explaining the separate impact of female employment and household wealth status in reducing malnutrition. However, our study has unraveled the combined impact of maternal employment and household wealth on undernutrition among children under three in Pakistan. METHODS: Using a sample of 1093 children under three years of age from the Pakistan Demographic and Health Survey 2017-2018, a binary logistic model was employed to gauge factors influencing the children's undernutrition. RESULTS: Our results indicated that children up to a certain age (three years old) with residence in certain regions (Pakistan) and recent episodes of diarrhea had an increased risk of undernutrition. Conversely, secondary and higher maternal education, access to improved water sources, and sanitation facilities lowered the chances of undernutrition in children under three in Pakistan. The interaction between maternal employment and household wealth showed that maternal employment significantly lowered the risk of stunting, being underweight, and wasting among the average, rich, and richest households; however, it did not contribute to child nutrition among the poorer and poor households. Notably, regardless of whether the mother was employed, the wealth status of being rich and richest reduced the risk of stunting, being underweight, and wasting. CONCLUSIONS: In overcoming undernutrition, maternal employment significantly contributed to middle-income households. However, in the richer and richest households, the wealth status played a more crucial role compared to the maternal employment. This indicates that while employment plays a supportive role in household resources, the wealth status is overall more influential in reducing undernutrition.

A Systems Approach in the Prevention of Undernutrition among Children under Five in Tanzania: Perspectives from Key Stakeholders.

Undernutrition among under-fives is one of the major public health challenges in Tanzania. However, there are limited studies assessing the contribution of cultural-related strategies in the prevention of child undernutrition in Tanzania. This study aimed at exploring participants' experiential views regarding developing culturally sensitive strategies for the elimination of child undernutrition for under-fives in Rukwa, Iringa, Ruvuma, Songwe and Njombe regions located in the Southern Highlands in Tanzania. This study applied focus group discussions (FGDs) with forty practitioners to explore culturally-sensitive strategies for effectively preventing child undernutrition in Tanzania. The study participants were purposively selected, and thematic analysis was used to identify themes within the data. This study revealed that district- and lower-level administrative systems should prioritize nutrition interventions in their plans, allocating adequate resources to implement culturally sensitive nutrition interventions, while national-level organs need to strengthen institutional capacity and ensure the availability of funds, skilled human resources and a legal framework for the effective implementation and sustainability of nutrition interventions at the district- and lower-levels. This study highlights that for the successful implementation of culturally sensitive strategies towards the elimination of child undernutrition, there is a need to use a systems approach that allows for collaborative governance whereby different sectors act together to address the persistent malnutrition epidemic.

Prevalence of Smartphone Addiction and its Relationship with Obesity among Young Adults: A Cross-sectional Study from Delhi, India.

Smartphone addiction (SA) has emerged as an important health concern worldwide. Recent studies have recognized SA as one of the factors that promote sedentarism and can contribute to obesity. However, the relationship between SA and obesity among Indian young adults remains understudied. The present study aims to estimate the prevalence of SA and explore its association with general and central obesity among young adults in Delhi, India. This cross-sectional study was conducted among 246 young adults (aged 18-30 years) of either sex (60.16% females) from Delhi. Screening for SA was done using the Smartphone Addiction Scale-Short Version. Somatometric measurements (height, weight, waist circumference, and hip circumference) were taken to determine general and central obesity. SA was prevalent among 25.2% of the participants. The prevalence of SA was higher among males and undergraduate students than among females and postgraduate/MPhil/PhD students, respectively. Further, SA was not associated with any of the obesity variables. Interestingly, smartphone addicts were found to have a 2.5-fold increased risk of being underweight. Though SA was not associated with obesity, it was found to be associated with being underweight, indicating a relationship between smartphone use and nutritional status among young adults.

Malnutrition and Anemia Among Particularly Vulnerable Tribal Groups of Odisha, India: Needs for Context-Specific Intervention.

Background: As undernutrition and anemia persist to be prevalent in India, the socioeconomically disadvantaged groups continue to take the greater brunt. Odisha is home to the largest number of particularly vulnerable tribal groups (PVTGs) in India. The study aimed to provide a comprehensive report on the undernutrition and anemia status of all the PVTGs of Odisha. Methods: A community-based cross-sectional study was conducted among (N = 1461, 683 males and 779 females) 13 PVTGs spread across 12 districts of Odisha from August 2018 to February 2019. Results: Among the under-five children, the prevalence of underweight was observed in 75.26%, stunting in 55.42%, and wasting in 60.00% and all forms of undernutrition were higher among girls. Among children and adolescents belonging to the age group of 5 to 19 years, the prevalence of thinness was 46.7%. In individuals above the age of 20, the prevalence of underweight among males was 37.7% and females was 44.3% and severe anemia was present in 36.5% of females and 35.8% of males. Women in the reproductive age have a higher prevalence of anemia. Conclusion: The study shows that undernutrition and anemia remain high in the PVTGs, especially among the under-five children and women in the reproductive age. As the country heads toward fulfilling Sustainable Development Goals (SDG) by 2030, national and state health policies need to be designed and implemented, giving special focus to these vulnerable groups.

Validity of "Mid-Upper Arm Circumference" as a Parameter to Identify Undernourished Children in Rural Gujarat.

Introduction: Mid-upper arm circumference (MUAC) measures the arm muscle and fat area. The use of MUAC as a screening measure for assessing undernutrition has the following advantages; it makes use of a simple equipment, is easy to carry at the field sites, and requires minimal training. In India, "mid-upper arm circumference" is widely used and accepted in many nutritional programs. Objectives: This study was conducted with the primary objective to compare different anthropometric parameters of children and to validate the usefulness and limitations of MUAC to screen out undernourished children. Subject and Methods: Anthropometric measurements were recorded for all the anganwadi centers of the selected sub-center that comes under the field practice area of our department. The measurements like weight, height, MUAC were done according to the standard guidelines as per WHO, and further, calculations were done with the help of "Anthro software 3.2.2." Comparisons were done between categorization of MUAC tape and Weight-for-Height Z-scores (WHZ), and hence, the sensitivity and specificity of the MUAC tape to screen the malnourished child were found out. Results: Sensitivity of MUAC to categorize a child in red/yellow was only 9.03%, negative predictive value (NPV) was 40.75%, specificity came 95.10%, and positive predictive value was 73.68% on taking WHZ as the gold standard. Conclusion: MUAC has a limited role in screening out an undernourished child (red/yellow category), whereas it has a good role in screening healthy children (green category).

Role of Women's Empowerment in Improving the Nutritional Status of Children Under Five Years of Age: An Insight From the National Family Health Survey-5.

Background Childhood malnutrition remains a global concern, especially in low- and middle-income countries, and is known to create an intergenerational cycle of illness and poverty. Women's empowerment has gained global recognition as a potential catalyst for improving child nutrition. The objective of this research was to investigate the association between women's empowerment factors and the nutritional status of children under five years of age. Methods The study used data from the National Family Health Survey-5, conducted in India between 2019 and 2021 by the International Institute of Population Sciences, Mumbai. A weighted sample of 29,491 mother-child pairs was analyzed. The odds ratio for women's empowerment and sociodemographic factors associated with the nutritional status of children under five years of age was calculated using Pearson's chi-square test and multiple logistic regression. Results The study found that the sex of the child (OR = 1.066, 95% CI: 1.017 to 1.117; p-value: 0.008), birth order (OR = 0.824, 95% CI: 0.780 to 0.871; p-value < 0.001), education of the mother (OR = 1.356, 95% CI: 1.255 to 1.464; p-value < 0.001), education of the father (OR = 1.227, 95% CI: 1.140 to 1.320; p-value < 0.001), having a bank or savings account that she uses (OR = 1.151, 95% CI: 1.084 to 1.221; p-value < 0.001), having a mobile phone that she uses (OR = 1.184, 95% CI: 1.125 to 1.246; p-value < 0.001), and wealth index (OR = 1.597, 95% CI: 1.514 to 1.684; p-value < 0.001) were significant predictors of undernutrition in children under the age of five (U5). Conclusion Women's empowerment factors play a significant role in improving childhood nutrition. In the study, male sex, higher birth order, lower parental education, poor wealth index, maternal lack of access to a bank or a savings account, and lack of mobile phone ownership were found to be significant predictors of undernutrition in children U5. The findings underscore the importance of family planning, financial inclusion, access to mobile phones, and higher education for women as important factors that can help improve the nutritional status of children under five years of age. Policymakers can utilize these insights to make targeted strategies for women's empowerment, thus improving the nutritional status of children. However, being a secondary data analysis, our research is constrained by the variables available in the dataset. Further research is required to better comprehend the complex relationship between women empowerment and child nutrition.

Factors associated with malnutrition among older people in Swedish short-term care: Poor oral health, dysphagia and mortality.

OBJECTIVES: To investigate the relationship between malnutrition and potential contributing factors such as poor oral health, dysphagia and mortality among older people in short-term care. METHODS: This cross-sectional study is a part of the multidisciplinary multicentre project SOFIA (Swallowing function, Oral health and Food Intake in old Age), which includes older people (≥65 years) in 36 short-term care units in five regions of Sweden. Nutritional status was measured with version II of the Minimal Eating Observation and Nutrition Form (MEONF-II), oral health with the Revised Oral Assessment Guide (ROAG), dysphagia with a water swallow test, and the mortality rate was followed for 1 year. Data were analysed using descriptive analysis and logistic regression models to calculate odds ratios for the association between malnutrition and these factors. RESULTS: Among the 391 participants, the median age was 84 years and 53.3% were women. Mortality rate was 25.1% within 1 year in the total group, and was higher among malnourished participants than among their well-nourished counterparts. Severe dysphagia (OR: 6.51, 95% CI: 2.40-17.68), poor oral health (OR: 5.73, 95% CI: 2.33-14.09) and female gender (OR: 2.2, 95% CI: 1.24-3.93) were independently associated with malnutrition. CONCLUSION: Mortality rate was higher among malnourished people than those who were well nourished. Severe dysphagia, poor oral health and female gender was predictors of malnutrition among older people in short-term care. These health risks should be given more attention in short-term care with early identification.