Sex differences in the impact of body mass index on outcomes of coronary artery disease in Koreans.

BACKGROUND: Obesity is often considered a risk factor for cardiovascular disease, but recent studies have shown conflicting results regarding the effect of BMI on the prognosis of coronary artery disease (CAD). This study aimed to evaluate the relationship between BMI and clinical outcomes of CAD according to sex in a Korean population. METHODS: A total of 3476 patients with a significant CAD who underwent percutaneous coronary intervention (PCI) were enrolled. Patients were classified as follows according to BMI using the Asia-Pacific cutoff points: underweight (<18.5 kg/m 2 ), normal weight (18.5-22.9 kg/m 2 ), overweight (23.0-24.9 kg/m 2 ) and obese (≥25 kg/m 2 ) patients. Underweight and normal weight patients were further categorized into the lower BMI group, whereas overweight and obese patients were categorized into the higher BMI group. The primary endpoint was all-cause mortality. RESULTS: Among women, the higher BMI group showed poor clinical features in the prevalence of hypertension and chest pain presentation, and among men, the higher BMI group had a significantly lower rate of chronic renal failure. At the end of the follow-up period (median 53.5 months), the all-cause mortality rate was lower in the higher BMI group in men, and cardiovascular death and stroke rates were significantly lower in the higher BMI group in women. CONCLUSION: In Korean CAD patients treated with PCI, inverse correlations were observed between the clinical outcomes and BMI, but there were differences between men and women.

Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia.

OBJECTIVE: Child malnutrition, comprising of undernutrition and obesity, is a global concern with severe implications for survival, leading to acute and chronic diseases that adversely affect the productivity of individuals and society. Asia shoulders the greatest burden, with 7 out of 10 undernourished children residing in the region. Despite the decline in global child stunting, particularly in Asia, its prevalence remains significant. In 2017, an estimated 151 million children under five experienced stunting, and an additional 38 million were overweight, with Africa and Asia accounting for 25% and 46% of the global figures, respectively. Therefore, this paper aims to analyze the geospatial and environmental determinants of undernutrition in rural South and Southeast Asia. METHODS: To explore the geospatial and environmental determinants of undernutrition (stunting, wasting, and underweight), we use Poisson regression and the data from recent rounds of the Demographic and Health Survey (DHS) from India, Bangladesh, Pakistan, Nepal, Cambodia, and Timor-Leste. RESULTS: This study found a high prevalence of stunting, wasting, and underweight among children aged 0 to 59 months in rural areas of South and Southeast Asia, with considerable variation between countries and clusters/primary sampling units. Results show a positive association between child malnutrition and factors such as maternal illiteracy, unsafe drinking water, and dirty cooking fuel in South and Southeast Asia. Children from impoverished households in India, Pakistan, and Cambodia were disproportionately affected. In addition to socio-economic factors, climatic risks such as temperature increase and rainfall variations also emerged as important determinants of child malnutrition in India, Bangladesh, and Timor-Leste. CONCLUSIONS: This paper emphasizes the role of environmental and climatic factors on child nutrition, underscoring their significance regardless of socio-economic conditions. As the impacts of climate change continue to intensify, and agrarian societies bear the brunt, these factors will play a critical role in shaping child nutritional outcomes. Thus, amid growing climate change, nutritional security should be prioritized, considering the spatial domain and targeting climate distress areas along with other socio-economic and demographic aspects.

Determinants of household-, maternal- and child-related factors associated with nutritional status among children under five in Mali: evidence from a Demographic and Health Survey, 2018.

OBJECTIVE: The current study aims to determine household-, maternal- and child-related factors influencing nutritional status among children under five in Mali. DESIGN: Quantitative cross-sectional study using secondary data extracted from Mali DHS-VI 2018. SETTING: Urban and rural areas of Mali. PARTICIPANTS: A total of 8908 children participated, with 3999 in the younger age group (0-24 months) and 4909 in the older age group (25-59 months). RESULTS: In the younger age group, the prevalence of stunting, wasting and underweight was 18·8 % (95 % CI%: 17·5, 20·0), 24·6 % (95 % CI: 23·2, 26·0) and 13·2 % (95 % CI: 12·1, 14·3), respectively, while in the older age group, it was 24·9 % (95 % CI: 23·7, 26·2), 22·7 % (95 % CI: 21·5, 24·0) and 5·7 % (95 % CI: 5·0, 6·5), respectively. Being average or large size at birth, having piped source of water, receiving Zn, deworming, high maternal BMI, receiving Fe during pregnancy, higher maternal education and being rich were associated with lower odds of one or more form of undernutrition in both groups. On the other hand, children who were anaemic, drank from a bottle, maternal anaemia, current pregnancy of mothers and living in rural areas were associated with higher odds of stunting, wasting or underweight. Interestingly, children who received Fe supplementation had a higher odds of wasting in the younger group but lower odds of all forms of undernutrition in the older group. CONCLUSIONS: This study emphasised the potential risk factors associated with undernutrition in children. Children who consume non-potable water, have mothers with lower levels of education and BMI and reside in rural areas are more likely to experience undernutrition.

Prevalence of undernutrition and associated factors among street adolescents in adama town, oromia regional state, Ethiopia, 2023: A cross sectional study.

BACKGROUND: Undernutrition remains a serious public health problem in developing countries, including Ethiopia. In particular, street adolescents are more at risk for undernutrition because they are the most underprivileged population. However, there is a paucity of information about undernutrition among street adolescents in Ethiopia. OBJECTIVE: To assess the prevalence of undernutrition (stunting and thinness) and factors associated with undernutrition among street adolescents in Adama town, Oromia regional state, Ethiopia, 2023. METHOD: A community-based cross sectional study was conducted among 358 street adolescents from January 15-30, 2023. A convenience sampling technique was used to select the required sample size. A structured, interviewer-administered questionnaire was used to collect the data from the respondents. The collected data were checked, coded, entered into Epidata 4.6 and exported to Statistical Package for Social Sciences version 25. Both Bivariable and Multivariable logistic regression analyses were conducted to determine the factors that are associated with thinness and stunting. P values below 0.05 at the 95% confidence interval were considered indicative of a statistically significant association. Finally, statements, graphs, tables and charts were used for result presentation. RESULT: This study revealed that, the prevalence of undernutrition was 47.2%. Thinness and stunting accounted for 20.4% and 34.1% respectively and 7.3% both thinness and stuting. Age (adusted odd ratio = 1.41; 95% confidence interval: 1.17-1.71), skipped one or more meals per day ((adusted odd ratio = 3.50; 95% confidence interval: 1.23-9.94), drinking unprotected water source ((adusted odd ratio = 3.23; 95% confidence interval: 1.49-6.98) and use of mastish ((adusted odd ratio = 2.91; 95% confidence interval: 1.19-7.12) were factors statistically associated with thinness. Being skipped one or more meals per day ((adusted odd ratio = 4.14; 95% confidence interval: 1.87-9.14), washing hands before meals ((adusted odd ratio = 0.46; 95% confidence interval: 0.26-0.81) and moderate depression ((adusted odd ratio = 2.93; 95% confidence interval: 1.05-8.15) were factors significantly associated with stunting. CONCLUSION AND RECOMMENDATION: In conculusion, the prevalence of undernutrition (thinness, stunting or both together) was high among street adolescents. To enhance street adolecents' nutritional status, targeted nutritional treatments, providing health services and good hygiene and sanitatios practices are urgently needed.

Undernutrition and determinants among adolescent street children in DireDawa City, eastern Ethiopia: Vulnerability assessment.

OBJECTIVES: Adolescents go through rapid development and increased nutritional requirements that can put them at higher risk of undernutrition--a problem that can be highest among orphaned or street children. Evidence on nutritional risk and its contributing factors among this segment is lacking in the city of Dire Dawa, where many children are on the streets with limited access to proper care. The aim of this study was to identify determinants of undernutrition among street adolescents in Ethiopia. METHODS: A community-based cross-sectional study was conducted with 358 street adolescents 12 to 19 y of age in Dire Dawa from January to February 2022. After conducting a preliminary survey and registering all available street children, a complete enumeration was made. For data collection, an interviewer-administered questionnaire was used along with anthropometric measurements using standard procedures. Height-for-age (HAZ) and body mass index (BMI) for age z scores were computed using World Health Organization (WHO) Anthroplus and statistical analysis was done using SPSS software version 26. Independent variables with P < 0.25 in bivariable analysis were included in multivariable logistic regression, and variables with P < 0.05 were considered statistically significant. A crude and adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. RESULTS: Among 358 street adolescents, 44% (38.9-49.5) and 56% (50.8-61.4) were thin and stunted, respectively. Thinness among street children could be associated with a longer stay on the street (AOR, 1.65; 95% CI, 1.40-1.90), infrequent meal frequency (AOR, 1.32; 95% CI, 1.19-1.45), unprotected drinking water sources (AOR, 1.55; 95% CI, 1.40-1.71), alcohol drinking (AOR, 2.92; 95% CI, 1.51-4.32), inadequately diversified diet (AOR, 1.21; 95% CI, 1.06-1.36), and illness history (AOR, 1.34; 95% CI, 1.21-1.47). Moreover, odds of stunting were significantly associated with staying on the street (AOR, 1.32; 1.10-1.54), unsafe drinking water (AOR, 1.63; 95% CI, 1.13-2.66), smoking cigarettes (AOR, 1.54; 95% CI, 1.21-2.52), dietary diversity (AOR, 2.34; 95% CI, 1.43-3.82), and acute illness (AOR, 2.12; 95% CI, 1.31-5.23). CONCLUSION: Thinness and stunting were prevalent among street children and are associated with infrequent meals, poor dietary diversity, substance abuse, unsafe water sources, and illness histories that could be targeted for multisectoral interventions.

Factors associated with physical growth status among children aged 12-59 months in the Japanese National Growth Survey on Preschool Children: A retrospective analysis.

This study aimed to examine the factors associated with physical growth status among children aged 12-59 months in Japan. Data from the 2010 National Growth Survey on Preschool Children, a nationwide cross-sectional survey, were used for this analysis (n = 4196). After adjustment for confounding factors, multiple logistic regression analyses showed that boys who were born small-for-gestational-age were more likely to be underweight (adjusted odds ratio [aOR]: 12.55, 95% confidence interval [CI]: [6.76-23.3], p < 0.001), stunted (aOR: 5.78, 95% CI: [3.48-9.60], p < 0.001) and wasted (aOR: 7.02, 95% CI: [3.30-15.0], p < 0.001), while boys who were large-for-gestational-age were less likely to be stunted (aOR: 0.26, 95% CI: [0.11-0.60], p < 0.01). Girls who were born small-for-gestational-age were more likely to be underweight (aOR: 5.42, 95% CI: [2.73-10.7], p < 0.001), stunted (aOR: 4.04, 95% CI: [2.43-6.73], p < 0.001) and wasted (aOR: 6.27, 95% CI: [2.55-15.4], p < 0.001), while girls who were large-for-gestational age were more likely to be overweight (aOR: 5.90, 95% CI: [1.64-21.3], p < 0.001). Moreover, the following factors were associated with the physical growth status in children: maternal prepregnancy body mass index, complications during pregnancy, continuous breastfeeding, initiation age of complementary feeding, smoking status of the father or those living with the mother during pregnancy and birth order. Further research is needed to expand support for high-risk families and to verify their effectiveness.

The impact of armed conflicts on the nutritional status of children: Evidence from Northern Nigeria.

Armed conflicts often significantly exacerbate the magnitude and severity of malnutrition by increasing food insecurity. Evidence shows that malnutrition is among the leading causes of morbidity and mortality among children during conflicts. This study examines the impact of the armed conflicts in Northern Nigeria on nutritional status of children under the age of five. Three waves (2008, 2013, and 2018) of individual-level birth records data from the Nigeria Demographic and Health Survey (NDHS) dataset are spatially merged with information on conflict events drawn from the Armed Conflict Location and Events Dataset. All fatal incidents in the study region during the 5-year intervals 2004-2008, 2009-2013 and 2014-2018 are aggregated and mapped to the 2008, 2013 and 2018 NDHS clusters, respectively. A cluster is classified to be exposed to conflict if located within 5-10 km radius of an incident with at least 1 fatality. We use matching analysis in a difference-in-differences approach to estimate the effects of the conflicts on stunting, wasting, and underweight. We find that the impact of conflict exposure differs by the dimension of child nutritional status. While it significantly lowers the risk of stunting, it has no discernible significant effect on the likelihood of wasting or being underweight among under-fives. Though nutritional support/interventions in the conflict-affected areas are crucial and must be prioritised, an all-inclusive strategy for a long-term resolution of the conflict is needed to engender development, improve food security, reduce vulnerability to malnutrition, and improve the health and wellbeing of the residents of the region.

The association between food environment, diet quality and malnutrition in low- and middle-income adult populations across the rural-Urban gradient in Vietnam.

BACKGROUND: Economic reforms and trade liberalisation in Vietnam have transformed the food environment, influencing dietary patterns and malnutrition status. The present study focuses on the relationship between food environments (proximity and density of food outlets) and malnutrition (underweight, overweight, obesity) through diet quality in adult populations across urban, periurban and rural areas of Vietnam. METHODS: We evaluated food environment by geospatial mapping of food outlets through a transect walk across the "food ecosystem" from rural to urban areas. Diet quality was assessed using the Diet Quality Index - Vietnamese (DQI-V) comprising Variety, Adequacy, Moderation and Balance components. Malnutrition status was determined using body mass index. We performed a mediation analysis utilising mixed effect models to control for neighbourhood clustering effects. Confounders included age, education, income and nutrition knowledge score. RESULTS: Analysis of data from 595 adult participants (mean ± SD age: 31.2 ± 6.4 years; 50% female) found that longer distance to the nearest food outlet was associated with higher overall DQI-V (ß = 2.0; 95% confidence interval = 0.2-3.8; p = 0.036) and the Moderation component (ß = 2.6; 95% confidence interval = 1.2-4.0; p = 0.001). Outlet density shows a negative association with the odds of underweight among women (odds ratio = 0.62; 95% confidence interval = 0.37-0.96). However, we did not observe statistically significant relationships between diet quality and malnutrition. Education and nutrition knowledge scores were positively associated with diet diversity, while income was negatively associated with diet moderation. CONCLUSIONS: The findings of the present study have important implications for nutrition and dietetics practice in Vietnam and globally. It emphasises the need to consider various dimensions of sustainable diets, including economic, health and socio-cultural/political factors. Longer distances to food outlets are associated with higher diet quality, whereas lower food outlet density increases the odds of underweight among women. This poses challenges in balancing modernisation and its adverse effects on sustainable food systems. Socio-economic status consistently correlated with diet quality and malnutrition, necessitating further research to promote healthy diets across socio-economic strata.

Trend of risk and correlates of under-five child undernutrition in Bangladesh: an analysis based on Bangladesh Demographic and Health Survey data, 2007-2017/2018.

OBJECTIVES: The objectives of this study are to identify the trend of undernutrition risk among under-five children (U5C) in Bangladesh and the trend of its correlates. DESIGN: Multiple cross-sectional data sets from different time points were used. SETTING: Nationally representative Bangladesh Demographic and Health Surveys (BDHSs) were conducted in 2007, 2011, 2014 and 2017/2018. PARTICIPANTS: In the BDHSs, the sample sizes for ever-married women (age: 15-49 years) were 5300 in 2007, 7647 in 2011, 6965 in 2014 and 7902 in 2017/2018. OUTCOMES: Extant indicators of undernutrition (stunted, wasted and underweight) have been considered as the outcome variables. MATERIALS AND METHODS: Descriptive statistics, bivariate analysis and factor loadings from factor analysis have been used to determine the prevalence of undernutrition over the years and find the trend of risk and its correlates. RESULTS: Risks of stunting among the U5C were 41.70%, 40.67%, 36.57% and 31.14%; that of wasting were 16.94%, 15.48%, 14.43% and 8.44%; and that of underweight were 39.79%, 35.80%, 32.45% and 22.46% in 2007, 2011, 2014 and 2017/2018, respectively. From the factor analysis, it has been found that the top five potential correlates of undernutrition are the wealth index, the education of the father and mother, the frequency of antenatal visits during pregnancy, the father's occupation and/or the type of place of residence in the last four consecutive surveys. CONCLUSION: This study helps us gain a better understanding of the impact of the top correlates on child undernutrition. To accelerate the reduction of child undernutrition more by 2030, Government and non-government organisations should focus on improving education and household income-generating activities among poor households and raising awareness among women about the importance of receiving antenatal care during pregnancy.

Underweight predicts extubation failure after planned extubation in intensive care units.

BACKGROUND: Body weight is associated with different physiological changes and the association between weight and mortality in critical care setting had been discussed before. In this study, we investigated the linkage between underweight and post-extubation failure in mechanical ventilated patients in critical setting. METHODS: This is a retrospective cohort study including patients who were admitted to medical or surgical intensive care units (ICU) between June 2016 and July 2018 and had received endotracheal intubation for more than 72 hours. Those who passed spontaneous breathing trial and underwent a planned extubation were enrolled. Extubation failure was defined as those who required reintubation within the first 72 hours for any reasons. The probability of extubation failure was calculated. Demographic and clinical characteristics were recorded. Multivariate logistic regression models were then used to determine the potential risk factors associated with extubation failure. RESULTS: Overall, 268 patients met the inclusion criteria and were enrolled in our study for analysis. The median age of included patients was 67 years (interquartile range, 55-80 years) with 65.3% being male; 63.1% of the patients were included from medical ICU. The proportion of extubation failure in our cohort was 7.1% (19/268; 95% confidence interval [CI], 4.3-10.9%). Overall, underweight patients had the highest risk of extubation failure (8/50), as compared with normoweight (9/135) and overweight patients (2/83). In the multivariate analysis, being underweight (adjust OR [aOR], 3.80, compared to normoweight; 95% CI, 1.23-11.7) and lower maximal inspiratory airway pressure (aOR per one cmH2O decrease, 1.05; 95% CI 1.00-1.09) remained significantly associated with extubation failure. CONCLUSION: In our study, being underweight and lower maximal inspiratory airway pressure was associated with post-extubation respiratory failure after a planned extubation.

Effects of armed conflicts on childhood undernutrition in Africa: a systematic review and meta-analysis.

BACKGROUND: Undernutrition is defined as not consuming enough nutrients and energy to meet one's needs for maintaining good health. It is exacerbated by armed conflict. Individuals cannot stick to jobs because of a lack of safety during conflicts, which has an impact on families' ability to purchase food. However, there is a paucity of evidence on pooled evidence on the impact of armed conflict on childhood undernutrition among children aged 6 to 59 months in Africa. Therefore, this review aimed to examine the effects of armed conflict on the magnitude of undernutrition, particularly stunting, underweight, and wasting among children in Africa. METHODS: A comprehensive literature search was conducted using electronic databases (PubMed, Hinari, and Google Scholar database) to locate potential studies. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics. Small-study effects were checked using Egger's statistical test at a 5% significance level. A random-effects model was employed to estimate the pooled prevalence and associated factors of undernutrition among children aged 6-59 months in Africa. RESULTS: Of a total of 585 articles retrieved from the databases, 12 studies met our inclusion criteria. The pooled prevalence of wasting, stunting, and being underweight among conflict-affected African countries was 20.25% (95%CI = 15.08-25.43), 34.18% (95% CI = 26.34-42.02), and 24.00% (95%CI = 16.35-31.65), respectively. The most consistent factors associated with childhood stunting, wasting, and being underweight in Africa were low mother's education, prolonged duration of armed conflict, and rural place of residence. CONCLUSION: The severity of malnutrition crises will be assisted by a better understanding of the variables associated with child malnutrition, which will improve the effectiveness of development and humanitarian responses. We urge that health planners, policymakers, and the general public prioritize children with acute malnutrition in Africa's conflict-affected areas. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022367487.

Expanded HCT-CI Definitions Capture Comorbidity Better for Younger Patients of Allogeneic HCT for Nonmalignant Diseases.

Allogeneic hematopoietic cell transplantation (HCT) can cure many nonmalignant conditions, but concern for morbidity and mortality remains. To help physicians estimate patient-specific transplant mortality risk, the HCT comorbidity index (HCT-CI) is used. However, pediatric physicians use the HCT-CI less frequently than adult counterparts. We used the Center for International Blood and Marrow Transplant Research database to expand the HCT-CI comorbidity definitions to be more inclusive of children and adolescent and young adult (AYA) patients, adding history of mechanical ventilation, history of invasive fungal infection, assessment of chronic kidney disease (CKD) by estimated glomerular filtration rate, expanding the definition of obesity, and adding an underweight category. A total of 2815 children and AYAs (<40 years old) who received first allogeneic HCT for nonmalignant diseases from 2008 to 2017 were included to create an expanded youth nonmalignant HCT-CI (expanded ynHCT-CI) and a simplified non-malignant (simplified ynHCT-CI) HCT-CI. The expanded comorbidities occurred frequently-history of mechanical ventilation (9.6%), history of invasive fungal infection (5.9%), mild CKD (12.2%), moderate/severe CKD (2.1%), obesity (10.9%), and underweight (14.5%). Thirty-nine percent of patients had an increase in their comorbidity score using the expanded ynHCT-CI, leading to a redistribution of scores: ynHCT-CI score 0 (35%), 1-2 (36.4%), and ≥3 (28.6%). Patients with an increase in their comorbidity score had an increased hazard of mortality compared to those whose score remained the same (hazard ratio = 1.41; 95% confidence interval, 1.01-1.98). Modifications to the HCT-CI can benefit children and AYA patients with nonmalignant diseases, creating a risk assessment tool that is clinically relevant and better captures comorbidity in this younger population.

Effects of maternal employment on child malnutrition in South Asia: An instrumental variable approach.

OBJECTIVE: Although the association between child malnutrition and maternal employment status has been widely studied in several developing countries, the causal effect of mothers' employment on their children's health remains largely unknown. The aim of this study was to examine the causal effect of maternal employment on child malnutrition in five South Asian countries. METHOD: This study used a data set of >55 200 children ages 0 to 5 y by pooling the most recent Demographic Health Surveys (DHS) from Bangladesh, India, the Maldives, Nepal, and Pakistan. An instrumental variable (IV) method was applied to measure the causal effect of the mother's employment status (working mother) on stunting and underweight among children. RESULTS: Results showed that of the children in South Asia, 37.9% and 33.6% were stunted and underweight, respectively. The IV estimates suggested that maternal employment significantly increased stunting and underweight in children. For example, the likelihood of stunting and underweight increased by about 9.5% and 6.3% points, respectively, in South Asia when mothers worked. The likelihoods in Bangladesh (39.9 and 26.6%) and Pakistan (28 and 33.4%) were high but were at moderate levels in India (5.3 and 4.2%) and Nepal (8 and 9%). CONCLUSIONS: In the present study, an adverse effect of maternal labor market participation on the nutritional status of under-five children in South Asian countries was found. These findings could be helpful for policymakers in South Asian countries to adopt suitable policies to reduce malnutrition among children, especially for the children of employed mothers.

A Stratified Analysis of the Risk Associated With Low Body Mass Index for Patients After Percutaneous Coronary Intervention.

AIMS: The relationship between low body mass index (BMI) and prognostic factors for patients with coronary artery disease, commonly observed in elderly individuals in Japan, is important. Few studies have evaluated the prognosis for patients with low BMI after percutaneous coronary intervention (PCI). Using a multivariable-adjusted model and data from a prospective cohort registry, we analyzed the risk associated with low BMI for patients after PCI. METHODS: This prospective, multicenter registry included 5965 consecutive patients with coronary artery disease who underwent successful PCI. The patients were followed-up clinically for up to 3 years or until the occurrence of major adverse cardiac events. The primary endpoint was all-cause death and nonfatal myocardial infarction composite. RESULTS: Primary events occurred in 639 (10.7%) patients during the follow-up period. A risk analysis of the primary endpoint adjusted for the multivariable model showed a significant increase in risk for elderly individuals, underweight individuals [HR 1.43 (95% confidence interval (CI), 1.10-1.85), P＜0.001], those with diabetes mellitus (DM), peripheral artery disease, low left ventricular ejection fraction or acute coronary syndrome (ACS), and smokers. A stratified adjusted risk analysis based on BMI levels showed that the risk associated with underweight status was significantly pronounced for male patients, those aged 60-74 years, and those with DM or ACS. CONCLUSION: Underweight patients with several risk factors significantly increased risk after PCI. Furthermore, the risk associated with low BMI was significantly more pronounced for men, individuals aged 60-74 years, and patients with DM or ACS.

The association between breastfeeding and childhood obesity/underweight: a population-based birth cohort study with repeated measured data.

BACKGROUND: The impact of breastfeeding on childhood obesity has long been under debate, with most research showing significant association, and others showing weak or no association between breastfeeding and childhood obesity. What's more, almost all of the previous studies focused on the association between breastfeeding and childhood obesity, and no studies have assessed the association between breastfeeding and childhood underweight. This study aimed to examine the association between breastfeeding and childhood obesity as well as childhood underweight from 1 to 6 years old. METHODS: A retrospective population-based cohort study of 59,564 children born between May 2009 and April 2013 in China was conducted using the healthcare records data from the Tianjin Maternal and Child Healthcare System. Information on infant breastfeeding (exclusive breastfeeding, mixed feeding, and exclusive formula feeding) within 6 months old and childhood growth (6 times of repeated measured weight and height from 1 to 6 years old) was collected. Multinomial logistic regression was used to test the potential associations between infant feeding modalities and childhood growth (underweight, normal weight and obesity). RESULTS: Compared with exclusive formula feeding, breastfeeding was inversely associatied with childhood obesity from 2 to 6 years old, and there was a trend from mixed feeding to exclusive breastfeeding (Ptrend < 0.05). The largest association with obesity was displayed at 3 years old, with the multivariable adjusted odds ratios (ORs) for exclusive formula feeding, mixed feeding and exclusive breastfeeding of 1.00, 0.62 (95% CI 0.49, 0.80) and 0.57 (95% CI 0.44, 0.74) (Ptrend = 0.001), respectively. Compared with exclusive breastfeeding, exclusive formula feeding may increase the risk of childhood underweight at 3 and 5 years old. CONCLUSIONS: Breastfeeding was inversely associated with the risk of childhood obesity from 2 to 6 years old, and there was a trend from mixed feeding to exclusive breastfeeding. Infant exclusive formula feeding might be a risk factor for childhood underweight at preschool time.

Risk factors associated with under-five stunting, wasting, and underweight in four provinces of the Democratic Republic of Congo: analysis of the ASSP project baseline data.

BACKGROUND: Determining the magnitude and risk factors of undernutrition in a country that has one of the highest prevalence of undernutrition in the world is paramount for developing contextual interventions. METHODS: This study used baseline data from the ASSP project to estimate prevalence of stunting, wasting, and underweight in four provinces of DRC. It involved 3911 children aged 0-59 months old and mother pairs. Height-for-age Z scores, Weight-for-height Z scores, and Weight-for-age Z scores were calculated and used to classify child stunting, wasting and underweight respectively, based on the 2006 World Health Organization (WHO) growth reference. Hierarchical logistic regressions were used to identify risk factors associated with stunting, wasting and underweight. All analyses were conducted using STATA 15.1, and statistical significance was set at p < 0.05. RESULTS: The prevalence of stunting, underweight and wasting was 42.7%, 21.9% and 8.2% respectively. Increasing child's age was a risk factor associated with stunting and underweight, while sex was not associated with the 3 indicators of undernutrition. Low levels of mother's education, mothers working in the last 12 months prior to the survey, children living in the province of Kasai occidental, children born at a health facility, children perceived by their mothers to be born very small were associated with higher risks of stunting. Factors associated with underweight were children from the province of Kasai occidental, mothers who worked in the last 12 months prior to the survey, and children perceived to be born very small or small by their mothers. Children born to mothers aged 35-49 years and children breastfed in combination with drinking water were at higher risk of wasting. CONCLUSION: Prevalence of undernutrition in DRC is high. This study has identified certain modifiable risk factors associated with stunting, wasting and underweight. To reduce the burden of undernutrition in DRC, authorities should target factors at individual and community levels by improving women's education, child feeding practices and promoting agriculture.

Nutritional assessment and associated factors in children with congenital heart disease-Ethiopia.

INTRODUCTION: Worldwide, congenital heart disease is the principal heart disease in children and constitutes one of the major causes of infant mortality, particularly in developing countries. Infants and children with congenital heart disease exhibit a range of delays in weight gain and growth. In some instances, the delay can be relatively mild, whereas in other cases, cause the failure to thrive. OBJECTIVES: To determine the nutritional status and associated factors of pediatric patients with congenital heart disease. MATERIAL AND METHOD: A cross sectional analytical study conducted over a period of 6 months (Feb to Jul 2020). A total of 228 subjects with congenital heart disease who visited the cardiac center during the study period where included until the calculated sample size attained. Data is collected from patient's card and their care giver. Data was then analyzed using Statistical Package for Social Sciences (SPSS) for windows version 25.0. Odds Ratio with 95% Confidence Interval (CI) was used to determine the effect of the independent variables on the outcome variable and P-value less than 0.05 was considered statistically significant. RESULTS: A total of 228 children ranging from 3month to 17yrs of age with mean age of 4.7 years (SD = 3.8 years) were included in the study. Most of the subjects had acyanotic heart disease accounting for 87.7%. The overall prevalence of wasting, underweight and stunting were 41.3%, 49.1% and 43% respectively. Children with congenital heart disease and having pulmonary hypertension, were found more likely to develop wasting compared to those without pulmonary hypertension with an odds of 1.9 (95% CI: 1.0-3.4) and also have greater chance of stunting with an odds of 1.9 (95% CI: 1.0-3.4). Children 5 to 10 years of age were 2.3 times more likely to be underweight. CONCLUSION: Malnutrition is a major problem in pediatric patients with congenital heart disease. Pulmonary hypertension and older age are associated with increased risk of undernutrition.

Birth weight and nutritional status of children under five in sub-Saharan Africa.

INTRODUCTION: Over the past three decades, undernutrition has become a major cause of morbidity and mortality among children under five years globally. Low birth weight has been identified as a risk factor for child morbidity and mortality, especially among children under five years in sub-Saharan Africa. There is, however, a paucity of empirical literature establishing the association between low birth weight and undernutrition in sub-Saharan Africa. We examined the association between birth weight and nutritional status of children under five in sub-Saharan Africa. METHODS: Our analyses were performed on a weighted sample of 110,497 children under five years from 32 countries in sub-Saharan Africa. Data were obtained from the Demographic and Health Surveys conducted from 2010 to 2019. We reported the prevalence of low birth weight and nutritional status (stunting, wasting, and underweight) for all the 32 countries using percentages. We used multilevel binary logistic regression to examine the association between birth weight and nutritional status (stunting, wasting, and underweight) of the children, controlling for covariates. The results of the regression analyses were presented using adjusted odds ratios (aOR) with 95% confidence intervals. Statistical significance was set at p<0.05. RESULTS: The prevalence of low birth weight was 5.4%, with the highest (13.1%) and lowest (0.9%) reportedin South Africa and Chad, respectively. The pooled prevalence of wasting, underweight, and stunting were 8.1%, 17.0%, and 31.3%, respectively. Niger had the highest prevalence of wasting (21.5%) and underweight (37.1%), whereas Burundi had the highest prevalence of stunting (51.7%). We found that children with low birth weight were more likely to be stunted [aOR = 1.68, 95% CI = 1.58-1.78], underweight [aOR = 1.82, 95% CI = 1.70-1.94], and wasted [aOR = 1.35, 95% CI = 1.20-1.38] after controlling for covariates. CONCLUSION: Our study has demonstrated that low birth weight is a key determinant of undernutrition among children under five in sub-Saharan Africa. Policymakers need to give special attention to improving the nutritional status of children under-five years in sub-Saharan Africa by implementing measures aimed at enhancing the weight of children. To accelerate progress towards the achievement of the Sustainable Development Goal 3.2 target of ending preventable deaths of newborns and under-five by 2030, it is imperative for countries in sub-Saharan Africa to intensify interventions aimed at improving maternal and child nutrition. Specific nutrition interventions such as dietary modification counselling should prioritized.

Factors Related to Underweight Prevalence among 33,776 Children Below 60 Months Old Living in Northern Geopolitical Zones, Nigeria (2008-2018).

The prevalence of underweight among children below 60 months old in Nigeria remains a significant public health challenge, especially in northern geopolitical zones (NGZ), ranging from 15% to 35%. This study investigates time-based trends in underweight prevalence and its related characteristics among NGZ children below 60 months old. Extracted NGZ representative dataset of 33,776 live births from the Nigeria Demographic and Health Survey between 2008 and 2018 was used to assess the characteristics related to underweight prevalence in children aged 0-23, 24-59, and 0-59 months using multilevel logistics regression. Findings showed that 11,313 NGZ children below 60 months old were underweight, and 24-59-month-old children recorded the highest prevalence (34.8%; 95% confidence interval: 33.5-36.2). Four factors were consistently significantly related to underweight prevalence in children across the three age groups: poor or average-income households, maternal height, children who had diarrhoea episodes, and children living in the northeast or northwest. Intervention initiatives that include poverty alleviation through cash transfer, timely health checks of offspring of short mothers, and adequate clean water and sanitation infrastructure to reduce the incidence of diarrhoea can substantially reduce underweight prevalence among children in NGZ in Nigeria.

Association between intimate partner violence and nutritional status of married Nepalese women.

BACKGROUND: Intimate partner violence (IPV) is physical, sexual, or psychological harm perpetrated by a spouse or an intimate partner. Its detrimental effects on women's physical, mental, sexual, and reproductive health are well-documented. However, its impact on nutritional status is not well-studied, and previous studies have led to contradictory findings. This study aimed to explore the association between intimate partner violence and the nutritional status of married Nepalese women. METHODS: The study used the 2016 Nepal Demographic Health Survey data, which employed a modified version of the Conflict Tactics Scale to determine women's exposure to IPV. Anemia and low body mass index (BMI) were used as proxies of nutritional status. Multinomial regression was used to analyze the relationship between BMI and IPV; multivariable logistic regression was used to analyze the association between anemia and IPV. RESULTS: The prevalence of underweight, overweight/obesity, and anemia were respectively 13.9%, 25.1%, and 38.7%. The prevalence of physical, sexual, and emotional IPVs experienced in the preceding year were respectively 9.8%, 4.6%, and 7.6%. Likewise, the prevalence of lifetime physical, sexual, emotional, and controlling behavior IPVs were respectively 21.8%, 7.4%, 12.3%, and 32.1%. The low intensity of emotional IPV (AOR 1.62; CI: 1.02-2.56) and moderate intensity of physical IPV (AOR 3.70; CI: 1.64-8.35) experienced in the preceding year, and low intensity of lifetime emotional IPV (AOR 1.69; CI: 1.11-2.58) were associated with an increased risk of overweight/obesity. Moderate intensity of sexual IPV (AOR 2.59; CI: 1.099-6.108) experienced in the preceding year was associated with an increased risk of underweight BMI. The low intensity of lifetime controlling behavior (AOR1.25; CI: 1.03-1.53) was associated with an increased risk of anemia. CONCLUSIONS: Emotional and Physical IPVs are significantly associated with an increased risk of overweight/obesity. Sexual IPV is significantly associated with an increased risk of underweight BMI, and controlling behavior is significantly associated with an increased risk of anemia. Seeking help could offset the detrimental effects of IPV; therefore, IPV screening should be a part of regular healthcare assessment for married women, and appropriate rehabilitation should be offered to IPV survivors.