Temporal variation of chronic child malnutrition in the context of strengthening healthcare services in Burkina Faso: an Oaxaca-Blinder multivariate decomposition analysis.

Malnutrition seriously affects children's health, survival, and future productivity. According to the literature, increasing the supply of health services should help reduce the spread of malnutrition. This article analyses the sources of changes in the decline of chronic malnutrition during the 2000s, where there was an increase in the supply of health services in Burkina Faso. We used data from demographic and health surveys conducted in 2003 and 2010 in Burkina Faso. Malnutrition was defined according to the recommendations of the World Health Organization, while using standards of growth which are current and uniform for the two periods of study considered. We analyzed the source of temporal variation of chronic malnutrition through the Oaxaca-Blinder multivariate decomposition of the proportion of children suffering from chronic malnutrition. The analyses showed that the relative extent of chronic malnutrition in children decreased significantly, from 43.4% (CI 95%: 42.3-44.4) in 2003 to 34.7% (CI 95%: 33.6-35.9) in 2010. A quarter of this variation is due to a change in characteristics (composition effect), and the remaining 74.74% is due to a difference in coefficients (performance or behavior effect). Improved access to health services played a crucial role in reducing the scale of chronic malnutrition between 2003 and 2010. Other factors, such as educating mothers and urbanization, also contributed significantly. This study shows that improving access to health services is crucial for reducing chronic malnutrition. So, programs tackling child malnutrition must first and foremost ensure that children have access to health services.

Evaluation of malnutrition and screening tools in hospitalized children.

BACKGROUND & AIMS: Detecting malnutrition and its related risk factors are crucial, in hospitalized children. Anthropometric z scores are used to assess malnutrition. Screening tools also aim to detect the presence of malnutrition and the developing risk of malnutrition in hospitalized children to determine who may benefit from nutritional support. Therefore, the aims of the study are to detect malnutrition and its related demographic and clinical risk factors in hospitalized children and determining the sensitivity of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Pediatric Yorkhill Malnutrition Score (PYMS) screening tools. METHODS: A total of 130 hospitalized children aged between 0 and 18 years were included in to study. A survey including demographic and clinical characteristics, STAMP and PYMS were applied to parents of the children. Patients were classified into nutritional risk groups through screening tools. Anthropometric measurements (body weight, length/height, and middle upper arm circumference (MUAC) of the children were taken. Body mass index-for-age and height-for-age z scores were calculated to assess acute and chronic malnutrition prevalence. MUAC-for-age z scores were calculated as well. To detect independent risk factors for acute and chronic malnutrition multivariable logistic regression models were constructed. RESULTS: A total of 14.6% of hospitalized children had acute malnutrition, 21.5% of children had chronic malnutrition and 27.7% of them had low MUAC standard deviation score (SDS) (less than -2). The independent risk factors for acute malnutrition were younger maternal age at birth and long length of stay (p < 0.05). The independent risk factors for chronic malnutrition were being female, younger maternal age at birth, longer illness duration and having urological or allergy and immunological diseases (p < 0.05). However, MUAC for age SDS groups were not related to any demographic and clinical factors, in children of all ages (p > 0.05). Regarding the screening tools, PYMS displayed 100% sensitivity against acute malnutrition. While PYMS displayed better sensitivity to identify acute malnutrition than STAMP, STAMP was more sensitive than PYMS to detect chronic malnutrition and low MUAC SDS. CONCLUSIONS: Low MUAC for age SDS was not related to any demographic and clinical factors, in hospitalized children of all ages, unlike acute and chronic malnutrition, in this study. Pediatric screening tools mainly PYMS did not have high sensitivity to detect chronic malnutrition and low MUAC SDS, in hospitalized children. Therefore, the tools have to be used along with z scores of anthropometric parameters.

Factors associated with childhood chronic malnutrition in West and Central Africa: a scoping review.

Chronic malnutrition is a major public health concern that is the focus of a large body of scientific research. However, there is no synthesis of knowledge about the factors associated with this disease in West and Central Africa, where its prevalence is particularly high. We conducted a systematic search for scientific articles published between January 1st, 2000, and October 15th, 2020, that focus on chronic malnutrition in children in West and Central Africa. We queried CAIRN, PubMed, CINAHL, MEDLINE, Scopus, and Google Scholar databases for this purpose. The search process followed the recommendations of Arksey and O'Malley. Items reported in this review follow the PRISMA-ScR guidelines. Sixty articles involving children from a total of twenty (20) countries, mainly Ghana and Nigeria, were included in the final analysis. The data used were predominantly cross-sectional and were mainly drawn from demographic and health surveys. The analysis revealed that chronic malnutrition in children is associated with sociocultural, economic, and healthcare factors related to the characteristics of children, mothers, households, and communities. The association with children's vulnerability to disease, maternal education, purchasing power, and autonomy need to be further investigated in West and Central Africa. Further analysis using longitudinal data is also needed to better understand the factors associated with chronic malnutrition in West and Central Africa.

Public Health Implications of Wasting and Stunting Relationship in Children under Five Years Highly Vulnerable to Undernutrition in Guatemala: The REDAC Study.

(1) Background: Guatemala is the Latin American country with the highest prevalence of childhood stunting. Short height can bias the diagnosis of wasting when using the weight-for-height indicator. The aim of this study was to evaluate the diagnostic concordance of the anthropometric indicators of wasting and the relationship between wasting and stunting in children from highly vulnerable communities in Guatemala. (2) Methods: The sample consisted of 13,031 anthropometric records of children under five years of age (49.5% girls, average age of 27.9 months), including weight, height, and mid-upper arm circumference (MUAC), collected in March-August 2019. The proportions of stunting, underweight, and wasting, assessed by three different indicators, as well as their concurrence through the Composite Index of Anthropometric Failure were calculated. (3) Results: Stunting affected 73% of the sample, and 74.2% showed anthropometric failure. Wasting varied by indicator (weight-for-height: 2.8%; MUAC: 4.4%; MUAC-for-age: 10.6%). Concordance between MUAC and weight-for-height was very low (Kappa: 0.310; sensitivity: 40.9%). MUAC identified more wasted children in the stunted group (53.6% vs. 26.5%), while the opposite occurred in the non-stunted group (34.8% vs. 46.7%). (4) Conclusion: The presence of stunting affected the diagnosis of wasting, and both indicators should be included as diagnostic criteria for screening campaigns and in the treatment of moderate to acute wasting in vulnerable populations affected by multiple forms of undernutrition.

Spatial trends and projections of chronic malnutrition among children under 5 years of age in Ethiopia from 2011 to 2019: a geographically weighted regression analysis.

INTRODUCTION: Undernutrition is a serious global health issue, and stunting is a key indicator of children's nutritional status which results from long-term deprivation of basic needs. Ethiopia, the largest and most populous country in Sub-Saharan Africa, has the greatest rate of stunting among children under the age of five, yet the problem is unevenly distributed across the country. Thus, we investigate spatial heterogeneity and explore spatial projection of stunting among under-five children. Further, spatial predictors of stunting were assessed using geospatial regression models. METHODS: The Ethiopia Demographic and Health Surveys (EDHS) data from 2011, 2016, and 2019 were examined using a geostatistical technique that took into account spatial autocorrelation. Ordinary kriging was used to interpolate stunting data, and Kulldorff spatial scan statistics were used to identify spatial clusters with high and low stunting prevalence. In spatial regression modeling, the ordinary least square (OLS) model was employed to investigate spatial predictors of stunting and to examine local spatial variations geographically weighted regression (GWR) and multiscale geographically weighted regression (MGWR) models were employed. RESULTS: Overall, stunting prevalence was decreased from 44.42% [95%, CI: 0.425-0.444] in 2011 to 36.77% [95%, CI: 0.349-0.375] in 2019. Across three waves of EDHS, clusters with a high prevalence of stunting in children under 5 years were consistently observed in northern Ethiopia stretching in Tigray, Amhara, Afar, and Benishangul-Gumuz. Another area of very high stunting incidence was observed in the Southern parts of Ethiopia and the Somali region of Ethiopia. Our spatial regression analysis revealed that the observed geographical variation of under-five stunting significantly correlated with poor sanitation, poor wealth index, inadequate diet, residency, and mothers' education. CONCLUSIONS: In Ethiopia, substantial progress has been made in decreasing stunting among children under the age of 5 years; although disparities varied in some areas and districts between surveys, the pattern generally remained constant over time. These findings suggest a need for region and district-specific policies where priority should be given to children in areas where most likely to exhibit high-risk stunting.

Implementation of a nutritional supplementation program in a population of Cambodian children and its impact on statural growth.

BACKGROUND: Stunting is a major health problem in low-income countries. We aimed to describe the implementation of a lipid-based nutrient supplement (LNS) program in a rural neighborhood in Cambodia and to assess its impact on statural growth. METHOD: This was a before-after comparative study. The program was promoted by the Pédiatres du Monde (PDM) organization between 2011 and 2019 in six villages in a rural area in Cambodia. The supplementation program consisted of daily administration of LNS during the third semester of pregnancy for the mothers and then between 6 and 24 months of age for the toddlers. Anthropometric data of the children were recorded during PDM visits before and after the program implementation, which allowed us to compare child growth in the two groups: control and intervention groups. Primary outcome was height-for-age between 24 and 35 months of age. RESULTS: Overall, 198 data were collected for children between 24 and 35 months of age in the control group. A total of 347 pregnant women were enrolled in the intervention phase. A total of 188 data were collected for children between 24 and 35 months of age in the intervention group. The mean height-for-age z-score in the population receiving LNS was higher than in the control group (-1.14 vs. -1.60, p < 0.001). There was no significant difference between the two groups regarding the weight-for-height z-score (WHZ; -1.11 vs. -1.26, p = 0.18) and children in the intervention group had a higher middle upper-arm circumference z-score (MUACZ; -0.75 vs.. -1.1, p < 0.001). CONCLUSION: LNS supplementation significantly and increased the HAZ between 24 and 35 months of age. However, the fight against malnutrition is complex and needs intervention on multiple levels.

Early childhood stunting and later life outcomes: A longitudinal analysis.

Using longitudinal data from four countries-Ethiopia, India, Peru and Vietnam- we show that early childhood stunting is highly persistent as measured by the association between stunting status in early childhood and stunting status at age 15. Stunting in early childhood is associated with lower grade completion by age 22 and has a negative relationship with cognition as measured by math, language and reading scores at ages 8, 12 and 15. Stunting in early childhood is also associated with poorer subjective assessment of a child's health at age 15. Analyzing determinants, we show that lack of preventive care and economic shocks are associated with an increase in the probability of stunting in early childhood.

Utilization patterns, outcomes and costs of a simplified acute malnutrition treatment programme in Burkina Faso.

Access to treatment for acute malnutrition remains a challenge, in part due to the fragmentation of treatment programmes based on case severity. This paper evaluates utilization patterns, outcomes and associated costs for treating acute malnutrition cases among a cohort of children in Burkina Faso. This study is a secondary analysis of a proof-of-concept trial, called Optimizing treatment for acute Malnutrition (OptiMA), conducted in Burkina Faso in 2016. A total of 4958 eligible children whose mid-upper arm circumference (MUAC) was less than 125 mm or with oedema were followed weekly and given ready-to-use therapeutic foods (RUTF). We evaluated the service utilization and outcomes among patients and estimated resource use and variable cost per patient, and examined factors driving variation in resource use. Children with lower initial MUAC level grew faster but required more time to recover than those with higher initial MUAC level. They also had higher rates of death, default and nonresponse. The simplified OptiMA approach for treating acute malnutrition achieved high rates of recovery overall (84%), especially among less severe cases, with modest quantities of RUTF. The average overall variable cost per child admitted was US$38.0 (SD: 20.5) half of which was accounted for by the cost of RUTF. Cost per recovered case was correlated with case severity, ranging from US$35.1 to US$132.8. If simplified integrated programmes using severity-based RUTF dosing can increase access to treatment at earlier, less severe stages of acute malnutrition, they can help avoid more serious and costlier cases.

Elucidating the sustained decline in under-three child linear growth faltering in Nepal, 1996-2016.

Childhood linear growth faltering remains a major public health concern in Nepal. Nevertheless, over the past 20 years, Nepal sustained one of the most rapid reductions in the prevalence of stunting worldwide. First, our study analysed the trends in height-for-age z-score (HAZ), stunting prevalence, and available nutrition-sensitive and nutrition-specific determinants of linear growth faltering in under-three children across Nepal's Family Health Survey 1996 and Nepal's Demographic and Health Surveys 2001, 2006, 2011, and 2016. Second, we constructed pooled multivariable linear regression models and decomposed the contributions of our time-variant determinants on the predicted changes in HAZ and stunting over the past two decades. Our findings indicate substantial improvements in HAZ (38.5%) and reductions in stunting (-42.6%) and severe stunting prevalence (-63.9%) in Nepalese children aged 0-35 months. We also report that the increment in HAZ, across the 1996-2016 period, was significantly associated (confounder-adjusted p < .05) with household asset index, maternal and paternal years of education, maternal body mass index and height, basic child vaccinations, preceding birth interval, childbirth in a medical facility, and prenatal doctor visits. Furthermore, our quantitative decomposition of HAZ identified advances in utilisation of health care and related services (31.7% of predicted change), household wealth accumulation (25%), parental education (21.7%), and maternal nutrition (8.3%) as key drivers of the long-term and sustained progress against child linear growth deficits. Our research reiterates the multifactorial nature of chronic child undernutrition and the need for coherent multisectoral nutrition-sensitive and nutrition-specific strategies at national scale to further improve linear growth in Nepal. [Correction added on 6 November 2020, after first online publication: in abstract, the citation year in the fourth sentence has been changed from '2001' to '2011'.].

La desnutrición infantil en Ecuador. Una revisión de literatura / Child malnutrition in Ecuador. A literature review

La desnutrición infantil constituye un grave problema de salud, afectando los sectores sociales más desfavorecidos. La desnutrición causa disminución del crecimiento y del desempeño escolar, altera el estado bioquímico e incrementa la morbimortalidad infantil. Entre las principales causas de desnutrición están la dieta inadecuada, la presencia de infecciones que interfieren con la utilización adecuada de nutrientes, inequidad e insuficiente disponibilidad de alimentos. En América Latina, aproximadamente 2,3 millones de niños de 0 a 4 años se ven afectados por desnutrición moderada o grave y 8,8 millones presentan baja talla para su edad, con alta prevalencia de desnutrición crónica, lo que es atribuible a determinantes sociales, económicos y políticas de salud deficientes en la mayoría de países de la región. En Ecuador existe una prevalencia de desnutrición de 23,2%, situación que se agrava en el contexto rural, presentando más frecuencia en la Sierra (32%), la Costa (15,7%), la Amazonía (22,7%) y la zona Insular (5,8%), y aun cuando se han implementado programas de nutrición, los logros positivos de indicadores nutricionales, no han alcanzado impactar lo suficiente en algunas comunidades indígenas en las que se estima una tasa de desnutrición crónica infantil por encima de 50%. La presente investigación muestra los principales rasgos de la desnutrición infantil en Ecuador, partiendo de un diseño cualitativo, interpretativo y análisis documental con el objetivo de sistematizar el conocimiento y fortalecer las bases teórico-metodológicas de planes y estrategias necesarios para disminuir los efectos negativos de la desnutrición en el desarrollo infantil(AU)

Infant malnutrition constitutes a serious health problem, affecting the most disadvantaged social sectors. Malnutrition causes a decrease in growth and school performance, an alteration in the biochemical state and an increase in infant morbidity and mortality. Among the main causes of malnutrition are an inadequate diet, the presence of infections that interfere with the adequate use of nutrients, inequity, and insufficient food availability. In Latin America, approximately 2.3 million children aged 0 to 4 are affected by moderate or severe malnutrition and 8.8 million are short for their age, with a high prevalence of chronic malnutrition, which is attributable to social determinants economic, economic and health policies in most countries of the region. In Ecuador there is a prevalence of malnutrition of 23.2%, a situation that worsens in the rural context, presenting more frequency in the Sierra (32%), the Coast (15.7%), the Amazon (22.7%) and the Insular zone (5.8%), and even when nutrition programs have been implemented, the positive achievements of nutritional indicators have not had a sufficient impact on some indigenous communities in which a rate of chronic child malnutrition is estimated by above 50%. This research shows the main features of child malnutrition in Ecuador, starting from a qualitative, interpretive design and documentary analysis with the aim of systematizing knowledge and strengthening the theoretical-methodological bases of plans and strategies necessary to reduce the negative effects of the malnutrition in child development(AU)

Nutritional status in young children prior to the malaria transmission season in Burkina Faso and Mali, and its impact on the incidence of clinical malaria.

BACKGROUND: Malaria and malnutrition remain major problems in Sahel countries, especially in young children. The direct effect of malnutrition on malaria remains poorly understood, and may have important implications for malaria control. In this study, nutritional status and the association between malnutrition and subsequent incidence of symptomatic malaria were examined in children in Burkina Faso and Mali who received either azithromycin or placebo, alongside seasonal malaria chemoprevention. METHODS: Mid-upper arm circumference (MUAC) was measured in all 20,185 children who attended a screening visit prior to the malaria transmission season in 2015. Prior to the 2016 malaria season, weight, height and MUAC were measured among 4149 randomly selected children. Height-for-age, weight-for-age, weight-for-height, and MUAC-for-age were calculated as indicators of nutritional status. Malaria incidence was measured during the following rainy seasons. Multivariable random effects Poisson models were created for each nutritional indicator to study the effect of malnutrition on clinical malaria incidence for each country. RESULTS: In both 2015 and 2016, nutritional status prior to the malaria season was poor. The most prevalent form of malnutrition in Burkina Faso was being underweight (30.5%; 95% CI 28.6-32.6), whereas in Mali stunting was most prevalent (27.5%; 95% CI 25.6-29.5). In 2016, clinical malaria incidence was 675 per 1000 person-years (95% CI 613-744) in Burkina Faso, and 1245 per 1000 person-years (95% CI 1152-1347) in Mali. There was some evidence that severe stunting was associated with lower incidence of malaria in Mali (RR 0.81; 95% CI 0.64-1.02; p = 0.08), but this association was not seen in Burkina Faso. Being moderately underweight tended to be associated with higher incidence of clinical malaria in Burkina Faso (RR 1.27; 95% CI 0.98-1.64; p = 0.07), while this was the case in Mali for moderate wasting (RR 1.27; 95% CI 0.98-1.64; p = 0.07). However, these associations were not observed in severely affected children, nor consistent between countries. MUAC-for-age was not associated with malaria risk. CONCLUSIONS: Both malnutrition and malaria were common in the study areas, high despite high coverage of seasonal malaria chemoprevention and long-lasting insecticidal nets. However, no strong or consistent evidence was found for an association between any of the nutritional indicators and the subsequent incidence of clinical malaria.

Prevalence of goiter and iodine deficiency in indigenous pregnant women from five nonmetropolitan areas of Colombia 2019 / [Prevalencia de bocio y yodo-deficiencia en embarazadas indígenas de cinco áreas no metropolitanas de Colombia 2019].

Objective: To assess the prevalence of goiter and iodine deficiency in indigenous pregnant women coming from five non-metropolitan areas in Colombia. Materials and methods: Descriptive cross-sectional cohort study that included pregnant women of any gestational age with no pregnancy-related conditions, seen in community health centers or in their homes. Patients with comorbidities at the time of pregnancy and those who were receiving iodine supplementation were excluded. Simple random sampling was used. The sociodemographic and obstetric characteristics, urinary iodine concentration and the presence of goiter were measured in accordance with the World Health Organization methodology. A descriptive analysis was performed. Results: Of 189 indigenous pregnant women who were candidates to enter the study, 2 declined participation, and 62 had exclusion criteria, and 125 were included in the final analysis. The mean urinary iodine concentration was 184.4 µg/L (min-max: 12.0-390.0). A total of 42 women (33.6%) had iodine deficiency (< 100 µg/L), and goiter (grade 1-2) was found in 43 (34.4%). No grade 3 or 4 goiter was identified. Conclusions: A high prevalence of goiter and iodine deficiency was found in indigenous pregnant women living in non-metropolitan areas. There is a need to assess maternal and perinatal effects and to implement nutritional interventions.

Objetivo: evaluar la prevalencia de yodo deficiencia y de bocio en mujeres indígenas gestantes de cinco áreas no metropolitanas en Colombia. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres embarazadas de cualquier edad gestacional sin condiciones patológicas del embarazo, atendidas en los centros de salud comunitarios o en sus residencias. Se excluyeron aquellas con comorbilidades presentes al momento del embarazo y también a quienes recibían suplementos con yodo. Muestreo aleatorio simple. Se midieron las características sociodemográficas y obstétricas, la concentración de yodo en orina y la presencia de bocio de acuerdo a la metodología de la Organización Mundial de la Salud. Se realizó un análisis descriptivo. Resultados: 189 gestantes indígenas fueron candidatas a ingresar al estudio, de las cuales 2 no aceptaron participar y 62 tenían criterios de exclusión, finalmente se analizaron 125. La concentración urinaria de yodo tuvo una mediana de 184,4 µg/L (min-max: 12,0-390,0). Un total de 42 gestantes (33,6%) tenían yodo deficiencia (< 100 µg/L) y se evidenció bocio (grado 1-2) en 43 (34,4%). No se identificó bocio grados 3 o 4. Conclusiones: embarazadas indígenas residentes en áreas no metropolitanas evidenciaron alta prevalencia de bocio y yodo deficiencia. Se requiere evaluar los efectos materno-perinatales e implementar intervenciones nutricionales.

Prevalencia de bocio y yodo-deficiencia en embarazadas indígenas de cinco áreas no metropolitanas de Colombia 2019 / Prevalence of goiter and iodine deficiency in indigenous pregnant women from five non-metropolitan areas of Colombia 2019

RESUMEN Objetivo: evaluar la prevalencia de yodo deficiencia y de bocio en mujeres indígenas gestantes de cinco áreas no metropolitanas en Colombia. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres embarazadas de cualquier edad gestacional sin condiciones patológicas del embarazo, atendidas en los centros de salud comunitarios o en sus residencias. Se excluyeron aquellas con comorbilidades presentes al momento del embarazo y también a quienes recibían suplementos con yodo. Muestreo aleatorio simple. Se midieron las características sociodemográficas y obstétricas, la concentración de yodo en orina y la presencia de bocio de acuerdo a la metodología de la Organización Mundial de la Salud. Se realizó un análisis descriptivo. Resultados: 189 gestantes indígenas fueron candidatas a ingresar al estudio, de las cuales 2 no aceptaron participar y 62 tenían criterios de exclusión, finalmente se analizaron 125. La concentración urinaria de yodo tuvo una mediana de 184,4 µg/L (min-max: 12,0-390,0). Un total de 42 gestantes (33,6%) tenían yodo deficiencia (< 100 µg/L) y se evidenció bocio (grado 1-2) en 43 (34,4%). No se identificó bocio grados 3 o 4. Conclusiones: embarazadas indígenas residentes en áreas no metropolitanas evidenciaron alta prevalencia de bocio y yodo deficiencia. Se requiere evaluar los efectos materno-perinatales e implementar intervenciones nutricionales.

ABSTRACT Objective: To assess the prevalence of goiter and iodine deficiency in indigenous pregnant women coming from five non-metropolitan areas in Colombia. Materials and methods: Descriptive cross-sectional cohort study that included pregnant women of any gestational age with no pregnancy-related conditions, seen in community health centers or in their homes. Patients with comorbidities at the time of pregnancy and those who were receiving iodine supplementation were excluded. Simple random sampling was used. The sociodemographic and obstetric characteristics, urinary iodine concentration and the presence of goiter were measured in accordance with the World Health Organization methodology. A descriptive analysis was performed. Results: Of 189 indigenous pregnant women who were candidates to enter the study, 2 declined participation, and 62 had exclusion criteria, and 125 were included in the final analysis. The mean urinary iodine concentration was 184.4 µg/L (min-max: 12.0-390.0). A total of 42 women (33.6%) had iodine deficiency (< 100 µg/L), and goiter (grade 1-2) was found in 43 (34.4%). No grade 3 or 4 goiter was identified. Conclusions: A high prevalence of goiter and iodine deficiency was found in indigenous pregnant women living in non-metropolitan areas. There is a need to assess maternal and perinatal effects and to implement nutritional interventions.

Histone Deacetylase Activity and the Renin-Angiotensin-Aldosterone System: Key Elements in Cardiorenal Alterations Provoked by Chronic Malnutrition in Male Adult Rats.

BACKGROUND/AIMS: Chronic malnutrition (M) affects >1 billion people worldwide. Epidemiological data point to long-term renal and cardiovascular outcomes (e.g. arterial hypertension, cardiorenal syndromes). The renin-angiotensin-aldosterone system (RAAS) has been implicated in the physiopathology of these disturbances, but M-induced alterations in RAAS-modulated renal Na+ handling and their cardiovascular repercussions are not known. Moreover, altered tissue-specific histone deacetylases (HDAC) results in arterial hypertension and the use of sodium Valproate (Val; a HDAC inhibitor) reduces blood pressure. However, there are no reports regarding the renal and cardiovascular effects of HDAC inhibition in M, or on the signaling pathways involved. The central aim of our study has been to investigate whether alterations in the HDAC/RAAS axis underpin alterations in active Na+ transport in the kidney and heart, and affects blood pressure. METHODS: Male rats aged 28 days were given either a control (C) or a multideficient diet (Regional Basic Diet, RBD), which mimics alimentary habits from developing countries. Subgroups received Losartan (Los), a blocker of type 1 Angiotensin II receptors. When the rats reached 70 days, new subgroups received Val until they were 90 days of age. Homogenates and enriched plasma membrane fractions from renal cortex corticis and cardiomyocytes were obtained by differential centrifugation of the tissues. The activity of renal and cardiac deacetylases was assayed by measuring - after incubation with the membranes - the amount of deacetylated lysines in a substrate containing an acetylated lysine side chain. Protein kinases activities were measured following the incorporation of the γ-phosphoryl group of [γ-32P]ATP into Ser/Thr residues of histone type III-S. The activity of Na+-transporting ATPases (kidney and heart) was quantified by measuring the release of Pi from ATP that was sensitive to ouabain ((Na++K+)ATPase), or sensitive to furosemide (Na+-ATPase). Tail-cuff plethysmography was used to measure systolic blood pressure and heart rate. RESULTS: M provoked HDAC downregulation, which was reversed by Los and Val, either alone or in combination, with selective upregulation of protein kinases C and A (PKC, PKA) in renal cortex corticis, but not in left ventricle cardiomyocytes. The 2 kinases were strongly inhibited by Los and Val in both organs. Malnourished rats developed elevated systolic arterial pressure (SAP) and heart rate (HR) at 70 days of age; Los and Val restored the control SAP, but not HR. Functional and the above biochemical alterations were associated with the deregulation of renal and cardiac Na+-transporting ATPases. (Na++K+)ATPase activities were downregulated in M rats in both organs, and were further inhibited by the pharmacological treatments in the renal cortex corticis (C and M groups) and the left ventricle (only in C rats). No additional effect was found in cardiac (Na++K+)ATPase from M rats. Ouabain-resistant Na+-ATPase was upregulated in renal cortex corticis and downregulated in cardiomyocytes, returning to C values after administration of Los and Val. CONCLUSION: The HDAC/RAAS axis appears to be a key regulator of Na+-transporting ATPases in renal cortex corticis and cardiomyocytes via an appropriate balance of PKC and PKA activities. Modifications within the HDAC/RAAS axis provoked by chronic M - with repercussions in renal and cardiac Na+ transport - underpin alterations in bodily Na+ homeostasis that culminate with the onset of arterial hypertension and potential cardiorenal syndrome.

Factors associated with stunting and wasting in children under 2 years in Bangladesh.

Child undernutrition has been a major concern for Bangladesh as it is amongst the highest stunting and wasting prevalent countries in the world. The objective of our study was to explore the socioeconomic determinants of stunting and wasting in children under two years. This study explored nationally representative sample of 7,230 children ranging in age from 0 to <24 months using two separate binary logistic regression models to determine the risk factors associated with child stunting and wasting. Our study estimated approximately 33 percent children to be stunted and 11 percent to be wasted. Our analysis found that, 12 to <24 months old children's height-for-age-z-score and weight-for-height-z-score deteriorated in comparison to those of below 6 months. Female children had significantly lower odds of stunting and wasting compared with male children. Study revealed that children from wealthier families were at lower risk of being stunted and wasted compared to children from poorer households. Parental education was determined as a significant predictor of stunting. Children who lived in Sylhet division were 1.26 times more likely to be stunted than the children of Dhaka division [OR = 1.26; 95% CI: 1.02-1.55]. Our study revealed age, gender, geographic distribution, and household's position in wealth index as common determinants of child stunting and wasting in Bangladesh. While parental education was significant predictor for child stunting, type of toilet facility was found as statistically significant determinant of child wasting in children of less than two years age.

The double burden of chronic malnutrition and overweight and obesity in Ecuadorian mothers and children, 1986-2012.

BACKGROUND:: The simultaneous presence of undernutrition and over-nutrition represents a paradox in global public health and is of increasing concern in Ecuador, where chronic malnutrition and overweight and obesity occur in the context of demographic and epidemiologic transitions. Two overlapping trends are present in Ecuador; while levels of stunting have decreased slowly in the past three decades, increasing proportions of children <5 years and women of reproductive age suffer from overweight and obesity. AIM:: To analyze stunting and overweight and obesity in children <5 and their mothers aged from 15 to 49 years in the context of demographic and household characteristics between 1986 and 2012. METHODS:: This study compares data from nationally-representative surveys conducted in Ecuador in 1986, 2004, and 2012, each of which collected information on children <5 and mothers aged 15-49 years. RESULTS:: The prevalence of chronic malnutrition in children <5 decreased at different rates among Ecuadorians who differ in terms of residence, socioeconomic status, and mothers' level of education, while overweight and obesity increased dramatically in the same period. CONCLUSION:: Chronic malnutrition in children <5 and overweight in children <5 and mothers 15-49 years represent a double burden of malnutrition in Ecuador. The phenomena differ in their effects, and, while the prevalence of stunting is declining in Ecuador as it is in many parts of the world, the problem of overweight and obesity has emerged in dramatic fashion, and currently represents an extraordinary challenge to public health.

Increased concentrations of serum nesfatin-1 levels in childhood with idiopathic chronic malnutrition

Background/aim: Nesfatin-1, an anorexigenic molecule, seems to play a role in appetite regulation and energy homeostasis. The goal of this study was to evaluate the relation of nesfatin-1 with anthropometric and metabolic (ghrelin, leptin) parameters in children with idiopathic chronic malnutrition. Materials and methods: The study included 37 underweight and 38 healthy children who were similar regarding age, sex, and pubertal status. Anthropometric and biochemical (nesfatin-1, ghrelin, and leptin levels) variables were assessed. Results: A total of 37 underweight subjects (mean age 10.5 ± 2.6 years) and 38 heathy subjects (mean age 10.3 ± 2.3 years) were recruited. Underweight children had significantly higher nesfatin-1 (2.76 ± 0.4 vs. 1.56 ± 0.7, P < 0.001) and lower leptin levels (2.21 ± 2.0 vs. 5.21 ± 2.4, P < 0.001) than those of the control subjects. Nesfatin-1 levels were significantly associated with only leptin levels, after adjusting for age and BMI (r = ­0.371, P = 0.001). Conclusion: The present study is the first to evaluate nesfatin-1 levels in relation with anthropometric and metabolic parameters in children with chronic malnutrition, who were subsequently found to have significantly higher nesfatin-1 levels. Our study underlines that nesfatin-1 may play a role in the development of malnutrition by inhibiting food intake in children.

Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention.

BACKGROUND: Child malnutrition, a leading cause of death and disability worldwide, is particularly severe in Madagascar, where 47% of children under 5 years are stunted (low height-for-age) and 8% are wasted (low weight-for-height). Widespread poverty and a weak health system have hindered attempts to implement life-saving malnutrition interventions in Madagascar during critical periods for growth faltering. OBJECTIVE: This study aimed to shed light on the most important factors associated with child malnutrition, both acute and chronic, and the timing of growth faltering, in Ifanadiana, a rural district of Madagascar. METHODS: We analyzed data from a 2014 district-representative cluster household survey, which had information on 1175 children ages 6 months to 5 years. We studied the effect of child health, birth history, maternal and paternal health and education, and household wealth and sanitation on child nutritional status. Variables associated with stunting and wasting were modeled separately in multivariate logistic regressions. Growth faltering was modeled by age range. All analyses were survey-adjusted. RESULTS: Stunting was associated with increasing child age (OR = 1.03 (95%CI 1.02-1.04) for each additional month), very small birth size (OR = 2.32 (1.24-4.32)), low maternal weight (OR = 0.94 (0.91-0.97) for each kilogram, kg) and height (OR = 0.95 (0.92-0.99) for each centimeter), and low paternal height (OR = 0.95 (0.92-0.98)). Wasting was associated with younger child age (OR = 0.98 (0.97-0.99)), very small birth size (OR = 2.48 (1.23-4.99)), and low maternal BMI (OR = 0.84 (0.75-0.94) for each kg/m2). Height-for-age faltered rapidly before 24 months, then slowly until age 5 years, whereas weight-for-height faltered rapidly before 12 months, then recovered gradually until age 5 years but did not reach the median. CONCLUSION: Intergenerational transmission of growth faltering and early life exposures may be important determinants of malnutrition in Ifanadiana. Timing of growth faltering, in the first 1000 days, is similar to international populations; however, child growth does not recover to the median.

Determinants of childhood stunting in the Democratic Republic of Congo: further analysis of Demographic and Health Survey 2013-14.

BACKGROUND: Prevalence of child stunting in the Democratic Republic of Congo (DRC) is among the highest in the world. There is a need to systematically investigate how stunting operates at different levels of determination and identify major factors contributing to the development of stunting. The aim of this study was to look for key determinants of stunting in the DRC. METHODS: This study used data from the DRC Demographic Health Survey 2013-14 which included anthropometric measurement for 9030 under 5 year children. Height-for-Age Z score was calculated and classified according to the WHO guideline. The association between stunting and bio-demographic characteristics was assessed using logistic regression. RESULTS: Prevalence of stunting was much higher in boys than girls. There was a significant rural urban gap in the prevalence of stunting with rural areas having a larger proportion of children living with stunting than urban. Male children, older than 6 months, preceding birth interval less than 24 months, being from lower wealth quintiles had the highest odds of stunting. Several provinces had in particular high odds of stunting. Early initiation of breastfeeding, mother's age more than 20 years at the time of delivery had lower odds of stunting. The taller the mother the less likely the child was to be stunted. Similarly, mother's BMI, access to safe water, access to hygienic toilet, mother's education were found negatively correlated with child stunting in the bivariate logistic regression, but they lost statistical significance in multivariate analysis together with numbers of children in the family and place of residence. CONCLUSIONS: Child stunting is widespread in the DRC and increasing prevalence is worrisome. This study has identified modifiable factors determining high prevalence of stunting in the DRC. Policy implementation should in particular target provinces with high prevalence of stunting and address modifiable determinants such as reducing socioeconomic disparity. Nutrition promotion intervention, including early initiation of breastfeeding should be an immediate priority.

Nasopharyngeal carriage of respiratory pathogens in Warao Amerindians: significant relationship with stunting.

OBJECTIVE: To assess risk factors for nasopharyngeal carriage of potential pathogens in geographically isolated Warao Amerindians in Venezuela. METHODS: In this point prevalence survey, nasopharyngeal swabs were obtained from 1064 Warao Amerindians: 504 children aged 0-4 years, 227 children aged 5-10 years and 333 caregivers. Written questionnaires were completed to obtain information on demographics and environmental risk factors. Anthropometric measurements were performed in children aged 0-4 years. RESULTS: Carriage rates of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Moraxella catarrhalis were 51%, 7%, 1% and 13%, respectively. Crowding index, method of cooking and tobacco exposure were not associated with increased carriage. In multivariable analysis, an increase in height-for-age Z score (i.e. improved chronic nutritional status) was associated with decreased odds of S. pneumoniae colonisation (OR 0.76, 95% CI 0.70-0.83) in children aged 0-4 years. CONCLUSIONS: Better knowledge of demographic and environmental risk factors facilitates better understanding of the dynamics of colonisation with respiratory bacteria in an Amerindian population. Poor chronic nutritional status was associated with increased pathogen carriage in children <5 years of age. The high rates of stunting generally observed in indigenous children may fuel the acquisition of respiratory bacteria that can lead to respiratory and invasive disease.