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Author(s): M Abera [sup.1] [sup.2] , M Tesfaye [sup.1] [sup.2] , T Girma [sup.3] , C Hanlon [sup.4] [sup.5] , G S Andersen [sup.6] , J C Wells [sup.7] , [...], Background/Objectives: Birth weight (BW), independent of socioeconomic status, has been identified as a predictor for childhood cognitive development. However, it is not known whether this relation is related to low BW per se or particularly related to a deficit in fat mass (FM) or fat-free mass (FFM) at birth. This study therefore aimed at investigating the relation between body composition at birth and child development at 2 years of age. Subjects/Methods: An Ethiopian birth cohort was followed up at 2 years. Body composition was measured within 48 h of birth using infant air-displacement plethysmography. Child development was assessed at 2 years of age using Denver developmental screening test. Associations between body composition at birth and development at 2 years of age were tested using linear regression analysis. Results: FFM but not FM at birth was positively associated with higher global developmental score at 2 years of age ([beta]=2.48, 95% confidence interval (CI) 0.17; 4.79) adjusted for neonatal, postnatal and parental characteristics. This association was attributable to the association with the language developmental domain ([beta]=1.61, 95 CI 0.33; 2.90). Conclusions: Among Ethiopian children, FFM at birth but not FM predicted better global and language development at 2 years of age. Higher FFM at birth might have exerted a positive effect on the growth and differentiation of the brain and neuronal circuits for better development. This study therefore highlights the need to improve mother's nutritional status during pregnancy in ways that stimulate fetal FFM growth.

This article has been corrected since Advance Online Publication and a corrigendum is also printed in this issue INTRODUCTION Infection with HIV continues to be a major public health problem [...], BACKGROUND/OBJECTIVES: The effects of inflammation on nutritional rehabilitation after starting antiretroviral therapy (ART) are not well understood. We assessed the relationship between inflammation and body composition among patients enrolled in the Nutritional Support for African Adults Starting Antiretroviral therapy (NUSTART) trial in Tanzania and Zambia from 2011 to 2013. SUBJECTS/METHODS: HIV-infected, ART-eligible adults with body mass index (BMI) of < 18.5 kg/[m.sup.2] enrolled in the NUSTART trial were eligible for this study. Anthropometric and body composition data were collected at recruitment and 6 and 12 weeks post ART and C-reactive protein (CRP) was measured at recruitment and 6 weeks. The relationships between CRP and body composition were assessed using multiple regression. RESULTS: Of the 1815 trial participants, 838 (46%) had baseline and 6-week CRP measurements. Median age was 36 years, 55% were females and median CD4 count was 135 cells/µl. A one-log reduction in CRP at 6 weeks was associated with increased mid-upper arm circumference (0.45 cm; 95% CI: 0.30, 0.61), calf circumference (0.38 cm; 0.23, 0.54), waist circumference (0.98 cm; 0.59, 1.37), BMI (0.37 kg/[m.sup.2]; 0.24, 0.50) and fat-free mass (0.58 kg; 0.26, 0.91), but not with fat mass (0.09 kg; -0.17, 0.34). Fat-free mass gains persisted at 12 weeks and were more closely associated with 6-week CRP values than with baseline values. CONCLUSIONS: Reduction in CRP shortly after ART initiation was associated with higher fat-free mass gains. Further studies are warranted to determine whether interventions to reduce systemic inflammation will enhance gains in fat-free mass. European Journal of Clinical Nutrition (2016) 70, 499-504; doi: 10.1038/ejcn.2015.221; published online 20 January 2016

INTRODUCTION High prevalence of low birth weight and infant malnutrition, combined with increasing rates of obesity, make sub-Saharan African countries prone to nutrition-related diseases. (1-3) Assessment of body composition (BC), [...], BACKGROUND/OBJECTIVES: Assessment of infant body composition (BC) is crucial to understand the consequences of suboptimal nutritional status and postnatal growth, and the effects of public health interventions. Bioelectrical impedance analysis (BIA) is a feasible, relatively inexpensive and noninvasive method for assessing BC. However, very little research has been conducted in lowand middle-income populations, where efforts to prevent or treat malnutrition in early life are a public health priority. We aimed to develop equations for predicting fat-free mass (FFM) and fat mass (FM) based on BIA in 0- to 6-month-old Ethiopian infants. SUBJECTS/METHODS: The study comprised a total of 186 BC assessments performed in 101 healthy infants, delivered at Jimma University Specialized Hospital. Infant air-displacement plethysmography (IADP) was the criterion method, whereas weight, length, sex, age and an impedance index ([L.sup.2]/[Z.sub.50]) were predictors. Prediction equations were developed using stepwise multiple linear regression and the accuracy was evaluated with a 10-fold cross-validation approach. RESULTS: A linear regression model based on body weight, age and sex predicted FFM, estimated by IADP, with an adjusted [R.sup.2] and root mean square error (RMSE) of 0.94 and 200 g, respectively. Adding impedance index to the model resulted in a significantly improved model fit ([R.sup.2] = 0.95;RMSE = 181 g). For infants below 3 months of age, inclusion of impedance index did not contribute to an improved model fit for predicting FFM compared with a model already comprising weight, sex and age. CONCLUSIONS: The derived equations predicted FFM with acceptable accuracy and may be used in future field surveys, epidemiological studies and clinical trials conducted in similar sub-Saharan African population groups aged 0-6 months. doi:10.1038/ejcn.2015.51; published online 1 April 2015

INTRODUCTION Severe nutritional deficit is common among tuberculosis (TB) patients (1) and may be associated with slow clinical and functional recovery (2) and increased risk of mortality. (3,4) Although treatment [...], BACKGROUND/OBJECTIVES: Gains in fat mass and lean mass during tuberculosis (TB) treatment may determine functional recovery and survival;yet, data are scarce. We aimed to assess predictors of fat and fat-free mass during 2 months of intensive TB treatment in a cohort in Mwanza, Tanzania. SUBJECTS/METHODS: Fat and fat-free mass were determined at the start of TB treatment and repeated after 2 months using the deuterium dilution technique. Gains in fat and fat-free mass were determined and predictors assessed using regression analysis. RESULTS: Data for 116 patients were available at baseline and during follow-up. Of these, 38.8% were females, mean age was 37.3 (s.d. 13.5) years, 69% (81) had sputum-positive TB, 45.7% (53) were HIV infected and 25% (29) were current smokers. The mean weight gain was 3.3 kg (95% confidence interval: 2.7;3.8), and it did not differ by sex. However, compared with females, males had 1.0 (0.4;1.6) kg/[m.sup.2] lower fat mass but 0.7 (0.2;1.3) kg/[m.sup.2] higher fat-free mass gain. Current smoking was associated with higher fat mass (0.7 kg/[m.sup.2], 0.04;1.4) but lower fat-free mass (-0.5 kg/[m.sup.2],-1.2;0.07) gain. Among HIV-infected patients, antiretroviral therapy (ART) led to a lower fat gain (- 1.2 kg/[m.sup.2],-2.2;-0.2) but to a higher fat-free mass among sputum-negative (2.9 kg/[m.sup.2], 0.8;5.1) but not sputum-positive patients. CONCLUSIONS: During intensive phase of TB treatment, sex, smoking and ART were predictors of body composition. Larger studies are needed to further understand predictors of body composition during recovery, to help design interventions to improve treatment outcomes. doi:10.1038/ejcn.2015.37; published online 1 April 2015

Introduction Vitamin A deficiency is widespread in developing countries, particularly in young children and women where it is an important cause of immune function impairment (Semba, 1994) and increased risk [...], Objective: To assess the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on serum retinol concentration, using schools as a health delivery system. Study area and population: From 19 primary schools in Bondo District, western Kenya, 977 children between 9 and 18y were included in the trial. The 644 (65.9%) children on whom baseline serum retinol was available were included in this study. Design: A randomised, placebo-controlled, double-blind, two-by-two factorial trial on the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on serum retinol after 8 months. Intervention: Single treatment with albendazole (600 mg) and praziquantel (40 mg/kg of body weight) and daily multimicronutrient supplementation with tablet containing 1000ILg vitamin A. Results: Micronutrient supplementation (0.08 µmol/l, 95% CI 0.01, 0.14; P=0.025), but not treatment (0.03 µmol/l, 95% CI -0.04, 0.10; P=0.38), increased serum retinol. However, treatment did increase serum retinol in S. mansoni-infected (0.09, 95% CI 0.02, 0.16; P=0.009), but not in uninfected children (-0.07, 95% CI -0.18, 0.03; P=0.18; interaction, P=0.01). Similarly, reduction in egg output of S. mansoni, but none of the geohelminth, was a predictor, corresponding to a 0.008 µmol/l (95% CI 0.00002, 0.02; P=0.049) increase in serum retinol per 100 epg reduction. Interestingly, interactions were found between age and sex (P=0.046), and malaria parasitaemia and sickle cell phenotype (P=0.04). Conclusion: Multi-micronutrient supplementation and reduction in S. mansoni egg output increased serum retinol, irrespective of initial serum retinol. Sponsorship: The Danish International Development Assistance. doi:10.1038/sj.ejcn.1601376 Keywords: micronutrients; anthelminthic treatment; malaria; S. mansoni; hookworm; T trichiura; A. lumbricoides; vitamin A; school children; Kenya

The destructive impact of HIV infection on micronutrient level illustrates the possible influence of micronutrient deficiencies on progression and transmission of HIV. Previous investigations have shown that vitamins A, B1, B2, B6, B12, C, and E, niacin, and selenium have interesting roles. Nevertheless, the function of some micronutrients such as iron, zinc, vitamin A and other antioxidants are complicated and there may be negative effects of high intakes.

The impact of zinc supplementation on susceptibility to Schistosoma mansoni reinfections among schoolchildren was investigated. A randomized, double-blind, placebo-controlled trial was used on 313 rural Zimbabwean schoolchildren. Findings revealed that there was no difference in reinfection rates between the zinc and placebo groups. However, the median intensity of S. mansoni reinfection, although low in both groups, was significantly lower in the zinc than in the placebo group.

The impact of zinc supplementation on growth and body composition among schoolchildren was studied in 313 rural Zimbabwean schoolchildren 11-17 years old using a randomized, double-blind, placebo-controlled trial. Findings indicated significant effects on weight gain, weight-for-age and arm muscle area-for-age for the first three months but no effects were seen over the full 12 months.

Schistosoma infection, age, C-reactive protein, and fever are good indicators of retinol concentration in the rural schoolchildren of Zimbabwe. S. mansoni infection decreases the retinol level and can cause vitamin A deficiency in children with marginal vitamin A status. The decrease is probably due to the malabsorption of vitamin A, increased consumption of retinol, or a decrease in retinol-binding protein synthesis, rather than metabolic changes. Serum retinol studies are helpful in age and metabolic responses to infections.

Author(s): P Kaestel [1, 2]; K F Michaelsen [1]; P Aaby [2]; H Friis [3] Introduction Low birth weight (LBW) is associated with increased risk of infant morbidity and mortality [...]

Author(s): H Friis [1, 4]; D Mwaniki [2]; B Omondi [2]; E Muniu [2]; F Thiong'o [3]; J Ouma [3]; P Magnussen [4]; P W Geissler [4]; K Fleischer Michaelsen [...]

Background: The diabetes burden in sub-Saharan Africa is rising, but there is little African data on associations between diet, insulin resistance, and beta-cell dysfunction., Objective: We investigated the association between dietary patterns and insulin resistance and beta-cell dysfunction among adults in Mwanza, Tanzania., Methods: In a cross-sectional study involving adults with or without HIV, insulin resistance and beta-cell dysfunction were calculated from plasma insulin and glucose measures during an oral glucose tolerance test. Diet data were collected using a validated food frequency questionnaire and dietary patterns were derived by principal component analysis and reduced rank regression. Logistic regression analysis was used to assess the association between exposure variables (dietary patterns terciles) with outcome variables (insulin resistance and beta-cell dysfunction), adjusting for HIV status, age, sex, body mass index, alcohol consumption, and smoking., Results: Of 462 participants, the mean age was 42 (±12) years, 58% were females, and 60% were HIV-infected. Carbohydrate-dense patterns were associated with more insulin resistance by HOMA-IR (aOR 2.7, 95% CI 1.5; 4.8) and Matsuda index (aOR 3.7, 95% CI 2.0; 6.7), but not with either HOMA-β, insulinogenic index or oral disposition index. The level of adherence to either the vegetable-rich or vegetable-poor pattern was not associated with any of the markers of insulin resistance or beta-cell dysfunction. HIV infection did not affect the association between patterns of diet and glucose metabolism outcomes., Conclusion: The lack of association between either vegetable-rich or vegetable-poor patterns with insulin resistance or beta cell dysfunction requires further research., Competing Interests: Competing interests: The authors declare no competing interests. Ethics approval: This study received ethical approval from the Medical Research Coordinating Committee of the National Institute for Medical Research, the joint Catholic University of Health and Allied Sciences/Bugando Medical Centre Research Ethics and Review Committee, and the London School of Hygiene and Tropical Medicine. The study was conducted according to principles embedded in the Declaration of Helsinki. Participants were enrolled after written informed consent and those with diabetes and other illnesses were referred to Sekou-Toure Referral Hospital or similar care facilities., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

In nutrition research, sample size calculations for continuous outcomes are important for the planning phase of many randomized trials and could also be relevant for some observational studies such as cohort and cross-sectional studies. However, only little literature dedicated to this topic exists within nutritional science. This article reviews the most common methods for sample size calculations in nutrition research. Approximate formulas are used for explaining concepts and requirements and for working through examples from the literature. Sample size calculations for the various study designs, which are covered, may all be seen as extensions of the sample size calculation for the basic two-group comparison through the application of suitable scaling factors and, possibly, modification of the significance level. The latter is needed for sample size calculations for multi-group designs and designs involving multiple primary outcomes. Like cluster-randomized designs, these types of study designs may be more challenging than standard sample size calculations. In such non-standard scenarios, there may be a need for consulting a biostatistician. Finally, it should be stressed that there may be many ways to plan a study. The final sample size calculation provided for a grant applicant, study protocol, or publication will often not only depend on considerations and input information as described in this article but will also involve restrictions in terms of logistics and/or resources., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Changes in body composition and muscle strength are common among individuals with HIV. We investigated the associations of inflammation with body composition and grip strength in adults with and without HIV., Methods: Cross-sectional study among Ethiopian treatment-naïve individuals with and without HIV. Fat mass and fat-free mass adjusted for height (kg/m 2 ) were used as indicators of body composition., Results: 288/100 individuals with/without HIV were included between July 2010 and August 2012. Females with HIV had lower fat mass index (FMI) and fat-free mass index (FFMI) than females without HIV, whereas no difference was seen between males with and without HIV. Males and females with HIV had lower grip strength than their counterparts without HIV. Serum alpha-1-acid glycoprotein (s-AGP) was negatively correlated with FMI (-0.71 kg/m 2 , 95% CI: -1.2; -0.3) among individuals with HIV, and those with HIV and serum C-reactive protein (s-CRP) ≥ 10 mg/l had 0.78 kg/m 2 (95% CI -1.4; -0.2) lower FMI than those with s-CRP < 10 mg/l. In contrast, s-AGP was positively correlated with FMI (2.09 kg/m 2 , 95% CI 0.6; 3.6) in individuals without HIV. S-CRP and AGP were negatively associated with grip strength in individuals with HIV, while no correlation was observed among those without HIV., Conclusion: Inflammation was positively associated with FMI in individuals without HIV while it was negatively associated with FMI in those with HIV, indicating that inflammation may be one of the drivers of depleting energy reserves among treatment-naïve individuals with HIV. Inflammation was associated with decreased muscle quantity and functional capacity among individuals with HIV, but not in those without HIV., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Moderate acute malnutrition (MAM) affects millions of children, increasing their risk of dying from infections. Thymus atrophy may be a marker of malnutrition-associated immunodeficiency, but factors associated with thymus size in children with MAM are unknown, as is the effect of nutritional interventions on thymus size., Methods: Thymus size was measured by ultrasound in 279 children in Burkina Faso with MAM, diagnosed by low mid-upper arm circumference (MUAC) and/or low weight-for-length z-score (WLZ), who received 12 weeks treatment with different food supplements as part of a randomized trial. Correlates of thymus size and of changes in thymus size after treatment, and after another 12 weeks of follow-up were identified., Results: Thymus size correlated positively with age, anthropometry and blood haemoglobin, and was smaller in children with malaria. Children with malnutrition diagnosed using MUAC had a smaller thymus than children diagnosed based on WLZ. Thymus size increased during and after treatment, similarly across the different food supplement groups., Conclusions: In children with MAM, the thymus is smaller in children with anaemia or malaria, and grows with recovery. Assuming that thymus size reflects vulnerability, low MUAC seems to identify more vulnerable children than low WLZ in children with MAM., Impact: Thymus atrophy is known to be a marker of the immunodeficiency associated with malnutrition in children. In children with moderate malnutrition, we found the thymus to be smaller in children with anaemia or malaria. Assuming that thymus size reflects vulnerability, low MUAC seems to identify more vulnerable children than low weight for length. Thymus atrophy appears reversible with recovery from malnutrition, with similar growth seen in children randomized to treatment with different nutritional supplements.

Children with moderate acute malnutrition (MAM) are treated based on low weight-for-length z-score (WLZ), low mid-upper arm circumference (MUAC) or both. This study aimed to assess associations of admission criteria and body composition (BC), to improve treatment of MAM. We undertook a cross-sectional study among 6-23 months old Burkinabe children with MAM. Fat-free (FFM) and fat mass (FM) were determined by deuterium dilution and expressed as FFM (FFMI) and FM index (FMI). Of 1,489 children, 439 (29.5%) were recruited by low MUAC only (MUAC-O), 734 (49.3%) by low WLZ and low MUAC (WLZ-MUAC) and 316 (21.2%) by low WLZ only (WLZ-O). Thus, 1,173 (78.8%) were recruited by low MUAC, with or without low WLZ (ALL-MUAC). After adjustments, WLZ-O had 89 g (95% confidence interval (CI) 5; 172) lower FFM compared to MUAC-O. Similarly, WLZ-O had 0.89 kg/m 2 (95% CI 0.77; 1.01) lower FFMI compared to MUAC-O, whereas there was no difference for FMI. However, boys included by WLZ-O compared to MUAC-O had 0.21 kg/m 2 (95% CI 0.05; 0.38) higher FMI. In contrast, girls included by WLZ-O had 0.17 (95% CI 0.01; 0.33) kg/m 2 lower FMI compared to MUAC-O (interaction, p = 0.002). We found that different criteria for admission into MAM treatment programmes select children with differences in BC, especially FFMI.Trial registration: ISRCTN42569496.

Background: We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM)., Methods: This was a prospective study nested in a randomized trial among 6-59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questionnaires and clinical examination, anthropometry and laboratory tests were performed. They were monitored daily until discharge or death during hospitalization while receiving care according to national guidelines. Predictors of death were assessed using Cox regression., Results: Of 400 children, 9.8% (n = 39) died during hospitalization. Predictors of mortality included diarrhoea at admission [hazard ratio [HR] 2.19, 95% confidence interval (CI): 1.06; 4.51], lack of appetite [HR 4.50, 95% CI: 1.76; 11.50], suspected sepsis [HR 2.23, 95% CI: 1.18; 4.24] and skin ulcers [HR 4.23, 95% CI: 1.26; 4.17]. Chest indrawing [HR 5.0, 95% CI: 1.53; 16.3], oxygen saturation below 94% [HR 3.92, 95% CI: 1.42; 10.83] and confirmed HIV infection [HR 3.62, 95% CI: 1.69; 7.77] also predicted higher mortality., Conclusion: Infections were major contributors to mortality. This underscores the need for improved prevention and management of these infections among children with severe malnutrition.

BACKGROUNDLow birth weight is associated with childhood stunting, but equivalent associations for birth body composition (BC) remain unknown. The aim of this study was to assess associations between birth BC and height-for-age z-score (HAZ) at 2 years of age.METHODSIn a prospective cohort study, fat mass (FM) and fat-free mass (FFM) were measured using air-displacement plethysmography within 48 h of birth. Linear regression models were applied to study the relationship between BC at birth and HAZ at 24 ±3 months.RESULTSA total of 268 children with height assessment at 2 years were included. Mean±SD HAZ at 2 years of age was -1.2±1.2, with 25.8% classified as stunted (HAZ <-2SD). FFM at birth was positively associated with HAZ at 2 years, independent of length at birth. When adjusted for potential confounders, HAZ at 2 years was 0.73 higher for each additional kg FFM at birth (β=0.73, 95% CI: 0.08, 1.38). FM was not associated with HAZ at 2 years in any model.CONCLUSIONThe FFM component of birth weight, independent of length at birth, explained variability in HAZ at 2 years. Further studies are required to explore how changes in early infant BC are associated with linear growth.

LBW increases the risk of a number of noncommunicable diseases in adulthood. However, birth weight (BW) cannot describe variability in infant body composition (BC). Variability in fat mass (FM) and fat-free mass (FFM) at birth may be particularly important in low-income countries because they undergo nutritional transition. There is a need for data on birth BC and its predictors from low-income countries in transition. We assessed absolute FM and FFM at birth and examined the role of gender, parity, GA, and LBW as predictors of birth BC. FM and FFM were assessed within 48 h of birth on 350 Ethiopian newborns using air displacement plethysmography (ADP). Female gender and being an infant of primi- or secundiparous mothers predicted lower BW and lower birth FFM but not FM, compared with male gender and infants of multiparous mothers, respectively. There was a positive linear relationship between BW and relative amount of FM for boys and girls. This study presents reference data on birth FM and FFM from a low-income setting and provides background for further longitudinal mapping of the relationship between fetal BC, childhood growth, and adult disease.

Excessive accumulation of fat in women of childbearing age is a concern, since obesity is an important cause of morbidity and mortality. Deposition of fat during pregnancy, which is not metabolized during lactation, may contribute. However, the individual effects of age and gravidity on fat accumulation have not been disentangled. Based on multiple linear regression analysis of anthropometric data from 1113 pregnant women from Zimbabwe, we found evidence to suggest that fat deposition is an effect of age rather than gravidity that is precipitated by the first pregnancy.