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1. Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts

Author

Tanya Khara, Mark Myatt, Kate Sadler, Paluku Bahwere, James A Berkley, Robert E Black, Erin Boyd, Michel Garenne, Sheila Isanaka, Natasha Lelijveld, Christine McDonald, Andrew Mertens, Martha Mwangome, Kieran O’Brien, Heather Stobaugh, Sunita Taneja, Keith P West, André Briend, SOUtenabilité et RésilienCE (SOURCE), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut de Recherche pour le Développement (IRD [France-Nord]), United States Agency for International Development, USAID: 720BHA23CA00001, 720FDA18GROO290, Irish Aid: HQPCR/2022/ENN, HQPU/2021/ENN, and Financial Support: This paper is made possible by the generous support of the American people through the United States Agency for International Development (USAID) (Award No’s 720FDA18GROO290 and 720BHA23CA00001) and of Irish Aid (Grant No’s HQPU/2021/ENN and HQPCR/2022/ENN). The ideas, opinions and comments herein are entirely the responsibility of its authors and do not necessarily represent or reflect the views of USAID or the United States Government or Irish Aid or the Irish Government.

Subjects
Stunting, Nutrition and Dietetics, Anthropometry, Public Health, Environmental and Occupational Health, Medicine (miscellaneous), Therapeutic feeding, Child survival, Wasting, Faculty of Science, Mid-upper arm circumference, Underweight, Mortality, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

Objective:To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications.Design:A multiple cohort individual data meta-analysis of mortality risk (within 6 months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences were modelled.Setting:Community-based cohort studies in twelve low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread.Participants:Children aged 6 to 59 months.Results:Of the twelve anthropometric case definitions examined, four (weight-for-age Z-score (WAZ) Z-score Conclusions:A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.

Published
2023

2. Anthropometric deficits and the associated risk of death by age and sex in children aged 6–59 months: A meta‐analysis

Author

Susan Thurstans, Stephanie V. Wrottesley, Bridget Fenn, Tanya Khara, Paluku Bahwere, James A. Berkley, Robert E. Black, Erin Boyd, Michel Garenne, Sheila Isanaka, Natasha Lelijveld, Christine M. McDonald, Andrew Mertens, Martha Mwangome, Kieran S. O'Brien, Heather Stobaugh, Sunita Taneja, Keith P. West, Saul Guerrero, Marko Kerac, André Briend, Mark Myatt, London School of Hygiene and Tropical Medicine (LSHTM), SOUtenabilité et RésilienCE (SOURCE), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut de Recherche pour le Développement (IRD [France-Nord]), Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Université Paris Cité (UPCité)-Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Paris Cité (UPCité)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Epicentre [Paris] [Médecins Sans Frontières], United States Agency for International Development, USAID, Irish Aid: HQPU/2021/ENN, This paper is made possible by the generous support of the American people through the United States Agency for International Development (USAID), and by funding from Irish Aid (grant number (HQPU/2021/ENN). The contents are entirely the responsibility of its authors and do not necessarily reflect the views of USAID or the United States Government or represent or reflect Irish Aid policy., Tampere University, and Clinical Medicine

Subjects
Male, Adolescent, wasting, Thinness, underweight, 3123 Gynaecology and paediatrics, Clinical Research, Prevalence, Humans, sex, Child, Growth Disorders, Pediatric, Nutrition and Dietetics, Anthropometry, Nutrition & Dietetics, Wasting Syndrome, Prevention, Malnutrition, stunting, Public Health, Environmental and Occupational Health, Infant, Obstetrics and Gynecology, mortality, Good Health and Well Being, age, Pediatrics, Perinatology and Child Health, Female, Zero Hunger, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in children 6–59 months by age and sex. We categorised children into younger (6–23 months) and older (24–59 months) age groups. Age and sex variations in near-term (within 6 months) mortality risk, associated with individual anthropometric deficits were assessed in a secondary analysis of multi-country cohort data. A random effects meta-analysis was performed. Data from seven low-or-middle-income-countries collected between 1977 and 2013 were analysed. One thousand twenty deaths were recorded for children with anthropometric deficits. Pooled meta-analysis estimates showed no differences by age in absolute mortality risk for wasting (RR 1.08, p = 0.826 for MUAC < 125 mm; RR 1.35, p = 0.272 for WHZ < −2). For underweight and stunting, absolute risk of death was higher in younger (RR 2.57, p < 0.001) compared with older children (RR 2.83, p < 0.001). For all deficits, there were no differences in mortality risk for girls compared with boys. There were no differences in the risk of mortality between younger and older wasted children, supporting continued inclusion of all children under-five in wasting treatment programmes. The risk of mortality associated with underweight and stunting was higher among younger children, suggesting that prevention programmes might be justified in focusing on younger children where resources are limited. There were no sex differences by age in mortality risk for all deficits.

Published
2022

3. Cluster Analysis of Physical Activity Patterns, and Relationship with Sedentary Behavior and Healthy Lifestyles in Prepubertal Children: Genobox Cohort

Author

Gloria Bueno, Francisco Jesus Llorente-Cantarero, Concepción M. Aguilera, Juan Jose Bedoya-Carpente, Augusto Anguita-Ruiz, Mercedes Gil-Campos, Jose Manuel Jurado-Castro, Rosaura Leis, Azahara Iris-Rupérez, Rocío Vázquez-Cobela, Universidade de Santiago de Compostela. Departamento de Ciencias Forenses, Anatomía Patolóxica, Xinecoloxía e Obstetricia, e Pediatría, [Leis,R, Bedoya-Carpente,JJ, Vázquez-Cobela,R] Unidad de Investigación en Nutrición, Crecimiento y Desarrollo Humano de Galicia, Departamento de Pediatría, Hospital Clínico Universitario de Santiago, Universidad de Santiago de Compostela, IDIS, Santiago de Compostela, Spain. [Leis,R, Llorente-Cantarero,FJ, Anguita-Ruiz,A, Vázquez-Cobela,R, Aguilera,CM, Bueno,G, Gil-Campos,M] CIBEROBN, (Physiopathology of Obesity and Nutrition) Institute of Health Carlos III (ISCIII), Madrid, Spain. [Jurado-Castro,JM, Gil-Campos,M] Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain. [Llorente-Cantarero,FJ] Department of Artistic and Corporal Education, Faculty of Education, University of Córdoba, Córdoba, Spain. [Anguita-Ruiz,A, Aguilera,CM] Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology 'José Mataix', Center of Biomedical Research, University of Granada, Armilla, Granada, Spain. [Anguita-Ruiz,A, Aguilera,CM] Instituto de Investigación Biosanitaria ibs, Granada, Spain. [Iris-Rupérez,A] GENUD Research Group, University of Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain. [Bueno,G] Unidad de Endocrinología Pediátrica, Hospital Clínico Lozano Blesa, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain., and This work was supported bythe Plan Nacional de Investigación Científica, Desarrollo e InnovaciónTecnológica (I + D + I), Instituto de Salud Carlos III-Health Research Funding (FONDOS FEDER) (PI051968, PI1102042 and PI1600871) and Redes temáticas de investigación cooperativa RETIC (Red SAMID RD12/0026/0015). The authors also acknowledge Instituto de Salud Carlos III for personal funding of A.A.-R: Contratos i-PFIS: doctorados IIS empresa en ciencias y tecnologías de la salud de la convocatoria 2017 de la Acción Estratégica en Salud 2013–2016 (IFI17/00048).This paper will be included in J.M.J.-C. doctorate, under the 'Social and Legal Sciences Program' at theUniversity of Córdoba, Spain.

Subjects
Male, obesity, Mediterranean diet, Health Behavior, Obesidad, Child Behavior, Diet, Mediterranean, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Cohort Studies, 0302 clinical medicine, Surveys and Questionnaires, Cluster Analysis, Insulin, 030212 general & internal medicine, skin and connective tissue diseases, Child, Chemicals and Drugs::Lipids::Glycerides::Triglycerides [Medical Subject Headings], Nutrition and Dietetics, exercise, Psychiatry and Psychology::Behavior and Behavior Mechanisms::Behavior::Health Behavior [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Nutrition Therapy::Diet Therapy::Diet, Mediterranean [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Electrical Equipment and Supplies [Medical Subject Headings], Conducta sedentaria, Ejercicio físico, Cardiovascular diseases, Psychiatry and Psychology::Behavior and Behavior Mechanisms::Behavior::Child Behavior [Medical Subject Headings], Cohort, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Health Surveys::Nutrition Surveys::Diet Surveys [Medical Subject Headings], Female, Anthropology, Education, Sociology and Social Phenomena::Human Activities::Leisure Activities::Recreation::Sports [Medical Subject Headings], Club, Enfermedades cardiovasculares, lcsh:Nutrition. Foods and food supply, Sports, musculoskeletal diseases, Electrical Equipment and Supplies, Anatomy::Digestive System::Pancreas::Islets of Langerhans::Insulin-Secreting Cells [Medical Subject Headings], Physical activity, Check Tags::Male [Medical Subject Headings], 030209 endocrinology & metabolism, lcsh:TX341-641, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Cluster Analysis [Medical Subject Headings], Disease cluster, Article, Information Science::Information Science::Data Collection::Questionnaires [Medical Subject Headings], 03 medical and health sciences, Screen time, Environmental health, Anthropology, Education, Sociology and Social Phenomena::Human Activities::Exercise [Medical Subject Headings], medicine, Humans, Persons::Persons::Age Groups::Child [Medical Subject Headings], Healthy Lifestyle, Obesity, Exercise, Triglycerides, business.industry, Psychiatry and Psychology::Behavior and Behavior Mechanisms::Psychology, Social::Life Style [Medical Subject Headings], Anthropometry, medicine.disease, Dieta mediterránea, cardiovascular diseases, stomatognathic diseases, Check Tags::Female [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies [Medical Subject Headings], Sedentary Behavior, business, Food Science
Abstract

The authors would like to thank the children and parents who participated in the study and Ana Yara Postigo-Fuentes for the assistance with the English editing., Sedentary habits during childhood are associated with adverse health outcomes. The aim of this work was to cluster lifestyle behaviors and metabolic biomarkers to establish different patterns in children. Their physical and sedentary activities were evaluated by accelerometry, and questionnaires that included lifestyle behaviors, such as adherence to a Mediterranean diet, anthropometry and blood biochemical markers. Cluster analysis was performed to establish different groups based on physical activity levels. A total of 489 children were finally selected. Cluster 1 included children with a mostly sedentary state, whereas Cluster 3 included the most active children and Cluster 2 included children that did not fit into either the sedentary or the highly active groups. In Cluster 3, 56% of children were in a sports club, and a lower percentage used electronic devices in their rooms compared to the other groups. Cluster 1 children exhibited higher insulin, HOMA-IR and triacylglycerides with respect to the other groups. No differences were found regarding adherence to a Mediterranean diet. The choice to practice an extracurricular sport could be an influencing factor to increase exercise and ensure an active lifestyle in children. Reducing or limiting screen time mainly in children’s rooms could contribute to an active lifestyle., Plan Nacional de Investigacion Cientifica, Desarrollo e InnovacionTecnologica (I + D + I), Instituto de Salud Carlos III-Health Research Funding (FONDOS FEDER) PI051968 PI1102042 PI1600871, Redes tematicas de investigacion cooperativa RETIC (Red SAMID) RD12/0026/0015, Instituto de Salud Carlos III IFI17/00048

Published
2020