Search

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.

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tesfaye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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., (© 2023 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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.

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Chuang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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 I 2 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., (© 2023. The Author(s).)

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., (Copyright © 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

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., (© 2022. The Author(s).)

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 (P trend  < 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) (P trend  = 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., (© 2022. The Author(s).)

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., Competing Interests: The authors have declared that no competing interests exist.

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., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Immunotherapy-related hepatitis accounts for 3-6% of all immune-related adverse events (irAE). Reintroduction of checkpoint inhibitors after irAE is matter of debate, weighing the risk of a relapse of adverse events against the possibility of improving disease control. Pharmacokinetic modelling has changed the paradigm of weight-based dosing to flat dose for checkpoint inhibitors, however, it is currently unknown if this poses underweight (<80 kg) patients to a higher risk of toxicity. Weight-based dosing has been opted as a less dangerous and more economic option, especially for underweight patients. Is dose reduction dosing a strategy to permit checkpoint inhibitors reintroduction after immune-related adverse events?, Methods: We describe a case of checkpoint inhibitor reintroduction after immunotherapy-related hepatitis, with dose reduction based on weight-based dosing (nivolumab 165 mg Q2w) in a patient with metastatic renal cell cancer., Results: After three cycles, he had a relapse of hepatitis leading to prolonged steroid use and opportunistic infections., Conclusion: Dose reduction in underweight patients is not the preferred strategy to permit rechallenge after immunotherapy-related hepatitis. Exploration of other secondary prevention strategies is warranted.

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., (© 2022. The Author(s).)

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.

Background: The association of body mass index with outcome in patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) is unclear. The purpose of this study was to examine the effect of body mass index (BMI) on neurological outcomes and mortality in resuscitated patients treated with TTM after OHCA., Methods: This multicenter, prospective, observational study was performed with data from 22 hospitals included in the Korean Hypothermia Network KORHN-PRO registry. Comatose adult patients treated with TTM after OHCA between October 2015 and December 2018 were enrolled. The BMI of each patient was calculated and classified according to the criteria of the World Health Organization (WHO). Each group was analyzed in terms of demographic characteristics and associations with six-month neurologic outcomes and mortality after cardiac arrest (CA)., Results: Of 1,373 patients treated with TTM identified in the registry, 1,315 were included in this study. One hundred two patients were underweight (BMI <18.5 kg/m2), 798 were normal weight (BMI 18.5-24.9 kg/m2), 332 were overweight (BMI 25-29.9 kg/m2), and 73 were obese (BMI ≥ 30 kg/m2). The higher BMI group had younger patients and a greater incidence of diabetes and hypertension. Six-month neurologic outcomes and mortality were not different among the BMI groups (p = 0.111, p = 0.234). Univariate and multivariate analyses showed that BMI classification was not associated with six-month neurologic outcomes or mortality. In the subgroup analysis, the underweight group treated with TTM at 33°C was associated with poor neurologic outcomes six months after CA (OR 2.090, 95% CI 1.010-4.325, p = 0.047), whereas the TTM at 36°C group was not (OR 0.88, 95% CI 0.249-3.112, p = 0.843)., Conclusions: BMI was not associated with six-month neurologic outcomes or mortality in patients surviving OHCA. However, in the subgroup analysis, underweight patients were associated with poor neurologic outcomes when treated with TTM at 33°C., Competing Interests: The authors have declared that no competing interests exist.

Objective: Child undernutrition is a global public health problem with serious implications. In this study, we estimate predictive algorithms for the determinants of childhood stunting by using various machine learning (ML) algorithms., Design: This study draws on data from the Ethiopian Demographic and Health Survey of 2016. Five ML algorithms including eXtreme gradient boosting, k-nearest neighbours (k-NN), random forest, neural network and the generalised linear models were considered to predict the socio-demographic risk factors for undernutrition in Ethiopia., Setting: Households in Ethiopia., Participants: A total of 9471 children below 5 years of age participated in this study., Results: The descriptive results show substantial regional variations in child stunting, wasting and underweight in Ethiopia. Also, among the five ML algorithms, xgbTree algorithm shows a better prediction ability than the generalised linear mixed algorithm. The best predicting algorithm (xgbTree) shows diverse important predictors of undernutrition across the three outcomes which include time to water source, anaemia history, child age greater than 30 months, small birth size and maternal underweight, among others., Conclusions: The xgbTree algorithm was a reasonably superior ML algorithm for predicting childhood undernutrition in Ethiopia compared to other ML algorithms considered in this study. The findings support improvement in access to water supply, food security and fertility regulation, among others, in the quest to considerably improve childhood nutrition in Ethiopia.

Objectives: The study aims to differentiate the risk factors of single and multiple concurrent forms of undernutrition among children under 5 in Bangladesh., Design: A nationally representative cross-sectional study., Setting: Bangladesh., Respondents: Children age under 5 years of age., Outcome Measure: This study considered two dichotomous outcomes: single form (children without single form and with single form) and multiple concurrent forms (children without multiple forms and with multiple forms) of undernutrition., Statistical Analysis: Adjusted OR (AOR) and CI of potential risk factors were calculated using logistic regression analysis., Results: Around 38.2% of children under 5 in Bangladesh are suffering from undernutrition. The prevalence of multiple concurrent forms and single form of child undernutrition was 19.3% and 18.9%, respectively. The key risk factors of multiple concurrent forms of undernutrition were children born with low birth weight (AOR 3.76, 95% CI 2.78 to 5.10); children in the age group 24-35 months (AOR 2.70, 95% CI 2.20 to 3.30) and in the lowest socioeconomic quintile (AOR 2.57, 95% CI 2.05 to 3.23). In contrast, those children in the age group 24-35 months (AOR 1.94, 95% CI 1.61 to 2.34), in the lowest socioeconomic quintile (AOR 1.79, 95% CI 1.45 to 2.21) and born with low birth weight (AOR 1.52, 95% CI 1.11 to 2.08) were significantly associated with a single form of undernutrition. Parental education, father's occupation, children's age and birth order were the differentiating risk factors for multiple concurrent forms and single form of undernutrition., Conclusion: One-fifth of children under 5 years of age are suffering multiple concurrent forms of undernutrition, which is similar to the numbers suffering the single form. Parental education, father's occupation, children's age and birth order disproportionately affect the multiple concurrent forms and single form of undernutrition, which should be considered to formulate an evidence-based strategy for reducing undernutrition among these children., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: This study aimed to describe the epidemiology of malnutrition among children with cerebral palsy (CP) in low- and middle-income countries (LMICs)., Methods: Data from children with confirmed CP aged <18 years registered into the Global LMIC CP Register (GLM CPR) from Bangladesh, Indonesia, Nepal, and Ghana were included. Anthropometric measurements were collected, and nutritional status was determined following the WHO guidelines. Descriptive statistics and adjusted logistic regression were used to describe the nutritional status and identify predictors of malnutrition., Results: Between January 2015 and December 2020, 3619 children with CP were registered into the GLM CPR (median age at assessment: 7.0 years, 39% female). Overall, 72-98% of children from Bangladesh, Indonesia, Nepal, and Ghana had at least one form of undernutrition. The adjusted analysis showed, older age, low maternal education, spastic tri/quadriplegia, and Gross Motor Functional Classification System (GMFCS) levels III-V were significant predictors of underweight and stunting among children with CP in Bangladesh. In Nepal, female children, GMFCS III-V had higher odds of underweight and stunting. In Ghana, low maternal education was significantly associated with underweight, whereas older age and the presence of associated impairments were the significant predictors of stunting among children with CP. Having a GMFCS of III-V increased the odds of being underweight among children in Indonesia; however, no predictors were identified for stunting, as nearly all children with CP registered from Indonesia were stunted., Conclusion: Most children with CP in GLM CPR had undernutrition. Maternal education and moderate-to-severe motor impairment (GMFCS III-V) were significant predictors. Practical nutrition education to mothers/caregivers and management guidelines according to the motor severity using local resources could improve the nutritional outcome of children with CP in LMICs.

Background: The study aimed to define the burden and underlying risk factors of malnutrition among children with cerebral palsy (CP) in Gorkha district, Nepal., Methods: The first population-based register of children with CP in Gorkha, Nepal (i.e., Nepal CP Register-NCPR) was established in 2018. Children aged <18 years with confirmed CP were registered following standard protocol. Nutritional status was determined based on anthropometric measurements (height/length, weight, mid-upper-arm-circumference) following WHO guidelines. Descriptive analyses and adjusted logistic regression were completed., Results: Between June-October 2018, 182 children with CP were registered into the NCPR (mean (SD) age at assessment: 10.3 (5.0) years, 37.4% female). Overall, 51.7%, 64.1%, and 29.3% children were underweight, stunted, and thin, respectively. Furthermore, 14.3% of children with CP aged <5 years had severe wasting. Underweight and stunting were significantly higher among children with spastic CP ( p = 0.02, p < 0.001) and/or Gross Motor Function Classification System (GMFCS) level (III-V) ( p = 0.01, p < 0.001) and/or who were not enrolled in school ( p = 0.01, p < 0.001). In adjusted analysis, GMFCS level III-V and non-attendance to school significantly increased the odds of stunting by 8.2 (95% CI 1.6, 40.8) and 4.0 (95% CI 1.2, 13.2) times, respectively., Conclusions: the high rate of different forms of undernutrition among children with CP in Gorkha, Nepal is concerning. Need-based intervention should be taken as priority to improve their nutritional outcome.

Aims: Malnutrition is a major health issue among Bangladeshi under-five (U5) children. Children are malnourished if the calories and proteins they take through their diet are not sufficient for their growth and maintenance. The goal of the research was to use machine learning (ML) algorithms to detect the risk factors of malnutrition (stunted, wasted, and underweight) as well as their prediction., Methods: This work utilized malnutrition data that was derived from Bangladesh Demographic and Health Survey which was conducted in 2014. The selected dataset consisted of 7079 children with 13 factors. The potential risks of malnutrition have been identified by logistic regression (LR). Moreover, 3 ML classifiers (support vector machine (SVM), random forest (RF), and LR) have been implemented for predicting malnutrition and the performance of these ML algorithms were assessed on the basis of accuracy., Results: The average prevalence of stunted, wasted, and underweight was 35.4%, 15.4%, and 32.8%, respectively. It was noted that LR identified five risk factors for stunting and underweight, as well as four factors for wasting. Results illustrated that RF can be accurately classified as stunted, wasted, and underweight children and obtained the highest accuracy of 88.3% for stunted, 87.7% for wasted, and 85.7% for underweight., Conclusion: This research focused on the identification and prediction of major risk factors for stunting, wasting, and underweight using ML algorithms which will aid policymakers in reducing malnutrition among Bangladesh's U5 children., Competing Interests: The authors have declared that no competing interests exist.

Objective: Nutrition is closely related to the health of the elderly population. This study aimed to provide a comprehensive picture of the nutrition status of elderly Chinese and its related dietary, geographical, and socioeconomic factors., Methods: A total of 13,987 ≥ 60-year-old persons from the 2010-2013 Chinese National Nutrition and Health Survey were included to evaluate various aspects of malnutrition, including underweight, overweight or obesity, and micronutrient inadequacy., Results: Overall, the prevalence of obesity, overweight, and underweight was 12.4%, 34.8%, and 5.7%, respectively, with disparities both geographically and socioeconomically. The prevalence of underweight was higher among the older old (≥ 75 years), rural residents and those with low income, with low education status, and residing in undeveloped West areas. More than 75% of the elderly do not meet the Dietary Reference Intakes for vitamins A, B 1 , B 2 , and E, folate, calcium, selenium, potassium, biotin, and choline, with the prevalence of inadequate intake increasing with age for most nutrients. At the population level, the mean intakes of numerous food groups did not meet the recommendations by the Chinese Dietary Guideline., Conclusions: Obesity epidemic, inadequacy of micronutrient intake, and high prevalence of underweight and anemia in susceptible older people are the major nutrition challenges for the rapidly aging population in China., (Copyright © 2021 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.)

Background: Childhood under-nutrition is a major global health problem. Although the rate of under-nutrition in Ethiopia has declined in the last decade, but it still remains being the major causes of morbidity and mortality of children under-five years. The problem is even worse in rural areas. The prevalence of underweight among rural children was 25% compared with 13% among urban children. To alleviate this problem, it is necessary to determine the magnitude and determinants of underweight. The study models non-Gaussian data analysis to identify risk factors associated with underweight among under-five children in rural Ethiopia., Methodology: The data source for this study was secondary data, which was retrieved from EDHS 2016 database. It was analyzed using two model families; one with marginal models (GEE and ALR) in which responses are modeled and marginalized overall other responses, and the other is random effects model (GLMM) which is useful when the interest of the analyst lies in the individual's response profiles as well as to evaluate within and between regional variations of underweight., Result: From fitting non-Gaussian data analysis to identify risk factors associated with underweight among under five children in rural Ethiopia, the independent variable which have significant effect on underweight were:-Age of child, birth interval, mothers education, fathers education, wealth index, diarrhea in last two weeks, fever in last two weeks are significant and also father's work status shows that difference in significance among the category., Conclusion: Child age, preceding birth interval, mother's education, household's wealth index, fever, diarrhea, father's education and father's work status were associated with child underweight. Furthermore, there is both within and between regional heterogeneity of underweight among children in rural Ethiopia. Therefore, rigorous community-based interventions (such as uplifting mother's education by providing formal education and preventing infectious diseases that cause diarrhea and fever) should be developed and executed throughout the country to improve this grave situation of underweight prevalence in rural areas of Ethiopia., Competing Interests: The authors have declared that no competing interests exist.

The current study sought to investigate the joint effect of maternal marital status and type of household cooking fuel on child nutritional status in sub-Saharan Africa. Data in the children's files of 31 sub-Saharan African countries were pooled from the Demographic and Health Surveys collected between 2010 and 2019. The outcome variables were three child anthropometrics: stunting (height-for-age z-scores); wasting (weight-for-height z-scores); and underweight (weight-for-age z-scores). The joint effect of maternal marital status and type of household cooking fuel on child nutritional status was examined using multilevel regression models. The results were presented as adjusted odds ratios (aORs) at p < 0.05. The percentages of children who were stunted, wasted and underweight in the 31 countries in sub-Saharan Africa were 31%, 8% and 17%, respectively. On the joint effect of maternal marital status and type of household cooking fuel on stunting, we found that compared to children born to married mothers who used clean household cooking fuel, children born to single mothers who use unclean household cooking fuel, children born to single women who use clean household cooking fuel, and children born to married women who used unclean household cooking were more likely to be stunted. With wasting, children born to single mothers who used unclean household cooking fuel and children born to married women who used unclean household cooking fuel were more likely to be wasted compared to children born to married mothers who used clean household cooking fuel. With underweight, we found that compared to children born to married mothers who used clean household cooking fuel, children born to single mothers who used unclean household cooking fuel, children born to single women who used clean household cooking fuel and children born to married women who used unclean household cooking were more likely to be underweight. It is imperative for the governments of the 31 sub-Saharan African countries to double their efforts to end the use of unclean household cooking fuel. This goal could be achieved by promoting clean household cooking fuel (e.g., electricity, gas, ethanol, solar, etc.) through effective health education, and promotion programmes. The attention of policymakers is drawn to the urgent need for children's nutritional status policies and programmes (e.g., dietary supplementation, increasing dietary diversity, improving agriculture and food security) to be targeted towards at-risk sub-populations (i.e., single mothered households).

Background: One-fourth of women experience substantially higher weight years after childbirth. We examined weight change from prepregnancy to 18 months postpartum according to subsequent maternal risk of hypertension and cardiovascular disease (CVD)., Methods and Findings: We conducted a cohort study of 47,966 women with a live-born singleton within the Danish National Birth Cohort (DNBC; 1997-2002). Interviews during pregnancy and 6 and 18 months postpartum provided information on height, gestational weight gain (GWG), postpartum weights, and maternal characteristics. Information on pregnancy complications, incident hypertension, and CVD was obtained from the National Patient Register. Using Cox regression, we estimated adjusted hazard ratios (HRs; 95% confidence interval [CI]) for hypertension and CVD through 16 years of follow-up. During this period, 2,011 women were diagnosed at the hospital with hypertension and 1,321 with CVD. The women were on average 32.3 years old (range 18.0-49.2) at start of follow-up, 73% had a prepregnancy BMI <25, and 27% a prepregnancy BMI ≥25. Compared with a stable weight (±1 BMI unit), weight gains from prepregnancy to 18 months postpartum of >1-2 and >2 BMI units were associated with 25% (10%-42%), P = 0.001 and 31% (14%-52%), P < 0.001 higher risks of hypertension, respectively. These risks were similar whether weight gain presented postpartum weight retention or a new gain from 6 months to 18 months postpartum and whether GWG was below, within, or above the recommendations. For CVD, findings differed according to prepregnancy BMI. In women with normal-/underweight, weight gain >2 BMI units and weight loss >1 BMI unit were associated with 48% (17%-87%), P = 0.001 and 28% (6%-55%), P = 0.01 higher risks of CVD, respectively. Further, weight loss >1 BMI unit combined with a GWG below recommended was associated with a 70% (24%-135%), P = 0.001 higher risk of CVD. No such increased risks were observed among women with overweight/obesity (interaction by prepregnancy BMI, P = 0.01, 0.03, and 0.03, respectively). The limitations of this observational study include potential confounding by prepregnancy metabolic health and self-reported maternal weights, which may lead to some misclassification., Conclusions: Postpartum weight retention/new gain in all mothers and postpartum weight loss in mothers with normal-/underweight may be associated with later adverse cardiovascular health., Competing Interests: The authors have declared that no competing interests exist.

Ensuring the nutritional demands of preterm (PT) infants during complementary feeding could contribute significantly to the infants' long-term health and development. However, the dietary guidelines for complementary feeding in PT are scarce. Thus, describing dietary intake and identifying nutritional targets for these infants could be of great interest. The aim of this study is to assess the food intake and anthropometric parameters in a Mediterranean infant cohort from 6 to 24 months and to identify nutritional targets especially focused on late preterm infants. This is a longitudinal prospective study analyzing information from administered questionnaires about general characteristics and food frequency consumption in 115 infants (20 PT (32 to 36 gestational weeks), 95 full-term (FT)) at 6, 12 and 24 months of age. Results show that the differences in the prevalence of underweight observed in PT infants vs. FT infants are maintained for up to 6 months of age but disappear at 12 and 24 months. The age of inclusion of new foods and the average intake of the main food groups was not different from that of FTs. Although protein intake at 6 months was directly correlated with weight gain and growth in FT, these associations were not observed in PT. At the nutritional level, the low intake of vitamin D in preterm infants is noteworthy. These findings may be useful when designing new intervention strategies for this population group.

Background: Craniopharyngiomas are benign tumors of embryologic origin located in the sellar region. Patients have both neurological and endocrinological symptoms. Symptoms may be subtle in the early clinical course, which leads to delayed diagnosis. This study evaluated the clinical and endocrinological manifestations of childhood-onset craniopharyngioma., Methods: We retrospectively reviewed medical records of 45 children diagnosed as having craniopharyngioma between 1995 and 2019. We collected data on clinical symptoms and signs, height, weight, biochemical and hormone data, images, operation records, and pathology reports. A three-graded classification system was applied to define the degree of hypothalamic damage (HD). We analyzed clinical and endocrinological manifestations among patients with and without obesity, with short and normal stature, and with differing degrees of HD., Results: Clinical endocrinologic manifestations included adrenocortical insufficiency (42%), central hypothyroidism (37%), short stature (31%), obesity (20%), weight < third percentile (19%), and polyuria or polydipsia (11%). The distribution of height and body mass index (BMI) revealed that a relatively large proportion of patients had short stature and obesity compared to the general population. Patients with grade 2 HD were significantly taller (height median SDS -0.07 vs. -2.05, P = 0.032), and had higher BMI (BMI median standard deviation scores [SDS] 1.14 vs. -0.54, P = 0.039) and shorter time to diagnosis (0.27 vs. 8.29 months, P = 0.007) than were those in the grade 0-1 HD. Delayed diagnosis was associated with short stature (6/7 vs. 4/26, P = 0.001) and no initial neurological symptoms (4/7 vs. 2/28, P = 0.009)., Conclusion: Growth patterns may change variously depend on the tumor location and the severity of hypothalamic damage. Therefore, monitoring possible neurological symptoms and evaluating the growth patterns of patients during regular outpatient clinical visits are paramount., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2020. Published by Elsevier B.V.)

Background: Despite economic growth observed in developing countries, under-nutrition still continues to be a major health problem. Undernutrition in adolescence can disrupt normal growth and puberty development and may have long-term impact. Therefore, it is important to study the undernutrition among adolescents. This study aimed to assess the prevalence and the associated factors of stunting, thinness and the coexistence of both (stunting and thinness) among the adolescent belonging to Uttar Pradesh and Bihar, India., Methods: The study utilized data from Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey, which was conducted in two Indian states Uttar Pradesh and Bihar, in 2016 by Population Council under the guidance of Ministry of Health and Family Welfare, Government of India. Utilizing information on 20,594 adolescents aged 10-19 years (adolescent boys-5,969 and adolescent girls-14,625), the study examined three outcome variables, i.e., thinness, stunting, and co-existence of both. The study used descriptive and bivariate analysis. Furthermore, the study examined income-related inequality in stunting and thinness through concentration index. At last, the study used Wagstaff decomposition analysis to decompose the concentration index., Results: The prevalence of thinness was higher among adolescent boys as compared to girls (25.8 per cent vs. 13.1 per cent). However, stunting was more prevalent among girls (25.6 per cent) than in boys (39.3 per cent). The odds of stunting were higher among late adolescents [Boys- OR:1.79; CI: 1.39, 2.30] and [Girls- OR: 2.25; CI: 1.90,2.67], uneducated adolescents [Boys- OR:2.90; CI: 1.67, 5.05] and [Girls- OR: 1.82; CI: 1.44,2.30], and poorest adolescents [Boys- OR:2.54; CI: 1.80, 3.58] and [Girls- OR: 1.79; CI: 1.38,2.32]. Similarly age, educational status, working status and wealth index were significantly associated with thinness among adolescent boys and girls. Media exposure [Boys- OR: 11.8% and Girls- 58.1%] and Wealth index [Boys: 80.1% and Girls: 66.2%] contributed significantly to the inequality in the prevalence of thinness among adolescents. Similarly, wealth index [Boys: 85.2% and Girls: 84.1%] was the only significant contributor to the inequality in the prevalence of stunting among adolescents., Conclusion: The study provides an understanding that stunting and thinness is a significant public health concern among adolescents, and there is a need to tackle the issue comprehensively. By tackling the issue comprehensively, we mean that the state government of Uttar Pradesh and Bihar shall screen, assess, and monitor the nutritional status of adolescent boys and girls. The interventions shall focus towards both boys as well as girl adolescents, and particular emphasis should be given to adolescents who belonged to poor households. Also, efforts should be taken by stakeholders to increase family wealth status., Competing Interests: The authors have declared that no competing interests exist.

Background: A body of evidences showed that adolescent undernutrition is a serious public health problem in developing countries including Ethiopia. Adolescence period is the last chance for curbing the consequences of undernutrition and breaking the intergenerational cycle of malnutrition and poor health. Despite this fact, they have been considered as a low-risk group for poor health and nutrition problems than the young children or the very old. This study aimed to assess prevalence of nutritional status and associated factors among adolescent girls in Afar, Northeastern Ethiopia, 2017., Methods: A school-based cross-sectional study design was conducted among 736 adolescent girls from February15 to March 05, 2017 in Afar, Northeastern Ethiopia, 2017. Multi-stage sampling technique was used to select study participants. A pretested and structured interviewer-administered questionnaire and anthropometric measurements was used to collect the data. The collected data were entered in to Epi Data version 3.1 and exported to SPSS version 20.0 for further statistical analysis. Body Mass Index for age (thinness) and height for age (stunting) was used to assess undernutrition of adolescent girls by using the new 2007 WHO Growth Reference. Data were analyzed using bivariate and multivariable logistic regression. The degree of association between dependent and independent variables were assessed using odds ratio with 95% confidence interval, and variables with p value < 0.05 were considered significant., Results: The study revealed that the prevalence of thinness and stunting were 15.8% (95% CI 13.3-18.5%) and 26.6% (95% CI 23.5-29.9%), respectively. Being at an early adolescent age (AOR = 2.89, 95% CI 1.23-6.81) for thinness and being at an early adolescent age (AOR = 1.96, 95% CI 1.02-3.74), household food insecure (AOR = 2.88, 95% CI 1.15-7.21), menstruation status (AOR = 2.42, 95% CI 1.03-5.71), and availability of home latrine (AOR = 3.26, 95% CI 1.15-4.42) for stunting were the independent predictors among the adolescent girls., Conclusions: The prevalence of thinness and stunting is above the public health importance threshold level. Thus, Multi-sector-centered nutrition interventions to improve nutritional status of disadvantaged adolescent girls through providing comprehensive nutritional assessment and counseling services at community, school, and health facility levels, and creating household's income-generating activities are recommended before they reach conception to break the intergenerational cycle effect of malnutrition.

Brain-derived neurotrophic factor (BDNF), a neurotrophin involved in the regulation of food intake and body weight, has been implicated in the development and maintenance of Anorexia nervosa (AN). The majority of previous studies reported lower BDNF levels in acutely underweight AN patients (acAN) and increasing levels after weight rehabilitation. Here, we investigated serum BDNF concentrations in the largest known AN sample to date, both before and after weight restoration therapy. Serum BDNF was measured in 259 female volunteers: 77 in-patient acAN participants of the restrictive type (47 reassessed after short-term weight rehabilitation), 62 individuals long-term recovered from AN, and 120 healthy controls. We validated our findings in a post-hoc mega-analysis in which we reanalyzed combined data from the current sample and those from our previous study on BDNF in AN (combined sample: 389 participants). All analyses carefully accounted for known determinants of BDNF (age, sex, storage time of blood samples). We further assessed relationships with relevant clinical variables (body-mass-index, physical activity, symptoms). Contrary to our hypotheses, we found zero significant differences in either cross-sectional or longitudinal comparisons and no significant relationships with clinical variables. Together, our study suggests that BDNF may not be a reliable state- or trait-marker in AN after all.

Side effects of severe weight loss during radiation therapy and its definitive risk factors are the significant complexities of cancer treatment. This study aimed to identify the reliable predictors of severe weight loss during three-dimensional conformal radiation therapy (3D-CRT) in head and neck cancer patients. Weight changes during radiotherapy were investigated on 87 patients. Tumor site, T-stage, BMI, age, smoking, treatment modality, and prior surgery were considered as effective factors. During the 3D-CRT, 78.7% of patients experienced weight loss (p<0.001). The risk of weight loss was higher in patients with cancer in the larynx and oral cavity. Severe weight loss (≥5% during the radiation course) was observed in 47.8% of patients. There was the highest risk of severe weight loss in patients undergoing chemoradiation therapy with previous surgical resection (83.3%). The incidence of severe weight loss in normal-weight patients compared to overweight patients was significant. Severe weight loss was more common at higher doses and in younger patients. BMI regardless of body composition is not a credible predictor. Advanced tumor stage and combined treatment modality in head and neck cancer patients which result in synergizing of treatment toxicities, can be used as the reliable risk factors of severe weight loss during radiotherapy., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Women with chronic-energy malnutrition persists in many developing countries, including Ethiopia. To avert this problem identifying the predictor variables for a high magnitude of underweight is paramount. Consequently, this study aimed to assess the factors associated with chronic energy malnutrition among reproductive-age women in Ethiopia., Methods: We used the 2016 Ethiopia demographic health survey data. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. A two-stage stratified cluster sampling technique was employed to select Participants. A total of 13,451 reproductive-age group women (age 15-49 years and who were not pregnant and < 2 months of postpartum) were included in the analysis. Both descriptive and analytical analyses were performed. A P-value of less than 0.05 was used to declare statistical significance., Results: About 22.6% (95%CI: 21.5%-23.6%) of reproductive-age women were underweight. The magnitude of underweight is highest in the Afar region (39.6%) and lowest in Addis Ababa city administration (13.5%). Women who lived in the rural area (AOR = 1.59; 95%CI: 1.19-2.12), those who did not attend formal education (AOR = 1.23; 95%CI: 1.01-1.50), unemployed women (AOR = 1.28; 95%CI:1.13-1.44), women who belong to the poorest household wealth index (AOR = 1.42; 95%CI:1.04-1.94), women who were not married (AOR = 1.41; 95%CI: 1.18-2.69), women who lived in Tigray and the pastoral regions have higher odds of underweight. On the other hand, women who lived in southern nations nationalities and people's region, and women whose age group 25-34 years had lower odds of underweight., Conclusions: Chronic-energy malnutrition among reproductive-age women is high in Ethiopia. Improving the food security of rural, never married, and unemployed women would reduce the magnitude of underweight. Moreover, strengthening girls' education, creating employment opportunities for women, and enhancing household income can further reduce the problem of chronic energy malnutrition., Competing Interests: The authors have declared that no competing interests exist.

Background: While considerable progress has been made in reducing undernutrition in Bangladesh, regional disparities are known to exist, and certain population subgroups may lag behind., Objective: To characterize nutritional status among school-age children in a historically marginalized population of Bangladesh., Methods: We conducted a cross-sectional assessment of children attending 14 nongovernmental organization-operated schools serving the tea estate population in Kulaura Upazila, Sylhet Division. We randomly selected 168 children from a population of 418 whose parents attended school-organized Parent-Teacher Association meetings. Parents provided consent and data on household food consumption in the past week, foods consumed by children in the past 24 hours, and household food insecurity. We drew venous blood from assenting children for the analysis of hemoglobin and plasma retinol, C-reactive protein, and α 1 -acid glycoprotein. Children were classified as stunted, underweight, or thin based on comparisons with the World Health Organization standards for height-for-age, weight-for-age, or body mass index-for-age, respectively., Results: Food insecurity was highly prevalent, with ∼85% of households affected. Roughly half of children had low dietary diversity. Prevalence estimates for stunting, underweight, and thinness were 32%, 50%, and 49%, respectively. Approximately 60% of children had a hemoglobin concentration <11 g/dL. The mean (±SD) plasma retinol concentration was 0.79 μmol/L (±0.23 μmol/L), with 34% deficient using a 0.70 μmol/L cutoff., Conclusions: A heightened focus on tracking progress in underserved populations and appropriately targeted programming will be critical as Bangladesh seeks to accelerate progress toward global development goals for nutrition.

Background: Several studies have been carried out assessing the prevalence of undernutrition and possible determinants among schoolchildren in Ethiopia, but there is a lack of systematically gathered and analyzed information., Objective: This systematic review and meta-analysis aimed to summarize epidemiological data on undernutrition and possible determinants among schoolchildren in Ethiopia., Methods: We conducted a systematic review using open access articles that report the prevalence of stunting and wasting/thinness among schoolchildren from PubMed Central, Scopus, and Science direct. The pooled prevalence was determined using a random-effect model while heterogeneities between studies were evaluated by I 2 test., Results: A total of 24 716 schoolchildren were included in the 39 eligible articles. The prevalence of stunting and wasting/thinness among schoolchildren in Ethiopia were 23.1% (95% CI: 19.0-27.0) and 22% (95% CI: 17-26), respectively. There was a marked difference in the prevalence of stunting and wasting/thinness across regions of Ethiopia. The risk of stunting was increased with meal frequency ≤3 times a day (odds ratio [OR] = 3.02, 95% CI: 1.90-4.14), age >10 years (OR = 2.16, 95% CI: 1.47-2.85), and family size ≥5 (OR = 1.88, 95% CI: 1.40-2.35). Similarly, the risk of wasting/thinness was increased with male sex (OR = 2.06, 95% CI: 1.54-2.58), low family income (OR = 2.16, 95% CI: 1.30-3.01), and age >10 years (OR = 1.78, 95% CI: 0.74-2.82)., Conclusion: This study revealed that more than one-fifth of schoolchildren are stunted or wasted/thin in Ethiopia. Large family size, male sex, and student age were consistently associated with stunting and wasting/thinness among schoolchildren. This study highlights the importance of an integrated effort to reduce undernutrition in Ethiopia.

Background: Malnutrition on the background of HIV (Human Immunodeficiency Virus) infection is a complex medical condition that carries significant morbidity and mortality for affected children, with greater mortality from SAM (Severe Acute Malnutrition) among HIV-positive children than their HIV-negative peers. HIV-induced immune impairment heightened risk of opportunistic infection and can worsen nutritional status of children. HIV infection often leads to nutritional deficiencies through decreased food intake, mal-absorption and increased utilization and excretion of nutrients, which in turn can hasten death., Objective: The aim of this systematic review and meta-analysis was to assess the magnitude of underweight, wasting and stunting among HIV positive children in East Africa., Methods: The authors systematically reviewed and meta-analyzed studies that assessed the prevalence of underweight, wasting and stunting among HIV positive children in East Africa from PubMed, Cochrane Library, Google Scholar, and Gray Literatures using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline. The last search date was December 30/2019. The data was extracted in excel sheet considering country, study design, year of publication, prevalence reported. Then the authors transformed the data to STATA 14 for analysis. Heterogeneity across the studies was assessed by the Q and the I2 test. A weighted inverse variance random-effects model was used to estimate the magnitude of underweight, wasting and stunting. The subgroup analysis was done by country, year of publication, and study design. To examine publication bias, a funnel plot and Egger's regression test were used., Results: For the analysis a total of 22 studies with 22074 patients were used. The pooled prevalence of under-weight, wasting, and stunting among HIV positive children in East Africa was found to be 41.63% (95%CI; 35.69-47.57; I2 = 98.7%; p<0.001), 24.65% (95%CI; 18.34-30.95; I2 = 99.2%; p<0.001), and 49.68% (95%CI; 42.59-56.77; I2 = 99.0%; p<0.001) respectively. The prevalence of under-weight among HIV positive children was found to be 49.67% in Ethiopia followed by 42.00 in Rwanda. It was high among cohort studies (44.87%). Based on the year of publication, the prevalence of under-weight among HIV positive children was found to be 40.88% from studies conducted from January 2008-December 2014, while it was 43.68% from studies conducted from 2015-2019. The prevalence of wasting among HIV positive children was found to be 29.7% in Tanzania followed by 24.94% in Ethiopia. Based on the study design, the prevalence of wasting among HIV positive children was found to be high in cohort studies (31.15%). The prevalence of stunting among HIV positive children was found to be 51.63% in Ethiopia, followed by 48.21% in Uganda., Conclusions: The results presented above provide evidence of a higher prevalence of under nutrition among HIV positive children in East Africa. Despite the country level variations of child under nutrition in East Africa, still it is high in all aspects compared to the studies from other parts of Africa. It is recommended that further systematic review and meta-analysis need to be conducted on magnitude of malnutrition among HIV positive children in Sub-Saharan Africa as a whole., Competing Interests: The authors have declared that no competing interests exist.

Aim: Prison is an especially difficult environment for promoting oral health and leads to the exacerbation of unhealthy behaviors. This study set out to assess the impact of incarceration on nutritional status and oral health among the male prison inmates of Central Jail of Jaipur city, Rajasthan, India., Material and Method: A cross sectional study was conducted among 181 male inmates. Dental caries and periodontal status were assessed by using modified the Decayed Missing Filled Teeth (DMFT) index and Community Periodontal Index (CPI) and Loss of Attachment (LOA) index as per the WHO methodology 1997. Nutritional status was assessed by Body Mass Index (BMI) and weight (kg)/height (m2)., Results: Out of 181 inmates, 141 (77.90%) had normal BMI. The majority (n=128, 70.70%) of inmates were incarcerated for less than 6 years. A significant difference (P<0.05) was found between age and periodontal status. A significant difference was observed (P<0.05) in the CPI score 3 and LOA 0 and 1 score. However, no significant difference (P>0.05) was observed in DMFT and period of incarceration. Age was the significant (P<0.001) risk factor for CPI and LOA., Discussion: Dental caries and periodontal health deteriorates with age and period of incarceration. Oral hygiene maintenance along with comprehensive oral care can be accomplished by establishing dental care facilities in prisons.

Introduction: the study aimed to investigate the prevalence and factors associated with underweight and overweight or obesity in an adult population in Kenya., Methods: data from a cross-sectional nationally representative community-based study in Kenya (N=4283, 18-69 years) conducted in 2015 was utilized. Assessments included anthropometric, interview, blood pressure and biochemistry mesures. Multinomial logistic regression was used to assess the determinants of underweight and overweight or obesity relative to normal weight., Results: in all, 11.9% of the study sample was underweight (BMI <18.5kg/m 2 ), 60.1% had normal weight (BMI 18.5-24.9kg/m 2 ), 18.9% overweight (25.0-29.9kg/m 2 ) and 9.1% obesity (BMI ≥30.0kg/m 2 ). In adjusted multinomial logistic regression, male sex (adjusted relative risk ratio-ARRR: 1.47, confidence interval-CI: 1.01, 2.13), lower education (ARRR: 0.63, CI: 0.46, 0.88), lower wealth status (ARRR: 0.47, CI: 0.29, 0.78), inadequate fruit and vegetable consumption (ARRR: 1.79, CI: 1.19, 2.70), adding daily sugar into beverages (ARRR: 1.49, CI: 1.01, 2.22) and having no hypertension (ARRR: 0.54, CI: 0.40, 0.74) were associated with underweight. Factors associated with overweight or obesity were middle and older age (ARRR: 2.15, CI: 1.46, 3.80), being female (ARRR: 0.30, CI: 0.22, 0.41), higher education (ARRR: 1.61, CI: 1.26, 2.24), greater wealth (ARRR: 2.38, CI: 1.41, 3.50), being a Kikuyu by ethnic group (ARRR: 1.68, CI: 1.19, 2.37), urban residence (ARRR: 1.45, CI: 1.06, 1.99), no current tobacco use (ARRR: 0.39, CI: 0.24, 0.54), low physical activity (ARRR: 1.49, CI: 1.02, 2.18) and having hypertension (ARRR: 1.96, CI: 1.54, 2.50)., Conclusion: more than one in ten were underweight and almost three in ten were overweight or obese among adults in Kenya. Several risk factors, including sociodemographic, lifestyle and health status risk variables, were identified for underweight and overweight or obesity, which can assist in developing intervention strategies targeting both these conditions., Competing Interests: The authors declare no competing interests., (Copyright: Supa Pengpid et al.)

Background: The National Family Health Surveys (NFHS) in India apply adult cutoffs of nutritional status for the estimation of undernutrition/overweight in the 15-19 age group. The prevalence of thinness in boys and girls thus estimated is 58.1% and 46.8% in NFHS-3, and 45% and 42% in NFHS-4 respectively. But the WHO recommends using age and sex-specific reference for adolescents. We reanalyzed the nutritional status of the adolescents using the WHO 2007 Growth Reference to obtain revised estimates of thinness, overweight and stunting across states, rural-urban residence, and wealth quintiles., Methods and Findings: Demographic information, anthropometric data, and wealth index were accessed from the Demographic and Health Survey (DHS) database. We re-analyzed the anthropometric data using WHO AnthroPlus software which uses the WHO 2007 Growth reference. The revised estimates of thinness assessed by BMI-for-age z-scores in boys and girls was 22.3% (95%CI: 21.6, 23.0) and 9.9% (95%CI: 9.5, 10.3) in NFHS-3 and 16.5% (95%CI: 16.0,17.0) and 9% (95%CI: 8.9, 9.2) in NFHS-4 respectively. Stunting was found to be 32.2% (95% CI: 31.6, 32.9) in boys and 34.4% (95% CI: 34.2, 34.7) in girls in NFHS-4. This was higher than that in NFHS-3; 25.2% (95% CI: 24.4, 26) in boys and 31.2 (95% CI: 30.6, 31.8) in girls. There was a clear socioeconomic gradient as there were higher thinness and stunting in rural areas. There was wide variation among the states with pockets of a double burden of malnutrition., Conclusion: Using the adult cutoffs significantly overestimates thinness in adolescents in the age group of 15-19 years old in India. Stunting, which is an indicator of long term nutrition is also widely prevalent in them. Future editions of DHS and NFHS should consider adolescents as a separate age group for nutritional assessment for a better understanding of nutritional transition in the population., Competing Interests: The authors have declared that no competing interests exist.

Background: India is expected to experience an increase in the frequency and intensity of extreme weather events in the coming decades, which poses serious risks to human health and wellbeing in the country., Objective: This paper aims to shed light on the possible detrimental effects of monsoon weather shocks on childhood undernutrition in India using the Demographic and Health Survey 2015-16, in combination with geo-referenced climate data., Methods: Undernutrition is captured through measures of height-for-age, weight-for-height, stunting and wasting among children aged 0-59 months. The standardised precipitation and evapotranspiration index (SPEI) is used to measure climatic conditions during critical periods of child development., Results: The results of a multivariate logistic regression model show that climate anomalies experienced in utero and during infancy are associated with an increased risk of child undernutrition; exposure to excessive monsoon precipitation during these early periods of life elevates the risk of stunting, particularly for children in the tropical wet and humid sub-tropical regions. In contrast, the risk of stunting is reduced for children residing in the mountainous areas who have experienced excessive monsoon precipitation during infancy. The evidence on the short-term effects of climate shocks on wasting is inconclusive. We additionally show that excessive precipitation, particularly during the monsoon season, is associated with an increased risk of contracting diarrhoea among children under five. Diseases transmitted through water, such as diarrhoea, could be one important channel through which excessive rainfall increases the risk of stunting., Conclusions: We find a positive association between childhood undernutrition and exposure to excessive monsoon precipitation in India. Pronounced differences across climate zones are found. The findings of the present analysis warn of the urgent need to provide health assistance to children in flood-prone areas., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Cerebral palsy (CP) is the most frequent cause of motor disability in the paediatric age. The aim of this article is the study of the nutritional status of patients with CP followed-up in a reference hospital, as well as the relationship between neurological and nutritional state., Material and Methods: A cross-sectional, observational, descriptive and analytical study was conducted on a sample consisting of 4-15years old patients with CP with Gross Motor Function Classification System (GMFCS) gradesIII-IV-V, from a specialised paediatric hospital reference area. An interview (collection of general data, medications and nutritional habits), anthropometric study and bioimpedance (BIA) measurements were carried out., Results: The study included 69 patients (recruitment 84.15%), with a mean age of 10.46±0.43years, and 50.7% females. The distribution according to GMFCS scale was: gradeIII (36.2%), gradeIV (29%), and gradeV (34.8%). According to weight for height: moderate malnutrition 21.8% (gradeV: 33.3%), severe malnutrition 5.8% (gradeV: 12.6%), overweight/obesity 23.2% (gradeIII: 24%, gradeIV: 35%). Adequate level of lean mass for height: gradeIII (36%), gradeIV (55%), and gradeV (16.7%). Fat excess: gradeIII (36%), gradeIV (40%), and gradeV (29.2%). Fat mass comparison: BIA 6.89±0.64kg versus anthropometry 5.56±4.43kg., Conclusions: In CP grade GMFCSV, the weight deficit associated with a decrease in lean body mass is common. Patients with CP grades GMFCSIII-IV have a significant prevalence of overweight/obesity. Anthropometry is a useful tool for nutritional assessment in children with CP, although fat levels could be underestimated., (Copyright © 2019. Publicado por Elsevier España, S.L.U.)

Background: Social inequalities in bodyweight start early in life and track into adulthood. Dietary patterns are an important determinant of weight development in children, towards both overweight and underweight. Therefore, we aimed to examine weight development between age 5 and 10 years by ethnicity, SES and thereafter by BMI category at age 5, to explore its association with dietary patterns at age 5., Methods: Participants were 1765 children from the Amsterdam Born Children and their Development (ABCD) cohort that had valid data on BMI at age 5 and 10 and diet at age 5. Linear mixed model analysis was used to examine weight development between age 5 and 10 years and to assess if four previously identified dietary patterns at age 5 (snacking, full-fat, meat and healthy) were associated with weight development. Analyses were adjusted for relevant confounders, stratified by ethnicity and SES and thereafter stratified per BMI category at age 5., Results: Overall, weight decreased in Dutch and high SES children and increased in non-Dutch and low/middle SES children. Across the range of bodyweight categories at age 5, we observed a conversion to normal weight, which was stronger in Dutch and high SES children but less pronounced in non-Dutch and low/middle SES children. Overall, the observed associations between weight development and dietary patterns were mixed with some unexpected findings: a healthy dietary pattern was positively associated with weight development in most groups, regardless of ethnicity and SES (e.g. Dutch B 0.084, 95% CI 0.038;0.130 and high SES B 0.096, 95% CI 0.047;0.143) whereas the full-fat pattern was negatively associated with weight development (e.g. Dutch B -0.069, 95% CI -0.114;-0.024 and high SES B -0.072, 95% CI -0.119;-0.026)., Conclusions: We observed differential weight development per ethnic and SES group. Our results indicate that each ethnic and SES group follows its own path of weight development. Associations between dietary patterns and weight development showed some unexpected findings; follow-up research is needed to understand the association between dietary patterns and weight development.

Background: Despite mixed reports, food insecurity emerges as a predictor of nutritional status, assumably limiting the quantity and quality of dietary intake. In Ethiopia, the prevalence of childhood undernutrition and food insecurity is highly pronounced. However, whether household food insecurity predicts undernutrition in children was not yet well established. Thus, the aim of the present study was to identify the link between household food access and undernutrition in children aged 6-23 months in West Oromia zones, Ethiopia., Methods: A cross-sectional study was conducted on a sample of 525 households during June-October 2016. Food access was measured as Household Food Insecurity Access Scale. Semistructured interviewer-administered questionnaires were employed to collect data on sociodemographics, child health, child dietary practices, household food security, and anthropometrics. The height and weight of children aged 6-23 months in each household were measured. Multivariate logistic regression models were constructed to assess the association between household food insecurity and child nutritional status measured from undernutrition indicators., Results: Overall, more than two-thirds (69%) of households were classified as food insecure (had insufficient access to adequate food), with a mean (SD) household food access score of 7.9 (7.7). The respective prevalence of mild and moderate food-insecure households was 56.6% and 12.4%. Higher proportions of children in food-insecure households were stunted (41.8% vs. 15.5%), underweight (22.0% vs. 6.1%), and wasted (14.9% vs. 6.1%). Overall, the prevalence of child undernutrition was 21.3% in the target population, with 16.2% stunted, 6.9% underweight, and 6.3% wasted. The present finding shows food-secure households were 54% protective (OR: 0.46, 95% CI: 0.25-0.84) for child undernutrition. Compared to children in food-secure households, children who were reportedly living in moderately food-insecure households were over twice more likely stunted (OR: 2.09, 95% CI: 1.02-4.28) and over 4 times more likely underweight (OR: 4.73, 95% CI: 1.81-12.35). However, household food insecurity was not a correlate for acute malnutrition (wasting) in children., Conclusions: The prevalence of household's food insecurity situation is very common and more pronounced among households with undernourished children aged 6-23 months in Ethiopia. The analysis of this work shows that moderately food-insecure households are a salient predictor for composite undernutrition, stunting, and underweight, but not for wasting. Thus, this finding informs the need for multisectoral strategies and policies to combat household's food insecurity and multiple forms of child undernutrition, beyond the socioeconomic wellbeing., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Wondu Garoma Berra.)

Background: Child growth faltering persists in sub-Saharan Africa despite the scale-up of nutrition, water, and sanitation interventions over the past 2 decades. High temperatures have been hypothesised to contribute to child growth faltering via an adaptive response to heat, reduced appetite, and the energetic cost of thermoregulation. We did a cross-sectional study to assess whether child growth faltering is related to environmental temperature in sub-Saharan Africa., Methods: Data were extracted from 52 Demographic and Heath Surveys, dating from 2003 to 2016, that recorded anthropometric data in children aged 0-5 years, and were linked with remotely sensed monthly mean daytime land surface temperature for 2000-16. The odds of stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age) relative to monthly mean daytime land surface temperature were determined using multivariable logistic regression., Findings: The study population comprised 656 107 children resident in 373 012 households. Monthly mean daytime land surface temperature above 35°C was associated with increases in the odds of wasting (odds ratio 1·27, 95% CI 1·16-1·38; p<0·0001), underweight (1·09, 1·02-1·16; p=0·0073), and concurrent stunting with wasting (1·23, 1·07-1·41; p=0·0037), but a reduction in stunting (0·90, 0·85-0·96; p=0·00047) compared with a monthly mean daytime land surface temperature of less than 30°C., Interpretation: Children living in hotter parts of sub-Saharan Africa are more likely to be wasted, underweight, and concurrently stunted and wasted, but less likely to be stunted, than in cooler areas. Studies are needed to further investigate the relationship between temperature and child growth, including whether there is a direct effect not mediated by food security, regional wealth, and other environmental variables. Rising temperature, linked to anthropogenic climate change, might increase child growth faltering in sub-Saharan Africa., Funding: UK Medical Research Council and UK Global Challenges Research Fund., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Socioeconomic inequality in child malnutrition is well-evident in Bangladesh. However, little is known about whether this inequality differs by regional contexts. We used pooled data from the 2011 and 2014 Bangladesh Demographic and Health Survey to examine regional differences in socioeconomic inequalities in stunting and underweight among children under five. The analysis included 14,602 children aged 0-59 months. We used logistic regression models and the Concentration index to assess and quantify wealth- and education-related inequalities in child malnutrition. We found stunting and underweight to be more concentrated among children from poorer households and born to less-educated mothers. Although the poverty level was low in the eastern regions, socioeconomic inequalities were greater in these regions compared to the western regions. The extent of socioeconomic inequality was the highest in Sylhet and Chittagong for stunting and underweight, respectively, while it was the lowest in Khulna. Regression results demonstrated the protective effects of socioeconomic status (SES) on child malnutrition. The regional differences in the effects of SES tend to diverge at the lower levels of SES, while they converge or attenuate at the highest levels. Our findings have policy implications for developing programs and interventions targeted to reduce socioeconomic inequalities in child malnutrition in subnational regions of Bangladesh.

The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994-2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased ( p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years ( p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years ( p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.

Background: The relation between malnutrition and pulmonary death in patients with cystic fibrosis (CF) has resulted in intensive nutritional intervention over the last few decades, leading to a significant decline in underweight and the emergence of overweight/obesity as a potential new problem., Methods: We performed a cross-sectional database analysis of 484 adults with CF seen at the University of Minnesota CF Center between January 2015-January 2017, to determine the prevalence and pulmonary/cardiovascular risk factors associated with overweight and obesity in this population., Results: Mean age was 35.2 ± 11.6 years. 5.2% were underweight (BMI<18.5 kg/m 2 ), 62.6% normal weight (BMI ≥ 18.5-24.9 kg/m 2 ), 25.6% overweight (BMI ≥ 25-29.9 kg/m 2 ) and 6.6% obese (BMI ≥ 30 kg/m 2 ). In the subgroup with severe genotypes, 25% had BMI ≥ 25 kg/m 2 . In the entire cohort, overweight/obese were likely to be older (OR = 1.04, p < 0.0001) and to have a mild CFTR genotype (OR = 3.33, p = 0.0003) and modestly elevated triglyceride levels (OR = 1.008, p < 0.0001). The prevalence of hypertension was higher in overweight (25%) and obese (31%) than normal (17%) or underweight (16%), p = 0.01. Total cholesterol levels were higher in overweight/obese versus normal/underweight (144-147 vs 123-131 mg/dL, p = 0.04) as were LDL levels (70-71 vs 53-60 mg/dL, p = 0.02), but all were within the normal range. Percent predicted FEV1 was higher in overweight/obese (78-81%) versus underweight (59%) and normal (70%), p < 0.0001, and overweight/obese experienced significantly fewer acute pulmonary exacerbations., Conclusions: Overweight/obesity is common in adults with CF including those with severe genotypes. Lung function is better in the overweight/obese and lipid levels are within the normal range, albeit higher than in normal/underweight., Competing Interests: Declaration of Competing Interest T. Harindhanavudhi, A. Moheet, A. Moran and Q. Wang have no competing interests. J. Dunitz has received grants from Vertex Pharmaceuticals Inc, Hillrom, Proteostasis Therapeutics, Inc, and Cystic Fibrosis Foundation independent from the submitted work., (Copyright © 2019 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Background: Each year, more than 13.7 million people became an active case of tuberculosis and more than 1.5 million cases of TB patient will die. The association between TB and malnutrition is bi-directional, TB leads the patient to malnutrition, and malnutrition increases the risk of developing active TB by 6 to 10 times. Improving the nutrition of individual greatly reduces tuberculosis. The aims of this study were to assess the nutritional status and determinants of underweight among TB patients., Methods: A comparative cross-sectional study design was implemented. The sample size was calculated using 95% CI, 90% power, the prevalence of malnutrition in TB patients 50%, TB patients to TB free resident ratio of 3, the design effect of 2 and a 5% non-response rate. Systematic random sampling was used to select TB patients and simple random sampling technique was used to select TB free residents. The data were collected from July 2015-May 2018. The data were collected by interviewing the patient, measuring anthropometric indicators and collecting the stool and blood samples. The data were entered into the computer using Epi-info software and analyzed using SPSS software. Descriptive statistics were used to find the proportion of malnutrition. Binary logistic regression was used to identify the determinants of malnutrition., Results: A total of 5045 study participants (1681 TB patients and 3364 TB free residents) were included giving for the response rate of 93.1%. The prevalence of underweight among TB patients was 57.17% (95% CI: 54.80, - 59.54%) and 88.52% of TB patients were anemic. The prevalence of malnutrition (underweight) among TB free residents was 23.37% (95% CI: 21.93-24.80). The nutritional status of TB patients was determined by site of infection AOR: 0.68 [0.49-0.94], sex of the patient AOR: 0.39 [0.25-0.56], residence AOR: 3.84 [2.74-5.54], intestinal parasite infection AOR: 7 [5.2-9.95], problematic alcohol use AOR: 1.52 [1.17-2.13]., Conclusion: High proportions of TB patients were malnourished. TB patients were highly susceptible to malnutrition and even a very distal reason for malnutrition in the community became a proximal cause for TB patients.

Objective: To investigate the association between eating habits and weight status in adolescents in Finland., Design: Cross-sectional study., Setting: The Finnish Health in Teens (Fin-HIT) study is a cohort study conducted in adolescents attending third to sixth grade in 496 schools in forty-four municipalities in Southern, Middle and Northern Finland in 2011-2014., Participants: Analyses included 10 569 adolescents from the Fin-HIT study aged 9-14 years (5005 boys and 5564 girls). Adolescents were categorized by their eating habits: healthy eaters (44·1 %; n 4661), unhealthy eaters (12·3 %; n 1298), and fruit and vegetable avoiders (43·6 %; n 4610); and they were grouped into weight status: underweight (11·1 %), normal weight (73·6 %) and excess weight (15·3 %)., Results: We found an increased risk of underweight in fruit and vegetable avoiders (OR = 1·28; 95 % CI 1·12, 1·46). An irregular breakfast pattern showed an inverse association with underweight (OR = 0·70; 95 % CI 0·59, 0·84) and an increased risk of excess weight (OR = 1·56; 95 % CI 1·37, 1·77) compared with a regular breakfast pattern. An irregular dinner pattern was inversely associated with underweight (OR = 0·83; 95 % CI 0·69, 0·99) compared with a regular dinner pattern., Conclusions: Avoiding fruits and vegetables and following irregular breakfast and dinner patterns were associated with underweight and excess weight in adolescents.

Objective: To investigate the relationship between maternal autonomy and various indices of child undernutrition among children aged &lt;2 years in Nigeria, considering the cultural context and sociodemographic factors., Design: Population-based, cross-sectional study. Associations between various indices of maternal autonomy and child undernutrition (specifically stunting, underweight and wasting) were determined using weighted bivariate and multivariable logistic regression modelling., Setting: 2013 Nigerian Demographic Health Survey., Participants: Children aged between 3 and 24 months (n 7532)., Results: Overall, 31·4 % (n 2270), 29·8 % (n 2060) and 25·0 % (n 1755) of children in the sample were stunted, underweight and wasted, respectively. Women with acceptance of domestic violence (low autonomy) were approximately 18 and 14 % less likely to have stunted (OR = 0·82; 95 % CI 0·71, 0·94) and underweight children (OR = 0·86; 95 % CI 0·75, 0·99), respectively. Similarly, women with low power in their couple relations were 17 % less likely to have children who were wasted (OR = 0·83; 95 % CI 0·72, 0·97). Sociodemographic predictors of all indices of undernutrition included maternal education and Hausa ethnicity. Additionally, stunting was predicted by lack of exclusive breast-feeding, low income and being of Fulani ethnicity; wasting by having mothers with low BMI; and underweight by breast-feeding initiation within 1 h hour of birth, polygamous homes, mothers with low BMI and being of Fulani ethnicity., Conclusions: Women with acceptance of domestic violence and low power in couple relations were found to be less likely to have children with indices of undernutrition. This unexpected finding calls for future exploratory research, and policies and interventions that target at-risk subgroups.

Background: Globally, in every three preschool children one is affected by malnutrition. In Ethiopia, child undernutrition continues to be a serious public health problem. Data are scarce, especially in 24-59 months age children. We aimed at estimating under nutrition and its associated factors among children 24-59 months age in Aykel Town, Northwest Ethiopia., Methods: A community based cross-sectional study was conducted among children aged 24-59 months in Aykel Town from January to February 2017. A total of 416 children were included in to the study using a systematic random sampling technique. Data were collected by interview and anthropometric measurements. Multivariable analysis was performed to identify the predictors of stunting, wasting and underweight., Results: The prevalence of stunting, wasting and underweight were 28.4, 10 and 13.5%, respectively. Children from low birth order; 1 st (AOR = 8.60, 95%CI: 2.40, 3.70) and 2nd -4th (AOR = 5.80, 95%CI: 1.80, 18.90), from large family size (AOR = 3.67, 95%CI: 1.92, 7.00), and had meal frequency < 3/day (AOR = 5.09, 95%CI: 2.96, 8.74) were at a higher risk of stunting. Children who had not fed on cow milk (AOR = 5.50, 95%CI: 2.30, 13.00), and from mothers who had poor hand washing practice (AOR = 11.00, 95%CI: 4.30, 27.9) were more likely to be wasted. Children who had not fed on cow milk (AOR = 2.90, 95%CI: 1.40, 6.00), breast fed for less than 24 months (AOR = 2.60, 95%CI: 1.35, 5.00), consumed foods from less than four food groups (AOR = 6.30, 95%CI: 1.70, 23.00), and were from mothers' who had poor hand washing practice (AOR = 2.50, 95%CI: 1.30, 4.70) had higher odds of being underweight., Conclusion: Stunting, wasting and underweight are high among children aged 24-59 months in Aykel Town. Poor child feeding and maternal hygienic practices were identified as risk factors of undernutrition. Educating mothers/care givers on the advantages of proper child feeding and maintaining hygienic practices at critical times is valuable in improving the nutritional status of children.