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Background: Leptin, mainly secreted by fat cells, plays a core role in the regulation of appetite and body weight, and has been proposed as a mediator of metabolic programming. During pregnancy leptin is also secreted by the placenta, as well as being a key regulatory cytokine for the development, homeostatic regulation and nutrient transport within the placenta. South Asians have a high burden of type 2 diabetes, partly attributed to a "thin-fat-phenotype"., Objective: Our aim was to investigate how maternal ethnicity, adiposity and glucose- and lipid/cholesterol levels in pregnancy are related to placental leptin gene ( LEP ) DNA methylation., Methods: We performed DNA methylation analyses of 13 placental LEP CpG sites in 40 ethnic Europeans and 40 ethnic South Asians participating in the STORK-Groruddalen cohort., Results: South Asian ethnicity and gestational diabetes (GDM) were associated with higher placental LEP methylation. The largest ethnic difference was found for CpG11 [5.8% (95% CI: 2.4, 9.2), p<0.001], and the strongest associations with GDM was seen for CpG5 [5.2% (1.4, 9.0), p=0.008]. Higher maternal LDL-cholesterol was associated with lower placental LEP methylation, in particular for CpG11 [-3.6% (-5.5, -1.4) per one mmol/L increase in LDL, p<0.001]. After adjustments, including for nutritional factors involved in the one-carbon-metabolism cycle (vitamin D, B12 and folate levels), ethnic differences in placental LEP methylation were strongly attenuated, while associations with glucose and LDL-cholesterol persisted., Conclusions: Maternal glucose and lipid metabolism is related to placental LEP methylation, whilst metabolic and nutritional factors largely explain a higher methylation level among ethnic South Asians., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Sletner, Moen, Yajnik, Lekanova, Sommer, Birkeland, Jenum and Böttcher.)

The vitamin D status of the United Kingdom (UK) African-Caribbean (AC) population remains under-researched, despite an increased risk of vitamin D deficiency due to darker skin phenotypes and living at a high latitude. This cross-sectional study explored the vitamin D status and intake of AC individuals ( n = 4046 with a valid serum 25(OH)D measurement) from the UK Biobank Cohort, aged ≥40 years at baseline (2006-2010). Over one third of the population were deficient (<25 nmol/L), 41.1% were insufficient (25-50 nmol/L) and 15.9% were sufficient (>50 nmol/L). Median (IQR) 25(OH)D was 30.0 (20.9) nmol/L. Logistic regression showed that brown/black skin phenotype, winter blood draw, not consuming oily fish and not using vitamin D supplements predicted increased odds of vitamin D deficiency, whilst older age and a summer or autumn blood draw were significantly associated with reduced odds of vitamin D deficiency. Vitamin D deficiency and insufficiency were prevalent in this AC population and is of considerable concern given the individual and societal implications of increased morbidity. Public health messaging for this group should focus on year-round vitamin D supplementation and increasing intakes of culturally appropriate vitamin D-rich foods. These data also support the urgent requirement for a revised vitamin D RNI for ethnic groups.

Background: In low-income countries, the high prevalence of pre-pregnancy undernutrition remains a challenge for the future health of women and their offspring. On top of good nutrition, adequate gestational weight gain has been recognized as an essential prerequisite for optimal maternal and child health outcomes. However, good-quality data on factors influencing gestational weight gain is lacking. Therefore, this study was aimed to prospectively identify pre-conception and prenatal factors influencing gestational weight gain in Ethiopia., Methods: A population based prospective study was undertaken between February 2018 and January 2019 in the Tigray region, northern Ethiopia. Firstly, the weight of non-pregnant women of reproductive age living in the study area was measured between August and October 2017. Subsequently, eligible pregnant women identified during the study period were included consecutively and followed until birth. Data were collected through an interviewer-administered questionnaire and anthropometric measurements complemented with secondary data. Gestational weight gain, i.e., the difference between 32 to 36 weeks of gestation and pre-pregnancy weights, was classified as per the Institute of Medicine (IOM) guideline. Linear, spline, and logistic regression models were used to estimate the influence of pre-conception and prenatal factors on gestational weight gain., Results: The mean gestational weight gain (standard deviation[SD]) was 10.6 (2.3) kg. Overall, 64.0% (95% CI 60.9, 67.1) of the women did not achieve adequate weight gain. Factors associated with higher gestational weight gain were higher women empowerment (B 0.60, 95% CI 0.06, 1.14), dietary diversity (B 0.39, 95% CI 0.03, 0.76), pre-pregnancy body mass index (B 0.13, 95% CI 0.05, 0.22), and haemoglobin (B 0.54, 95% CI 0.45, 0.64). Additionally, adequate prenatal care (B 0.58, 95% CI 0.28, 0.88) was associated with higher gestational weight gain., Conclusions: Adequate gestational weight gain was not achieved by most women in the study area, primarily not by those who were underweight before pregnancy. Interventions that advance women's empowerment, dietary quality, pre-pregnancy nutritional status, and prenatal care utilization may improve gestational weight gain and contribute to optimizing maternal and child health outcomes., (© 2021. The Author(s).)

Adequate nutritional status may influence progression to frailty. The purpose of this study is to determine the prevalence of frailty and examine the relationship between dietary protein intake and the transition between frailty states and mortality in advanced age. We used data from a longitudinal cohort study of Māori (80-90 years) and non-Māori (85 years). Dietary assessments (24-h multiple pass dietary recalls) were completed at the second year of follow-up (wave 2 and forms the baseline in this study). Frailty was defined using the Fried Frailty criteria. Multi-state modelling examined the association of protein intake and transitions between frailty states and death over four years. Over three quarters of participants were pre-frail or frail at baseline (62% and 16%, respectively). Those who were frail had a higher co-morbidity ( p < 0.05), where frailty state changed, 44% showed a worsening of frailty status (robust → pre-frail or pre-frail → frail). Those with higher protein intake (g/kg body weight/day) were less likely to transition from robust to pre-frail [Hazard Ratio (95% Confidence Interval): 0.28 (0.08-0.91)] but also from pre-frail to robust [0.24 (0.06-0.93)]. Increased protein intake was associated with lower risk of transitioning from pre-frailty to death [0.19 (0.04-0.80)], and this association was moderated by energy intake [0.22 (0.03-1.71)]. Higher protein intake in this sample of octogenarians was associated with both better and worse outcomes.

One in five Canadians are first-generation immigrants. Evidence suggests the baseline risk for vitamin D (vitD) deficiency is increased among immigrants who move from equatorial to northern countries. We investigated the prevalence and determinants of vitD deficiency/insufficiency among first-generation immigrants compared with native-born Canadians and identified explanatory covariables. We used a cross-sectional design with data from the national Canadian Health Measures Survey (Cycles 3 and 4) (11,579 participants aged 3-79 years). We assessed serum 25-hydroxyvitamin D (S-25(OH)D) levels, sociodemographic and environmental factors, immigration status, length of time in Canada, vitD-rich food intake, ethnicity, and place of birth. Immigrants had lower mean S-25(OH)D than non-immigrants (51.23 vs. 62.72 nmol/L, p < 0.001). Those with younger age at the time of immigration (<18 years) had a high risk for low vitD, and S-25(OH)D levels increased with the length of time they had lived in Canada. The highest deficiency levels were in immigrants born in Morocco, India, and Lebanon compared with native-born Canadians. Ethnicity was the factor most strongly associated with S-25(OH)D. Compared with the white ethnic grouping, the Japanese had the highest level of vitD deficiency, followed by Arabs and Southeast Asians. Ethnic variations, dietary intake, and lifestyle factors are the main predictors of/explanatory factors for vitD status among Canadian immigrants.

This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Māori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77-84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0-64.7). Women scored slightly higher than men ( p = 0.042). DQI-I components identified better dietary variety in men ( p = 0.044), and dietary moderation in women ( p = 0.002); both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4-25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6-1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty.

Background: The Multiple Source Method (MSM) and the National Cancer Institute (NCI) method estimate usual dietary intake from short-term dietary assessment instruments, such as 24-hour recalls. Their performance varies according to sample size and nutrients distribution. A comparison of these methods among a multiethnic youth population, for which nutrient composition and dietary variability may differ from adults, is a gap in the literature., Objective: To compare the performance of the NCI method relative to MSM in estimating usual dietary intakes in Hispanic/Latino adolescents., Design: Data derived from the cross-sectional population-based Hispanic Community Health Study/Study of Latino Youth, an ancillary study of offspring of participants in the adult Hispanic Community Health Study/Study of Latino Youth cohort. Dietary data were obtained by two 24-hour recalls., Participants/setting: One thousand four hundred fifty-three Hispanic/Latino youth (aged 8 to 16 years) living in four urban US communities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) during 2012 through 2014., Main Outcome Measures: The NCI method and the MSM were applied to estimate usual intake of total energy, macronutrients, minerals and vitamins, added sugar, and caffeine., Statistical Analyses: Mean, standard deviation, minimum and maximum values, coefficient of variation, variance ratio, and differences between NCI and MSM methods and the 2-day mean were estimated in several percentiles of the distribution, as well as concordance correlation coefficients and Bland-Altman plot analysis., Results: The distributions of all nutrients studied were very similar between NCI and MSM. The correlation between NCI and MSM was >0.80 for all nutrients (P<0.001), except dietary cholesterol, vitamin C, and n-3 fatty acids. In individual estimations, NCI method predicted higher estimates and lower variance than the MSM. The lowest level of agreement was observed in the values at the tails of the distribution, and for nutrients with high variance ratio., Conclusions: Overall, both MSM and NCI method provided acceptable estimates of the usual intake distribution using 24-hour recall, and they better represented the usual intake compared with 2-day mean, correcting for intraindividual variability., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Vitamin B12 deficiency is prevalent worldwide especially in vegetarian communities. Its deficiency in early childhood may result in serious neurological and cognitive deficits. It is important to know the prevalence among our infants and toddlers so that nutritional policy changes could be suggested in this regard., Objective: To evaluate the vitamin B12 status of apparently healthy Indian children between 6 and 23 months of age., Methods: Apparently healthy Indian children (n = 210), of age 6 to 23 months, attending pediatric outpatient department were recruited and samples obtained to evaluate their hemogram and levels of vitamin B12, folate, and ferritin. Data were analyzed to obtain the mean levels and the proportion of participants deficient in vitamin B12. The dietary habits of the children were also analyzed and correlated with their vitamin B12 status., Results: Vitamin B12 deficiency was observed in 37.6% of the participants., Conclusions: There is a high prevalence of vitamin B12 deficiency in our infants and toddlers, and there is need to initiate supplement to prevent any possible neurological consequences. Early initiation of animal milk had a positive effect on the vitamin B12 status of the child, though it was not significant.

Objectives: The incentives underlying men's hunting acquisition patterns among foragers are much debated. Some argue that hunters preferentially channel foods to their households, others maintain that foods are widely redistributed. Debates have focused on the redistribution of foods brought to camp, though the proper interpretation of results is contested. Here we instead address this question using two nutritional variables, employed as proxies for longer-term food access. We also report on broader patterns in nutritional status., Materials and Methods: We measured male hunting success, hemoglobin concentration and body fatness among bush-living Hadza. Hunting success was measured using an aggregated reputation score. Hemoglobin concentration, a proxy for dietary red meat, was measured from fingerprick capillary blood. Body fatness, a proxy for energy balance, was measured using BMI and bioelectrical impedance., Results: We find no statistically significant relationship between a hunter's success and any measure of his nutritional status or that of his spouse. We further find that: women are, as elsewhere, at greater risk of iron-deficiency anemia than men; men had slightly lower BMIs than women; men but not women had significantly lower hemoglobin levels than in the 1960s., Discussion: The absence of an association between hunting reputation and nutritional status is consistent with generalized food sharing. Null results are difficult to interpret and findings could potentially be a consequence of insufficient signal in the study measures or some confounding effect. In any event, our results add to a substantial corpus of existing research that identifies few nutritional advantages to being or marrying a well-reputed Hadza hunter., (© 2020 Wiley Periodicals, Inc.)

Common mental disorders (CMD) among mothers cause disability, negatively affect child development, and have high long-term economic costs. Little is known about how factors across multiple life dimensions, modeled together, are differentially related to maternal mental health in high poverty contexts. Further, there is limited evidence on determinants of CMD in areas where self-help groups (SHGs) exist to promote women's wellbeing. Filling this evidence gap is important given the high prevalence of CMD and the rapid expansion of SHGs in rural India. Cross-sectional data were collected from 1644 mother-infant pairs living in disadvantaged rural villages across five Indian states-Jharkhand, Madhya Pradesh, West Bengal, Odisha, and Chhattisgarh-surveyed in the Women Improving Nutrition through Group-based Strategies study. CMD were assessed using the 20-item Self Reporting Questionnaire (SRQ). We examined 31 factors across four life dimensions: work (work type, time spent in labor, domestic and caretaking activities), agency (SHG membership, decision-making, gender attitudes), health/nutrition (underweight, fertility, diet diversity, child illness), and household/environment (dependency ratio, wealth, food security, shocks, water, sanitation). Survey-adjusted multivariate logistic and ordinary least squares regression models were fit to examine predictors of CMD or SRQ score. On average, mothers were 26 (range 18-46) years old and their children were 15 (range 6-24) months old. CMD defined as ≥ 8 positive SRQ responses were reported by 262 women (16%). Protective factors included being engaged in agricultural labor as a main occupation relative to being a housewife (AOR 0.18, 95% CI 0.10-0.32), more time working (0.85, 0.77-0.93), higher decision-making (0.33, 0.16-0.69), SHG membership (0.73, 0.56-0.96), and having an improved toilet (0.49, 0.33-0.72). Risk factors included food insecurity (1.13, 1.07-1.20) and shocks to non-farm livelihoods (2.04, 1.10-3.78). Practitioners and policymakers should aim to improve food security, economic wellbeing and social capital, such as that created through SHG membership, to improve maternal mental health. Future research should aim to understand why working outside the home, albeit in agricultural work, appears to protect maternal mental health in this context., Competing Interests: The authors have declared that no competing interests exist.

Background: Malnutrition among women in Nepal persists as a major public health burden. Global literature suggests that domestic violence may have a negative impact on women's nutritional status. The contribution of intimate partner violence (IPV) to increased stress levels, poor self-care including the consumption of less food and, in turn, malnutrition has been documented. However, there is little empirical evidence on IPV and its relationship with women's nutritional status in Nepal and thus, this paper assesses these associations., Methods: We used data on non-pregnant married women (n = 3293) from the 2016 Nepal Demographic and Health Survey (NDHS). The primary exposure variable was whether the women had ever experienced physical, sexual, or emotional violence or controlling behaviours by a current or former partner, based on her responses to the NDHS domestic violence questions. The primary outcome variables were three indicators of malnutrition: under-weight (BMI < 18.5), over-weight (BMI > 25), and anemia (Hb < 11.0 g dL). We used logistic and multinomial regression models, adjusted for potential socio-demographic and economic confounders, as well as clustering, to examine associations between IPV exposure and malnutrition., Results: Approximately 44% of women had experienced at least one of the four types of IPV. Among them, around 16, 25%. and 44% were underweight, overweight, or anemic, respectively, compared to 13, 29, and 35% of women never exposed to IPV. We did not find any associations between underweight and any of the four types of IPV. Overweight was associated with physical violence (adjusted RRR = 0.67, P < 0.01, CI = 0.50-0.88) and severe physical violence (adjusted RRR = 0.53, P < 0.05, CI = 0.32-0.88) Controlling behaviors were associated with anemia (adjusted RRR = 1.31, P < 0.01, CI = 1.11-1.54)., Conclusions: Among married Nepalese women, physical violence appears to be a risk factor for one's weight and controlling behaviors for one's anemia status. Additional, rigorous, mixed-methods research is needed to understand the reporting of IPV and what relationships do or do not exist between IPV experience and nutrition both in Nepal and in other settings.

Objective: To examine the extent and nature of coverage of nutrition in the Koori Mail., Methods: Content and framing analysis were used to examine articles in the Koori Mail published between 2013 and 2017 that included the terms 'nutrition∗', 'diet∗', 'food', 'eating', 'weight', 'tucker' or 'sugary drinks'. The analysis focused on the portrayal of Aboriginal and Torres Strait Islander people/communities, inclusion of First Peoples' voices and the framing of nutrition issues., Results: A total of 102 articles were included. Most articles (88%, n=90) portrayed Aboriginal and Torres Strait Islander communities in a neutral or positive way and more than half (53%, n=54) included an Aboriginal or Torres Strait Islander voice. While nutrition was often framed as an individual or community responsibility, articles predominantly promoted programs or initiatives undertaken in local communities., Conclusion: Despite the limited prominence of Aboriginal and Torres Strait Islander nutrition in the mainstream media, the coverage of nutrition issues in the Koori Mail demonstrates the salience of this topic for local communities. This study highlights how journalism can better reflect the diversity and strengths of First Peoples. Implications for public health: Including more Aboriginal and Torres Strait Islander voices and using a strengths-based approach in press releases may improve media advocacy., (© 2020 The Authors.)

Objectives: We compared δ 15 N and δ 13 C values from bone and dentine collagen profiles of individuals interred in famine-related and attritional burials to evaluate whether individuals in medieval London who experienced nutritional stress exhibit enriched nitrogen in bone and tooth tissue. Dentine profiles were evaluated to identify patterns that may be indicative of famine during childhood and were compared with the age of enamel hypoplasia (EH) formation to assess whether isotopic patterns of undernutrition coincide with the timing of physiological stress., Materials and Methods: δ 15 N and δ 13 C isotope ratios of bone collagen were obtained from individuals (n = 128) interred in attritional and famine burials from a medieval London cemetery (c. 1120-1539). Temporal sequences of δ 15 N and δ 13 C isotope profiles for incrementally forming dentine collagen were obtained from a subset of these individuals (n = 21)., Results: Results indicate that individuals from attritional graves exhibit significantly higher δ 15 N values but no significant differences were found between burial types for the sexes. Analyses of dentine profiles reveal that a lower proportion of famine burials exhibit stable dentine profiles and that several exhibit a pattern of opposing covariance between δ 15 N and δ 13 C. EH were also observed to have formed during or after the opposing covariance pattern for some individuals., Conclusions: The results of this study may reflect differences in diet between burial types rather than nutritional stress. Though nutritional stress could not be definitively identified using bone and dentine collagen, the results from dentine analysis support previous observations of biochemical patterns associated with nutritional stress during childhood., (© 2020 Wiley Periodicals, Inc.)

Adult day care (ADC) centers provide community-based care (including meals) to frail, ethnically diverse older adults, many of whom are at risk for malnutrition. To support the development of interventions to benefit ADC users, the authors aimed to identify barriers and facilitators of healthy nutrition among ADC users born in Vietnam and China. Semi-structured qualitative interviews were conducted among ADC stakeholders to identify barriers and facilitators. Data were analyzed using Braun and Clarke's six-step method and organized within the framework of the Social Ecological Model. Facilitators of good nutrition included adherence to traditional diet at the ADC center, peer networks, and access to ethnic grocers. Poor health, family dynamics, and loneliness all contributed to poor nutrition, as did the restrictive nature of nutrition programs serving ADC users in the United States. Individual, relationship, organizational, community, and policy level factors play a role in ADC users' nutritional status. Targeted nutrition interventions should leverage culturally congruent relationships between ADC users and staff and include advocacy for enhancement of federal programs to support this population. [Research in Gerontological Nursing, 13(3), 146-157.]., (Copyright 2019, SLACK Incorporated.)

When traditional measures for material and economic welfare are scarce or unreliable, height and the body mass index (BMI) are now widely accepted measures that represent cumulative and current net nutrition in development studies. However, as the ratio of weight to height, BMI does not fully isolate the effects of current net nutrition. After controlling for height as a measure for current net nutrition, this study uses the weight of a sample of international men in US prisons. Throughout the late 19th- and early-20th centuries, individuals with darker complexions had greater weights than individuals with fairer complexions. Mexican and Asian populations in the US had lower weights and reached shorter statures. Black and white weights stagnated throughout the late 19th- and early-20th centuries. Agricultural workers' had greater weights than workers in other occupations.

Diabetes is one of the main health problems among Saharawi refugees living in Algerian camps, especially for women. As is known, diet plays an important role in the management of diabetes. However, the dietary habits of Saharawi diabetic women are unknown. Therefore, we investigated the dietary habits and established their relationship with the nutritional status and glycemic profile of such women. We recruited 65 Saharawi type II diabetic women taking orally glucose-lowering drugs only. Dietary habits were investigated using qualitative 24 h recall carried out over three non-consecutive days. Anthropometric measurements were taken and blood parameters were measured. About 80% of the women were overweight and about three out of four women had uncompensated diabetes and were insulin resistant. The Saharawi diet was found to mainly include cereals, oils, sugars, vegetables (especially onions, tomatoes, and carrots), tea, and meat. Principal component analysis identified two major dietary patterns, the first one "healthy" and the second one "unhealthy". Women in the higher tertile of adherence to the unhealthy dietary pattern had a higher homeostatic model assessment for insulin resistance (HOMA) index (b = 2.49; 95% CI: 0.41-4.57; p = 0.02) and circulating insulin (b = 4.52; 95% CI: 0.44-8.60; p = 0.03) than the women in the lowest tertile. Food policies should be oriented to improve the quality of diet of Saharawi diabetic women.

Purpose: One of the major federal food assistance programs, the Special Supplemental Program for Women, Infants, and Children (WIC), serves approximately 1.5 million low-income pregnant women per year; however, limited information is available on their dietary habits. This is critical because low-income women are at higher risk of gaining excess weight during pregnancy. Thus, the study objectives were to (1) determine the overall diet quality of WIC pregnant women and (2) examine diet quality and eating behaviors by race/ethnicity and other sociodemographics., Design: This was a cross-sectional study., Setting: One of the 3 WIC offices in a north-central county in North Carolina, USA., Sample: Pregnant women (n = 198) in the second trimester., Measures: Interviews included sociodemographics, food security, diet, and eating behaviors. Diet quality was assessed by the Healthy Eating Index (HEI) 2010 scores., Analysis: Descriptives, bivariate analysis, and multivariate analysis., Results: Average participant age was 26 years, and the mean HEI-2010 score was 56 of maximum score of 100. Specifically, African American women consumed significantly lower servings of whole grains (β = -1.71; 95% CI: -3.10 to -0.32; P < .05) and dairy (β = -1.42; 95% CI: -2.51 to -0.33; P < .05) compared with non-Hispanic white women. Hispanic women scored higher in daily intake of fruits (β = 0.98; 95% CI: 0.17-1.79; P < .05) and for consuming empty calories in moderation (β = 1.57; 95% CI: 0.06-3.09; P < .05). Frequency of intake of fast foods/outside meals was higher among African American women (57%, P = .025)., Conclusion: Efforts are warranted to promote optimal nutrition among WIC pregnant women. Specifically, African American women are highly vulnerable to poor dietary habits during pregnancy. Further investigation of barriers/facilitators for healthy eating is necessary to address nutrition disparities among WIC pregnant women.

This study investigated whether the association between household air pollution (HAP) and nutritional status (stunting, underweight, or wasting) among children differ by caste/ethnicity. Child anthropometry data for 9,914 children aged 0-59 months were analyzed linearly as Z scores and as dichotomous categories. Exposure to HAP was significantly associated with a decrease in child height-for-age and child weight-for-age, as well as with stunting and underweight. Children in low caste (Dalits) had higher prevalence of stunting (odds ratio [OR] = 1.21; 95% confidence intervals [CI] = 1.01, 1.44), underweight (OR = 1.47; 95% CI = 1.24, 1.75), and wasting (OR = 1.53; 95% CI = 1.21, 1.92) than those children in upper caste group. This association was modestly attenuated with adjustment for HAP. Exposure to HAP partly explained the caste-ethnic difference in undernutrition among children in Nepal.

High requirements for macro- and micronutrients of the organism of a pregnant woman living in the Far North are associated with the influence of extreme factors of high latitudes, and the needs of the mother and the growing fetus. Only the products of the unique food culture of the Arctic people - the Nenets, make it possible to meet the emerging needs. The aim of the work was to study the impact of traditional nutrition on the reproductive health of Nenets women living in the Arctic zone of Western Siberia. Material and methods . 619 indigenous inhabitants (Nenets) of the Yamal, Nadym and Taz districts of the Yamal-Nenets Autonomous Okrug at the age of 18-65 years were examined. The influence of the type of nutrition (traditional or imported products) on reproductive health indicators (the number of pregnancies, the number of children, the number of spontaneous abortions, frequency of gestosis, threats of termination of pregnancy, operative deliveries) for the period 2013-2018 was studied by analyzing official statistics and by questioning of the female population in own research. Results . The consumption of traditional products (venison, local fishery products, at least 3 times a week) by Nenets women was more often accompanied by a normal physiological course of pregnancy and childbirth (75.2 versus 64.2%, χ 2 =8.7; p=0.003). It led to a 1.5-fold decrease in the frequency of complications during pregnancy (gestosis, the threat of abortion) (χ 2 =5.8; p=0.01) and a 20% decrease in the frequency of delivery by cesarean section (χ 2 =16.6; p<0.001). As a result, a family whose diet was dominated by traditional products had a statistically significantly larger number of children (per child). Conclusion . The preservation of the consumption of reindeer and river fishery products by indigenous women will contribute to the sufficient intake of macro- and micronutrients, that will make it possible to gestate and give birth to a healthier generation of the Nenets society., Competing Interests: The authors declare no overt and potential conflict of interest related to the publication of this article., (Copyright© GEOTAR-Media Publishing Group.)

Background and Objectives: A previous pilot study revealed stunted children and obese adults in urbanized settled Tibetan communities. A survey with a representative population in selected communities was conducted to test the preliminary findings., Methods and Study Design: A cross-sectional study on the nutritional status involving 504 children (244 boys and 260 girls, 5-16 y) and 927 adults (422 men and 505 women, 18-90 y) was conducted in communities, with anthropometric parameters measured. The z-scores for height-for-age (HAZ) and BMI-for-age (BAZ) in children were calculated according to WHO 2007 reference., Results: The children showed a double burden of both under- and over-nutrition. The prevalence of under-nutrition in children was high - stunting (HAZ <-2) 10.7%, underweight (BAZ <-2) 9.5%, combined prevalence of stunting and underweight 19.4%. The rate of over-nutrition was also alarming - obesity 12.7% (BAZ >2). The mean value of HAZ (- 0.45±1.41) was lower than, whereas that of BAZ (0.05±1.76) was comparable to, the WHO reference. No significant differences were found in under- or over-nutrition between genders. Specifically, 8.9% of children demonstrated both short stature (HAZ <-1) and overweight (BAZ >1). By contrast, community adults showed almost a one-way direction tilted towards over-nutrition - overweight 61.4% (BMI ≥24 kg/m2), obesity 30.1% (BMI ≥28 kg/m2), and central obesity 62.0% (waist circumference, men ≥85 cm, women ≥80 cm). Women were marginally more likely to be obese than men (p=0.061)., Conclusions: The co-existence of under- and over-nutrition in the community may have reflected the suboptimal early life nutrition and the obesogenic environment afterwards. Potential determinants need to be explored for future interventions.

The objective of the current study was to examine micronutrient intake from foods in women of childbearing age and to better understand potential nutritional problems varied by body weight status in minority women. A sample of women aged 19-39 years from the National Health and Nutrition Examination Surveys (NHANES) 2003-2014 was analyzed. Dietary intakes of 13 micronutrients were estimated using the National Cancer Institute method. Mexican-American and non-Hispanic Black women were categorized into normal/under-weight, overweight, or obese groups according to their body mass index (BMI). Mexican-American and non-Hispanic Black women had lower dietary intakes for vitamins A, B 2 , B 6 , B 12 , and D, folate, calcium, and magnesium than non-Hispanic Whites. Among Mexican-Americans, obese women had the lowest dietary intake of vitamins A, B 2 , C and D. Obese non-Hispanic Black women had significantly lower dietary intakes of iron and zinc than their normal/under-weight counterparts. Comparable percentages (>30%) of Mexican-American and non-Hispanic Black women had dietary intake less than the Estimated Average Requirements (EARs) for several key nutrients including vitamin A, C and D, folate, calcium and magnesium, and the percentages varied by body weight status. These results indicate micronutrient inadequacies persist among and within racial/ethnic and body weight groups.

Studies on dietary practices in the scope of the Brazilian National School Feeding Program (PNAE) have identified a paradox: while the PNAE has progressed as a policy based on the human right to adequate diet, it has a paternalistic bias which tends to contribute to stigmatized identities. A study was thus performed to understand the interactions between dietary practices in school meals and identities. The theoretical and methodological approach was ethnographic, focusing on the scenario of a public school in the municipality (county) of Santo Antônio de Jesus, Bahia State, Brazil, in the upper years of elementary school. The ethnographic work was done in seven months, consisting of observation of daily meals at the school, recorded on a field diary, as well as 23 interviews with students and key actors. Analysis of the material consisted of a hermeneutic exercise and categorization of the emerging themes. This article is a cross-section of the study, presenting two categories: the first, "The school is ours", analyzes the redefinition of school in relation to a stigmatized identity; the second, "Food is what unites", presents school meals as a structuring element in students' identities and that of the school itself. The findings also show how the dialogue between the field of education and the field of food and nutrition can help school meals become part of school practices, not as mere nutritional support, but as food that values the public school and its members.

(1) Background: Vietnam is a multiethnic country undergoing rapid economic development, the improvement in nutritional status in preschool children is not equally shared by all ethnic groups; (2) Methods: A cross-sectional study was performed from September-December 2018 on 16,177 children aged 24-60 months representing Kinh ( n = 14421), Muong ( n = 1307) and Tay ( n = 449) ethnic groups. Prevalence of malnutrition, overweight, obesity and anthropometric indices were compared across ethnic groups, using WHO 2006 child growth standards; (3) Results: The prevalence of malnutrition among children of Kinh, Muong and Tay origins was 14.7%, 34.3% and 43.2%, respectively. The corresponding data for overweight was 5.5%, 2.7%, 2.2% and for obesity 2.8%, 0.8% and 0.4%, respectively. The prevalence of stunting remained the highest in three subtypes of malnutrition in all ethnic groups. Kinh children were heavier and taller than the other groups, while Muong children were taller than Tay children ( p -value < 0.001); and (4) Conclusions: Malnutrition remains a major public health issue among children of minor ethnicities while overweight and obesity is an emerging challenge for the Kinh ethnic group. The results imply that a community-based intervention should be specific to ethnicity to reduce the gap in nutritional status between ethnic groups in Vietnam.

Background: Thailand has millions of migrants working in different sectors of industries. Pattani is a deep southern provincial city having thousands of Myanmar migrants working in fishery-related jobs. Children from those migrant families are vulnerable and lack from proper care and raising by their parents., Objectives: The aim of the study is to describe the nutritional status of Myanmar migrant children and identify conditions which are responsible for undernutrition in that community., Methods and Study Design: A cross-sectional study was conducted from December 2016 to April 2017 among mothers and children under 2.5 years of age in that community. A total number of 100 children were involved in statistical analysis after excluding 2 comorbid children. Nutritional status of migrant children was classified by WHO Anthro version 3.2.2., Results: Prevalence of abnormal nutritional status was reported by (19.6%) stunted, (10.8%) underweight, and (7.8%) wasted. Other ethnic children rather than Mon and Dawei were more likely to be stunted (p < 0.007). Being occupied by a fisherman father was significantly associated with stunting (p < 0.005)., Discussion: To improve feeding practices in infant and young children, a migrant-friendly health education program should be launched and evaluated in this community.

The aim of this study was to conduct a review of the health and nutritional status of Chilean indigenous children, specifically Mapuche children, as published in the literature and specific population-based studies. The searches were conducted in PubMed and LILACS in the last 15 years. From 2006 to 2015, the poverty rate was higher in the indigenous population, with a decrease in the gap from 16% in 2006 to 7.7% in 2015 (p < 0.001). In the first decade of this century, infant mortality in indigenous children was 17.1/1,000 live births, while in non-indigenous children it was 8.8/1,000, and the gap was maintained in the five-year follow-up (p < 0.001). Newborns with birthweight < 2,500g in the year 2000 did not reach 6% (5.6% in non-indigenous and 5.2% in indigenous children). Low height at first school enrollment was 8.4% in indigenous schoolchildren and 3.1% in non-indigenous children, decreasing to 3.7% in indigenous children and 2.6% in non-indigenous children in 2004, while obesity increased more in indigenous children, reaching 24.2% in indigenous and 25.3% in non-indigenous children (p < 0.001). Menarche appeared four months later on average in indigenous girls (12.7 years), and body mass index, waist circumference, and fat mass were significantly greater in indigenous girls at the time of thelarche, as was the overweight rate (55%, vs. 42% in non-indigenous). Mapuche children show favorable health and nutritional status compared to indigenous children elsewhere in Latin America, but there is still an adverse gap compared to non-indigenous Chilean children. This inequality affecting indigenous Chilean children should be acknowledged and corrected.

Although social marketing principles have been successfully employed in school-based interventions to prevent obesity, use in early care and education (ECE) settings has been limited. This paper describes the use of the social marketing approach to develop an ECE-based intervention that encourages an ECE provider-parent partnership to improve the quality of preschool children's diets and their level of physical activity. A six-step social marketing approach for public health interventions guided the development of this ECE-based intervention. These steps were as follows: (i) initial planning, (ii) formative research, (iii) strategy development, (iv) program development, (v) implementation, and (vi) monitoring and evaluation. During this process, we reviewed current literature, conducted focus groups with ECE providers and parents, developed a detailed conceptual model and content map, created and tested the campaign concept, and developed final campaign materials along with strategies for its implementation. The final intervention resulting from this process was an 8-month campaign known as Healthy Me, Healthy We. The campaign is delivered by the child care center and includes branded materials for use in the classroom and at home. The final campaign is being evaluated in a cluster-randomized trial. Healthy Me, Healthy We offers an innovative approach to promoting healthy eating and physical activity during early childhood, a key developmental period, that leverages partnership between ECE providers and parents to affect behavior change., (© Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: We describe differences in linear growth as measured by height-for-age z-score (HAZ) between children from Bengali and tribal populations in the Chittagong Hill Tracts of Bangladesh and examine factors associated with HAZ in both groups., Design: We used nutritional surveillance data collected in Bangladesh from 2003 to 2006 to analyze HAZ among 12,006 children aged 6-23 months and conducted multivariate linear regression and Blinder-Oaxaca decomposition to quantify the relative contribution of independent variables to differences in HAZ between Bengali and tribal children., Results: Mean HAZ was stable for Bengali children (-1.88 in 2003 to -1.90 in 2006) but improved for tribal children (-1.87 in 2003 to -1.68 in 2006). The difference between groups was significant across the study period (p = 0.008). Among Bengali children, HAZ was positively associated with father's schooling (β = 0.221; 95% CI: 0.079-0.363). Among tribal children, HAZ was positively associated with consumption of animal source foods (β = 0.073; 95% CI: 0.051-0.096) and goat ownership (β = 0.240; 95% CI: 0.025-0.454). Results of a likelihood ratio test indicated that distance to a health center was inversely associated with HAZ among tribal children (p < 0.001). Blinder-Oaxaca decomposition demonstrated a difference in pooled coefficients between groups (p = 0.004), explained primarily by differences in coefficients for paternal education (p = 0.001) and village-level prevalence of open defecation (p = 0.004)., Conclusions: Different responses among Bengali and tribal children to village-level open defecation are an explanatory factor for the difference in HAZ between Bengali and tribal populations. Open defecation may also act a proxy for unmeasured factors such as household environmental conditions and food hygiene., Abbreviations: Chittagong Hill Tracts (CHT); height-for-age z-scores (HAZ); Nutrition Surveillance Project (NSP); World Health Organization (WHO).

Background: South Asians (SA) have increased prevalence of type 2 diabetes mellitus (T2DM). The role of nutrient intakes in T2DM in SA is not well understood, however., Objective: The paper reviewed the relationship between macronutrient and micronutrients intakes and T2DM in SA., Methods: The MEDLINE database was searched for relevant papers on this topic in SA., Results: There was some evidence that dietary fiber and linoleic acid intake may reduce but carbohydrates may increase the risk of T2DM. Some studies found higher energy from protein and fat in subjects with T2DM versus controls. Other studies, however, found lower carbohydrate intake among those with T2DM or no relationship between diet composition and T2DM. Several vitamins and minerals were also inversely related to T2DM., Conclusions: The data were limited to a few epidemiological studies. Most studies did not distinguish between undiagnosed and known T2DM. Subjects with known T2DM are more likely to have changed their diet. Prospective cohort or randomized controlled studies examining the role of diet composition, using precise image-assisted dietary assessment method and blood biomarkers, in the development of T2DM among migrant and native SA are needed. Lastly, a more complete nutrient database for foods consumed by SA is needed., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This study investigated associations between cardiovascular health (CVH), adiposity, and food insecurity by race, sex, and health literacy in a sample of 800 underserved patients with obesity (body mass index [BMI] ≥ 30 kg/m 2 ). CVH was assessed using American Heart Association Life's Simple 7 (LS7) and adiposity was estimated using BMI and waist circumference (WC). Mixed models including interaction terms between food insecurity and sex, race, and health literacy were analyzed for LS7, BMI, and WC. Stratified models were analyzed as indicated by significant interactions. Mean BMI and WC were 37.3 kg/m 2 (4.6 SD) and 113.5 cm (12.4 SD), respectively. Among patients, 31% were food insecure and 31% had low health literacy. There were significant positive associations between food insecurity and BMI ( p = 0.03) and WC ( p = 0.03) in the overall sample. In sex-stratified models, women who were food insecure had higher BMI ( p = 0.02) and WC ( p = 0.007) than their food secure counterparts. Further, food insecure patients with better health literacy had greater BMI ( p = 0.004) and WC ( p = 0.007) than their food secure counterparts. Results suggest that adiposity is a greater burden in food insecure patients, which may be an important consideration for obesity treatment in underserved populations.

Objective: To describe the current situation of spermarche/menarche of 13 ethnic minority groups in China in 2014, and analyze the association between spermarche/menarche and nutritional status among ethnic minority groups. Methods: The sample of 13 ethnic minorities (Bai, Hani, Dai, Lisu, Wa, Naxi, Miao, Shui, Buyi, Dong, Zhuang, Yao and Qiang) from Yunnan, Guizhou, Sichuan province and Guangxi Zhuang autonomous region were selected from Chinese National Survey on Students' Constitution and Healthy of 2014. A total of 25 964 students with completed records of height, weight, spermarche and menarche were selected, including 11 276 boys aged 11-18 years old and 14 688 girls aged 9-18 years old. Probit analysis was used to calculate the median age at spermarche or menarche. All subjects were classification into four nutritional status groups (normal, malnutrition, overweight and obesity) according to the Screening standard for malnutrition of school-age children and adolescents (WS/T 456-2014) and the Screening for overweight and obesity among school-age children and adolescent (WS/T 586-2018) of China. Binary logistic regression was used to analyze the association between spermarche, menarche and nutritional status. Results: The median age at spermarche (95 %CI ) of 13 ethnic minorities were ranged from 13.4 (13.1, 13.7) years old to 15.3 (15.1, 15.5) years old. In the 11 -year age group, all ethnic girls experienced menarche. The median age at menarche (95 %CI ) of 13 ethnic minorities were ranged from 12.1 (11.4, 12.7) years old to13.6 (13.4, 13.7) years old. Logistics regression analysis showed that students with malnutrition experienced spermarche or menarche later than normal weight students, the OR (95 %CI ) for boys about 0.49 (0.42, 0.56) and girls about 0.15 (0.12, 0.19), while overweight and obese students entered puberty at earlier age, the OR (95 %CI ) for boys about 1.37(1.10, 1.72) and girls about 3.21(2.51, 4.12). Conclusion: Boys from 13 ethnic minorities began to have spermatorrhea at the age of 13, and girls from 13 ethnic minorities began menstruating at the age of 9 in 2014. Nutrition status was closely related to spermarche and menarche.

In the United States (U.S.), food fortification and/or enrichment and dietary supplement (DS) use impacts nutrient intakes. Our aim was to examine race/ethnicity and income (Poverty Income Ratio, PIR) differences in meeting the Dietary Reference Intakes based on estimated dietary intakes among the U.S. population age ≥2 years ( n = 16,975). Two 24-hour recalls from the National Health and Nutrition Examination Survey (NHANES) cycles 2009-2012 were used to estimate the intake of 15 nutrients as naturally occurring, enriched/fortified, and plus DSs. Across racial/ethnic groups and within PIR categories, significant differences were observed in the %< Estimated Average Requirement (EAR) for vitamin A following enrichment/fortification (E/F) and for vitamin B 12 and riboflavin following both E/F and DS use when comparing non-Hispanic blacks, Hispanics, and the other race/ethnicity group to non-Hispanic whites. The %6 for Hispanics and the other race/ethnicity group than non-Hispanic whites. Non-Hispanic blacks were inadequate in all nutrients examined except vitamin C based on the %

Introduction: We examined diet quality and intake of pregnancy-specific micronutrients among pregnant American Indian women in the Northern Plains., Methods: We conducted an analysis of nutrition data from the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network Safe Passage Study and the PASS Diet Screener study (N = 170). Diet intake, including dietary supplementation, was assessed by using three 24-hour recalls conducted on randomly selected, nonconsecutive days. Diet intake data were averaged across the participant's recalls and scored for 2 dietary indices: the Healthy Eating Index 2010 (HEI-2010) and the Alternate Healthy Eating Index for Pregnancy (AHEI-P). We also assessed nutrient adequacy with Dietary Reference Intakes for pregnancy., Results: On average, participants were aged 26.9 (standard deviation [SD], 5.5) years with a pre-pregnancy body mass index of 29.8 (SD, 7.5) kg/m 2 . Mean AHEI-P and HEI-2010 scores (52.0 [SD, 9.0] and 49.2 [SD, 11.1], respectively) indicated inadequate adherence to dietary recommendations. Micronutrient intake for vitamins D and K, choline, calcium, and potassium were lower than recommended, and sodium intake was higher than recommended., Conclusion: Our findings that pregnant American Indian women are not adhering to dietary recommendations is consistent with studies in other US populations. Identifying opportunities to partner with American Indian communities is necessary to ensure effective and sustainable interventions to promote access to and consumption of foods and beverages that support the adherence to recommended dietary guidelines during pregnancy.

Objectives: The objective of this systematic review was to evaluate the effectiveness of interventions that include a nutrition component aimed at improving gestational weight gain and/or postpartum weight retention., Introduction: Excessive gestational weight gain and postpartum weight retention increase the risk of adverse maternal and neonatal outcomes. Current evidence comprises many interventions targeting gestational weight gain and postpartum weight retention that incorporate a nutrition component. To date, no review has synthesized evidence from pregnancy through the postpartum period or described the intervention approaches in detail., Inclusion Criteria: The review included women (≥18 years) during pregnancy and/or up to 12 months postpartum. Studies were included if they involved a weight management intervention with a nutrition component and had the primary objective of determining the impact of gestational weight gain and/or postpartum weight change. Interventions were compared to usual care (i.e. control conditions with no intervention or wait-list control or standard pregnancy or postpartum care) or "other" (alternative intervention). The review considered randomized controlled trials published between 1980 and January 21, 2016. Studies that included a weight related primary outcome measured during pregnancy and/or postpartum were included., Methods: Seven databases were searched and the reference lists of included studies were searched for additional studies not previously identified. Two independent reviewers assessed the methodological quality of studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI). The JBI SUMARI standardized data extraction tool was used to extract data. A narrative synthesis was undertaken to qualitatively synthesize included studies, with meta-analyses used to pool weight outcome data from studies conducted separately for pregnancy and postpartum. Effect sizes for meta-analyses have been expressed as weighted mean differences (95% confidence intervals)., Results: The search yielded 4063 articles of which 48 articles from 39 studies were included. Eleven of 20 studies during pregnancy reported significant reductions in gestational weight gain with the intervention when compared to control groups. One of five studies where the intervention was conducted during both pregnancy and postpartum reported statistically significant reductions in gestational weight gain, and postpartum weight retention between intervention and control groups. Nine of 14 studies conducted after childbirth reported statistically significant intervention effects, indicating lesser postpartum weight retention. Random effects meta-analyses indicated that despite considerable heterogeneity, interventions conducted during pregnancy (-1.25 kg; 95% CI: -2.10 kg, -0.40 kg; p = 0.004), and postpartum (-3.25 kg; 95% CI: -4.69 kg, -1.82 kg; p < 0.001) were significantly more effective at improving weight outcomes compared to usual care or other interventions. Most studies were of moderate quality due to lack of clarity in describing study details required for appraising methodological quality. Few interventions were conducted from pregnancy through the postpartum period (n = 5). Limited interventions adopted online modalities in intervention delivery (n = 4). Intention-to-treat analysis was used in only 12 studies., Conclusions: The pregnancy and postpartum period presents a unique opportunity to engage women in interventions to help optimize lifestyle behaviors for weight management, however the optimal approach is unclear. Improving consistency in intervention implementation and reporting will improve future evidence synthesis.

Background: In Thailand, despite widespread improvements in child nutrition, stunting is still highly prevalent among northern hill tribe children., Objective: To understand how villagers and health workers (volunteers and officials) gauge health of children younger than 5 years, whether growth monitoring is salient, and the relationships of villagers with the health system in this remote location., Methods: Qualitative research was undertaken with 8 hill tribe villages. A workshop on infant and young child health and nutrition was held with 8 village health volunteers, 2 per village, selected by a public health officer. In-depth interviews were conducted with 20 villagers and 2 volunteers who had children 0 to 5 years. Eight other health workers were also interviewed. All dialogue was conducted in Thai through bilingual facilitators and recorded, transcribed, and translated into English. Transcripts were coded and analyzed thematically within and across participant groups., Results: Overall, villagers considered strength and independence of children to be hallmarks of health; the size of children featured rarely. Volunteers did not perceive local benefits of growth monitoring, and the extent of child malnutrition was unclear to them. Nutrition counseling was seldom mentioned by villagers or health workers. Across all accounts, and considering silences, relationships of villagers with the health system seemed fragile., Conclusion: Villagers understand child health in terms of functional abilities rather than size. Volunteer health workers in this remote location have limited resources and support. Together this helps explain why, against a background of poverty and food insecurity, growth monitoring does not translate to improvements in child nutrition.

Objectives: Malnutrition is a persistent health concern throughout the world. Globally, Indigenous peoples experience poorer health outcomes compared to their non-Indigenous neighbours. Despite this, malnutrition among Indigenous populations is poorly understood. This analysis estimated the prevalence, and modeled possible determinants of, moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) for Indigenous Batwa and non-Indigenous Bakiga of Kanungu District in Southwestern Uganda. We then characterize possible mechanisms driving differences in malnutrition., Methods: Retrospective cross-sectional surveys were administered to 10 Batwa communities and 10 matched Bakiga Local Councils during April of 2014 (n = 1167). Individuals were classified as MAM and SAM based on middle upper-arm circumference (MUAC) for their age-sex strata. Mixed-effects regression models quantified the variation in malnutrition occurrence, considering individual, household, and community-ethnicity level effects. Models controlled for age, sex, number of dependents, education, and relative wealth., Results: Malnutrition is high among Batwa children and adults, with nearly half of Batwa adults (45.34%, 95% CI 34.82 to 55.86 for males; 45.86%, 95% CI 37.39 to 54.33 for females) and nearly a quarter of Batwa children (20.31%, 95% CI 13.07 to 26.93 for males; 25.81%, 95% CI 17.56 to 32.84 for females) meeting MAM criteria. SAM prevalence is lower than MAM prevalence, with SAM highest among adult Batwa males (11.60%, 95% CI 4.83 to 18.37) and adult Batwa females (3.00%, 95% CI 0.10 to 5.90). SAM prevalence among children was higher for Batwa males (7.03%, 95% CI 1.36 to 12.70) compared to Bakiga males (0.57%, 95% CI 0 to 1.69). Models that incorporated community ethnicity explained the greatest variance (>60%) in MUAC values., Conclusion: This research demonstrates a malnutrition inequality between the Indigenous Batwa and non-Indigenous Bakiga of Kanungu District, Uganda, with model results suggesting further investigation into the role of ethnicity as an upstream social determinant of health., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Healthy lifestyle choices, particularly optimal nutrition, are crucial to stroke prevention and reducing risk of recurrent stroke. Racial differences exist in poststroke outcomes; however, few studies have examined the influence of race on poststroke diet or nutrition practices, despite nutrition being critical to stroke recovery. The objective of this analyzes was therefore to examine racial/ ethnic differences in nutrition activities among stroke survivors using data from the National Health and Nutrition Examination Surveys., Methods: Cross-sectional data from National Health and Nutrition Examination Surveys (2011-2014) were analyzed for adults (n = 431) who responded "yes" that they had been told by a health professional that they had a stroke. The main outcome measure was food consumption/nutrition behavior. Descriptive statistics were conducted for demographic characteristics. Pearson Chi square statistics were performed for baseline demographic and clinical comparisons. A negative binomial regression analysis was utilized for racial/ethnic comparisons of dietary/nutrition behaviors., Results: The mean age of the sample was 66.6 years (Standard Deviation, 12.7) but the mean age of stroke onset was 57.9 years (Standard Deviation, 15.8), with Mexican American/Hispanics experiencing their strokes at a younger age than other racial groups (P < .007). After controlling for baseline differences in key demographic and clinical covariates variables, Blacks consumed a higher number of ready-to-eat foods (P = .000) in the past 30 days while Mexican American/Hispanics consumed a higher number of frozen meals/pizza in the past 30 days (P = .004)., Conclusions: Racial/ethnic differences in poststroke nutrition practices, highlight a potential need for focused nutrition counseling for minority population at higher risk of poor poststroke outcomes., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Undernutrition is associated with maternal morbidity and poor pregnancy outcomes. This qualitative study seeks to understand the multilevel factors influencing maternal dietary practices in Niger, including the impact of pregnancy illnesses on diet. Criterion-based, purposive sampling was used to select pregnant women and household members from 24 villages in a rural district of the Maradi Region in south-central Niger. Semistructured interviews (n = 153) and focus group discussions (n = 38) explored 4 primary themes: (a) perceptions of ideal diet during pregnancy, (b) barriers to consuming the ideal diet, (c) coping strategies including dietary responses related to pregnancy illnesses, and (d) changes in perceptions from early to late pregnancy. Longitudinal data collection allowed for repeated interviews of pregnant women to document changes in dietary practices throughout pregnancy. Transcripts were coded using an inductive approach informed by grounded theory methodology. Participants categorized foods into 4 primary dietary taxonomies when discussing ideal maternal diets but cited constraints related to accessibility and availability impeding routine consumption of these foods. Perceptions of "modern," urban foods as healthy, coupled with key structural barriers such as food costs, were identified. Maternal morbidity influenced food consumption, as women reported reducing food intake early in pregnancy in response to illness episodes. Although awareness of optimal foods for supporting healthy pregnancies was moderately high, some misconceptions were observed and multilevel barriers to food security restricted opportunities for consuming these foods. Nutrition-specific and nutrition-sensitive interventions could improve access and availability of acceptable foods for supporting increased dietary intake during pregnancy., (© 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.)

Lack of variability in dietary intake within a population makes identification of relationships between diet and disease difficult. Studies in populations with greater interindividual variation can provide important insights. The Puerto Rican diet is in transition from a traditional to a more Western-type diet, resulting in greater interindividual variability. We identified foods contributing to absolute intake and variability in the intake of macronutrients among Puerto Rican women. One hundred women, aged 30⁻79, residents of San Juan, Puerto Rico, completed three, interviewer-administered, 24-h dietary recalls from which foods contributing to absolute intake and intake variability in intake of energy, fat, protein, carbohydrate and dietary fiber were determined. The overall prevalence of intake of foods was also calculated. Traditional Puerto Rican foods such as legumes, rice, and plantains were important contributors to the intake of calories and macronutrients as were foods more typical of Western diets including white bread and sweetened carbonated beverages. Identification of food sources of nutrients for this population with a diet in transition can contribute to the development of instruments to measure dietary intake and to understand the contribution of diet to the etiology of chronic disease among Puerto Rican women.

Background: Nutrition imbalance is common in chronic kidney disease (CKD) children. This study evaluated the nutrition status of CKD children at different stages using bioimpedance analysis (BIA) compared with anthropometry., Methods: Fifty-five CKD children at stages III, IV, V and 19 age- and sex-matched healthy controls were recruited. Fat, protein and mineral composition on BIA were analyzed together with anthropometry for height, weight and body mass index (BMI). Biochemistry was also checked in CKD children., Results: Of the CKD children, 23.6%, 10.9% and 56.3% were underweight, overweight/obese and stunted, respectively. On BIA, 52.7%, 70.9%, 14.5% and 40.0% of the CKD children had protein reduction, fat reduction, fat enhancement and mineral reduction, respectively. Growth retardation and nutrition reduction became remarkable at stages IV and V. Approximately 65% of healthy-weight children had nutrition reduction. In the underweight and healthy-weight groups, fat reduction rates were higher than protein reduction rate. In the overweight/obese group, fat enhancement was most notable. Mineral reduction was less remarkable., Conclusions: The nutrition imbalance in CKD children on BIA correlated well with anthropometry and disease process, supporting BIA as an auxiliary diagnosis tool., (© 2018 Japan Pediatric Society.)

Background: Food supply to poor populations is a big challenge, particularly in periods of economic stress and in an era of chronic diseases epidemics. In Israel more than 4000 poor families are currently receiving food support. Many of the food support products given to the family have low nutrient values, therefore not appropriately ensuring food security of the population. The aim of the current study was to examine for the first time the demographic, nutritional and chronic diseases profiles of food support beneficiaries, so as to aid in planning future food support components in Israel. In addition, the study examined associations between levels of food insecurity status and selected morbidities among food support recipients., Methods: In 2016, 3000 families (classified as very poor) in 24 municipalities received food support in Israel from the "National Food Security Project" (NFSP), under the guidance of the National Food Security Council. The 400 new families who joined the program in 2016 were requested to complete a questionnaire regarding the demographic and health characteristics of their families. Three hundred sixty-two of them completed the questionnaire for a response rate of 90%. The current study includes these families only., Results: The disposable income per capita of the surveyed families was very low - less than NIS 1100 a month ($280). About half the families were working families and 40% of them were in debt. Of the 362 responding families, about 82% of them were food insecure, with more than half severely food-insecure; this, despite receiving food support. About one-third of the families had at least one member with anemia, and a quarter of the families had a member with hyperlipidemia. Hypertension is present in about 22% of the families, diabetes in 17%, and there is a 12% incidence of at least one family member with heart disease. These rates are markedly higher than those in the general population. Higher levels of food insecurity were associated with higher levels of hyperlipidemia, heart disease and hypertension., Discussion and Conclusions: The nutrition and medical status of the population receiving food support is much worse than in the general population. There is a need to improve the nutritional value of food support; this could include greater emphasis on whole grains, fruits and vegetables. There is also a need for a nationwide education program to focus on healthy nutrition and to subsidize healthy foods. Many health and nutrition promotion models show that in order to effect changes in dietary habits and behaviors related to improving nutrition, there is a need for nutrition education (Kamp et al., J Nutr Educ Behav 42:72-82, 2010).

Dietary and physical activity behaviours during preconception and in pregnancy are important determinants of maternal and child health. This review synthesised the available evidence on dietary and physical activity behaviours in pregnant women and women of childbearing age women who have migrated from African countries to live in high income countries. Searches were conducted on Medline, Embase, PsycInfo, Pubmed, CINAHL, Scopus, Proquest, Web of Science, and the Cochrane library. Searches were restricted to studies conducted in high income countries and published in English. Data extraction and quality assessment were carried out in duplicate. Findings were synthesised using a framework approach, which included both a priori and emergent themes. Fourteen studies were identified; ten quantitative and four qualitative. Four studies included pregnant women. Data on nutrient intakes included macro- and micro-nutrients; and were suggestive of inadequacies in iron, folate, and calcium; and excessive sodium intakes. Dietary patterns were bicultural, including both Westernised and African dietary practices. Findings on physical activity behaviours were conflicting. Dietary and physical activity behaviours were influenced by post-migration environments, culture, religion, and food or physical activity-related beliefs and perceptions. Further studies are required to understand the influence of sociodemographic and other migration-related factors on behaviour changes after migration., Competing Interests: The authors declare no conflicts of interest.

Objectives: To investigate the association between domains of nutrition risk with hospitalisations and mortality for New Zealand Māori and non-Māori in advanced age., Methods: Within LiLACS NZ, 256 Māori and 399 non-Māori octogenarians were assessed for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II) questionnaire according to three domains of risk. Sociodemographic and health characteristics were established. Five years from inception, survival analyses examined associations between nutrition risk from the three domains of SCREEN II with all-cause hospital admissions and mortality., Results: For Māori but not non-Māori, lower nutrition risk in the Dietary Intake domain was associated with reduced hospitalisations and mortality (Hazard Ratios [HR] [95%CI] 0.97 [0.95-0.99], p=0.009 and 0.91 [0.86-0.98], p=0.005, respectively). The 'Factors Affecting Intake' domain was associated with mortality (HR, [95%CI] 0.94 [0.89-1.00], p=0.048), adjusted for age, gender, socioeconomic deprivation, education, previous hospital admissions, comorbidities and activities of daily living., Conclusion: Improved dietary adequacy may reduce poor outcomes for older Māori. Implications for public health: Nutrition risk among older Māori is identifiable and treatable. Effort is needed to engage relevant community and whānau (family) support to ensure older Māori have food security and cultural food practices are met., (© 2018 The Authors.)

Background: Little is reported about the nutrition-related needs and preferences of women seeking maternity services, particularly Maori and Pasifika (M&P) women who have higher chronic disease rates in Queensland., Aim: Nutrition-related knowledge, needs, behaviours and education preferences were compared between women of M&P ancestry and non-Maori and Pasifika women (NMP)., Method: Women (≥18 years) admitted to the postnatal ward were surveyed. Anthropometry, dietary quality, nutrition education preferences, country of birth and ancestry were collected. Analysis included chi-squared and t-tests., Findings: The survey was completed by 399 eligible women. Country of birth data suggested 4% of respondents were Pasifika and failed to separately identify New Zealand Maori, whereas 18% of respondents (n=73) reported M&P ancestry. Descriptors were similar between groups (28±5 years; 91% any breastfeeding; 18% gestational diabetes mellitus; p>0.05). However M&P women were less often university educated (M&P:6(9%); NMP:71(22%), p<0.01) and more likely had >2 children (M&P: 30(54%); NMP:70(30%), p<0.01). M&P women reported heavier weight at conception (M&P:79.0±20.2kg, 29.2±7.5kg/m 2 ; NMP:71.3±18.9kg, 26.3±6.5kg/m 2 , p<0.01), and were more likely to report excess gestational weight gain (M&P:30(56%), NMP:96(36%), p<0.05). Most (>75%) women did not know their recommended weight gain. Many respondents reported inadequate intake of vegetables (95%), fruit (29%) and dairy (69%) during pregnancy. Two-fifths (38-41%) reported interest in perinatal nutrition education, with topics including healthy eating postpartum., Discussion: Findings enable targeted service delivery according to women's preferences., Conclusion: Collecting ancestral and maternal data to facilitate the provision of appropriate nutrition education may be critical for achieving optimal maternal outcomes in Maori and Pasifika women., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

This study evaluated the impact of a 6-month school nutrition intervention on changes in dietary knowledge, attitude, behavior (KAB) and nutritional status of Syrian refugee children. A quasi-experimental design was followed; Syrian refuge children in grades 4 to 6 were recruited from three informal primary schools (two intervention and one control) located in the rural Bekaa region of Lebanon. The intervention consisted of two main components: classroom-based education sessions and provision of locally-prepared healthy snacks. Data on household socio-demographic characteristics, KAB, anthropometric measures and dietary intake of children were collected by trained field workers at baseline and post-intervention. Of the 296 school children enrolled, 203 (68.6%) completed post-intervention measures. Significant increases in dietary knowledge (β = 1.22, 95% CI: 0.54, 1.89), attitude (β = 0.69, 95% CI: 0.08, 1.30), and body mass index-for-age-z-scores (β = 0.25, 95% CI = 0.10, 0.41) were observed among intervention vs. control groups, adjusting for covariates ( p < 0.05). Compared to the control, the intervention group had, on average, significantly larger increases in daily intakes of total energy, dietary fiber, protein, saturated fat, and several key micronutrients, p < 0.05. Findings suggest a positive impact of this school-based nutrition intervention on dietary knowledge, attitude, and nutritional status of Syrian refugee children. Further studies are needed to test the feasibility and long-term impact of scaling-up such interventions.

High dietary salt intake is associated with increased blood pressure (BP) and cardiovascular disease (CVD) risk. The migration of Somalis from East Africa to Norway may have altered their dietary habits, making them vulnerable to adverse health outcomes. Since little is known about the lifestyle and health status of this population, the purpose of our study was to estimate salt intake in Somali adults in Oslo, Norway. In this cross-sectional study, we included 161 Somali adults (76 men, 86 women) from the Sagene borough in Oslo, Norway. Sodium and potassium excretion was assessed through the collection of 24-hour urine. Creatinine-based exclusions were made to ensure completeness of urine collections. Sodium excretion corresponding to an estimated dietary salt intake of 8.66 ± 3.33 g/24 h was found in men and 7.39 ± 3.64 g/24 h in women ( p = 0.013). An estimated 72% of participants consumed >5 g salt/day. The Na:K ratio was 2.5 ± 1.2 in men and 2.4 ± 1.1 in women ( p = 0.665). In conclusion, estimated salt intake was, while above the WHO recommendation, within the lower range of estimated salt intakes globally and in Western Europe. Further research is required to assess the health benefits of sodium reduction in this Somali immigrant population.

Proper nutrition early in life can influence children&rsquo;s present and future health. While several authoritative sources provide eating/food recommendations, only a few studies have assessed whether these recommendations are followed. The goal of this paper was to examine food and nutrient intakes on any given day during infancy and early childhood among various ethnicities. Twenty-four-hour dietary recall data of 0⁻5 years-old children ( n = 2431) from the National Health and Nutrition Examination Survey (NHANES) 2011⁻2014 was used to estimate intakes of nutrients and food groups and prevalence of inadequate intake. Data was analyzed separately for various age groups and ethnicities, and differences in means by age and or race/ethnicity were determined by t -tests with p < 0.05 as significant. The results indicate that intakes of all food groups were expectedly low at 0⁻11 months, increased with age, and were influenced by race/ethnicity. Mixed dish consumption, which also increased with age, made substantial contributions to children&rsquo;s food group intakes. However, there was a substantial percentage of the population among all age and race/ethnic groups who did not consume the recommended amounts for each food group and had inadequate intakes of key nutrients, such as calcium, vitamin D, and vitamin E. Non-Hispanic black children consumed less dairy and more protein foods, and a significantly greater proportion of these children had inadequate intakes of calcium and vitamin D compared to their peers. In conclusion, the results from this study suggest that a substantial population of American infants and children from 0 to five years of age did not meet food group recommendations and had inadequate intakes of key nutrients such as calcium, vitamin D, and vitamin E from foods.

To describe the nutritional status and the environmental and health conditions of the Pataxó children from five villages of Minas Gerais State, Brazil. Among the under 10 years old, weight and height/length were classified according to the growth references of World Health Organization. Questionnaires evaluating environmental conditions of the households and health conditions of under 5 years old were based in the First National Survey of Indigenous People's Health and Nutrition. Among the 70 children evaluated (93.3%), 34 were under 5 years old. Nutritional deficits were not observed and overweight was registered for 11.4% of the children. Most of the children (74.3%) lived in households with electric energy, 95% in households with toilets and 52.9% in households that threw waste in septic tanks. Six or more antenatal appointments were reported by 82.4% of the mothers of the under five years old and 91.2% started the antenatal appointments within the first trimester of pregnancy. Among the causes of hospitalizations in the previous 12 months (23.5%), only one was due to diarrhea and none to respiratory infection. Universal coverage was observed for the majority of the vaccines. The absence of nutritional deficits among the Pataxó children may be associated to better housing and sanitation conditions and coverage of basic childhood health actions when compared to the conditions reported by the First National Survey of Indigenous People's Health and Nutrition and related studies with other specific indigenous peoples. The current study aims to back discussions and measures to improve the nutritional status of indigenous children in Brazil.

Background: Understanding the context of infant and young child feeding (IYCF) is recognized as essential for designing appropriate complementary feeding interventions., Objective: Our objective was to study household IYCF behaviors in 2 districts in southern and northern Ghana to identify opportunities to improve existing nutrition programs., Methods: We interviewed 80 caregivers of children aged 6 to 23 months using ethnographic methods, including free listing, guided discussions and cognitive mapping techniques, and 24-hour dietary recall. Descriptive statistics and thematic content analysis were used to analyze quantitative and qualitative data., Results: In both settings, children's diets were predominantly maize based. Fish, the main animal source food, was consumed daily but in very small quantities. Milk was consumed by only a few children, in tea and porridge. Fruits were seldom consumed. Household food production did not meet requirements, and the markets were heavily relied on for staples and other key ingredients. Most caregivers demonstrated basic knowledge and understanding of key health and nutrition concepts. Barriers to optimal child feeding identified were lack of money to purchase the nutritious foods recommended for children, seasonal food insecurity, and some caregiver beliefs, practices, and nutrition knowledge gaps. Positive contextual features include caregiver recognition of the dietary needs of young children and commitment to provide foods to meet these needs., Conclusion: Our findings suggest that complementary feeding in these rural settings can be improved through reinforcement or modification of strategic components of local health and nutrition education in light of existing barriers and enablers to optimal IYCF.