Prevalence of double burden on malnutrition at household level in four Latin America countries / Prevalência de dupla carga de má nutrição em nível domiciliar em quatro países da América Latina

Abstract Objectives: to estimate the prevalence of maternal overweight and short stature in children at household level in Brazil, Bolivia, Colombia and Peru. Methods: a cross-sectional descriptive study. Population-based studies on children (0-5 years old) and women (15 to 49 years old) who participated in the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher(National Survey on Children and Women Demography and Health) in Brazil and the Encuesta Nacional de Demografía y Salud, (National Survey on Demography and Health), in Bolivia, Colombia and Peru. Variables of interest: overweight mother and child with short stature, a double burden when both outcomes are present. Global prevalence and stratification, according to rural and urban areas and 95% confidence intervals, were estimated. Results: the global sample consisted of 26,506 households. The prevalence of double burden was 9.3% in Bolivia (CI95%= 8.3-10.4), 6.7% in Peru (CI95%=5.9-7.5), Colombia (3.2%; CI95%=2.8-3.6) and Brazil (2.2%; CI95%=1.4-3.2). The highest prevalence were observed in the rural areas in Bolivia (13% vs 6.5%; p<0.001) and Peru (11.9% vs 4.1%; p<0.001). Conclusions: the highest prevalence were registered in Peru and Bolivia, and the lowest in Brazil and Colombia.

Resumo Objetivos: estimar a prevalência de excesso de peso materno e baixa estatura infantil em nível domiciliar no Brasil, Bolívia, Colômbia e Peru. Métodos: estudo descritivo transversal. Utilizou-se estudos de base populacional de crianças (0-5 anos) e mulheres (15 a 49 anos) que participaram da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher, no Brasil, e da Encuesta Nacional de Demografía y Salud, na Bolívia, Colômbia e Peru. Variáveis de interesse: mãe com excesso de peso e filho com baixa estatura, sendo dupla carga quando presentes ambos os desfechos. Foi estimada a prevalência global e estratificada por área rural e urbana e os intervalos de confiança de 95%. Resultados: a amostra global foi composta de 26.506 domicílios. As prevalências de dupla carga foram na Bolívia 9,3% (IC95%= 8,3 - 10,4), no Peru 6,7% (IC95%= 5,9 - 7,5), Colômbia (3,2%; IC95%= 2,8 - 3,6) e Brasil (2,2%; IC95%= 1,4 - 3,2). As maiores prevalências foram mostradas nas áreas rurais da Bolívia (13% vs 6,5%; p < 0,001) e do Peru (11,9% vs 4,1%; p < 0,001). Conclusões: as mais altas prevalências foram registradas no Peru e Bolívia, e as menores no Brasil e Colômbia.

Malnutrición infantil en Cochabamba, Bolivia: la doble carga entre la desnutrición y obesidad / Infant Malnutrition in Cochabamba, Bolivia: the double burden between underweight and obesity

La presencia concomitante de talla baja y obesidad, conocida como la doble carga de la malnutrición infantil, es observada con mayor frecuencia en países de bajos y medios ingresos económicos como el nuestro. OBJETIVO: analizar la prevalencia de la desnutrición y obesidad infantil en Cochabamba, Bolivia. MÉTODOS: se realizó un estudio observacional de corte transversal, con una muestra de n=4885 niños menores de 5 años, estratificada para las 5 macrorregiones de Cochabamba, aplicando el Sistema de Vigilancia Nutricional Comunitario. Las mediciones antropométricas se ingresaron al Software WHO-Anthro v3.1.0, para el cálculo de Z-score y su categorización. Se presentan proporciones e IC-95%; Chi2 para la asociación entre variables categóricas, correlación de Pearson para la interacción entre variables cuantitativas y regresión logística multivariada para el cálculo de Odds Ratio (OR) ajustados. RESULTADOS: encontramos una prevalencia de 22,1% para DNT-Crónica; 6,0% para DNT-Global; 6,1% para DNT-Aguda; 16,4% de probable retraso de crecimiento del perímetro cefálico y 10,8% con reserva energética inadecuada. La prevalencia de sobrepeso y obesidad fue del 16,5% para el indicador peso/talla; 17,6% según el IMC/edad y 10,8% para el PMB/Edad. El 66,03% de los niños con talla baja presentaban sobrepeso u obesidad. La prevalencia de desnutrición y obesidad fue mayor en la región andina, el grupo etario más afectado por la obesidad fueron los niños de 1 a 3 años. CONCLUSIÓN: existe una asociación estadísticamente significativa entre la talla baja y la presencia de obesidad; esta doble carga de malnutrición infantil fue más prevalente en la región andina.

A concomitant presence of chronically malnourished (stunted) and obesity, is known as the double burden of childhood malnutrition, is observed more frequently in low and middle-income countries. OBJECTIVE: to analyze the prevalence of underweight and childhood obesity in Cochabamba, Bolivia. METHODS: a cross-sectional study was conducted, with a sample of n=4885 children under 5 years, stratified for the 5 macro regions from Cochabamba, applying the Community Nutritional Surveillance System. The anthropometric measurements were entered into the WHO-Anthro Software v3.1.0, to calculate the Z-score and its nutritional status categorization. Proportions and IC-95% are presented; Chi2 to associations between categorical variables, Pearson correlation for the interaction between quantitative variables, and multivariate logistic regression for adjusted Odds Ratio (OR). RESULTS: we found a prevalence of 22,1% for estunted; 6,0% for global underweight; 6,1% for acute underweight; 16,4% probable delay of growth of the cephalic perimeter and 10,8% with inadequate energy reserve. The prevalence of overweight and obesity was 16,5% for the weight/height indicator; 17,6% according to the BMI/age and 10.8% for the MUAC/age. 66,03% of stunted children were overweight or obese. The prevalence of underweight and obesity was higher in the Andean region, the age group most affected by obesity were children from 1 to 3 years. CONCLUSION: there is a statistically significant association between stunted and obesity; this double burden of child malnutrition was more prevalent in the Andean region.

Levels of childhood nutritional status among the Muslims of char areas in Barpeta district, Assam

Background: The chars depend mostly on the whims of the current of river. The location, delicate ecological conditions and the political situation arising out of the ill- defined problem of immigration have collectively made the chars of Barpeta a challenging place to live. The worst sufferers are the children before entering adolescence period. This study aims to assess the level of nutritional status among the pre-adolescent children.Methods: 466 children (250 boys and 216 girls) from age 3 to10 years were measured cross-sectionally for their height and weight. Sample was collected from Chasra No. 2 char which fall under Baghbor revenue circle of the district. Using Z-score value, the underweight, wasting and stunting status was evaluated.Results: It has been detected that 39.2% boys and 18.98% girls are underweight. The percentage of stunted among them is 16% for the boys and 12.96% for the girls. With the increase of age the prevalence of stunting has decreased. BMI-for -age has detected 24% boys and 24.53% girls to be affected. When the children of the present study were compared with other populations, they were below the tribal children but above other children in their nutritional status.Conclusions: The prevalence of stunting is lesser than underweight percentage, reflecting their current nutritional status to be more affected than the long term exposure to undernutrition. The prevalence of underweight and stunting is higher among the boys than the girls. Further analytic studies are required to identify the underlying causes of their status.

Síndrome Rusell Silver. Presentación de caso / Russell-Silver syndrome. Presentation of a case

RESUMEN El síndrome Russell Silver es una enfermedad genética de baja frecuencia, caracterizada por retardo del crecimiento prenatal y postnatal, dismorfias faciales y digitales, así como asimetría corporal. Se presenta una paciente femenina de dos años de edad, remitida a consulta de Genética Clínica, por retardo en el desarrollo pondoestatural psicomotor, dismorfias faciales y asimetría corporal. Se realizño el diagnóstico clínico de esta afección. Es importante establecer un diagnóstico precoz para la estimulación temprana, seguimiento multidisciplinario y se brindó un adecuado asesoramiento genético a los familiares (AU).

ABSTRACT The Russell-Silver syndrome is a low-frequency genetic disease, characterized by a pre-natal growth retardation and postnatal digital and facial dysmorphia, and also body asymmetry. We present a female patient, aged 2 years, who was remitted to the consultation of Clinical Genetics because of a retardation in the psychomotor, height-weight development, facial dysmorphia and body asymmetry. The disease was clinically diagnosed. It is important to arrive to a precocious diagnosis for the early stimulation, multidisciplinary follow-up and adequate genetic advice to the relatives (AU).

An Update on Gut Microbiota and Infant's Health

Childhood malnutrition is a global problem and one of the leading cause of stunted growth, and responsible for the death of millions of children every year. Although extensive efforts have been made to promote healthy growth but results are not satisfactory and infant's health remains a challenge. Previously, it was demonstrated that undernourished children have disrupted normal pattern of intestinal microbiota and led to a proposal that it might be involved in impaired postnatal growth. Recently, various research groups focused on Malawian population and proved the role of intestinal microbiota in the stunted growth of children. In addition, one group showed the role of sialylated bovine milk oligosaccharides in promoting microbiota-dependent growth in malnourished children. Moreover, it was also revealed that Clostridium symbiosum and Ruminococcus gnavus might be used as therapeutic agent for ameliorating growth abnormalities in malnourished children. The current article summarizes the recent advancement in identifying interventions regarding health promotion of malnourished children.

Clinical Profile of Children with Celiac Disease in Gujarat.

Introduction : Celiac Disease (CD), an autoimmune enteropathy, triggered by the ingestion of gluten in genetically susceptible individuals, is one of the commonest causes of malabsorption in the west. It is now well documented from north India where wheat is the staple diet. We report here 22 children of CD from Gujarat to bring the awareness amongst the pediatricians for its early diagnosis. The clinical presentation, serological tests & duodenal biopsy confirms the diagnosis. The results of Gluten Free Diet (GFD) are quite gratifying. Methodology : Retrospective analysis of presentation of children diagnosed to have CD was done from maintained database of CD patients of last 5 years. Results : Twenty two children were diagnosed to have CD at our centre in last 5 years. The age of presentation was from 14 months to 11 years. Short stature, pallor & chronic diarrhoea were the commonest features. Distention of abdomen, anorexia, pain in abdomen & oedema were other manifestations. Vomiting, voracious appetite, irritability & dermatitis were also noted in some cases. Rickets, rectal prolapse & clubbing were less common findings. Serological tests, besides routine investigations & duodenal biopsy confirmed the diagnosis. Gluten Free Diet (GFD) showed impressive results in 3 to 6 months time. Conclusion : CD is well documented in north India, but it also exists in Gujarat. With clinical presentation of stunted growth, chronic diarrhoea & unexplainable anaemia, one should think of CD. Some other less common & atypical features should also be kept in mind. The results of serological tests for CD are fairly reliable. Still, it is mandatory to confirm the diagnosis by duodenal biopsy. The results of GFD are quite rewarding. To emphasize for compliance of GFD & to provide the list of GFD to the parent & regular follow up are essential components of management.

Nutritional status of children attending OPD at tertiary care hospital in Katihar, Bihar.

Background: Despite India’s remarkable economic growth over the last decade, many children still struggle to meet their basic needs, include access to sufficient food and health care .In this context it was important to get a more recent data on child nutritional status. Aims & Objective: (1) Prevalence of malnutrition in children under 5 years of age coming to Pediatric OPD at Katihar medical college; (2) Age and sex most severely affected by malnutrition; (3) Identify major risk factors associated with malnutrition in the population under study. Material and Methods: Institution based cross-sectional study was carried out in Pediatric OPD of Katihar medical college The median weight for height, height for age and weight for height of NCHS standard were used as references anthropometric indices. A total of 260 randomly selected children were covered in the study of 20 days. Results: Prevalence of underweight (30%), stunted (74.2%) and wasting (41.9%). The major risk factors affecting nutritional status include mother’s age, mothers and fathers education, monthly per capita income, pre lacteal feeds, birth order and duration of breast feeding. The study demonstrates multiple risk factors affecting nutrition status. Conclusion: The study demonstrates multiple risk factors affecting nutrition status. A more elaborate community based study would help to find out prevalence of malnutrition in children of Katihar and it should be done at regular interval in order to monitor the situation.

Nutritional Status of Malaysian Primary School Children Aged 8-10 Years: Findings from the 2008 National IDD Survey

Introduction: Child malnutrition continues to be a major public health problem in developing countries. This study aims to determine the current nutritional status of Malaysian school children using the anthropometric indicators of weight for age (WAZ), height for age (HAZ), and body mass index for age (BAZ). Methods: A nationwide school-based survey was undertaken in all Malaysian states and territories, which included 18,078 children aged 8-10 years attending 445 primary schools. The software WHO AnthroPlus was used to calculate zscores for the nutritional status (WAZ, HAZ and BAZ) of the target population relative to the World Health Organization (WHO) 2007 reference. Results: The national prevalence of underweight among school children was 13.6% and in rural areas, this rate was nearly double that of urban areas. The national prevalence rate for stunting was 10.9%, double among rural school children compared to their urban counterparts. As for thinness, the national prevalence was 6.5%. Using the WAZ indicator, we found that the national prevalence of overweight children was 7.6%. Additionally, we found that urban areas showed a higher prevalence of overweight children (8.8%) than rural areas (5.9%). Conclusion: The findings of this study indicate that Malaysian school children face the burden of malnutrition, suffering from both undernourishment and overweight. Malaysia must make a concerted effort to overcome the problems of malnutrition among children.

Alguns fatores associados a excesso de peso, baixa estatura e déficit de peso em menores de 5 anos / Some risk factors associated with overweight, stunting and wasting among children under 5 years old

OBJETIVO: Examinar fatores socioeconômicos e outras condições de vida familiar associadas a excesso de peso, baixa estatura e baixo peso para a estatura em menores de 5 anos. MÉTODOS: Estudo transversal avaliou 3.957 crianças entre 1 mês e 5 anos de idade durante campanha nacional de imunização no município de São Leopoldo (RS) em 2002. As condições socioeconômicas e de saneamento das áreas de abrangência das unidades de saúde foram agrupadas por análise de cluster dos setores do censo populacional de 2001. RESULTADOS: Déficit de peso para estatura ocorreu em 2,6 por cento das crianças, baixa estatura em 9,1 por cento e excesso de peso em 9,8 por cento. A regressão logística multivariada sugere que os fatores associados à chance de excesso de peso foram: área de condições socioeconômicas alta (RC = 1,47; IC95 por cento 1,09-1,96), filhos únicos (RC = 1,44; IC95 por cento 1,00-2,07) e peso ao nascer ≥ 2.500 g (RC = 2,21; IC95 por cento1,27-3,83). A chance de déficit de peso associou-se ao baixo peso ao nascer (RC = 3,46; IC95 por cento 2,06-5,80) e idade da mãe < 20 anos (RC = 1,99; IC95 por cento 1,09-3,62). A baixa estatura associou-se à área de condições socioeconômicas baixas (RC = 2,36; IC95 por cento 1,51-3,69), três ou mais irmãos (RC = 3,12; IC95 por cento 2,18-4,47), peso ao nascer < 2.500 g (RC = 3,49; IC95 por cento 2,53-4,80), idade < 36 meses (RC = 1,77; IC95 por cento 1,37-2,29) e idade materna < 20 anos (RC = 1,60; IC95 por cento1,09-2,35). CONCLUSÕES: Excesso de peso e baixa estatura foram os principais desvios antropométricos observados neste estudo, constituindo prioridades que devem ser consideradas nas políticas públicas atuais.

OBJECTIVE: To explore whether socioeconomic and sanitary conditions, maternal and child factors are associated with overweight, stunting, and wasting in children under five year old in the city of São Leopoldo, southern Brazil. METHODS: Cross-sectional study of 3,957 children aged 1 month to 5 years conducted in all primary care services of the city during the National Children's Vaccination Day in 2002. Maternal and child factors were assessed by a questionnaire. Children's height and weight were measured. Cluster analysis was used to group the areas served by the primary care services according to socioeconomic and sanitary conditions of the census tracts assessed by the 2001 National Census. RESULTS: Wasting was observed in 2.6 percent of children, stunting in 9.1 percent and overweight in 9.8 percent. The multivariable logistic regression model suggests that overweight was associated with higher socioeconomic status and better sanitation of the area (OR = 1.47; 95 percentCI 1.09-1.96), single child (OR = 1.44; 95 percentCI 1.00-2.07) and birth weight ≥ 2,500 g (OR = 2.21; 95 percentCI 1.27-3.83). Wasting was associated with low birth weight (OR = 3.46; 95 percentCI 2.06-5.80) and mother's age < 20 years (OR = 1.99; 95 percentCI 1.09-3.62). Stunting was associated with low socioeconomic status and poor sanitation of the area (OR = 2.36; 95 percentCI 1.51-3.69), three or more siblings (OR = 3.12; 95 percentCI 2.18-4.47), low birth weight < 2,500 g (OR = 3.49; 95 percentCI 2.53-4.80), child age < 36 months (OR = 1.77; 95 percentCI 1.37-2.29) and mother's age < 20 years (OR = 1.60; 95 percentCI 1.09-2.35). CONCLUSIONS: Overweight and stunting were the major anthropometric problems and therefore should be a priority for public policies.