Child undernutrition in Brazil: the wound that never healed

Abstract Objective To describe the scenario of child undernutrition in Brazil and its determinants. Data source Narrative review of the literature with inclusion of data from population surveys, surveillance and monitoring systems, and active search in favelas and underserved communities carried out by CREN. Data synthesis Household surveys carried out from 1974 to 2019 indicate that undernutrition (<5 years) decreased until 2006. Underweight (W/A ≤-2 Z) and stunting (H/A ≤-2 Z) showed a decrease of 17% to 3% and 37% to 7%, respectively. After 2006, there was an increase in underweight of 53% and 76% for wasting (BMI/A ≤-2 Z), with the prevalence of stunting being stagnant at around 7%. Active search data in favelas and underserved communities show that the prevalence of stunting is 11% in those <5 years. In 2021, 30% of the population lived in poverty, 73% of which were black or brown. Stunting in black and brown children <5 years old is, respectively, 9% and 12% higher when compared to white children. Poverty decreased between 2012 and 2015 (27 to 25%), but increased again (2016=26% to 2021=30%), in parallel with food insecurity, which decreased between 2004 and 2013 (12% to 6%), but reached its worst level in the historical series (2022:15%). Conclusion Despite advances, Brazil's social protection system was not able to reduce inequalities and the reversal of the trend towards decreasing child undernutrition could be observed from 2006 onwards.

Conmemorando los cincuenta años de Leche Purita: importancia de la leche en la erradicación de la desnutrición infantil en Chile

La desnutrición ocurre cuando hay una ingesta o asimilación deficiente de la energía y los nutrientes. Si esta se produce dentro de los primeros años de vida, las consecuencias para la salud son devastadoras. El tratamiento temprano de la desnutrición es clave para reducir estas consecuencias y en este proceso la leche tiene una participación destacada. La leche es un excelente alimento debido al contenido y calidad de sus macro- y micronutrientes, lo que ha llevado a que la investigación y el uso de la leche en el tratamiento de la desnutrición hayan aumentado sostenidamente desde comienzos del siglo XX. En Chile, la desnutrición infantil fue prácticamente erradicada entre los años 1960 y 1980 debido a la aplicación exitosa de una serie de políticas públicas materno-infantiles, dentro de las cuales la Leche Purita fue fundamental. Sin embargo, la historia de la leche como parte de las políticas nutricionales en Chile comenzó mucho antes. Conmemorando los cincuenta años desde el nacimiento de Leche Purita, el objetivo de este trabajo es realizar un breve repaso acerca de la importancia histórica de la leche en las políticas nutricionales en Chile, enfatizando la contribución realizada por la Leche Purita a la erradicación de la desnutrición infantil y a la disminución de la anemia en niños.

Undernutrition occurs when there is poor intake or assimilation of energy and nutrients. If undernutrition is established within the first years of life, the health consequences are devastating. Early treatment of undernutrition is critical to reduce these consequences and milk plays an important role in this treatment. Cow's milk is an excellent food due to the content and quality of its macro- and micronutrients. This has led to a steady increase in research and the use of milk in treating undernutrition since the beginning of the 20th century. In Chile, child undernutrition was practically eradicated between the decades of 1960 and 1980 due to the successful application of maternal and child public policies, within which the product Leche Purita was fundamental. However, the history of milk as part of nutritional policies in Chile began much earlier. Commemorating fifty years since the introduction of Leche Purita, we aim to summarize the historical importance of milk in Chile's nutritional policies. We emphasize Leche Purita's role in eradicating child undernutrition and reducing anemia among children.

Dénutrition chez les patients en postopératoire de chirurgie digestive dans deux hôpitaux publics au Bénin en 2022 / Undernutrition in postoperative digestive surgery patients in two public hospitals in Benin in 2022

Objectif : Déterminer la fréquence et les facteurs associés à la dénutrition en postopératoire dans deux hôpitaux universitaires publics au Bénin. Méthode : Il s'agissait d'une étude observationnelle transversale descriptive et analytique, qui s'est déroulée de mai à juillet 2022. Un recrutement exhaustif des patients devant être pris en charge chirurgicalement pour une pathologie digestive et ayant consenti à l'étude, a été effectué. Des données anthropométriques et de consommation alimentaire, des données cliniques ont été recueillies grâce à un questionnaire standardisé. Résultats : Un total de 51 patients a été inclus, avec une prédominance d'adultes âgés de moins de 50 ans (70,6%), un sex-ratio de 0,9 ; 72,5% avait un niveau d'instruction ≥ secondaire, 60,8% vivait en couple. Le niveau de revenu était inférieur au salaire minimum interprofessionnel garanti (SMIG) dans 52,9% des cas. La fréquence de la dénutrition était de 29,4% à l'admission contre 54% en postopératoire. Seuls les patients dénutris avaient présenté des complications postopératoires (36%). L'évaluation de l'état nutritionnel n'avait été consignée dans aucun des dossiers médicaux. En analyse multivariée, l'insuffisance en apport protéique et un bas niveau de revenu étaient associées à la dénutrition postopératoire (p = 0,002). Conclusion : La dénutrition en chirurgie digestive est une réalité dans les hôpitaux publics du Bénin et constitue un facteur de risque de complications postopératoires. Son dépistage et sa prise en charge doivent être systématiques et consignés dans le dossier médical du malade

Objective: To determine the frequency and factors associated with postoperative undernutrition in two public teaching hospitals in Benin. Method: This was a descriptive and analytical cross-sectional observational study conducted from May to July 2022. An exhaustive recruitment of patients to be managed surgically for a digestive pathology and who consented to the study, was carried out. Anthropometric, food consumption and clinical data were collected using a standardized questionnaire. Results: A total of 51 patients were included, with a predominance of adults under 50 years of age (70.6%), a sex ratio of 0.9; 72.5% had an educational level ≥ secondary, 60.8% were living as a couple. Income was below the guaranteed minimum wage in 52.9% of cases. The incidence of undernutrition was 29.4% on admission, compared with 54% postoperatively. Only the undernourished patients (36%) presented postoperative complications. Assessment of nutritional status was not recorded in any of the medical register. In multivariate analysis, insufficient protein intake and low income were associated with postoperative undernutrition. Conclusion: Undernutrition in digestive surgery is a reality in public hospitals in Benin, and constitutes a risk factor for postoperative complications. Its detection and management must be systematic and recorded in the patient's medical register.

A case study on undernutrition among children under five years of age in Barangay Calumpang, Nagcarlan, Laguna

Background@#In 2020, Barangay Calumpang, a 2nd class municipality in Nagcarlan, Laguna recorded the highest prevalence of undernutrition among children under five years of age out of the 52 barangays.@*Objectives@#This study was undertaken to describe the factors possibly causing undernutrition among children under five years of age in Barangay Calumpang and provide key recommendations to improve their nutritional status.@*Methods@#The study used a descriptive research design wherein secondary data from the 2020 Barangay Management Information System (BMIS) and Operation Timbang (OPT) 2021 was merged to extract the children's data. The Statistical Package for the Social Sciences (SPSS) was used for the principal component analysis (PCA) and creation of the wealth index. The children’s nutrition situation and profile were also cross-tabulated.@*Results@#We included 28 children. Undernutrition was more prevalent in boys than girls. Most of the children had improved water sources, sanitation facilities, and waste disposal methods. The wealth index showed that half of the subjects were in the lower quintiles, and all were partially immunized. The most prevalent forms of undernutrition were severe underweight (36%) and severe stunting (39%). Other forms of undernutrition were also present in the barangay, such as underweight (14%) and severe wasting (14%). There was also a prevalence of 11% for both stunting and wasting.@*Conclusion@#Undernutrition was more frequent in boys, lower quintile households (stunting), and partially immunized children. Conducting gender-targeted nutrition programs, developing nutrition-focused livelihood programs, increasing awareness on the advantages of immunization, and promoting proper infant and child feeding practices were some of the recommendations given to improve the nutritional status of children under five.

Nutritional profile of indigenous children under five years of age in the Upper Solimões River, Amazonas, Brazil (2013) / Perfil nutricional de crianças indígenas menores de cinco anos de idade no Alto Rio Solimões, Amazonas, Brasil (2013)

Abstract Objectives: to characterize the nutritional status of indigenous children underfive years of age living in rural communities in the Upper Solimões River region, inhabited by seven ethnic groups, based on data of december 2013. Methods: weight and height data extracted from SISVAN-I (Indigenous Food and Nutritional Surveillance System) forms filled in 2013 for 7,520 children (86.0% of the estimated children in this age group). The indices height-for-age (H/A), weight-for-age (W/A), weight-for-height(W/H), and body mass index-for-age (BMI/A) were calculated. Growth reference curves proposed by the World Health Organization were used to calculate z-scores. Results: the height-for-age (H/A) index presented the lowest mean z-score values, reaching -1.95 among children between 36 and 60 months. Mean z-score values for the weight-for-age (W/A) index also remained below zero. Mean z-score values for the indices weight-for-height (W/H) and body mass index-for-age (BMI/A) remained slightly above zero, reaching a maximum value of 0.5. Of all children, 45.7% presented low H/A, 9.6% presented low W/A, 4.5% presented low W/H, and 10.7% presented overweight based on BMI/A. Conclusion: our analysis show that in 2013 poor nutritional status persisted as an important health issue among these rural indigenous children.

Resumo Objetivos: caracterizar o estado nutricional de crianças indígenas menores de cinco anos, de comunidades rurais na região do Alto Solimões, habitada por sete etnias, com base em dados de dezembro de 2013. Métodos: foram extraídos dos formulários do SISVAN Indígena dados de peso e estatura, coletados em 2013, de 7.520 crianças (86,0% das crianças estimadas nesta faixa etária). Foram calculados os índices estatura-para-idade (E/I), peso-para-idade (P/I), peso-para-estatura (P/E) e índice de massa corporal para idade (IMC/I). Curvas de referência para crescimento propostas pela Organização Mundial da Saúde foram utilizadas para calcular escores z. Resultados: o índice estatura-para-idade (E/I) apresentou os menores valores médios de escore z, chegando a -1,95 nas crianças entre 36 e 60 meses. Os valores médios do escore z do índice peso-para-idade (P/I) também permaneceram abaixo de zero. Os valores médios do escore z para os índices P/E e índice de massa corporal para idade (IMC/I) mantiveram-se ligeiramente acima de zero, atingindo valor máximo de 0,5. Do total de crianças, 45,7% apresentaram baixa E/I, 9,6%, baixo P/I, 4,5% baixo P/E e 10,7% de excesso de peso de acordo com o IMC/I. Conclusão: em 2013 a desnutrição persistia como um importante agravo à saúde nessas crianças.

Child Undernutrition among the Bhoksa Tribe of Uttarakhand in India.

Aim: The study aimed to investigate the prevalence of undernutrition in terms of low birth weight, stunting, wasting, and underweight among children up to 3 years of age. Materials and Methods: We recruited 150 children of the Bhoksa Tribe aged between 2 to 36 months. Information related to nutritional indicators (length-for-age, weight-for-age, and weight-for-length) of the child and socio-demographic variables of the household were collected. Results: The prevalence of undernutrition in terms of low birth weight, stunting, wasting, and underweight was 15.4%, 32%, 29.98%, and 36.66%, respectively. The prevalence percentage of undernutrition was high among girls but the difference based on sex was not significant. A significant difference in mean birth weight was observed between low and high SES (2.45 kg v/s 2.93 kg). Conclusion: High prevalence of undernutrition concerning birth weight among the children of the Bhoksa Tribe was observed which may be due to socioeconomic inequality in the population.

INTRA-FAMILY DIFFERENCES IN NUTRITIONAL STATUS BETWEEN PRE-SCHOOL AND SCHOOL AGE CHILDREN

Currently under- and over-nutrition are public health problems in Indian children. A community-based study in 3249 children was undertaken to assess the magnitude of intra-family differences in nutritional status between pre-school and school age children from urban low middle income families. Length/height and weight were measured; nutritional status was computed using WHO Anthro and Anthro Plus software. One-fourth of children were stunted, 1/5th underweight, 1/10th wasted and less than 5% were overweight. Prevalence of stunting, underweight and wasting was higher in children whose elder siblings were stunted, underweight or wasted. However, majority of the younger siblings of under-nourished elder siblings were normally nourished; majority of the elder siblings of undernourished younger sibling were normally nourished. In view of this, it is essential to screen all children, identify those who are under- or overnourished using BMI-for-age and provide appropriate interventions.

Growth and Nutritional Status of Kandra (Fisherman) Adolescent Girls from Ganjam, Odisha, India.

Introduction: The National Family Health Survey-4 data from Odisha shows, adolescent growth spurt and nutritional level needs to be studied comprehensively for designing appropriate policies. Kandra community of Odisha is a Schedule Caste (SC) community with low socio-economic status. No study has been done on growth spurt of girls from this community. Hence, the paper examined growth and nutritional trend and test for significant difference on height, weight, and Body Mass Index (BMI). Methodology: Cross-sectional study with 78 sample were collected from one Gram Panchayat of Ganjam district, India. Somatometric measurements i.e., height, weight, chest, and calf circumference were collected from school-going adolescent, randomly. Mean difference between early and middle adolescent were seen through Levene's Test for equality of variances and independent sample-t-test. Result: Findings say, adolescent growth spurt was highest at age 13-14 years. The overall median height and weight were reported less than Indian and National Center for Health Statistics (NCHS) standards. The difference between 12-13 years and 14-16 years were significant at p<.001 for BMI. Conclusion: Findings were like the gaps reported in NFHS-4 nutritional indictors and is a concern as the girls are going to be future mother, and deficiency may pull their life into risk.

Regional Differences of Child Undernutrition in India: The Reflection of Composite Index of Anthropometric Failure (CIAF) from CNNS-2016-18 Data.

Background: The Composite Index of Anthropometric Failure (CIAF) has its multifaceted application in understanding child undernutrition. The nationwide data of Community National Nutrition Survey (CNNS) 2016-18 in India has unfolded this opportunity to re-examine the use of CIAF and its determinants. One recent study showed significant differences in child undernutrition between rich and poor wealth index households using this CNNS -16-18 data. But, the study did not consider regional as well as state-wise CIAF variation. However, it is a fact that regional understanding of child undernutrition is equally vital for national and regional health and nutritional planning, specifically in India. Therefore, the present study aims to understand the geographical region and state-wise distribution of CIAF and determine some selected determinants of CIAF. Methods: The study used secondary data set from the Community National Nutrition Survey (CNNS), India undertaken in 2016-18. The study sample comprised of 32941 children aged 0-59 months. The multivariate logistic regression models were used to explore the determinants of CIAF. Results: The results revealed that nearly half of the under-five children suffered from undernutrition (CIAF-46.71%). The final adjusted multivariate regression models showed that the higher CIAF prevalence was mainly confined in the central region states like Madhya Pradesh (56.0%) and Uttar Pradesh (52.0%). Besides, the Jharkhand state in the eastern region showed the highest percentage of CIAF (57.0%). The prevalence of child undernutrition was more elevated in poor economic households and Muslim households. Children in the age group ?12 months, boys, who did not consume milk other than breast milk and lived in rural areas, had a higher prevalence of undernutrition. In the case of mother characteristics, mother's age at birth < 20 years, mother never attended school and mother did not watch television had a higher number of undernourished children. Despite several significant determinants associated with child undernutrition, the considerable impact of the region was consistent throughout the statistical models. Conclusion: Therefore, the vulnerable geographical regions and states in terms of child undernutrition should prioritise nutrition-sensitive interventions in India and consider the involvement of other key risk factors.

Impact of Intervention on Nutritional Status of Under-Fives in Tribal Blocks of Palghar District in Maharashtra, India

Background: There is a need to improve their nutritional status of under?five children through specific targeted interventions. The present study discusses the impact of intervention on nutritional status among under?five children in Palghar district from Maharashtra. Objective: The objective is to improve the nutritional status of under?five children by implementing multi?component health and nutrition education intervention, focusing on dietary counseling and modification keeping in view the cultural and socio?economic status of population. Methods: A prospective pre? and post?intervention study was conducted in two tribal blocks. Total 480 under?five children were included in pre? and post?intervention survey each. Results: Exclusive breastfeeding rates improved from 48.9% to 50.5% and initiation of complementary feeding at 6 months improved from 48.3% to 72.5% in post intervention survey as compared to preintervention survey. Among other Infant and Young Child Feeding indicators, Minimum Meal Frequency increased significantly to 67.03% from 5.91% and minimum acceptable diet improved from 5.37% to 47.2% in post intervention survey. The prevalence of Severe Acute Malnutrition (SAM) reduced from 5.4% to nil whereas severe stunting and underweight significantly decreased by 17% and 8% respectively in post intervention survey. Severe anemia decreased from 16.24% to nil post intervention. Conclusion: The study reveals a substantial improvement in timely initiation of complementary feeds, nil cases of SAM, stunting, and underweight along with severe anemia in postintervention phase. This highlights the impact of multicomponent health and nutrition education interventions which may be adapted at a programmatic level to reduce child mortality and morbidity in India.

Assessment of Nutritional Status and Its Determinants among Fewer than 5 Children in a Rural Area of Southern India

Background: Globally malnutrition possesses a double burden in the forms of undernutrition and obesity. The most adverse form of human deprivation is undernutrition among under five children. A child who is underweight may be stunted, wasted or both. Objectives: To assess the nutritional status of under-five children and to identify the determinants of nutritional status among under-five children. Materials and Methods: This is a community based cross-sectional, analytical study conducted on 330 under-five children from a rural area of Salem district of Tamilnadu. Simple random sampling was used to select the study participants. Data was collected using a pre tested semi-structured questionnaire containing socio-demographic particulars, details pertaining to the mother, details pertaining to the child and anthropometric measurements. Data was entered in MS Excel and analysed using SPSS version 20. Results: In this study, majority 60% of them were males. Around 16.4%, 26.4% and 32% of Under 5 children were underweight, wasted and stunted respectively. During the last 1 year about 33.6% and 73.6% had history of acute diarrhoeal infection and acute respiratory tract infection. Variables significantly associated with underweight, stunting and wasting were female gender, nourishment of mother, exclusive breastfeeding (p value < 0.05). Underweight was significantly associated (p value < 0.05) with wasting and stunting. Conclusion: Stunting and wasting rates were higher compared to the National and regional rates given inNFHS-5 data. Proper care of the girl child, frequent sensitization of the mothers regarding the nutrition of their children by community health workers and early diagnosis and treatment of infection are some measures that can be adopted to combat the problem of undernutrition in the locality.

A Community-Based Cross-Sectional Study to assess the Burden of Prevalence of Undernutrition in 0−6 Years Anganwadi Children of Panvel Block, Raigad District, Maharashtra

An impaired nutritional status in preschool children leaves significant impact on their overall childhood development. A community‑based, cross‑sectional study was conducted in Panvel, Maharashtra, over 15 months to assess the overall prevalence and patterns of undernutrition in preschool children using the composite index of anthropometric failure (CIAF). The sample size of 8542 was obtained from randomly selected 132 Anganwadis. Conventional indices (underweight, stunting, and wasting) and CIAF classification were used to assess the prevalence of undernutrition. Statistical analysis was performed using the SPSS version 27. About 50.6% of children were detected as “anthropometric failure” by CIAF method which is higher than conventional indices for underweight (32.9%), stunting (35.7%), and wasting (16.4%). The 13–25 months’ age group was most significantly affected (57%) as per the CIAF. Undernutrition prevalence was similar for both genders across all age groups. A comprehensive policy is needed to identify and treat all anthropometrical failure children with special emphasis on 13–25 months’ age group.

Prevalence and Risk Factors for Severe Acute Malnutrition among Less Than Five Children from an Urban Locality of Surat City, Western India

Introduction Undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery. The percentage of undernutrition, stunting and wasting in children under 5 years of the age in India are 35.7, 38.4 and 21.0 respectively. The etiology of malnutrition is complex and multi-factorial usually a consequence of inadequate dietary intake and various diseases. Methodology: A community based case-control study was conducted among children aged 6 to 59 months, registered at the Anganwadi centers in an urban locality of Surat city, Gujrat. Study population was divided into cases and controls using WHO classification based on anthropometric measurements. Result: The prevalence of undernutrition and severe acute malnutrition among the under-five children were 26.2 and 8.7% respectively. Significant association was found between nutritional status of the children and type of the family( OR 3.84, 95% CI =1.87-7.86, p = 0.000), low birth weight (OR 4.85, 95% CI =2.29 � 10.26, p = 0.000), poor appetite (OR = 2.89, 95% CI = 1.38-6.01, p = 0.004), bottle feeding (OR = 5.41, 95% CI = 1.91-15.29, p= 0.001) and children with habits of eating wafers/candies (OR = 21.99, 95% CI = 9.02-53.60, p = 0.000). Conclusion: Severe acute malnutrition continues to be an important health concern among under five children in the urban area and is affected by many risk factors which can be mitigated through structured and timely interventions using IEC materials.

Trends in undernutrition mortality among children under five years of age and adults over 60 / Tendencias en la mortalidad por desnutrición en menores de 5 años y mayores de 60 años

Introduction: Children under five years of age living in poor areas and with low availability of healthy food have a higher risk of undernutrition-related mortality. However, this relationship has not been well established among older adults. Objective: To analyse socioeconomic inequality trends related to undernutrition mortality in children under five years of age and adults over 60 in Colombian municipalities during 2003-2009 and 2010-2016. Materials and methods: We conducted an ecological study of trends between 2003 and 2016. The study population consisted of children under five years of age and adults over 60 residing in the Colombian municipalities during the study period. We estimated smoothed and standardized mortality rates by fitting a hierarchical Bayesian model and explored their relationship with five socioeconomic area-level variables. Results: In most of the municipalities, undernutrition-related mortality was three times higher in older adults compared to children. Moreover, the difference in the risk of undernutrition-related mortality between municipalities showed a marked reduction. Finally, the poor and less developed municipalities had higher rates of undernutrition-related mortality in children; conversely, wealthier territories had higher rates in older adults. Conclusions: Although in most of the municipalities the mortality rates due to undernutrition in children under five and older adults have decreased, their socioeconomic conditions influence in different ways the risk of mortality for these two populations so there is the need to develop age-specific strategies to close social gaps considering the structural conditions of the areas.

Introducción. Los niños menores de cinco años que viven en zonas pobres y con poca disponibilidad de alimentos saludables, tienen mayor riesgo de mortalidad relacionada con la desnutrición, relación que no se ha determinado claramente entre los adultos mayores. Objetivo. Analizar las tendencias de la desigualdad socioeconómica relacionada con la mortalidad por desnutrición en niños menores de cinco años y adultos mayores de 60 en los municipios colombianos durante 2003-2009 y 2010-2016. Materiales y métodos. Se hizo un estudio ecológico de tendencias entre 2003 y 2016. La población de estudio incluyó a niños menores de cinco años y adultos mayores de 60 residentes en los municipios colombianos durante el período de estudio. Se estimaron las tasas de mortalidad suavizadas y estandarizadas ajustadas mediante un modelo bayesiano jerárquico y se exploró su relación con cinco variables socioeconómicas a nivel de área. Resultados. En la mayoría de los municipios, la mortalidad relacionada con la desnutrición fue tres veces mayor en los adultos mayores que en los niños. Además, la diferencia en el riesgo de mortalidad por desnutrición entre municipios mostró una marcada reducción. Por último, los municipios pobres y menos desarrollados registraron tasas más altas de mortalidad infantil relacionada con la desnutrición, en tanto que, en los territorios más ricos, las tasas más altas se registraron en adultos mayores. Conclusiones. Si bien en la mayoría de los municipios las tasas de mortalidad por desnutrición en niños menores de cinco años y adultos mayores han disminuido, sus condiciones socioeconómicas influyen de diferente manera en el riesgo de mortalidad de estas dos poblaciones, por lo que surge la necesidad de desarrollar estrategias específicas por edades para cerrar las brechas sociales con base en las condiciones estructurales de las zonas.

Predictive Performance Of Different Diagnostic Criteria For Overweight And Obesity Between 2008-2015 In Adolescents

Background: The reference cut-offs for overweight and obesity have evolved from the use of International obesity task force (IOTF) to extended IOTF and revised Indian Academy of Pediatrics (IAP) growth charts. Methods: Secondary analysis of anthropometric data of school-going children from Delhi in the year 2008, 2013 and 2015 was performed. The proportions of children with overweight, obesity, and undernutrition were checked for agreement using different diagnostic cutoffs, and compared at three-time points. Results: Among 8417 adolescents, weighted Kappa statistics showed good agreement between extended IOTF and IAP cutoffs (k=0.933; 95% CI 0.93-0.94), between eIOTF and IOTF (k=0.624; 95% CI 0.619 - 0.629) and between IAP and IOTF (k=0.654; 95% CI 0.645-0.662). A higher proportion of adolescents were diagnosed with obesity with extended IOTF and IAP charts than IOTF charts (P<0.001 for both genders). The mean (SD) BMI showed a rising trend for adolescents overall from 19.61 (3.89) kg/m2 in 2008, 20.44 (4.37) kg/m2 in 2013 and 20.88 (4.60) kg/m2 in 2015 (P<0.001). 158 adolescent (97 girls) were undernourished using combined IAP and extended IOTF criteria. Conclusion: Both extended IOTF and IAP charts showed good agreement for diagnosing overweight and obesity in adolescents. A secular trend in malnutrition was observed in adolescent girls.

Prevalence and Factors Associated with Geriatric Malnutrition in Healthcare Institutions: A Systematic Review

@#Aim and Design: The world’s population is ageing. Not only it changes the body composition, but ageing also causes psychological, pathological and economic alterations. These may impact an individual’s quality of life and nutritional status. Thus, this systematic review article aims to review the prevalence of geriatric malnutrition in healthcare institutions and its associated factors. Data Sources: The articles are screened and reviewed based on their titles, abstracts and keywords. English written articles, open-accessed and published between January 2009 and December 2019 are then selected. Review Methods: The PRISMA method is used for this study. Potential studies related to geriatric malnutrition in healthcare institutions were identified using two different combinations and two major electronic search engines, namely Pubmed and Science Direct. Results: From a search of 1011 articles, 22 articles were identified related to geriatric malnutrition in healthcare institutions. Globally, it is found that the prevalence of malnourished elderly patients ranged between 6% – 74.5%. The factors associated with malnutrition among the elderly in the healthcare institutions were recognised, namely socio-demography, medical background, anthropometry data, biochemical data, nutrition-focus physical findings, and dietary inadequacy. Conclusion and Impact: Despite the studies done, geriatric malnutrition is still a matter of concern. Hence, future strategies for interventions need to be taken to aid in overcoming this issue otherwise affecting the health status and life expectancy of the elderly.

Addressing the Double Burden of Malnutrition using the Life Course Perspective

@#The double burden of malnutrition refers to the coexistence of undernutrition which is typically characterised by stunting and wasting, alongside overnutrition at all levels of the population. The objective of this article is to review the current issues in addressing the double burden of malnutrition using the life course approach. Studies addressing life course approach in DBM were identified through PubMed & EMBASE databases. Relevant studies were critically appraised. The challenges, opportunities and way forward in addressing DBM through the life course concept were discussed. The review showed that the DBM dilemma could be addressed via a holistic perspective through a life course concept as nutrition plays an important role in influencing health from pre-conception to old age. The life course concept proposes that environmental exposures, including biological, physical, social, and behavioral factors, including life experiences, throughout life, influence health outcomes in current generations and their offspring.

Ciência da disseminação em DOHaD para a promoção da saúde nas futuras gerações / Dissemination Science in DOHaD for health promotion in future generations

Após o reconhecimento de princípios evolutivos e da epigenética associada à plasticidade do desenvolvimento, a ciência de DOHaD (Origens Desenvolvimentistas da Saúde e Doença) floresceu. Segundo DOHaD, a exposição a condições adversas no início da vida, como a subnutrição, leva a respostas adaptativas para aumentar as chances de sobrevivência imediata e posterior, as quais podem aumentar o risco de doenças crônicas não transmissíveis (DCNT) no curso da vida. Outros insultos como obesidade (materna e paterna) na preconcepção e gestação, diabetes gestacional, aleitamento e a alimentação inadequada na infância podem induzir respostas não adaptativas e aumentar o risco de doenças, independentemente do ambiente posterior. A exposição à desreguladores endócrinos, substâncias tóxicas e poluentes também podem ter efeitos de longo prazo. Esses efeitos são mediados por alterações epigenéticas, as quais se tornam mais sensíveis nesse período crítico de desenvolvimento de intensa reorganização. Diante da transição nutricional e coexistência das diferentes formas de desnutrição nos países de baixa e média renda (PBMR); do aumento global das DCNT, cujo impacto social e econômico é maior nesses países; da fraca contribuição de fatores genéticos fixos na etiologia dessas doenças; e da ineficácia das atuais intervenções, a implementação de DOHaD representa uma estratégia potencial para beneficiar as futuras gerações. Considerando que a disseminação de DOHaD não têm acompanhado seu florescimento científico, esse trabalho teve como objetivo o desenvolvimento de um ebook direcionado para nutricionistas e um artigo relativo aos impactos da pandemia de COVID-19 na perspectiva de DOHaD, a fim de aproximar a ciência destes profissionais e fomentar sua implementação. Trata-se de uma revisão narrativa de literatura a partir artigos científicos em inglês e português, publicados nas bases de dados SciELO, PubMed e BVS, sem limite de data. O trabalho evidenciou que o desafio da dupla carga de doenças e das diferentes formas de desnutrição nos PBMR, foi agravado pela pandemia, tornando imperativo medidas de intervenção por seu provável impacto no ciclo intergeracional de DCNT e desenvolvimento dos países. A aproximação dessa ciência do nutricionista, propicia uma formação mais ampla e integrativa, através de capacitação técnica e habilidades interpessoais, capazes de acionar as fragilidades biopsicossociais, e melhor intervir, equacionando resultados de curto e longo prazo, a fim de interromper o ciclo intergeracional de DCNT, assim como otimizar o capital humano, a capacidade de produção e renda da futura geração. Conclui-se que o material desenvolvido é de grande valia, dado que a disseminação desse conhecimento deve se estender aos nutricionistas de todas as áreas e ser multiplicado

After evolutionary and epigenetics principles associated with the plasticity of development were recognized, DOHaD (Developmental Origins of Health and Disease) science flourished. According to DOHaD, the exposure to adverse conditions at the beginning of life, like undernutrition, leads to adaptive responses to increased immediate and later odds of survival, which may increase the risk of noncommunicable diseases (NCD) during life. Other conditions such as obesity (maternal and paternal) in preconception and pregnancy, gestational diabetes, lactation, and inadequate nourishment during infancy can induce non-adaptive responses and increased risk of diseases, regardless of the upcoming environment. The exposure to endocrine disruptors, and toxic and pollutant substances can also have long-term effects. Those effects are mediated by epigenetic changes, which become more sensitive during this critical period of development under intense reorganization. Considering the nutritional transition and coexistence of the different forms of undernutrition in the low- and middle-income countries (LMIC); the global increase of NCDs, with a higher social and economic impact in those countries; the weak contribution of fixed genetic factors in the etiology of those diseases; and the inefficacy of current interventions, the implementation of DOHaD represents a potential strategy to benefit future generations. Considering that the dissemination of DOHaD have not followed its scientific progress, the goal of the present work was to develop an e-book targeting nutritionists and an article about the impacts of the COVID-19 pandemic in the perspective of DOHaD, intended to drive the science closer to those professionals and foster its implementation. It is a narrative review of the literature regarding scientific articles published in English and Portuguese on the data bases SciELO, PubMed and BVS, with no date limit. The work has highlighted that the challenge of the double burden of the diseases and the several forms of undernutrition in the LMIC, was aggravated by the pandemic, making intervention measures imperative due to its likely impact on the intergenerational cycle of NCD and the development of countries. By inching closer to nutritionists this science provides larger and more integrative education through technical training and interpersonal abilities that help activate biopsychosocial fragilities, and better intervention; providing short- and long-term results aiming to interrupt the NCD intergenerational cycle, as well as optimize the human capital, the work and income capacity of the future generation. It is concluded that the material developed is of great value, given that the dissemination of this knowledge should reach all nutritionists from all areas and be multiplied

Implications of undernutrition in children with acute lymphoblastic leukaemia during induction therapy – experience from a developing country

@#Introduction: Undernutrition is an important prognostic factor in children with acute lymphoblastic leukaemia (ALL) and higher incidences of mortality are reported during induction remission in severely undernourished children. This study was conducted to assess the prevalence and implications of malnutrition among ALL children during induction therapy. Methods: All children ≤18 years diagnosed and treated for ALL at our institution, between June 2010 to July 2016 were included in this retrospective cohort study. Nutrition was assessed by body mass index-forage z-scores calculated using World Health Organization’s Anthro (<5 years) and Anthro-Plus Software (≥5 years). Children with a z-score of <-2 standard deviation (SD) were classified as undernourished. All events and outcomes were compared between undernourished and adequately nourished children. Results: A total of 72 children were included in this study. Nineteen (26.4%) were undernourished at the time of diagnosis. Twenty-eight (38.8%) children had significant weight loss. Sixty-seven of them attained remissions by the end of induction chemotherapy. Five children who died had significant weight loss. Children with significant weight loss during induction phase had a higher risk of developing complications such as febrile neutropenia, pneumonia, mucositis, and drug interruptions. Those with a deteriorating nutritional status had a higher chance of poor treatment outcome (p=0.05, CI=95%). Conclusion: It is important to assess and monitor the nutrition status of children and timely nutritional intervention is essential. A simple, cost effective nutritional intervention that will decrease morbidity and mortality associated with the disease must be devised.

Prevalence and factors associated with undernutrition among Dayak children in rural areas of Sarawak, Malaysia

@#Background: Undernutrition among children has become a major public health issue due to the high risk of morbidity and mortality involving this vulnerable age group. This study focused on the rural population, especially among the Dayak children in Sarawak, Malaysia. Methodology: This community-based cross-sectional study was conducted in Sarawak’s rural areas using a multistage stratified cluster sampling technique. Data were collected through face-to-face interviews using an interviewer-guided questionnaire. The nutritional status of the under-five children was measured according to the World Health Organization guidelines. The nutritional indicators were calculated as z-scores. Multivariate logistic regression analyses were performed using SPSS to identify the factors associated with nutritional status. Results: The prevalence of undernutrition among the under-five Dayak children in the rural areas of Sarawak was 39.6%. The analysis suggested that wasting was predominantly associated with parental education levels of primary and below, poor wealth index, environmental and sanitation issues, children with history of low birth weight, shorter duration of exclusive breastfeeding, and poor appetite. Stunting was high within the age group of <3 years old and was associated with parents’ occupation and household wealth index. Low parental education, poor wealth index, environmental and sanitation issues, poor appetite, and the children’s recent illness predicted underweight. Conclusion: These findings imply that a multi-sectoral and multi-dimensional approach is essential to address undernutrition in rural settings. Improvement on households’ socioeconomy, environment and sanitation should be emphasised to reduce undernutrition among the children.