Special Issue "Nutritional Status among Vulnerable Populations"

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: 30 November 2021.

Special Issue Editor

Prof. Gulam Khandaker
E-Mail Website
Guest Editor
Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, 4700 Queensland, Australia
Interests: childhood disability; infectious disease; early childhood development; child survival; maternal and childhood undernutrition; poverty dynamics
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

Globally, it is estimated 45% of deaths in under-fives are directly or indirectly linked to malnutrition (WHO, Malnutrition. Available from: https://www.who.int/news-room/fact-sheets/detail/malnutrition). Children born pre-term and those with low birthweights, congenital anomalies, neurodevelopmental disorders, and disabilities are at high risk of malnutrition and infection in both HICs and LMICs. In LMICs, food insecurity, in addition to poor environmental conditions, make the situation more complex. At the same time, children in countries affected by war or living in conflict zones or refugee camps are exposed to extreme environmental conditions, food insecurity, and inhumane circumstances, making their survival a challenge.

On 1st of April 2016, the General Assembly of United Nations (UN) declared 2016–2025 as the “United Nations Decade of Action on Nutrition”. The proclamation brought about the opportunity to work strategically toward the global agenda of the sustainable development goals (SDG 2 and SDG 3).

As Ban Ki-moon, United Nations 8th Secretary General, said, “Nutrition is both a maker and a marker of development. Improved nutrition is the platform for progress in health, education, employment, empowerment of women and the reduction of poverty and inequality, and can lay the foundation for peaceful, secure and stable societies.”

There is an urgent need for population-based observational and experimental studies and translational research in this area to tackle the burden of malnutrition among vulnerable children globally. This Special Issue aims to present a collection of the latest research on issues and initiatives around malnutrition among vulnerable children in both high income countries (HICs) and low- and middle-income countries (LMICs).

Prof. Gulam Khandaker
Guest Editor

Manuscript Submission Information

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Keywords

  • childhood malnutrition
  • pre-term birth
  • low-birth weight
  • childhood disability
  • neurodevelopmental disorder
  • low income settings
  • displaced population
  • conflict zones

Published Papers (7 papers)

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Research

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Article
Nutritional Status of Adolescent Afghan Refugees Living in Peshawar, Pakistan
Nutrients 2021, 13(9), 3072; https://doi.org/10.3390/nu13093072 - 31 Aug 2021
Viewed by 707
Abstract
Pakistan has hosted millions of Afghan refugees over the last several decades. Due to poor socioeconomic status, food insecurity and inadequate access to health care, these refugees are considered to be at high risk of malnutrition. Previous studies on nutritional assessment of high-risk [...] Read more.
Pakistan has hosted millions of Afghan refugees over the last several decades. Due to poor socioeconomic status, food insecurity and inadequate access to health care, these refugees are considered to be at high risk of malnutrition. Previous studies on nutritional assessment of high-risk populations (refugees) have focused mainly on women and children (0–59 months). The current study aims to assess nutritional status of adolescent Afghan refugees; the population who are equally vulnerable to malnutrition and its consequences. In this cross sectional study, the nutritional status of 206 adolescent (10–19 years old) Afghans boys and girls living in a refugee camp in Peshawar, Pakistan was assessed using standard methods. The results indicate a prevalence of stunting, thinness, and overweight and obesity at 35.3%, 4.4% and 14.8%, respectively. Furthermore, there was a significantly high prevalence of micronutrient deficiencies (vitamin D, 80.5%; vitamin B12, 41.9%; and folate, 28.2%); and anemia (10.1%). Together, these findings indicate that this vulnerable population group suffers from the double burden of malnutrition and are thus at serious risk of impaired psychosocial cognitive development, general ill-health and diminished wellbeing. This study therefore highlights the urgent need to include adolescents in regular screening and intervention programs of such at-risk populations. Full article
(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)
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Article
Nutritional Status of Children with Cerebral Palsy in Gorkha, Nepal: Findings from the Nepal Cerebral Palsy Register
Nutrients 2021, 13(8), 2537; https://doi.org/10.3390/nu13082537 - 25 Jul 2021
Viewed by 728
Abstract
Background: The study aimed to define the burden and underlying risk factors of malnutrition among children with cerebral palsy (CP) in Gorkha district, Nepal. Methods: The first population-based register of children with CP in Gorkha, Nepal (i.e., Nepal CP Register—NCPR) was established in [...] Read more.
Background: The study aimed to define the burden and underlying risk factors of malnutrition among children with cerebral palsy (CP) in Gorkha district, Nepal. Methods: The first population-based register of children with CP in Gorkha, Nepal (i.e., Nepal CP Register—NCPR) was established in 2018. Children aged <18 years with confirmed CP were registered following standard protocol. Nutritional status was determined based on anthropometric measurements (height/length, weight, mid-upper-arm-circumference) following WHO guidelines. Descriptive analyses and adjusted logistic regression were completed. Results: Between June–October 2018, 182 children with CP were registered into the NCPR (mean (SD) age at assessment: 10.3 (5.0) years, 37.4% female). Overall, 51.7%, 64.1%, and 29.3% children were underweight, stunted, and thin, respectively. Furthermore, 14.3% of children with CP aged <5 years had severe wasting. Underweight and stunting were significantly higher among children with spastic CP (p = 0.02, p < 0.001) and/or Gross Motor Function Classification System (GMFCS) level (III–V) (p = 0.01, p < 0.001) and/or who were not enrolled in school (p = 0.01, p < 0.001). In adjusted analysis, GMFCS level III–V and non-attendance to school significantly increased the odds of stunting by 8.2 (95% CI 1.6, 40.8) and 4.0 (95% CI 1.2, 13.2) times, respectively. Conclusions: the high rate of different forms of undernutrition among children with CP in Gorkha, Nepal is concerning. Need-based intervention should be taken as priority to improve their nutritional outcome. Full article
(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)
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Article
Mapping Geographical Differences and Examining the Determinants of Childhood Stunting in Ethiopia: A Bayesian Geostatistical Analysis
Nutrients 2021, 13(6), 2104; https://doi.org/10.3390/nu13062104 - 19 Jun 2021
Viewed by 925
Abstract
Understanding the specific geographical distribution of stunting is essential for planning and implementing targeted public health interventions in high-burdened countries. This study investigated geographical variations in the prevalence of stunting sub-nationally, and the determinants of stunting among children under 5 years of age [...] Read more.
Understanding the specific geographical distribution of stunting is essential for planning and implementing targeted public health interventions in high-burdened countries. This study investigated geographical variations in the prevalence of stunting sub-nationally, and the determinants of stunting among children under 5 years of age in Ethiopia. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) dataset for children aged 0–59 months with valid anthropometric measurements and geographic coordinates (n = 9089). We modelled the prevalence of stunting and its determinants using Bayesian geospatially explicit regression models. The prevalence of stunting among children under five years was 36.3% (95% credible interval (CrI); 22.6%, 51.4%) in Ethiopia, with wide variations sub-nationally and by age group. The prevalence of childhood stunting ranged from 56.6% (37.4–74.6%) in the Mekelle Special zone of the Tigray region to 25.5% (10.5–48.9%) in the Sheka zone of the Southern Nations, Nationalities and Peoples region. Factors associated with a reduced likelihood of stunting in Ethiopia included non-receipt of breastmilk, mother’s BMI (overweight/obese), employment status (employed), and higher household wealth, while the enablers were residence in the “arid” geographic areas, small birth size of the child, and mother’s BMI (underweight). The prevalence and determinants of stunting varied across Ethiopia. Efforts to reduce the burden of childhood stunting should consider geographical heterogeneity and modifiable risk factors. Full article
(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)
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Article
Micronutrient Deficiencies and Stunting Were Associated with Socioeconomic Status in Indonesian Children Aged 6–59 Months
Nutrients 2021, 13(6), 1802; https://doi.org/10.3390/nu13061802 - 26 May 2021
Viewed by 1182
Abstract
Micronutrient deficiencies and stunting are known as a significant problem in most developing countries, including Indonesia. The objective of this study was to analyze the association between micronutrient deficiencies and stunting with socioeconomic status (SES) among Indonesian children aged 6–59 months. This cross-sectional [...] Read more.
Micronutrient deficiencies and stunting are known as a significant problem in most developing countries, including Indonesia. The objective of this study was to analyze the association between micronutrient deficiencies and stunting with socioeconomic status (SES) among Indonesian children aged 6–59 months. This cross-sectional study was part of the South East Asian Nutrition Surveys (SEANUTS). A total of 1008 Indonesian children were included in the study. Anemia, iron deficiency, vitamin A deficiency, vitamin D deficiency, and stunting were identified in this study. Structured questionnaires were used to measure SES. Differences between micronutrient parameters and anthropometric indicators with the SES groups were tested using one-way ANOVA with post-hoc test after adjusted for age, area resident (rural and urban), and sex. The highest prevalence of anemia, stunting, and severe stunting were found to be most significant in the lowest SES group at 45.6%, 29.3%, and 54.5%, respectively. Children from the lowest SES group had significantly lower means of Hb, ferritin, retinol, and HAZ. Severely stunted children had a significantly lower mean of Hb concentration compared to stunted and normal height children. Micronutrient deficiencies, except vitamin D, and stunting, were associated with low SES among Indonesian children aged 6–59 months. Full article
(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)
Article
Impacts of a School-Based Intervention That Incorporates Nutrition Education and a Supportive Healthy School Canteen Environment among Primary School Children in Malaysia
Nutrients 2021, 13(5), 1712; https://doi.org/10.3390/nu13051712 - 18 May 2021
Cited by 1 | Viewed by 978
Abstract
In this study, a school nutrition program (SNP) that incorporates nutrition education and a healthy school canteen environment was developed to improve nutrition knowledge among intervention respondents and provide a healthier environment for them to practice healthy eating. In the current study, we [...] Read more.
In this study, a school nutrition program (SNP) that incorporates nutrition education and a healthy school canteen environment was developed to improve nutrition knowledge among intervention respondents and provide a healthier environment for them to practice healthy eating. In the current study, we evaluated the impacts of the SNP on eating behaviors, physical activity, body mass index-for-age (BAZ), and cognitive performance at pre-intervention, post-intervention, and 3-month follow-up points between intervention and comparison groups. This intervention study involved 523 primary school children (7–11 years old) from six selected schools in Batu Pahat District, Malaysia. Each respondent completed anthropometric and cognitive performance assessments and a set of standardized questionnaire at pre-intervention, post-intervention, and 3-month follow-up points. Multiple linear mixed model analysis was performed to determine the impacts of that SNP after being adjusted for covariates. After the program, the intervention group increased their frequency of breakfast, lunch, and dinner consumption and morning tea snacking and showed more frequent physical activity and better cognitive performance as compared to the comparison group overtime (p < 0.05). At 3-month follow-up, the intervention group showed lower BAZ scores than their comparison counterparts (p < 0.05). The SNP showed positive effects on eating behaviors, physical activity, BAZ, and cognitive performance in school children. Hence, the SNP is highly recommended for all primary school children. Full article
(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)
Article
A High Prevalence of Vitamin D Deficiency Observed in an Irish South East Asian Population: A Cross-Sectional Observation Study
Nutrients 2020, 12(12), 3674; https://doi.org/10.3390/nu12123674 - 28 Nov 2020
Cited by 2 | Viewed by 1294
Abstract
At northern latitudes, non-ethnic population groups can be at an increased risk of vitamin D deficiency (defined as a 25-hydroxyvitamin D [25(OH)D] status ≤30 nmol/L). The vitamin D status of ethnic minority groups has been examined both in UK and European populations, but [...] Read more.
At northern latitudes, non-ethnic population groups can be at an increased risk of vitamin D deficiency (defined as a 25-hydroxyvitamin D [25(OH)D] status ≤30 nmol/L). The vitamin D status of ethnic minority groups has been examined both in UK and European populations, but not in the Irish context. The aim of this study is to assess the vitamin D status from a selection of the Dublin population of South East Asian descent. A search was conducted, using the laboratory information system of St James’s Hospital, Dublin, for vitamin D requests by General practitioners. From 2013 to 2016, 186 participants were identified and 25(OH)D analysis was quantified using liquid chromatography-tandem mass spectrometry (LC-MS-MS). Overall, the median age was 32 years, 51% were male, and the 25(OH)D concentration ranged from 10 to 154 nmol/L. In total, 66.7% of the total sample were vitamin D deficient and 6.7% had a 25(OH)D status greater than 50 nmol/L (the 25(OH)D concentration defined by the EU as ‘sufficient’). Females had a significantly higher 25(OH)D concentration than males (25.0 vs. 18.0 nmol/L; p = 0.001) but both groups had a significant proportion with deficient status (56% and 76.8%, respectively). Seasonal variation of 25(OH)D was not evident while high rates of deficiency were also observed in those aged <18 years and >50 years. Given the importance of vitamin D for health, this sub-population could be at a significantly increased risk of rickets, impaired bone metabolism, and osteoporosis. In addition, vitamin D deficiency has been associated with several non-bone related conditions, including cardiovascular disease and diabetes. Currently, there is no unique vitamin D intake or vitamin D status maintenance guidelines recommended for adults of non-Irish descent; this needs to be considered by the relevant public health bodies in Ireland. Full article
(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)
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Review

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Review
Burden of Malnutrition among Children and Adolescents with Cerebral Palsy in Arabic-Speaking Countries: A Systematic Review and Meta-Analysis
Nutrients 2021, 13(9), 3199; https://doi.org/10.3390/nu13093199 - 15 Sep 2021
Viewed by 696
Abstract
Background: We aimed to estimate the burden and underlying risk factors of malnutrition among children and adolescents with cerebral palsy in Arabic-speaking countries. Methods: OVID Medline, OVID Embase, CINAHL via EBSCO, Cochrane Library, and SCOPUS databases were searched up to 3 July 2021. [...] Read more.
Background: We aimed to estimate the burden and underlying risk factors of malnutrition among children and adolescents with cerebral palsy in Arabic-speaking countries. Methods: OVID Medline, OVID Embase, CINAHL via EBSCO, Cochrane Library, and SCOPUS databases were searched up to 3 July 2021. Publications were reviewed to identify relevant papers following pre-defined inclusion/exclusion criteria. Two reviewers independently assessed the studies for inclusion. Data extraction was independently completed by two reviewers. Descriptive and pooled analysis has been reported. Results: From a total of 79 records screened, nine full-text articles were assessed for eligibility, of which seven studies met the inclusion criteria. Study characteristics, anthropometric measurements used, and nutritional outcome reported varied between the studies. The included studies contained data of total 400 participants aged 1–18 years. Overall, (mean: 71.46%, 95% confidence interval: 55.52–85.04) of children with cerebral palsy had at least one form of malnutrition. Severe gross motor function limitation, feeding difficulties, cognitive impairment and inadequate energy intake were the commonly reported underlying risk factors for malnutrition among children with cerebral palsy. Conclusions: The burden of malnutrition is high among children with cerebral palsy in Arabic-speaking countries. More research is needed for better understanding of this public health issue in these countries. Full article
(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)
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