Search Results (98)

Childhood malnutrition remains a pressing public health challenge in Europe, where stunting, wasting, and underweight coexist with rising rates of childhood overweight and obesity. This policy review provides a strategic roadmap for promoting healthy nutrition in early childhood by synthesizing WHO and EU guidance and proposing coordinated action across three time horizons. Short-term goals (1–3 years) include harmonizing food-based dietary guidelines, implementing universal nutrition screening in pediatric care, and strengthening breastfeeding-supportive environments. Mid-term priorities (3–7 years) focus on fiscal levers, such as sugar taxes and healthy food subsidies; reformulating children’s products; and embedding nutrition education within school curricula. Long-term strategies (7+ years) emphasize harmonized EU-wide monitoring systems, alignment of early-life nutrition with social protection policies, and sustained investment in research on the DOHaD. Through a unified, multisectoral strategy emphasizing early-life nutrition, equitable access to healthy foods, education, and robust regulation, Europe can effectively address the double burden of malnutrition and sustainably reduce childhood obesity. Full article

Aflatoxins, mycotoxins produced by Aspergillus flavus and Aspergillus parasiticus, were discovered sixty-five years ago and remain a significant public health threat, particularly amid increasing instances of extreme weather events. Of the four principal forms of aflatoxins found in foods (B₁, B₂, G₁, and G₂), aflatoxin B₁ is the most potent carcinogen. Aflatoxins commonly contaminate a variety of foodstuffs, with maize being among the most susceptible. Chronic exposure to aflatoxins has been linked to liver cancer, childhood stunting, gallbladder cancer, and other adverse health effects. Due to public health concerns related to the consumption of aflatoxin-contaminated foods, most countries have established regulatory limits. Here, we present estimated aflatoxin exposure per day derived from human biomarker data across many studies around the world spanning more than forty years. We specifically focus on the impact of dietary aflatoxin in northern Latin America, where assessment of the total problem remains limited. These findings suggest a multipronged toolkit could mitigate aflatoxin exposure in the region, which would help to decrease the health burden. Full article

Background: Childhood undernutrition and overnutrition continue to be major public health challenges in South Africa. There is limited evidence on how socio-economic factors and dietary behaviors influence nutritional outcomes among school-aged children, particularly in rural areas such as Thulamela Municipality. Objective: This study aimed to examine the socio-demographic determinants, dietary patterns, and nutritional status among school-aged children in Thulamela Municipality, Limpopo Province, South Africa. Methods: A cross-sectional survey was conducted with 347 children aged 8–12 years. Simple random sampling was used to select eight villages from a total of 227 within the municipality. A snowball sampling method was used to recruit eligible children. Data on socio-demographic characteristics, including the child’s sex, parental education level, marital status, and employment status, were collected. Additionally, their dietary habits and meal frequency patterns were collected using structured questionnaires. Anthropometric measurements including height, weight, and BMI-for-age were obtained following WHO growth standards. Associations between variables were assessed using chi-square tests, with p-values < 0.05 considered statistically significant. Results: The prevalence of severe and moderate stunting was 20.5% and 21.0%, respectively. Overweight conditions and obesity affected 32.6% and 16.2% of participants, respectively. Parental education (p = 0.027), marital status (p = 0.001), and household income (p = 0.043) showed significant associations with height-for-age and BMI-for-age Z-scores. Additionally, regular breakfast consumption and the frequent intake of vegetables and dairy products were positively associated with improved nutritional outcomes (p < 0.05). Conclusions: The nutritional profile of school-aged children in Thulamela Municipality reflects a double burden of malnutrition, with concurrent high rates of stunting, overweight conditions, and obesity. Interventions that promote balanced diets and address socio-economic disparities are crucial for improving child growth and overall health. Socio-economic factors, including parental education, marital status, and household income, were significantly associated with children’s height-for-age and BMI-for-age. Furthermore, the regular consumption of breakfast, vegetables, and dairy products was associated with better nutritional outcomes, highlighting the influence of both dietary behaviors and socio-demographic determinants on child growth and health. Implementing nutrition education programs within schools that emphasize the value of balanced diets and highlighting the significance of eating breakfast regularly and incorporating vegetables and dairy products into daily meals is important. These programs should include both children and their caregivers to support regular healthy eating behaviors at home and in school. Additionally, schools should carry out regular growth monitoring and nutritional assessments to identify early indications of undernutrition or overnutrition, enabling prompt referrals and interventions for children who may be at risk. Full article

Background/Objectives: In Pakistan, 41.7% of women of reproductive age and 53.7% of children aged 6–59 months are anaemic. This study aimed to evaluate the effectiveness of a nutritional supplementation programme, underpinned with behaviour change communication and implemented through Lady Health Workers (LHWs), in reducing anaemia among pregnant and lactating women as well as 6–59-month-old children. Methods: This study used a quasi-experimental design with an intervention and a control group. A total of 2821 and 2410 pregnant and lactating women and 3397 and 3277 children aged 6–59 months participated in the baseline and endline surveys, respectively. The study areas were matched for demographic and economic characteristics, and both had routine public-sector health and nutrition programmes, including iron–folic acid supplementation during pregnancy. The participants in the intervention group received additional nutritional support. Throughout the pregnancy and in the first six months of exclusive breast feeding, women were provided 5 kg (165 g/day) of wheat soya blend (WSB) per month. Children aged 6–23 months received lipid-based nutrient supplements (LNS), and those aged 24–59 months received micronutrient powder. We applied a difference-in-difference (DID) analysis with kernel propensity score matching to assess the impact on anaemia, a secondary outcome of a stunting prevention programme. Results: Maternal anaemia (both pregnant and breastfeeding women) declined substantially in the intervention areas from 80.4% to 62.6% compared with a smaller reduction in the control areas (80.0% to 72.9%). The DID estimate showed a 10.7-percentage-point (pp) greater decline in maternal anaemia (p ≤ 0.001). Both pregnant and lactating women benefited, with DID reductions of 16.7 pp (p ≤ 0.001) and 9.4 pp (p = 0.005), respectively. The largest gains occurred among women in higher-wealth quintiles, with reductions up to 22.6 pp (p ≤ 0.001). In contrast, childhood anaemia showed no overall significant difference between intervention and control areas (DID = −0.7 pp, p = 0.73). However, significant improvements were observed among male children (DID = −10.3 pp, p = 0.001) and those in higher-wealth quintiles (DID = −15.0 pp, p = 0.002). Conclusions: Overall, the findings suggest that LHWs can effectively reduce maternal anaemia when iron–folic acid supplementation is complemented with WSB and targeted behaviour change communication. Full article

Background/Objectives: This study examines the associations between household socioeconomic status (SES), child nutrition, and developmental status among children aged 24–59 months in the Mont Ngafula health zone in Kinshasa. The primary research question focuses on how SES and stunting affect developmental outcomes in early childhood. Methods: A cross-sectional analysis was conducted involving 348 children, assessing developmental outcomes using the Early Childhood Development Index (ECDI2030). Results: The study found that 70.4% of children were classified as on track, with ONTRACK prevalence increasing across SES tertiles. Children who attended preschool education had higher odds of being on track. The rich tertile had higher odds of being on track than those in the poor tertile, while the middle tertile showed a weaker association. Child age categories and stunting were inversely associated with being developmentally on track. The results are consistent with multiple imputation sensitivity analyses. Conclusions: The study concludes that preschool attendance and a higher household socioeconomic position are strongly associated with better early developmental outcomes, while an age of 48–59 months and stunting are associated with a markedly lower likelihood of being developmentally on track. Integrated policies that reduce household poverty, promote early education, and prevent/treat early faltering growth could improve early childhood developmental trajectories. Full article

Malnutrition afflicts millions of the world’s children and predisposes to death from diarrhea and infectious diseases. Children with severe acute malnutrition (SAM) are at highest risk. Our review of the endocrinology and metabolomics of SAM implicates critical roles for white adipose tissue and its regulatory hormones and growth factors in the adaptation to nutritional deprivation and the restoration of metabolic homeostasis: white adipose provides substrates and energy for hepatic glucose production and cardiopulmonary and central nervous system function, and products of fat metabolism inhibit muscle glucose uptake and utilization and spare muscle protein. Collectively, these effects maintain glucose availability for the brain, red blood cells, and renal medulla and conserve muscle mass. White adipose tissue also secretes leptin, which facilitates the immune response and may protect against mortality from infection. Euglycemia and survival in SAM are thereby prioritized over linear growth, which is suppressed owing to inhibition of insulin-like growth factor 1 production and action. Diversion of energy from growth serves to maintain essential bodily functions in critically ill malnourished children, who have limited energy reserves. Thus, short-term reductions in growth rate have adaptive benefits in SAM. Under favorable conditions, clinical and metabolic recovery are accompanied by catch-up growth, which can mitigate, and in many cases reverse, the stunting of growth in childhood. Nevertheless, clinical recovery can be complicated by preferential accrual of central fat and a relative deficiency of lean/skeletal mass, with potential long-term complications including insulin resistance, glucose intolerance, and metabolic syndrome. Full article

Anemia has been a growing concern for the pediatric population in sub-Saharan Africa. Emerging risk factors for anemia under five years of age in low-income countries are multifaceted, including infectious diseases, nutritional deficiencies, hidden hunger, and various economic determinants, and its health burdens include childhood stunting and reduced cognitive function diminished school performance in children. However, the influence of climatic factors, particularly ambient temperatures, on pediatric anemia remains understudied. In this population-based study, we assess the region-specific associations between pediatric anemia and ambient temperatures in 43 countries in Africa from 2000 to 2019. Using generalized linear regression models (upon adjusting for covariates), we found that the risk of temperatures on pediatric anemia varies across four African regions, whereby the Central and Southern African regions have a positive association between pediatric anemia and ambient temperatures, and Western and Eastern regions are negatively affected. The study aims to provide evidence to stakeholders to curtail the onset of pediatric anemia in high-risk African regions to set up key interventions based on the sustainability goals set by the World Health Organization. Full article

Stunting is a chronic growth disorder that not only affects height but may also impair craniofacial development. Facial proportions, especially in the vertical dimension, may provide additional anthropometric insight into growth status among children. Objectives: To assess and compare the vertical and horizontal facial proportions of stunted and non-stunted children, and to explore the potential of facial dimensions as supportive indicators for early-stunting detection in community-based settings. Methods: This cross-sectional analytical study involved 266 children aged 7–72 months (mean age 42.63 ± 13.82 months) from several community health centers in Bandung, Indonesia. Children were categorized as stunted or non-stunted based on WHO height-for-age Z-scores. Facial dimensions were measured directly by calibrated pediatric dentistry residents using manual instruments. The vertical dimensions included Nasion–Subnasale (N–SN) and Subnasale–Menton (SN–M), while horizontal dimensions included zygomatic width and intergonion width. Data were analyzed using the Mann–Whitney U test and Spearman correlation. Results: Significant differences were found in vertical facial dimensions between stunted and non-stunted children: median N–SN (32.4 mm vs. 33.6 mm; p = 0.003) and SN–M (42.5 mm vs. 45.1 mm; p < 0.001). No significant differences were observed in horizontal dimensions. All facial parameters showed a positive correlation with age (p < 0.001). No significant differences were found based on sex. Conclusions: Stunted children exhibited shorter vertical facial dimensions compared to their non-stunted peers, while horizontal dimensions remained stable across groups. Vertical facial proportions may serve as supportive indicators in the screening and monitoring of childhood stunting. This method has potential for integration into community-based growth monitoring using simple or digital anthropometric tools. Full article

Background/Objectives: Childhood stunting remains a critical public health issue in low- and middle-income countries. Despite Malaysia’s economic growth, there is limited large-scale evidence on the determinants of stunting among children from infancy to primary school age. This cross-sectional study, part of South East Asian Nutrition Surveys II (SEANUTS II), aimed to determine sociodemographic and environmental risk factors for stunting among 2989 children aged 0.5–12 years. Methods: Children were recruited from four regions in Peninsular Malaysia (Central, East Coast, 2022–2030Northern, Southern). Standing height or recumbent length was measured, and stunting was classified based on WHO criteria (height-for-age Z-score below −2 standard deviations). Parents reported information on socioeconomic status, sanitation facilities, and hygiene practices. Multivariate binary logistic regression was used to determine the determinants of stunting. Results: Stunting prevalence was 8.9%, with infants (aOR = 2.92, 95%CI:1.14–7.52) and young children (aOR = 2.92, 95%CI:1.80–4.76) having higher odds than school-aged children. Key biological predictors included low birth weight (aOR = 2.41; 95%CI:1.40–4.13) and maternal height <150 cm (aOR = 2.24; 95%CI:1.36–3.70). Chinese (aOR = 0.56; 95%CI:0.35–0.88) and Indian children (aOR = 0.16; 95%CI:0.05–0.52) had a lower risk of stunting compared to Malays. Conclusions: This study highlights the ongoing challenge of childhood stunting in Malaysia, with age, birth weight, ethnicity, and maternal height identified as key determinants. These findings call for early identification of at-risk households and targeted support, especially through education and financial aid to foster healthy child growth. Full article

Background: Worldwide, the awareness about childhood obesity as a public health concern is increasing, particularly in developing countries like Pakistan. Obesity during early childhood may persist into later ages, increasing the risk of chronic illnesses such as diabetes and hypertension. Objective: The aim of this study was to examine the relationship of different types of food groups with obesity among children with normal and stunted growth trajectories in Pakistan. Methods: This cross-sectional study conducted a secondary analysis of Pakistan Demographic and Health Surveys (PDHSs) conducted in the years 2012–2013 and 2017–2018. Data of 1230 healthy and obese children with either normal or stunted growth were analysed after excluding those who were aged below six months, wasted, underweight, or had missing anthropometric or dietary data. The relationship of different food groups with obesity among the children with normal and stunted growth was analysed by bivariate logistic regression. Results: The prevalence of paediatric obesity dropped from 7.3% in 2012–2013 to 2.4% in 2017–2018. However, the coexistence of stunting with obesity—termed the nutritional paradox—slightly increased from 2.8% in 2012–2013 to 3% in 2017–2018. Among the different food groups, the continuation of breastmilk was associated with lowering the odds of obesity by 69% (25% to 88%) among children with normal growth. Conversely, among children with stunted growth, the continuation of breastmilk was associated with an increase in the odds of obesity by 3.71 (1.08 to 12.62) times. Conclusion: Despite the 4.9% reduction in paediatric obesity, cases of the nutritional paradox are still escalating in Pakistan. This reflects an urgent need for targeted nutritional interventions to mitigate the impact of obesogenic diets and reduce the prevalence of childhood obesity in Pakistan. Full article

Background/Objectives: This study investigates the prevalence and impact of the double burden of malnutrition (DBM), malnutrition and overnutrition, in infants aged 0–24 months in the rural municipality of Ampefy, Itasy region, Madagascar. The Global Nutrition Report 2022 highlights the widespread issue of malnutrition, affecting 2 billion adults and 38 million children under five. Madagascar, characterized by severe poverty and high malnutrition rates, serves as a critical case study. Methods: A structured questionnaire was administered to 437 mother–child pairs from November 2022 to March 2023, collecting data on maternal education, dietary habits, and socio-economic status. Anthropometric measurements were taken using either a stadiometer or UNICEF length charts to assess height/length and an electronic scale to determine weight. Results: Findings reveal a high prevalence of malnutrition, with 29.7% of children affected by either wasting, stunting, and/or underweight, and 13.3% classified as overweight or obese. This study identifies significant age-related differences, with younger children more likely to be overweight and older children more likely to suffer from stunting or wasting. Maternal nutritional status, breastfeeding practices, and socio-economic conditions are strongly associated with child malnutrition outcomes. Lower dietary diversity among mothers and insufficient antenatal care are significant risk factors. Households with lower incomes and limited access to water and transport face higher malnutrition risks. Conclusions: This study underscores the critical need for targeted nutritional interventions and education to address DBM in Madagascar, highlighting the importance of maternal health and dietary diversity in early childhood development. Further longitudinal research is recommended to establish causality and develop comprehensive public health strategies. Full article

Background/Objectives: Anemia, particularly iron-deficiency anemia (IDA), and stunting remain notable early childhood public health challenges in Indonesia; however, studies are still scarce. This study aimed to determine the co-occurrence of anemia and stunting (CAS), their prevalence, and the associated factors, as well as to describe the erythrocyte parameters. Methods: Approximately 2200 children aged 6–24 months were identified by midwives to have problematic nutritional status at Bandung Regency, West Java, Indonesia. These children were included in the population frame for a cohort study of vitamin D deficiency, vitamin D binding protein, and its impact on neurodevelopmental functions. A cross-sectional study was nested in the cohort study. The subjects were selected by stratified random sampling of 270 villages to meet the required number of samples. Medical doctors reassessed the anthropometric measurements and performed guided interviews to collect associated factors for IDA and CAS. Erythrocyte profiles of the children were examined from venous blood. Results: One hundred and ninety-four subjects were included in the analysis, among which 54.1% were stunted. Anemia was present in 40.7% of the subjects, largely due to IDA (87.3%). A wasting child and the factor of low paternal education (up to elementary school) were associated with IDA (aOR of 7.12 and aOR of 3.32, p < 0.05, respectively). Co-occurrence of anemia and stunting was found in 41/194 (21.1%) subjects, but it did not show significant association. Conclusions: Anemia and stunting were prevalent among children aged 6–24 months, but no associations were found between anemia and stunting in this study. Iron deficiency was the main cause of anemia, and it was associated with wasting and low paternal education. Full article

Background: Childhood malnutrition remains a significant global public health concern. The Demographic and Health Surveys (DHS) program provides specific data on child health across numerous countries. This meta-analysis aims to comprehensively assess machine learning (ML) applications in DHS data to predict malnutrition in children. Methods: A comprehensive search of the peer-reviewed literature in PubMed, Embase, and Scopus databases was conducted in January 2024. Studies employing ML algorithms on DHS data to predict malnutrition in children under 5 years were included. Using PROBAST (Prediction model Risk Of Bias Assessment Tool), the quality of the listed studies was evaluated. To conduct meta-analyses, Review Manager 5.4 was used. Results: A total of 11 out of 789 studies were included in this review. The studies were published between 2019 and 2023, with the major contribution from Bangladesh (n = 6, 55%). Of these, ten studies reported stunting, three reported wasting, and four reported underweight. A meta-analysis of ten studies reported a pooled accuracy of 68.92% (95% CI: 66.04, 71.80; I² = 100%) among ML models for predicting stunting in children. Three studies indicated a pooled accuracy of 84.39% (95% CI: 80.90, 87.87; I² = 100%) in predicting wasting. A meta-analysis of four studies indicated a pooled accuracy of 73.60% (95% CI: 70.01, 77.20; I² = 100%) for ML models predicting underweight status in children. Conclusions: This meta-analysis indicated that ML models were observed to have moderate to good performance metrics in predicting malnutrition using DHS data among children under five years. Full article

Malnutrition and overweight are significant public health challenges, especially in low- and middle-income countries. In the Amazon, high rates of malnutrition and the alarming rise of obesity highlight persistent regional inequalities. Therefore, the aim of this study was to analyze spatial distributions and temporal trends of malnutrition among children under five, adults, and elderly individuals in primary healthcare services across municipalities in the Legal Amazon from 2013 to 2023. Methods: This ecological study used data from the Food and Nutritional Surveillance System (SISVAN). The analysis included the prevalences of underweight, overweight, and obesity, stratified by year, sex, and federative unit. Spatial distributions were analyzed using QGIS version 3.22, and temporal trends were assessed with Joinpoint version 4.6 and expressed as annual percentage changes (APCs) and 95% confidence intervals (95% CIs). Results: Between 2013 and 2023, SISVAN monitored 10,451,758 children under five years, 30,831,720 adults, and 4,456,650 elderly individuals in the Legal Amazon. Stunting in children under five years decreased from 20.45% to 15.30%, with a significant downward trend (APC: −2.7; 95% CI: −3.7; −1.6). Childhood overweight exhibited a general downward trend but with notable fluctuations. Overweight in adults increased from 48.85% to 64.64%, and obesity from 17.10% to 28.49%, both showing significant upward trends. For the elderly, underweight decreased from 17.47% to 13.04%, with a downward trend until 2018, while overweight increased from 42.35% to 48.22%, with a significant upward trend until 2017. Conclusions: Despite progress in reducing childhood underweight, its prevalence in the Legal Amazon remains high compared to national averages. Significant regional disparities and rising overweight rates among adults and elderly individuals indicate a need for targeted public health strategies to address these nutritional issues. Full article

Milk is the principal nutrient of newborn humans and a diagnostic feature of the order Mammalia. Its release is elicited as a reflex by infant sucking under the control of the hormone oxytocin. While it is recognized that breast milk optimally promotes infant longitudinal growth and development, this review explores facts and controversies regarding the extent to which the milks of several dairy animals and infant formula milk (IF) approximate special properties and bioactivities of breast milk. It also provides evidence that early exposure to undernutrition during the very rapid fetal and early infancy growth predominantly and permanently stunts longitudinal growth trajectory in both animals and humans and is often followed in later life by obesity and metabolic dysfunction, and sometimes also by precocious timing of sexual maturation. There is a knowledge gap as to whether there may be additional critical periods of nutritional vulnerability in human development, which is characterized by a relatively prolonged period of slow childhood growth bracketed by the rapid fetal–neonatal and pubertal growth spurts. It is also unclear whether any quantitative differences in caloric intake and supply during neonatal period may influence developmental fatness programming. A further knowledge gap exists regarding the role of infant microbiome composition and development in the possible epigenetic programming of longitudinal growth or fatness in later life. Extending the research of early developmental programming to the entire period of human growth from conception to the end of puberty, examining infant caloric intake and supply as possible factors modulating the epigenetic programming in favor of obesity, and examining the role of infant gut microbiome in developing infant’s capacity to process nutrients may provide a better understanding of the interaction between critical nutritional influences in the control of human longitudinal growth and later-life obesity. Full article