evidence-based blog of Filippo Dibari

Archive for the ‘Under-nutrition’ Category

Children who are both wasted and stunted are also underweight and have a high risk of death: a descriptive epidemiology of multiple anthropometric deficits using data from 51 countries

In Under-nutrition on October 9, 2018 at 7:04 pm

from BioMedCentral

By: Mark Myatt, Tanya Khara, Simon Schoenbuchner, Silke Pietzsch, Carmel Dolan, Natasha Lelijveld and André Briend.

Archives of Public Health201876:28

Background

Wasting and stunting are common. They are implicated in the deaths of almost two million children each year and account for over 12% of disability-adjusted life years lost in young children. Wasting and stunting tend to be addressed as separate issues despite evidence of common causality and the fact that children may suffer simultaneously from both conditions (WaSt). Questions remain regarding the risks associated with WaSt, which children are most affected, and how best to reach them.

Methods

A database of cross-sectional survey datasets containing data for almost 1.8 million children was compiled. This was analysed to determine the intersection between sets of wasted, stunted, and underweight children; the association between being wasted and being stunted; the severity of wasting and stunting in WaSt children; the prevalence of WaSt by age and sex, and to identify weight-for-age z-score and mid-upper arm circumference thresholds for detecting cases of WaSt. An additional analysis of the WHO Growth Standards sought the maximum possible weight-for-age z-score for WaSt children.

Results

All children who were simultaneously wasted and stunted were also underweight. The maximum possible weight-for-age z-score in these children was below − 2.35. Low WHZ and low HAZ have a joint effect on WAZ which varies with age and sex. WaSt and “multiple anthropometric deficits” (i.e. being simultaneously wasted, stunted, and underweight) are identical conditions. The conditions of being wasted and being stunted are positively associated with each other. WaSt cases have more severe wasting than wasted only cases. WaSt cases have more severe stunting than stunted only cases. WaSt is largely a disease of younger children and of males. Cases of WaSt can be detected with excellent sensitivity and good specificity using weight-for-age.

Conclusions

The category “multiple anthropometric deficits” can be abandoned in favour of WaSt. Therapeutic feeding programs should cover WaSt cases given the high mortality risk associated with this condition. Work on treatment effectiveness, duration of treatment, and relapse after cure for WaSt cases should be undertaken. Routine reporting of the prevalence of WaSt should be encouraged. Further work on the aetiology, prevention, case-finding, and treatment of WaSt cases as well as the extent to which current interventions are reaching WaSt cases is required.

Composition and Properties of Aquafaba: Water Recovered from Commercially Canned Chickpeas.

In Over-nutrition, Under-nutrition on September 30, 2018 at 4:37 am

by Shim YY1, Mustafa R2, Shen J2, Ratanapariyanuch K2, Reaney MJT3.

J Vis Exp. 2018 Feb 10;(132). doi: 10.3791/56305.

Abstract

Chickpea and other pulses are commonly sold as canned products packed in a thick solution or a brine. This solution has recently been shown to produce stable foams and emulsions, and can act as a thickener.

Recently interest in this product has been enhanced through the internet where it is proposed that this solution, now called aquafaba by a growing community, can be used a replacement for egg and milk protein.

As aquafaba is both new and being developed by an internet based community little is known of its composition or properties. Aquafaba was recovered from 10 commercial canned chickpea products and correlations among aquafaba composition, density, viscosity and foaming properties were investigated.

Proton NMR was used to characterize aquafaba composition before and after ultrafiltration through membranes with different molecular weight cut offs (MWCOs of 3, 10, or 50 kDa). A protocol for electrophoresis, and peptide mass fingerprinting is also presented. Those methods provided valuable information regarding components responsible for aquafaba functional properties.

This information will allow the development of practices to produce standard commercial aquafaba products and may help consumers select products of superior or consistent utility.

Aquafaba, wastewater from chickpea canning, functions as an egg replacer in sponge cake

In Over-nutrition, Under-nutrition on September 30, 2018 at 4:33 am
First published: 07 May 2018, https://doi.org/10.1111/ijfs.13813

Summary

Aquafaba, the viscous liquid resulting from cooking chickpeas in water is typically discarded. However, this solution is now widely used by the vegan community as an egg replacement that adds texture to food products, such as mayonnaise, pudding, ice cream and baked goods.

Sponge cake was prepared with either egg white or aquafaba derived from ten different brands of canned chickpea and the texture and colour were compared. Aquafaba obtained from each chickpea can produced foam which differed in both properties and stability.

In addition, aquafaba from some brands provided comparable foam volume and stability to that achieved with egg white.

The colour and texture of sponge cake made with either egg white or aquafaba were similar and acceptable, but cakes prepared with aquafaba were less springy, and less cohesive than cake that included egg white.

Based on our results, it appears that aquafaba has potential to replace egg white in eggless cake recipes.

Use of Mid-Upper Arm Circumference by Novel Community Platforms to Detect, Diagnose, and Treat Severe Acute Malnutrition in Children: A Systematic Review

In Under-nutrition on September 6, 2018 at 5:48 am

from: the Journal of Global Health Science and Practice

by Jessica Bliss, Natasha Lelijveld, André Briend, Marko Kerac, Mark Manary, Marie McGrath, Zita Weise Prinzo, Susan Shepherd, Noël Marie Zagre, Sophie Woodhead, Saul Guerrero and Amy Mayberry

Limited studies suggest that with robust program inputs caregivers and CHWs can correctly use mid-upper arm circumference to detect severe acute malnutrition (SAM) and that properly trained and supported CHWs can treat uncomplicated SAM in communities.

(download)

Abstract

Background: A stubborn persistence of child severe acute malnutrition (SAM) and continued gaps in program coverage have made identifying methods for expanding detection, diagnosis, and treatment of SAM an urgent public health need. There is growing consensus that making mid-upper arm circumference (MUAC) use more widely accessible among caregivers and community health workers (CHWs) is an important next step in further decentralizing SAM care and increasing program coverage, including the ability of CHWs to treat uncomplicated SAM in community settings.

 

Methods: We conducted a systematic review to summarize published and operational evidence published since 2000 describing the use of MUAC for detection and diagnosis of SAM in children aged 6–59 months by caregivers and CHWs, and of management of uncomplicated SAM by CHWs, all outside of formal health care settings. We screened 1,072 records, selected 43 records for full-text screening, and identified 22 studies that met our eligibility criteria. We extracted data on a number of items, including study design, strengths, and weaknesses; intervention and control; and key findings and operational lessons. We then synthesized the qualitative findings to inform our conclusions. The issue of treating children classified as SAM based on low weight-for-height, rather than MUAC, at household level, is not addressed in this review.

 

Findings: We found evidence that caregivers are able to use MUAC to detect SAM in their children with minimal risk and many potential benefits to early case detection and coverage. We also found evidence that CHWs are able to correctly use MUAC for SAM detection and diagnosis and to provide a high quality of care in the treatment of uncomplicated SAM when training, supervision, and motivation are adequate. However, the number of published research studies was small, their geographic scope was narrow, and most described intensive, small-scale interventions; thus, findings are not currently generalizable to public-sector health care systems.

 

Conclusions: Scaling up the use of MUAC by caregivers and CHWs to detect SAM in household and community settings is a promising step toward improving the coverage of SAM detection, diagnosis, and treatment. Further research on scalability, applicability across a wider range of contexts, coverage impact, and cost is needed. The primary use of MUAC for SAM detection should also be explored where appropriate.

Internship Opportunities with the WFP – Ethiopia

In Over-nutrition, Under-nutrition on September 5, 2018 at 7:00 pm

Background

Ethiopia has made important development gains over the past two decades, reducing poverty and expanding investments in basic social services. However, food insecurity and under-nutrition still hinder economic growth. In 2015 it ranked 174 out of 188 in the UNDP Human Development Report. The country is also home to the second largest refugee population on the continent; it currently hosts 909,000 registered refugees from South Sudan, Somalia, Sudan, Eritrea and Kenya. 2016 was a challenging year for Ethiopia as it suffered from the worst El Niño impact in the last 50 years. The onset of El Niño combined with failed Belg (spring harvest) and Meher (main harvest) rains in 2015 left 10.2 million people in need of emergency food and nutrition assistance. While the Government and partners averted a major humanitarian catastrophe, the drought has left a negative legacy on many families, who lost livestock and other productive assets. The residual needs from the past year have been compounded by a new and devastating drought which hit Ethiopia and other parts of the Horn of Africa in early 2017. In  August 2017, the Government of Ethiopia released the Mid-Year Humanitarian Requirements Document which outlined the need to support 8.5 million people with emergency food, nutrition, health, water and education programmes. WFP supports the Ethiopian Government through a range of life-saving and resilience-building activities as well as providing assistance in refugee camps. We use food, cash, nutrition assistance and innovative approaches to improve nutrition, empower women, build local capacities and enhance preparedness to climate-related shocks.

 

Opportunity – WFP Ethiopia Country Office seeks (1) graduate (BSc), and post-graduate (MSc) students looking for field-based dissertation topics, (2) BSc and MSc students already graduated within a year, looking for opportunity hands-on work experience, and (3) researchers looking for settings where to develop operational research topics. Background: Nutrition/Public Health/Epidemiology, Food Technology, Communication, Social Sciences, Logistics, Engineering, Economy and any other field related to food and nutrition.

 

More information

  • What? The interns will be integrated into WFP existing and/or about-to-start programmes. The potential areas include (1) integrated nutrition and food security surveillance, (2) treatment of moderate acute malnutrition, (3) development of social behavioural change communication to reduce stunting and wasting, (4) interlinkages between HIV and malnutrition, (5) food fortification, (6) nutrition advocacy, strategic evidence-based policy- and decision-making, (7) social protection in food insecure households.
  • When? Candidate can apply anytime during the year.
  • Where? According to the Terms of Reference (ToR) and the deliverables of the internship, the candidate will be placed either at WFP Country Office (Addis Abeba) and/or at the provincial Sub-Offices.
  • Supervised by who? Administratively the interns will be supervised by a WFP line manager. The ToR and the deliverables will be agreed by and with the candidate, eventually with the tutor of the institution of origin and WFP.
  • For how long? The duration of the internship will depend on the nature of the ToR and its deliverables.
  • Which kind of support? WFP has limited resources for support to internship programmes. Therefore, candidates are encouraged to rely on their own means of support for living, and international / national travel costs. WFP can cover at least the intern health insurance. Additional WFP support can be put under consideration in case of strong candidatures.
  • I am interested. How to apply? For an initial contact, get in touch with both Filippo Dibari (filippo.dibari@wfp.org) and Pauline Akabwai (pauline.akabwai@wfp.org). Note that the email subject should be reading exactlyinternship at WFP’). Be ready to submit curriculum vitae (one page max), provide specific evidence of your skills, undertake a written test and an interview, share reference contact details.

 

For further reading – Ethiopia nutrition profile – source: Global Nutrition Report 2017 (link  or under request) and WFP Ethiopia Country Profile (Link)

Impact of anthropogenic CO2 emissions on global human nutrition

In Under-nutrition on August 29, 2018 at 4:40 am

by Matthew R. Smith & Samuel S. Myers

Nature Climate Change volume 8pages 834–839 (2018) – link

Abstract

Atmospheric CO2 is on pace to surpass 550 ppm in the next 30–80 years. Many food crops grown under 550 ppm have protein, iron and zinc contents that are reduced by 3–17% compared with current conditions.

We analysed the impact of elevated CO2 concentrations on the sufficiency of dietary intake of iron, zinc and protein for the populations of 151 countries using a model of per-capita food availability stratified by age and sex, assuming constant diets and excluding other climate impacts on food production.

We estimate that elevated COcould cause an additional 175 million people to be zinc deficient and an additional 122 million people to be protein deficient (assuming 2050 population and CO2 projections).

For iron, 1.4 billion women of childbearing age and children under 5 are in countries with greater than 20% anaemia prevalence and would lose >4% of dietary iron.

Regions at highest riskSouth and Southeast Asia, Africa, and the Middle East—require extra precautions to sustain an already tenuous advance towards improved public health.

New book: Mass starvation – the history and future of famine

In Under-nutrition on August 23, 2018 at 9:32 pm

In Mass Starvation, world-renowned expert on humanitarian crisis and response, and WPF Executive Director, Alex de Waal, provides an authoritative history of modern famines: their causes, dimensions and why they ended. He analyses starvation as a crime, and breaks new ground in examining forced starvation as an instrument of genocide and war. Refuting the enduring but erroneous view that attributes famine to overpopulation and natural disaster, he shows how political decision or political failing is an essential element in every famine, while the spread of democracy and human rights, and the ending of wars, were major factors in the near-ending of this devastating phenomenon.

Hard-hitting and deeply informed, Mass Starvation (Polity Books, 2017) explains why man-made famine and the political decisions that could end it for good must once again become a top priority for the international community.

(from WPF web page)

 

 

Acceptability and Utilization of Three Nutritional Supplements during Pregnancy: Findings from a Longitudinal, Mixed-Methods Study in Niger

In Under-nutrition on August 23, 2018 at 9:21 pm

by Adrienne Clermont , Stephen R. Kodish , Amadou Matar Seck , Aichatou Salifou, Joseph Rosen, Rebecca F. Grais and Sheila Isanaka.

Nutrients 2018, 10(8), 1073; https://doi.org/10.3390/nu10081073

(download)

Abstract

Nutritional status in pregnancy is a key determinant of birth outcomes. In low-income countries, maternal diets are often limited, and daily nutrient supplements are recommended to fill nutrient gaps.

As a result, it is important to understand the factors influencing acceptability and utilization of nutrient supplements in these settings. Qualitative data (individual interviews and focus group discussions with pregnant women, household members, and study staff) and quantitative data (unannounced household spot checks) were collected in 24 villages in the Maradi region of south-central Niger.

Each village was randomly assigned to one of three study arms, with pregnant women receiving either iron and folic acid (IFA) supplements, multiple micronutrient (MMN) supplements, or medium-quantity lipid-based nutrient supplements (MQ-LNS) for daily consumption during pregnancy. Data were collected longitudinally to capture changes in perspective as women progressed through their pregnancy. Participants accepted all three supplement types, and perceived a wide range of health benefits attributed to supplement consumption.

However, several important barriers to appropriate consumption were reported, and rumors about the supplements leading to childbirth complications also decreased utilization. The household spot checks suggested that IFA had the highest level of correct consumption. Overall, despite a stated high level of acceptance and enthusiasm for the supplements among participants and their household members, certain fears, side effects, and organoleptic factors led to decreased utilization.

The effectiveness of future programs to improve maternal nutritional status through supplementation may be improved by understanding perceived barriers and facilitating factors among participants and tailoring communication efforts appropriately.

Position of the American Dietetic Association: vegetarian diets

In Over-nutrition, Under-nutrition on August 11, 2018 at 7:12 am

Craig WJ1, Mangels AR; American Dietetic Association.

(download pdf)

Abstract

It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. A vegetarian diet is defined as one that does not include meat (including fowl) or seafood, or products containing those foods.

This article reviews the current data related to key nutrients for vegetarians including protein, n-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. A vegetarian diet can meet current recommendations for all of these nutrients. In some cases, supplements or fortified foods can provide useful amounts of important nutrients. An evidence- based review showed that vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes.

The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians.

Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates. Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals.

The variability of dietary practices among vegetarians makes individual assessment of dietary adequacy essential. In addition to assessing dietary adequacy, food and nutrition professionals can also play key roles in educating vegetarians about sources of specific nutrients, food purchase and preparation, and dietary modifications to meet their needs.

Global Event: ACCELERATING THE END OF HUNGER AND MALNUTRITION

In Over-nutrition, Under-nutrition on August 10, 2018 at 5:25 am

source: conference web page

An IFPRI-FAO global event
November 28-30, 2018
Bangkok, Thailand
Improving food security and nutrition is critical to meeting the Sustainable  Development Goals (SDGs), but the world is not on track to end hunger and malnutrition by 2030.
How can we accelerate progress in transforming our agri-food systems to meet the needs of the hungry and malnourished?
To answer this question, the International Food Policy Research Institute (IFPRI) and the Food and Agriculture Organization of the United Nations (FAO) are organizing a global event on Accelerating the End of Hunger and Malnutrition on November 28-30, 2018 in Bangkok, Thailand
The event will share evidence and lessons learned from around the world on food system transformation for reducing hunger and malnutrition; explore innovations to build further momentum and accelerate progress; and identify opportunities for scaling up successful actions.
For more information, please go to the conference website.
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