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Archive for the ‘Under-nutrition’ Category

Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence

In Under-nutrition on June 3, 2019 at 9:49 am

by Jef L LeroyEdward A Frongillo on Advance in Nutrition journal

Advances in Nutrition, Volume 10, Issue 2, March 2019, Pages 196–204,

Abstract

The past decade has seen an unprecedented increase in attention to undernutrition, and drastically reducing child stunting has become a global development objective. The strong focus on linear growth retardation and stunting has enabled successful advocacy for nutrition, but with this focus has come some confusion and misunderstanding about the meaning of linear growth retardation and stunting among researchers, donors, and agencies active in nutrition.

Motivated by the belief that a sharp focus will further accelerate progress in reducing undernutrition, we critically reviewed the evidence. The global attention to stunting is based on the premise that any intervention aimed at improving linear growth will subsequently lead to improvements in the correlates of linear growth retardation and stunting.

Current evidence and understanding of mechanisms does not support this causal thinking, with 2 exceptions: linear growth retardation is a cause of difficult births and poor birth outcomes. Linear growth retardation is associated with (but does not cause) delayed child development, reduced earnings in adulthood, and chronic diseases. We thus propose distinguishing 2 distinctly different meanings of linear growth retardation and stunting.

First, the association between linear growth retardation (or stunting) and other outcomes makes it a useful marker.

Second, the causal links with difficult births and poor birth outcomes make linear growth retardation and stunting outcomes of intrinsic value.

In many cases a focus on linear growth retardation and stunting is not necessary to improve the well-being of children; in many other cases, it is not sufficient to reach that goal; and for some outcomes, promoting linear growth is not the most cost-efficient strategy.

We appeal to donors, program planners, and researchers to be specific in selecting nutrition outcomes and to target those outcomes directly.

Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali

In Under-nutrition on May 6, 2019 at 3:20 pm

source: BMJ webpage

By Sheila Isanaka1, Dale A Barnhart2, Christine M McDonald3, Robert S Ackatia-Armah4, Roland Kupka5, Seydou Doumbia6, Kenneth H Brown4, Nicolas A Menzies7

Abstract

Introduction Moderate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6–35 months of age in Mali.

Methods We conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn–soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal–legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.

Results Compared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.

Conclusion MAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.

Affiliation of the authors:

  1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. Children’s Hospital Oakland Research Institute, Oakland, California, USA
  4. Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, CA, USA
  5. United Nations Children’s Fund, Nutrition Section, New York, NY, USA
  6. Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
  7. Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  8. Correspondence toDr Sheila Isanaka; sisanaka@hsph.harvard.edu

WHO/Cochrane/Cornell Summer Institute for Systematic Reviews in Nutrition for Global Policy Making

In Over-nutrition, Under-nutrition on April 12, 2019 at 12:12 pm

source: Cornell Uni webpage.

July 15 – July 26, 2019, Cornell University, Ithaca campus

Overview

This unique institute on the Cornell University campus brings together experts from the World Health Organization (WHO), Cochrane, and Cornell University to train participants in the development of systematic reviews of nutrition interventions in populations.

Systematic reviews following the Cochrane methodology are used to ensure that WHO recommendations are based on sound evidence. Participants will learn to apply the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool to assess the overall quality of evidence.

Who should attend

The institute is intended for nutrition scientists and practitioners with interest in the application of scientific evidence in policy making. Candidates must have a university degree in health or social sciences with interest in nutrition interventions for public health and be willing to be registered as authors in a Cochrane Group.

Applications from women and from nationals of low- and middle-income countries are particularly encouraged.

Program benefits

In this program, you will:

  • update and develop your technical skills and knowledge in systematic reviews of nutrition and nutrition-sensitive interventions;
  • build understanding of the process for global policy making, nutrition, and evidence assessment and its challenges;
  • complete hands-on training in the development of Cochrane systematic reviews on a topic of immediate global health relevance in nutrition and public health; and
  • develop confidence with the review methods and foster development of professional networks with fellow participants and faculty

In the news

Summer course trains experts in WHO policies, Institute launched in 2014

The following article from the Cornell Chronicle, published July 8, 2014, describes our experiences in the first year of the Institute. The 2018 Summer Institute was our 5th Institute.

More than 30 nutrition experts from around the globe gathered at Cornell July 7-18, 2014, for hands-on training in World Health Organization (WHO) procedures to retrieve, summarize and assess reliable, current evidence to inform WHO’s recommendations for nutrition and public health policy.

Institute focuses on global nutrition policy impact

When the Division of Nutritional Sciences at Cornell University hosted the 4th annual Summer Institute for Systematic Reviews in Nutrition for Global Policy Making  from July 24 to August 4, 2017, its participants included 29 experts from around the world, and 10 faculty members from the World Health Organization (WHO), Cornell University and Cochrane.

Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems

In Over-nutrition, Under-nutrition on March 23, 2019 at 8:22 pm

Published: January 16, 2019 on The Lancet

Executive Summary 

Food systems have the potential to nurture human health and support environmental sustainability, however our current trajectories threaten both. The EAT–Lancet Commission addresses the need to feed a growing global population a healthy diet while also defining sustainable food systems that will minimise damage to our planet.   

The Commission quantitively describes a universal healthy reference diet, based on an increase in consumption of healthy foods (such as vegetables, fruits, whole grains, legumes, and nuts), and a decrease in consumption of unhealthy foods (such as red meat, sugar, and refined grains) that would provide major health benefits, and also increase the likelihood of attainment of the Sustainable Development Goals.

This is set against the backdrop of defined scientific boundaries that would ensure a safe operating space within six Earth systems, towards sustaining a healthy planet.  

The EAT–Lancet Commission is the first of a series of initiatives on nutrition led by The Lancet in 2019, followed by the Commission on the Global Syndemic of obesity, undernutrition, and climate change. Find out more in our Editorial.

Concurrent wasting and stunting among under‐five children in Niakhar, Senegal

In Under-nutrition on November 27, 2018 at 12:59 pm

by Garenne M, Myatt M, Khara T, Dolan C, Briend A.

2018 Oct 26:e12736

(download)

Abstract

Senegal; anthropometry; child survival; concurrent wasting & stunting; stunting; wasting

The study describes the patterns of concurrent wasting and stunting (WaSt) among children age 6-59 months living in the 1980s in Niakhar, a rural area of Senegal under demographic surveillance.

Wasting and stunting were defined by z scores lower than -2 in weight for height and height for age. Both conditions were found to be highly prevalent, wasting more so before age 30 months, stunting more so after age 30 months. As a result, concurrent WaSt peaked around age 18 months and its prevalence (6.2%) was primarily the product of the two conditions, with an interaction term of 1.57 (p < 10-6 ).

The interaction was due to the correlation between both conditions (more stunting if wasted, more wasting if stunted). Before age 30 months, boys were more likely to be concurrently wasted and stunted than girls (RR = 1.61), but the sex difference disappeared after 30 months of age.

The excess susceptibility of younger boys could not be explained by muscle mass or fat mass measured by arm or muscle circumference, triceps, or subscapular skinfold.

Concurrent WaSt was a strong risk factor for child mortality, and its effect was the product of the independent effect of each component, with no significant interaction.

 

 

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)

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