evidence-based blog of Filippo Dibari

Posts Tagged ‘children’

Breastfeeding: NOT good news in developing countries

In Under-nutrition on September 30, 2012 at 6:13 am

Global trends in exclusive breastfeeding

by Xiaodong Cai, Tessa Wardlaw and David W Brown

International Breastfeeding Journal 2012, 7:12 

(entire doc)




Infant and young child feeding is critical for child health and survival. Proportion of infants 0–5 months who are fed exclusively with breast milk is a common indicator used for monitoring and evaluating infant and young child feeding in a given country and region. Despite progress made since 1990, a previous review in 2006 of global and regional trends found improvement to be modest. The current study provides an update in global and regional trends in exclusive breastfeeding from 1995 to 2010, taking advantage of the wealth of data from recent household surveys.


Using the global database of infant and young child feeding maintained by the United Nations Children’s Fund, the authors examined estimates from 440 household surveys in 140 countries over the period between 1995 and 2010 and calculated global and regional averages of the rate of exclusive breastfeeding among infants 0–5 months for the two time points to assess the trends.


Trend data suggest the prevalence of exclusive breastfeeding among infants younger than six months in developing countries increased from 33% in 1995 to 39% in 2010. The prevalence increased in almost all regions in the developing world, with the biggest improvement seen in West and Central Africa.


In spite of the well-recognized importance of exclusive breastfeeding, the practice is not widespread in the developing world and increase on the global level is still very modest with much room for improvement. Child nutrition programmes worldwide continue to require investments and commitments to improve infant feeding practices in order to have maximum impact on children’s lives.

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Famine Exposure in the Young and the Risk of Type 2 Diabetes in Adulthood (n=7,837)

In Under-nutrition on September 28, 2012 at 9:26 am

Annet F.M. van AbeelenSjoerd G. EliasPatrick M.M. BossuytDiederick E. GrobbeeYvonne T. van der SchouwTessa J. Roseboom and Cuno S.P.M. Uiterwaal

in Diabetes. 2012 Sep;61(9):2255-60


The developmental origins hypothesis proposes that undernutrition during early development is associated with an increased type 2 diabetes risk in adulthood.

We investigated the association between undernutrition during childhood and young adulthood and type 2 diabetes in adulthood. We studied 7,837 women from Prospect-EPIC (European Prospective Investigation Into Cancer and Nutrition) who were exposed to the 1944-1945 Dutch famine when they were between age 0 and 21 years. We used Cox proportional hazards regression models to explore the effect of famine on the risk of subsequent type 2 diabetes in adulthood. We adjusted for potential confounders, including age at famine exposure, smoking, and level of education.

Self-reported famine exposure during childhood and young adulthood was associated with an increased type 2 diabetes risk in a dose-dependent manner. In those who reported moderate famine exposure, the age-adjusted type 2 diabetes hazard ratio (HR) was 1.36 (95% CI [1.09-1.70]); in those who reported severe famine exposure, the age-adjusted HR was 1.64 (1.26-2.14) relative to unexposed women. These effects did not change after adjustment for confounders.

This study provides the first direct evidence, using individual famine exposure data, that a short period of moderate or severe undernutrition during postnatal development increases type 2 diabetes risk in adulthood.

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Nutrition Barometer – Measuring What Matters

In Under-nutrition on September 26, 2012 at 5:43 pm

from 2000 days web site:

“Recently, Save the Children and World Vision joined forces to launch a ground-breaking Nutrition Barometer that examines the progress being made to improve nutrition in the 36 countries that are home to 90% of the world’s malnourished children.

“The Nutrition Barometer measures the political and financial commitments made by governments to tackle malnutrition, and looks at progress in transforming these commitments into real improvements for mothers and children.

“Of the countries profiled, Guatemala, Malawi and Peru –all SUN countries– are making the greatest strides against malnutrition, while the Democratic Republic of Congo, India and Yemen show the weakest performance, with frail commitments and poor outcomes for children.

“The Nutrition Barometer stresses the need to hold governments accountable for sustaining nutrition investments over the long-term in order to reverse the “unacceptably high levels” of chronic malnutrition and child mortality.”

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(Chinese trial:) β-Carotene in Golden Rice is as good as β-carotene in oil at providing vitamin A to children

In Under-nutrition on September 20, 2012 at 8:46 am

Guangwen TangYuming HuShi-an YinYin WangGerard E DallalMichael A Grusak, and Robert M Russell

Am J Clin Nutr September 2012 



Background: Golden Rice (GR) has been genetically engineered to be rich in β-carotene for use as a source of vitamin A.

Objective: The objective was to compare the vitamin A value of β-carotene in GR and in spinach with that of pure β-carotene in oil when consumed by children.

Design: Children (n = 68; age 6–8 y) were randomly assigned to consume GR or spinach (both grown in a nutrient solution containing 23 atom% 2H2O) or [2H8]β-carotene in an oil capsule. The GR and spinach β-carotene were enriched with deuterium (2H) with the highest abundance molecular mass (M) at Mβ-C+2H10. [13C10]Retinyl acetate in an oil capsule was administered as a reference dose. Serum samples collected from subjects were analyzed by using gas chromatography electron-capture negative chemical ionization mass spectrometry for the enrichments of labeled retinol: Mretinol+4 (from [2H8]β-carotene in oil), Mretinol+5 (from GR or spinach [2H10]β-carotene), and Mretinol+10 (from [13C10]retinyl acetate).

Results: Using the response to the dose of [13C10]retinyl acetate (0.5 mg) as a reference, our results (with the use of AUC of molar enrichment at days 1, 3, 7, 14, and 21 after the labeled doses) showed that the conversions of pure β-carotene (0.5 mg), GR β-carotene (0.6 mg), and spinach β-carotene (1.4 mg) to retinol were 2.0, 2.3, and 7.5 to 1 by weight, respectively.

Conclusions: The β-carotene in GR is as effective as pure β-carotene in oil and better than that in spinach at providing vitamin A to children. A bowl of ∼100 to 150 g cooked GR (50 g dry weight) can provide ∼60% of the Chinese Recommended Nutrient Intake of vitamin A for 6–8-y-old children. This trial was registered at http://www.clinicaltrials.gov as NCT00680212.

Feel free to suggest web sites which debate the results from this study. Thanks. fil

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NY Museum of Modern Art (MOMA) and…children acute malnutrition

In Uncategorized, Under-nutrition on September 10, 2012 at 8:15 am

An email from a dear friend nutritionist of mine recently informed me that…

“…the Museum of Modern Art (MOMA) in New York is doing an exhibition on the ‘century of the child: growing by design 1900-2000.

“…a diverse array of ideas, practitioners and objects illustrates how progressive design has informed the physical, intellectual, and emotional development of children….”

You can click here to see the web site.

But the interesting part of the email was to come:

“…if you click on designing better worlds 1960’s to 2000 there is a Middle-upper Arm Circumference tape (MUAC)…. Ok it is the wrong one, called a funny name and it’s origins are wrongly quoted. But it’s there and it has the red yellow and green that we so love. A design classic.. Pretty cool I thought.

“Lots of other interesting stuff there from lego and spacehoppers to a cardboard carseat (yes they include design mistakes!), Bennetons advert showing children labour, and one of those working wire cars made by a child in south africa, BUT definitely no scales or height boards… Hurrah!!

I hope you also will enjoy this event/web site. Have a nice week.

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Ready to Use Therapeutic Foods (RUTF) improves undernutrition among ART-treated, HIV-positive children in Dar es Salaam, Tanzania

In Under-nutrition on September 1, 2012 at 3:31 pm

Bruno F Sunguya, Krishna C Poudel, Linda B Mlunde, Keiko Otsuka, Junko Yasuoka, David P Urassa, Namala P Mkopi and Masamine Jimba

Nutrition Journal 2012, 11:60 

(entire doc)



HIV/AIDS is associated with an increased burden of undernutrition among children even under antiretroviral therapy (ART). To treat undernutrition, WHO endorsed the use of Ready to Use Therapeutic Foods (RUTF) that can reduce case fatality and undernutrition among ART-naive HIV-positive children. However, its effects are not studied among ART-treated, HIV-positive children. Therefore, we examined the association between RUTF use with underweight, wasting, and stunting statuses among ART-treated HIV-positive children in Dar es Salaam, Tanzania.


This cross-sectional study was conducted from September-October 2010. The target population was 219 ART-treated, HIV-positive children and the same number of their caregivers. We used questionnaires to measure socio-economic factors, food security, RUTF-use, and ART-duration. Our outcome variables were underweight, wasting, and stunting statuses.


Of 219 ART-treated, HIV-positive children, 140 (63.9%) had received RUTF intervention prior to the interview. The percentages of underweight and wasting among non-RUTF-receivers were 12.4% and 16.5%; whereas those of RUTF-receivers were 3.0% (P = 0.006) and 2.8% (P = 0.001), respectively. RUTF-receivers were less likely to have underweight (Adjusted Odd Ratio (AOR) =0.19, CI: 0.04, 0.78), and wasting (AOR = 0.24, CI: 0.07, 0.81), compared to non RUTF-receivers. Among RUTF receivers, children treated for at least four months (n = 84) were less likely to have underweight (P = 0.049), wasting (P = 0.049) and stunting (P < 0.001).


Among HIV-positive children under ART, the provision of RUTF for at least four months was associated with low proportions of undernutrition status. RUTF has a potential to improve undernutrition among HIV-positive children under ART in the clinical settings in Dar es Salaam, Tanzania.

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Maternal Multiple Micronutrient Supplements and Child Cognition: A Randomized Trial in Indonesia

In Under-nutrition on September 1, 2012 at 7:20 am

Elizabeth L. PradoKatherine J. AlcockHusni MuadzMichael T. UllmanAnuraj H. Shankar, for the SUMMIT Study Group

Pediatrics. August 20, 2012


OBJECTIVES: We investigated the relative benefit of maternal multiple micronutrient (MMN) supplementation during pregnancy and until 3 months postpartum compared with iron/folic acid supplementation on child development at preschool age (42 months).

METHODS: We assessed 487 children of mothers who participated in the Supplementation with Multiple Micronutrients Intervention Trial, a cluster-randomized trial in Indonesia, on tests adapted and validated in the local context measuring motor, language, visual attention/spatial, executive, and socioemotional abilities. Analysis was according to intention to treat.

RESULTS: In children of undernourished mothers (mid-upper arm circumference <23.5 cm), a significant benefit of MMNs was observed on motor ability (B = 0.39 [95% confidence interval (CI): 0.08–0.70]; P = .015) and visual attention/spatial ability (B = 0.37 [95% CI: 0.11–0.62]; P = .004). In children of anemic mothers (hemoglobin concentration <110 g/L), a significant benefit of MMNs on visual attention/spatial ability (B = 0.24 [95% CI: 0.02–0.46]; P = .030) was also observed. No robust effects of maternal MMN supplementation were found in any developmental domain over all children.

CONCLUSIONS: When pregnant women are undernourished or anemic, provision of MMN supplements can improve the motor and cognitive abilities of their children up to 3.5 years later, particularly for both motor function and visual attention/spatial ability. Maternal MMN but not iron/folic acid supplementation protected children from the detrimental effects of maternal undernutrition on child motor and cognitive development.

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Efficacy of a high-dose in addition to daily low-dose vitamin A in children suffering from severe acute malnutrition with other illnesses

In Under-nutrition on August 29, 2012 at 11:49 am

by Sattar SAhmed TRasul CHSaha DSalam MAHossain MI

PLoS One. 2012;7(3):e33112. Epub 2012 Mar 27

(download the entire paper)



Efficacy of high-dose vitamin A (VA) in children suffering from severe acute malnutrition (SAM) has recently been questioned. This study compared the efficacy of a single high-dose (200,000 IU) in addition to daily low-dose (5000 IU) VA in the management of children suffering from SAM with diarrhea and/or acute lower respiratory tract infection (ALRI).


In a randomized, double-blind, controlled clinical trial in icddr,b, Bangladesh during 2005-07, children aged 6-59 months with weight-for-height <-3 Z-score and/or bipedal edema (SAM) received either a high-dose VA or placebo on admission day. Both the groups received 5,000 IU/day VA in a multivitamins drop for 15 days and other standard treatment which is similar to WHO guidelines.


A total 260 children (130 in each group) were enrolled. All had diarrhea, 54% had concomitant ALRI, 50% had edema, 48.5% were girl with a mean±SD age of 16±10 months. None had clinical signs of VA deficiency. Mean±SD baseline serum retinol was 13.15±9.28 µg/dl, retinol binding protein was 1.27±0.95 mg/dl, and pre-albumin was 7.97±3.96 mg/dl. Median (inter quartile range) of C-reactive protein was 7.8 (2.1, 22.2) mg/L. Children of the two groups did not differ in any baseline characteristic. Over the 15 days treatment period resolution of diarrhea, ALRI, edema, anthropometric changes, and biochemical indicators of VA were similar between the groups. The high-dose VA supplementation in children with SAM did not show any adverse event.


Efficacy of daily low-dose VA compared to an additional single high-dose was not observed to be better in the management of children suffering from SAM with other acute illnesses. A single high-dose VA may be given especially where the children with SAM may leave the hospital/treatment center early.

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An evaluation of an operations research project to reduce childhood stunting in a food-insecure area in Ethiopia

In Under-nutrition on August 28, 2012 at 8:52 pm

by Bridget Fenn, Assaye T Bulti, Themba Nduna, Arabella Duffield and Fiona Watson

Public Health Nutrition / Volume 15 / Issue 09 / September 2012 , pp 1746-1754


Objective To determine which interventions can reduce linear growth retardation (stunting) in children aged 6–36 months over a 5-year period in a food-insecure population in Ethiopia.

Design We used data collected through an operations research project run by Save the Children UK: the Child Caring Practices (CCP) project. Eleven neighbouring villages were purposefully selected to receive one of four interventions: (i) health; (iii) nutrition education; (iii) water, sanitation and hygiene (WASH); or (iv) integrated comprising all interventions. A comparison group of three villages did not receive any interventions. Cross-sectional surveys were conducted at baseline (2004) and for impact evaluation (2009) using the same quantitative and qualitative tools. The primary outcome was stunted growth in children aged 6–36 months measured as height (or length)-for-age Z-scores (mean and prevalence). Secondary outcomes were knowledge of health seeking, infant and young child feeding and preventive practices.

Setting Amhara, Ethiopia.

Subjects Children aged 6–36 months.

Results The WASH intervention group was the only group to show a significant increase in mean height-for-age Z-score (+0·33, P = 0·02), with a 12·1 % decrease in the prevalence of stunting, compared with the baseline group. This group also showed significant improvements in mothers’ knowledge of causes of diarrhoea and hygiene practices. The other intervention groups saw non-significant impacts for childhood stunting but improvements in knowledge relating to specific intervention education messages given.

Conclusions The study suggests that an improvement in hygiene practices had a significant impact on stunting levels. However, there may be alternative explanations for this and further evidence is required.

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An effectiveness trial showed lipid-based nutrient supplementation but not corn–soya blend offered a modest benefit in weight gain among 6- to 18-month-old underweight children in rural Malawi

In Under-nutrition on August 28, 2012 at 8:44 pm

by Chrissie M Thakwalakwa, Per Ashorn, Mpumulo Jawati, John C Phuka, Yin Bun Cheung and Kenneth M Maleta

Public Health Nutrition / Volume 15 / Issue 09 / September 2012 , pp 1755-1762


 Objective To determine if supplementation with corn–soya blend (CSB) or lipid-based nutrient supplement (LNS) improved the weight gain of moderately underweight infants and children when provided through the national health service.

Design A randomised, controlled, assessor-blinded clinical trial. Infants and children were randomised to receive for 12 weeks an average daily ration of 71 g CSB or 43 g LNS, providing 1188 kJ and 920 kJ, respectively, or no supplement (control). Main outcome was weight gain. Secondary outcomes included changes in anthropometric indices and incidence of serious adverse events. Intention-to-treat analyses were used.

Setting Kukalanga, Koche, Katema and Jalasi health centres in Mangochi District, rural Malawi.

Subjects Underweight (weight-for-age Z-score <−2) infants and children aged 6–15 months (n 299).

Results Mean weight gain was 630 g, 680 g and 750 g in control, CSB and LNS groups, respectively (P = 0·21). When adjusted for baseline age, children receiving LNS gained on average 90 g more weight (P = 0·185) and their weight-for-length Z-score increased 0·22 more (P = 0·049) compared with those receiving no supplementation. No statistically significant differences were observed between the CSB and control groups in mean weight and length gain.

Conclusions LNS supplementation provided during the lean season via through the national health service was associated with a modest increase in weight. However, the effect size was lower than that previously reported under more controlled research settings.

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