evidence-based blog of Filippo Dibari

Posts Tagged ‘research’

WHO: e-Library of Evidence for Nutrition Actions (eLENA), now on a mobile app

In Over-nutrition, Under-nutrition on June 16, 2017 at 8:26 pm

from WHO webpage

eLENA mobile phone application

Since 2011, the WHO e-Library of Evidence for Nutrition Actions (eLENA) has provided more than 1 million users with evidence-informed guidance and related information for nutrition interventions. Though the reach of eLENA continues to expand through a steady increase in the number of website users, there is a recognized need for access to eLENA content in settings without regular or reliable internet access.

In order to address this unmet need, the Nutrition Policy and Scientific Advice Unit of the WHO Department of Nutrition for Health and Development has developed an eLENA mobile phone application, eLENAmobile, which delivers much of the content of eLENA to smartphones and can be accessed anywhere – no internet connection required.

Download eLENAmobile for iPhones and Android smartphones now, at Google Play or the Apple App Store.

Training: 4th Annual Summer Institute for systematic reviews in nutrition for global policy-making

In Over-nutrition, Under-nutrition on March 17, 2017 at 3:14 pm

4th Annual Summer Institute for systematic reviews in nutrition for
global policy-making


World Health Organization (WHO)/Pan American Health Organization (PAHO) Collaborating Centre on implementation research in nutrition and global policy and Cochrane

Date: 24 July to 4 August 2017
Venue: Division of Nutritional Sciences, Cornell University Campus, Ithaca, NY, United States of America

Scope and purpose

The World Health Organization (WHO) follows a guideline development process, described in detail in the
WHO Handbook for Guideline Development (2nd edition), overseen by the Guidelines Review Committee (GRC) established by the Director-General in 2007. The WHO Guidelines Review Committee ensures that WHO guidelines are of a high methodological quality, developed using a transparent and explicit process, and are informed on high quality systematic reviews of the evidence using state-of–the art systematic search strategies, synthesis, quality assessments and methods.

The WHO Department of Nutrition for Health and Development has worked with the Cochrane editorial office and various groups within the Cochrane to produce systematic reviews for WHO nutrition guidelines since 2010. This allows for faster and prioritized completion of systematic reviews on the effects of interventions that contribute towards guideline development.

Cochrane is an international network of more than 28 000 people from over 120 countries working together to help health-care providers, policy-makers, and patients, their advocates and carers, make well-informed decisions about health care. This collaboration hosts the Cochrane Library and CENTRAL, the largest collection of records of randomized controlled trials in the world. On 24 January 2011, WHO awarded Cochrane a seat on the World Health Assembly, allowing the collaboration to provide input on WHO health resolutions.

In order to further increase capacity in systematic review methodology among nutrition scientists and practitioners, the WHO/PAHO Collaborating Centre on implementation research in nutrition and global policy, in collaboration with Cochrane has convened the Summer Institute for systematic reviews in nutrition for global policy-making in Ithaca, NY, United States of America since 2014. The 4th Annual Summer Institute will be held on 24 July to 4 August 2017.

This unique institute will bring together experts from WHO, PAHO, Cochrane, and Cornell University to train participants in the development of systematic reviews of nutrition interventions in public health following the Cochrane methodology. Participants will use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool to assess the overall quality of evidence.

The WHO/Cochrane/Cornell University Summer Institute for systematic reviews in nutrition for global policy-making is intended for nutrition scientists and practitioners from various fields with interest in the application of scientific evidence in policy making. Applications from women and from nationals of low- and middle-income countries are particularly encouraged. Partial financial support is available for limited number of accepted participants.

The objectives of this programme are:

• To update and develop technical skills and knowledge in systematic reviews of nutrition and nutrition-sensitive interventions;
• To build understanding of the process for global policy making in nutrition, and evidence assessment and its challenges;
• To complete hands-on training in the development of Cochrane systematic reviews on a topic of immediate global health relevance in nutrition and public health.

For additional information, please see the Summer Institute website (here). To apply, please submit your application materials to DNSDirector@cornell.edu at your earliest convenience. The Institute will process applications as they are received, therefore on a rolling basis, and will close the class when the limit of participants is reached. Once accepted, participants will receive a link with additional information for registration.

For further information and specific application instructions, visit this link: http://who-cochrane-cornell-summer-institute.nutrition.cornell.edu/


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Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers: results from a large-scale pragmatic trial in rural Niger

In Under-nutrition on September 14, 2016 at 9:59 pm

by Franck G.B. Alé, Kevin P.Q. Phelan, Hassan Issa, Isabelle Defourny, Guillaume Le Duc, Geza Harczi, Kader Issaley, Sani Sayadi, Nassirou Ousmane, Issoufou Yahaya, Mark Myatt, André Briend, Thierry Allafort-Duverger, Susan Shepherd and Nikki Blackwell



Community health workers (CHWs) are recommended to screen for acute malnutrition in the community by assessing mid-upper arm circumference (MUAC) on children between 6 and 59 months of age. MUAC is a simple screening tool that has been shown to be a better predictor of mortality in acutely malnourished children than other practicable anthropometric indicators. This study compared, under program conditions, mothers and CHWs in screening for severe acute malnutrition (SAM) by color-banded MUAC tapes.


This pragmatic interventional, non-randomized efficacy study took place in two health zones of Niger’s Mirriah District from May 2013 to April 2014. Mothers in Dogo (Mothers Zone) and CHWs in Takieta (CHWs Zone) were trained to screen for malnutrition by MUAC color-coded class and check for edema. Exhaustive coverage surveys were conducted quarterly, and relevant data collected routinely in the health and nutrition program. An efficacy and cost analysis of each screening strategy was performed.


A total of 12,893 mothers and caretakers were trained in the Mothers Zone and 36 CHWs in the CHWs Zone, and point coverage was similar in both zones at the end of the study (35.14 % Mothers Zone vs 32.35 % CHWs Zone, p = 0.9484). In the Mothers Zone, there was a higher rate of MUAC agreement (75.4 % vs 40.1 %, p <0.0001) and earlier detection of cases, with median MUAC at admission for those enrolled by MUAC <115 mm estimated to be 1.6 mm higher using a smoothed bootstrap procedure. Children in the Mothers Zone were much less likely to require inpatient care, both at admission and during treatment, with the most pronounced difference at admission for those enrolled by MUAC < 115 mm (risk ratio = 0.09 [95 % CI 0.03; 0.25], p < 0.0001). Training mothers required higher up-front costs, but overall costs for the year were much lower ($8,600 USD vs $21,980 USD.)


Mothers were not inferior to CHWs in screening for malnutrition at a substantially lower cost. Children in the Mothers Zone were admitted at an earlier stage of SAM and required fewer hospitalizations. Making mothers the focal point of screening strategies should be included in malnutrition treatment programs.

Trial registration

The trial is registered with clinicaltrials.gov (Trial number NCT01863394).

Why You Should Care About Nutrition

In Over-nutrition, Under-nutrition on September 10, 2016 at 10:39 am

Published on Sep 9, 2016

Subscribe to Dr. Greger’s free nutrition newsletter at http://www.nutritionfacts.org/subscribe and get a free excerpt from his latest NYT Bestseller HOW NOT TO DIE. (All proceeds Dr. Greger receives from his books, DVDs, and speaking go to charity).

DESCRIPTION: Most deaths in the United States are preventable and related to nutrition.

This video is part of an experiment to find ways to appeal to those new to the site. So much of what I do is targeted towards those who already know the basics, but in the user survey about a thousand of you filled out a few weeks ago, many of your asked for me to take a step back and do some videos targeted more towards those new to evidence-based nutrition.

So with the volunteer help of videographer Grant Peacock (http://www.gpi.tv/) I came up with ten introduction and overview-type videos for both new users to orient themselves, and for long-time users to use to introduce people to the site. If you missed The Story of NutritionFacts.org (http://nutritionfacts.org/video/the-s…) check that out, and stay tuned for:

• Taking Personal Responsibility for Your Health (http://nutritionfacts.org/video/takin…)
• The Philosophy of NutritionFacts.org (http://nutritionfacts.org/video/the-p…)
• Behind the Scenes at NutritionFacts.org (http://nutritionfacts.org/video/behin…)
• How Not to Die from Heart Disease (http://nutritionfacts.org/video/how-n…)
• How Not to Die from Cancer (http://nutritionfacts.org/video/how-n…)
• How Not to Die from Diabetes (http://nutritionfacts.org/video/how-n…)
• How Not to Die from Kidney Disease (http://nutritionfacts.org/video/how-n…)
• How Not to Die from High Blood Pressure (http://nutritionfacts.org/video/how-n…)

What we’re going to do is alternate between these broader overview-type videos and the regularly scheduled content so as not to bore those who just crave the latest science.

Have a question about this video? Leave it in the comment section at http://nutritionfacts.org/video/why-y… and someone on the NutritionFacts.org team will try to answer it.

Want to get a list of links to all the scientific sources used in this video? Click on Sources Cited at http://nutritionfacts.org/video/why-y…. You’ll also find a transcript of the video, my blog and speaking tour schedule, and an easy way to search (by translated language even) through our videos spanning more than 2,000 health topics.

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Thanks for watching. I hope you’ll join in the evidence-based nutrition revolution!
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The role of dairy in the comparative effectiveness and cost of fortified blended foods versus ready-to-use foods in treatment of children with moderate acute malnutrition

In Under-nutrition on June 6, 2016 at 8:41 pm

from FASEB journal

Authors:Devika J Suri, Denish Moorthy and Irwin H. Rosenberg1



Objective Recent meta-analyses found treating young children with MAM using ready-to-use foods (RUF) versus fortified blended foods (FBF) resulted in higher recovery rates and weight gain. This analysis aimed to compare studies of RUF and FBF with and without dairy to determine whether the addition of dairy to these food supplements modified the comparative effectiveness and cost of treatment.


Methods A review of literature on the comparative effectiveness of FBF and RUF in treatment of MAM was conducted. Outcomes of recovery from MAM, weight gain and length gain were compared among study cohorts, which included FBF with dairy (FBF+), FBF without dairy (FBF−), RUF with dairy (RUF+) and RUF without dairy (RUF−). Data on recovery from MAM was pooled among the 4 supplement categories. The cost per 500 kcal of each category of food supplement was averaged among studies that reported cost data.


Results Among the 7 studies included, 9 RUFs were tested, of which 5 contained dairy, and 9 FBFs were tested, of which 3 contained dairy. Children treated with RUF+ had higher recovery rates compared with FBF− in 5 out of 5 study cohorts, higher weight gain in 4 out of 4, and significantly higher length gain in 1 out of 4. Children treated with RUF+ vs FBF+ had higher recovery rates in 1 out of 2 study cohorts, with no differences in weight or length gain. No differences were found in the 2 studies comparing RUF− and FBF+. Finally, children treated with RUF− had higher recovery rates compared with FBF− in 1 of 2 studies, higher weight gain in 2 out of 2, and no differences in length gain. Recovery from MAM among the 7 studies was 65% (FBF−), 79% (FBF+), 82% (RUF−), and 80% (RUF+). Four of the 7 studies included cost data; on average per 500 kcal costs were $0.15 (FBF−), $0.18 (FBF+), $0.17 (RUF−), and $0.35 (RUF+).


Conclusion Our results suggest that addition of dairy to FBF make it comparative in effectiveness to both RUF with and without dairy, but does not appear to be a factor between the RUF categories. RUF with dairy was twice the cost per kcal compared with the other food supplement categories. Cost-effectiveness analysis will be useful to help determine the most appropriate food supplement for treatment of MAM.

Associations of Suboptimal Growth with All-Cause and Cause-Specific Mortality in Children under Five Years: A Pooled Analysis of Ten Prospective Studies

In Under-nutrition on June 3, 2016 at 3:38 pm

Olofin I, McDonald CM, Ezzati M, Flaxman S, Black RE, et al. (2013) Associations of Suboptimal Growth with All-Cause and Cause-Specific Mortality in Children under Five Years: A Pooled Analysis of Ten Prospective Studies. PLoS ONE 8(5): e64636.





Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies.


Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR) using proportional hazards models comparing children with mild (−2≤Z<−1), moderate (−3≤Z<−2), or severe (Z<−3) anthropometric deficits with the reference category (Z≥−1).


53 809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81) for mild underweight; 2.63 (2.20, 3.14) for moderate underweight; and 9.40 (8.02, 11.03) for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76) compared with 5.48 (4.62, 6.50) for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality.


All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases.

What are the implications for humanitarian programming of responding to stunting in protracted emergency contexts, and what should we be doing about it?

In Under-nutrition on June 3, 2016 at 7:43 am


from ENN

A number of recent reviews of crises, including Syria (ENN 2014), Lebanon and the Ukraine (GNC-ENN 2015) have raised questions about the humanitarian nutrition response in contexts where levels of wasting are not elevated or high in terms of emergency thresholds, but where stunting is prevalent.

ENN decided to investigate the implications of operating in situations of protracted crisis where levels of stunting may be high and of concern. This brief investigation included a review of documents and informal discussions with a number of nutrition focal points in some of the donors and agencies. The purpose is to begin to explore the issues and pose questions and in so doing get the issue of stunting in protracted contexts higher up the nutrition agenda

Download: Stunting-Brief-2015_WEB_01022016.pdf (PDF, 1.3mb)

Visiting Venice soon? Do not miss: “Dietary Innovation and Disease in the Nineteenth and Twentieth Centuries”

In Under-nutrition on June 3, 2016 at 7:09 am

from Dietary Innovation

San Servolo Island, Venice  /  8-10 June 2016

Gluten is seen as such a threat to health by some that foods that have never contained gluten are advertised as being ‘gluten-free’. In a range of popular health books and blogs, gluten—asociated with newer, high-yielding varieties of wheat, increased fertiliser and pesticide use, as well as modern bread-making processes—has been linked to autism, depression, Alzheimer’s, multiple sclerosis, diabetes and some skin diseases. The link between dietary innovation and disease, both perceived and real, is nothing new, of course. From deficiency diseases to food intolerances, the nineteenth and twentieth centuries witnessed numerous innovations in food production, preparation and consumption that impacted on health. What are the economics and politics of dietary change? What are the health risks? This international conference on Dietary Innovation and Disease aims to unpack these current concerns by historicising and contextualising the relationship between dietary change and health in the past.

This conference is being organised as part of the research project ‘Rough Skin: Maize, Pellagra and Society in Italy, 1750-1930’, PI Professor David Gentilcore, and is funded by the Economic and Social Research Council. The organisers are: David Gentilcore (School of History and Centre for Medical Humanities, University of Leicester) and Matthew Smith (Department of History and Centre for the Social History of Health and Healthcare, University of Strathclyde)

 Follow this link for the Call for Papers.

Follow this link for more information on the conference venue.

Also do not miss to check on these related events supported by the University Leicester:

  1. Rough Skin: Maize, Pellagra and Society in Italy, 1750-1930
  2. Exhibition: “Rough Skin”: Maize, Pellagra and Insanity in the Veneto, Italy, 1850-1900


ENN: The relationship between wasting and stunting: policy, programming and research implications (2014)

In Under-nutrition on April 24, 2015 at 6:16 am


by Tanya Khara and Carmel Dolan – from ENN website

Download – (4.2mb)

This paper is a narrative review of the available literature on the relationship between wasting andstunting. It was born out of previous work carried out by the ENN which illustrated the divide at programme, policy and financing level between wasting and stunting.

This divide ultimately has profound implications for how children worldwide receive nutrition interventions and services and, may well contribute to the lack of nutritional impact seen in programmes only addressing one part of the undernutrition problem.

Gaining a clearer and common understanding of the relationship between wasting and stunting has the potential to help governments and supporting organisations to better justify, design and evaluate programmes to improve childhood nutrition.

This paper aims to contribute to that clearer and common understanding.

Learning how programs achieve their impact: Embedding theory-driven process evaluation and other program learning mechanisms in Alive & Thrive

In Under-nutrition on September 7, 2014 at 2:02 pm

by Rawat, Rahul; Nguyen, Phuong H.; Ali, Disha; Saha, Kuntal; Alayon, Silvia; Kim, Sunny S.; Ruel, Marie; Menon, Purnima

from Food & Nutrition Bulletin, Volume 34, Supplement 2, September 2013, pp. 212S-225S(14)


Background. Traditionally, impact evaluations have focused primarily on answering what impact programs or interventions have, with less attention to how or why impacts are achieved, or not achieved. The Alive & Thrive initiative, a 6-year program that aims to improve infant and young child feeding (IYCF) practices and reduce stunting in Bangladesh, Ethiopia, and Vietnam, has a specific objective to generate learning on how to achieve and replicate Alive & Thrive’s impact.

Objective. In Alive & Thrive, theory-driven process evaluation methods are the primary mechanism through which data are generated to address this objective. This paper focuses on the different methodological approaches that are being utilized, to answer the critical “how” questions, and to generate information on the many processes and pathways to program impact.

Methods. We identify four key principles in our methodological approach that guides all process evaluation activities: 1) developing detailed program impact pathway (PIP) models, 2) linking data collection to PIPs utilizing mixed methods and multiple data sources, 3) linking evaluation activities with program implementation timelines, and 4) engaging with the program implementation and management teams.

Results. Beginning with the launch of the program, we outline the steps that have been taken in the design and implementation of the process evaluations of Alive & Thrive, and provide examples of how these steps have been operationalized in different country contexts.

Conclusions. This theory-driven and country- and component-specific approach, centered on careful analysis of PIPs, is intended to generate information on implementation and utilization pathways of Alive & Thrive’s interventions, thereby answering the questions of how impacts are achieved, or why not. This evaluation approach is not without challenges, and we highlight some of these key challenges.

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