evidence-based blog of Filippo Dibari

Posts Tagged ‘research’

Prenatal malnutrition and adult cognitive impairment: a natural experiment from the 1959–1961 Chinese famine

In Under-nutrition on May 10, 2018 at 8:39 pm

from British Journal of Nutrition – link

by Ping He, Li Liu, J. M. Ian Salas, Chao Guo, Yunfei Cheng, Gong Chen and Xiaoying Zheng 


The current measures of cognitive functioning in adulthood do not indicate a long-term association with prenatal exposure to the Dutch famine. However, whether such association emerges in China is poorly understood.

We aimed to investigate the potential effect of prenatal exposure to the 1959–1961 Chinese famine on adult cognitive impairment. We obtained data from the Second National Sample Survey on Disability implemented in thirty-one provinces in 2006, and restricted our analysis to 387 093 individuals born in 1956–1965.

Cognitive impairment was defined as intelligence quotient (IQ) score under 70 and IQ of adults was evaluated by the Wechsler Adult Intelligence Scale – China Revision. Famine severity was defined as excess death rate. The famine impact on adult cognitive impairment was estimated by difference-in-difference models, established by examining the variations of famine exposure across birth cohorts.

Results show that compared with adults born in 1956–1958, those who were exposed to Chinese famine during gestation (born in 1959–1961) were at greater risk of cognitive impairment in the total sample. Stratified analyses showed that this effect was evident in males and females, but only in rural, not in urban areas.

In conclusion, prenatal exposure to famine had an enduring deleterious effect on risk of cognitive impairment in rural adults.

Impact on birth weight and child growth of Participatory Learning and Action women’s groups with and without transfers of food or cash during pregnancy: Findings of the low birth weight South Asia cluster-randomised controlled trial (LBWSAT) in Nepal

In Under-nutrition on May 10, 2018 at 8:31 pm

from PlosOne website




Undernutrition during pregnancy leads to low birthweight, poor growth and inter-generational undernutrition. We did a non-blinded cluster-randomised controlled trial in the plains districts of Dhanusha and Mahottari, Nepal to assess the impact on birthweight and weight-for-age z-scores among children aged 0–16 months of community-based participatory learning and action (PLA) women’s groups, with and without food or cash transfers to pregnant women.


We randomly allocated 20 clusters per arm to four arms (average population/cluster = 6150). All consenting married women aged 10–49 years, who had not had tubal ligation and whose husbands had not had vasectomy, were monitored for missed menses. Between 29 Dec 2013 and 28 Feb 2015 we recruited 25,092 pregnant women to surveillance and interventions: PLA alone (n = 5626); PLA plus food (10 kg/month of fortified wheat-soya ‘Super Cereal’, n = 6884); PLA plus cash (NPR750≈US$7.5/month, n = 7272); control (existing government programmes, n = 5310). 539 PLA groups discussed and implemented strategies to improve low birthweight, nutrition in pregnancy and hand washing. Primary outcomes were birthweight within 72 hours of delivery and weight-for-age z-scores at endline (age 0–16 months). Only children born to permanent residents between 4 June 2014 and 20 June 2015 were eligible for intention to treat analyses (n = 10936), while in-migrating women and children born before interventions had been running for 16 weeks were excluded. Trial status: completed.


In PLA plus food/cash arms, 94–97% of pregnant women attended groups and received a mean of four transfers over their pregnancies. In the PLA only arm, 49% of pregnant women attended groups. Due to unrest, the response rate for birthweight was low at 22% (n = 2087), but response rate for endline nutritional and dietary measures exceeded 83% (n = 9242). Compared to the control arm (n = 464), mean birthweight was significantly higher in the PLA plus food arm by 78·0 g (95% CI 13·9, 142·0; n = 626) and not significantly higher in PLA only and PLA plus cash arms by 28·9 g (95% CI -37·7, 95·4; n = 488) and 50·5 g (95% CI -15·0, 116·1; n = 509) respectively. Mean weight-for-age z-scores of children aged 0–16 months (average age 9 months) sampled cross-sectionally at endpoint, were not significantly different from those in the control arm (n = 2091). Differences in weight for-age z-score were as follows: PLA only -0·026 (95% CI -0·117, 0·065; n = 2095); PLA plus cash -0·045 (95% CI -0·133, 0·044; n = 2545); PLA plus food -0·033 (95% CI -0·121, 0·056; n = 2507). Amongst many secondary outcomes tested, compared with control, more institutional deliveries (OR: 1.46 95% CI 1.03, 2.06; n = 2651) and less colostrum discarding (OR:0.71 95% CI 0.54, 0.93; n = 2548) were found in the PLA plus food arm but not in PLA alone or in PLA plus cash arms.


Food supplements in pregnancy with PLA women’s groups increased birthweight more than PLA plus cash or PLA alone but differences were not sustained. Nutrition interventions throughout the thousand-day period are recommended.

Trial registration


NO WASTED LIVES: the research agenda

In Under-nutrition on April 3, 2018 at 8:20 pm

from the webpage of No Wasted Lives

Screen Shot 2018-04-03 at 10.17.59 PM.png

The No Wasted Lives Coalition is investing in cutting edge ideas to drive forward global learning and action on acute malnutrition. As part of this effort, in 2018, No Wasted Lives and the Council of Research & Technical Advice (CORTASAM) launched the global Research Agenda for Acute Malnutrition and a call for Expressions of Interest from organisations working in research and programming for acute malnutrition and who want to support this effort. Our aim is to support coordination and concrete action across the sector, filling critical gaps and scaling-up evidence-based prevention and treatment of acute malnutrition.


Prioritising Research for Impact

The Council for Research and Technical Advice on Acute Malnutrition (CORTASAM) was assembled under No Wasted Lives with the goal to drive the use of evidence for action, in order to ultimately reach more children with effective treatment and prevention programmes.

Over the course of 2017, CORTASAM and No Wasted Lives launched a research prioritisation exercise, with the involvement and contribution of over 300 individuals from national governments, NGOs, academia, UN agencies and technical experts from around the world. In line with the priority research areas identified and a review of the existing evidence, CORTASAM has identified the following research areas with high potential impact on the effective management of acute malnutrition at scale but where further research and evidence generation is critically needed in order to achieve this:

  1. Effective approaches to detect, diagnose, and treat acute malnutrition in the community: taking community detection using mid-upper arm circumference (MUAC) to scale while building the evidence on diagnosis and treatment of acute malnutrition in the community across contexts and health platforms.
  2. Appropriate entry and discharge criteria for treatment of acute malnutrition to ensure optimum outcomes: building the evidence base on expanded MUAC thresholds for treatment to improve treatment outcomes for all children with acute malnutrition. Also needed is research to explore different options to identify high-risk children not selected by MUAC<115mm and analysis on the impact on burden estimates and operational feasibility, including supply and supply chain.
  3. Optimum dosage of ready-to-use food (RUF) for treatment of acute malnutrition:  investigating the safety, effectiveness, and cost-effectiveness of reduced dosage of RUF for treatment of acute malnutrition.
  4. Effective treatment of diarrhoea in children with severe acute malnutrition (SAM): using evidence to streamline guidance and generating implementation research to understand how the operational application of guidelines can inform improved practice and better treatment outcomes.
  5. Rates and causal factors of post-treatment relapse across contexts: understanding the burden of relapse post-treatment and, if found to be high, effective solutions to reduce relapse across contexts.
  6. Identification and management of at-risk mothers and of infants <6 months of age: generating the evidence required to influence country-level policies and implementation at scale.
  7. Alternative formulations for ready-to-use foods for acute malnutrition: continuation of the large amount of ongoing research to investigate the effectiveness, and cost-effectiveness, of formulas using alternative and local ingredient.

More details about the evidence gaps and CORTASAM’s call for more research can be found in the Research Agenda. Download it below.



In January 2018 we ran a call for Expressions of Interest in response to the Research Agenda. The call closed in February 2018 and applications are now being considered for possible donor funding. Download an overview of the submissions received here.

LSHTM: (free courses on) (1) ‘Agriculture, Nutrition and Health’ and (2) ‘Programming for Nutrition Outcomes Self enrolment’

In Over-nutrition, Under-nutrition on March 3, 2018 at 2:13 pm

Afbeeldingsresultaat voor lshtm logo

weblink source on Agriculture, Nutrition and Health

This open-access course has been designed to explore the multi-sectoral links between agriculture, nutrition and health, highlight current evidence and identify potential programmatic solutions.

A printed and personalised Certificate of Participation can be obtained for a fee of £30. In order to be eligible for a Certificate of Participation, registered participants must complete the assessment for the two core sessions (Sessions 1 and 2). This assessment is a set of multiple choice questions that can be found in the Certification for Core Sessions section. This assessment must be attempted in order to be eligible for a Certification of Participation, but there is no defined pass mark.

Afbeeldingsresultaat voor lshtm logo

weblink source on  Programming for Nutrition Outcomes

This course has been designed to explore the complicated problem of undernutrition, highlight its multi-sectoral causes and identify potential programmatic solutions. Chronic undernutrition affects nearly 200 million children in low- and middle-income countries and there is strong evidence that undernutrition is associated with up to 45% of all child deaths globally.

A printed and personalised Certificate of Participation can be obtained for a fee of £30. In order to be eligible for a Certificate of Participation, registered participants must complete the assessment for the three core sessions (Sessions 1 to 3). This assessment is a set of multiple choice questions that can be found in the Certification for Core Sessions section. This assessment must be attempted in order to be eligible for a Certification of Participation, but there is no defined pass mark.


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/


Subscription Details
You are subscribed to WHO Nutrition mailing list. To unsubscribe, visit:

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.

If you’d rather watch these videos on YouTube, subscribe to my YouTube Channel here: https://www.youtube.com/subscription_…

Thanks for watching. I hope you’ll join in the evidence-based nutrition revolution!
-Michael Greger, MD FACLM

• Subscribe: http://www.NutritionFacts.org/subscribe
• Donate: http://www.NutritionFacts.org/donate
• HOW NOT TO DIE: http://nutritionfacts.org/book
• Facebook: http://www.facebook.com/NutritionFact…
• Twitter: http://www.twitter.com/nutrition_facts
• Instagram: http://instagram.com/nutrition_facts_…
• Google+: https://plus.google.com/+Nutritionfac…
• Podcast: http://www.bit.ly/NFpodcast

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.

%d bloggers like this: