evidence-based blog of Filippo Dibari

Posts Tagged ‘undernutrition’

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


WHO: Updates on the management of severe acute malnutrition in infants and children Guideline

In Under-nutrition on April 27, 2015 at 7:02 am

(from WHO website)

Publication details

Editors: World Health Organization – 2013
Number of pages: 111
Languages: English, French

(Full document)


This guideline provides global, evidence-informed recommendations on a number of specific issues related to the management of severe acute malnutrition in infants and children, including in the context of HIV.

The guideline will help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions for severely malnourished children. It will also support Member States in their efforts to achieve global targets on the maternal, infant and young child nutrition comprehensive implementation plan, especially global target 1, which entails achieving 40% reduction by 2025 of the global number of children under 5 years who are stunted and global target 6 that aims to reduce and maintain childhood wasting to less than 5%.

The guideline is intended for a wide audience, including policy-makers, their expert advisers, and technical and programme staff in organizations involved in the design, implementation and scaling-up of nutrition actions for public health. The guideline will form the basis for a revised manual on the management of severe malnutrition for physicians and other senior health workers, and a training course on the management of severe malnutrition.


Reaching the missing middle: Overcoming hunger and malnutrition in middle income countries

In Over-nutrition, Under-nutrition on April 23, 2015 at 7:00 am

by Shenggen Fan and Ertharin Cousin

wfp logo

from WFP web site

(download entire document)

Hunger and malnutrition are not problems exclusive to low income countries.

That is why the international community cannot realise its ambitious international agenda of achieving zero hunger and malnutrition without a renewed focus on countries in economic transition where hunger and malnutrition remain.

The majority of the world’s hungry and malnourished population now live in Middle Income Countries (MICs).

For these countries to best fulfil their vital role in supporting zero hunger and malnutrition, they must promote effective country-led strategies that will reduce hunger and malnutrition at home.

Global Nutrition Report 2014

In Over-nutrition, Under-nutrition on November 18, 2014 at 4:19 pm

November 13, 2014 by

The first-ever Global Nutrition Report provides a comprehensive narrative and analysis on the state of the world’s nutrition.

Download the 2014 Global Nutrition Report

More information:

Technical Meeting on Nutrition – Oxford, UK: 7th, 8th and 9th October 2014

In Over-nutrition, Under-nutrition on April 15, 2014 at 10:55 am

CaptureCall for Abstracts/Summaries

 Introduction – The ENN will host a 3 day meeting in Oxford, UK, from 7th – 9th October 2014. The aim of the meeting is to facilitate a technical learning and networking meeting on nutrition specific and nutrition sensitive[1] programming in emergencies and high burden contexts[2]; to inform better practice, research priorities and advocacy. The meeting will engage a broad audience (up to 200 participants) that includes NGOs, UN agencies, academia, bilateral and multilateral donors, foundations, private sector and government representatives.

The meeting will connect with other nutritional fora planned for 2014 to maximise relevance, such as; the Global Nutrition Cluster meetings, the World Health Assembly and the ICN-2. The ENN will document and rapidly share the meeting discussions and outcomes.

Meeting format – The meeting will use formal and informal approaches to present, share and discuss research, policy and programming through a combination of the following:

  • Plenary presentations
  • ‘Market place’ presentations
  • Panel Q & A discussions
  • Technical development networking opportunities such as active networking and space and bookings for pre-identified side meetings (which, in some cases, may be by invitation only)

 Thematic Areas – A process of identification and prioritisation of thematic areas for the meeting has been undertaken by the TMN Steering Committee. The highest ranked thematic areas have been identified as follows:

1)     Adolescent and maternal nutrition programming and research

2)     Nutrition within the basic package of health services

3)     Cash transfer programming (conditional and unconditional), and combinations of cash with other sectoral interventions

4)     Nutrition resilience – programming and evidence

 A further six thematic areas have also been identified and will be addressed at the meeting:

5)     Innovative financing in humanitarian and high burden contexts

6)     Nutrition and WASH programming and research

7)     Governance across the nutrition sector (institutional architecture, mandate challenges, successes and challenges strengthening governance)

8)     Nutrition sensitive agricultural programming and evidence

9)     M&E, global and national systems; innovation, standardisation and alignment

10)   Links between wasting & stunting (research and evidence)

 We seek abstracts on these 10 thematic areas. Abstracts that address the top four priority themes will be favoured for presentation in the plenary sessions (although abstracts that describe ‘cutting edge’ research or programming may also be selected for presentation at plenary). Abstracts that speak to themes 5-10 will be considered for presentation in the side meetings and in the market place forum, in particular.

A series of cross-cutting questions will be developed over the next two months that presentations selected for plenary will be asked to consider (you will be informed by the meeting organisers, as required).

Required information for abstract/summary submissions – An abstract submission template is available clicking here.  The abstracts/summaries to be submitted must be no longer than 300 words. All must be received by Friday 30th May 2014. Please submit your abstract to the following address: tmnabstracts@ennonline.net. You will receive an automatic email saying that it has been received.  After review of your submitted abstract/summary (likely between 2 and 4 weeks from submission), one of three things will happen.

–          It will be accepted for presentation at plenary

–          It will be accepted for the marketplace

–          It will not be accepted

You will be informed of the decision by email as soon as possible.

All attendees will be self-funding (unless you have secured funding from alternative sources) as there is no funding available from the ENN for attendance of presenters.


[1] Programmes whose primary objectives are not specific to nutrition but have the potential for nutrition impact.

[2] ‘High burden contexts’ refers to countries with high rates of undernutrition and/or those facing the double burden of malnutrition.




Association between economic growth and early childhood undernutrition: evidence from 121 Demographic and Health Surveys from 36 low-income and middle-income countries

In Under-nutrition on April 2, 2014 at 5:06 pm

by  Sebastian Vollmer, Kenneth Harttgen, Malavika A Subramanyam, Jocelyn Finlay, Stephan Klasen, S V Subramanian

The Lancet Global Health. Volume 2, Issue 4, April 2014, Pages e225–e234




Economic growth is widely regarded as a necessary, and often sufficient, condition for the improvement of population health. We aimed to assess whether macroeconomic growth was associated with reductions in early childhood undernutrition in low-income and middle-income countries.


We analysed data from 121 Demographic and Health Surveys from 36 countries done between Jan 1, 1990, and Dec 31, 2011. The sample consisted of nationally representative cross-sectional surveys of children aged 0–35 months, and the outcome variables were stunting, underweight, and wasting. The main independent variable was per-head gross domestic product (GDP) in constant prices and adjusted for purchasing power parity. We used logistic regression models to estimate the association between changes in per-head GDP and changes in child undernutrition outcomes. Models were adjusted for country fixed effects, survey-year fixed effects, clustering, and demographic and socioeconomic covariates for the child, mother, and household.


Sample sizes were 462 854 for stunting, 485 152 for underweight, and 459 538 for wasting. Overall, 35·6% (95% CI 35·4–35·9) of young children were stunted (ranging from 8·7% [7·6–9·7] in Jordan to 51·1% [49·1–53·1] in Niger), 22·7% (22·5–22·9) were underweight (ranging from 1·8% [1·3–2·3] in Jordan to 41·7% [41·1–42·3] in India), and 12·8% (12·6–12·9) were wasted (ranging from 1·2% [0·6–1·8] in Peru to 28·8% [27·5–30·0] in Burkina Faso). At the country level, no association was seen between average changes in the prevalence of child undernutrition outcomes and average growth of per-head GDP. In models adjusted only for country and survey-year fixed effects, a 5% increase in per-head GDP was associated with an odds ratio (OR) of 0·993 (95% CI 0·989–0·995) for stunting, 0·986 (0·982–0·990) for underweight, and 0·984 (0·981–0·986) for wasting. ORs after adjustment for the full set of covariates were 0·996 (0·993–1·000) for stunting, 0·989 (0·985–0·992) for underweight, and 0·983 (0·979–0·986) for wasting. These findings were consistent across various subsamples and for alternative variable specifications. Notably, no association was seen between per-head GDP and undernutrition in young children from the poorest household wealth quintile. ORs for the poorest wealth quintile were 0·997 (0·990–1·004) for stunting, 0·999 (0·991–1·008) for underweight, and 0·991 (0·978–1·004) for wasting.


A quantitatively very small to null association was seen between increases in per-head GDP and reductions in early childhood undernutrition, emphasising the need for direct health investments to improve the nutritional status of children in low-income and middle-income countries.

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PROFILES: A Data Based Approach to Nutrition Advocacy and National Development

In Under-nutrition on December 15, 2013 at 9:20 am


From Fanta III website

“PROFILES is an evidence-based advocacy tool to support increased political and social commitment to nutrition. PROFILES uses computer models and up-to-date country-specific data to project, over a defined period of time, the consequences that malnutrition will have on national development. It estimates the cost savings that reducing malnutrition will have over that time period in terms of lives improved and saved, and the economic losses averted. Those estimates are then used to engage country governments and other high-level stakeholders in a collaborative process to identity and prioritize actions to reduce malnutrition. Such actions may include developing or refining policies, more effectively implementing existing policies, identifying priority geographic areas in which selected interventions should be focused, and scaling up interventions.”

More info and documents are available on fhi360 website:

Pdf Profiles – A Data Based Approach to Nutrition Advocacy (Front Matter) (782 kb)

Pdf Profiles – A Data Based Approach to Nutrition Advocacy (Pages 1 – 10) (1 mb)

Pdf Profiles – A Data Based Approach to Nutrition Advocacy (Pages 11 – 20) (6 mb)

Pdf Profiles – A Data Based Approach to Nutrition Advocacy (Pages 21-30) (2 mb)

Pdf Profiles – A Data Based Approach to Nutrition Advocacy (Pages 41-50) (3 mb)

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Ground-breaking Book release: “The Road to Good Nutrition” – by multiple “very special” writers

In Over-nutrition, Under-nutrition on October 5, 2013 at 12:49 pm




Eggersdorfer M.
Kraemer K.
Ruel M.
Van Ameringen M.
Biesalski  H.K.
Bloem M.
Chen J.
Lateef A.
Mannar V.

Some of the chapters are free for downloading here.


(from the Karger’s web site)

This is a work of advocacy, whose prime objective is to inform people about the relationship between nutrition security and public health. It draws on the thinking and experience of a selected number of experts in the field of nutrition and public health. Collating up-to-the-minute information in a clear and accessible way, the book forms a ‘one-stop information source’, and paves the way for further, science-led publications in this field. ‘The Road to Good Nutrition’ puts the topic of nutrition security on the agenda of policy-makers, academics, private sector organizations and civil society, as well as of organizations dedicated to the nutrition space. It is also of interest to the educated lay reader who is generally well informed in matters of health, nutrition and sustainability.
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