Severe acute malnutrition and mortality in children in the community : Comparison of indicators in a multi-country pooled analysis

Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Acknowledgments We would like to acknowledge the principal investigators of the original studies: Jan Van den Broeck for the DRC cohort, Michel Garenne for the Senegal cohort, and Keith West for the Nepal cohort. The DRC study was supported by the Centre de Développement Intégrale–Bwamanda, and funding was provided by the Flemish Inter-University Council (Vlaamse Interuniversitaire Raad), the Belgian Administration for Development Cooperation, and the Nutricia Research Foundation. Catherine Schwinger is affiliated to the Centre for Intervention Science in Maternal and Child Health (CISMAC), which is funded by the Research Council of Norway through its Centres of Excellence funding scheme (project number 223269), the University of Bergen (UiB), Norway.Peer reviewedPublisher PD

Inconsistent diagnosis of acute malnutrition by weight-for-height and mid-upper arm circumference : contributors in 16 cross-sectional surveys from South Sudan, the Philippines, Chad, and Bangladesh

Background: The two anthropometric indicators of acute malnutrition in children under 5 years, i.e. a Mid-Upper Arm Circumference < 125 mm (MUAC(125)) or a Weight-for-Height Z-score<-2 (WHZ(-2)), correlate poorly. We aimed at assessing the contribution of age, sex, stunting (Height-for-Age HAZ<-2), and low sitting-standing height ratio Z-score (SSRZ in the 1st tertile of the study population, called hereafter 'longer legs') to this diagnosis discrepancy. Methods: Data from 16 cross-sectional nutritional surveys carried out by Action Against Hunger International in South Sudan, the Philippines, Chad, and Bangladesh fed multilevel, multivariate regression models, with either WHZ -2 or MUAC(125) as the dependent variable and age, sex, stunting, and 'longer legs' as the independent ones. We also compared how the performance of MUAC125 and WHZ-2 to detect slim children, i.e. children with a low Weight-for-Age (WAZ=-2), was modified by the contributors. Results: Overall 23.1 % of the 14,409 children were identified as acutely malnourished by either WHZ-2 or MUAC125, but only 28.5 % of those (949/3,328) were identified by both indicators. Being stunted (+17.8 %; 95 % CI: 14.8 %; 22.8 %), being a female (+16.5 %; 95 % CI: 13.5 %; 19.5 %) and being younger than 24 months (+33.6 %; 95 % CI: 30.4 %; 36.7 %) were factors strongly associated with being detected as malnourished by MUAC125 and not by WHZ-2, whereas having 'longer legs' moderately increased the diagnosis by WHZ-2 (+4.2 %; 95 % CI: 0.7 %; 7.6 %). The sensitivity to detect slim children by MUAC125 was 31.0 % (95 % CI: 26.8 %; 35.2 %) whereas it was 70.6 % (95 % CI: 65.4 %; 75.9 %) for WHZ-2. The sensitivity of MUAC125 was particularly affected by age (57.4 % vs. 18.1 % in children aged = 24 months). Specificity was high for both indicators. Conclusions: MUAC125 should not be used as a stand-alone criterion of acute malnutrition given its strong association with age, sex and stunting, and its low sensitivity to detect slim children. Having 'longer legs' moderately increases the diagnosis of acute malnutrition by WHZ-2. Prospective studies are urgently needed to elucidate the clinical and physiological outcomes of the various anthropometric indicators of malnutrition

Contributions à l'étude de l'influence de l'alimentation sur la régulation du sommeil

Interactions between sleep and food intake are well recognized as being complex and multiple. In this context, we decided to study the influence of food intake on sleep regulation through two complementary approachs: in the so-called metabolic approach, we considered the influence of the whole proteino-energetic intake; in the so-called nutraceutical approach, we considered food intake as a natural source of active molecules. In this last approach, we focused on the case of a particular food compound, that is a tryptic peptidic hydrolysate with anxiolytic properties. First, we produced an original model where not only quantitative but also qualitative modulations of sleep stages appear to be induced by specific modulations of the proteino-energetic composition of the diet, in link with specific modulations of whole body metabolism. Secondly, we showed that the peptidic hydrolysate appears to be able to improve sleep in a physiological way in an animal model of stress-induced sleep impairments. These results bring promising clues for a better understanding of sleep regulation and its links with metabolism and stress. Finally, they also encourage further work on the ability of restaurating a functionnal and physiological sleep by developing alternative dietary treatments of sleep troubles. Keywords: proteic and energetic intake, energy and protein metabolism, αs1–casein hydrolysate, stress, sleep, SWS, PS.Les rapports entre sommeil et alimentation sont l'objet d'interactions complexes et multiples. Dans ce cadre, le champ d'étude de l'influence de l'alimentation sur le sommeil constitue non seulement une porte d'entrée vers une meilleure compréhension de la régulation du sommeil, mais aussi une importante voie thérapeutique pour en prévenir et soigner les dysfonctionnements. Nous avons choisi d'aborder ce thème par deux approches différentes : une "approche métabolique", celle de l'influence sur le sommeil de l'alimentation globale en terme d'apports protéino-énergétiques, c'est-à-dire, de substrats métaboliques; une "approche nutraceutique", celle de l'influence sur le sommeil de molécules spécifiques apportées par l'alimentation. Ces angles d'étude complémentaires, représentatifs de la diversité et de la complexité des possibilités d'influence de l'alimentation sur le sommeil, ont servi de base à nos travaux de recherche, réalisés sur le modèle du rat. Dans la première approche, nous avons pu vérifier l'existence d'un modèle dans lequel des perturbations de la quantité et de la qualité du sommeil sont induites de manière spécifique par des modifications de l'apport alimentaire protéino-énergétique. Dans la deuxième approche, nous nous sommes intéressés au cas particulier d'un hydrolysat peptidique qui, présentant des propriétés anxiolytiques originales, est considéré comme une source potentielle de principe actif agissant sur la régulation du sommeil. Nous avons pu créer un modèle expérimental montrant les propriétés protectrices de l'apport alimentaire de cet hydrolysat sur les perturbations de sommeil induites par le stress. Outre les perspectives que ces résultats ouvrent pour une modulation de la régulation du sommeil et de ses troubles par l'alimentation, comme, par exemple, la possibilité de rétablir un sommeil physiologique, respectant les cycles normaux d'alternance des phases de Sommeil Lent et de Sommeil Paradoxal (que les traitements pharmacologiques ont souvent du mal à rétablir), nos travaux permettent aussi d'éclairer certains aspects de la régulation du sommeil, comme ses liens avec la régulation du métabolisme périphérique et celle de la réponse au stress. Mots clés: apport protéino-énergétique, métabolisme énergétique et protéique, hydrolysat peptidique de la caséine αs1 bovine, stress, sommeil, SOL, S

Contributions à l'étude de l'influence de l'alimentation sur la régulation du sommeil

PARIS-AgroParisTech Centre Paris (751052302) / SudocSudocFranceF

Haemocytes from Crassostrea gigas and OsHV-1: A promising in vitro system to study host/virus interactions

Since 2008, mass mortality outbreaks associated with the detection of particular variants of OsHV-1 have been reported in Crassostrea gigas spat and juveniles in several countries. Recent studies have reported information on viral replication during experimental infection. Viral DNA and RNA were also detected in the haemolymph and haemocytes suggesting that the virus could circulate through the circulatory system. However, it is unknown if the virus is free in the haemolymph, passively associated at the surface of haemocytes, or able to infect and replicate inside these cells inducing (or not) virion production. In the present study, we collected haemocytes from the haemolymphatic sinus of the adductor muscle of healthy C. gigas spat and exposed them in vitro to a viral suspension. Results showed that viral RNAs were detectable one hour after contact and the number of virus transcripts increased over time in association with an increase of viral DNA detection. These results suggested that the virus is able to initiate replication rapidly inside haemocytes maintained in vitro. These in vitro trials were also used to carry out a dual transcriptomic study. We analyzed concomitantly the expression of some host immune genes and 15 viral genes. Results showed an up regulation of oyster genes currently studied during OsHV-1 infection. Additionally, transmission electron microscopy examination was carried out and did not allow the detection of viral particles. Moreover, All the results suggested that the in vitro model using haemocytes can be valuable for providing new perspective on virus-oyster interactions

Anthropometry at discharge and risk of relapse in children treated for severe acute malnutrition: a prospective cohort study in rural Nepal

Background There is a dearth of evidence on what should be the optimal criteria for discharging children from severe acute malnutrition (SAM) treatment. Programs discharging children while they are still presenting varying levels of weight-for-height (WHZ) or mid-upper-arm circumference (MUAC) deficits, such as those implemented under the current national protocol in Nepal, are opportunities to fill this evidence gap. Methods We followed a cohort of children discharged as cured from SAM treatment in Parasi district, Nepal. Relapse as SAM, defined as the occurrence of WHZ<-3 or MUAC < 115 mm or nutritional edema, was investigated through repeated home visits, during six months after discharge. We assessed the contribution of remaining anthropometric deficits at discharge to relapse risk through Cox regressions. Results Relapse as SAM during follow-up was observed in 33 % of the cohort (35/108). Being discharged before reaching the internationally recommended criteria was overall associated with a large increase in the risk of relapse (HR = 3.3; p = 0.006). Among all anthropometric indicators at discharge, WHZ<-2 led to a three-fold increase in relapse risk (HR = 3.2; p = 0.003), while MUAC < 125 mm significantly raised it only in the older children. WHZ<-2 at discharge came up as the only significant predictor of relapse in multivariate analysis (HR = 2.8, p = 0.01), even among children with a MUAC ≥ 125 mm. Of note, more than 80 % of the events of relapse as SAM would have been missed if WHZ had not been monitored and used in the definition of relapse. Conclusions Our results suggest that the priority for SAM management programs should be to ensure that children reach a high level of WHZ at discharge, at least above or equal to the WHO recommended cut-off. The validity of using a single MUAC cut-off such as 125 mm as a suitable discharge criterion for all age groups is questioned. Further follow-up studies providing a complete assessment of nutritional status at discharge and not based on a restricted MUAC-only definition of relapse as SAM would be urgently needed to set evidence-based discharge criteria. These studies are also required to assess programs currently discounting or omitting WHZ for identification and management of SAM