Feeding practices and growth among young children during two seasons in rural Ethiopia

BACKGROUND: The use of indices of infant and young child feeding practices to predict growth has generated inconsistent results, possibly through age and seasonal confounding. The aim of this study was to evaluate the association of a dietary diversity score (DDS) and infant and child feeding index (ICFI) with growth among young children in a repeated cross-sectional and a follow-up study in two distinct seasons in rural southwest Ethiopia. METHODS: We used a repeated cross-sectional design comparing child feeding practices to nutritional status in 6–12 month old children during harvest (HS; n = 320) and pre-harvest season (PHS; n = 312). In addition, 6–12 month old children from the HS were reassessed 6 months later during PHS. In addition to child anthropometry, child feeding practices were collected using 24-h and 7-day dietary recalls. RESULTS: The mean (±SD) length-for-age z-score (LAZ) of the 6–12 month old children was −0.77 (±1.4) and −1.0 (±1.3) in HS and PHS, respectively, while the mean (±SD) of the follow-up children in PHS was −1.0 (±1.3). The median DDS (IQR) was 2.0 (1.0, 3.0.), 2.0 (2.0, 3.0) and 3.0 (2.0, 4.0) for the children in HS, PHS and the follow-up children in PHS, respectively. The DDS in HS was positively associated with LAZ at follow-up (β = 0.16; 95% CI: 0.01, 0.30; P = 0.03) after controlling for confounding factors. ICFI and DDS were not associated with mean LAZ, weight-for-height z-score and weight-for-age z-score within season. However, the odds of being stunted when having a DDS ≤ 2 was 2.3 times (95% CI: 1.10, 4.78; P = 0.03) higher compared to a DDS > 2 child in HS and 1.7 times (95% CI: 1.04, 2.71; P = 0.04) higher for the pooled sample of 6–12 months old children in HS and PHS. CONCLUSIONS: The DDS was found to be an indicator for child stunting during the Ethiopian harvest season. The DDS can be an appropriate tool to evaluate the association of child feeding practices with child growth irrespective of season. Inclusion of other dimensions in the construction of ICFI should be considered in future analysis as we found no association with growth

Food insecurity, food based coping strategies and suboptimal dietary practices of adolescents in Jimma Zone Southwest Ethiopia

Despite the high prevalence of adolescent food insecurity in Ethiopia, there is no study which documented its association with suboptimal dietary practices. The objective of this study is to determine the association between adolescent food insecurity and dietary practices. We used data on 2084 adolescents in the age group of 13–17 years involved in the first round survey of the five year longitudinal family study in Southwest Ethiopia. Adolescents were selected using residence stratified random sampling methods. Food insecurity was measured using scales validated in developing countries. Dietary practices were measured using dietary diversity score, food variety score and frequency of consuming animal source food. Multivariable regression models were used to compare dietary behaviors by food security status after controlling for socio-demographic and economic covariates. Food insecure adolescents had low dietary diversity score (P<0.001), low mean food variety score (P<0.001) and low frequency of consuming animal source foods (P<0.001). After adjusting for other variables in a multivariable logistic regression model, adolescent food insecurity (P<0.001) and rural residence (P<0.001) were negatively associated with the likelihood of having a diversified diet (P<0.001) and frequency of consuming animal source foods, while a high household income tertile was positively associated. Similarly, multivariable linear regression model showed that adolescent food insecurity was negatively associated with food variety score, while residence in semi-urban areas (P<0.001), in urban areas (P<0.001) and high household income tertile (P = 0.013) were positively associated. Girls were less likely to have diversified diet (P = 0.001) compared with boys. Our findings suggest that food insecurity has negative consequence on optimal dietary intake of adolescents. Food security interventions should look into ways of targeting adolescents to mitigate these dietary consequences and provide alternative strategies to improve dietary quality of adolescents in Southwest Ethiopia

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

Nutritional profile of foods offered and consumed in a Belgian university canteen

Objective: To evaluate the nutritional profile of a lunch offered and consumed in a university canteen in Belgium. Design: The qualitative and quantitative content of 4365 meals theoretically available and 330 meals consumed was recorded during five weekdays spread over three weeks. Meal combinations were evaluated using a scoring system based on recommendations for Na content, energy from fat, and fruit and vegetable portions. Setting: University canteen in Belgium. Results: Only a 5 % of the meal combinations available and consumed complied with the three basic dietary recommendations for a hot lunch. The nutritional profile of the meals consumed was in line with that of the meals available. Conclusions: Our results show how the nutritional profile of what is eaten is largely determined by what is offered. To ensure overall compliance with dietary recommendations, considerable changes on the supply side, i.e. an increase in fruit and vegetable portions and a reduction in salt and fat of the lunch, are needed first in our setting. Our assessment provides baseline data to pilot a nutrient profiling intervention and shows how a nutrient profiling system can be used for meal evaluation purposes

Unconditional cash transfers do not prevent children's undernutrition in the Moderate Acute Malnutrition Out (MAM'Out) cluster-randomized controlled trial in rural Burkina Faso

International audienceBackground: Limited evidence is available on the impact that unconditional cash transfer (UCT) programs can have on child nutrition, particularly in West Africa, where child undernutrition is still a public health challenge.Objective: This study examined the impact of a multiannual, seasonal UCT program to reduce the occurrence of wasting (weight-for-height, midupper arm circumference), stunting (height-for-age), and morbidity among children 0.05) in children's anthropometric measurements and stunting between the 2 groups at the end point. However, children in the intervention group had a lower risk [21% (95% CI: 18.6%, 21.3%); P < 0.001] of self-reported respiratory tract infections than did children in the control group.Conclusions: We found that seasonal UCTs in the framework of safety nets did not result in a significant decrease in the incidence of acute malnutrition among children in Tapoa Province. Cash transfers combined with complementary interventions targeted to child nutrition and health should be investigated further. This trial was registered at clinicaltrials.gov as NCT01866124

The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity : a cluster-randomized controlled trial

Background: Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program. Methods and Findings: We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p < 0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (-29.3%; 95% CI: 20.5, 37.2; p < 0.001) and fever episodes (-22.5%; 95% CI: 14.0, 30.2; p < 0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions. Conclusions: Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity

Sensitivity to reward and adolescents’ unhealthy snacking and drinking behavior: the role of hedonic eating styles and availability

Background: Although previous research found a positive association between sensitivity to reward (SR) and adolescents' unhealthy snacking and drinking behavior, mechanisms explaining these associations remain to be explored. The present study will therefore examine whether the associations between SR and unhealthy snack and/or sugar-sweetened beverage (SSB) intake are mediated by external and/or emotional eating and if this mediation is moderated by availability at home or at school. Methods: Cross-sectional data on snacking, availability of snacks at home and at school, SR (BAS drive scale) and external and emotional eating (Dutch eating behavior questionnaire) of Flemish adolescents (n = 1104, mean age = 14.7 +/- 0.8 years; 51 % boys; 18.0 % overweight) in 20 schools spread across Flanders were collected. Moderated mediation analyses were conducted using generalized structural equation modeling in three steps: (1) direct association between SR and unhealthy snack or SSB intake, (2) mediation of either external or emotional eating and (3) interaction of home or school availability and emotional or external eating. Results: Partial mediation of external eating (a*b = 0.69, p < 0.05) and of emotional eating (a*b = 0.92, p < 0.01) in the relation between SR and intake of unhealthy snacks was found (step 2). The relation between SR and SSB intake was not mediated by external or emotional eating (step 2). No moderation effects of home or school availability were found (step 3). Conclusion: Our findings indicate that the association between SR and the consumption of unhealthy snacks is partially explained by external and emotional eating in a population-based sample of adolescents irrespective of the home or school availability of these foods

The impact of integrated prevention and treatment on child malnutrition and health: the PROMIS project, a randomized control trial in Burkina Faso and Mali

Abstract Background Evidence suggests that both preventive and curative nutrition interventions are needed to tackle child acute malnutrition (AM) in developing countries. In addition to reducing the incidence of AM, providing preventive interventions may also help increase attendance (and coverage) of AM screening, a major constraint in the community-based management of child acute malnutrition (CMAM) model. There is a paucity of evidence-based strategies to deliver integrated preventive and curative interventions effectively and affordably at scale. The aim of the Innovative Approaches for the Prevention of Childhood Malnutrition (PROMIS) study is to assess the feasibility, quality of implementation, effectiveness and cost-effectiveness of an integrated child malnutrition prevention and treatment intervention package implemented through a community-based platform in Mali and a facility-based platform in Burkina Faso. Methods/Design The PROMIS intervention entails a comprehensive preventive package offered on a monthly basis to caregivers of children, while children are screened for acute malnutrition (AM). The package consists of behavior change communication on essential nutrition and hygiene actions, and monthly preventive doses of small quantity lipid-based nutrient supplements (SQ-LNS) for children aged 6 to 23.9 months. Positive AM cases are referred to treatment services offered by first-line health services according to the CMAM model. The PROMIS intervention will be evaluated using a mixed methods approach. The impact study encompasses two types of study design: i) repeated cross-sectional surveys conducted at baseline and at endline after 24 months of program implementation and ii) a longitudinal study with a monthly follow-up for 18 months. Primary study impact measures include the incidence and endpoint prevalence of AM, AM screening coverage and treatment compliance. A process evaluation will assess the feasibility and quality of implementation of the intervention guided by country specific program impact pathways (PIPs). Cost-effectiveness analysis will assess the economic feasibility of the intervention. Discussion The PROMIS study assesses the effectiveness of an innovative model to integrate prevention and treatment interventions for greater and more sustainable impacts on the incidence and prevalence of AM using a rigorous, theory-based randomized control trial approach. This type of programmatic research is urgently needed to help program implementers, policy makers, and investors prioritize, select and scale-up the best program models to prevent and treat AM and achieve the World Health Assembly goal of reducing childhood wasting to less than 5% globally by the year 2025. Trial registration Clinicaltrials.gov NCT02323815 (registered on December 18, 2014) and NCT02245152 (registered on September 16, 2014