Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children.

Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy

How age and sex affect treatment outcomes for children with severe malnutrition: A multi-country secondary data analysis

Key messages * There are few differences in recovery outcomes for wasting treatment by age and sex. * Though differences are small, mean daily weight gain (g/kg/day) appears to be significantly lower in boys than girls. Likewise, though differences are small, younger children (6–23 months) often have a significantly longer mean length of stay compared with older children (24–59 months). * The strength of our evidence does not indicate the need to change current inclusion criteria for wasting treatment programmes on the basis of age and sex but does suggest the need for further research to understand the effects of different confounders on treatment outcomes.Data Availability Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.Supporting Information is available online at: https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13596#support-information-section .Age and sex influence the risk of childhood wasting. We aimed to determine if wasting treatment outcomes differ by age and sex in children under 5 years, enroled in therapeutic and supplementary feeding programmes. Utilising data from stage 1 of the ComPAS trial, we used logistic regression to assess the association between age, sex and wasting treatment outcomes (recovery, death, default, non-response, and transfer), modelling the likelihood of recovery versus all other outcomes. We used linear regression to calculate differences in mean length of stay (LOS) and mean daily weight gain by age and sex. Data from 6929 children from Kenya, Chad, Yemen and South Sudan was analysed. Girls in therapeutic feeding programmes were less likely to recover than boys (pooled odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.72–0.97, p = 0.018). This association was statistically significant in Chad (OR: 0.61, 95% CI: 0.39–0.95, p = 0.030) and Yemen (OR: 0.47, 95% CI: 0.27–0.81, p = 0.006), but not in Kenya and South Sudan. Multinomial analysis, however, showed no difference in recovery between sexes. There was no difference between sexes for LOS, but older children (24–59 months) had a shorter mean LOS than younger children (6–23 months). Mean daily weight gain was consistently lower in boys compared with girls. We found few differences in wasting treatment outcomes by sex and age. The results do not indicate a need to change current programme inclusion requirements or treatment protocols on the basis of sex or age, but future research in other settings should continue to investigate the aetiology of differences in recovery and implications for treatment protocols

South Africa's Health Promotion Levy: excise tax findings and equity potential

In 2016, the South African government proposed a 20% sugar-sweetened beverage (SSB) tax. Protracted consultations with beverage manufacturers and the sugar industry followed. This resulted in a lower sugar-based beverage tax, the Health Promotion Levy (HPL), of approximately 10% coming into effect in April 2018. We provide a synthesis of findings until April 2021. Studies show that despite the lower rate, purchases of unhealthy SSBs and sugar intake consumption from SSBs fell. There were greater reductions in SSB purchases among both lower socioeconomic groups and in subpopulations with higher SSB consumption. These subpopulations bear larger burdens from obesity and related diseases, suggesting that this policy improves health equity. The current COVID-19 pandemic has impacted food and nutritional security. Increased pandemic mortality among people with obesity, diabetes, and hypertension highlight the importance of intersectoral public health disease-prevention policies like the HPL, which should be strengthened

Anthropometric deficits and the associated risk of death by age and sex in children aged 6-59 months: A meta-analysis.

Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in children 6-59 months by age and sex. We categorised children into younger (6-23 months) and older (24-59 months) age groups. Age and sex variations in near-term (within 6 months) mortality risk, associated with individual anthropometric deficits were assessed in a secondary analysis of multi-country cohort data. A random effects meta-analysis was performed. Data from seven low-or-middle-income-countries collected between 1977 and 2013 were analysed. One thousand twenty deaths were recorded for children with anthropometric deficits. Pooled meta-analysis estimates showed no differences by age in absolute mortality risk for wasting (RR 1.08, p = 0.826 for MUAC < 125 mm; RR 1.35, p = 0.272 for WHZ < -2). For underweight and stunting, absolute risk of death was higher in younger (RR 2.57, p < 0.001) compared with older children (RR 2.83, p < 0.001). For all deficits, there were no differences in mortality risk for girls compared with boys. There were no differences in the risk of mortality between younger and older wasted children, supporting continued inclusion of all children under-five in wasting treatment programmes. The risk of mortality associated with underweight and stunting was higher among younger children, suggesting that prevention programmes might be justified in focusing on younger children where resources are limited. There were no sex differences by age in mortality risk for all deficits

Physical activity and sedentary behaviours during pregnancy are associated with neonatal size at birth

Background. Pregnancy is a crucial time to examine modifiable maternal behaviours associated with neonatal outcomes so that preventative measures can be taken against childhood obesity. Objectives. This study aimed to examine the pathways through which maternal physical activity impacted neonatal size and body composition. Methods. A subsample of participants who had objectively measured physical activity data were included from a pregnancy cohort study. Sociodemographic data were collected at the first visit during pregnancy. Gestational weight gain (GWG) was calculated at each visit, and the presence of gestational diabetes, hypertension and HIV were assessed. Physical activity was measured using a hip-worn triaxial accelerometer, at 14-18 weeks’ and 29-33 weeks’ gestation. At delivery, gestational age, birthweight and length were measured and neonatal body composition was analysed. A structural equation model (SEM) was run with either weight-to-length ratio (WLR) or fat mass index (FMI) as the outcome. Results. A total of 84 participants were included in this study, and a subsample of neonates (n=45) also had FMI data. Most (66%) mothers presented as overweight or obese at their first visit, and gained on average 0.35 (19) kg per week. The SEM showed that only gestational age at delivery and sedentary time were positively associated with WLR. Step count was directly associated with GWG (ß=-0.02, p=0.01), and with gestational age (ß=0.16, p=0.04), and was therefore indirectly associated with decreased fetal abdominal circumference. Conclusion. This study showed that increasing daily step count and decreasing sedentary behaviour could have beneficial effects on maternal health as well as delivery outcomes and neonatal size.</p

Supplementary Material for: Africa in Transition: Growth Trends in Children and Implications for Nutrition

The aims of this paper were to: (1) review the literature and examine contemporary child growth in terms of stunting prevalence across Africa; (2) discuss child stunting within the context of economic growth and adult obesity, and (3) elucidate the implications for child nutrition. It is evident that stunting in under-5-year-old children still plagues Africa and has not decreased as expected in line with the concomitant improvement in economic development over the past decade. Persisting and possibly widening inequality ensures that not all segments of the population, in particular the most vulnerable, benefit equally from economic growth. Of concern is the association between the increasing economic progress across Africa and the rising adult obesity, especially amongst females. More and more African countries are now afflicted with a double burden of malnutrition. The implication for child nutrition is that African countries need not only apply a multisectoral approach to accelerate the reduction in stunting levels, but also to arrest and prevent obesity

Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children.

Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy