Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia Chronic energy deficiency in women from rural Bangladesh: some socioeconomic determinants. Long-chain PUFA supplementation in rural African infants: a randomized controlled trial of effects on gut integrity, growth, and cognitive development123 Early short-term infant food supplementation, maternal weight loss and duration of breast-feeding: a randomised controlled trial in rural Senegal Effect of early infant feeding practices on infection-specific neonatal mortality: an investigation of the causal links with observational data from rural Ghana. Evaluation of vitamin A supplementation regimens in Ghanaian postpartum mothers with the use of the modified-relative-dose-response test. Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. Vitamin A supplementation during war-emergency in Guinea-Bissau 1998-1999. Risk and causes of paediatric hospital-acquired bacteraemia in Kilifi District Hospital, Kenya: a prospective cohort study Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa. Maternal plasma 25-hydroxyvitamin D concentration and birthweight, growth and bone mineral accretion of Gambian infants Maternal protein-energy supplementation does not affect adolescent blood pressure in The Gambia Multisector intervention to accelerate reductions in child stunting: an observational study from 9 sub-Saharan African countries. Relationship between Paternal Involvement and Child Malnutrition in a Rural Area of Vietnam Nutritional supplementation during pregnancy and offspring cardiovascular disease risk in The Gambia. The Effect of Antenatal Vitamin A and &bgr;-Carotene Supplementation on Gut Integrity of Infants of HIV-Infected South African Women Mini Nutritional Assessment of rural elderly people in Bangladesh: the impact of demographic, socio-economic and health factors. Multi-micronutrient-fortified biscuits decreased prevalence of anemia and improved micronutrient status and effectiveness of deworming in rural Vietnamese school children. Beneficial Effects of Breast Milk in the Neonatal Intensive Care Unit on the Developmental Outcome of Extremely Low Birth Weight Infants at 18 Months of Age
Background Children with severe malnutrition who develop shock have a high  mortality . Contrary to contemporaneous paediatric practice , current guidelines recommend use of low dose hypotonic fluid resuscitation ( half-strength Darrows/5 % dextrose ( HSD/5D ) . We evaluated the safety and efficacy of this guideline compared to resuscitation with a st and ard isotonic solution . Methods A Phase II r and omised controlled , safety and efficacy trial in Kenyan children aged over 6 months with severe malnutrition and shock including children with severe dehydration/shock and presumptive septic shock ( non-diarrhoeal shock ) . Eligible children were r and omised to HSD/5D or Ringer 's Lactate ( RL ) . A maximum of two boluses of 15 ml/kg of HSD/5D were given over two hours ( as recommended by guidelines ) while those r and omised to RL received 10 ml/kg aliquots half hourly ( maximum 40 ml/kg ) . Primary endpoint was resolution of shock at 8 and 24 hours . Secondary outcomes included resolution of acidosis , adverse events and mortality . Results 61 children were enrolled : 41 had shock and severe dehydrating diarrhoea , 20 had presumptive septic shock ; 69 % had decompensated shock . By 8 hours response to volume resuscitation was poor with shock persisting in most children:-HSD/5D 15/22 ( 68 % ) and RL14/25 ( 52 % ) , p = 0.39 . Oliguria was more prevalent at 8 hours in the HSD/5D group , 9/22 ( 41 % ) , compared to RL-3/25 ( 12 % ) , p = 0.02 . Mortality was high , HSD/5D-15/26(58 % ) and RL 13/29(45 % ) ; p = 0.42 . Most deaths occurred within 48 hours of admission . Neither pulmonary oedema nor cardiogenic failure was detected . Conclusions Outcome was universally poor characterised by persistence of shock , oliguria and high case fatality . Isotonic fluid was associated with modest improvement in shock and survival when compared to HSD/5D but inconclusive due to the limitations of design and effectiveness of either resuscitation strategy . Although isotonic fluid resuscitation did not result in cardiogenic heart failure , as previously feared , we conclude that the modest volumes used and rate of infusion were insufficient to promptly correct shock . The adverse performance of the recommended fluid resuscitation guideline for severe malnutrition should prompt clinical investigation of isotonic fluids for resuscitation of compensated shock , defining rate and volumes required to inform future guidelines .Trial Registration The trial is registered as ISCRTN : This paper explores a number of socioeconomic factors thought to explain the wide prevalence of undernutrition among rural Bangladeshi women . The 1992 baseline survey data of the BRAC-ICDDR , B Joint Research Project at Matlab were used . Anthropometry was performed on a r and om sub- sample of 1462 currently married , non-pregnant women between 15 and 49 years of age . Women 's nutritional status was defined in terms of Body Mass Index ( BMI = wt in kg/ht in m2 ) . Compared with women from better-off households , the mean weight ( 41.2 vs 43.0 kg ; p < 0.0001 ) , mid-upper arm circumference ( MUAC ) ( 22.1 vs 22.7 ; p < 0.0001 ) , and BMI ( 18.5 vs 19.1 ; p < 0.0001 ) of poor women were consistently lower . However , no significant difference in mean height was found between the two groups . The results showed that women aged more than 35 years are twice as likely to have a BMI < 18.5 compared with younger women . Both years of schooling received and socioeconomic status are found to be important predictors of women 's BMI . Women who have received one or more years of formal education are nearly half as likely to suffer chronic energy deficiency ( BMI < 18.5 ) than women with no schooling . Again , better-off women are found to be 0.77 times less likely to have chronic energy deficiency than women from poor households . The implication s of these findings in improving the nutritional status of rural Bangladeshi women are discussed Background : Intestinal damage and malabsorption caused by chronic environmental enteropathy are associated with growth faltering seen in infants in less-developed countries . Evidence has suggested that supplementary omega-3 ( n−3 ) long-chain PUFAs ( LC-PUFAs ) might ameliorate this damage by reducing gastrointestinal inflammation . LC-PUFA supplementation may also benefit cognitive development . Objective : We tested whether early n−3 LC-PUFA supplementation improves  infant intestinal integrity , growth , and cognitive function . Design : A r and omized , double-blind , controlled trial [ 200 mg DHA and 300 mg EPA or 2 mL olive oil/d for 6 mo ] was conducted in a population of 172 rural Gambian infants aged 3–9 mo . The primary endpoints were anthropometric measures and gut integrity [ assessed by using urinary lactulose : mannitol ratios ( LMRs ) ] . Plasma fatty acid status , intestinal mucosal inflammation ( fecal calprotectin ) , daily morbidity , and cognitive development ( 2-step means-end test and an attention assessment ) were secondary endpoints . Results : PUFA supplementation result ed in a significant increase in plasma n−3 LC-PUFA concentrations ( P < 0.001 for both DHA and EPA ) and midupper arm circumference ( MUAC ) ( effect size : 0.31 z scores ; 95 % CI : 0.06 , 0.56 ; P = 0.017 ) at 9 mo of age . At 12 mo , MUAC remained greater in the intervention group , and we observed significant increases in skinfold thicknesses ( P ≤ 0.022 for all ) . No other significant differences between treatment groups were detected for growth or LMRs at 9 mo or for secondary outcomes . Conclusions : Fish-oil supplementation successfully increased plasma n−3 fatty acid status . However , in young , breastfed Gambian infants , the intervention failed to improve linear growth , intestinal integrity , morbidity , or selected measures of cognitive development . The trial was registered at www.is rct n.org as IS RCT N66645725 Objective : Early supplementation of breastfed infants may have consequences both for the mother and the child . We hypothesised that it would result in decreased maternal weight loss and in shorter duration s of breastfeeding and birth intervals . Design : Controlled r and omised population -based trial . Setting : Six villages in the Sine area of Senegal , West Africa . Subjects : Healthy breastfed infants and their mothers , 68 controls and 66 supplemented infants at r and omization . Intervention : Supplementation with high-energy , nutrient dense food from 4 to 7 months of age , twice daily under supervision of field workers . Both controls and supplemented infants were free to eat other complementary foods .  Maternal weight was measured monthly . Date s of breastfeeding cessation and of subsequent births were collected prospect ively through weekly demographic surveillance , and were analysed using Cox 's regression models and ‘ intent-to-supplement ’ approach . Results : Mean maternal weight gain from 4 to 7 months postpartum tended to be greater in the supplemented group ( + 0.25 kg/months , 95 % confidence interval ( CI ) : −0.07 , + 0.57 ) . Supplemented infants were breastfed for significantly longer duration s than controls ( medians : 24.9 and 23.7 months , respectively , P : 0.034 ) . Their adjusted hazard ratio ( HR ) for breastfeeding cessation was 0.59 ( 95 % CI : 0.40 , 0.89 ) . Their mothers had a lower risk of a new birth than mothers of controls ( adjusted HR : 0.57 , 95 % CI : 0.36 , 0.92 ) . Conclusions : Early short-term infant supplementation tended to decrease maternal postpartum weight loss , but it increased , rather than shortened , the duration of breastfeeding and birth interval . Sponsorship : This study was supported by a grant from the French Ministry of Research ( Grant 92L0623 ) BACKGROUND Strong associations between delayed initiation of breastfeeding and increased  neonatal mortality  ( 2 - 28 d ) were recently reported in rural Ghana . Investigation into the biological plausibility of this relation and potential causal pathways is needed . OBJECTIVE The objective was to assess the effect of early infant feeding practice s ( delayed initiation , prelacteal feeding , established neonatal breastfeeding ) on infection-specific neonatal mortality in breastfed neonates aged 2 - 28 d. DESIGN This prospect i ve observational cohort study was based on 10 942 breastfed singleton neonates born between 1 July 2003 and 30 June 2004 , who survived to day 2 , and whose mothers were visited in the neonatal period . Verbal autopsies were used to ascertain the cause of death . RESULTS One hundred forty neonates  died from day 2 to day 28 ; 93 died of infection and 47 of noninfectious causes . The risk of death as a result of infection increased with increasing delay in initiation of breastfeeding from 1 h to day 7 ; overall late initiation ( after day 1 ) was associated with a 2.6-fold risk [ adjusted odds ratio ( adj OR ) : 2.61 ; 95 % CI : 1.68 , 4.04 ] . Partial breastfeeding was associated with a 5.7-fold adjusted risk of death as a result of infectious disease ( adj OR : 5.73 ; 95 % CI : 2.75 , 11.91 ) . No obvious associations were observed between these feeding practice s and noninfection-specific mortality . Prelacteal feeding was not associated with infection ( adj OR : 1.11 ; 95 % CI : 0.66 , 1.86 ) or noninfection-specific ( adj OR : 1.33 ; 95 % CI : 0.55 , 3.22 ) mortality . CONCLUSIONS This study provides the first epidemiologic evidence of a causal association between early breastfeeding and reduced infection-specific neonatal mortality in young human infants BACKGROUND Vitamin A deficiency is an important public health problem in many developing countries . Women of childbearing age and children are documented as the most affected groups . OBJECTIVE The objective was to determine the length of time mothers are protected postpartum against vitamin A depletion after receiving either 400,000 IU vitamin A in 2 divided doses or 200,000 IU as a single dose plus a placebo 24 h apart . DESIGN Mothers ( n = 168 ) were recruited by trained fieldworkers 7 - 10 d after delivery .  Modified-relative-dose-response ( MRDR ) tests  were performed at baseline in 167 women , and vitamin A was administered within 6 wk after delivery . The women were r and omly assigned to 2 main treatment groups , and each treatment group was divided into 3 follow-up subgroups . Each subgroup was invited back once at month 1 , 3 , or 5 for a second MRDR test . RESULTS The serum retinol concentration and the MRDR value were 1.4 + /- 0.5 micromol/L and 0.048 + /- 0.037 , respectively , at baseline . A significant improvement in vitamin A status occurred after vitamin A treatment as assessed by the MRDR test ( P < 0.0001 ) . Serum retinol concentrations were not different after vitamin A treatment ( P = 0.87 ) . CONCLUSIONS The mothers had marginally depleted liver reserves of vitamin A at baseline on the basis of MRDR test results . Liver reserves of vitamin A significantly improved in both treatment groups , and the improvement was maintained for > or= 5 mo OBJECTIVE To determine the association of different feeding patterns for infants ( exclusive breastfeeding , predominant breastfeeding , partial breastfeeding and no breastfeeding ) with  mortality and hospital admissions  during the first half of infancy . METHODS This paper is based on a secondary analysis of data from a multicentre r and omized controlled trial on immunization-linked vitamin A supplementation . Altogether , 9424 infants and their mothers ( 2919 in Ghana , 4000 in India and 2505 in Peru ) were enrolled when infants were 18 - 42 days old in two urban slums in New Delhi , India , a periurban shanty town in Lima , Peru , and 37 villages in the Kintampo district of Ghana . Mother-infant pairs were visited at home every 4 weeks from the time the infant received the first dose of oral polio vaccine and diphtheria-pertussis-tetanus at the age of 6 weeks in Ghana and India and at the age of 10 weeks in Peru . At each visit , mothers were queried about what they had offered their infant to eat or drink during the past week . Information was also collected on hospital admissions and deaths occurring between the ages of 6 weeks and 6 months . The main outcome measures were all-cause mortality , diarrhoea-specific mortality , mortality caused by acute lower respiratory infections , and hospital admissions . FINDINGS There was no significant difference in the risk of death between children who were exclusively breastfed and those who were predominantly breastfed ( adjusted hazard ratio ( HR ) = 1.46 ; 95 % confidence interval ( CI ) = 0.75 - 2.86 ) . Non-breastfed infants had a higher risk of dying when compared with those who had been predominantly breastfed ( HR = 10.5 ; 95 % CI = 5.0 - 22.0 ; P < 0.001 ) as did partially breastfed infants ( HR = 2.46 ; 95 % CI = 1.44 - 4.18 ; P = 0.001 ) . CONCLUSION There are two major implication s of these findings . First , the extremely high risks of infant mortality associated with not being breastfed need to be taken into account when informing HIV-infected mothers about options for feeding their infants . Second , our finding that the risks of death are similar for infants who are predominantly breastfed and those who are exclusively breastfed suggests that in setting s where rates of predominant breastfeeding are already high , promotion efforts should focus on sustaining these high rates rather than on attempting to achieve a shift from predominant breastfeeding to exclusive breastfeeding BACKGROUND Vitamin A supplementation is recommended by WHO in emergency situations . OBJECTIVE To evaluate the impact of Vitamin A supplementation on  childhood mortality  in an emergency situation . DESIGN Since this was not a r and omised study , we evaluated the impact in different ways ; we used the variation in the delay of provision of Vitamin A in a step-wedged design , compared wartime with pre-wartime mortality and examined whether Vitamin A as a free commodity reduced cultural and social-economic inequalities in childhood mortality . SUBJECTS 5926 children 6 months to 5 years of age , resident in four suburbs in the capital of Guinea-Bissau between October 1 , 1998 and March 31 , 1999 . INTERVENTIONS From October 1 , 1998 until the end of the war in 1999 all children present in the study area were offered Vitamin A at regular three-monthly visits to their homes . RESULTS Using the variation in the provision of Vitamin A , we found a slight non-significant reduction in mortality for children between 6 months and 5 years of age ( mortality ratio ( MR ) 0.49 ; 95 % CI 0.09 - 2.70 ) . Comparing with a three-year period before the war , children offered Vitamin A at home during the war had a 12 % reduction in mortality ( MR 0.88 ; 0.41 - 1.87 ) , whereas the overall impact of the war was an 89 % increase in mortality ( MR 1.89 ; 1.32 - 2.71 ) . Vitamin A supplementation was associated with a reduction in cultural and socio-economic inequalities . CONCLUSIONS Vitamin A supplementation may have a beneficial impact on  childhood mortality  in an emergency situation Summary Background In sub-Saharan Africa , community-acquired bacteraemia is an important cause of illness and death in children . Our aim was to establish the magnitude and causes of hospital-acquired ( nosocomial ) bacteraemia in African children . Methods We review ed prospect ively collected surveillance data of 33 188 admissions to Kilifi District Hospital , Kenya , between April 16 , 2002 , and Sept 30 , 2009 . We defined bacteraemia as nosocomial if it occurred 48 h or more after admission . We estimated the per-admission risk , daily rate , effect on mortality , and microbial cause of nosocomial bacteraemia and analysed risk factors by multivariable Cox regression . The effect on morbidity was measured as the increase in hospital stay by comparison with time-matched patients without bacteraemia . Findings The overall risk of nosocomial bacteraemia during this period was 5·9/1000 admissions ( 95 % CI 5·2–6·9 ) but we recorded an underlying rise in risk of 27 % per year . The incidence was 1·0/1000 days in hospital ( 0·87–1·14 ) , which is about 40 times higher than that of community-acquired bacteraemia in the same region . Mortality in patients with nosocomial bacteraemia was 53 % , compared with 24 % in community-acquired bacteraemia and 6 % in patients without bacteraemia . In survivors , nosocomial bacteraemia lengthened hospital stay by 10·1 days ( 3·0–17·2 ) . Klebsiella pneumoniae , Escherichia coli , Staphylococcus aureus , Acinetobacter spp , group D streptococci , and Pseudomonas aeruginosa accounted for three-quarters of nosocomial infections . Nosocomial bacteraemia was significantly associated with severe malnutrition ( hazard ratio 2·52 , 95 % CI 1·79–3·57 ) and blood transfusion in children without severe anaemia ( 4·99 ; 3·39–7·37 ) . Interpretation Our findings show that although nosocomial bacteraemia is rare , it has serious effects on morbidity and mortality , and the microbiological causes are distinct from those of community-acquired bacteraemia . Nosocomial infections are largely unrecognised or undocumented as a health risk in low-income countries , but they are likely to become public health priorities as awareness of their occurrence increases and as other prominent childhood diseases are progressively controlled . Funding Wellcome Trust OBJECTIVES To determine the prevalence of stunting , wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province , South Africa . DESIGN Prospect i ve cohort study . SETTING Rural villages in the Central Region of the Limpopo Province , South Africa . SUBJECTS One hundred and sixty-two children who were followed from birth were included in the study .  Anthropometric measurements and sociodemographic characteristics of the children were recorded . RESULTS Height-for-age Z-scores were low , with a high prevalence of stunting ( 48 % ) . The children also exhibited a high prevalence of overweight ( 22 % ) and obesity ( 24 % ) . Thirty-one ( 19 % ) children were both stunted and overweight . Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times ( 95 % confidence interval ( CI ) 1.96 - 4.18 ) while having a greater length at 1 year was protective against stunting ( odds ratio ( OR ) 0.41 ; 95 % CI 0.17 - 0.97 ) . Having a mother as a student increased the risk for stunting at 3 years by 18.21 times ( 95 % CI 9.46 - 34.74 ) while having a working mother increased the risk for overweight by 17.87 times ( 95 % CI 8.24 - 38.78 ) . All these factors also appeared as risks or as being protective in children who were both overweight and stunted , as did living in a household having nine or more persons ( OR 5.72 ; 95 % CI 2.7 - 12.10 ) . CONCLUSION The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight . Furthermore , it is important to realise the importance of normal length and weight being attained at 1 year of age , since these in turn predict nutritional status at 3 years of age Maternal vitamin D deficiency during pregnancy is a recognized risk factor for rickets and osteomalacia in infancy ( 1 ) . The circulating plasma concentration of 25-hydroxyvitamin D ( 25OHD ) , a long-lived metabolite of vitamin D , is used to judge vitamin D status ; values below 25 nmol/L are associated with an increased risk of rickets and osteomalacia ( 1 ) . There is evidence that a low maternal plasma 25OHD in pregnancy may influence the growth and bone mineral accrual of the offspring during foetal life , infancy and childhood . Positive associations have been reported between maternal  vitamin D  status in pregnancy and birthweight , birth length , length at 1 year and bone mineral accretion at 9 years ( 2–6 ) , although evidence is conflicting ( 7,8 ) . These relationships have been observed at concentrations of 25OHD higher than those associated with rickets and osteomalacia , and there are calls to raise the accepted lower threshold of vitamin D sufficiency for pregnant women , most recently to 80 nmol/L ( 9 ) . On a population basis , plasma 25OHD concentrations above 80 nmol/L are relatively uncommon in countries at temperate latitudes but are more common among people living in the tropics who have abundant skin sunshine exposure ( 10 ) . To contribute to the debate on the definition of vitamin D sufficiency in pregnancy , we have investigated the influence of maternal plasma 25OHD concentration on foetal and infant growth in a rural area of The Gambia , West Africa ( 13 ° N ) . In this region , there is tropical sunshine all year , the women are farmers who work out-of-doors for much of each day , and local female dress does not restrict regular sunshine exposure to the face , neck , shoulders , arms and feet , especially during farm work and gardening . The study was a secondary analysis of biochemical , anthropometric and bone data from a subset of 125 women and infants collected during a calcium supplementation study of blood pressure in pregnant Gambian women ( International Trial Registry : IS RCT N96502494 ) . No significant benefits for foetal and infant growth of maternal calcium supplementation were identified despite the low customary calcium intake in The Gambia ( 11 ) . The protocol , methods , maternal characteristics and infant data from the detailed study have been published ( 11 ) . Briefly , women from the rural villages of Keneba and M and uar , West Kiang , The Gambia were recruited at 20 weeks of pregnancy ( P20 ) and r and omized to a daily calcium supplement or a matching placebo tablet until parturition ( 1500 mg Ca as calcium carbonate and microcellulose-lactose , respectively ; Nycomed Pharma AS , Asker , Norway ) . Fasting , early morning blood was collected and anthropometry performed at P20 and 36 weeks of pregnancy ( P36 ) . The mean ( ± SD ) age , weight , height and dietary calcium intake of the women at P20 were 27.4 ± 7.5 years , 56.3 ± 6.7 kg , 1.61 ± 0.05 m and 356 ± 190 mg/day , respectively . The median parity ( range ) was 3 ( 0–10 ) . Infant birthweight was measured within 24 h of delivery . Weight , crown-heel length and head circumference were measured at 2 , 13 and 52 weeks postpartum . In addition , infant bone mineral content ( BMC ) , bone mineral density ( BMD ) and bone width ( BW ) or bone area ( BA ) , were measured by single photon absorptiometry of the midshaft radius ( Lunar SP2 , Lunar Corporation , Madison , WI , USA ) and , for a subset ( n = 44 , 47 and 52 at 2 , 13 and 52 weeks , respectively ) , by whole-body dual-energy X-ray absorptiometry ( Lunar DPX+ , software version 4.7b , Lunar Corporation ) . Plasma 25OHD was measured a using radioimmunometric assay ( Diasorin Ltd , Wokingham , Berks , UK ) , with assay performance monitored through the Vitamin D External Quality Assessment Scheme ( DEQAS ; Endocrine/Oncology Laboratory , Charing Cross Hospital , London , UK ) . The intra- and inter-assay coefficients of variation were 4 % and 100 ) ; possible trends in the data with p = 0.01–0.1 were noted . The analysis was conducted on 123 mother – infant pairs ; blood sample s from two subjects were not available . Mean ± SD 25OHD ( range ) was : P20 = 103 ± 25 ( 53–167 ) nmol/L ; P36 = 111 ± 27 ( 51–189 ) nmol/L. No subject had a 25OHD value < 50 nmol/L , 20 % and 16 % had 25OHD < 80 nmol/L , at P20 and P36 , respectively . There was a high degree of within-subject consistency in 25OHD at P20 and P36 ( 25OHDP36 = 33.2 + [ 0.79 ± 0.07] × 25OHDP20 , p ≤ 0.001 , R2 adjusted 51.5 % , n = 121 ) ; 11 % of women had 25OHD < 80 nmol/L at both P20 and P36 . The mean birthweight of the infants was 2.99 ± 0.36 kg . The infant anthropometric and bone measures during the first year are given in Table 1 . No significant relationships or trends in the data were observed between maternal 25OHD concentration using the values at P20 , P36 or the mean of the two and any of the following infant measures : birthweight , infant weight , length , head circumference , BMC , BW ( or BA ) , BMD and size-adjusted BMC of the midshaft radius and whole body at any time postpartum . This is illustrated in Figure 1 for birthweight as a function of maternal 25OHD concentration at P20 . Comparing the results for mothers with 25OHD above and below 80 nmol/L did not alter this finding . Table 1 Anthropometric and bone measures  of Gambian infants Figure 1 Lack of a significant relationship between infant birthweight and maternal vitamin D status at 20 weeks of pregnancy ( p = 0.8 ) . Multiple regression model included season , maternal height , weight , weight gain , supplement group and sex of the infant . No significant interaction between supplement group and maternal 25OHD concentration was observed for any infant variable . Trends in the data were observed in a few instances for a supplement group × 25OHD interaction among the bone measures but no consistent picture emerged and they were considered to have arisen by chance . We conclude that there is no evidence for an influence of vitamin D status during pregnancy on infant growth and bone mineral accrual in the conditions prevailing in The Gambia . The children in this study , as is common in this region of The Gambia ( 13 ) , were born small , grew well for the first months of life but experienced growth faltering during later infancy compared to Western children ( 11,14 ) , as demonstrated by their weight and length SDS . The 25OHD concentrations of the women were > 50 nmol/L in the second half of pregnancy , and no distinction could be drawn in infant outcomes between mothers with concentrations above or below 80 nmol/L. Thus , our study suggests that , for women with regular , adventitious UVB sunshine exposure and in situations where foetal and infant growth may be constrained by multiple factors , there would be no benefit for foetal and infant growth or bone mineral accrual in aim ing to increase the vitamin D status of individual mothers during pregnancy above 50 or 80 Background Birthweight , and by inference maternal nutrition during pregnancy , is thought to be an important determinant of offspring blood pressure but the evidence base for this in humans is lacking data from r and omized controlled trials . Methods The offspring from a maternal prenatal protein-energy supplementation trial  were enrolled into a follow-up study of chronic disease risk factors including blood pressure . Subjects were 11–17 years of age and blood pressure was measured in triplicate using an automated monitor ( Omron 705IT ) . One-thous and two-hundred sixty seven individuals ( 71 % of potential participants ) were included in the analysis . Results There was no difference in blood pressure between those whose mothers had consumed protein-energy biscuits during pregnancy and those whose mothers had consumed the same supplement post-partum .  For systolic blood pressure the intention-to-treat regression coefficient was 0.46 ( 95 % CI : –1.12 , 2.04 ) . Mean systolic blood pressure for control children was 110.2 ( SD ± 9.3 ) mmHg and for intervention children was 110.8 ( SD ± 8.8 ) mmHg . Mean diastolic blood pressure for control children was 64.7 ( SD ± 7.7 ) mmHg and for intervention children was 64.6 ( SD ± 7.6 ) mmHg . Conclusions We have found no association between maternal prenatal protein-energy supplementation and offspring blood pressure in adolescence amongst rural Gambians . We found some evidence to suggest that offspring body composition may interact with the effect of maternal supplementation on blood pressure BACKGROUND In sub-Saharan Africa , ~ 40 % of children < 5 y old are stunted , with levels that have remained largely unchanged over the past 2 decades . Although the complex determinants of undernutrition are well recognized , few studies have evaluated strategies that combine nutrition-specific , health-based approaches with food system- and livelihood-based interventions . OBJECTIVE We examined changes in childhood stunting and its determinants after 3 y of exposure to an integrated , multisector intervention and compared these changes with national trends . DESIGN A prospect i ve observational trial was conducted across rural sites in 9 sub-Saharan African countries with baseline levels of childhood stunting > 20 % . A stratified r and om sample of households and resident children < 2 y old from villages exposed to the program were enrolled in the study . Main outcome measures included principal determinants of undernutrition and childhood stunting , which was defined as a height-for-age z score less than -2 . National trends in stunting were generated from demographic and health surveys . RESULTS Three years after the start of the program in 2005 - 2006 , consistent improvements were observed in household food security and diet diversity , whereas coverage with child care and disease-control interventions improved for most outcomes . The prevalence of stunting in children < 2 y old at year 3 of the program ( 2008 - 2009 ) was 43 % lower ( adjusted OR : 0.57 ; 95 % CI : 0.38 , 0.83 ) than at baseline . The average national stunting prevalence for the countries included in the study had remained largely unchanged over the past 2 decades . CONCLUSION These findings provide encouraging evidence that a package of multisector interventions has the potential to produce reductions in childhood stunting Background Malnutrition is a public health problem in Vietnam . Child health and the status of women have been targets for various health programs in the country . In general , reports in the literature suggest that care is positively correlated with positive nutritional status of children . In the household , the father is considered a re source for care . However , the role of paternal care in health programs has not received the attention it deserves . Objective To identify associations between the involvement of fathers in child care and housework and the nutritional status of children under 3 years of age . Methods This cross-sectional study was based on a r and om sample of 547 children under 3 years of age from intact families and their biological parents . The main outcome variable was child nutrition . Predictor variables represented two domains of father 's involvement . Multivariable general linear modeling and multivariable logistic regression modeling were performed with the use of a combination of stepwise and hierarchical approaches in data analysis . Results The overall prevalence of underweight among children was 19.1 % , and the prevalence of stunting was 14.4 % . Children whose fathers did not bring them to a medical facility for immunization were about 1.7 times more likely to be underweight and stunted than those whose fathers did bring them for immunization after child 's age , household economic status , and mother 's education were controlled for . Father 's involvement in housework was not found to be related to the prevalence of malnutrition . Conclusions Paternal involvement in child immunization should be encouraged by health-care providers who manage immunization programs BACKGROUND Maternal nutritional intake during pregnancy may have important consequences for long-term health in offspring . OBJECTIVE The objective was to follow up the offspring in 2 r and omized trials of nutrient supplementation during pregnancy to investigate the effect on cardiovascular disease ( CVD ) risk  in offspring . DESIGN We recruited offspring born during 2 trials in The Gambia , West Africa . One trial provided protein-energy-dense food supplements ( 1015 kcal and 22 g protein/d ) to pregnant ( intervention , from 20 wk gestation until delivery ) or lactating ( control , for 20 wk from birth ) women and was r and omized at the village level . The second was a double-blind , individually r and omized , placebo-controlled trial of calcium supplementation ( 1.5 g/d ) , which was also provided from 20 wk gestation until delivery . RESULTS Sixty-two percent ( n = 1267 ) of children ( aged 11 - 17 y ) born during the protein-energy trial were recruited and included in the analysis , and 64 % ( n = 350 ) of children ( aged 5 - 10 y ) born during the calcium trial were recruited and included in the analysis . Fasted plasma glucose was marginally lower in children born to mothers receiving protein-energy supplements during pregnancy than in those children of the lactating group ( adjusted mean difference : -0.05 mmol/L ; 95 % CI : -0.10 , -0.001 mmol/L ) . There were no other differences in CVD risk factors , including blood pressure , body composition , and cholesterol , between children born to intervention and control women from the protein-energy trial . Maternal calcium supplementation during pregnancy was unrelated to offspring blood pressure . CONCLUSION These data suggest that providing supplements to pregnant women in the second half of pregnancy may have little effect on the CVD risk of their offspring , at least in this setting and at the ages studied here . This trial was registered at www.controlled-trials.com as IS RCT N96502494 Background Vitamin A is important for protection against diarrhea , and supplements may benefit gut function of infants of HIV-infected mothers . Methods We studied 238 infants of HIV-infected South African women participating in a r and omized , double-blind , placebo-controlled trial of vitamin A during pregnancy ( 1.5 mg retinyl palmitate and 30 mg & bgr;-carotene daily ) plus 60 mg retinyl palmitate at delivery . The placebo group received identical placebo capsules at the same times . When infants were 1 , 6 , and 14 weeks of age , lactulose/mannitol dual sugar intestinal permeability tests were performed . Results Maternal vitamin A supplementation did not significantly affect infant gut permeability in the group as a whole at any time . By multiple regression analysis , HIV infection of the infant by 14 weeks was significantly associated with increased gut permeability at both 6 and 14 weeks . After controlling for birth weight , gestational age , current weight , feeding mode and recent morbidity , there was a trend toward an interaction between vitamin A supplementation and HIV infection ( P = 0.086 ) at 14 weeks . Vitamin A made no difference to gut permeability of uninfected infants ( lactulose/mannitol ratio for vitamin A group : 0.11 , 95 % confidence interval [ CI ] 0.08 , 0.15 , n = 73 and for placebo group : 0.09 , 95 % CI 0.06 , 0.12 , n = 76 ) , but largely prevented the increase in the ratio of HIV-infected infants  ( vitamin A group : 0.17 , 95 % CI 0.13 , 0.23 , n = 23 ; placebo group : 0.50 , 95 % CI 0.37 , 0.68 , n = 20 ) . The effects on the lactulose/mannitol ratio were related to changes in lactulose , not mannitol , excretion .  Vitamin A supplementation was associated with significantly lower lactulose excretion at 1 and 14 weeks , suggesting the major effect of vitamin A was on maintaining the integrity of gut tight junctions . Conclusions Vitamin A supplementation of HIV-infected pregnant women may prevent the deterioration in gut integrity in the subgroup of their infants who themselves become infected . Improving vitamin A status of HIV-infected infants may decrease their gastrointestinal morbidity OBJECTIVE In stating the Millennium Development Goals , the United Nations aims to halve malnutrition around the world by 2015 . Nutritional status of the elderly population in low-income countries is seldom focused upon . The present study aim ed to evaluate the magnitude of malnutrition among an elderly population in rural Bangladesh . DESIGN AND SETTING Data collection for a multidimensional cross-sectional study of community-based elderly people aged 60 years and over was conducted in a rural area in Bangladesh . SUBJECTS Of 850 r and omly selected elderly individuals , 625 participated in home interviews .  Complete nutritional information was available for 457 individuals ( mean age 69+/-8 years , 55 % female ) .  Nutritional status was assessed using an adapted form of the  Mini Nutritional Assessment ( MNA ) including body mass index ( BMI ) . Age , sex , education , household expenditure on food and self-reported health problems were investigated as potential predictors of nutritional status . RESULTS BMI < 18.5 kg m(-2 ) , indicating chronic energy deficiency , was found in 50 % of the population . MNA revealed a prevalence of 26 % for protein-energy malnutrition and 62 % for risk of malnutrition . Health problems rather than age had a negative impact on nutritional status . Level of education and food expenditure were directly associated with nutritional status . CONCLUSION In order to reduce world hunger by half in the coming decade , it is important to recognise that a substantial proportion of the elderly population , particularly in low-income countries , is undernourished Concurrent micronutrient deficiencies are prevalent among Vietnamese school children . A school-based program providing food fortified with multiple micronutrients could be a cost-effective and sustainable strategy to improve health and cognitive function of  school children . However , the efficacy of such an intervention may be compromised by the high prevalence of parasitic infestation . To evaluate the efficacy of school-based intervention using multi-micronutrient-fortified biscuits with or without deworming on anemia and micronutrient status in Vietnamese schoolchildren , a r and omized , double-blind , placebo-controlled trial was conducted among 510 primary schoolchildren , aged 6 - 8 y , in rural Vietnam .  Albendazole ( Alb ) ( 400 mg ) or placebo was given at baseline . Nonfortified or multi-micronutrient-fortified biscuits including iron ( 6 mg ) , zinc ( 5.6 mg ) , iodine ( 35 microg ) , and vitamin A ( 300 microg retinol equivalents ) were given 5 d/wk for 4 mo . Multi-micronutrient fortification significantly improved the concentrations of hemoglobin ( + 1.87 g/L ; 95 % CI : 0.78 , 2.96 ) , plasma ferritin ( + 7.5 microg/L ; 95 % CI : 2.8 , 12.6 ) , body iron ( + 0.56 mg/kg body weight ; 95 % CI : 0.29 , 0.84 ) , plasma zinc ( + 0.61 micromol/L ; 95 % CI : 0.26 , 0.95 ) , plasma retinol ( + 0.041 micromol/L ; 95 % CI : 0.001 , 0.08 ) , and urinary iodine ( + 22.49 micromol/L ; 95 % CI : 7.68 , 37.31 ) . Fortification reduced the risk of anemia and deficiencies of zinc and iodine by > 40 % . Parasitic infestation did not affect fortification efficacy , whereas fortification significantly enhanced deworming efficacy , with the lowest reinfection rates in children receiving both micronutrients and Alb . Multi-micronutrient fortification of biscuits is an effective strategy to improve the micronutrient status of Vietnamese schoolchildren and enhances effectiveness of deworming OBJECTIVE . Beneficial effects of breast milk on cognitive skills and behavior ratings have been demonstrated previously in term and very low birth weight infants . Extremely low birth weight infants are known to be at increased risk for developmental and behavior morbidities . The benefits of breast milk that is ingested in the NICU by extremely low birth weight infants on development and behavior have not been evaluated previously . METHODS . Nutrition data including enteral and parenteral feeds were collected prospect ively , and follow-up assessment s of 1035 extremely low birth weight infants at 18 months ’ corrected age were completed at 15 sites that were participants in the National Institute of Child Health and Human Development Neonatal Research Network Glutamine Trial between October 14 , 1999 , and June 25 , 2001 .  Total volume of  breast milk feeds  ( mL/kg per day ) during hospitalization was calculated . Neonatal characteristics and morbidities , interim history , and neurodevelopmental and growth outcomes at 18 to 22 months ’ corrected age were assessed . RESULTS . There were 775 ( 74.9 % ) infants in the breast milk and 260 ( 25.1 % ) infants in the no breast milk group . Infants in the breast milk group were similar to those in the no breast milk group in every neonatal characteristic and morbidity , including number of days of hospitalization . Mean age of first day of breast milk for the breast milk infants was 9.3 ± 9 days . Infants in the breast milk group began to ingest non – breast milk formula  later ( 22.8 vs 7.3 days ) compared with the non – breast milk group . Age at achieving full enteral feeds was similar between the breast milk and non – breast milk groups ( 29.0 ± 18 vs 27.4 ± 15 ) . Energy intakes of 107.5 kg/day and 105.9 kg/day during the hospitalization did not differ between the breast milk and non – breast milk groups , respectively . At discharge , 30.6 % of infants in the breast milk group still were receiving breast milk . Mothers in the breast milk group were significantly more likely to be white ( 42 % vs 27 % ) , be married ( 50 % vs 30 % ) , have a college degree ( 22 % vs 6 % ) , and have private health insurance ( 34 % vs 18 % ) compared with the no breast milk group . Mothers who were black , had a low household income ( ≤$20000 ) , or had higher parity were less likely to provide breast milk feeds . The analysis of outcomes between the any human milk and no human milk groups were adjusted for maternal age , maternal education , marital status , race/ethnicity , and the other st and ard covariates . Children in the breast milk group were more likely to have a Bayley Mental Development Index ≥85 , higher mean Bayley Psychomotor Development Index , and higher Bayley Behavior Rating Scale percentile scores for orientation/engagement , motor regulation , and total score . There were no differences in the rates of moderate to severe cerebral palsy or blindness or hearing impairment between the 2 study groups . There were no differences in the mean weight ( 10.4 kg vs 10.4 kg ) , length ( 80.5 cm vs 80.5 cm ) , or head circumference ( 46.8 cm vs 46.6 cm ) for the breast milk and no breast milk groups , respectively , at 18 months . Multivariate analyses , adjusting for confounders , confirmed a significant independent association of breast milk on all 4 primary outcomes : the mean Bayley ( Mental Development Index , Psychomotor Development Index , Behavior Rating Scale , and incidence of rehospitalization ) . For every 10-mL/kg per day increase in breast milk ingestion , the Mental Development Index increased by 0.53 points , the Psychomotor Development Index increased by 0.63 points , the Behavior Rating Scale percentile score increased by 0.82 points , and the likelihood of rehospitalization decreased by 6 % . In an effort to identify a threshold effect of breast milk on Bayley Mental Development Index and Psychomotor Development Index scores and Behavior Rating Scale percentile scores , the mean volume of breast milk per kilogram per day during the hospitalization was calculated , and infants in the breast milk group were divided into quintiles of breast milk ingestion adjusted for confounders . Overall , the differences across the feeding quintiles of Mental Development Index and Psychomotor Development Index were significant . There was a 14.0 % difference in Behavior Rating Scale scores between the lowest and highest quintiles . For the outcomes ( Mental Development Index , Psychomotor Development Index , Behavior Rating Scale , and Rehospitalization < 1 year ) , only the values for the > 80th percentile quintile of breast milk feeding were significantly different from the no breast milk values . In our adjusted regression analyses , every 10 mL/kg per day breast milk contributed 0.53 points to the Bayley Mental Development Index ; therefore , the impact of breast milk ingestion during the hospitalization for infants in the highest quintile ( 110 mL/kg per day ) on the Bayley Mental Development Index would be 10 × 0.53 , or 5.3 points . CONCLUSIONS . An increase of 5 points potentially would optimize outcomes and decrease costs by decreasing the number of very low birth weight children who require special education services . The societal implication s of a 5-point potential difference ( one third of an SD ) in IQ are substantial . The potential long-term benefit of receiving breast milk in the NICU for extremely low birth weight infants may be to optimize cognitive potential and reduce the need for early intervention and special education services
Background Nutrition is the intake of food in relation to the body 's dietary needs .
Malnutrition results from the intake of inadequate or excess food .
This can lead to reduced immunity , increased susceptibility to disease , impaired physical and mental development , and reduced productivity .
Objective To perform a systematic review to assess research conducted by the International Network for the Demographic Evaluation of Population s and their Health ( INDEPTH ) of health and demographic surveillance systems ( HDSSs ) over a 15-year period on malnutrition , its determinants , the effects of under and over nutrition , and intervention research on malnutrition in low- and middle-income countries ( LMICs ) .