What Explains Child Malnutrition of Indigenous People of Northeast India?

Household risk factors affecting child health, particularly malnutrition, are mainly basic amenities like drinking water, toilet facility, housing and fuel used for cooking. This paper considered the collective impact of basic amenities measured by an index specially constructed as the contextual factor of child malnutrition. The contextual factor operates at both the macro and micro levels namely the state level and the household level. The importance of local contextual factors is especially important when studying the nutritional status of children of indigenous people living in remote and inaccessible regions. This study has shown the contextual factors as potential factors of malnutrition among children in northeast India, which is home to the largest number of tribes in the country. In terms of macro level contextual factor it has been found that 8.9 per cent, 3.7 per cent and 3.6 per cent of children in high, medium and low risk households respectively, are severely wasted. Lower micro level household health risks, literate household heads, and scheduled tribe households have a negating effect on child malnutrition. Children who received colostrum feeding at the time of birth and those who were vaccinated against measles are also less subject to wasting compared to other children, and these differences are statistically significant.     

Household and community socioeconomic influences on early childhood malnutrition in Africa

This paper uses multilevel modelling and Demographic and Health Survey data from five African countries to investigate the relative contributions of compositional and contextual effects of socioeconomic status and place of residence in perpetuating differences in the prevalence of malnutrition among children in Africa. It finds that community clustering of childhood malnutrition is accounted for by contextual effects over and above likely compositional effects, that urban-rural differentials are mainly explained by the socioeconomic status of communities and households, that childhood malnutrition occurs more frequently among children from poorer households and/or poorer communities and that living in deprived communities has an independent effect in some instances. This study also reveals that socioeconomic inequalities in childhood malnutrition are more pronounced in urban centres than in rural areas.     

Contextual risk factors for maternal malnutrition in a food-insecure zone in southern Ethiopia

This study examined the nutritional status of mothers in one of the most populous food-insecure zones in southern Ethiopia, the Sidama zone. The study used primary data collected from 1094 households with a child under 24 months located in ten kebeles (the smallest administrative district). Households were selected using multi-stage probability sampling techniques. The mothers' nutritional status was estimated using both body mass index (BMI) and mid-upper-arm circumference (MUAC). The results from the BMI analysis revealed that 28.1% of the women were malnourished (BMI <18.5) and 67.5% were normal (BMI 18.5 to <25.0), while the remaining small proportion (4.5%) fell in the overweight or obese categories. Similarly, the computation of maternal nutritional status by MUAC analysis showed that 31.4% of the women were malnourished (MUAC <22). Further analysis of the main predictors of maternal malnutrition using logistic regression showed that three individual-level variables and three household-level variables predicted maternal malnutrition: woman's age, duration of breast-feeding, literacy status, marital form, land size and intra-household food distribution. The study concludes that maternal malnutrition is a serious problem in the study area and that there are contextual risk factors that could be addressed to partially tackle the problem.     

Post-Discharge Mortality in Children with Severe Malnutrition and Pneumonia in Bangladesh

Background

Post-discharge mortality among children with severe illness in resource-limited settings is under-recognized and there are limited data. We evaluated post-discharge mortality in a recently reported cohort of children with severe malnutrition and pneumonia, and identified characteristics associated with an increased risk of death.

Methods

Young children (<5 years of age) with severe malnutrition (WHO criteria) and radiographic pneumonia on admission to Dhaka Hospital of icddr,b over a 15-month period were managed according to standard protocols. Those discharged were followed-up and survival status at 12 weeks post-discharge was determined. Verbal autopsy was requested from families of those that died.

Results

Of 405 children hospitalized with severe malnutrition and pneumonia, 369 (median age, 10 months) were discharged alive with a follow-up plan. Of these, 32 (8.7%) died in the community within 3 months of discharge: median 22 (IQR 9–35) days from discharge to death. Most deaths were reportedly associated with acute onset of new respiratory or gastrointestinal symptoms. Those that died following discharge were significantly younger (median 6 [IQR 3,12] months) and more severely malnourished, on admission and on discharge, than those that survived. Bivariate analysis found that severe wasting on admission (OR 3.64, 95% CI 1.66–7.97) and age <12 months (OR 2.54, 95% CI 1.1–8.8) were significantly associated with post-discharge death. Of those that died in the community, none had attended a scheduled follow-up and care-seeking from a traditional healer was more common (p<0.001) compared to those who survived.

Conclusion and Significance

Post-discharge mortality was common in Bangladeshi children following inpatient care for severe malnutrition and pneumonia. The underlying contributing factors require a better understanding to inform the potential of interventions that could improve survival.     

The outcome of acute schistosomiasis infection in adult mice with postnatal exposure to maternal malnutrition

Maternal malnutrition during the lactation period in early development may have long-term programming effects on adult offspring. We evaluated the combined effects of parasitological behaviour and histopathological features and malnutrition during lactation. Lactating mice and their pups were divided into a control group (fed a normal diet of 23% protein), a protein-restricted group (PR) (fed a diet containing 8% protein) and a caloric-restricted group (CR) (fed according to the PR group intake). At the age of 60 days, the offspring were infected with Schistosoma mansoni cercariae and killed at nine weeks post-infection. Food intake, body and liver masses, leptinaemia, corticosteronaemia, collagen morphometry and neogenesis and the cellular composition of liver granulomas were studied. PR offspring showed reduced weight gain and hypophagia, whereas CR offspring became overweight and developed hyperphagia. The pre-patent period was longer (45 days) in both programmed offspring as compared to controls (40 days). The PR-infected group had higher faecal and intestinal egg output and increased liver damage. The CR-infected group showed a lower number of liver granulomas, increased collagen neogenesis and a higher frequency of binucleate hepatocytes, suggesting a better modulation of the inflammatory response and increased liver regeneration. Taken together, our findings suggest that neonatal malnutrition of offspring during lactation affects the outcome of schistosomiasis in mice.     

The Abundance of Protein in Amazonia: A Reply to Gross

A critical examination of Gross's hypothesis that aboriginal Amazonian populations were limited to low levels by lack of adequate protein resources concludes that (1) evidence either for or against the hypothesis is still in short supply; (2) the role of vegetable protein in aboriginal diets needs much more attention and may ultimately overthrow the protein-limitation hypothesis; (3) the abundance of animal protein in the tropical forest has likely also been underestimated; (4) the abundance of people in precontact Amazonia may well have been underestimated as well. [Amazonia, protein, cultural ecology, limiting factors, population].     

Factors affecting onset of puberty

In humans, foetal and early postnatal growth failure may have persistent consequences for growth and pubertal development in later life. During this period, the developing organs are still plastic to change their function, which may have long-lasting effects. At the time of onset of puberty, acute factors may also interfere with pubertal development. Malnutrition, as seen in anorexic patients, and chronic diseases with malabsorption or diseases with systemic effects result in a delayed onset of puberty. We have observed an earlier onset of puberty in girls with low birth weight; menarcheal age also tended to be earlier. In boys, a low birth weight tended to be associated with a later development. Two rat models with growth failure based on perinatal malnutrition have been examined, one with intrauterine growth retardation (IUGR) by ligation of the uterine arteries and one with postnatal food restriction (FR) by increasing the litter size postnatally. In both models, the rats had a persistent postnatal growth failure. The onset of puberty in female rats, defined by vaginal opening, was delayed only in the IUGR group. Despite a significantly lower weight, there was no difference in the timing of puberty onset in the FR group. In IUGR rats, the ovaries had fewer follicles, while FR rats had a normal number of follicles but an abnormal maturation pattern. In male rats, both models showed a delayed onset of puberty, defined by the balano-preputial separation, as well as impaired testicular function, shown by decreased testosterone levels. These data indicate that early malnutrition during a critical developmental time window may have long-lasting effects on pubertal development, including gonadal maturation in both humans and rats.     

Socio-demographic determinants of abortion in India: a north-South comparison

Data from the 1998-99 National Family Health Survey (NFHS2) of India are used to examine the net effects of social and demographic characteristics of women on the likelihood of abortion while emphasizing important differences between women from northern and southern states. A north-south comparison illustrates that southern women have relatively higher levels of literacy and labour force participation, lower levels of son preference, and smaller family size. Results from logistic regression analyses show that literacy, type of work, belonging to a scheduled caste or tribe, urban residence, standard of living, parity, religion, age, age at union and contraceptive behaviour all have significant effects on the likelihood of abortion. However, most of these effects significantly differ for southern and northern women. Moreover, the effects of agricultural work, son preference and age at union on the likelihood of abortion are significant for northern but not southern women.     

Interaction of intermittent fasting on the cytotoxic effects of nickel in rats at puberty

This study has been undertaken with the aim of determining if intermittent fasting can be considered as a malnutrition that amplifies, according to numerous authors, the cytotoxic effects of environmental pollutants. We have used 200 male and female rats of 'Wistar' descent (BW approximately 180 g). These rats are distributed into two groups: some nourished daily (N) and others nourished one day over two (J) during a month. By the end of this month, each group is itself split into two subgroups, the first one receiving tap water as drinkable water (group NO and JO); the other one receiving the water enriched by the chloride of nickel at the rate of 100 mg NiCl2 per litre (groups NNi and JNi). Intermittent fasting goes on parallel to treatment during 2, 4, 10, 16, 30 and 60 days. For the exploration of the protein of stress (HSP) and of the metallothioneines (MT), the nickel is administered by injection at the rate of 4 mg NiCl2 per kg during 1 and 5 days. Our results show that the mineral seric and renal balance does not vary in conditions of intermittent fasting compared with conditions of normal nutrition. Our study show than that nickel induced a renal deficiency by decreasing the creatinemia and uraemia rate, which is confirmed by the histological study, and induced a decrease in the induction of the HSP73 and in the synthesis of the (MT). The association of nickel with intermittent fasting would inhibit these effects. In conclusion, intermittent fasting does not manifest itself as a malnutrition that amplifies the nickel's effects. Nevertheless, it seems that the calorific lack provoked by intermittent fasting is beneficial to the body by increasing its performances against the cytotoxic effects induced by nickel.     

Malnutrition Has No Effect on the Timing of Human Tooth Formation

The effect of nutrition on the timing of human tooth formation is poorly understood. Delays and advancements in dental maturation have all been reported as well as no effect. We investigated the effect of severe malnutrition on the timing of human tooth formation in a large representative sample of North Sudanese children. The sample (1102 males, 1013 females) consisted of stratified randomly selected healthy individuals in Khartoum, Sudan, aged 2-22 years using a cross-sectional design following the STROBE statement. Nutritional status was defined using WHO criteria of height and weight. Body mass index Z-scores and height for age Z-scores of ≤−2 (cut-off) were used to identify the malnourished group (N = 474) while the normal was defined by Z-scores of ≥0 (N = 799). Clinical and radiographic examination of individuals, with known ages of birth was performed including height and weight measurements. Mandibular left permanent teeth were assessed using eight crown and seven root established tooth formation stages. Mean age at entry and mean age within tooth stages were calculated for each available tooth stage in each group and compared using a t-test. Results show the mean age at entry and mean age within tooth stages were not significantly different between groups affected by severe malnutrition and normal children (p>0.05). This remarkable finding was evident across the span of dental development. We demonstrate that there is little measurable effect of sustained malnutrition on the average timing of tooth formation. This noteworthy finding supports the notion that teeth have substantial biological stability and are insulated from extreme nutritional conditions compared to other maturing body systems.     

Association of genetic variants of ghrelin, leptin and UCP2 with malnutrition inflammation syndrome and survival in end-stage renal disease patients

Malnutrition inflammation syndrome (MIS) is common among ESRD patients. In the present study, we have investigated the association of genetic markers associated with appetite and energy regulation with malnutrition inflammation syndrome among end-stage renal disease (ESRD) patients. Two hundred and fifty-seven patients on maintenance hemodialysis and 200 normal healthy controls were included in the study. Nutritional assessment was done by subjective global assessment scores (SGA). Genotyping of leptin-2548 G/A (rs7799039), ghrelin Leu72Met (rs696217-408 C/A), Arg51Gln (rs34911341-346 G/A) and uncoupling protein 2 (UCP2) 45 bp insertion deletion was done using PCR–RFLP. Levels of leptin and acyl ghrelin were assessed using ELISA. Leptin-2548 AA genotype was associated with twofold higher risk of disease susceptibility while UCP2 insertion–deletion heterozygotes showed protective effect. Ghrelin Gln51Gln and Met72Met genotype were associated with 3.4- and 2.5-fold higher disease susceptibility. The Met72 and Gln51 allele showed 3.3- and 2.1-fold higher susceptibility to malnutrition in severe SGA group. Further, the levels of acyl ghrelin were significantly less in severe category of malnutrition and in poor appetite group. On combined analysis, the group 2 (presence of 3–4 risk alleles) showed 1.5- and twofold higher susceptibility to disease and malnutrition, respectively. On docking analysis, it was observed that higher receptor binding energy was associated with the mutant form of ghrelin (Gln51). Moderate and severe SGA were associated with 2.2- and 4.1-fold higher death hazard. Our study suggests that ghrelin may be major marker contributing to susceptibility to MIS among ESRD patients.     

帕金森病患者营养不良的影响因素分析及与衰弱、认知功能和跌倒风险的关系研究

摘要 目的：分析帕金森病（PD）患者营养不良的影响因素,并观察营养不良对衰弱、认知功能和跌倒风险的影响。方法：选取江苏省人民医院2019年3月至2022年3月期间收治的100例PD患者。采用简易营养评价量表（MNA）对研究对象进行营养状态评估,将100例患者分为营养不良组（n=52）和无营养不良组（n=48）。获取所有患者的一般资料,经Logistic回归分析PD患者营养不良的影响因素。同时对比无营养不良组、营养不良组的衰弱、认知功能和跌倒风险情况。结果：PD患者营养不良与年龄、体质量指数、Hoehn-Yahr分级、居住地、婚姻状况、血红蛋白、白蛋白、前白蛋白、每日左旋多巴等效剂量（LEDDs）、睡眠状况、焦虑状况、抑郁状况、味觉障碍、吞咽障碍、食欲下降有关（P<0.05）。Logistic回归分析,结果显示：年龄偏大、Hoehn-Yahr分级为III~V级、睡眠状况偏差、焦虑/抑郁状况严重、味觉障碍、吞咽障碍、食欲下降、LEDDs偏高是PD患者出现营养不良的危险因素（P<0.05）。营养不良组的衰弱发生率高于无营养不良组,衰弱前期、无衰弱发生率低于无营养不良组（P<0.05）。营养不良组的简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MOCA）评分低于无营养不良组（P<0.05）。营养不良组的起立-行走计时测验（TUGT）时间、站起测验（CRT）时间长于无营养不良组,走直线步态测验（TGT）正确步数少于无营养不良组（P<0.05）。结论：PD患者营养不良发生风险较高,且受到年龄、睡眠状况、焦虑状况、抑郁状况、Hoehn-Yahr分级、味觉障碍、吞咽障碍、食欲下降、LEDDs的影响,且营养不良可加重衰弱、降低认知功能和增加跌倒风险。     

Body mass index and chronic energy deficiency of adult males of Central Indian populations

Data on body weight, height, and sitting height from 11,496 adult males, age 18-62 years, belonging to 38 different populations of five major social groups (scheduled tribes, scheduled castes, "other backward castes," general castes, and Muslims) of Central India were taken for our analysis to assess the nutritional status of these groups. Cormic index and body mass index (BMI) were computed, and an analysis of variance (ANOVA) was carried out among different populations as well as among social groups separately on Cormic index and BMI. Shape, size, and generalized distances among the different social groups were computed and dendrograms were drawn. The level of malnutrition is the lowest among the general castes. The opposite is the case with the scheduled castes and scheduled tribes. Comparison of the coefficient of variation shows that there is variation in weight and BMI but that there is no marked variation in the other anthropometric variables. The ANOVA on Cormic index and BMI suggests that the people within a population are more homogeneous than the people between populations. There is a positive but statistically insignificant correlation between Cormic index and BMI. The five social groups differ more in size distance than in shape distance. According to the dendrogram of generalized distance values, the Muslims and the general castes can be grouped into one cluster and the scheduled castes, scheduled tribes, and other backward castes can be grouped into another cluster.     

The effect of women's status and community on the gender differential in children's nutrition in India

This study uses the third National Family Health Survey (2005-06) in India to investigate whether differences in women's status, both at the individual and community levels, can explain the persistent gender differential in nutritional allocation among children. The results show that girls are less likely than boys to receive supplemental food and more likely to be malnourished. In general it appears that higher women's status within a community, as well as higher maternal status, have beneficial effects on a daughter's nutritional status. Further, the moderating effects of community appear to be more consistent and stronger than the individual-level characteristics. A positive relationship between the percentage of literate women in a community and the gender differential in malnutrition appears to be an exception to the general findings regarding the beneficial nature of women's status on a daughter's well-being, showing the need for more than just basic adult literacy drives in communities to overcome the problem of daughter neglect.     

先天性心脏病患儿术前营养不良的危险因素分析及其对术后临床结局、免疫功能和生存质量的影响

摘要 目的：分析先天性心脏病（CHD）患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。方法：选取2020年1月-2022年6月期间江苏省人民医院收治的65例CHD患儿,采用世界卫生组织（WHO）推荐的美国国家卫生统计中心制订的相关营养诊断标准评估CHD患儿的营养情况,统计CHD患儿术前营养不良发生率,采用单因素和多因素Logistic回归分析CHD患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。结果：本次研究入选的患儿中,有31例出现术前营养不良,34例无营养不良。根据患儿的营养状况将患儿分为营养不良组（n=31）和非营养不良组（n=34）。多因素Logistic回归分析结果显示：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,母亲主动获取疾病知识则是其保护因素（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05）,营养不良组的住院时间长于非营养不良组,住院费高于非营养不良组（P<0.05）。两组术后3个月CD3⁺、CD4⁺、CD4⁺/CD8⁺升高,CD8⁺下降,且非营养不良组的改善效果优于营养不良组（P<0.05）。两组术后3个月术前沟通问题、心脏问题和症状、治疗焦虑、感知身体外貌、认知心理问题评分均升高,且非营养不良组的改善效果均优于营养不良组（P<0.05）。结论：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,而母亲主动获取疾病知识是CHD患儿术前营养不良的保护因素。术前营养不良会导致CHD患儿术后免疫功能下降,生存质量降低,临床结局相对偏差。     

Phosphorylated ATM and H2AX in T and B lymphocytes from rats with moderate and severe malnutrition

Protein calorie malnutrition (PCM) occurs when insufficient nutrients are consumed to satisfy the biological needs of an organism. The literature supports the relationship between malnutrition and DNA damage, and among the injuries to genetic material, DNA double-strand breaks (DSBs) are the most dangerous. This study aimed to determine whether the ability of splenic and peripheral blood T and B lymphocytes from nursing rats to recognize DSB-induced DNA damage is affected by PCM. Wistar strain rats were used, and experimental malnutrition was induced by creating food competition during lactation by increasing the number of offspring per wet nurse. Due to its high specificity, the phosphorylated H2AX variant histone assay associated with pATM (Ser1981) combined with flow cytometry was herein used to demonstrate the impact of malnutrition on the DNA damage response. Flow cytometry data indicated that splenic T and B lymphocytes from rats with severe PCM have the capacity to detect genetic material damage, as shown by an increased number of pATM + cells and altered signaling pathway continuity. Collectively, these data suggest that severe malnutrition compromises the continuity of the DNA damage response.     

Organoids as a model to study intestinal and liver dysfunction in severe malnutrition

Hospitalized children with severe malnutrition face high mortality rates and often suffer from hepatic and intestinal dysfunction, with negative impacts on their survival. New treatments cannot be developed without understanding the underlying pathophysiology. We have established and characterized translational organoid models of severe malnutrition of the liver and the intestine. In these models, amino acid starvation recapitulates the expected organ-specific functional changes (e.g., hepatic steatosis, barrier dysfunction) accompanied by reduced mitochondrial and peroxisomal proteins, and altered intestinal tight junction proteins. Re-supplementation of amino acids or pharmacological interventions with rapamycin or fenofibrate lead to partial recovery. Restoration of protein levels aligned with signs of improved peroxisomal function in both organoids, and increased mitochondrial proteins and tight junction protein claudin-3 in intestinal organoids. We present two organoid models as novel tools to gain mechanistic insights and to act as a testing platform for potential treatments for intestinal and hepatic dysfunction in severe malnutrition.     

Humoral immunity in malnutrition

Malnutrition affects the humoral immune system in diverse fashions. B lymphocyte subpopulations, serum IgG, and IgA levels, and immunoglobulin synthesis and metabolism are usually normal or increased. Hypogammaglobulinemia may occur in very young, severely malnourished infant. Although usually normal, deficient antibody responses to injected antigens are occasionally present, depending on the severity of the malnutrition. Serum IgE levels are usually high in malnutrition, probably due both to the increased incidence of intestinal parasites and to the lack of T cell control of IgE. Despite these high IgE levels, allergy is unusual. Secretory IgA levels in the respiratory and gastrointestinal (GI) fluids are generally decreased, as are secretory IgA antibody responses. This local antibody deficiency may increase GI permeability, stimulate immune complex formation, and result in the formation of IgG food antibodies. Breast milk secretory IgA levels are equivalent in malnourished mothers but because of lessened milk volume, the total amount of secretory IgA delivered to their offspring is diminished. Complement levels are somewhat diminished in the presence of malnutrition with a resultant opsonic deficiency. Although these B cell system aberrations undoubtedly contribute to the enhanced susceptibility to infection of malnourished patients, they are usually less severe than are concomitant T cell deficiencies.     

老年心力衰竭患者营养不良的影响因素分析及早期肠内营养对营养不良患者心功能、营养状况和肠道黏膜屏障功能的影响

摘要 目的：探讨老年心力衰竭（HF）患者营养不良的影响因素及早期肠内营养对营养不良患者心功能、营养状况和肠道黏膜屏障功能的影响。方法：选取2021年2月~2022年4月期间在我院接受治疗的180例老年HF患者作为研究对象。入院后采用微型营养评价简表（MNA-SF）评估患者的营养状况。根据MNA-SF评分结果分为营养不良组（n=83）和营养正常组（n=97）。应用单因素及多因素Logistic回归分析老年HF患者营养不良的危险因素。对老年HF营养不良患者给予早期肠内营养干预,观察其治疗前、治疗一周后心功能、营养状况和肠道黏膜屏障功能的变化情况。结果：老年HF患者营养不良与性别、居住地、饮酒史、病因、职业类别、谷丙转氨酶、血肌酐、收缩压（SBP）、舒张压（DBP）无关（P>0.05）,而与年龄、医保类型、病程、婚姻状况、美国纽约心脏病学会（NYHA）分级、文化程度、C反应蛋白（CRP）、家庭人均月收入、B型脑钠肽（BNP）、吸烟史、左心室射血分数（LVEF）有关（P<0.05）。Logistic回归分析结果显示：病程偏长、CRP偏高、BNP偏高、NYHA分级为IV级、年龄偏大、吸烟史是老年HF患者发生营养不良的危险因素（P<0.05）。治疗1周后,营养不良组老年HF患者的LVEF升高,BNP下降（P<0.05）。治疗1周后,营养不良组老年HF患者的前白蛋白（PA）、转铁蛋白（TRF）升高（P<0.05）。治疗1周后,营养不良组老年HF患者的D-乳酸（D-Lac）、二胺氧化酶（DAO）、肠脂肪酸结合蛋白（IFABP）下降（P<0.05）。结论：老年HF患者营养不良受到病程、CRP、BNP、NYHA分级、年龄、吸烟史等多种因素的影响,针对老年HF患者营养不良给予早期肠内营养,有助于改善患者心功能、营养状况和肠道黏膜屏障功能。