Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants

Background

The World Health Organization (WHO) released new Child Growth Standards in 2006 to replace the current National Center for Health Statistics (NCHS) growth reference. We assessed how switching from the NCHS to the newly released WHO Growth Standards affects the estimated prevalence of wasting, underweight and stunting, and the pattern of risk factors identified.

Methodology/Principal Findings

Data were drawn from a village-informant driven Demographic Surveillance System in Northern Malawi. Children (n = 1328) were visited twice at 0–4 months and 11–15 months. Data were collected on the demographic and socio-economic environment of the child, health history, maternal and child anthropometry and child feeding practices. Weight-for-length, weight-for-age and length-for-age were derived in z-scores using the two growth references. In early infancy, prevalence estimates were 2.9, 6.1, and 8.5 fold higher for stunting, underweight, and wasting respectively using the WHO standards compared to NCHS reference (p<0.001 for all). At one year, prevalence estimates for wasting and stunting did not differ significantly according to reference used, but the prevalence of underweight was half that with the NCHS reference (p<0.001). Patterns of risk factors were similar with the two growth references for all outcomes at one year although the strength of association was higher with WHO standards.

Conclusions/Significance

Differences in prevalence estimates differed in magnitude but not direction from previous studies. The scale of these differences depends on the population''s nutritional status thus it should not be assumed a priori. The increase in estimated prevalence of wasting in early infancy has implications for feeding programs targeting lactating mothers and ante-natal multiple micronutrients supplementation to tackle small birth size. Risk factors identified using WHO standards remain comparable with findings based on the NCHS reference in similar settings. Further research should aim to identify whether the young infants additionally diagnosed as malnourished by this new standard are more appropriate targets for interventions than those identified with the NCHS reference.     

Comparison of the Nutritional Status of Overseas Refugee Children with Low Income Children in Washington State

Introduction

The extent that the dual burden of undernutrition and overnutrition affects refugee children before resettlement in the US is not well described.

Objective

To describe the prevalence of wasting, stunting, overweight, and obesity among refugee children ages 0–10 years at their overseas medical screening examination prior to resettlement in Washington State (WA), and to compare the nutritional status of refugee children with that of low-income children in WA.

Methods

We analyzed anthropometric measurements of 1047 refugee children ages 0–10 years old to assess their nutritional status at the overseas medical screening examination prior to resettlement in WA from July 2012—June 2014. The prevalence estimates of the nutritional status categories were compared by country of origin. In addition, the nutritional status of refugee children age 0–5 years old were compared to that of low-income children in WA from the Center for Disease Control and Prevention’s Pediatric Nutrition Surveillance System.

Results

A total of 982 children were eligible for the study, with the majority (65%) from Somalia, Iraq and Burma. Overall, nearly one-half of all refugee children had at least one form of malnutrition (44.9%). Refugee children ages 0–10 years were affected by wasting (17.3%), stunting (20.1%), overweight (7.6%) and obesity (5.9%). Among children 0–5 years old, refugee children had a significantly higher prevalence of wasting (14.3% versus 1.9%, p<0.001) and stunting (21.3% versus 5.5%, p<0.001), and a lower prevalence of obesity (6.2% versus 12.9%, p<0.001) than low-income children in WA.

Conclusion

The dual burden of under- and over-nutrition among incoming refugee children as well as their overall difference in prevalence of nutritional status categories compared to low-income children in WA provides evidence for the importance of tailored interventions to address the nutritional needs of refugee children.     

Soil-transmitted helminth infection,anemia, and malnutrition among preschool-age children in Nangapanda subdistrict,Indonesia

BackgroundSoil-transmitted helminth (STH) infections are still prevalent in Indonesia, with roughly one-third of infected population being preschool-age children (PSC), which are generally at higher risk of morbidity such as malnutrition and anemia. This study aimed to investigate the association of STH infections with nutritional status and anemia among PSC in Nangapanda subdistrict, Ende, East Nusa Tenggara.MethodsA cross-sectional survey involving PSC ranging from 12 to 59 months old from Nangapanda subdistrict, Ende district, East Nusa Tenggara was performed. Socio-demographic, breastfeeding, and complementary feeding information was obtained from structured questionnaires, while nutritional and anemia status was determined from anthropometry and hemoglobin measurements, respectively. Anthropometric z-scores were calculated based on the World Health Organization 2006 standards and stool samples were examined using Kato-Katz method.ResultsA total of 393 PSC randomly selected from 22 villages were examined. The prevalence of underweight, stunting, wasting, and anemia were 33.1%, 40.2%, 17.1%, and 60.3%, respectively. STH infection, predominated by Ascaris lumbricoides, was found in 160 (58.8%) PSC. Single STH infection, but not multiple infection, was independently associated with a lower risk of anemia (odds ratio [OR] 0.320, 95% confidence interval [CI]: 0.126–0.809, p = 0.016). Similar association with anemia was also found on mild STH infection (OR 0.318 [95% CI: 0.114–0.887], p = 0.029). On the other hand, younger children were found to have a higher risk of anemia and stunting. None of the examined variables were independently associated with underweight and wasting.ConclusionSTH infection as well as anemia and malnutrition were prevalent in this region. However in this study, current STH infections seemed to have minimal negative impact on children’s nutritional status.     

Stunted at 10 Years. Linear Growth Trajectories and Stunting from Birth to Pre-Adolescence in a Rural Bangladeshi Cohort

Background

Few studies in low-income settings analyse linear growth trajectories from foetal life to pre-adolescence. The aim of this study is to describe linear growth and stunting from birth to 10 years in rural Bangladesh and to analyse whether maternal and environmental determinants at conception are associated with linear growth throughout childhood and stunting at 10 years.

Methods and Findings

Pregnant women participating in the MINIMat trial were identified in early pregnancy and a birth cohort (n = 1054) was followed with 19 growth measurements from birth to 10 years. Analyses of baseline predictors and mean height-for-age Z-scores (HAZ) over time were modelled using GLMM. Logistic regression analysis was used to investigate the associations between baseline predictors and stunting (HAZ<-2) at 10 years. HAZ decreased to 2 years, followed by an increase up to 10 years, while the average height-for-age difference in cm (HAD) to the WHO reference median continued to increase up to 10 years. Prevalence of stunting was highest at 2 years (50%) decreasing to 29% at 10 years. Maternal height, maternal educational level and season of conception were all independent predictors of HAZ from birth to pre-adolescence (p<0.001) and stunting at 10 years. The highest probability to be stunted at 10 years was for children born by short mothers (<147.5 cm) (OR_adj 2.93, 95% CI: 2.06–4.20), mothers with no education (OR_adj 1.74, 95% CI 1.17–2.81) or those conceived in the pre-monsoon season (OR_adj 1.94, 95% CI 1.37–2.77).

Conclusions

Height growth trajectories and prevalence of stunting in pre-adolescence showed strong intergenerational associations, social differentials, and environmental influence from foetal life. Targeting women before and during pregnancy is needed for the prevention of impaired child growth.     

Scaling-Up Access to Family Planning May Improve Linear Growth and Child Development in Low and Middle Income Countries

Background

A large literature has indicated a robust association between birth spacing and child survival, but evidence on the association of birth timing with physical growth in low and middle income countries (LMICs) remains limited.

Methods and Results

Data from 153 cross-sectional Demographic and Health Surveys (DHS) across 61 LMICs conducted between 1990 and 2011 were combined to assess the association of birth timing with child stunting (height-for-age z-score <−2). A total of 623,789 children of birth order 1–5 contributed to the maternal age analysis, while the birth spacing dataset consisted of 584,226 children of birth order 2 and higher. Compared to 27–34 year old mothers, maternal age under 18 years was associated with a relative stunting risk of 1.35 (95% CI: 1.29–1.40) for firstborn children, whereas the relative risk was 1.24 (95% CI: 1.19–1.29) for mothers aged 18–19 years. The association of young maternal age with stunting was significantly greater for urban residents and those in the top 50% of household wealth. Birth intervals less than 12 months and 12–23 months had relative risks for stunting of 1.09 (95% CI: 1.06–1.12) and 1.06 (95% CI: 1.05–1.06) as compared to a 24–35 month inter-pregnancy interval, respectively. The strength of both teenage pregnancy and short birth interval associations showed substantial variation across WHO region. We estimate that 8.6% (6.9–10.3%) of stunted cases in the South Asian DHS sample would have been averted by jointly eliminating teen pregnancies and birth intervals less than 24 months, while only 3.6% (1.5–5.7%) of stunting cases would have prevented in the Middle East and North Africa sample.

Conclusions

Postponing the age of first birth and increasing inter-pregnancy intervals has the potential to significantly reduce the prevalence of stunting and improve child development in LMICs.     

Nutritional Manipulation for the Primary Prevention of Gestational Diabetes Mellitus: A Meta-Analysis of Randomised Studies

IntroductionThe rise in gestational diabetes (GDM), defined as first onset or diagnosis of diabetes in pregnancy, is a global problem. GDM is often associated with unhealthy diet and is a major contributor to adverse outcomes maternal and fetal outcomes. Manipulation of nutrition has the potential to prevent GDM.MethodsWe assessed the effects of nutritional manipulation in pregnancy on GDM and relevant maternal and fetal outcomes by a systematic review of the literature. We searched MEDLINE, EMBASE, and Cochrane Database from inception to March 2014 without any language restrictions. Randomised controlled trials (RCT) of nutritional manipulation to prevent GDM were included. We summarised dichotomous data as relative risk (RR) and continuous data as standardised mean difference (SMD) with 95% confidence interval (CI).ResultsFrom 1761 citations, 20 RCTs (6,444 women) met the inclusion criteria. We identified the following interventions: diet-based (n = 6), mixed approach (diet and lifestyle) interventions (n = 13), and nutritional supplements (myo-inositol n = 1, diet with probiotics n = 1). Diet based interventions reduced the risk of GDM by 33% (RR 0.67; 95% CI 0.39, 1.15). Mixed approach interventions based on diet and lifestyle had no effect on GDM (RR 0.95; 95% CI 0.89, 1.22). Nutritional supplements probiotics combined with diet (RR 0.40; 95% CI 0.20, 0.78) and myo-inositol (RR 0.40; 95% CI 0.16, 0.99) were assessed in one trial each and showed a beneficial effect. We observed a significant interaction between the groups based on BMI for diet-based intervention. The risk of GDM was reduced in obese and overweight pregnant women for GDM (RR 0.40, 95% CI 0.18, 0.86).ConclusionsNutritional manipulation in pregnancy based on diet or mixed approach do not appear to reduce the risk of GDM. Nutritional supplements show potential as agents for primary prevention of GDM.     

西安市2010-2015年0-5岁儿童HBV感染状况的流行病学研究

摘要 目的：总结西安市2010-2015年 0-5岁儿童乙肝病毒感染的发病趋势和流行病学特征,寻找高危人群。通过随访研究获取HBV感染儿童疾病转归及乙肝监测系统存在的问题,为乙肝监测系统完善及制定防治策略提供科学依据。方法：采用描述性流行病学方法对西安市2010-2015年的0-5岁儿童乙肝患者进行三间分布描述分析;采用前瞻性队列研究方法,检测母亲及儿童的外周血HBV病毒学情况,获得母亲感染状况和患儿转归。结果：6年间,西安市0-5岁儿童共上报乙肝病例175例,年均HBV感染率为6.05/10万,2013年最高,为9.73/10万,以散发为主;0-1岁为高发年龄段,男童发病多于女童;未央区、雁塔区为高发地区。截止2016年8月,随访HBV感染学龄前儿童139例,仅17例完成流行病学调查和体检检测,失访率高达87.7%,17例HBV感染儿童中HBsAg慢性化高达88.2%,其中14例(82.3%)母亲为HBsAg阳性者。结论：西安市0-5岁儿童HBV感染的高危人群为HBsAg阳性母亲的儿童,与宫内感染/母婴传播有关。0-5岁HBV感染儿童转归结局不良,建议加强HBV宫内阻断,并对高危新生儿进行乙肝抗体监测。     

Cost-effectiveness of antenatal multiple micronutrients and balanced energy protein supplementation compared to iron and folic acid supplementation in India,Pakistan, Mali,and Tanzania: A dynamic microsimulation study

BackgroundMalnutrition among women of childbearing age is especially prevalent in Asia and sub-Saharan Africa and can be harmful to the fetus during pregnancy. In the most recently available Demographic and Health Survey (DHS), approximately 10% to 20% of pregnant women in India, Pakistan, Mali, and Tanzania were undernourished (body mass index [BMI] <18.5 kg/m²), and according to the Global Burden of Disease (GBD) 2017 study, approximately 20% of babies were born with low birth weight (LBW; <2,500 g) in India, Pakistan, and Mali and 8% in Tanzania. Supplementing pregnant women with micro and macronutrients during the antenatal period can improve birth outcomes. Recently, the World Health Organization (WHO) recommended antenatal multiple micronutrient supplementation (MMS) that includes iron and folic acid (IFA) in the context of rigorous research. Additionally, WHO recommends balanced energy protein (BEP) for undernourished populations. However, few studies have compared the cost-effectiveness of different supplementation regimens. We compared the cost-effectiveness of MMS and BEP with IFA to quantify their benefits in 4 countries with considerable prevalence of maternal undernutrition.Methods and findingsUsing nationally representative estimates from the 2017 GBD study, we conducted an individual-based dynamic microsimulation of population cohorts from birth to 2 years of age in India, Pakistan, Mali, and Tanzania. We modeled the effect of maternal nutritional supplementation on infant birth weight, stunting and wasting using effect sizes from Cochrane systematic reviews and published literature. We used a payer’s perspective and obtained costs of supplementation per pregnancy from the published literature. We compared disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (ICERs) in a baseline scenario with existing antenatal IFA coverage with scenarios where 90% of antenatal care (ANC) attendees receive either universal MMS, universal BEP, or MMS + targeted BEP (women with prepregnancy BMI <18.5 kg/m² receive BEP containing MMS while women with BMI ≥18.5 kg/m² receive MMS). We obtained 95% uncertainty intervals (UIs) for all outputs to represent parameter and stochastic uncertainty across 100 iterations of model runs. ICERs for all scenarios were lowest in Pakistan and greatest in Tanzania, in line with the baseline trend in prevalence of and attributable burden to LBW. MMS + targeted BEP averts more DALYs than universal MMS alone while remaining cost-effective. ICERs for universal MMS compared to baseline IFA were $52 (95% UI: $28 to $78) for Pakistan, $72 (95% UI: $37 to $118) for Mali, $70 (95% UI: $43 to $104) for India, and $253 (95% UI: $112 to $481) for Tanzania. ICERs for MMS + targeted BEP compared to baseline IFA were $54 (95% UI: $32 to $77) for Pakistan, $73 (95% UI: $40 to $104) for Mali, $83 (95% UI: $58 to $111) for India, and $245 (95% UI: $127 to $405) for Tanzania. Study limitations include generalizing experimental findings from the literature to our populations of interest and using population-level input parameters that may not reflect the heterogeneity of subpopulations. Additionally, our microsimulation fuses multiple sources of data and may be limited by data quality and availability.ConclusionsIn this study, we observed that MMS + targeted BEP averts more DALYs and remains cost-effective compared to universal MMS. As countries consider using MMS in alignment with recent WHO guidelines, offering targeted BEP is a cost-effective strategy that can be considered concurrently to maximize benefits and synergize program implementation.

In a dynamic microsimulation study, Nicole Young and colleagues compare the cost-effectiveness of antenatal multiple micronutrients and balanced-energy protein supplementation with iron and folic acid supplementation in India, Pakistan, Mali and Tanzania.     

200例先天性尿道下裂患儿的临床特征及其危险因素分析

目的:研究200例先天性尿道下裂患儿的临床特征及其危险因素.方法:选择2016年1月?2019年12月我院收治的先天性尿道下裂患儿200例进行研究,记作观察组,另取同期于我院接受体检的健康儿童200例作为对照组,分析观察组患儿的临床分型情况,比较两组儿童父母的一般情况、儿童出生情况,并采用多因素Logistic回归分析...     

First birth of a healthy infant following intra-cytoplasmic sperm injection using a new permeable cryoprotectant-free sperm vitrification protocol

PurposeThe purpose of this study is to present the first birth of healthy infant born following ICSI using the new permeable cryoprotectant-free sperm vitrification protocol Easy-Sperm^®.Principal resultsA 39 years old woman and his 40 years old partner underwent egg donation treatment at IVF-Spain Alicante (Spain). Half of the mature oocytes obtained from a young and healthy donor were fertilized by ICSI, using slow-frozen spermatozoa and the other half with vitrified spermatozoa. A total of 5 blastocysts were obtained on day 5 (3 resulting from vitrified spermatozoa and 2 from frozen sperm). The best embryo, with AA quality (derived from one of the oocytes fertilized with vitrified sperm) was transferred. The woman conceived and, following a normal pregnancy, delivered a healthy boy.ConclusionsTo the best of our knowledge, this is the first case report of a successful pregnancy and delivery of a healthy infant from ICSI with permeable vitrified spermatozoa in an oocyte donation program with transfer on blastocyst stage.     

Pregnancy after Treatment for Cervical Cancer Precursor Lesions in a Retrospective Matched Cohort

ObjectiveTo determine whether treatments for precancerous cervical lesions were associated with lower pregnancy rates compared to rates in unexposed women and women who had a diagnostic cervical biopsy or colposcopy.DesignMatched, retrospective cohort study.SettingKaiser Permanente Northwest (KPNW), an integrated healthcare delivery system in Oregon and Washington.PatientsWomen 14 to 53 years old with KPNW enrollment during the period 1998 through 2009.ResultsWe observed 570 pregnancies following cervical treatment in 4,137 women, 1,533 pregnancies following a diagnostic procedure in 13,767 women, and 7,436 pregnancies in a frequency-matched sample of 81,435 women unexposed to treatment or diagnostic procedures. After adjusting for age and contraceptive use, we observed a higher rate of pregnancies in the treatment group compared to unexposed women (hazard ratio (HR) = 1.42, 95% confidence interval (CI): 1.30–1.55), but no difference in pregnancy rates between the treatment and diagnostic procedure groups (HR = 1.03, 95% CI: 0.93–1.13).ConclusionsNo adverse effects of cervical procedures on subsequent rates of pregnancy were observed in this cohort with up to twelve years of follow-up time.     

Youths' perceptions of overweight-related prevention counseling at a primary care visit

Objective: We examined youths’ report of receiving specific overweight‐related preventive counseling and perceived readiness to adopt nutrition and physical activity behaviors recommended by their clinicians. Research Methods and Procedures: We surveyed 324 youth 10 to 18 years old who had a physical exam within the past year. The survey included questions on height, weight, race/ethnicity, mother's education, and topics they discussed with their clinician during their visit. We used multivariable analyses to examine whether weight status and sociodemographic characteristics were predictors of which youth received counseling from their clinicians and which youth were ready to change. Results: The mean (standard deviation) age of participants was 13.7 (1.8) years; 54% were black, and 22% were Hispanic. Less than one‐half of participants reported discussing sugar‐sweetened beverages [38%; 95% confidence interval (CI), 32% to 43%] or television viewing (41%; 95% CI, 36% to 47%) with their clinicians. In multivariable analyses adjusting for participant's age, sex, race/ethnicity, overweight status, and mother's educational attainment, youth whose mothers lacked education beyond high school were significantly less likely to report receiving counseling on any overweight‐specific topic including television viewing [odds ratio (OR), 0.46; 95% CI, 0.27, 0.79], sugar‐sweetened beverage (OR, 0.47; 95% CI, 0.28, 0.80), and fast food consumption (OR, 0.54; 95% CI, 0.32, 0.92). In addition, youth 10 to 14 years old were more likely than those 15 to 18 years old to report they would try to change their television viewing (OR, 4.10; 95% CI, 1.78, 9.44) if recommended by their clinician. Discussion: Youth report infrequently receiving counseling on specific overweight prevention topics during routine primary care visits. Our findings suggest that greater efforts may be needed to reduce social class disparities in overweight prevention counseling and that counseling to prevent overweight in youth may be more acceptable to younger children.     

Cross-Sectional Study of Malnutrition and Associated Factors among School Aged Children in Rural and Urban Settings of Fogera and Libo Kemkem Districts,Ethiopia

Introduction

Little information is available on malnutrition-related factors among school-aged children ≥5 years in Ethiopia. This study describes the prevalence of stunting and thinness and their related factors in Libo Kemkem and Fogera, Amhara Regional State and assesses differences between urban and rural areas.

Methods

In this cross-sectional study, anthropometrics and individual and household characteristics data were collected from 886 children. Height-for-age z-score for stunting and body-mass-index-for-age z-score for thinness were computed. Dietary data were collected through a 24-hour recall. Bivariate and backward stepwise multivariable statistical methods were employed to assess malnutrition-associated factors in rural and urban communities.

Results

The prevalence of stunting among school-aged children was 42.7% in rural areas and 29.2% in urban areas, while the corresponding figures for thinness were 21.6% and 20.8%. Age differences were significant in both strata. In the rural setting, fever in the previous 2 weeks (OR: 1.62; 95% CI: 1.23–2.32), consumption of food from animal sources (OR: 0.51; 95% CI: 0.29–0.91) and consumption of the family''s own cattle products (OR: 0.50; 95% CI: 0.27–0.93), among others factors were significantly associated with stunting, while in the urban setting, only age (OR: 4.62; 95% CI: 2.09–10.21) and years of schooling of the person in charge of food preparation were significant (OR: 0.88; 95% CI: 0.79–0.97). Thinness was statistically associated with number of children living in the house (OR: 1.28; 95% CI: 1.03–1.60) and family rice cultivation (OR: 0.64; 95% CI: 0.41–0.99) in the rural setting, and with consumption of food from animal sources (OR: 0.26; 95% CI: 0.10–0.67) and literacy of head of household (OR: 0.24; 95% CI: 0.09–0.65) in the urban setting.

Conclusion

The prevalence of stunting was significantly higher in rural areas, whereas no significant differences were observed for thinness. Various factors were associated with one or both types of malnutrition, and varied by type of setting. To effectively tackle malnutrition, nutritional programs should be oriented to local needs.     

5岁以下哮喘患儿血清过敏原病例对照研究及相关性分析

摘要 目的：探讨5岁以下哮喘儿童与血清特异性过敏原（specific IgE,sIgE）的分布情况。方法：本研究采用免疫印迹法对 2019 年1月至 2019 年12月在西安交通大学第二附属医院住院的5岁以下62例哮喘患儿和49例喘息患儿的行血清特异性过敏原检测,对比分析5岁以下哮喘和喘息儿童过敏原分布情况及与哮喘的发病关系。结果：户尘螨、猫毛皮屑、狗毛皮屑、蒿草、葎草、桤杨柳山毛榉橡胡桃、烟曲霉、念珠菌点青霉分枝孢霉交链孢霉黑曲霉吸入过敏原和花生黄豆、腰果开心果榛子杏仁核桃、虾蟹、桃苹果芒果荔枝草莓食物过敏原这12类过敏原在哮喘组与喘息组有显著差异（P<0.05）,与哮喘发病有关。多因素logistic回归分析结果显示户尘螨、猫毛皮屑、坚果类、霉菌、水果类是哮喘发病的危险因素（P<0.05）。户尘螨、猫毛皮屑和虾蟹是男性哮喘患儿发病的危险因素,念珠菌点青霉分枝孢霉交链孢霉黑曲霉是女性哮喘患儿发病的危险因素（P<0.05）。结论：血清特异性（sIgE）过敏原在哮喘与喘息患儿中分布不同,同时发现过敏原在哮喘患儿中存在性别差异,故对哮喘患儿进行过敏性检测可以作为回避过敏原的依据。     

The Prevalence of Gestational Diabetes Mellitus Among Asian Females is Lower Using the New 2013 World Health Organization Diagnostic Criteria

ObjectiveTo determine the impact of the new 2013 World Health Organization (WHO) criteria for gestational diabetes mellitus (GDM) diagnosis on GDM prevalence and pregnancy outcomes in Asian ethnic groups compared to the 1999 WHO criteria.MethodsA retrospective cohort study included 855 pregnant females of Chinese, Malay, and Asian Indian ethnicity at high risk of GDM who underwent 75-g oral glucose tolerance tests (OGTTs) between July 2008 and June 2010 in a tertiary center in Singapore. GDM prevalence, reclassification, and pregnancy outcomes were determined using the 2013 and 1999 diagnostic cutoffs for fasting and 2-hour postglucose (PG) values.ResultsThe prevalence of GDM was reduced from 28.8% to 21.1% when the 2013 criteria were used. Overall, 10.2% subjects were reclassified from GDM to normal using the 2013 criteria, and 2.6% were reclassified from normal to GDM, giving a net reclassification rate of 12.8%. Reclassification from GDM to normal was greatest among Chinese, followed by Asian Indians, but the prevalence rate was unchanged among Malays. Babies of mothers who were reclassified from normal to GDM were more likely to have birth weight > 95^th centile and shoulder dystocia.ConclusionThe prevalence of GDM was reduced when the 2013 criteria were used, with the greatest reduction seen among Chinese, followed by Asian Indians. Lowering the fasting cutoff as per the new criteria identified a select group of patients who might benefit from GDM treatment. However, raising the 2-hour PG cutoff would miss a significant number of patients who might potentially benefit from GDM treatment. (Endocr Pract. 2014;20:1064-1069)     

血清25-羟维生素D水平与儿童骨密度的相关性研究

目的:研究血清25-羟维生素D[25-(OH)D]水平与儿童骨密度(BMD)的相关性。方法:选择2017年1月到2017年12月在亳州市人民医院接受健康体检的儿童100例作为研究对象。根据血清25-(OH)D水平对维生素D(Vit D)营养状况进行分组,其中严重缺乏组9例,缺乏组28例,不足组42例和充足组21例。对比不同年龄段和不同性别儿童血清25-(OH)D、BMD水平以及不同Vit D营养状况儿童对应的BMD水平,并采用Spearman相关性分析法分析血清25-(OH)D水平与儿童BMD、年龄的相关性。结果:5-9岁和10-14岁儿童的血清25-(OH)D及BMD水平均分别低于1-4岁儿童,而10-14岁儿童又低于5-9岁儿童(P0.05)。男童的血清25-(OH)D及BMD水平均分别高于女童,差异有统计学意义(P0.05)。不足组、缺乏组、严重缺乏组儿童的BMD水平均分别低于充足组,且缺乏组和严重缺乏组低于不足组,严重缺乏组又低于缺乏组(P0.05)。根据Spearman相关性分析结果显示,血清25-(OH)D水平与儿童BMD呈正相关,而与年龄呈负相关(P0.05),年龄与儿童BMD呈负相关(P0.05)。结论:血清25-(OH)D水平与儿童BMD呈正相关,但与年龄则呈负相关,及时补充适量的Vit D以满足儿童的机体所需,有利于儿童健康成长。     

Estimating the Global Prevalence of Zinc Deficiency: Results Based on Zinc Availability in National Food Supplies and the Prevalence of Stunting

Background

Adequate zinc nutrition is essential for adequate growth, immunocompetence and neurobehavioral development, but limited information on population zinc status hinders the expansion of interventions to control zinc deficiency. The present analyses were conducted to: (1) estimate the country-specific prevalence of inadequate zinc intake; and (2) investigate relationships between country-specific estimated prevalence of dietary zinc inadequacy and dietary patterns and stunting prevalence.

Methodology and Principal Findings

National food balance sheet data were obtained from the Food and Agriculture Organization of the United Nations. Country-specific estimated prevalence of inadequate zinc intake were calculated based on the estimated absorbable zinc content of the national food supply, International Zinc Nutrition Consultative Group estimated physiological requirements for absorbed zinc, and demographic data obtained from United Nations estimates. Stunting data were obtained from a recent systematic analysis based on World Health Organization growth standards. An estimated 17.3% of the world’s population is at risk of inadequate zinc intake. Country-specific estimated prevalence of inadequate zinc intake was negatively correlated with the total energy and zinc contents of the national food supply and the percent of zinc obtained from animal source foods, and positively correlated with the phytate: zinc molar ratio of the food supply. The estimated prevalence of inadequate zinc intake was correlated with the prevalence of stunting (low height-for-age) in children under five years of age (r = 0.48, P<0.001).

Conclusions and Significance

These results, which indicate that inadequate dietary zinc intake may be fairly common, particularly in Sub-Saharan Africa and South Asia, allow inter-country comparisons regarding the relative likelihood of zinc deficiency as a public health problem. Data from these analyses should be used to determine the need for direct biochemical and dietary assessments of population zinc status, as part of nationally representative nutritional surveys targeting countries estimated to be at high risk.     

胚胎移植术前指导患者憋尿对移植结局影响的研究

摘要 目的：探讨胚胎移植术前患者憋尿准备的细化指导方法,并分析其对患者移植结局的影响。方法：选取2019年9月至2020年12月期间我院收治的194例胚胎移植患者（包括新鲜周期胚胎移植和冻融周期胚胎移植）,按随机数字表法分为指导组（101例）和对照组（93例）。对照组患者给予常规指导憋尿,指导组患者在对照组的基础上给予更细化的憋尿指导方法。比较两组总妊娠率、不同年龄段患者的移植妊娠率,分析提前指导憋尿对瘢痕子宫和无子宫手术史患者移植妊娠率的影响。结果：指导组总妊娠率为59.41%,对照组总妊娠率为53.76%,指导组总妊娠率高于对照组,但是未见显著性差异（P>0.05）;在<35岁的患者中,指导组妊娠率（76.47%）高于对照组（58.33%）,差异有统计学意义（P<0.05）;在瘢痕子宫和无子宫手术史的患者中,两组移植妊娠率比较未见显著性差异（P>0.05）。结论：胚胎移植术前给予患者细化的憋尿指导方法能提高<35岁患者的移植妊娠率,对瘢痕子宫和无子宫手术史患者的移植妊娠率无明显影响。     

Parasite risk factors for stunting in grade 5 students in a community of extreme poverty in Peru

Malnutrition in school-age children is common in developing countries and includes both stunting and underweight. Stunting, which represents a chronic state of nutritional stress, leads to adverse health, educational and cognitive effects. Although much research is focused on preschool-age children, recent studies show both the high prevalence of stunting and the effectiveness of interventions in school-age children. The objectives of the current study were to determine the risk factors for stunting only, and stunting and underweight. A survey was conducted in 1074 grade 5 children (mean age 10 years) from 17 schools in Belen, Peru, a community of extreme poverty. Prevalence of underweight and stunting were 10.5 and 34.5%, respectively, co-prevalence was 9.3%. Based on multivariable logistic regression analyses, significant independent risk factors (odds ratio: OR) for stunting and underweight were: age (per 1 year increment) (OR=1.55; 95% confidence interval (CI): 1.33, 1.81); diarrhoea in the last week (OR=1.96; 95% CI: 1.17, 3.29) and hookworm infection (OR=1.74; 95% CI: 1.05, 2.86). Significant independent risk factors for stunting only were: age (per 1 year increment) (OR=1.51; 95% CI: 1.35, 1.70); anaemia (OR=1.98; 95% CI: 1.26, 3.11); and moderate and heavy Trichuris and Ascaris co-infection (OR=1.95; 95% CI: 1.35, 2.82). Our results indicate a high prevalence of stunting, in addition to other adverse health indicators, in the study population. Due to the interrelation between many of these health and nutrition problems, interventions at both the school and community levels, including de-worming, feeding programs and health and hygiene education, are needed to reduce malnutrition in this and other similar populations living in conditions of extreme poverty.     

脑胶质瘤组织CMTM1、ME2表达与临床病理特征和复发的关系研究

摘要 目的：探讨脑胶质瘤组织含CKLF样MARVEL跨膜结构域的蛋白1（CMTM1）、苹果酸酶2（ME2）表达与临床病理特征和复发的关系。方法：选取2018年1月～2021年1月徐州医科大学附属医院接受切除手术的92例脑胶质瘤患者，根据术后是否复发分为复发组和未复发组。采用免疫组化法检测脑胶质瘤组织和瘤旁组织CMTM1、ME2表达，分析二者与临床病理特征的关系，采用多因素Logistic回归分析脑胶质瘤患者术后复发的影响因素。结果：与瘤旁组织比较，脑胶质瘤组织中CMTM1、ME2阳性表达率升高（P＜0.05）。不同分化程度、世界卫生组织（WHO）中枢神经系统肿瘤分类脑胶质瘤组织中CMTM1、ME2阳性表达率比较，差异有统计学意义（P＜0.05）。随访2年，92例脑胶质瘤患者术后复发率为47.83%（44/92）。多因素Logistic回归分析显示，低分化、WHO中枢神经系统肿瘤分类Ⅲ～Ⅳ级、部分切除和CMTM1、ME2阳性表达为脑胶质瘤患者术后复发的独立危险因素（P＜0.05）。结论：脑胶质瘤组织中CMTM1、ME2阳性表达率升高，与分化程度、WHO中枢神经系统肿瘤分类等级和术后复发有关，可能成为脑胶质瘤患者术后复发的辅助评估指标。