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To describe trends in country- and individual-level dual burden of malnutrition in children <5 years, and age-stratified (<2 years, ≥2 years) country-level trends, in thirty-six low- and middle-income countries (LMIC).
Using repeated cross-sectional nationally representative data, we calculated the prevalence of malnutrition (stunting, wasting, overweight) at each survey wave, annualized rates of prevalence change for each country over time, and trends before and after 2000, for all children <5 years and separately for those </≥2 years. We examined country- (ratio of stunting to overweight) and individual-level (coexistence of stunting and overweight) dual burden in children <5 years.
Demographic and Health Surveys from thirty-six LMIC between 1990 and 2012.
Children <5 years.
Overall malnutrition prevalence decreased in children <5 years, driven by stunting decreases. Stunting rates decreased in 78 % of countries, wasting rates decreased in 58 % of countries and overweight rates increased in 36 % of countries. Rates of change differed for children </≥2 years, with children <2 years experiencing decreases in stunting in fewer countries yet increases in overweight in more countries. Countries with nearly equal prevalences of stunting and overweight in children <5 years increased from 2000 to the final year. Within a country, 0·3–10·9 % of children <5 years were stunted and overweight, and 0·6–37·8 % of stunted children <5 years were overweight.
The dual burden exists in children <5 years on both country and individual levels, indicating a shift is needed in policies and programmes to address both sides of malnutrition. Children <2 years should be identified as a high-risk demographic.
To assess how breast-feeding and dietary diversity relate to infant length-for-age Z-score (LAZ) and weight-for-age Z-score (WAZ).
Breast-feeding, dietary and anthropometric data from the Cebu Longitudinal Health and Nutrition Survey were analysed using sex-stratified fixed-effects longitudinal regression models. A dietary diversity score (DDS) based on seven food groups was classified as low (<4) or high (≥4). The complementary feeding patterns were: (i) non-breast-fed with low DDS (referent); (ii) breast-fed with low DDS; (iii) non-breast-fed with high DDS; and (iv) breast-fed with high DDS (optimal). Interactions between age, energy intake and complementary feeding patterns were included.
Infants (n 2822) measured bimonthly from 6 to 24 months.
Breast-feeding (regardless of DDS) was significantly associated with higher LAZ (until 24 months) and WAZ (until 20 months). For example, at 6 months, breast-fed boys with low DDS were 0·246 (95 % CI 0·191, 0·302) sd longer and 0·523 (95 % CI 0·451, 0·594) sd heavier than the referent group. There was no significant difference in size between breast-fed infants with high v. low DDS. Similarly, high DDS conferred no advantage in LAZ or WAZ among non-breast-fed infants. There were modest correlations between the 7-point DDS and nutrient intakes but these correlations were substantially attenuated after energy adjustment. We elucidated several interactions between sex, age, energy intake and complementary feeding patterns.
These results demonstrate the importance of prolonged breast-feeding up to 24 months. The DDS provided qualitative information on infant diets but did not confer a significant advantage in LAZ or WAZ.
To identify factors associated with the presence and severity of food insecurity among a sample of Honduran caregivers of young children.
Cross-sectional study in which the dependent variable, household food insecurity, was measured using a fourteen-item questionnaire developed and validated in a population of similar cultural context. A predictive modelling strategy used backwards elimination in logistic regression and multinomial logit regression models to compute odds ratios and 95 % confidence intervals for food insecurity.
Rural Honduras in the department of Intibucá, between March and April 2009.
Two-hundred and ninety-eight Honduran caregivers of children aged 6–18 months.
Ninety-three per cent of households were classified as having some degree of food insecurity (mild, moderate or severe). After controlling for caregiver age and marital status, compared with caregivers with more than primary-school education, those with less than primary-school education had 3·47 (95 % CI 1·34, 8·99) times the odds of severe food insecurity and 2·29 (95 % CI 1·00, 5·25) times the odds of moderate food insecurity. Our results also found that child anthropometric status was not associated with the presence or severity of food insecurity.
These results show that among the sociodemographic factors assessed, food insecurity in rural Honduras is associated with maternal education. Understanding key factors associated with food insecurity that are unique to Honduras can inform the design of interventions to effectively mitigate the negative impact of food insecurity on children.
We aimed to develop, test and describe the Exhaustive Home Food Inventory (EHFI), which measures foods in the home using scanning of the universal product code (UPC) and EHFI software to link codes to food identities and energy values.
Observational design with up to three repeated measures in each household yielded a total of 218 inventories.
Eighty private households in North Carolina.
Low-income African-American women with an infant between the ages of 12 and 18 months. Recruitment rate was 71 %.
Approximately 12 200 different food items were successfully recorded using the EHFI method. The average number of food items within a household was 147. The time required for the first measurement in a home declined from 157 to 136 min (P < 0·05) for the first third compared to the last third of homes measured. In the sixty-four households in which three assessments were performed, the time required decreased from 145 to 97 min as did the time per item from 1·10 to 0·73 min.
It is feasible to record all foods and drinks in the home using UPC scanning. Further development and enhancement of databases linking UPC to food identification, nutrients and other information are needed.
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