Low Mid-upper Arm Circumference Research Articles

Association of maternal nutritional status and small for gestational age neonates in peri-urban communities of Karachi, Pakistan: findings from the PRISMA study

BackgroundEarly pregnancy nutritional status can be associated with adverse birth outcomes such as small-for-gestational age (SGA) and low birth weight (LBW). BMI (Body Mass Index) and MUAC (Mid-upper arm circumference) are easy to use assessments and are indicative of the pre-pregnancy nutritional status if obtained in the first trimester. This study primarily assesses the association of maternal nutritional status using BMI and MUAC with SGA in a community-based cohort of Pakistani women. It also aims to determine the predictive ability of MUAC and BMI in predicting SGA. Secondarily, we assessed the association between maternal nutrition and large for gestational age (LGA) and LBW.MethodsThis study is a secondary analysis of an ongoing pregnancy cohort “Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA)“in Ibrahim Hyderi and Rehri Goth, Karachi. PRISMA participants who were enrolled between January 2021 to August 2022 were included given they had a gestational age < 14 weeks confirmed via ultrasound, MUAC and BMI measurements were available and birth weight was captured within 72 hours. Multivariable logistic regression was used to determine an association between maternal nutritional status and SGA. The PRISMA study was approved by the Aga Khan University Ethics Review Committee (2021–5920-15,518).ResultsOf 926 women included in the analysis, 26.6% (n = 247) had a low MUAC (< 23 cm) while 18.4% (n = 171) were underweight (BMI < 18.5 kg/m2). Nearly one third of low MUAC and underweight women delivered SGA infants (34.4 and 35.1% respectively). Underweight women and women with low MUAC had a statistically significant association with SGA (Underweight: OR 1.49, 95% CI 1.1,2.4; Low MUAC-OR 1.64, 95% CI 1.2,2.3) as well as LBW (Underweight: OR-1.63, 95% CI 1.1,2.4; Low MUAC-OR-1.63, 95% CI 1.2,2.3). ROC curves showed that MUAC and BMI had modest predictability for SGA (AUC < 0.7).ConclusionMaternal nutritional status as indicated by BMI and MUAC are strongly associated with adverse pregnancy outcomes including SGA, LGA and LBW. Although MUAC and BMI are widely used to determine maternal nutritional status, they have poor predictive ability for newborn size. Further research is needed to identify other tools or a combination of tools to better predict adverse birth outcomes in resource-limited settings and plan interventions.

Relapse of severe acute malnutrition among children discharged from outpatient therapeutic program in western Ethiopia

BackgroundChildren with severe acute malnutrition (SAM) without complication are treated in the outpatient therapeutic program (OTP) and the program has been reported to be effective. However, relapse post-discharge from the program is poorly defined, and scarcely evaluated across programs and research. The objective of this study is to assess the prevalence of SAM among children post-discharge from the OTP and to identify factors associated with SAM relapse in Gambella Region, Western Ethiopia.MethodsWe conducted a facility-based cross-sectional study among 208 children aged 6–59 months who have been discharged from the OTP as cured. Baseline data were collected from caregivers using structured questionnaire. Child anthropometry and oedema was measured. The association between SAM relapse and the risk factors were assessed using bivariate and multivariable logistic regression models.ResultsThe prevalence of SAM relapse was 10.1% (95% CI: 5.8–14.0%). The odds of SAM relapse was significantly higher in children with mothers who had no exposure to education and promotion about infant and young child feeding (IYCF) practices (OR = 5.7; 95% CI: 1.3–12.6), children who were not fully immunized for their age (OR = 8.0; 95% CI: 3.8–23.4), and children with mid-upper arm circumference (MUAC) at discharge of < 12.5 cm (OR = 4.4; 95% CI: 2.1–12.8) than their counterparts.ConclusionsTo reduce SAM relapse, the OTP programs should avoid premature discharge and consider provision of supplementary food for children with low MUAC at discharge. Further, the OTP discharge criteria should consider both the anthropometric indicators – weight-for-height/length z-score (WHZ) and MUAC – and the absence of bilateral pitting oedema irrespective of the anthropometric indicator that is used during admission. Promotion of nutrition education and improving child immunization services and coverage would help reduce SAM relapse.

Should we consider sarcopenia in pediatric patients with chronic kidney disease? A preliminary cross-sectional analysis.

Pediatric patients with chronic kidney disease (CKD) frequently present an inadequate nutritional profile and musculoskeletal impairments. We investigated sarcopenia and its related traits in children and adolescents with CKD. A cross-sectional study that enrolled pediatric patients with CKD (≥ 4 and < 18years old). Physical function was assessed by handgrip strength and the 60-s sit-to-stand (STS-60) tests. Body composition measurement was performed by bioelectrical impedance analysis and anthropometry through mid-upper arm circumference (MUAC). Normative reference values from healthy pediatrics were used for identifying poor physical function and low MUAC. Probable sarcopenia was considered as low handgrip strength, whereas sarcopenia was defined by adding low MUAC. Twenty-two pediatric patients with CKD (11 ± 4years and 59% boys) were evaluated; eight on peritoneal dialysis (36%), six on hemodialysis (27%), and eight non-dialysis (36%). Regarding sarcopenia traits, we observed low physical function by handgrip strength and STS-60 in 59% and 100% of the patients, respectively, while low MUAC in 77%. Probable sarcopenia was found in 9% and sarcopenia in 50%, but prevalence did not differ among stages. Handgrip strength was strongly associated with MUAC (r = 0.90; p < 0.001); on the other hand, the STS-60 was not significantly associated with any of the body composition variables. Among pediatric patients with CKD, the prevalence of sarcopenia and its related traits was high. Nephrology professionals should consider the assessment of sarcopenia in this population, while more evidence is needed to determine its prognostic value. A higher resolution version of the Graphical abstract is available as Supplementary information.

Validating a linear regression equation using mid-upper arm circumference to predict body mass index

Estimating body mass index (BMI) in hospitalised patients for nutritional assessment is challenging when measurement of weight and height is not feasible. The study aimed to validate a previously published regression equation to predict BMI using mid-upper arm circumference (MUAC). We also evaluated the proposed global MUAC cut-off of ≤24cm to detect undernutrition. We measured standing height, weight, and MUAC prospectively in a sample of stable patients. Agreement between calculated and predicted BMI was evaluated using Bland-Altman analysis. We studied 201 patients; 102 (51%) were male. Median (IQR age was 42 (29-50) years. 95% limits of agreement between predicted and calculated BMI were+0.6767 to+1.712 and the bias was+1.076. MUAC ≤24cm was 97% sensitive and 83% specific to detect undernutrition. BMI derived from MUAC had poor calibration for estimating actual BMI. However, low MUAC has good discriminative accuracy to detect undernutrition.

BESLENME DEĞERLENDİRMESİ: KARNATA’DAKI JENE KURUBA KABILESINDEKI YETIŞKIN ERKEKLERIN KRONIK ENERJI EKSIKLIĞININ IKI YARARLI ANTROPOMETRIK ÖLÇÜMÜNÜN KARŞILAŞTIRILMASI

India has a severe health issue with undernutrition (U.N.), particularly among the underprivileged poor tribal population. The current cross-sectional study aims to evaluate the nutritional condition of 145 adult male Jene Kurubas in Karnataka and compare the two functional anthropometric indices of Chronic Energy Deficiency (C.E.D.). C.E.D. was assessed using the B.M.I. (body mass index) and the MUAC (mid-upper-arm circumference). According to the results of the current study, chronic energy deficiency was prevalent in 53.8% of cases, and undernutrition based on MUAC &amp;lt; 23.0 cm was present in 48.3% of cases. According to WHO recommendations, these prevalences fall into the highly high-prevalence category (≥ 40 per cent), signifying a critical situation. The rate of C.E.D. was significantly higher (81.4%) among those with low MUAC (&amp;lt; 23.0 cm) than among those with a normal MUAC (≥ 23.0 cm) (18.6%). The findings of this study suggest that the Jene Kurubas tribal group was under significant dietary and nutritional stress. For surveys of the human population, particularly among indigenous people, i.e. tribes of developing countries like India, it may be more appropriate to employ mid-upper-arm circumference due to budget constraints or lack of resources and professional labour.

Assessment of dietary intake of Vitamin A-rich foods and associated factors among lactating mothers attending Lunga Lunga Health Centre, in Sinai slum, Nairobi County, Kenya

Vitamin A deficiency is a problem of public health significance among lactating mothers. Low dietary intake of vitamin A results in inadequate vitamin A concentration in breastmilk, thereby putting the life of the breastfed child at risk. Food availability is critical for quality nutrition that leads to a balanced diet. The poor in urban areas spend most of their income on food yet do not meet their dietary needs. This study aimed to assess the dietary intake of vitamin A rich foods, prevalence of undernutrition and household food insecurity among lactating mothers (15-49 years) attending Lunga Lunga Health Centre from Sinai Slum, Nairobi, Kenya. This cross-sectional study was undertaken using systematic random sampling for 384 lactating mothers from April to June 2017. A structured questionnaire was used to obtain socio-demographic information. Dietary intake was assessed using a 24-hour recall and Food Frequency Questionnaire (FFQ). Prevalence of undernutrition was determined through anthropometric measurements: Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC). Household food security was determined using food insecurity access scale and dietary diversity questionnaires. Statistical analysis was undertaken using Microsoft excel and SPSS. Chi-square test was used to determine for associations between inadequate intake of vitamin A, maternal undernutrition, household food security and socio-demographics. Logistic regression analysis determined the predictors of adequate dietary intake of vitamin A, undernutrition and food security. The mean age of the lactating mothers was 26.5 (SD 5.6) years. Majority (72.9%) had primary education while 57.6% were self-employed. Inadequate dietary intake of vitamin A was reported amongst 58.6% of the mothers, 31.3% had low MUAC&lt;220mm while 13.8% had low BMI. Mothers who consumed dark green leafy vegetables were 26.6% compared to those consuming fruits like bananas (18.2%), mangoes (13.3%), pineapple (10.7%) and papaya (8.3%). Fish formed the main source of proteins (18.8%), followed by meat (16.7%) and eggs (14.8%). Vitamin A intake had a significant association with income (p&lt;0.001), energy (p&lt;0.001), food insecurity (p&lt;0.001) and buying food (p&lt;0.001). Household Dietary Diversity Score (HDDS) had a significant association with low MUAC (χ2 = 1.694, p =0.031 and low BMI (χ2 = 3.039, p = 0.042). Lactating mothers from Sinai slum had inadequate dietary vitamin A intake, were under nourished and food insecure. Food security interventions: food-based strategies and policies that include Vitamin A food fortification aimed at increasing intake of Vitamin A rich food, campaigns for increased dietary diversity, alongside routine nutrition education among mothers should be emphasized to enhance their nutritional status and reduce micronutrient deficiencies. Key words: Vitamin A, Nutritional status, Slum, dietary diversity, Food Frequency

The impacts of okra consumption on the nutritional status of pregnant women, west Ethiopia.

Food-insecurity and poor-quality diets remain a challenge for pregnant women. Consumption of okra has a great impact on improving the nutritional status of pregnant women. Okra plays a critical role in the prevention of malnutrition among pregnant women living in resource-limited settings. The evidence is scarce on the impacts of okra on mid-upper arm circumference (MUAC) measurement of pregnant women. A community-based cross-sectional study was employed among randomly selected 224 pregnant women from June 1 to July 30, 2020. An interviewer-administered questionnaire was used. The MUAC was measured by using an adult MUAC measuring tape. Data were entered into Epi-data version 3.1 and exported to SPSS version 25 for analysis by linear regression. The statistical significance of variables was declared at a p-value of .05, and unstandardized beta (β) coefficients along with a 95% confidence interval were computed. The proportion of pregnant women with low MUAC (≤22 cm) was 42.4%. In the multivariable linear regression model, hemoglobin concentration (β = 0.346, [95% CI: 0.153, 0.539], p = .001), food insecurity (β = -0.887, (95% CI: -1.441, -0.334), p = .002), daily consumption of okra (β = 1.269, [95% CI: 0.583, 1.956], p ≤ .001), and women working in NGO (β = 0.443, [95% CI: 0.256, 0.630], p ≤ .001) were significant variables. The prevalence of malnutrition among pregnant women (MUAC ≤ 22 cm) was 42.4%. Therefore, behavioral change communication interventions to promote okra consumption on regular basis were recommended.

Malnutrition, Cancer Stage and Gastrostomy Timing as Markers of Poor Outcomes in Gastrostomy-Fed Head and Neck Cancer Patients.

For percutaneous endoscopic gastrostomy (PEG)-fed head and neck cancer (HNC) patients, risk markers of poor outcomes may identify those needing more intensive support. This retrospective study aimed to evaluate markers of poor outcomes using TNM-defined stages, initial anthropometry [body mass index (BMI), mid-upper arm circumference (MUAC), tricipital skinfold (TSF), mid-arm muscle circumference (MAMC)] and laboratory data (albumin, transferrin, cholesterol), with 138 patients, 42-94 years old, enrolled. The patients had cancer, most frequently in the larynx (n = 52), predominantly stage IV (n = 109). Stage IVc presented a four times greater death risk than stage I (OR 3.998). Most patients presented low parameters: low BMI (n = 76), MUAC (n = 114), TSF (n = 58), MAMC (n = 81), albumin (n = 47), transferrin (n = 93), and cholesterol (n = 53). In stages I, III, IVa, and IVb, MAMC and PEG-timing were major survival determinants. Each MAMC unit increase resulted in 16% death risk decrease. Additional 10 PEG-feeding days resulted in 1% mortality decrease. Comparing IVa/IVb vs. IVc, albumin and transferrin presented significant differences (p = 0.042; p = 0.008). All parameters decreased as severity of stages increased. HNC patients were malnourished before PEG, with advanced cancer stages, and poor outcomes. Initial MAMC, reflecting lean tissue, significantly increases survival time, highlighting the importance of preserving muscle mass. PEG duration correlated positively with increased survival, lowering death risk by 1% for every additional 10 PEG-feeding days, signaling the need for early gastrostomy.

Prevalence and related factors of possible sarcopenia among Thai community-dwelling older adults

Sarcopenia is a geriatric syndrome that increases the risk of fall-related injury. Low muscle strength with or without reduced physical performance is used to identify possible sarcopenia, or those at risk of sarcopenia. To date, there is limited evidence available regarding the situation of sarcopenia risk among Thai older adults. Our study evaluated the prevalence of possible sarcopenia and determined the related factors among Thai community-dwelling older adults. Information about socio-demography, chewing difficulty, and food consumption was collected by interview as well as anthropometric measurements. Possible sarcopenia was defined using the recommendation of the 2019 Asian Working Group for Sarcopenia (AWGS) consensus. Factors that were related to possible sarcopenia were examined using multiple logistic regression, presented as adjusted odds ratios (AOR) and their 95% confidence intervals (CI). Participants were randomly selected using multi-stage sampling from population registers provided by local village health staff in selected sub-districts of Khon Kaen province. Among 510 older adults, the mean age was 69.1 (SD = 6.7) years, 67.3% were women, and 29.2% of them had chewing difficulty. The overall prevalence of possible sarcopenia was 32.2%. Women with high waist circumference (WC) had a higher rate of possible sarcopenia than men (25.9% and 10.5%, respectively). Factors relating to possible sarcopenia were chewing difficulty (AOR = 2.10; 95% CI: 1.36-3.22; p-value = 0.001), low mid-upper arm circumference or MUAC (AOR = 6.51; 95% CI: 3.40-12.47; p-value &lt; 0.001), and normal waist circumference or WC (AOR = 2.14; 95% CI: 1.35-3.39; p-value = 0.001). Possible sarcopenia was prevalent among Thai community-dwelling older adults. Chewing difficulty, low MUAC, and normal WC were related to possible sarcopenia. Dietary and exercise modifications in this population are therefore a good target for lessening the occurrence of possible sarcopenia.

Nutritional status in patients with rheumatoid arthritis: is there an association with the sarcopenic phenotype of body composition?

Aim – to evaluate the nutritional status and its relationship with the sarcopenic phenotype of body composition in women with rheumatoid arthritis (RA).Material and methods. The study included 91 women aged 40 to 75 years with RA according to ACR/EULAR criteria (2010) and a disease duration of at least 1 year. A questionnaire, laboratory and densitometric examination were conducted. Nutritional status was assessed using a MNA (Mini Nutricial Assessment) questionnaire.Results. Malnutrition and at risk of malnutrition according to the MNA were detected in 44.0% of patients with RA. These patients differed from those with normal nutritional status with a higher risk of osteoporotic hip fractures according to FRAX (p=0.035), lower appendicular muscle mass (AMM) (p=0.048) and lower self-assessment of health status (p=0.012). Patients significantly differed in nutritional status according to MNA, daily intake of calcium with food, circumferences of the mid-upper arm, calf, waist and hips, depending on the presence of sarcopenic phenotype. Multivariate regression analysis showed that the sarcopenic phenotype was associated with a nutritional status according to MNA less than 24 points (odds ratio (OR) – 6.14; p=0.036), daily calcium intake less than 500 mg (OR=9.55; p=0.007) and mid-upper arm circumference less than 25 cm (OR=9.32; p=0.015).Conclusion. Malnutrition was found in almost half of the patients with RA. It was revealed that a low nutritional status according to the MNA, low calcium intake and mid-upper arm circumference less than 25 cm increased the risk of having a sarcopenic phenotype in women with RA.

Post-paracentesis Ascitic Fluid Leak in Patients with Cirrhosis of Liver and its Management: A Prospective Study

Ascites is the most common complication of decompensated cirrhosis of liver requiring paracentesis for diagnostic and therapeutic purposes. The ascitic fluid leak can develop after paracentesis in patients with cirrhosis leading to significant morbidity if persistent. We aimed to study the incidence and predictors of post-paracentesis leak in patients with ascites. In this prospective study, patients with cirrhosis undergoing therapeutic paracentesis were followed up, and those patients who developed persistent leak were included as cases. Controls were randomly selected in a 2:1 ratio from the group of patients who did not develop leak. Clinical and laboratory parameters were compared between the two groups. A total of 256 patients underwent 1126 sessions of therapeutic abdominal paracentesis over a period of 14 months. Post-paracentesis leak was seen in 55 (4.8%) patients while only 20 (1.7%) patients had persistent leak. The management of leak was in a stepwise manner initially with tincture benzoin with tight dressing followed by topical cyanoacrylate adhesive and followed by autologous blood patch in those not responding. The persistent leak group had higher proportion of patients with parietal edema, higher PT-INR and Child-Pugh score, lower mid-upper arm circumference, short physical performance battery score, and handgrip strength. On multivariate analysis, only the presence of parietal edema was an independent predictor of post-paracentesis persistent leak (odds ratio 10.35, 95% confidence interval 1.61-66.54, P=0.014). Persistent leak after paracentesis develops in a minority of patients with cirrhosis. The presence of parietal edema is a risk factor for persistent leak. The majority of these patients can be managed in a stepwise approach.

Childhood Stunting and Wasting Following Independence in South Sudan.

South Sudan has experienced ongoing civil and environmental problems since gaining independence in 2011 that may influence childhood nutritional status. To estimate the prevalence of undernutrition among children in South Sudan in 2018 and 2019 compared to the prevalence in 2010. Data on height and weight were collected using a 2-stage stratified sample framework in which households were randomly selected at the county level and nutritional status was calculated for all children under 5 years of age to determine height-for-age, weight-for-height, and weight-for-age Z-scores (HAZ, WHZ, and WAZ) and the prevalence of stunting, wasting, and underweight. Linear and logistic regression analyses were used to determine factors associated with nutritional status and the odds ratio for nutritional outcomes. In 2010, the mean HAZ, WHZ, and WAZ was -0.78, -0.82, and -1.15, respectively, and the prevalence of stunting, wasting, and underweight was 30%, 23%, and 32%, respectively. In 2018 and 2019, the mean HAZ, WHZ, and WAZ was -0.50, -0.70, -0.77 and -0.53, -0.77, -0.76, respectively. The prevalence of stunting, wasting, and underweight in 2018 and 2019 was 17%, 14%, 15% and 16%, 16%, 17%, respectively. Age was negatively associated with all nutritional indices and girls had higher HAZ, WHZ, and WAZ and a lower mid upper arm circumference (P < .01) compared to boys. The risk of poor nutritional outcomes was associated with vaccine status and varied by state of residence. Following independence in 2010, the prevalence of undernutrition in South Sudan decreased, but the risk for undernutrition varied by state and efforts to address food security and health need to ensure equitable access for all children in South Sudan.

Anemia Is a Strong Predictor of Wasting, Disease Severity, and Progression, in Clinical Tuberculosis (TB).

A typical trait of chronic tuberculosis (TB) is substantial weight loss that concurs with a drop in blood hemoglobin (Hb) levels, causing anemia. In this observational study, we explored Hb levels in 345 pulmonary TB patients. They were divided into anemic or non-anemic groups which related to clinical symptoms, anthropometric measurements, and immune status. Data was obtained in a randomized controlled trial that we previously conducted using nutritional supplementation of TB patients in Ethiopia. A post hoc analysis demonstrated that anemic patients have a higher composite clinical TB score at baseline than non-anemic patients. Consequently, Hb values were significantly lower in underweight patients with moderate to severe disease and/or cavitary TB compared to normal weight patients with mild disease or non-cavitary TB. Anemia was associated with a low body mass index (BMI), low mid-upper arm circumference (MUAC), lower peripheral CD4 and CD8 T cells counts and IFN-γ levels, and a higher erythrocyte sedimentation rate (ESR). Chronic inflammation and TB disease progression appeared to be driven by elevated systemic levels of pro-inflammatory IL-6 in anemic patients. Multivariable modeling confirmed that a low Hb and a low BMI were key variables related to an unfavorable TB disease status. Although Hb levels increased with successful chemotherapy, anemic TB patients maintained a slower clinical recovery compared to non-anemic patients during the intensive phase treatment (two months). In conclusion, anemia is a strong predictor of wasting, disease severity, inflammation, and slower recovery in patients with pulmonary TB.

Neurodevelopmental, cognitive, behavioural and mental health impairments following childhood malnutrition: a systematic review

BackgroundSevere childhood malnutrition impairs growth and development short-term, but current understanding of long-term outcomes is limited. We aimed to identify studies assessing neurodevelopmental, cognitive, behavioural and mental health outcomes following...

Malnutrition in Children with Uncomplicated Versus Complicated Appendicitis

Background : Acute appendicitis is one of the commonest surgical emergencies in children and malnutrition is prevalent in the country. This study was designed to compare if complicated appendicitis occurs more in malnourished children.&#x0D; Materials and methods: This cross-sectional study was conducted in Department of Paediatric Surgery, Chittagong Medical College Hospital from March 2017 to December 2019 with 155 children. Anthropometric measurements (Height, weight, Mid Upper Arm Circumference (MUAC) Triceps Skin Fold Thickness (TSFT) were recorded and biochemical assessment (Haemoglobin, albumin and total lymphocyte count) were done before surgery. Patients were grouped into two groups: Group A (Acute uncomplicated appendicitis; n=65) and Group B (Acute complicated appendicitis, n=90). Anthropometric and biochemical indices were compared between these two groups. &#x0D; Results: Age ranged from 2 -12 years (Mean 9.2 ±2.5 years) (Male: female- 1.35:1). Among the five anthropometric indices abnormal measurements in Group A vs Group B were respectively. Abnormal TSFT (73.8% vs 80%, p=0.4) wasting (38.5% vs 44.4%, p=0.4) low MUAC for age (13.8% vs 17.8%, p=0.8) low weight for age (30.8% vs 36.7%, p=0.5) and low height for age (21.5% vs 24.4%, p=0.7) low albumin (52.3% vs 83.3%, p&lt;0,001); low haemoglobin (61.5% vs 60.0%, p=0.6)) and low total lymphocyte count (39.5% vs 44.8%, p=0.7).&#x0D; Conclusions: Malnutrition was widely prevalent in both groups. Although the proportion of malnutrition was more with acute complicated appendicitis, it was not statistically significant. The lower serum albumin level in these patients might be due to the consequence of the disease rather than prevailing malnutrition.&#x0D; JCMCTA 2022 ; 33 (1) : 66-70

Understanding the child mortality decline in Guinea-Bissau: the role of population-level nutritional status measured by mid-upper arm circumference.

Malnutrition is considered an important contributing factor to child mortality, and the mid-upper arm circumference (MUAC) is regarded as one of the better anthropometric predictors of child mortality. We explored whether the decline in child mortality over recent decades could be explained by changes in children's MUAC. This prospective study analysed individual-level data from 47731 children from the capital of Guinea-Bissau followed from 3 months until 36 months of age over 2003 to 2016. We used standardization to compare the mortality rate as if only the MUAC distribution had changed between an early period (2003-05) and a late period (2014-16). We adjusted the analyses for age, sex, socioeconomic-related possessions and maternal education. A total of 949 deaths were included in the analysis. The adjusted mortality rate was 18.9 [95% confidence interval (CI) 14.3-23.3] deaths per 1000 person-years (pyrs) in the early period and declined to 4.4 (95% CI 2.9-6.0) deaths per 1000 pyrs in the late period, a 77% (95% CI 71-83%) reduction in the mortality rate. At all calendar years, the MUAC distribution in the population was close to the WHO reference population. MUAC below -1 z-score was associated with increased child mortality. The change in MUAC distribution from the early period to the late period (in the early period mortality standardization) corresponded to 1.5 (95% CI 1.0-2.2) fewer deaths per 1000 pyrs, equivalent to 11% (95% CI 7-14%) of the observed change in child mortality. From 2003 to 2016, child mortality in urban Guinea-Bissau declined considerably but, though a low MUAC was associated with increased mortality, changes in the MUAC distribution in the population explained little of the decline. Understanding the driving factors of child mortality decline can help scope tomorrow's interventions.

Undernutrition and its associated factors among pregnant women at the public hospitals of Bench-Sheko and Kaffa zone, southwest Ethiopia

BackgroundUndernutrition in pregnant women, expressed as low mid-upper arm circumference, is responsible for maternal mortality and morbidity, adverse birth outcomes, subsequent childhood malnutrition, and mortality. As a result, the purpose of this study was to determine the prevalence of maternal undernutrition and associated factors during pregnancy in public hospitals in the Bench-Sheko and Kaffa zones of southwest Ethiopia. MethodsA facility-based cross-sectional study design was employed among 566 women who received antenatal care from March–May 2021 at the public hospitals of the Bench-Sheko and Kaffa zones, Southwest Ethiopia. A systematic random sampling technique was used to select the research unit. Undernutrition was measured by mid-upper arm circumference. The data were entered into Epi- Data version 3.1 and then exported to Statistical Package for Social Science (SPSS) version 21 software for analysis. Multivariate logistic regression models were constructed using variables with a P-value <0.25 in bivariate logistic regression analysis. Finally, in multivariate logistic regression analysis, the variable with a (P-value < 0.05) is considered statistically significant. ResultsA total of 566 pregnant women participated in our study with a response rate of 98.3%. The overall prevalence of undernutrition among pregnant women was 42.4% (95% CI: 38.3, 46.5). In multivariate logistic regression, the age of mothers between 16-24 years old (AOR = 3.9, 95% CI: 1.60, 9.70), household food insecurity (AOR = 1.81, 95% CI: 1.04, 3.15), and poor dietary knowledge (AOR = 3.25, 95% CI: 1.94, 5.47) were the factors significantly associated with undernutrition among pregnant women. ConclusionAccording to this study finding, the prevalence of undernutrition was very much high in the study area, which was significantly associated with the age groups of 16–24 years older women, poor dietary knowledge, and household food insecurity. Therefore, the strategies and programs targeted towards reducing and preventing undernutrition among pregnant mothers should be made at all levels to improve their nutritional status, and also health information, nutrition counseling, and food assistant should be provided.

Reference values of low body mass index, mid-upper arm circumference, and calf circumference in cancer patients: A nationwide multicenter observational study

ObjectiveAnthropometric measurements including body mass index (BMI), mid-upper arm circumference (MUAC), and calf circumference (CC) are simple and convenient indicators of nutritional status and muscle mass. However, most of their reference values come from studies based on healthy Western populations. The optimal reference values of these anthropometric factors in Asian patients with cancer are unclear. The aim of this study was to develop reference values of severely and moderately low BMI, MUAC, and CC by analyzing a large sample of patients with cancer from a nationwide population. MethodsWe conducted a retrospective analysis of 16 104 patients who were diagnosed with malignant diseases from June 2012 to January 2019. The median age of the patients was 58 y, and 52.5% were men. Optimal stratification was used to calculate reference values using X-tile software. Kaplan–Meier and multivariate Cox analysis were performed to analyze survival data. A receiver operating characteristic analysis was conducted to test the performance of new reference values in diagnosing malnutrition. ResultsThe optimal reference values were calculated for BMI (moderately low: 19.7 [women] and 19 [men]; severely low: 16.7 [women] and 16.7 [men]), MUAC (moderately low: 24.5 [women] and 23.2 [men] severely low: 20.6 [women] and 19.4 [mnen]), and CC (moderately low: 29.1 [women] and 29.3 [men]; severely low: 26.7 [women] and 26.9 [men]). New reference values had more significant affects on mortality risk and better performance in predicting malnutrition than existing ones. ConclusionsThe present study defined reference values of moderately and severely low BMI, MUAC, and CC, which showed strong associations with quality of life, malnutrition, and mortality risk. New reference values from the present study are classification references specifically for the Asian population, which is a new step to promote the application of Global Leadership Initiative on Malnutrition criteria and its severity grading system in Asia.

Dietary Outcomes, Nutritional Status, and Household Water, Sanitation, and Hygiene (WASH) Practices

ABSTRACTBackgroundThe Government of Ethiopia has made a major commitment toward improving food security, diet, nutrition, and health through a series of national nutrition plans. The focus of these plans is on providing both nutrition-specific as well as nutrition-sensitive approaches for achieving national priorities for health and nutrition. The present study conducted a secondary analysis of data provided through a larger birth cohort study conducted in Ethiopia between 2014 and 2016.ObjectivesThe overall objectives of this research were to assess the relation between minimum dietary diversity in women and water, sanitation, and hygiene (WASH), and evaluate the association between midupper arm circumference (MUAC) in women and WASH.MethodsIn addition to descriptive statistics, the study used mixed effects logistic regression analyses to investigate the relation between dietary diversity, MUAC, and household WASH practices.ResultsImproved WASH practices were associated with an increased probability (p = 0.04) that a woman would consume a diet with foods from 5 or more food groups. A beneficial effect was observed for improved WASH practices and a decrease in low MUAC. Improved household WASH practices were successful in contributing to improved dietary diversity in women as well as an improved MUAC.ConclusionsInterventions aimed at improving the diet and nutritional status of women during and after pregnancy should include relevant WASH components as essential elements in multisector nutrition programming.

Serum cobalamin in children with moderate acute malnutrition in Burkina Faso: Secondary analysis of a randomized trial.

Among children with moderate acute malnutrition (MAM) the level of serum cobalamin (SC) and effect of food supplements are unknown. We aimed to assess prevalence and correlates of low SC in children with MAM, associations with hemoglobin and development, and effects of food supplements on SC. A randomized 2 × 2 × 3 factorial trial was conducted in Burkina Faso. Children aged 6 to 23 months with MAM received 500 kcal/d as lipid-based nutrient supplement (LNS) or corn-soy blend (CSB), containing dehulled soy (DS) or soy isolate (SI) and 0%, 20%, or 50% of total protein from milk for 3 months. Randomization resulted in baseline equivalence between intervention groups. Data on hemoglobin and development were available at baseline. SC was available at baseline and after 3 and 6 months. SC was available from 1,192 (74.1%) of 1,609 children at baseline. The mean (±SD) age was 12.6 (±5.0) months, and 54% were females. Low mid-upper arm circumference (MUAC; <125 mm) was found in 80.4% (958) of the children and low weight-for-length z-score (WLZ; <-2) in 70.6% (841). Stunting was seen in 38.2% (456). Only 5.9% were not breastfed. Median (IQR) SC was 188 (137; 259) pmol/L. Two-thirds had SC ≤222 pmol/L, which was associated with lower hemoglobin. After age and sex adjustments, very low SC (<112 pmol/L) was associated with 0.21 (95% CI: 0.01; 0.41, p = 0.04) and 0.24 (95% CI: 0.06; 0.42, p = 0.01) z-score lower fine and gross motor development, respectively. SC data were available from 1,330 (85.9%) of 1,548 children followed up after 3 months and 398 (26.5%) of the 1,503 children after 6 months. Based on tobit regression, accounting for left censored data, and adjustments for correlates of missing data, the mean (95% CI) increments in SC from baseline to the 3- and 6-month follow-up were 72 (65; 79, p < 0.001) and 26 (16; 37, p < 0.001) pmol/L, respectively. The changes were similar among the 310 children with SC data at all 3 time points. Yet, the increase was 39 (20; 57, p < 0.001) pmol/L larger in children given LNS compared to CSB if based on SI (interaction, p < 0.001). No effect of milk was found. Four children died, and no child developed an allergic reaction to supplements. The main limitation of this study was that only SC was available as a marker of status and was missing from a quarter of the children. Low SC is prevalent among children with MAM and may contribute to impaired erythropoiesis and child development. The SC increase during supplementation was inadequate. The bioavailability and adequacy of cobalamin in food supplements should be reconsidered. ISRCTN Registry ISRCTN42569496.