International Journal of Child Health and Nutrition

132-138

Authors: Benjamin T. Crookston, Cudjoe Bennett, P. Cougar Hall, Muhamad Hasan, Mary Linehan, Ahmad Syafiq, Scott Torres, Joshua H. West, Kirk A. Dearden

Background: Optimal infant and young child feeding during the first two years of life is essential to optimum child development and health. While the link between feeding practices and child health outcomes is well documented, little is known about the determinants of these feeding practices in Indonesia. The purpose of this study was to better understand factors associated with appropriate child feeding among Indonesian children 6–23 months of age. Methods: Interviewers conducted interviews with 1498 mothers of children 6–23 months of age to identify practices. Measures of feeding practices included dietary diversity, meal frequency, and minimum acceptable diet. Multivariate logistic regression was used to identify factors associated with dietary diversity and separately with meal frequency. Results: After adjusting for covariates, increased maternal education was associated with improved dietary diversity. Age of child [OR=1.11], knowledge of stunting [OR=1.80], and having ever received nutrition information [OR=1.89] were also associated with greater dietary diversity. Wealth [OR=0.86] and age of child [OR=0.92] were inversely associated with meal frequency. Maternal education, age of child, being a male child, knowledge of stunting, and having received nutrition information increased the odds of the child consuming a minimum acceptable diet.Conclusion: Increasing maternal education, knowledge of stunting, and knowledge of nutrition may improve dietary diversity while poverty alleviation has the potential to improve minimum meal frequency. These findings corroborate similar studies and confirm the importance of government efforts that help girls stay in school, improve families’ understanding of nutrition, and reduce poverty

146-156

Authors: T.A. Nicklas, C.E. O’Neil, V.L. Fulgoni III

Objective: The goals of this study were to assess the impact of recent changes in the WIC allotment on fruit intake, dietary quality/adequacy, energy/nutrient intakes, and potential impact of the complete removal of 100% fruit juic e (FJ) from the package.Methods: 24-hour recalls from children 1-4 years who were WIC participants or income-eligible nonparticipants in the NHANES 2007-2008 and 2011-2014 (before and after WIC package changes) were analyzed.Results: There were no differences in the Healthy Eating Index-2015 total score; subcomponent scores for “greens and beans” and for “fatty acid ratio” were higher in 2011-2014 than in 2007-2008 in children participating in WIC; scores for “sodium” were higher in 2011-2014 than in 2007-2008 in children not participating in WIC but income-eligible. In WIC participants mean intakes of riboflavin, vitamins B12 and C, and zinc were significantly (p<0.01) lower, and intake of vitamin E was significantly (p<0.01) higher in 2011-2014 compared to 2007-2008. One significant difference in nutrient adequacy in children was that of a lower (p<0.01) percentage of inadequacy for WIC participants for vitamin E and a higher (p<0.01) percentage of inadequacy for WIC participants for vitamin A in 2011-2014 as compared to those in 2007-2008. The elimination of FJ from the WIC food packages resulted in a 38-50% lower total fruit intake and a 4-5% reduction in total HEI-2015 score.Conclusion: Changes in the WIC program resulted in potential adverse effects on mean intakes of some nutrients but not on the nutrient adequacy or overall diet quality. Confirmatory studies are needed.

163-168

Authors: John Worobey

Objective: To examine the association between maternal responsive feeding in infancy and later parental feeding style in childhood, with a secondary aim of linking parenting style to child weight statusDesign: Short-term, longitudinal studySubjects: 65 mother-infant pairs, followed from 3-months to 3-yearsMethods: Mother-child dyads were seen at enrollment, observed at home when the infant was 3-months-old, and at home again when the infant turned 2-years of age. When the child reached 3-years, mothers self-reported their feeding style.Results: Responsive maternal feeding at 3-months predicted an authoritative feeding style at 3-years, and the authoritative feeding style was associated with a healthier weight status. Conclusion: Responsive feeding in infancy may serve as the foundation for responsive feeding in childhood and may serve to help in reducing obesity risk

175-183

Authors: Urmila Deshmukh, Tinku Thomas, Sumathi Swaminathan, Anura Kurpad

Background: Nutritional exposures and growth in early life are linked to immediate and also to long term health outcomes. Objective: To assess infant and young child feeding (IYCF) practices using WHO-UNICEF defined indicators in rural and urban-slum populations in India. Methods:A community-based, cross-sectional study was conducted in mothers and infants up to age 24 months. Data on socio-demographics, birth history, feeding practices (WHO-UNICEF IYCF indicators), maternal weight, height, and infant’s weight, length, mid-arm, and head circumferences were collected. Results:Five hundred and two (252 rural and 250 urban-slum) mother-infant dyads were studied. Proportions of IYCF indicators in rural and urban-slum infants were: Early initiation of breastfeeding 71 and 64%; Exclusive breastfeeding under six months, 59 and 25%; Minimum acceptable diet 11 and 27% respectively. Consumption of animal-source food (other than dairy products) and vitamin-A rich fruits and vegetables was below 15%. Cesarean section [aOR, 95% CI: 2.94 (1.53, 5.65)], hospitalization of newborn [aOR, 95% CI: 6.21 (2.95, 13.16)], pre-lacteal feeding [aOR, 95% CI: 3.38 (1.77, 6.45)], needing help in breastfeeding [aOR, 95% CI: 2.15 (1.04, 4.17)], and male gender [aOR, 95% CI: 2.13 (1.15, 4.25); p<0.05 for all] were associated with delayed initiation of breastfeeding, whereas lower monthly household income [aOR, 95% CI: 2.62 (1.10, 6.25)], and younger age [aOR, 95% CI: 1.24 (1.11, 1.38); p<0.05 for both] were associated with poor dietary diversity. Conclusions:Education of optimum IYCF practices, targeting early initiation of breastfeeding, increasing meal frequency and intake of vitamin-A rich and animal-source foods need urgent attention

194-200

Authors: Bizuhareg Teka Hailemariam, Tesfaye Girma Legesse, Kassahun Alemu

Acute respiratory infection is still a major health problem among under-five children specifically in Ethiopia, where 38% of them are reported as living in the status of under-nutrition. However, there are studies limitation regarding the relationship of nutritional status of under-five children and outcome of pneumonia treatment. Institutional based cross-sectional study design had been employed to see the Effect of nutritional status and associated factors on pneumonia treatment outcome among under-five children in 2015. Data was collected using interview administered structured questionnaires and anthropometric measurement.The study revealed that high probability of poor pneumonia treatment outcome 26(40%) among exposed groups. Those children to house wife mothers 11(16.92%), smoker family member 6(9.23%), non-fully immunized 9(13.85%), less than 500birr spent for a child 26(40%) are observed to be with poor pneumonia treatment outcome. The risk of poor pneumonia treatment outcome was 4 times and 5 times more like among children who lives with smoker family member and exposed groups respectively. But it was 0.075 and 0.05 times less like among Children from urban and whom their monthly budget is 1000 birr or more respectively.Child nutritional status has significant effect on pneumonia treatment outcome among under-five children. Undernourishment, smoker family member, rural residency, monthly budget are among factors impact pneumonia treatment outcome. Nutritional education, Mother education, Employing mothers, Budgeting more than 500 birr per child per month, alleviate smoking among the family member, Limiting family members number per house hold, All children should feed colostrums and Full immunization should be done

97-101

Authors: Andrew S. Day, Vesal Moeeni, Tony Walls

Background: Although it is widely acknowledged that hospitalized children are at greater risk of malnutrition, the available paediatric Nutritional Risk Screening (NRS) tools have not yet become universally used to identify those children at greater risk. Furthermore, the utility of one NRS tool over another remains unclear. Materials and Methods:The utility of a recently developed tool, the Paediatric Nutritional Screening Tool (PNST), was evaluated using data previously collected in the assessment of three other NRS tools in 281 children from Iran and New Zealand. The sensitivity and specificity of each tool was then assessed based on the WHO criteria for malnutrition. Results: The PNST recognized about half of the malnourished patients while the other three tools identified at least 85% of these children. The sensitivity of PNST for moderate (BMI-z < 2) and severe malnutrition (BMI-z <-3) was 37% and 46% respectively, while the sensitivity for other three NRS tools ranged from 82-100%. Conclusion: In this data set, the PNST tool did not perform as well as the three more established NRS tools. Further work is required to provide optimal tools for the identification of hospitalized children at risk of malnutrition

109-114

Authors: Fatih Kara, Serap Bati

Background and Aim: Every year in the world millions of children die from malnutrition and infectious diseases. Children under the age of five are affected more quickly than other age groups from negative conditions. This study is aimed to determine the risk factors of malnutrition and incidence of malnutrition in children aged 1-4 years living in Konya.Materials and Methods: This is a cross-sectional epidemiological study. The survey about demographical information about the child and their family, child's nutrition and anthropometric measurements described by both Z-scoring and GOMEZ classification, was conducted between May-December,2016 with 1000 children aged 1-4 years in Konya province. Descriptive statistics, chi-square test, student t-test and multivariate logistic regression were performed by SPSS 18.0 considering p<0.05 as statistically significant.Results:According to the GOMEZ classification, 18.7% of children living in Konya are malnourished. According to Z-score, 3.5% (n=35) of the children were found to be underweight and 7.2% (n=72) were found as stunted. Factors affecting the malnutrition were the age range of children, the working status of the mother, the kinship status between the parents, the number of living children, maternal age, birth weight, the duration of breastfeeding, the time spent on TV/computer, the attitude and anxiety level of the mother when her child does not eat and the mother's nutrition education.Conclusion:Malnutrition is a common problem and its rate is high in Konya.It is suggested that health professionals should educate the society, especially mothers by organizing various training meetings. Moreover, it can be emphasized that health planners should prepare a program to determine malnourished children considering the risk factors of malnutrition in health screens and first step medical centers

122-131

Authors: Tasmiah Sad Sutopa, Wasimul Bari

Background:To explore non-linear effects of continuous covariates on response variable, generalized additive model (GAM) has now been extensively used. The main aim of this study is to explore the non-linear effect of some selected continuous covariates on malnutrition status of children in Bangladesh using logistic additive model.Methods: To determine the factors of malnutrition status of children in Bangladesh, data are excluded from Bangladesh Demographic and Health survey 2014 (BDHS 2014). The anthropometric index of nutrition status, stunting is used as binary response variable and several demographic, socio-economic and health related variables are used as covariates. Bivariate analysis and additive logistic regression model is used to uncover the non-linear effect of included continuous variables as well as effect of categorical covariates on stunting in the study.Results:The analysis exposes that mother’s current age, mother’s BMI and child’s age have significant non-linear impact on stunting of children. Conclusion: The analysis suggests that to improve nutrition status of children in Bangladesh, the government should take necessary steps targeting women in higher and lower age groups and women with higher and lower BMI. Moreover, the children after 20 months should be properly taken care of for achieving better nutritional health.

39-46

Authors: Cyril Bennouna, Hanna-Tina Fischer, Michael Wessells, Neil Boothby

The humanitarian system is struggling to adapt to changes in the global political environment, trends in armed conflict and displacement, and advances in science and technology. In recent years, the international community has undertaken a number of efforts to overcome these challenges, such as the Agenda for Humanity, a plan that outlines the changes needed to alleviate suffering, reduce risk, and lessen vulnerability on a global scale. This article reviews recent evidence from a range of disciplines to inform these efforts, especially as they relate to the protection of children. Early childhood and adolescence constitute two critical periods of child development that lay the foundations for future health and wellbeing. Exposure to adversity in crisis contexts can compromise this development, with potentially life-long consequences. Evidence suggests that relationships with caregivers and peers play a central role in mediating childhood experiences of adversity. Unfortunately, interventions for children affected by crises are usually too fragmented to maximize the protective effects of healthy relationships. This article stresses the importance of developing multisectoral and relational interventions capable of promoting healthy development across the life course. Given the central role of caregivers, the household is an especially powerful level of intervention for combining approaches from different sectors. More concerted efforts are needed to develop household interventions that combine traditional sectoral approaches with innovative, cross-cutting measures, such as cash transfers and parental support. Household interventions should also be an integral part of broader community and society level actions, which together form more comprehensive systems of care

63-73

Authors: A. Merrotsy, A.L. McCarthy, J. Flack, S. Lacey, T Coppinger

Objective: Examine dietary intake (DI), anthropometric measures, cardiorespiratory fitness (CRF) and nutritional knowledge (NK) of school children. Design:Cross-sectional study. Food Diary, NK questionnaire and 550m walk/run test were used to assess DI, NK and CRF respectively. Blood pressure (BP) was also taken and body mass index (BMI) and waist to height ratio (WHtR) were calculated.Setting: Two primary schools, Cork, Ireland. Subjects: Six (n = 49, age 5.9 ± 0.6 years) and ten (n = 52, age 9.8 ± 0.5 years) year olds. Results:Intakes of fruit and vegetables, fibre, calcium and iron were sub-optimal. Unhealthy snacks and saturated fat intakes were higher than recommended. A total of 24.4% of six year olds and 35.4% of ten year olds were classified as ‘fast’. Furthermore, 45.9% of six and ten year olds had high-normal BP and 27.9% had high BP. NK was negatively correlated with sugar intake (r = -0.321, p = 0.044) in ten year olds. WHtR was negatively correlated with servings of vegetables in six year olds (r = -0.377, p = 0.014). For ten year olds, there was a positive correlation between WHtR and run score (r = 0.350, p = 0.014) and BMI and run score (r = 0.482, p = 0.001). Conclusion:This study highlights, for the first time, DI, NK, CRF, BP and anthropometric data for Irish children and their potential combined effect on overall health. Study results suggest preventive initiatives are needed, in children as young as 6 years of age

82-96

Authors: Goran Livazovic, Iva Mudrinic

This paper analyses the relation between socioeconomic characteristics, family and peer relations, depression and eating disorders with 218 (144 female, 66.1%) participants aged 14-19 from Croatia. The questionnaire encompassed questions on socioeconomic traits, family and peer relations, depression and anorexia, bulimia, binge eating and orthorexia. Girls reported most dissatisfaction with the abdominal region (38.5%), thighs (31.2%) and breasts (16.1%). Boys reported most dissatisfaction with the abdomen (12.4%), chest (10.1%) and legs/calves (7.3%). Gender was significant for depression (p<.001), anorexia (p<.01), bulimia (p<.001) and binge eating (p<.05), with girls scoring higher on all scales. Age was significant for depression (p<.05) in younger participants, and orthorexia (p<.05) for older adolescents. Participants from vocational schools reported significantly higher family life satisfaction (p<.01), while gymnasium students reported significantly higher depression (p<.000), bulimia (p<.01) and binge eating behaviour (p<.01). Higher mother’s educational level was significant for anorexia (p<.05) and orthorexia (p<.01). Family relations correlated negatively with bulimia and binge eating, but positively with orthorexia. Peer relations were not significant for eating disorders. Eating disorders show positively correlated comorbidity (p<.000), and were significantly correlated to depression (p<.000). Anorexia is best predicted by bulimia (p<.001), orthorexia (p<.001), depression (p<.01) and mother’s education (p<.01). Bulimia is strongly predicted by anorexia (p<.001), binge eating (p<.001), depression (p<.001) and gender (p<.001). Binge eating is strongly predicted by bulimia (p<.001), depression (p<.01) and school type (p<.05). Orthorexia is strongly predicted by anorexia (p<.001), family relations quality (p<.05), the mother’s education (p<.05) and school success (p<.05).

1-8

Authors: Laura Nabors, Kristen Welker, Brandon Pavilack, Myia Lang, Renee Hawkins, Anne Bauer

Dissemination of obesity prevention programs in different settings is needed. Moreover, new outreach tools to teach parents healthy eating and exercise lessons provided in these programs are important to develop. The pilot studies presented in this paper examined the implementation of the Children’s Healthy Eating and Exercise Program in two different after school programs in 2015 and 2016. Participants were elementary school-age children and their parents. Eight lessons were presented at each school. Child perceptions of healthy eating and exercise goals were examined as well as child knowledge retention and perceptions of behavior change. Parent perceptions of the program were analyzed. Results indicated that children reported improved knowledge and behaviors. Parents reported satisfaction with the program, but remained hard to reach. Children recalled key components of the healthy eating lessons at long-term follow-up assessments. In the second pilot study, children served as health coaches for teaching parents about family goals. Children believed they were successful at coaching parents, but they requested help in developing family eating and exercise goals. Improving outreach to parents and involving siblings remains a goal for future studies as does beginning to examine changes in eating and physical activity using food diaries and accelerometry.

15-21

Authors: Rana H. Mosli, Manal N. Al-Lahyani, Amani Najjar, Doaa A. Zoghbi, Rawan H. Al-Haddad, Hala H. Mosli

Objectives: To examine the association of maternal GDM with 1) child BMI z-score at preschool; 2) breastfeeding initiation and duration, while adjusting for child birthweight in addition to potential confounders.Method: Sample included 53 children (3 - 5 years old) recruited from two preschools in Jeddah, Saudi Arabia. Mothers completed a self-administered questionnaire. Child anthropometry was completed using standardized procedures. BMI z-scores were calculated using the WHO standards/reference data. Linear regression models were tested to examine the association between maternal GDM and child BMI z-score, as well as breastfeeding duration. Logistic regression models were tested to examine the association between maternal GDM and breastfeeding initiation. Models were adjusted for child birthweight, maternal BMI, and maternal age at pregnancy.Results: Mean child BMI z-score was 1.10 (SD= 1.22). About one quarter (24.5%) of mothers reported being diagnosed with GDM. Mean birthweight of children whose mothers were diagnosed with GDM was 3.10 kg (SD= 0.74). Adjusting for covariates, we found that maternal GDM was associated with increased child BMI z-score (B= 1.04, 95% CI= 0.14 -1.94, P-value= 0.02), and lower odds of breastfeeding initiation (OR= 0.10, 95% CI= 0.02 – 0.49, P-value= 0.005). Maternal GDM was not associated with breastfeeding duration (B= -4.75, 95% CI: -11.79 – 2.29, P-value= 0.18).Conclusion: Findings suggest that maternal GDM is associated with higher child BMI z-score at preschool and lower likelihood of breastfeeding initiation. Studies are needed in order to identify the underlying mechanisms of associations. Obesity prevention programs may target children whose mothers were diagnosed with GDM; prenatal breastfeedingcounseling may be offered.

30-38

Authors: Rajan Bhandari, Sangita Kumari Khatri, Khadga Bahadur Shrestha

Background:Severe acute malnutrition is an excessive loss of weight due to the acute shortage of food or illness. It is one of the major public health problems in developing countries including Nepal. According to multiple indicator cluster survey (MICS) 2014, 2.6% severely malnourished in Nepal and 4.4% are severely malnourished in Kavre district. However, there are limited studies about predictors of severe acute malnutrition in Nepal. Thus, this study was aimed to identify the predictors of severe acute malnutrition in Kavre district of Nepal. Methods: Health facility based matched case control study was conducted among 210 (70 cases and 140 controls) children aged 6-59 months from November 2015 to April 2016. Data was collected through face to face interview with mother of eligible children using structured questionnaires. Multivariate analysis was applied to estimate adjusted odds ratio along with 95% confidence interval.Results:Children with severe acute malnutrition were 11.32 times more likely than control to have recurrent diarrhea in past six months (95% CI=4.64-28.21). Similarly, severe acute malnutrition was associated with female sex (AOR=2.44, 95% CI=1.88-6.78), fathers occupation daily labor (AOR=4.69, 95% CI=1.17-13.76) and agriculture (AOR=6.850, 95%CI=3.81-12.93), improper exclusive breast feeding (AOR=6.646, 95%CI=2.11-20.90), not feeding colostrum (AOR=3.89, 95% CI=2.88-11.21), severe food insecurity access (AOR=3.55, 95% CI=1.85-9.77) and monthly income less than average level (AOR=8.214, 95% CI=1.43-22.16). Conclusion: Severe acute malnutrition was independently associated with sex of child, occupation of father, monthly household income, not feeding colostrum, improper exclusive breast feeding, severe household food insecurity access and recurrent diarrhea.