BACKGROUND: Undernutrition is a leading cause of childhood mortality in low-income countries. Orphaned children are particularly vulnerable due to the absence of parental care and support, as well as factors such as infection and poor feeding practices. Undernutrition is often associated with developmental delays and recurrent infections. This study aimed to determine the prevalence of undernutrition and its associated factors among orphaned children aged 6-59 months in Nekemte town, Ethiopia. METHODS: This study employed a cross-sectional, community-based study collected data through interviewer-administered questionnaires and anthropometric measurements. A total of 373 orphans paired with caregivers were selected using a simple random sampling technique from first June to July 30, 2023. Data were coded and entered into Epi Data V.4.6, and SPSS version 25 was used for analysis. Anthropometric indices were measured using the WHO ENA Software. Both binary and multivariate logistic regression analyses were conducted with a 95% confidence interval to identify factors associated with undernutrition, considering a significance level of p < 0.05. RESULTS: The prevalence of stunting, wasting, and underweight in the studied population was 37.3% (95% CI: 32.4-41.8), 28.7% (95% CI: 23.6-33.2), and 24.4% (95% CI: 20.1-28.9), respectively. Factors associated with stunting included caregivers who obtained the child not through a legal process (AOR = 1.74, 95% CI: 1.06-2.86) and children who did not receive vitamin A in the last six months (AOR = 0.59, 95%CI: 0.371-0.94). For wasting, significant associations were found with orphans aged 6-23 months (AOR = 2.76, 95%CI: 1.27-6.02), those receiving treatment (AOR = 0.45, 95% CI: 0.26-0.76), incomplete vaccination status (AOR = 3.53, 95% CI: 1.65-7.04), and caregivers lacking information about nutrition for children under five (AOR = 1.82, 95%CI: 1.08-3.06). Additionally, orphans who began consuming additional food before six months of age (AOR = 2.76, 95%CI: 1.27-6.02) and those with caregivers who were government employees (AOR = 1.89, 95% CI: 1.07-3.34) were more likely to be underweight. CONCLUSIONS: The prevalence of undernutrition among orphaned children is high in Nekemte town. It is crucial to improve the knowledge and communication skills of healthcare workers and caregivers regarding infant and young child feeding practices and vitamin A supplementation for children under five years of age. Additionally, improving the supervision of orphans by legal bodies is essential for better health outcomes.
BACKGROUND: In accordance with the global trend, over the past decades, countries in the Western Pacific Region (WPR) have also experienced substantial improvement in life expectancy. However, this accomplishment was coupled with the differences between countries. METHODS: Using the latest data from the Global Burden of Disease study, we explored the underlying reasons for changes in life expectancy among observed WPR countries. RESULTS: Compared with observed high-income countries, lower-middle-income countries remain disadvantaged with respect to life expectancy, despite their substantial growth over time. The patterns of contribution varied considerably across countries. From 1990 to 2019, in lower-middle-income countries such as Cambodia and Laos, the gains in life expectancy could be mainly explained by reductions in under-5, 5-24, 25-44 mortality from communicable diseases and maternal-neonatal disorders, as well as reductions in mortality from communicable diseases and cardiovascular diseases at 45-84 years. In high-income countries, declines in middle and old-age mortality from cardiovascular diseases and neoplasms were mainly responsible for their life expectancy gains. After 2019, COVID-19 and related outcomes contributed to different magnitude of declines in life expectancy in lower-middle-income countries and Malaysia. In high-income countries, the impact of the pandemic resulted in a stagnation of life expectancy in Singapore and slight decline in life expectancy in South Korea. CONCLUSIONS: Despite the efforts from the government and WHO in the WPR, the gaps between lower-middle-income and high-income countries remain substantial and further enlarged because of the COVID-19 pandemic. Long-term reductions in mortality and gains in life expectancy in all observed countries in the Region require the further modification of the profile of the underlying risks.
Yan Zheng, Stefanos Tyrovolas, Paul S F Yip et al.
Survival
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Early childhood growth, a key indicator of child well-being, is shaped by both the prenatal and postnatal environment. To understand where and when environmental factors influence growth most, we analyzed size at birth, postnatal growth trajectories, and associations with environmental factors across a rural-urban gradient in the ECoMiD longitudinal birth cohort. METHODS AND FINDINGS: Between 2021-2022, pregnant women were enrolled from four sites in northwest coastal Ecuador (urban city, intermediate town, rural villages connected by road, rural villages connected by river) and children were visited shortly after birth and quarterly thereafter for 24 months. We selected exposure variables using UNICEF's Conceptual Framework on Maternal and Child Malnutrition, including demographics, maternal characteristics, household infrastructure, and environmental factors. We used multivariable linear models and generalized estimating equations to analyze associations between exposures and length-for-gestational-age Z-score (LGAZ) and postnatal change in 3-month length-for-age Z-score (3-month ΔLAZ) and explored effect measure modification by site and child age (0-6 versus 7-24 months). Among 401 children, LGAZ was higher among children born to taller mothers, in households with higher food security, and in the rural river site. However, the postnatal growth of children in rural river sites faltered most rapidly, particularly after six months, resulting in 51% of children stunted (LAZ < -2 SD) at 24 months, compared to urban (8%), intermediate (14%), rural road (5%). Over the 0-24 month postnatal period, 3-month ΔLAZ was negatively associated with children who were male, from poorer households, had shorter mothers, and had greater exposure to animals and animal feces. Other associations, including with season, hygiene characteristics, and maternal demographics, varied by age and site. CONCLUSIONS: These findings show that environmental conditions influenced postnatal linear growth more strongly, compared to prenatal growth, which was associated with maternal anthropometry and nutrition. Community context strongly influenced growth only after age six months and modified associations with environmental conditions, suggesting that interventions targeting child growth faltering after six months may be important for certain populations.
Peer-reviewed article·PubMed (US National Library of Medicine)·
Background: Late preterm delivery accounts for approximately 5% of all births. Although there is a growing body of literature recognizing that children born late preterm are at risk for mild neurodevelopmental issues, these children are often excluded from follow-up programs. From a preventive perspective, it could be useful to promote protective factors for child development. Among these, human milk feeding is highly recommended due to its advantages for child health and development. However, there is limited research on the complex interactions between late preterm birth, human milk feeding, and subsequent cognitive and emotional development. This paper aims to explore these interactions. Methods: This study focuses on late preterm children aged 8 to 12 years who are attending school. A trained psychologist conducted assessments of cognitive development using the Wechsler Intelligence Scale for Children-III (WISC-III). Additionally, the family pediatrician gathered neonatal and current growth data, while parents completed the Child Behavior Checklist 6-18 (CBCL) regarding their child's emotional and behavioral profile. Results: A significant impact of early nutrition on children's cognitive development was observed, with those fed human or formula milk scoring higher than those in the mixed milk group. Additionally, early feeding, high maternal and low paternal perception of externalizing difficulties significantly predicted children's cognitive development. Conclusions: The study suggests the potential role of early nutrition and externalizing difficulties in the cognitive development of late preterm children at school age. Therefore, the inclusion of protective factors such as breastfeeding should be encouraged in future research.
Augusto Biasini, Francesca Agostini, Marcello Stella et al.
Survival
Peer-reviewed article·PubMed (US National Library of Medicine)·
Background/Objectives: Stunting and weight faltering (WF) remain pressing public health challenges in low- and middle-income countries, with long-term consequences for child growth, development, and survival. While the role of gut health in early growth is increasingly recognized, evidence on how the gut microbiome and metabolome respond to nutritional interventions in WF infants is scarce. This study explored gut microbiome and metabolome changes in Indonesian infants aged 6-12 months who overcame WF following a one-month intervention. Methods: Infants were assigned to either a Nutritional Advice (NA) group or a Nutritional Advice plus Oral Nutritional Supplements (NAONS) group. Stool samples were collected before and after the intervention for microbiome (16S rRNA sequencing) and metabolome (LC-MS) analysis. Results: Significant shifts in gut microbial composition (beta diversity) and species richness (Chao1 index) were observed in both groups, suggesting enhanced microbial diversity and gut resilience. Within-group analysis revealed increases in beneficial genera such as Faecalibacterium and Peptostreptococcus, and a reduction in pro-inflammatory Fusobacterium in the NA group. The NAONS group showed a notable decrease in Proteus, a potentially pathogenic genus. Between-group comparisons indicated higher abundances of Lactococcus and Leuconostoc in the NAONS group, likely reflecting the influence of milk protein-rich supplements on microbial colonization, favoring lactic acid bacteria over SCFA-producing taxa, leading to better gut health. Metabolome analysis revealed significant changes in the NA group, increases in metabolites like Threonine, Tryptophan, and Xylose pointed to improved energy metabolism and gut health, while a decrease in Oxalic Acid suggested better metabolic efficiency. In contrast, the NAONS group, while benefiting from rapid weight gain, displayed a distinct metabolic profile influenced by high milk protein intake. No significant correlations were found between microbiome and metabolome changes, highlighting the complexity of gut-host interactions, suggesting that the interventions led to independent shifts in the aforementioned profiles. Conclusions: Overall, the findings suggest that nutritional interventions may enhance gut health and support recovery from weight faltering, providing insights into strategies that may contribute to restoring healthy growth trajectories and preventing stunting by modulating gut health.
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Malnutrition in children is associated with cognitive delays, learning disorders, and disturbances in growth indicators. Inadequate food intake, bad eating habits, lack of nutritional knowledge, low mother's education, and poor economic status are among the causes of malnutrition. School children are more at risk of inappropriate eating behaviors, skipping breakfast, consuming unhealthy snacks, and low physical activity. Therefore, the purpose of this study is to investigate the effect of nutritional education on improving growth indicators, knowledge, attitudes, and food intake. METHODS: This parallel-arm, open-label, randomized clinical trial study will be conducted on 254 children aged 7 to 12 with malnutrition, who will be randomly divided into intervention and control groups. Nutrition education will be conducted during 8 weeks of intervention, and each session will last 45 to 60 min. However, the control group will not receive any education. Weight for age, height for age, BMI for age, food intake, and PRECEDE questionnaire items will be accessed before the intervention, 1 month later, and 3 months after the intervention. The PRECEDE questionnaire prioritizes educational needs and includes specific subscales: predisposing factors (knowledge, attitude, self-efficacy), reinforcing factors, enabling factors, and behavioral assessment. We will analyze the data based on the intention-to-treat protocol. Also, linear regression will be conducted to determine the effect of the intervention on the outcomes after adjustment for the confounding factors. DISCUSSION: Primary school children are at a special age to improve their eating habits, so they are a suitable target for nutrition education interventions to prevent and treat malnutrition. Therefore, the purpose of this research is to determine whether nutrition education can be effective in improving growth indicators and food intake. The results of this intervention can create a new perspective to reduce the prevalence of malnutrition and improve the symptoms caused by it. TRIAL REGISTRATION: IRCT20181111041611N7. Registered on 2023-07-25. https://www.irct.ir/trial/67548 .
Peer-reviewed article·PubMed (US National Library of Medicine)·
Household food security plays a critical role in determining the nutritional status of children, which in turn impacts their growth and development. This study assessed factors influencing household food security and childhood nutritional status and explored the relationship between these variables in Namutumba District. A total of 299 child-caregiver pairs participated in the study. Data were collected through structured interviews and analyzed, with multi-level mixed effects generalized linear models to examine factors associated with severe household food insecurity and children's nutritional status. Multilinear regressions were used to evaluate the relationship between severe household food insecurity and child nutritional status. The results revealed that most households (60.2%) were severely food insecure. A double burden of malnutrition was observed, with 28.0% of children stunted and 2.8% overweight or obese. Factors positively associated with improved household food security included secondary-level education (p = 0.011), medium to high wealth percentile (p < 0.001), and the presence of at least one income-earning household member (p = 0.045). Conversely, lack of access to agricultural land, food stocks, and access to treated drinking water were significantly linked to severe food insecurity (p < 0.001). Severe food insecurity was positively associated with wasting (β = 0.81, p = 0.007) and negatively associated with stunting (β = -0.37, p = 0.039). In conclusion, multiple factors influence household food security, and the nutritional status of children aged 24-59 months. A comprehensive, food systems-based approach may be key to addressing malnutrition in Namutumba District.
Jacent Kamuntu Asiimwe, Kizito Ndegeya, Joweria Nambooze et al.
Survival
Peer-reviewed article·PubMed (US National Library of Medicine)·
INTRODUCTION: Optimal nutrition during early childhood is crucial for psychosomatic development and for preventing diet-related diseases. However, evidence from Poland highlights significant deviations from recommended dietary practices. The previous Polish Infants and Toddler Nutritional Study conducted in 2016 (PITNUTS 2016) revealed imbalances in nutrient intake among children aged 5-36 months. The aim of this study (PITNUTS 2024) is to assess the diet and nutritional status of infants and children aged 5-72 months, providing a broader understanding of eating behaviours across critical stages of growth and development and allowing evaluation of how dietary practices changed in recent years. METHODS AND ANALYSIS: This cross-sectional study will recruit a nationally representative sample of Polish infants and children aged 5 to 72 months using stratified random sampling. Survey interviews will be conducted with parents or legal guardians as proxy reporters for the children. Dietary practices will be evaluated through validated qualitative and quantitative dietary assessments, ensuring a comprehensive evaluation of food consumption and energy and nutrient intake. Dietary data will be collected using the 3 day food record and the survey questionnaire, including a food frequency questionnaire (FFQ). Daily energy and nutrient intake will be compared with national dietary standards and WHO guidelines. Dietary patterns will be derived based on the FFQ data. Nutritional status will be assessed based on measured anthropometric parameters. Energy, macro- and micronutrient intake as well as dietary patterns identified among children will be associated with nutritional status, including body mass index z-score and body weight status. ETHICS AND DISSEMINATION: The study has been approved by the ethics board of the Institute of Mother and Child. Written informed consent was obtained from all participants' parents or legal guardians before the interviews began. The results from this study will be presented at scientific conferences and published in peer-reviewed journals, contributing to nutrition policies in Poland and informing educational materials and dietary consultation services. TRIAL REGISTRATION NUMBER: NCT06417151, results.
Peer-reviewed article·PubMed (US National Library of Medicine)·
Background: Background: Childhood dietary habits are critical determinants of physical growth, cognitive development, and long-term health. In Ecuador, malnutrition remains a major public health concern, with both undernutrition and overweight/obesity affecting children-especially in rural and indigenous populations. Methods: This systematic review followed PRISMA 2020 guidelines (PROSPERO ID: CRD420251080987). Searches were conducted in SciELO, Dialnet, and ScienceDirect (accessed August 2025) using Boolean operators to identify quantitative studies in Spanish or English published between 2018 and 2025 that assessed dietary habits and nutritional status in Ecuadorian children aged 1-11 years. Seventeen studies, including approximately 12,000 children, were included. Results: Prevalence of chronic undernutrition ranged from 15% to 35%, while overweight and obesity reached 20-30%. Undernutrition was higher among rural and indigenous children, whereas overweight predominated in urban and higher-income settings. Common dietary patterns included high consumption of ultra-processed foods and sugar-sweetened beverages, and insufficient intake of fruits, vegetables, and quality proteins. Maternal education, socioeconomic level, and school food environments were key determinants. Conclusions: Both malnutrition and overweight persist among Ecuadorian children, reflecting a nutrition transition influenced by socioeconomic and environmental factors. Context-specific public health actions are urgently needed, including school-based nutrition education, regulation of food marketing, improved access to affordable healthy foods, and community-level engagement to promote sustainable dietary habits. The included studies were mostly cross-sectional and often used non-validated dietary assessment tools, which may influence the reported prevalence estimates.
Keila S Micoanski, Cristina Izquierdo-García, Alex S Huacho-Jácome et al.
Survival
Peer-reviewed article·PubMed (US National Library of Medicine)·
BACKGROUND: Environmental enteric dysfunction (EED) is a subclinical condition caused by fecal-oral contamination leading to enteric inflammation and dysbiosis. Bile acids serve to facilitate lipid digestion and absorption, regulate metabolic pathways associated with childhood growth and inflammation, and may be affected by EED. AIM: To investigate bile acid metabolism in Bangladeshi children with EED and its association with growth impairment. METHODS: We conducted a cross-sectional study of 100 Bangladeshi infants (aged 6-9 months) and quantified serum and fecal bile acids using LC-MS/MS. We compared profiles to a control group of 6 American children (6-12 months) and 80 older Bangladeshi children (aged 2 years). RESULTS: Bangladeshi infants had higher levels of plasma unconjugated primary (65.23% vs 44.25%, P = 0.003) and sulfated primary bile acids (12.98% vs < 0.001%, P = 0.01), with lower primary conjugated bile acids (0.69% vs 2.74%, P ≤ 0.001) compared to American children. Stool unconjugated primary bile acids were inversely associated with weight-for-age [regression coefficient (β) = -0.01, P = 0.01] and height-for-age Z scores (β = -0.01, P = 0.03). Conjugated secondary bile acids were inversely associated with small intestine bacterial overgrowth (β = -1096.68, P = 0.05). Fecal myeloperoxidase was associated with sulfated secondary bile acids (β = -0.40, P = 0.04). Compared to 2-year-old children, the Bangladeshi infant's serum had higher levels of unconjugated primary bile acids (65.23% vs 9.20%, P ≤ 0.001) and lower levels of primary conjugated bile acids (0.69% vs 80.38%, P ≤ 0.001). CONCLUSION: Our data suggests an age-dependent defect in conjugation of primary bile acids in Bangladeshi children with compensatory hydrophilic shunting. Additionally, bile acid profiles are associated with intestinal overgrowth.
Farah Hasan, Phillip B Hylemon, Rashidul Haque et al.
