Background: Nigeria faces a severe child malnutrition crisis, with approximately 1 million severe cases reported for 2025. This burden positions Nigeria among the top countries globally for stunting and wasting in under-fives, exacerbated by factors like food insecurity, flooding, and conflict-particularly in the northern part. This study investigated the development and assessment of Ready-to-Use Therapeutic Foods (RUTF) produced from locally sourced ingredients in Kano State, Nigeria, targeting child malnutrition. Methods: Three distinct RUTF formulations were prepared using rice, wheat, groundnut, and soybean, with raw materials purchased from local markets and processed into blends. Proximate, vitamin (A, C, and E), and mineral (zinc, iron, potassium, magnesium, calcium, and sodium) compositions were measured following the Association of Official Analytical Chemists' (AOAC) standard procedures. Sensory evaluation using a 9-point hedonic scale assessed taste, aroma, flavour, appearance, and overall acceptability. Results: Notable variations were observed among the samples. Blend A exhibited the highest energy (563.08 kcal/100 g), carbohydrate (46.57%), fat (35.84%), and vitamin E (9.29 mg/100 g) content. Blend B was highest in protein (16.71%), iron (2.40 mg/100 g), calcium (21.05 mg/100 g), and vitamin A (15.89 µM). Blend C contained the most potassium (61.65 mg/100 g) and vitamin C (11.70 mg/100 g), with moderate levels of other nutrients. Sensory ratings showed no significant (p < 0.05) differences among the parameters. Conclusions: The nutrient composition and acceptability of RUTF blends suggest that affordable, effective dietary solutions can be produced using local crops. These findings support the potential for locally formulated RUTFs to contribute to reducing child malnutrition in low-resource settings with further enhancements.
Amina Sa'id Muhammad, Eridiong Ogbonna Onyenweaku, Kamaluddeen Babagana et al.
BACKGROUND: Integrated Child Development Services (ICDS) is India's flagship programme to improve the nutritional and health status of children. Appropriate complementary feeding is essential for young children age 6 and 23 months to meet additional nutrient needs. However, there are limited evidence on how ICDS utilization affects complementary feeding practices in India. METHODS: This study used a sample of 59,115 children age 6-23 months from the National Family Health Survey 2019-21. Modified Poisson regression analysis was performed to evaluate the association between the utilization of ICDS services and complementary feeding practices, estimating the adjusted prevalence ratio (aPR). RESULTS: Children age 6-23 months receiving ICDS services had a 19% high probability of consuming diverse diet (95% CI 1.13-1.25, p < 0.001), a 27% high probability of consuming egg and flesh foods (95% CI 1.20-1.34, p < 0.001), and a 3% higher probability of consuming vegetables and fruits (95% CI 1.00-1.06, p < 0.05). However, ICDS utilization is not significantly associated with the timely introduction of semi-solid foods (6-8 months) and the minimum acceptable diet (6-23 months). The probability of achieving recommended meal frequency is significantly 14% lower (95% CI 0.83-0.90, p < 0.001) among ICDS beneficiaries. CONCLUSION: Despite the programme expansion, ICDS have limited influence on improving complementary feeding practices in India. Targeted efforts to improve service delivery to young children by Integrated Child Development Services could potentially support better complementary feeding practices.
BACKGROUND: Acute malnutrition, also known as wasting, affected an estimated 45 million children under five (CU5) globally in 2023. Wasting is measured using a child's mid upper arm circumference (MUAC), weight-for-height z-score (WHZ), or nutritional oedema. In low-resource contexts, MUAC is often the only measurement used to regularly screen for malnutrition, but recent research suggests MUAC alone fails to diagnose 25-80% of WHZ-wasted children. Mid upper arm circumference, an age-adjusted MUAC z-score, may identify additional cases missed by MUAC alone. METHODS: This was a secondary analysis of 1408 CU5 enrolled in a cluster-randomised controlled trial in two high-wasting regions of Somalia. This analysis explored wasting prevalences, concordance between indicator pairs, linear regression modelling, and receiver operating characteristic (ROC) analysis using WHZ as a reference standard to examine alternative MUAC and MUACZ thresholds. RESULTS: Wasting prevalence was 1.5% by MUAC, 8.5% by MUACZ, and 14.8% by WHZ. Mid upper arm circumference alone failed to identify 94% of WHZ-wasted children. There was slight concordance between MUAC and WHZ (kappa (κ) = 0.089) and fair concordance between MUACZ and WHZ (κ = 0.385). Linear regression indicated that MUAC, age, sex, and stunting were all statistically significant variables for estimating child WHZ. Using WHZ as a reference standard, a MUAC of 13.7cm and MUACZ of -0.9 both accurately diagnosed >82% of wasted children ages 9-23 months. A MUAC of 14.4 cm and MUACZ of -1 both accurately diagnosed >76% of wasted children ages 24-59 months. CONCLUSIONS: Poor concordance between MUAC and WHZ should prompt review of wasting measurement guidelines for this population. Stratified analyses and regression modelling showed increased MUAC with age among CU5. MUACZ or age-specific MUAC thresholds may identify more truly wasted children, improving coverage of treatment interventions. Policymakers should examine how adapting screening guidelines impacts health facilities and treatment availability. Future studies should consider long-term outcomes and mortality associated with increased thresholds of MUAC and MUACZ. REGISTRATION: The cluster-RCT is registered at ClinicalTrials.gov, ID: NCT06642012.
Sydney Garretson, Shelley Walton, Kemish Kenneth Alier et al.
Background: Picky eating (PE), also termed food selectivity, is one of the most common feeding concerns in childhood. Although often a transient developmental stage, persistent or severe selectivity may lead to nutritional deficiencies, growth impairment, and psychosocial consequences. Methods: This narrative review is based on literature searches conducted in April 2025 across PubMed, Web of Science, Embase, Medline, and Google Scholar. Articles published between 2015 and 2025 were included if they addressed the epidemiology, etiology, assessment, or management of PE in children aged 0-18 years. Additional seminal references predating this period were also considered. Results: Prevalence estimates of PE vary widely (13-50%), with peak incidence between ages two and six. Contributing factors include genetic predisposition, sensory sensitivities, temperament, family feeding practices, environmental influences, and adverse feeding experiences. Distinction from avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) is essential, as these conditions carry greater risk of nutritional and psychosocial impairment. Assessment relies on caregiver-report instruments, clinical observation, growth monitoring, and targeted nutritional evaluation. Effective management integrates parental education, responsive feeding strategies, repeated exposure to novel foods, and, when indicated, nutritional supplementation or referral to multidisciplinary teams. Sensory-based therapies, behavioral interventions, and psychoeducational programs show particular benefit in persistent cases. Conclusions: While most children outgrow PE without adverse outcomes, a subset remains at risk of long-term nutritional compromise and psychosocial difficulties. Early recognition, family-centered guidance, and evidence-based interventions are essential. Future research should refine diagnostic criteria, develop culturally sensitive assessment tools, and evaluate innovative therapies to improve outcomes.
Dorina Pjetraj, Amarildo Pjetraj, Dalia Sayed et al.
Rural communities in resource-limited settings are exposed to seasonal patterns in food insecurity. The pre- and early post-natal period is a key developmental window, sensitive to nutritional availability and quality. While season of birth has been associated with differences in epigenetic, developmental and health outcomes, it is unclear if this imprints on the developing metabolome and contributes to adverse phenotypic outcomes. Here we show that urinary and plasma metabolites in Tanzanian infants follow seasonal waveforms dependent upon their month of birth, persisting up to at least 18 months of life, which were related to food insecurity, breastmilk composition and rainfall. This includes developmentally relevant metabolites, including choline, trimethylamine-N-oxide, and polyunsaturated fatty acids. Cognitive measures at 18 months also followed seasonal waveforms based upon month of birth which correlated with seasonal metabolites. Additionally, variation in metabolic status modulated the effectiveness of a maternal-infant nicotinamide intervention targeting stunting. Our findings show that seasonal environmental pressures shape mother-infant dyad food insecurity with lasting ramifications for the infant metabolome and development. These findings support the need for season-dependent nutritional and lifestyle interventions targeting developmental shortfalls in these communities.
Elizabeth A Wimborne, Daniela Hampel, Lindsay Allen et al.
INTRODUCTION: Indonesia reduced the prevalence of stunting from 37.6% in 2013 to 21.6% in 2022; however, it remains above the 2024 target of 14%. In Central Java, the prevalence is 20.7%, underscoring the need for targeted interventions. This study examined the determinants of stunting in children in Central Java. METHODS: A matched case-control study was conducted in June-July 2024 across selected districts. A total of 138 children aged 6 to 59 months were included in the study. Data were collected using structured questionnaires and medical records. Chi-square test and logistic regression were used for bivariate and multivariate analyses. RESULTS: Stunted children more often had pulmonary infections (87.5%), low birth weight (84.6%), and a history of hospitalization (53.5%). Maternal postpartum depression (82.4%) and low education levels were also significant. Hospitalization (OR 5.985, P < .01) and postpartum depression (OR 5.155, P < .05) remained key predictors. CONCLUSION: Integrated strategies addressing healthcare, maternal mental health, and nutrition are essential for reducing stunting.
Yuni Dwi Purwani, Teguh Yuwono, Eti Rimawati et al.
Background/Objectives: Early-onset inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), frequently presents with a more severe clinical course. Genetic susceptibility, particularly involving the TGF-β signaling pathway, plays a key role in IBD pathogenesis. SMAD3 and LTBP3 encode crucial components of this pathway and have been implicated in IBD in previous genome-wide association studies. Methods: This study aimed to assess the clinical significance of the rs17293632 (SMAD3) and rs11545200 (LTBP3) polymorphisms in a pediatric IBD cohort. A total of 286 children (133 with UC and 153 with CD) were recruited from seven pediatric centers in Poland. Clinical data included age at diagnosis, inflammatory markers (CRP, albumin), growth indices (Z-scores for weight, height, and BMI), and treatment regimens. Results: The LTBP3 rs11545200 minor allele was significantly associated with a younger age at diagnosis, poorer nutritional status during disease flares, and a more frequent use of infliximab-particularly in patients with UC. In CD, the SMAD3 rs17293632 major homozygous genotype was associated with increased use of systemic corticosteroids, suggesting a more severe or treatment-resistant disease phenotype. Conclusions: The assessed polymorphisms in LTBP3 and SMAD3, both involved in TGF-β signaling, are associated with clinical characteristics of pediatric IBD. These findings support the potential role of genetic variants as biomarkers for disease severity and treatment tailoring, contributing to the development of personalised therapeutic strategies in children with IBD.
Jan Brylak, Mariusz Szczepanik, Jan K Nowak et al.
Infants and children with congenital heart diseases (CHDs) are especially susceptible to malnutrition. The pathogenesis of nutritional disorders in this population reflects a multifactorial balance between increased metabolic demands, reduced dietary intake, and altered nutrient absorption. This narrative review summarizes current knowledge on the prevalence, risk factors, and underlying mechanisms of malnutrition in paediatric CHDs. It also discusses available tools for nutritional assessment, practical strategies for dietary management, and perioperative considerations. Early identification through screening, combined with individualized nutritional support and multidisciplinary care, is essential to optimize growth and enhance clinical recovery. Special attention is given to feeding difficulties, micronutrient imbalances, and the contribution of human milk and energy-dense feeding approaches in promoting growth. Integrating nutrition into cardiac management is essential to improve both short- and long-term outcomes. Future research should focus on the development of standardized, evidence-based protocols and the implementation of precision nutrition in paediatric CHDs.
Giovanna Fernanda Vazzana, Alessia Romano, Claudio Romano
BACKGROUND: The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories. METHODS: The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities. FINDINGS: In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target. INTERPRETATION: Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground. FUNDING: Bill & Melinda Gates Foundation.
The neighbourhood food environment is a potentially modifiable determinant of children's diets, yet evidence for associations with dietary outcomes remains mixed. This study examined cross-sectional associations between residential food environment characteristics and dietary outcomes among 8-year-old Dutch children, and whether maternal education (indicating household socioeconomic status) moderated these associations. Data were drawn from (n = 3739) children in the Generation R Study, a population-based birth cohort in Rotterdam, the Netherlands. Residential food environment exposure was assessed using Geographic Information System-based measures of absolute and relative fast-food outlet density and an overall neighbourhood food environment healthiness score within 400m from children's residences. Dietary outcomes were derived from a parent-reported Food Frequency Questionnaire, and included a validated overall diet quality score (out of 10), and non-core food and drink intake (g/day). Associations were examined using generalized linear models, adjusting for potential confounders. Findings revealed limited and unexpected associations. A healthier food environment score was associated with children's poorer diet quality, and no interaction with maternal education was found. Greater absolute fast-food outlet exposure was associated with better diet quality, but only among children with higher-educated mothers (+0.021 point/outlet, 95% CI: 0.008, 0.034). No associations were found between relative fast-food outlet density and any dietary outcomes. No consistent associations were found for food environment exposure and non-core food and drink intake. In the urban Dutch context, neighbourhood food environments showed weak and inconsistent associations with child diet, with some evidence of potential moderation by household socioeconomic status. These findings highlight the need for multidimensional research and intervention strategies that consider family resources and cultural context to effectively support healthy eating among children.
Holly A Harris, Famke J M Mölenberg, Wilma Jansen et al.
