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Background: Food allergy (FA) affects approximately 8% of children and may be immunoglobulin E (IgE)-mediated or non-IgE-mediated. It is recognized clinically that children with both subtypes of FA may present with features of pediatric feeding disorder (PFD); however, there is currently a limited detail of presenting characteristics. Objective: The objective of this study was to synthesize the current evidence regarding the feeding characteristics of children with FA, with a focus on the feeding skills and psychosocial domains of PFD. Method: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Papers published between 2001 and 2022 describing feeding characteristics in the feeding skills and psychosocial domains in children with FA/history of FA were included. Papers that focused solely on characteristics from the medical or nutritional domains were excluded. Descriptive information regarding demographics, methodology, allergy profile and history, and the characteristics of PFD observed was extracted using a preconceived data extraction form. Results: Overall, 40 papers contained descriptions of feeding characteristics of children with non-IgE-mediated FA (n = 22) and IgE-mediated FA (n = 11), while four were nonspecific. In the psychosocial domain, food refusal/aversion, anxiety with eating, and poor intake were the most frequently reported, regardless of FA subtype. Less information was reported regarding feeding skills, although slowness in eating, immature diet, and delays in oral sensory-motor skills were described. Conclusions: Children with FA/history of FA may present with a range of characteristics that map across the feeding skill and psychosocial domains of PFD. Systematic research is needed to fully describe the feeding characteristics of children with FA. [ABSTRACT FROM AUTHOR]

Consumption of sugar-sweetened beverages (SSBs) during pregnancy has been associated with childhood obesity. Research in which rodent dams have been given high-fat/high-sugar diets has consistently found metabolic alterations in their offspring. However, what remains unclear is the potential impact on the developing fetus of giving sugar in isolation at concentrations similar to SSBs to the mothers. Therefore, we conducted a systematic review and meta-analysis (Protocol No: 127115 on Prospero) to identify potential relationships between maternal sucrose consumption and metabolic outcomes in offspring of rodent (rat or mouse) models. We analysed studies that provided rodent mothers dams with access to sucrose solutions (8–20% w/v) prior to conception, during pregnancy and/or lactation and that reported offspring outcomes of body weight (BW), body composition and glycaemic control. Following a systematic search of four databases (PubMed, EMBASE, Web of Science and Scopus) performed on 15 January 2019, maternal and offspring data from 15 papers were identified for inclusion. Only rat studies were identified. Meta-analyses were performed on standardised mean differences for maternal and offspring BW and fasting glucose levels, with subgroup analyses of strain, sucrose concentration, exposure period and sex of offspring. A bias towards the inclusion of only data from male offspring was identified and this limited interpretation of potential sexually dimorphic outcomes. Maternal sucrose exposure was associated with an increased risk of obesity and poor glucose disposal in adult and aged offspring. [ABSTRACT FROM AUTHOR]

Background: Malnutrition among children under five years of age is a major public health issue in many low and middle-income constrained countries. According to WHO, 5.3 million under-five children die every year and about 45% of these deaths are linked to malnutrition. While it is clear that poverty and lack of food are important factors in children's malnutrition, less is known about the ways in which local conceptions of malnutrition affect parents' treatment choices. In Ethiopia, child malnutrition is a severe public health problem and a common cause of child death, and this paper explores the local views of malnutrition and how these shape people's health-seeking behaviour.Methods: The study was conducted in eastern Ethiopia from December 2017 to January 2019, conducting interviews and focus group discussions to explore different views and treatment options malnutrition. The study used grounded theory because it allows new and unexpected themes to arise from the data. Researchers' assumptions on local terminologies of child malnutrition are also controlled as a principle of ground theory.Results: Child malnutrition was not only perceived to be related to lack of food but was understood in a wider local conceptualization of health and illness. Parents often relied on healers because they are long-standing members of the community, possess indigenous knowledge, and cost less than other options. Because health professionals and the community perceive and speak of health very differently, people often do not seek support from health services. The misalignments between how health professionals and healers diagnose and treat malnourished children have implications on the possibilities to implement change to reduce malnutrition.Conclusions: Through an exploration of people's own terminology and understandings of what a malnourished child is, as well as the underlying reasons for their illness, this paper explores how people understand malnutrition symptoms and why many tend to rely on healers rather than seeking care from health centres. [ABSTRACT FROM AUTHOR]

Background: Widespread variation exists in pediatric critical care nutrition practices, largely because of the scarcity of evidence to guide best practice recommendations.Objective: The objective of this paper was to develop a list of topics to be prioritized for nutrition research in pediatric critical care in the next 10 years.Methods: A modified 3-round Delphi process was undertaken by a newly established multidisciplinary group comprising 11 international researchers in the field of pediatric critical care nutrition. Items were ranked on a 5-point Likert scale.Results: Forty-five research topics (with a mean priority score >3(0-5) were identified within the following 10 domains: the pathophysiology and impact of malnutrition in critical illness; nutrition assessment: nutrition risk assessment and biomarkers; accurate assessment of energy requirements in all phases of critical illness; the role of protein intake; the role of pharmaco-nutrition; effective and safe delivery of enteral nutrition; enteral feeding intolerance: assessment and management; the role of parenteral nutrition; the impact of nutrition status and nutrition therapies on long-term patient outcomes; and nutrition therapies for specific populations. Ten top research topics (that received a mean score >4(0-5) were identified as the highest priority for research.Conclusions: This paper has identified important consensus-derived priorities for clinical research in pediatric critical care nutrition. Future studies should determine topics that are a priority for patients and parents. Research funding should target these priority areas and promote an international collaborative approach to research in this field, with a focus on improving relevant patient outcomes. [ABSTRACT FROM AUTHOR]

In low- and middle-income countries, nutrition support strategies are often suboptimal or non-existent in hospital settings. This is further compounded by high rates of malnutrition in these countries. The first four dietitians graduated in Malawi in 2017 providing a new opportunity to build capacity to introduce nutrition support in an acute care setting. A paediatric nutrition support program was implemented at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi including the hiring of a local dietitian. This capacity building paper explains the development and introduction of the nutrition support program including a description of perceptions of health professionals at QECH working alongside the dietitian. In the first four months of the program at QECH, the dietitian provided nutrition support to 183 different patients across paediatric wards. Nutritional interventions predominantly included infant formula and breastmilk fortification, provision of therapeutic feeds orally or via nasogastric tubes, increased dietary protein intake for children identified to be at high risk, and nutritional counselling to caregivers. More complex nutritional interventions were also given such as the insertion of gastrostomy tubes to deliver nutrition directly to the stomach. Following the introduction of the program, qualitative interviews were done with health professionals at QECH including nurses (n = 5) and physicians (n = 11). All participants emphasized the importance and impact of the nutrition support program in enhancing the care of hospitalized children, therefore improving outcomes such as tolerability of clinical interventions, decreased duration of stay, and reduced risk of hospital readmission. In conclusion, there is a need for nutrition support provided by a dietitian for different paediatric patients which was corroborated by positive feedback from health professionals at QECH. Integration of dietitians into the healthcare system by respective Ministries of Health will require advocacy around the potential for nutrition support to strengthen the quality of care of vulnerable children. A Chichewa abstract for this paper is available in a supplementary file. [ABSTRACT FROM AUTHOR]

Child undernutrition is responsible for 45% of all under‐five deaths in low‐ and middle‐income countries (LMICs) and numerous morbidities. Although progress has been made, high levels of child undernutrition persist in Zambia. Existing studies have explored primary caretakers' (PCs) explanatory models of child undernutrition in LMICs, without comparison with those of health care providers (HCPs). This paper examines and compares the perceived causes of child undernutrition among PCs and HCPs in Zambia. We conducted a qualitative study, using semistructured one‐to‐one and group interviews, with 38 PCs and 10 HCPs to explore their perceptions of child undernutrition and its perceived causes in Lusaka district, Zambia. Interview data were analysed with thematic analysis. Our findings indicate that PCs and HCPs in Lusaka district have divergent explanatory models of child undernutrition and perceive parental agency differently. In divergently framing how they conceptualise undernutrition and who is able to prevent it, these models underpin different attributions of causality and different opportunities for intervention. PCs highlighted factors such as child food preferences, child health, and household finances. Contrarily, HCPs stressed factors such as 'improper feeding', only highlighting factors such as wider economic conditions when these impacted specifically on health care services. One factor, identified by both groups, was 'inadequate mothering'. To accelerate the reduction of child undernutrition, interventions must address divergences between PCs and HCPs' explanatory models. Additionally, attention needs to be paid to how wider socio‐economic and cultural contexts not only impact childhood undernutrition but shape attributions of causality. [ABSTRACT FROM AUTHOR]

Background: Undernutrition is the main cause of child death in developing countries. This paper aimed to explore the efficacy of machine learning (ML) approaches in predicting under-five undernutrition in Ethiopian administrative zones and to identify the most important predictors.Method: The study employed ML techniques using retrospective cross-sectional survey data from Ethiopia, a national-representative data collected in the year (2000, 2005, 2011, and 2016). We explored six commonly used ML algorithms; Logistic regression, Least Absolute Shrinkage and Selection Operator (L-1 regularization logistic regression), L-2 regularization (Ridge), Elastic net, neural network, and random forest (RF). Sensitivity, specificity, accuracy, and area under the curve were used to evaluate the performance of those models.Results: Based on different performance evaluations, the RF algorithm was selected as the best ML model. In the order of importance; urban-rural settlement, literacy rate of parents, and place of residence were the major determinants of disparities of nutritional status for under-five children among Ethiopian administrative zones.Conclusion: Our results showed that the considered machine learning classification algorithms can effectively predict the under-five undernutrition status in Ethiopian administrative zones. Persistent under-five undernutrition status was found in the northern part of Ethiopia. The identification of such high-risk zones could provide useful information to decision-makers trying to reduce child undernutrition. [ABSTRACT FROM AUTHOR]

The implementation of intersectoral community approaches targeting childhood obesity ( IACO) is considered challenging. To help overcome these challenges, an overview of the evidence to date is needed. We searched four databases to identify papers that reported on the determinants of successful implementation of IACOs, resulting in the inclusion of 25 studies. We appraised study quality with the Crowe Critical Appraisal Tool and the Quality Framework; reported implementation outcome indicators were reviewed via narrative synthesis. Quality of included studies varied. The most frequently reported indicators of implementation success were fidelity and coverage. Determinants related to the social-political context and the organization were most often cited as influencing implementation, in particular, 'collaboration between community partners', 'the availability of (human) resources' and 'time available for implementation'. The association between determinants and implementation variability was never explicated. We conclude that although some insights into the effective implementation of IACOs are present, more research is needed. Emphasis should be placed on elucidating the relationship between determinants and implementation success. Research should further focus on developing a 'golden standard' for evaluating and reporting on implementation research. These actions will improve the comparison of study outcomes and may constitute the cumulative development of knowledge about the conditions for designing evidence-based implementation strategies. [ABSTRACT FROM AUTHOR]

Background: Nutritional status of children who are less than 5 years old is of significant regard as the beginning years of life are important for best development. Childhood malnutrition occurs due to several reasons, but spacing of birth is frequently unnoted even if it is accompanied with stunting which reflect chronic malnutrition. Aims: To assess the nutritional status of children less than 5 years old, and its relationship with birth interval, and associated factors. Materials and Methods: It was a cross sectional study was carried on children of 0-5 years age groups of both sexes. Data was collected using predesigned and pretested questionnaire, face to face interview with the mothers and anthropometric measurements of children were performed. Results: Most of undernourished children were with birth space less than 24 months. The frequency of stunting and wasting was the highest among children with birth interval less than 24 months, it was (14.5%) and (6.8%) respectively as compared to those with birth interval 24-59 months were frequency of stunting and wasting was found to be the lowest, it was (11.2%) and (2.2%) respectively. Conclusion: This paper draws attention to significant linkages between birth spacing and child nutritional status. Most of undernourished children were with birth space less than 24 months. [ABSTRACT FROM AUTHOR]

Purpose — The purpose of this paper is to show that, as a factor in the socialization of children, school can play a major mediating role in the reduction of the prevalence of childhood obesity through school programs aimed at promoting healthy and well-balanced food intake. Design/methodology/approach — The paper is an exploratory study with children and parents, using semi-directive interviews. Findings — The findings indicate that parents modified their own eating habits — and consequently that of all the family — by taking into account information acquired by the children in their school context. This change in the family food habits operated through a learning mechanism called "reverse socialization" where children transmit knowledge and consumption skills to their parents. Research limitations/implications — A small sample size was used and results should be considered as indicative. Practical implications — The paper provides suggestions for public and private agencies and actors to better target their messages in order to reduce child obesity prevalence by promoting school programmes aimed at reducing child obesity Originality/value — The paper shows that reverse socialization is a sociological concept not often included in consumer behaviour research and has not yet been applied to food habits. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Economics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The dramatically increasing prevalence of obesity, especially among children, has become a major public health problem in Europe. In reaction to this alarming trend, a series of initiatives and actions has been launched in recent years. As the potential impact of these activities is widely unknown so far, we underline the need for adequate evaluation of these measures. The aim of this paper is to report the latest developments in the fight against obesity at different political levels across Europe, with special attention to the major results of the recent World Health Organization European Ministerial Conference on Counteracting Obesity. In accordance with the main principles of the European Charter on Counteracting Obesity adopted at the meeting, immediate action should be taken now by implementing the few available schemes with proven effectiveness. Finally, given the lack of appropriate evaluation, we consider it particularly important to establish national research centres to collect country-specific data that are to be evaluated together by a central European administration department. Based on the results of such a comprehensive data pool, concrete strategies could be developed for future policy building. [ABSTRACT FROM AUTHOR]

Background/objective: The nutritional risk in hospitalized children and adolescents is a frequent and under-diagnosed reality. There is still no consensus regarding the best nutritional screening method in pediatrics, with StrongKids being one of the existing proposals. A systematic review was performed to evaluate the scientific evidence about StrongKids, with emphasis on the world frequency of nutritional risk, associations of interest in health, validation and reproducibility studies.Methods: Databases Pubmed, Lilacs, Scielo, ScienceDirect, Web of Science, Scopus and Cochrane Library were searched, using keyword "StrongKids," without limit on the year of publication, in English, Spanish, and Portuguese.Results: From 125 papers initially identified, 22 original were included in analysis. The sample size ranged from 43 to 2874, with a maximum of 44 hospitals. The frequency of nutritional risk (medium or high) ranged from 35.7 to 100%. The nutritional risk was mainly associated with acute and/or chronic malnutrition already installed, lower anthropometric indexes and longer length of hospital stay. The method presented satisfactory inter-rater and intra-rater agreements and was validated in the three studies performed with this proposal.Conclusions: The prevalence of nutritional risk in hospitalized children and adolescents is high. StrongKids is a valid, easy-to-use, and reproducible method, with significant associations of interest in health. [ABSTRACT FROM AUTHOR]

Background The evidence regarding the relationship between postnatal exposure of air pollution and child malnutrition indicators, as well as the corresponding urban-rural disparities, is limited, especially in low-pollution area of low- and middle-income countries (LMICs). Therefore, our aim was to contrast the effect estimates of varying ambient particulate matter (PM) on malnutrition indicators between urban and rural areas in Tibet, China. Methods Six malnutrition indicators were evaluated in this study, namely, Z-scores of height for age (HFA), Z-scores of weight for age (WFA), Z-scores of weight for height (WFH), stunting, underweight, and wasting. Exposure to particles with an aerodynamic diameter ≤2.5 micron (μm) (PM2.5), particles with an aerodynamic diameter ≤10 μm (PM10) and particles with an aerodynamic diameter between 2.5 and 10 μm (PMc) was estimated using satellite-based random forest models. Linear regression and logistic regression models were used to assess the associations between PM and the above malnutrition indicators. Furthermore, the effect estimates of different PM were contrasted between urban and rural areas. Results A total of 2511 children under five years old were included in this study. We found long-term exposure to PM2.5, PMc, and PM10 was associated with an increased risk of stunting and a decreased risk of underweight. Of these air pollutants, PMc had the strongest association for Z-scores of HFA and stunting, while PM2.5 had the strongest association for underweight. The results showed that the odds ratio (OR) for stunting were 1.36 (95% confidence interval (CI)=1.06 to 1.75) per interquartile range (IQR) microgrammes per cubic metre (μg/m3) increase in PM2.5, 1.80 (95% CI=1.30 to 2.50) per IQR μg/m3 increase in PMc and 1.55 (95% CI=1.17 to 2.05) per IQR μg/m3 increase in PM10. The concentrations of PM were higher in urban areas, and the effects of PM on malnutrition indicators among urban children were higher than those of rural children. Conclusions Our results suggested that PM exposure might be an important trigger of child malnutrition. Further prospective researches are needed to provide important scientific literature for understanding child malnutrition risk concerning postnatal exposure of air pollutants and formulating synthetically social and environmental policies for malnutrition prevention. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The rates of childhood obesity have increased dramatically in the last few decades. Non-causal evidence suggests that childhood obesity is highly persistent over the life cycle. However, little is known about the origins of this persistence. This paper examines the evolution of anthropometric measures from birth through primary school. We provide estimates of the causal effect of past anthropometric outcomes on future anthropometric outcomes (state dependence) and investigate the importance of time-varying and time-invariant factors in the dynamics of childhood anthropometric measures. We find that anthropometric measures are highly persistent from infancy through primary school. Moreover, most of this persistence is driven by time-invariant, unobserved factors that are determined prior to birth, consistent with the so-called fetal origins hypothesis. Thus, policy interventions designed to improve childhood obesity will only have meaningful, long-run effects if these time-invariant, unobserved factors are altered. Future research is needed to identify such factors, although evidence suggests that maternal nutrition may play an important role. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The health system is the primary vehicle for the delivery of nutrition‐specific interventions that aim to reduce maternal and child malnutrition. The integration of nutrition interventions into existing health interventions is promising, but to ensure that no one is left behind requires that access to essential health services is equitably distributed. This study aims to assess trends and socioeconomic inequalities in coverage of reproductive, maternal, newborn and child health (RMNCH) and assess its association with child nutritional outcomes in Ethiopia. Using the Ethiopian Demographic and Health Survey (2005, 2011, 2016, and 2019), we estimated the coverage of RMNCH interventions in Ethiopia using the co‐coverage index, which is a count of the number of interventions accessed. We assessed the trend and inequalities in co‐coverage and evaluated its association with child nutritional outcomes like stunting, wasting, and minimum dietary diversity (MDD). The national co‐coverage index has shown a significant increase over the 2005–2019 period. However, all of the RMNCH interventions constituting the co‐coverage index showed a pro‐rich and pro‐urban distribution (p < 0.05). The highest inequality, based on the slope index of inequality (SII), was observed for skilled assistance during delivery (SII: 80.4%), followed by access to an improved source of drinking water (SII: 62.6%), and antenatal care visits (SII: 55.5%). The low coverage in RMNCH and the observed inequality were associated with stunting, wasting, and MDD. Reducing socioeconomic inequality in RMNCH is key to achieve the health, nutrition and equity‐related goals of the Sustainable Development Goals. Key messages: Significant increases in the coverage of reproductive, maternal, newborn and child health (RMNCH) interventions were observed between 2005 and 2019.Inequalities in RMNCH interventions were stark and showed pro‐rich and pro‐urban distribution.Improved co‐coverage of RMNCH interventions is associated with reduced odds of stunting and wasting, and increases in dietary diversity among children 6–23 months of age.Analyses stratified by rural/urban residence and wealth quintile showed that the association between co‐coverage and dietary diversity was stronger for urban and the wealthiest quintile. [ABSTRACT FROM AUTHOR]

Child malnutrition remains a significant concern in the Asia‐Pacific region, with short birth intervals recognised as a potential risk factor. However, evidence of this association is inconclusive. This study aimed to systematically review the existing evidence and assess the summary effects of short birth interval on child malnutrition in the Asia‐Pacific region. Five electronic databases were searched in May 2023 to identify relevant studies reporting the association between short birth interval and child malnutrition, including stunting, wasting, underweight, anaemia and overall malnutrition, in Asia‐Pacific region between September 2000 and May 2023. Fixed‐effects or random‐effects meta‐analysis was performed to estimate the summary effects of short birth interval on child malnutrition. Out of 56 studies meeting the inclusion criteria, 48 were included in quantitative synthesis through meta‐analysis. We found a slightly higher likelihood of stunting (n = 25, odds ratio [OR] = 1.13; 95% confidence interval [CI]: 0.97–1.32) and overall malnutrition (n = 3, OR = 2.42; 95% CI: 0.88–6.65) among children born in short birth intervals compared to those with nonshort intervals, although the effect was not statistically significant. However, caution is warranted due to identified heterogeneity across studies. Subgroup analysis demonstrated significant effects of short birth intervals on child malnutrition in national‐level studies and studies with larger sample sizes. These findings underscore short birth intervals as a significant contributor to child malnutrition in the Asia‐Pacific region. Implementing effective policies and programs is vital to alleviate this burden, ultimately reducing child malnutrition and associated adverse outcomes, including child mortality. Key messages: Short interval pregnancies pose a persistent public health threat in the South Asian region.While a potential link with child malnutrition exists, reported associations often conflict.Our findings suggest that short interval births slightly increase the risk of child malnutrition.Addressing short interval pregnancies is crucial to mitigate the ongoing nutritional burden in South Asian countries. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is one of the most pressing health issues of our time. Key health organizations have recommended research be conducted on the effectiveness of well-designed interventions to combat childhood obesity that can be translated into a variety of settings. This paper describes the design and methods used in the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) trial, an ongoing multi-site randomized controlled trial, in overweight/obese children comparing the efficacy of three interventions: 1) a parent-centered dietary modification program; 2) a child-centered physical activity skill-development program; and 3) a program combining both 1 and 2 above. Methods/Design: Each intervention consists of three components: i) 10-weekly face-to-face group sessions; ii) a weekly homework component, completed between each face-to-face session and iii) three telephone calls at monthly intervals following completion of the 10-week program. Details of the programs' methodological aspects of recruitment, randomization and statistical analyses are described here a priori. Discussion: Importantly this paper describes how HIKCUPS addresses some of the short falls in the current literature pertaining to the efficacy of child obesity interventions. The HIKCUPS trial is funded by the National Medical Research Council, Australia. [ABSTRACT FROM AUTHOR]

Objectives. Obesity in childhood is associated with the presence of risk factors for later disease and with the early development of these diseases. This paper aims to estimate the numbers of children with obesity-related disease risk factors and co-morbidities in the European Union (EU). Methods. A search of the scientific literature identified prevalence rates relating variously to impaired glucose tolerance, hyperinsulinaemia, type 2 diabetes, several cardiovascular risk factors, non-alcoholic fatty liver disease, and the metabolic disease syndrome among obese children. Using the lowest likely prevalence rates for each disease indicator, estimates were made of the expected numbers of obese children within the EU likely to be showing the specified indicator. Results. On the most conservative estimate, over 20?000 obese children in the EU have type 2 diabetes, while over 400?000 have impaired glucose tolerance. Over a million obese children are likely to show a range of indicators for cardiovascular disease, including hypertension and raised blood cholesterol levels, and have three or more indicators of the metabolic syndrome. Over 1.4 million may have early stages of liver disorder. Conclusions. Although there will be considerable overlap in the numbers of obese children with the various risk factors described, the estimated burden of disease indicators among obese children is high. Paediatric services need to consider their ability to screen and treat children if we are to avoid a substantial rise in chronic obesity-related disease among young adults over the next decade. [ABSTRACT FROM AUTHOR]

Objectives. Surveys have shown the prevalence of overweight among school age children to be as high as 35% in parts of Europe, and several countries have reported prevalence rates increasing year-on-year. The purpose of the present paper is to review the rate of change in prevalence of overweight and obesity among children in the European region. Methods. A search of published and unpublished surveys was undertaken to find pairs of surveys that could indicate rates of change of prevalence within comparable population groups using comparable measures. Data from 45 pairs of surveys from 11 countries were analysed. Results. Annual increases in prevalence of overweight (including obesity) rose from typically below 0.5 percentage points in the 1980s, to over 1.0 percentage points in the late 1990s. For obesity alone, the annual increase in prevalence was typically below 0.1 percentage points in the 1980s and typically 0.3 percentage points in the late 1990s. Conclusions. The prevalence of overweight and obesity among children is rising in the European region, and the annualised rates of increase are themselves increasing. Unless action is taken to counteract these trends, by the year 2010 the European Union can expect to see the numbers of overweight and obese children rising by approximately 1.3 million children per year, of which the numbers of obese children will be rising by over 0.3 million per year. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity in Australia has risen at an alarming rate over the last 20 years as in other industrialised countries around the world, yet the policy response, locally and globally, has been limited. Using a childhood obesity summit held in Australia in 2002 as a case study, this paper examines how evidence was used in setting the agenda, influencing the Summit debate and shaping the policy responses which emerged. The study used multiple methods of data collection including documentary analysis, key informant interviews, a focus group discussion and media analysis. The resulting data were content analysed to examine the types of evidence used in the Summit and how the state of the evidence base contributed to policy-making. Results: Empirical research evidence concerning the magnitude of the problem was widely reported and largely uncontested in the media and in the Summit debates. In contrast, the evidence base for action was mostly opinion and ideas as empirical data was lacking. Opinions and ideas were generally found to be an acceptable basis for agreeing policy action coupled with thorough evaluation. However, the analysis revealed that the evidence was fiercely contested around food advertising to children and action agreed was therefore limited. Conclusion: The Summit demonstrated that policy action will move forward in the absence of strong research evidence. Where powerful and competing groups contest possible policy options, however, the evidence base required for action needs to be substantial. As with tobacco control, obesity control efforts are likely to face ongoing challenges around the nature of the evidence and interventions proposed to tackle the problem. Overcoming the challenges in controlling obesity will be more likely if researchers and public health advocates enhance their understanding of the policy process, including the role different types of evidence can play in influencing public debate and policy decisions, the interests and tactics of the different stakeholders involved and the part that can be played by time-limited yet high profile events such as Summits. [ABSTRACT FROM AUTHOR]

Background: The SELEVER study is designed to evaluate the impact of an integrated agriculture-nutrition package of interventions (including poultry value chain development, women's empowerment activities, and a behavior change communications strategy to promote improved diets and feeding, care, and hygiene practices) on the diets, health, and nutritional status of women and children in Burkina Faso. This paper presents the rationale and study design.Methods: The impact evaluation involves a cluster randomized controlled trial design that will be implemented in 120 rural communities/villages within 60 communes supported by SELEVER in the Boucle de Mouhoun, Centre-Ouest, and Haut-Bassins regions of Burkina Faso. Communities will be randomly assigned to one of three treatment arms, including: (1) SELEVER intervention group; (2) SELEVER with an intensive WASH component; and (3) control group without intervention. Primary outcomes include the mean probability of adequacy of diets for women and children (aged 2-4 years at baseline), infant and young child feeding practices of caregivers of children aged 0-2 years, and household poultry production and sales. Intermediate outcomes along the agriculture and nutrition pathways will also be measured, including child nutrition status and development. The evaluation will follow a mixed-methods approach, including a panel of child-, household-, community-, and market-level surveys, and data collection points during post-harvest and lean seasons, as well as one year after implementation completion to examine sustainability.Discussion: To our knowledge, this study is the first to rigorously examine from a food systems perspective, the simultaneous impact of scaling-up nutrition-specific and nutrition-sensitive interventions through a livestock value-chain and community-intervention platform, across nutrition, health, and agriculture domains. The findings of this evaluation will provide evidence to support the design of market-based nutrition-sensitive interventions.Trial Registration: ISRCTN registry, ISRCTN16686478 . Registered on 2 December 2016. [ABSTRACT FROM AUTHOR]

Different approaches have been used to estimate the economic benefits of reducing undernutrition and to estimate the costs of investing in such programs on a global scale. While many of these studies are ultimately based on evidence from well-designed efficacy trials, all require a number of assumptions to project the impact of such trials to larger populations and to translate the value of the expected improvement in nutritional status into economic terms. This paper provides a short critique of some approaches to estimating the benefits of investments in child nutrition and then presents an alternative set of estimates based on different core data. These new estimates reinforce the basic conclusions of the existing literature: the economic value of reducing undernutrition in undernourished populations is likely to be substantial. [ABSTRACT FROM AUTHOR]

The Global Hunger Index Report published in 2015 brings back the problem of malnutrition in India into sharp focus. Malnutrition continues to be a national problem but there have been positive developments in tackling it too. As per the India Health Report on Nutrition published in 2015, the rate of child undernutrition is declining in the country; initially it was at a slower pace between 1992 and 2005 but since 2006 at an accelerated pace which continues even today. Between 2006 and 2014, the rate of stunting among under five-yearold children declined from 48 percent to 39 percent. However, the Report states that the development in India is still below the rate needed to achieve World Health Assembly's global nutrition targets that our country is committed to. This paper enumerates two innovative initiatives "Surguja Fulwari" in Chhattisgarh and "Aman Persera" of Meghalaya which aim at reducing child undernutrition both as a maker and marker of development. The "Surguja Fulwari" initiative won the Prime Minister's Award for Excellence in Public Administration in 2013. Currently, the model of "Surguja Fulwari" is being replicated by the State of Meghalaya as "Aman Persera." [ABSTRACT FROM AUTHOR]

Background: Nutrition plays an important role in child survival and development. Treatment action in the management of child health and nutrition is influenced by perceptions of illness, and gender plays an important role. However, little is known about if and how moderate undernutrition is recognised among lay populations, or how local social norms and intra-household dynamics affect decisions to seek biomedical assistance for nutritional concerns. In this paper we describe how childhood nutritional problems are recognised and understood within rural households. We demonstrate how context influences local constructs of 'normal', and suggest the centrality of gender in the management of child health and nutrition in our research context.Methods: This qualitative study was undertaken in Kilifi County on the Kenyan Coast. A set of 15 households whose children were engaged in a community-based nutrition intervention were followed up over a period of twelve months. Over a total of 54 household visits, group and individual in-depth interviews were conducted with a range of respondents, supplemented by non-participant observations. Eight in-depth interviews with community representatives were also conducted.Results: Local taxonomies of childhood undernutrition were found to overlap with, but differ from, biomedical categories. In particular, moderate undernutrition was generally not recognised as a health problem requiring treatment action, but rather as routine and manageable, typically seasonal, weight-loss. Where symptoms were considered more serious and requiring remedial action, household management strategies were typically based on perceived aetiology of the illness. Additionally, gender emerged as a potentially central theme in childhood nutrition problems and related management. Women reported that they have primary responsibility for ensuring children's good health and nutritional status, and that they are often held accountable when their children are of sub-optimal health.Conclusion: Perceptions of child nutrition and illness and gendered roles within households influence treatment action, and engagement with nutrition interventions. Community-based nutrition interventions must recognise these complex realities. [ABSTRACT FROM AUTHOR]

The International Lipid‐Based Nutrient Supplements (iLiNS) Project began in 2009 with the goal of contributing to the evidence base regarding the potential of lipid‐based nutrient supplements (LNS) to prevent undernutrition in vulnerable populations. The first project objective was the development of acceptable LNS products for infants 6–24 months and for pregnant and lactating women, for use in studies in three countries (Burkina Faso, Ghana and Malawi). This paper shares the rationale for a series of decisions in supplement formulation and design, including those related to ration size, ingredients, nutrient content, safety and quality, and packaging. Most iLiNS supplements have a daily ration size of 20 g and are intended for home fortification of local diets. For infants, this ration size is designed to avoid displacement of breast milk and to allow for dietary diversity including any locally available and accessible nutrient‐dense foods. Selection of ingredients depends on acceptability of flavour, micronutrient, anti‐nutrient and essential fatty acid contents. The nutrient content of LNS designed to prevent undernutrition reflects the likelihood that in many resource‐poor settings, diets of the most nutritionally vulnerable individuals (infants, young children, and pregnant and lactating women) are likely to be deficient in multiple micronutrients and, possibly, in essential fatty acids. During ingredient procurement and LNS production, safety and quality control procedures are required to prevent contamination with toxins or pathogens and to ensure that the product remains stable and palatable over time. Packaging design decisions must include consideration of product protection, stability, convenience and portion control. [ABSTRACT FROM AUTHOR]

Background: Millions of people in low and low middle income countries suffer from extreme hunger and malnutrition. Research on the effect of food insecurity on child nutrition is concentrated in high income settings and has produced mixed results. Moreover, the existing evidence on food security and nutrition in children in low and middle income countries is either cross-sectional and/or is based primarily on rural populations. In this paper, we examine the effect of household food security status and its interaction with household wealth status on stunting among children aged between 6 and 23 months in resource-poor urban setting in Kenya.Methods: We use longitudinal data collected between 2006 and 2012 from two informal settlements in Nairobi, Kenya. Mothers and their new-borns were recruited into the study at birth and followed prospectively. The analytical sample comprised 6858 children from 6552 households. Household food security was measured as a latent variable derived from a set of questions capturing the main domains of access, availability and affordability. A composite measure of wealth was calculated using asset ownership and amenities. Nutritional status was measured using Height-for-Age (HFA) z-scores. Children whose HFA z-scores were below -2 standard deviation were categorized as stunted. We used Cox regression to analyse the data.Results: The prevalence of stunting was 49 %. The risk of stunting increased by 12 % among children from food insecure households. When the joint effect of food security and wealth status was assessed, the risk of stunting increased significantly by 19 and 22 % among children from moderately food insecure and severely food insecure households and ranked in the middle poor wealth status. Among the poorest and least poor households, food security was not statistically associated with stunting.Conclusion: Our results shed light on the joint effect of food security and wealth status on stunting. Study findings underscore the need for social protection policies to reduce the high rates of child malnutrition in the urban informal settlements. [ABSTRACT FROM AUTHOR]

Background: Evidence from studies conducted in nutritionally deprived children in low- and middle-income countries (LIMC) in past decades showed little or no population-level catch-up in linear growth (mostly defined as reductions in the absolute height deficit) after 2 years of age. Recent studies, however, have reported population-level catch-up growth in children, defined as positive changes in mean height-for-age z-scores (HAZ). The aim of this paper was to assess whether population-level catch-up in linear growth is found when height-for-age difference (HAD: child's height compared to standard, expressed in centimeters) is used instead of HAZ. Our premise is that HAZ is inappropriate to measure changes in linear growth over time because they are constructed using standard deviations from cross-sectional data.Methods: We compare changes in growth in populations of children between 2 and 5 years using HAD vs. HAZ using cross-sectional data from 6 Demographic and Health Surveys (DHS) and longitudinal data from the Young Lives and the Consortium on Health-Orientated Research in Transitional Societies (COHORTS) studies.Results: Using HAD, we find not only an absence of population-level catch-up in linear growth, but a continued deterioration reflected in a decrease in mean HAD between 2 and 5 years; by contrast, HAZ shows either no change (DHS surveys) or an improvement in mean HAZ (some of the longitudinal data). Population-level growth velocity was also lower than expected (based on standards) in all four Young Lives data sets, confirming the absence of catch-up growth in height.Discussion: We show no evidence of population-level catch-up in linear growth in children between 2 to 5 years of age when using HAD (a measure more appropriate than HAZ to document changes as populations of children age), but a continued deterioration reflected in a decrease in mean HAD.Conclusions: The continued widening of the absolute height deficit after 2 years of age does not challenge the critical importance of investing in improving nutrition during the first 1000 days (i.e., from conception to 2 years of age), but raises a number of research questions including how to prevent continued deterioration and what is the potential of children to benefit from nutrition interventions after 2 years of age. Preventing, rather than reversing linear growth retardation remains the priority for reducing the global burden of malnutritionworldwide. [ABSTRACT FROM AUTHOR]

In this issue of the Journal, Isanaka et al. (Am J Epidemiol. 2016;184(12):861-869) set out to update an incidence correction factor used for estimating numbers of cases of severe acute malnutrition (SAM) in children aged 6-59 months. The total number of current SAM cases (prevalent cases) increases by the number of new (incident) cases and decreases as a result of recovery or death. Prevalence estimates are obtained from cross-sectional surveys. Calculation of incidence typically requires longitudinal data, which evidently are rarely collected for SAM, and so a correction factor is applied instead. Isanaka et al. pool and meta-analyze data from longitudinal and community programs in 3 West African countries (Mali, Niger, and Burkina Faso), covering the period 2009-2012. Heterogeneity and the ongoing lack of data undermine the use of a single incidence correction factor for SAM estimates. Routine data collection is recommended as a way forward and aligns with recommendations of the World Health Organization. This commentary helps to outline a context for the use of such data and provide some perspective on the inadequacy of data, relative to the importance of the issue. [ABSTRACT FROM AUTHOR]

Background: Adequate treatment of severe childhood obesity is important given its serious social, psychological and physical consequences. Self-regulation may be a crucial determinant of treatment success. Yet, little is known about the role that self-regulation and other psychosocial factors play in the long-term outcome of obesity treatment in severely obese children and adolescents. In this paper, we describe the design of a study that aims to determine whether the ability to self-regulate predicts long-term weight loss in severely obese children and adolescents. An additional objective is to identify other psychosocial factors that may modify this relation. Methods/design: The study is designed as a prospective observational study of 120 severely obese children and adolescents (8-19 years) and their parents/caregivers undergoing an intensive combined lifestyle intervention during one year. The intervention uses behavior change techniques to improve the general ability to self-regulate. Measurements will be taken at three points in time: at baseline (start of treatment), at the end of treatment (1 year after baseline) and at follow-up (2 years after baseline). The primary outcome measurement is the gender and age-specific change in SDS-BMI. The children's general self-regulation abilities are evaluated by two behavioral computer tasks assessing two distinct aspects of self-regulation that are particularly relevant to controlling food intake: inhibitory control (Stop Signal Task) and sensitivity to reward (Balloon Analogue Risk Task). In addition to the computer tasks, a self-report measure of eating-specific self-regulation ability is used. Psychosocial factors related to competence, motivation, relatedness and outcome expectations are examined as moderating factors using several questionnaires for the patients and their parents/caregivers. Discussion: This study will provide knowledge about the relation between self-regulation and long-term weight loss after intensive lifestyle interventions over a two-year period in severely obese children and adolescents, a growing but often overlooked patient group. We aim to investigate to what extent (changes in) the general ability to self-regulate predicts weight loss and weight loss maintenance. This study will also contribute to the knowledge on how this association is modified by other psychosocial factors. The results may contribute to the development of more successful interventions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to evaluate the effectiveness of school-based nutrition education interventions in reducing or preventing overweight and obesity among children and adolescents. Methods: We conducted a systematic search of 14 databases until May 2010 and cross-reference check in 8 systematic reviews (SRs) for studies published that described randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. An additional search was carried out using PubMed for papers published through May 2012, and no further papers were identified. Body mass index (BMI) was the primary outcome. The title and abstract review and the quality assessment were performed independently by two researchers. The software EPPI-Reviewer3 was used to store, manage and analyze all data. This SR is registered at ClinicalTrials.gov (NCT00985972). Results: From the 4888 references initially retrieved, only 8 met the eligibility criteria for a random-effects meta-analysis. The total population consisted of 8722 children and adolescents. Across the studies, there was an average treatment effect of −0.33kg/m2 (−0.55, −0.11 95% CI) on BMI, with 84% of this effect explained by the highest quality studies. Conclusion: This systematic review provides evidence that school-based nutrition education interventions are effective in reducing the BMI of children and adolescents. [Copyright &y& Elsevier]

Childhood obesity is a significant public health problem requiring innovative solutions. While recent reviews indicate that some policies show promise, there is a lack of information regarding which policies, and policy combinations, work best. Low-nutrition, energy-dense foods and beverages such as sugar-sweetened beverages (SSBs) have been identified as a major contributor to the problem. The purpose of this paper is to use simulation modeling to show how changes in three categories of SSB policies-school nutrition, school-based education, and taxes-impact SSB and other food consumption. The model shows that policies directed at SSBs, particularly tax hikes, could lead to substantial reductions in the number of calories consumed by youth. The estimates, however, are subject to a high degree of uncertainty. Estimates from school-based nutrition and school-based education policies, while also helping to reduce caloric intake, generally show smaller effects than tax policies and considerable variation around parameter estimates for individual and combined policies. We conclude with a discussion of the limits of the model, and suggest where additional information is needed. Limitations notwithstanding, simulation modeling is a promising methodology that can help advance our understanding of policy effects, thereby helping policymakers to better formulate effective policies to reduce obesity prevalence and the associated social harms. [ABSTRACT FROM AUTHOR]

Background. To reverse the trend of rising child obesity rates in many middle-income countries, recommendations include increasing fruit and vegetable consumption. Schools can positively impact children's eating behavior, and multicomponent interventions that include the curriculum, school food environments, and parental involvement are most effective. Objective. To find out how fruits and vegetables feature in the dietary guidelines provided to schools, what specific schemes are available for providing these foods, the extent to which nutrition education is included in the curriculum, and how vegetables and fruits are procured in primary schools. Methods. In 2008, a survey questionnaire previously validated and revised was sent electronically to national program managers and focal points for school feeding programs in 58 middle-income countries. The rationale was to obtain information relevant to the entire country from these key informants. The survey response rate was 46%. The information provided by 22 respondents in 18 countries was included in the current study. On average, respondents answered 88% of the questions analyzed in this paper. Of the respondents, 73% worked for the national authority responsible for school food programs, with 45% at the program coordinator or director level. Results. Few countries have any special fruit and vegetable schemes; implementation constraints include cost and lack of storage facilities. Although 11 of 18 countries have both nutrient-based guidelines and school food guidelines for meals, fruits and vegetables are often not adequately specified. Conclusions. In some countries, nutrition education, special activities, school gardens, and parental participation are used to promote fruits and vegetables. Specific schemes are needed in some, together with school food guidelines that include fruits and vegetables. [ABSTRACT FROM AUTHOR]

As both overweight and underweight epidemics are plaguing the world, this study investigates the situation in the Korean peninsula. Particularly, the political division of Korea as a result of the Cold War offers researchers a unique opportunity to study how the so-called nutrition transition has affected one people living in two nations. In the early 2000s, overweight-to-underweight ratios were expectedly higher in developed South Korea (6.9) than in underdeveloped North Korea (0.1), meaning that more children were suffering from overnutrition than undernutrition in South Korea while the polar opposite was true for North Korea. Nevertheless, South Korea's ratios increased from 6.9 to 7.4 from the early to late 2000s, whereas they stagnated in the North during the same period. Further analysis revealed that less children were overweight and underweight in North Korea in the late 2000s compared to the early 2000s. If so, this indicates that North Korea is slowly shifting towards "normal" weights, whereas the overweight burden is increasing in South Korea. The paper concludes that more development aid is needed in the North, one of the poorest countries in the world. In stark contrast, effective campaigns fighting overeating patterns are needed in the South. While North Korea is stuck in the second (famine) phase of the nutrition transition, South Korea's nutrition transition to the last (healthy and wealthy) fifth phase is far from complete. Interestingly, as both Koreas were unified for centuries prior to their political division in 1948, differences in overweight-to-underweight ratios cannot be attributed to genes. [ABSTRACT FROM AUTHOR]

Childhood obesity is a growing public health problem. The application of detailed body composition assessment techniques is important to better understand the health status of children and adolescents. However, body composition assessment techniques in current use may involve assumptions which render them inappropriate for many individuals. The physical characteristics of children and adults differ and similarly there are differences between obese and non-obese individuals. Therefore, body composition values derived from obese children and adolescents need to be interpreted with caution if equations or approaches have been generated using normal-weight individuals. The current paper provides an overview of selected body composition assessment techniques with an emphasis on their usefulness in estimating body composition among obese children and adolescents. The paper also presents some future recommendations for research in this area. [ABSTRACT FROM AUTHOR]

This paper provides a review of three sets of recent expert recommendations on the treatment of childhood and adolescent obesity: 2007 Healthcare Organizations' Four Stage Model; 2009 Seven Step Model; and 2010 US Preventive Task Force Recommendations. A consensus emerged from this analysis. All three groups viewed the evidence as supporting intensive (>25 contact hours) dietary, physical activity and cognitive-behavioral counseling and two of the three groups discouraged reliance on educational interventions alone. A case is made for the advantages of the Seven Steps model and immersion treatments. [ABSTRACT FROM AUTHOR]

Identifying early risk factors for childhood obesity is critical, as weight in infancy and early childhood tracks to later periods. Continued bottle use – primarily from excess milk intake – is emerging as a potential risk factor for early childhood overweight. Over three fourths of US infants drink from bottles beyond the recommended weaning age of 12 months, and two thirds of UK infants use a bottle at 18 months. This paper is divided into three parts. Part 1 reviews the literature on beverage intake, weight and bottle use in young children. Part II describes pilot data on milk bottle use and weight in 12–60-month-olds, collected prior to a randomized controlled (RCT) trial of a bottle-weaning intervention. Median daily milk bottle consumption at 12 months was 5.0 (interquartile range = 3–6). Among 12–36-month-olds, current users were significantly more likely to be >95th% weight-for-height (19% vs. 0%, P < 0.02), and more were >85% weight-for-height (27% vs. 11%, P < 0.11), vs. non-users. In contrast, current bottle use was not associated with either overweight or obesity in 37–60-month-olds. Part III describes the RCT, begun in fall 2008. It is enrolling 464 parent/12-month-old dyads from a nutrition assistance programme for low-income families. Children's bottle use, anthropometrics, dietary intake and nutrient density (via 24 h recall) are assessed quarterly through 24 months of age. For the intervention, site nutritionists employ a project-developed, visually attractive flip chart. An observational study nested within the RCT will describe dietary changes during this period of feeding transitions. [ABSTRACT FROM AUTHOR]

Objective. To investigate the relationship between IGF-I and the nutritional status of West-African children hospitalised for nutritional rehabilitation. Patients and methods. A cohort study was performed in two centres for nutritional rehabilitation and education (CREN) in Burkina Faso. Children were followed and the anthropometric data as well as the capillary blood samples were taken on the 7th and on the 14th days after their admission. IGF-I levels were determined from dried blood spots on filter paper on IGF-I RIA, after separation of the IGF-I from its binding proteins, using Sep-Pak chromatography. Results. A total of 59 children was included in the cohort. The IGF-I mean geometric values (SD) were 6.3 (1.4) μg/L on admission, 8.6 (1.8) μg/L at day 7 and 13.6 (2.0) μg/L at day 14. The differences between these values were statistically significant (P < .001). There is a significant correlation between the changes of IGF-I with the change of weight for height Z-score (P = .01). Conclusion. These results suggest that IGF-I can be considered as a potential marker to follow the nutritional status of children admitted in hospital for protein and energy malnutrition. [ABSTRACT FROM AUTHOR]

Given the moral and medical panic surrounding rising rates of childhood obesity, there has been much debate about who on what is to be blamed, with parents and HFSS (high fat, salt, and sugar)food advertising often censured for their role. In this paper, we review the literature on childhood obesity and pester power, and the broader context of consumer socialization within the family. We then discuss findings from a questionnaire and focus group study of 8-11 year old children in New Zealand exploring aspects of their advertising experiences and everyday snack food consumption. HFSS food ads were well-represented in their repertoire of favorite ads, and they reported being influenced by these. However, their accounts of snacking highlighted the extent to which their actual consumption was shaped by parental agendas and concerns. Although they gravitated towards less healthy snack foods, fruit, and vegetables were included in their categorization and repertoire of snacks, perhaps reflecting the level of monitoring and gatekeeping exerted by their parents, who established ground rules for snacking and in many cases directly controlled their access to snack foods, although the limits imposed varied according to context. The children were generally accepting of this, although they drew on a range of strategies and tactics to access their preferred snacks. We conclude by considering the implications of this study for parents who seek to provide their children with a healthy diet and others concerned about health and public policy, and we suggest some avenues for developing knowledge in this area. [ABSTRACT FROM AUTHOR]

The purpose of this article is to comprehensively review studies that have examined the relation between diet and childhood obesity. The review specifically considers the roles of total energy intake and energy density; dietary composition; individual foods, food groups, and dietary patterns; beverage consumption; and eating behaviors. The paper also discusses methodological considerations and future research directions and concludes by summarizing the evidence presented and highlighting the ethical issues surrounding providing dietary advice. [ABSTRACT FROM AUTHOR]

Childhood obesity has become a public health epidemic, and currently a battle exists over how to frame and address this problem. This paper explores how public policy approaches can be employed to address obesity. We present the argument that obesity should be viewed as the consequence of a “toxic environment” rather than the result of the population failing to take enough “personal responsibility.” In order to make progress in decreasing the prevalence of obesity, we must shift our view of obesity away from the medical model (which focuses on the individual)to a public health model (which focuses on the population). At the same time, we must be sensitive to the problem of weight bias.Potential obstacles to taking a public policy approach are identified, as well as suggestions on how to overcome them. [ABSTRACT FROM AUTHOR]

The article presents perspectives concerning the papers of D. Fayter et al and F.K. Grote et al on the effectiveness of growth monitoring in children in relation to probable associated diseases. The author commends the scientists suggestion that height monitoring of children is a beneficial and a must as a public health measure. He expresses his surprise over the averse feelings parents feel in explaining to their children about body mass index (BMI) for fears that it would cause a hysteria over obesity and result to eating disorders. The author commends the British government's efforts in undertaking an online BMI calculator, as a sign of its resolve in the issue of childhood obesity.

Information about several papers discussed at the informal consultation meeting of several international health organizations regarding the community-based management of child malnutrition. Since severe malnutrition is one of the cause of death in children, health organizations continue to develop health programs that would solve malnutrition problems. The meeting did not make any recommendations on preventing malnutrition.

Aim: (i) To determine the ability of general practitioners (GPs) and paediatricians to correctly identify children as overweight or obese by visual cues alone; (ii) to describe the current management practices of overweight and obese children by these practitioners; and (iii) to compare these with National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines. Methods: Forty-four GPs and 29 paediatricians participated in the study. Respondents completed a questionnaire based on a series of body images, rating the size of the child as acceptable weight, overweight or obese and indicating the likelihood of carrying out a series of management options. Results: There was considerable variation in ability to rate images correctly with the total number of correct responses being 72% and 68%, respectively, for GPs and paediatricians. There were statistically significant differences in management between GPs and paediatricians in terms of conducting appropriate anthropometry and screening for co-morbidities, with paediatricians performing closer to the NHMRC Clinical Practice Guidelines. Conclusion: GPs and paediatricians have the opportunity to screen children for overweight and obesity during their everyday practice. Accurate determination of weight status cannot be performed by visualisation alone and all children should have height and weight measured and correctly interpreted. Some areas of current GP and paediatrician management of overweight and obese children fall short of the NHMRC clinical guidelines and areas for improvement are highlighted in this paper. [ABSTRACT FROM AUTHOR]

The goal of this paper is to compare the extent of child obesity in Canada, Norway and the United States. As child poverty is an important correlate of child obesity, we wish to examine the potential role of international differences in child poverty in explaining international differences in the extent of child obesity. We use three representative microdata surveys containing parental reports of child height and weight collected in the mid-1990s in Canada, Norway and the US. We calculate both the prevalence and proportional severity of child obesity for 6–11-year-old children in each country, and represent the ‘extent’ of obesity diagrammatically. Differences in patterns of child poverty are similarly depicted. Obesity extent is also compared for poor and non-poor children in Canada and the US. Finally, child obesity in the three countries is compared using only non-poor children where we find that the extent of child obesity is much lower in Norway than in Canada or the US. The pattern apparent for obesity is remarkably similar to that found for child poverty. In Canada and especially in the US, we find a much greater extent of obesity for poor than non-poor children. However, when we compare only non-poor children in the three countries, although the magnitude of difference is smaller, it remains clear that Norwegian children are much less likely to be obese. Policy and research directed towards reducing the extent of child obesity in both Canada and the US should pay particular attention to issues of child poverty. [ABSTRACT FROM AUTHOR]

The overall aim of this paper is to describe important issues regarding paediatric obesity as a public health problem. This paper focuses on actions taken, and on the prevalence of obesity in children, teens and adults in Denmark. In addition, the paper describes some important prevention studies, all of which are performed outside Denmark. Thus, this paper is not a classical review but rather a highlight of some aspects that the author finds important. The latest Danish national figures show a marked increase in the prevalence of obesity, especially among young men—a sevenfold increase from 1987 to 2000 (0.7 to 4.9%). Among young women aged 16–24, the increase is threefold in the same period. Among teens, the prevalence has increased by 2–3 times in recent decades. Nevertheless, compared to other European countries and the US, Denmark has a relatively low prevalence of obesity in adolescents. The present paper also covers results from prevention studies performed in both preschool and school settings. Some of these focus on the reduced intake of carbonated drinks, whereas others focus on both diet and physical exercise. Finally, this paper demonstrates that Denmark is at the forefront regarding a national action plan against obesity. Conclusion: This paper highlights some important aspects of the epidemiology, prevention and actions in the field of paediatric obesity with special focus on Denmark. [ABSTRACT FROM AUTHOR]

Children with developmental delays often suffer feeding difficulties. It has become common for those with a severe likelihood of malnutrition to be considered for alternative methods of nutritional intake, often a gastrostomy. As part of a pilot study investigating the effects of gastrostomy on the child and their family, we conducted a literature review in order to establish the current areas of research, progress and concern. This paper describes the method and findings of the literature review and concludes with a discussion of the topics raised. The main conclusion is that although the need for gastrostomy in this group of children has been shown to be effective in maintaining adequate weight gain and nutritional intake, the support given to the family prior to, and after the operation is inadequate. Greater emphasis needs to be placed on detailed family assessment as part of the early intervention package. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: Dietary supplement use is common in Northern Europe. Many dietary supplements contain 100% of nutrient reference values (NRV) of micronutrients. This study investigates the contribution of dietary supplements to micronutrient intake, the prevalence of excess intake of micronutrients, and parental characteristics of dietary supplement use in Danish children. Methods: Data on 499 4–10-year-old children from the Danish National Survey of Diet and Physical Activity 2011–2013 were analysed using non-parametric statistics to compare micronutrient intake from the diet and dietary supplements to the reference intake (RI), and to the tolerable Upper Intake Level (UL) for users and non-users of dietary supplements. Furthermore, characteristics of the parents of users and non-users of dietary supplements were examined by logistic regression analysis. Results: Sixty-four percent of the children were dietary supplement users. Multivitamin-mineral supplements were the most frequently used type of supplement (60%). Children of never-smokers were more likely to use supplements than children of smokers. Users had significantly higher total intakes of 15 micronutrients compared to non-users. Intakes of vitamin A, zinc, and iodine from the diet alone exceeded ULs in 12–30% of the children. Use of dietary supplements gave rise to 21–73% of children in exceedance of the aforementioned three ULs as well as the UL for iron (6–45%). Conclusion: Dietary supplement use was common among 4–10-year-old Danish children and resulted in a considerable proportion of users exceeding the ULs for vitamin A, zinc, iodine, and iron. The long-term health consequences of exceeding these ULs for children are unknown. [ABSTRACT FROM AUTHOR]