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Cachexia is a wasting syndrome that manifests in more than half of all cancer patients. Cancer‐associated cachexia negatively influences the survival of patients and their quality of life. It is characterized by a rapid loss of adipose and skeletal muscle tissues, which is partly mediated by inflammatory cytokines. Here, we explored the crucial roles of interleukin‐6 (IL‐6) family cytokines, including IL‐6, leukemia inhibitory factor, and oncostatin M, in the development of cancer cachexia. These cytokines have been shown to exacerbate cachexia by promoting the wasting of adipose and muscle tissues, activating mechanisms that enhance lipolysis and proteolysis. Overlapping effects of the IL‐6 family cytokines depend on janus kinase/signal transducer and activator of transcription 3 signaling. We argue that the blockade of these cytokine pathways individually may fail due to redundancy and future therapeutic approaches should target common downstream elements to yield effective clinical outcomes. [ABSTRACT FROM AUTHOR]

Summary Equine sarcoidosis (ES) is a rare disease characterised by granulomatous inflammation of one or multiple organs. The skin is most frequently affected in horses and the clinical presentation can range from scaling and crusting lesions to nodular or tumour‐like masses. ES has been divided into three subtypes depending on the distribution of lesions in the body: the localised, partially generalised and generalised form. Overall, no breed or sex predilections have been consistently observed so far. Most affected horses are older than 3 years although the disease may occur at any age. While aetiology and pathogenesis of ES have not yet been fully determined, a chronic exaggerated immune response to one specific or multiple antigens is frequently hypothesised. Diagnosis is based upon history, clinical presentation, histopathology and exclusion of likely differential diagnoses. The treatment of choice in ES is initial anti‐inflammatory to immunosuppressive doses of corticosteroids with subsequent tapering doses. Reported treatment success seems to be highly variable and prospective studies on the efficacy of corticosteroids or other agents are currently lacking in ES. Prognosis for survival is good for the localised form and poor for the other forms of ES. Complete remission of lesions in the localised form following treatment is less frequent and response to treatment is typically characterised by a slowdown or cessation of disease progression. There are scarce reports of spontaneous remission of this disease. [ABSTRACT FROM AUTHOR]

The prevention of wasting should be a public health priority as the global burden of acute malnutrition is still high. Gaps still exist in our understanding of context‐specific risk factors and interventions that can be implemented to prevent acute malnutrition. We used data from the four rounds of the Ethiopia Demographic and Health Survey (2000–2016) to identify risk factors that have contributed to the change in weight‐for‐height z‐score (WHZ) among children under 5 years of age. We performed a pooled linear regression analysis followed by a decomposition analysis to identify relevant risk factors and their relative contribution to the change in WHZ. Modest improvements in WHZ were seen between 2000 and 2016. The sharpest decrease in mean WHZ occurred from birth to 6 months of age. Perceived low weight at birth and recent diarrhoea predicted a decline in WHZ among children aged 0–5, 6–23 and 23–59 months. Less than 50% of the change in WHZ was accounted for by the change in risk factors included in our regression decomposition analysis. This finding highlights data gaps to identify context‐specific wasting risk factors. The decline in the prevalence of recent diarrhoea (15% of the improvement), decline in low birth size (7%–9%), and an increase in wealth (15%–30%) were the main risk factors that accounted for the explained change in WHZ. Our findings emphasize the importance of interventions to reduce low birthweight, diarrhoea and interventions that address income inequities to prevent acute malnutrition. Key messages: The sharpest decrease in weight‐for‐height z‐score (WHZ) was seen from birth to 6 months of age.Of the factors included in this analysis, perceived low size at birth and recent diarrhoea were the main drivers of change in WHZ.More than 50% of the improvement in WHZ was unexplained highlighting data gaps to understand context‐specific risk factors. [ABSTRACT FROM AUTHOR]

The management of wasting in Ethiopia is heavily reliant on the Community‐based Management of Acute Malnutrition (CMAM) programme that has been implemented in more than 18,000 service delivery points scattered across the country. Despite the full‐scale implementation of the CMAM, the number of child death averted, and the cost per child death averted remains unknown. This study aimed to estimate the cost and the number of child death averted by the CMAM programme between 2008 and 2020. Using data from routine monitoring of the CMAM programme, we estimated the excess mortality averted by the programme and estimated the cost per averted child death based on supply and labour. Over the past 13 years between 2008 and 2020, 3.6 million children under 5 years were admitted to the Ethiopian CMAM programme. The yearly average admission of 317,228 was achieved since 2011. On average, ~34,000 child deaths were averted yearly. The CMAM programme was estimated to have saved 437,654 (95% confidence interval [CI]: 320,161; 469,932) child deaths between 2008 and 2020, approximately 12% of the admitted cases. The average cost of the programme per adverted death was estimated at US$762/child death averted (95% CI = 639; 1001). The CMAM programme in Ethiopia is cost‐effective and has continued to avert a significant number of child death. Given the high short‐ and long‐term economic and health consequences of child wasting, concerted multi‐sectoral efforts are needed to accelerate progress not only in its treatment but also in its prevention. Key messages: A total of 3.6 million children were admitted between 2008 and 2020, increasing annually from 92,000 in 2008 to 390,000 in 2020 due to improvement in case findings and referral.Death rate in Community‐based Management of Acute Malnutrition (CMAM) programmes has decreased by sixfold between 2008 and 2020 from 1.23% to 0.22%During 13 years of implementation, the Ethiopian CMAM programme averted the death of >400 thousand children under five. [ABSTRACT FROM AUTHOR]

Child undernutrition disproportionally affects children in low‐ and middle‐income countries. In Ethiopia, both wasting and stunting are serious public health concerns, with high human and economic costs. Understanding the dynamics in ponderal and linear growth faltering is critical to inform the design of innovative interventions that can prevent both wasting and stunting in poor and complex settings. Using two longitudinal studies conducted in 2017 and 2019 in four highland regions of Ethiopia, we evaluated the dynamics and drivers of child growth faltering in children 6–23 months of age (N = 5003). Child wasting prevalence peaked during the first 6 months of life, whereas stunting increased significantly after 6 months of age. Male sex, child illnesses (i.e., diarrhoea or fever) and low consumption of fruits and vegetables were associated with higher odds of acute undernutrition (P < 0.05). The consumption of animal source foods (ASF) was associated with increases (β: 95% CI) in weight‐for‐length Z‐score (WLZ; 0.12: 0.0002; 0.242), whereas fruit or vegetables consumption was associated with increases in midupper arm circumference (MUAC; 0.11 cm: 0.003; 0.209). Only consumption of ASF was the statistically significant predictor of future linear growth (0.14: 0.029; 0.251). Distinct trends in WLZ and MUAC were observed by child sex and age. Improving diet quality through improved nutrition knowledge and increased access and affordability of ASFs, along with effective infection prevention/control measures could prevent both child wasting and stunting concurrently. [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]

Age and sex influence the risk of childhood wasting. We aimed to determine if wasting treatment outcomes differ by age and sex in children under 5 years, enroled in therapeutic and supplementary feeding programmes. Utilising data from stage 1 of the ComPAS trial, we used logistic regression to assess the association between age, sex and wasting treatment outcomes (recovery, death, default, non‐response, and transfer), modelling the likelihood of recovery versus all other outcomes. We used linear regression to calculate differences in mean length of stay (LOS) and mean daily weight gain by age and sex. Data from 6929 children from Kenya, Chad, Yemen and South Sudan was analysed. Girls in therapeutic feeding programmes were less likely to recover than boys (pooled odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.72–0.97, p = 0.018). This association was statistically significant in Chad (OR: 0.61, 95% CI: 0.39–0.95, p = 0.030) and Yemen (OR: 0.47, 95% CI: 0.27–0.81, p = 0.006), but not in Kenya and South Sudan. Multinomial analysis, however, showed no difference in recovery between sexes. There was no difference between sexes for LOS, but older children (24–59 months) had a shorter mean LOS than younger children (6–23 months). Mean daily weight gain was consistently lower in boys compared with girls. We found few differences in wasting treatment outcomes by sex and age. The results do not indicate a need to change current programme inclusion requirements or treatment protocols on the basis of sex or age, but future research in other settings should continue to investigate the aetiology of differences in recovery and implications for treatment protocols. Key messages: There are few differences in recovery outcomes for wasting treatment by age and sex.Though differences are small, mean daily weight gain (g/kg/day) appears to be significantly lower in boys than girls. Likewise, though differences are small, younger children (6–23 months) often have a significantly longer mean length of stay compared with older children (24–59 months).The strength of our evidence does not indicate the need to change current inclusion criteria for wasting treatment programmes on the basis of age and sex but does suggest the need for further research to understand the effects of different confounders on treatment outcomes. [ABSTRACT FROM AUTHOR]

Infectious disease can shape community structure, particularly when pathogens affect foundation species. Seagrasses are foundation species that form meadows along coasts worldwide, controlling sediment deposition and biogeochemical cycling while supporting a diverse community of fish and invertebrates. These plants are hosts to wasting diseases that cause necrotic tissue lesions, which could alter seagrass value as food, habitat and mediators of ecosystem processes. However, such biotic interactions and influences on disease dynamics are still not well understood. We investigated whether a common herbivore affected the development of wasting disease on eelgrass.We measured the severity and prevalence of eelgrass wasting disease in a meadow across two summers through repeated field surveys. We assessed the role of the eelgrass herbivore on disease spread and growth using microcosm and mesocosm experiments. We further explored herbivore feeding preferences in a choice trial, which was paired with chemical analysis of plant tissue and analysed using a structural equation model.While the herbivore facilitates the growth of new disease lesions among isolated leaves, on balance they reduce lesion severity by more than 50% in comparison with no‐herbivore controls in field‐realistic settings. This was likely because the herbivore strongly prefers to eat diseased rather than healthy tissue, consuming nearly twice as much lesion area in choice trials. This preference arises from pathogen‐driven changes in the host plant; lesioned tissue requires less force to penetrate than non‐lesioned tissue. Additionally, as lesions increase in size, their polyphenolic concentrations drop, which further increases the magnitude of preference for lesioned tissue.Synthesis: These results suggest that these herbivores could help maintain disease in this system at a high prevalence (by facilitating disease development) but low severity (through preferential consumption), which is consistent with our field observations of nearly 100% prevalence and low severity in a natural bed where herbivore density is high. Describing such multi‐species interactions in marine systems will advance our predictions of future disease states, as current understandings focus primarily on how environmental change contributes to pathogen outbreaks. [ABSTRACT FROM AUTHOR]

Objective: To describe a dog with suspected cerebral salt wasting syndrome (CSWS) secondary to traumatic brain injury (TBI). Case Summary: A 2‐month‐old intact male Chihuahua‐American Pitbull Terrier mix weighing 1.94 kg presented to a veterinary teaching emergency room after suffering bite wound‐penetrating trauma to the head. Treatment was initiated with hyperosmotic agents, fluid resuscitation, and analgesia. The dog's neurologic dysfunction warranted hospitalization and continuous monitoring. Within 24 hours, the dog developed hyponatremia (133 mmol/L compared to 143 mmol/L on presentation [reference interval 142–149 mmol/L]). As the dog had concurrent tachycardia, increase in urine sodium concentration, polyuria, and weight loss, a diagnosis of cerebral salt wasting was suspected. A 2% hypertonic saline constant rate infusion was administered for volume replacement, and the patient showed improvement in clinical signs and blood sodium concentration. The dog was discharged on Day 5. Recheck examination showed significant neurologic improvement with sodium just below the low end of the reference range (141 mmol/L [reference interval 142–149 mmol/L]). New or Unique Information Provided: This is the first description of suspected CSWS in veterinary medicine. Hyponatremia is a common finding in critically ill neurologic people, including those with TBI, and is typically associated with either syndrome of inappropriate antidiuretic hormone or CSWS. As treatment recommendations for syndrome of inappropriate antidiuretic hormone and CSWS are diametrically opposed, identifying the presence of hyponatremia and distinguishing between these 2 clinical entities is critical for improving patient care for those with TBI. This case highlights the characteristics and clinical progression regarding the diagnosis and management of suspected CSWS. [ABSTRACT FROM AUTHOR]

This Editorial comments on the article by Jauffret et al. in this issue. [ABSTRACT FROM AUTHOR]

Host‐associated microbes influence host health and function and can be a first line of defence against infections. While research increasingly shows that terrestrial plant microbiomes contribute to bacterial, fungal, and oomycete disease resistance, no comparable experimental work has investigated marine plant microbiomes or more diverse disease agents. We test the hypothesis that the eelgrass (Zostera marina) leaf microbiome increases resistance to seagrass wasting disease. From field eelgrass with paired diseased and asymptomatic tissue, 16S rRNA gene amplicon sequencing revealed that bacterial composition and richness varied markedly between diseased and asymptomatic tissue in one of the two years. This suggests that the influence of disease on eelgrass microbial communities may vary with environmental conditions. We next experimentally reduced the eelgrass microbiome with antibiotics and bleach, then inoculated plants with Labyrinthula zosterae, the causative agent of wasting disease. We detected significantly higher disease severity in eelgrass with a native microbiome than an experimentally reduced microbiome. Our results over multiple experiments do not support a protective role of the eelgrass microbiome against L. zosterae. Further studies of these marine host–microbe–pathogen relationships may continue to show new relationships between plant microbiomes and diseases. [ABSTRACT FROM AUTHOR]

Adolescent pregnancy is associated with poor fetal growth and development which, in turn, increases the risk of childhood wasting and underweight. However, evidence on how young maternal age affects childhood anthropometry beyond the neonatal period is limited. This systematic review and meta‐analysis examined associations between adolescent pregnancy and child wasting and underweight and explored potential underlying social and biological factors. Peer‐reviewed literature published in English since 1990 was systematically searched. Eligible studies presented data on wasting and/or underweight in children (≤59 months) born to adolescent mothers (10–19, or ≤24 years where applicable) from low‐ and middle‐income countries. Data extraction used a predefined extraction sheet. Both meta‐analysis and qualitative synthesis were performed. Of 92 identified studies, 57 were included in the meta‐analysis. The meta‐analysis showed that children born to adolescent versus adult mothers were at a higher risk of moderate (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.00–1.26 p = 0.04) and severe underweight (OR: 1.21, 95% CI: 1.08–1.35 p < 0.01). Associated risk of wasting was not statistically significant: (OR: 1.05, 95% CI: 0.98–1.12 p = 0.17); severe wasting (OR: 1.16, 95% CI: 0.68–1.96 p = 0.59). These findings were supported by the qualitative synthesis. Evidence on the potential role of biological/social factors was limited, but suggested an intermediary role of maternal nutritional status which warrants further exploration. Particularly in contexts where adolescent pregnancy remains common, interventions to both delay adolescent pregnancy and improve adolescent nutritional status could help reduce the risk of undernutrition in children and contribute to breaking the intergenerational cycle of malnutrition. Key messages: Adolescent pregnancy is a potential risk factor for poor child growth and development in low‐ and middle‐income countries.This systematic review and meta‐analysis showed that being born to an adolescent mother increases a child's risk of moderate and severe underweight up to 5 years of age; data on wasting was more heterogenous.Evidence on underlying biological/social factors was limited but suggested a possible intermediary role of maternal nutritional status.Where adolescent pregnancy is common, interventions to delay adolescent pregnancy and improve adolescent nutritional status could help reduce the risk of undernutrition in children, helping break the intergenerational cycle of malnutrition. [ABSTRACT FROM AUTHOR]

Significance: Two of the leading causes of death worldwide are cancer and cardiovascular diseases. Most cancer patients suffer from a metabolic wasting syndrome known as cancer‐induced cardiac cachexia, resulting in death in up to 30% of cancer patients. Main symptoms of this disease are severe cardiac muscle wasting, cardiac remodeling, and cardiac dysfunction. Metabolic alterations, increased inflammation, and imbalance of protein homeostasis contribute to the progression of this multifactorial syndrome, ultimately resulting in heart failure and death. Cancer‐induced cardiac cachexia is associated with decreased quality of life, increased fatiguability, and decreased tolerance to therapeutic interventions. Recent advances: While molecular mechanisms of this disease are not fully understood, researchers have identified different stages of progression of this disease, as well as potential biomarkers to detect and monitor the development. Preclinical and clinical studies have shown positive results when implementing certain pharmacological and non‐pharmacological therapy interventions. Critical issues: There are still no clear diagnostic criteria for cancer‐mediated cardiac cachexia and the condition remains untreated, leaving cancer patients with irreversible effects of this syndrome. While traditional cardiovascular therapy interventions, such as beta‐blockers, have shown some positive results in preclinical and clinical research studies, recent preclinical studies have shown more successful results with certain non‐traditional treatment options that have not been further evaluated yet. There is still no clinical standard of care or approved FDA drug to aid in the prevention or treatment of cancer‐induced cardiac cachexia. This review aims to revisit the still not fully understood pathophysiological mechanisms of cancer‐induced cardiac cachexia and explore recent studies using novel treatment strategies. Future directions: While research has progressed, further investigations might provide novel diagnostic techniques, potential biomarkers to monitor the progression of the disease, as well as viable pharmacological and non‐pharmacological treatment options to increase quality of life and reduce cancer‐induced cardiac cachexia‐related mortality. [ABSTRACT FROM AUTHOR]

Background: Kidney failure patients receiving haemodialysis experience protein‐energy wasting, muscle mass loss and physical function impairment. Intradialytic exercise interventions seem to modify these features, but they are often not implemented as a clinical routine. Objective: To investigate the feasibility of implementing a supervised intradialytic resistance training programme as a clinical routine for patients receiving short daily haemodialysis. Design: A prospective longitudinal study. Participants: Eighteen patients in a supervised intradialytic resistance training programme for 8 months. Measurements: It consisted of a warm‐up, lower‐ and upper‐limb resistance exercises and a cool‐down. Patients performed the resistance training during the first half of haemodialysis, twice a week, supervised by exercise physiologists and physiotherapists. The feasibility was assessed by the total and partial adherences, the reasons for refusing or for not exercising and the intradialytic complications. Results: From a total of 953 potential exercise sessions, 759 were performed, with a 79.6% adherence rate. In the first 9 weeks, the adherence rate was 86.6% and the lowest rate was in the 19–27 weeks (73.5%). The main intradialytic complication during exercise sessions was hypotension (n = 31; 4.1%). The highest number of complications was reported during the first 9 weeks (n = 27; 9.1%). The main reasons for refusing or for not performing the intradialytic exercise sessions were clinical complications previous to exercise time (n = 63; 32.5%) and self‐reported indisposition (n = 62; 32.0%). Conclusions: The intradialytic resistance training programme, supervised by exercise physiologists and physiotherapists, had very low complications, achieved a high long‐term adherence rate and showed to be feasible as a clinical routine for patients receiving short daily haemodialysis. [ABSTRACT FROM AUTHOR]

Concurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia. A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed-effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5-4.9)), with respectively 2.5% (95% CI: 2.1-3.1) and 4.9% (95% CI: 4.7-5.2) among children in urban and rural settings. Children: (i) in the age group 12-23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20-5.42)) and 24-59 months (AOR: 3.08, 95% CI: (2.28-4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57-2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11-1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10-1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48-0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55-0.89)), having a mother with a normal body mass index (18.5-24.9 kg/m²) (AOR: 0.57, 95% CI: (0.48-0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50-0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32-0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt. [ABSTRACT FROM AUTHOR]

Cisplatin is a well‐known chemotherapeutic agent that can be associated with hyponatremia. It is known to be associated with a multitude of renal disorders including acute kidney injury with reduced glomerular filtration, Fanconi syndrome, and renal tubular acidosis, nephrogenic diabetes insipidus and renal salt wasting syndrome. We report a case of an elderly male presenting with significant recurrent hyponatremia, and prerenal azotemia. With recent exposure to cisplatin along with significant hypovolemia and urinary loss of sodium, he was diagnosed to have cisplatin induced renal salt wasting syndrome. [ABSTRACT FROM AUTHOR]

Temperature increases due to climate change have affected the distribution and severity of diseases in natural systems, causing outbreaks that can destroy host populations. Host identity, diversity, and the associated microbiome can affect host responses to both infection and temperature, but little is known about how they could function as important mediators of disease in altered thermal environments. We conducted an 8‐week warming experiment to test the independent and interactive effects of warming, host genotypic identity, and host genotypic diversity on the prevalence and intensity of infections of seagrass (Zostera marina) by the wasting disease parasite (Labyrinthula zosterae). At elevated temperatures, we found that genotypically diverse host assemblages had reduced infection intensity, but not reduced prevalence, relative to less diverse assemblages. This dilution effect on parasite intensity was the result of both host composition effects as well as emergent properties of biodiversity. In contrast with the benefits of genotypic diversity under warming, diversity actually increased parasite intensity slightly in ambient temperatures. We found mixed support for the hypothesis that a growth–defense trade‐off contributed to elevated disease intensity under warming. Changes in the abundance (but not composition) of a few taxa in the host microbiome were correlated with genotype‐specific responses to wasting disease infections under warming, consistent with the emerging evidence linking changes in the host microbiome to the outcome of host–parasite interactions. This work emphasizes the context dependence of biodiversity–disease relationships and highlights the potential importance of interactions among biodiversity loss, climate change, and disease outbreaks in a key foundation species. [ABSTRACT FROM AUTHOR]

Declines in eelgrass, an important and widespread coastal habitat, are associated with wasting disease in recent outbreaks on the Pacific coast of North America. This study presents a novel method for mapping and predicting wasting disease using Unoccupied Aerial Vehicle (UAV) with low‐altitude autonomous imaging of visible bands. We conducted UAV mapping and sampling in intertidal eelgrass beds across multiple sites in Alaska, British Columbia, and California. We designed and implemented a UAV low‐altitude mapping protocol to detect disease prevalence and validated against in situ results. Our analysis revealed that green leaf area index derived from UAV imagery was a strong and significant (inverse) predictor of spatial distribution and severity of wasting disease measured on the ground, especially for regions with extensive disease infection. This study highlights a novel, efficient, and portable method to investigate seagrass disease at landscape scales across geographic regions and conditions. Plain Language Summary: Diseases of marine organisms are increasing in many regions worldwide, therefore, efficient time‐series monitoring is critical for understanding the dynamics of disease and examining its progression in time to implement management interventions. In the first study of its kind, we use high‐resolution Unoccupied Aerial Vehicle (UAV) imagery collected to detect disease at 12 sites across the North‐East Pacific coast of North America spanning 18 degrees of latitude. The low altitude UAV visible‐bands imagery achieved 1.5 cm spatial resolution, and analysis was performed at the seagrass leaf scale based on object‐oriented image analysis. Our findings suggest that drone mapping of coastal plants may substantially increase the scale of disease risk assessments in nearshore habitats and further our understanding of seagrass meadow spatial‐temporal dynamics. These can be scaled up by searching for environmental signals of the pathogen, for example, with surveillance of wastewater for signs of Covid in human populations. This application could easily apply to other areas to construct a high‐resolution monitoring network for seagrass conservation. Key Points: First study using low‐altitude high‐resolution Unoccupied Aerial Vehicle (UAV) imagery to detect coastal seagrass diseaseThe low altitude UAV mapping achieved 1.5 cm spatial resolution and the object‐oriented analysis were performed at the seagrass leaf scaleStatistical validation against in situ sampling demonstrated reliable results to use drone imaging for coastal plants disease assessment [ABSTRACT FROM AUTHOR]

Children with weight‐for‐age z‐score (WAZ) <−3 have a high risk of death, yet this indicator is not widely used in nutrition treatment programming. This pooled secondary data analysis of children aged 6–59 months aimed to examine the prevalence, treatment outcomes, and growth trajectories of children with WAZ <−3 versus children with WAZ ≥−3 receiving outpatient treatment for wasting and/or nutritional oedema, to inform future protocols. Binary treatment outcomes between WAZ <−3 and WAZ ≥−3 admissions were compared using logistic regression. Recovery was defined as attaining mid‐upper‐arm circumference ≥12.5 cm and weight‐for‐height z‐score ≥−2, without oedema, within a period of 17 weeks of admission. Data from 24,829 children from 9 countries drawn from 13 datasets were included. 55% of wasted children had WAZ <−3. Children admitted with WAZ <−3 compared to those with WAZ ≥−3 had lower recovery rates (28.3% vs. 48.7%), higher risk of death (1.8% vs. 0.7%), and higher risk of transfer to inpatient care (6.2% vs. 3.8%). Growth trajectories showed that children with WAZ <−3 had markedly lower anthropometry at the start and end of care, however, their patterns of anthropometric gains were very similar to those with WAZ ≥−3. If moderately wasted children with WAZ <−3 were treated in therapeutic programmes alongside severely wasted children, we estimate caseloads would increase by 32%. Our findings suggest that wasted children with WAZ <−3 are an especially vulnerable group and those with moderate wasting and WAZ <−3 likely require a higher intensity of nutritional support than is currently recommended. Longer or improved treatment may be necessary, and the timeline and definition of recovery likely need review. Key messages: Children with WAZ <−3 have a high risk of death, yet this indicator is not widely used in nutrition treatment programming.WAZ <−3 is common among both severely and moderately wasted children (64% and 43%, respectively), and those with WAZ <−3 do not meet conventional definitions of nutritional recovery as often as other wasted children. While they do gain weight in a similar pattern as other wasted children, they have further to catch up.Children with wasting and WAZ <−3 likely require longer or more tailored treatment, especially children with both moderate wasting and WAZ <−3, who are usually not eligible for therapeutic feeding.An intervention trial is needed to further explore these hypotheses and must include non‐wasted children with WAZ <−3, who are currently not represented in this secondary data. [ABSTRACT FROM AUTHOR]

Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in children 6–59 months by age and sex. We categorised children into younger (6–23 months) and older (24–59 months) age groups. Age and sex variations in near‐term (within 6 months) mortality risk, associated with individual anthropometric deficits were assessed in a secondary analysis of multi‐country cohort data. A random effects meta‐analysis was performed. Data from seven low‐or‐middle‐income‐countries collected between 1977 and 2013 were analysed. One thousand twenty deaths were recorded for children with anthropometric deficits. Pooled meta‐analysis estimates showed no differences by age in absolute mortality risk for wasting (RR 1.08, p = 0.826 for MUAC < 125 mm; RR 1.35, p = 0.272 for WHZ < −2). For underweight and stunting, absolute risk of death was higher in younger (RR 2.57, p < 0.001) compared with older children (RR 2.83, p < 0.001). For all deficits, there were no differences in mortality risk for girls compared with boys. There were no differences in the risk of mortality between younger and older wasted children, supporting continued inclusion of all children under‐five in wasting treatment programmes. The risk of mortality associated with underweight and stunting was higher among younger children, suggesting that prevention programmes might be justified in focusing on younger children where resources are limited. There were no sex differences by age in mortality risk for all deficits. Key points: There is a high risk of mortality associated with child wasting. We found no difference in mortality risk between children 6–23 months and children 24–59 months, indicating the need to include all children under 5 years in wasting treatment programmes.For underweight and stunting, younger children had a significantly higher risk of mortality than older children. Where resources are limited, prevention programmes may be justified in targeting younger children.Despite sex differences in the prevalence of wasting, stunting and underweight, there were no differences in mortality risk between girls and boys in both younger and older age groups. [ABSTRACT FROM AUTHOR]

Child wasting is defined as a weight‐for‐height/length z‐score (WLZ/WHZ) < −2, and this indicator of nutritional status is used worldwide. However, a precise measurement is required for the assessment of a child's nutritional status, which may not always be possible due to expensive instruments, especially in poor resource settings. In some instances, mid‐upper arm circumference‐for‐age z‐score (MUACZ) is also being used for screening purposes, which is a simple and useful nutritional indicator. The objective of this paper is to identify the optimal cut‐off point for the MUACZ to identify wasted children, and also to determine if the same factors are associated with MUACZ and wasting. Data were derived from the Suchana evaluation data. The optimal cut‐off value was estimated via receiver operating characteristic (ROC) curve analysis using acute malnutrition as a gold standard with maximum sensitivity and specificity. Multiple logistic regression was used to assess the associated factors with the MUACZ. Using the gold standard indicator of nonwasting (WLZ ≥ −2), a positive outcome, the optimal cut‐off point for the MUACZ was −1.27. The area under the ROC curve was 0.88, indicating that the model had a power of 88% to differentiate between the positive and negative classes. It implies that a child's MUACZ was correlated with WLZ, and a MUACZ below −1.27 appeared to accurately identify wasting among children aged 3–23 months. MUACZ < −1.27 might be another useful indicator of childhood wasting than a WLZ < −2. Key messages: We calculated the cut‐off point for a child's mid‐upper arm circumference‐for‐age z‐score (MUACZ) that MUACZ below −1.27 appears to accurately identify acute malnutrition among children aged 3–23 months with the highest sensitivity and specificity.Determinants of a child's MUACZ < −1.27 were estimated.Measurement of MUAC would be especially helpful when large numbers of children need to be screened quickly, particularly in humanitarian aid settings.MUACZ < −1.27 may represent a more useful indicator of childhood malnutrition than a weight‐for‐length z‐score < −2. [ABSTRACT FROM AUTHOR]

Childhood stunting remains a public health burden worldwide. Although many studies have examined early life and in‐utero risk factors; most have been observational and have used analytic techniques that make inferences limited to population means, thereby obscuring important within‐group variations. This study addressed that important gap. Using data from a birth cohort of Ugandan infants (n = 4528), we applied group‐based trajectory modelling to assess diverse patterns of growth among children from birth to 1‐year old. A multinomial regression model was conducted to understand the relationship between risk factors and observed patterns across groups. We found that the onset of stunting occurred before birth and followed four distinct growth patterns: chronically stunted (Group 1), recovery (Group 2), borderline stunted (Group 3) and normal (Group 4). The average length‐for‐age z‐score (LAZ) at birth was −2.6, −3.9, −0.6 and 0.5 for Groups 1–4, respectively. Although both Groups 1 and 2 were stunted at birth, stunting persisted in Group 1 while children in Group 2 recovered by the fourth month. Group 3 exhibited mild stunting while Group 4 was normal. Wasting and underweight were observed in all groups, with the highest prevalence of underweight in Group 1. Wasting gradually increased among children born already stunted (Groups 1 and 2). This showed the importance of distinguishing children by their growth patterns rather than aggregating them and only comparing population averages against global growth standards. The design of nutrition interventions should consider the differential factors and potential for growth gains relative to different risks within each group. Key messages: In a sample of Ugandan infants, the onset of stunting occurred in utero and set in motion a range of possible growth trajectories for the child after birth.Child growth can be characterised by diverse patterns that suggest temporal variations in children's growth. This provides an opportunity for policymakers to provide specialised and targeted nutrition interventions.Addressing low birth weight, preterm births and small‐for‐gestational‐age is critical to effectively reduce rates of stunting in rural Uganda. [ABSTRACT FROM AUTHOR]

Mid‐upper arm circumference (MUAC) < 11.5 cm and weight‐for‐height Z‐score (WHZ) < −3 are used for screening for severe acute malnutrition (SAM). Underweight and concurrent wasting and stunting may better target those at the highest risk of mortality. We compared anthropometric outcomes in children enrolled in a trial of antibiotics for SAM based on categories of baseline anthropometry, including indicators for programme admission (WHZ < −3, MUAC < 11.5) and alternative indicators (weight‐for‐age Z‐score [WAZ] < −3, concurrent wasting and stunting [WHZ < −3 and height‐for‐age Z‐score < −3]). Participants were followed weekly until nutritional recovery and at 8 weeks. We evaluated changes in weight gain (g/kg/day), MUAC, and WHZ in children admitted by admissions criteria (MUAC only, WHZ only, or MUAC and WHZ) and by underweight or concurrent wasting and stunting. Of 301 admitted children, 100 (33%) were admitted based on MUAC only, 41 (14%) WHZ only, and 160 (53%) both MUAC and WHZ, 210 (68%) were underweight and 67 (22%) were concurrently wasted/stunted. Low MUAC and low WHZ children had the lowest probability of nutritional recovery (17% vs. 50% for MUAC‐only and 34% for WHZ‐only). There was no difference in weight gain velocity or WHZ by admissions criteria (WHZ and/or MUAC). Underweight and concurrently wasted/stunted children had lower MUAC and WHZ at 8 weeks compared with those who were not underweight or concurrently wasted and stunted. Children with both low MUAC and low WHZ had the worst outcomes. Relying on MUAC alone may miss children who have poor outcomes. Other indicators, such as WAZ, may be useful for identifying vulnerable children. Key messages: Mid‐upper arm circumference (MUAC) and weight‐for‐height Z‐score (WHZ) are currently used for severe acute malnutrition (SAM) screening, but alternative indicators such as weight‐for‐age Z‐score (WAZ) may be additional options.Children admitted to the nutritional program based on both low MUAC and low WHZ had the worst outcomes, including the lowest probability of nutritional recovery and the worst anthropometric outcomes.While MUAC identified most children with SAM, WHZ may provide additional information about poor outcomes beyond MUAC alone.WAZ may be a useful alternative indicator to identify children who would benefit from a therapeutic feeding program without requiring height measurement. [ABSTRACT FROM AUTHOR]

Ocean warming endangers coastal ecosystems through increased risk of infectious disease, yet detection, surveillance, and forecasting of marine diseases remain limited. Eelgrass (Zostera marina) meadows provide essential coastal habitat and are vulnerable to a temperature‐sensitive wasting disease caused by the protist Labyrinthula zosterae. We assessed wasting disease sensitivity to warming temperatures across a 3500 km study range by combining long‐term satellite remote sensing of ocean temperature with field surveys from 32 meadows along the Pacific coast of North America in 2019. Between 11% and 99% of plants were infected in individual meadows, with up to 35% of plant tissue damaged. Disease prevalence was 3× higher in locations with warm temperature anomalies in summer, indicating that the risk of wasting disease will increase with climate warming throughout the geographic range for eelgrass. Large‐scale surveys were made possible for the first time by the Eelgrass Lesion Image Segmentation Application, an artificial intelligence (AI) system that quantifies eelgrass wasting disease 5000× faster and with comparable accuracy to a human expert. This study highlights the value of AI in marine biological observing specifically for detecting widespread climate‐driven disease outbreaks. [ABSTRACT FROM AUTHOR]

Background: Chronic gastroenteropathies, including gluten sensitivity and marmoset wasting syndrome, frequently occur in captive colonies of common marmosets (Callithrix jacchus). Early identification and diagnosis of affected animals are desirable. Endoscopic examination of the colon in marmosets is described, but the small intestine can harbor significant mucosal lesions not representing those in the colon. Evaluating the small intestine currently requires invasive surgical biopsies due to the small patient size, carrying a risk of severe complications. Methods: Endoscopic intubation and multisite biopsy of the duodenum/proximal jejunum are demonstrated in 10 marmosets under general anesthesia. Results: Esophagogastroduodenoscopy with colonoscopy efficiently aid in examining the gastrointestinal tract and obtaining an antemortem histologic diagnosis in marmosets with chronic gastrointestinal signs. Conclusions: This minimally invasive technique is feasible in marmosets. Future investigations into the pathogenesis of chronic gastroenteropathies will benefit from these data, leading to improved animal welfare and better individual and colony health management. [ABSTRACT FROM AUTHOR]

Background: We sought to determine whether peaks in essential amino acid (EAA) concentration associated with intermittent feeding may provide anabolic advantages when compared with continuous feeding regimens in critical care. Methods: We performed a secondary analysis of data from a multicenter trial of UK intensive care patients randomly assigned to intermittent or continuous feeding. A linear mixed‐effects model was developed to assess differences in urea‐creatinine ratio (raised values of which can be a marker of muscle wasting) between arms. To investigate metabolic phenotypes, we performed k‐means urea‐to‐creatinine ratio trajectory clustering. Amino acid concentrations were also modeled against urea‐to‐creatinine ratio from day 1 to day 7. The main outcome measure was serum urea‐to‐creatinine ratio (millimole per millimole) from day 0 to the end of the 10‐day study period. Results: Urea‐to‐creatinine ratio trajectory differed between feeding regimens (coefficient −.245; P =.002). Patients receiving intermittent feeding demonstrated a flatter urea‐to‐creatinine ratio trajectory. With k‐means analysis, the cluster with the largest proportion of continuously fed patients demonstrated the steepest rise in urea‐to‐creatinine ratio. Neither protein intake per se nor serum concentrations of EAA concentrations were correlated with urea‐to‐creatinine ratio (coefficient =.088 [P =.506] and coefficient <.001 [P =.122], respectively). Conclusion: Intermittent feeding can mitigate the rise in urea‐to‐creatinine ratio otherwise seen in those continuously fed, suggesting that catabolism may have been, to some degree, prevented. [ABSTRACT FROM AUTHOR]

Malnutrition is a threat to optimal child development, with its occurrence during foetal and infancy stages associated with poor cognitive, motor and socio‐emotional skills. However, information on the effects of various types of malnutrition on early childhood development (ECD) is limited in Nepal. To assess the association of stunting, wasting and underweight (three prominent forms of malnutrition) with the four domains of the ECD index (literacy‐numeracy, physical, social‐emotional and learning development) among children 36–59 months of age, we conducted an adjusted logistic regression using Nepal's national household Multiple Indicator Cluster Survey (MICS) 2019 data set. The study sample consisted of children aged 36–59 months (n = 2871). Children were considered developmentally on track if they met criteria in each of the four ECD domains. Regarding ECD status of children 36–59 months old, 35% of children were not developmentally on track for the ECD index. The adjusted odds ratio indicated that stunting was associated with lower odds of not being developmentally on track according to the ECD index as well as the literacy‐numeracy, physical and learning domains of the ECD index. Likewise, underweight was associated with lower odds of not being developmentally on track according to the ECD index, primarily for ECD domains of literacy‐numeracy, physical and learning. Notably, no association between wasting and ECD indicators was observed. Children's nutrition status impacts child development outcomes. Adding ECD interventions, such as responsive and stimulating caregiving, within nutrition programmes among children who are stunted and underweight could improve child development outcomes. Key messages: In Nepal, 35% of children in our data set did not display optimal early childhood development (ECD).Children who are malnourished, especially indicating signs of stunting and underweight, are likely to exhibit poor ECD indicators and may have limited cognitive capabilities in adulthood.Wasting demonstrated no notable association with ECD indicators.Study findings suggest that ECD interventions among children who are stunted and underweight could support optimal childhood development globally.Establishing partnerships between nutrition and ECD sectors to adopt the Nurturing Care Framework, especially targeting the first 5 years of life, would contribute to childhood development efforts. [ABSTRACT FROM AUTHOR]

Pathogens can cause host extinction, affect population dynamics and influence natural selection. Host susceptibility to pathogens can vary by species, demographics and genetics which affect epizootic and population dynamics, ultimately determining population trends and evolution.Chronic wasting disease (CWD), a fatal neuro‐degenerative prion disease of cervids, has varying host susceptibility conferred by polymorphisms of the prion protein gene (PRNP) at codon 96 for white‐tailed deer Odocoileus virginianus.Deer with the homozygous Glycine allele (96GG) are most susceptible and a single Serine allele (96GS/96SS) reduces the risk of infection and mortality.We developed epizootiological models that demonstrate CWD infection and disease‐associated mortality were higher for the more susceptible (96GG) genotype; and, infection was higher for males than females. We used population models to evaluate future shifts in genotype frequencies under alternative harvest and infection rate scenarios.Genetic shifts towards less susceptible genotypes were predicted as CWD prevalence increased during the course of an outbreak. This further increased CWD prevalence, and likely environmental contamination from prion shedding, due to longer incubation periods. Alternative harvest management strategies directly influenced CWD prevalence and spread, the rate of genetic selection and deer population growth.Synthesis and applications. We show that chronic wasting disease (CWD) transmission varied by sex, age class and PRNP genotype, and that CWD disease‐associated mortality varied by genotype. Together, these forces lead to CWD‐mediated genetic selection for a white‐tailed deer population. We predict that genetic selection pressure increases when hunter harvest pressure is lowered, and conversely, increasing hunter harvest can reduce genetic selection rates of antlered deer. Our results support the control of CWD prevalence by aggressive harvest of adult males, because they have the highest infection rates. Our results have strong implications for evolution, disease ecology, geographical spread, disease mitigation and cervid population management. [ABSTRACT FROM AUTHOR]

Background: Nutritional status and protein energy wasting (PEW) is prevalent in patients with nondialysis‐dependent chronic kidney disease (CKD). The relationship between PEW and long‐term development of clinically important outcomes remains to be examined. Objectives: To investigate the relationships between PEW, as measured by Subjective Global Assessment (SGA 1‐7), and progression to important clinical outcomes: mortality and/or kidney failure. Design: Prospective cohort design. Participants: One hundred and thirty‐nine participants were well‐nourished and 37 moderately malnourished patients with CKD 3‐5. Measurements: The outcomes were 2, 5, and 10‐year progression to kidney failure (dialysis or transplant) or mortality, kidney failure alone, and mortality alone. SGA was determined by a registered renal dietitian. Food frequency questionnaires were used to assess dietary intake. Clinical and laboratory baseline characteristics were collected. Multivariable regression models and Cox models were created to examine the relationship between SGA and outcomes. Results: PEW was associated with the combined outcome of kidney failure or mortality at 2 (p = 0.003), 5 (p = 0.004), but not at 10 (p = 0.73) years. This relationship was primarily driven by the relationship between PEW and kidney failure. In Cox models, the relationship between PEW and kidney failure remained after adjusting for Kidney Failure Risk Equation scores. The multivariable modeling revealed that PEW remained a statistically significant predictor of the combined outcome and ESKD after adjustment for age, estimated glomerular filtration rate (eGFR), sex, albumin‐to‐creatinine ratio, diabetes, albumin, and protein intake. Conclusions: PEW, determined by the SGA 1‐7, is an important prognostic tool. Further research looking at clinically important outcomes are needed to implement nutritional interventions for nondialysis‐dependent CKD patients. [ABSTRACT FROM AUTHOR]

The keystone species Pisaster ochraceus suffered mass mortalities along the northeast Pacific Ocean from Sea Star Wasting Syndrome (SSWS) outbreaks in 2013–2016. SSWS causation remains of debate, leading to concerns as to whether outbreaks will continue to impact this species. Considering the apparent link between ocean temperature and SSWS, the future of this species and intertidal communities remains uncertain. Surveys of co‐occurring apparently normal and wasting P. ochraceus along the central Oregon coast in 2016 allowed us to address whether variation in disease status showed genetic variation that may be associated with differences in susceptibility to SSWS. We performed restriction site‐associated DNA sequencing (2bRAD‐seq) to genotype ~72,000 single nucleotide polymorphism (SNP) loci across apparently normal and wasting sea stars. Locus‐specific analyses of differentiation (FST) between disease‐status groups revealed no signal of genetic differences separating the two groups. Using a multivariate approach, we observed weak separation between the groups, but identified 18 SNP loci showing highest discriminatory power between the groups and scanned the genome annotation for linked genes. A total of 34 protein‐coding genes were found to be located within 15 kb (measured by linkage disequilibrium decay) of at least one of the 18 SNPs, and 30 of these genes had homologies to annotated protein databases. Our results suggest that the likelihood of developing SSWS symptoms does not have a strong genetic basis. The few genomic regions highlighted had only modest levels of differentiation, but the genes associated with these regions may form the basis for functional studies aiming to understand disease progression. [ABSTRACT FROM AUTHOR]

In China, the prevalence of undernutrition among children under 5 years of age has declined significantly during recent decades. However, noticeable gaps exist between rural and urban areas. Since 2012, a government‐funded nutrition programme, Ying Yang Bao (YYB; soybean powder‐based iron‐rich supplement) programme, has been implemented in poor rural areas to decrease the risk of developing anaemia among children aged 6–23 months, but there are still inadequate health care awareness, feeding knowledge and skills among caregivers. From June 2018 to December 2020, a child health counselling intervention was delivered through a home visit based on the YYB programme in Liangshan. Child health messages were given by trained village child health assistants while distributing YYB. Surveys were conducted before and after the intervention to analyse changes in child health check‐up frequency, complementary feeding practice and prevalence of undernutrition. After the intervention, the proportion of children who had regular health check‐ups, who were vaccinated and who met the minimum YYB consumption significantly increased from 26.0%, 81.6%, and 67.8% to 59.7%, 95.0%, and 79.2%. Increased rates of IYCF indicators (introduction of solid, semisolid, or soft foods, minimum dietary diversity and consumption of iron‐rich or iron‐fortified foods) were observed after the intervention. The prevalence of stunting, underweight, wasting, and anaemia significantly decreased from 26.3% to 10.8%, 13.4% to 8.7%, 14.0% to 10.5%, and 52.1% to 43.9%. This intervention can be well integrated into the YYB programme with less additional resources. Children in resource‐limited areas will benefit more from a comprehensive nutritional package, including food supplements and child health education. Key messages: Current evidence suggests there is a decrease in the prevalence of undernutrition among children under 5 years of age in China during recent decades. However, imbalanced development exists between rural and urban areas.Government‐funded Ying Yang Bao (YYB) programme has been implemented in poor rural areas across China covering over 800 counties, to decrease the risk of developing anaemia among children aged 6–23 months.After a child health counselling intervention jointly implemented with YYB programme, the prevalence of stunting, underweight, wasting, and anaemia among children decreased significantly.Child health counselling intervention could be well integrated into the ongoing YYB programme to reach resource‐limited areas on a large scale. [ABSTRACT FROM AUTHOR]

We aimed to describe the co‐occurrence of known risk factors for undernutrition and the prevalence of modifiable risks in wasted, stunted and healthy children. Quota sampling was used to recruit healthy [weight for age Z scores (WAZ) > −2 SD] and undernourished [weight for length (WLZ) or WAZ scores ≤ −2 SD] children aged 6–24 months from seven clinics in low‐income areas of Nairobi. Structured interviews were used to identify exposure to socioeconomic, water and hygiene, infant feeding, dietary and behavioural risks (low interest in food, high food refusal and force feeding). We recruited 92 wasted WLZ ≤ −2 SD, 133 stunted (length for age Z scores LAZ ≤ −2 SD) and 172 healthy (LAZ and WLZ > 2SD) children. Nearly all children were exposed to hygiene risks (90%) and low dietary diversity (95%) regardless of nutritional status. Stunted children were more likely to be exposed to socio‐economic risks (54% healthy, 64% wasted and 72% stunted; P = 0.001). Compared with healthy children, wasted and stunted children were more likely to be exposed to infant feeding (25% healthy, 40% wasted and 41% stunted; P = 0.02) and behaviour risks (24% healthy, 49% wasted, and 44% stunted; P = 0.004). Overall, wasted and stunted children were twice as likely to be exposed to more than three risks (23% healthy, 48% wasted, and 50% stunted; P = <0.001). They were also more likely to be exposed to more than three modifiable risks (dietary, handwashing and behaviour risks). Wasting and stunting are associated with exposure to multiple risk factors, many of which are potentially modifiable using targeted advice. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis aimed to assess the robustness of designs and tools used in nutrition social behaviour change communication (NSBCC) interventions and establish their effectiveness. EBSCOhost as an umbrella database including Medline (Ovid) and CINAHL, EMBASE, and ProQUEST databases were searched for peer‐reviewed articles from January 1960 to October 2018. Additional sources were searched to identify all relevant studies including grey literature. Studies' biases were assessed according to Cochrane handbook. Pooled estimate of effectiveness of interventions on infant and young child feeding (IYCF) practices and child nutritional status with 95% confidence intervals were measured using random‐effects models. Eighty studies were included in this review: Fifty‐one (64%) were cluster randomised controlled trials (RCTs), 13 (16%) were RCTs and 16 (20%) quasi‐experimental. Of the included studies, 22 (27%) measured early initiation of breastfeeding, 38 (47%) measured exclusive breastfeeding, 29 (36%) measured minimum dietary diversity, 21 (26%) measured minimum meal frequency, 26 (32%) measured height for age z‐scores (HAZ), 23 (29%) measured weight for height z‐scores (WHZ), 27 (34%) measured weight for age z‐scores (WAZ), 20 (25%) measured stunting, 14 (17%) measured wasting, and 11 (14%) measured underweight. The overall intervention's effect was significant for exclusive breastfeeding (EBF) (odds ratio = 1.73; 95% confidence interval [CI]: 1.35–2.11, p < 0.001), HAZ (standardized mean differences [SMD] = 0.19; 95% CI: 0.17–0.21; p < 0.001), WHZ (SMD = 0.02; 95% CI: 0.004–0.04; p < 0.001), and WAZ (SMD = 0.04; 95% CI: 0.02–0.06; p < 0.001). Evidence shows the effectiveness of NSBCC in improving EBF and child anthropometric outcomes. Further research should test the impact on child nutritional status with clearly specified and detailed NSBCC interventions. Key messages: Some nutrition social behaviour change communication (NSBCC) interventions significantly improved exclusive breastfeeding (EBF) practices and child anthropometric outcomes and need to be considered while planning child nutrition interventions.Studies used different intervention protocols and operational definitions. Most studies employed a mix of the NSBCC interventions often with unspecified frequency and dosage.Future intervention studies should provide detailed implementation strategies for NSBCC interventions and use standard indicators to measure child nutritional status outcome indicators. [ABSTRACT FROM AUTHOR]

In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We identified search terms that describe wasting and stunting and the relationship between the two. We included studies related to children under five from low‐ and middle‐income countries that assessed both ponderal growth/wasting and linear growth/stunting and the association between the two. We included 45 studies. The review found the peak incidence of both wasting and stunting is between birth and 3 months. There is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Children with multiple anthropometric deficits, including concurrent stunting and wasting, have the highest risk of near‐term mortality when compared with children with any one deficit alone. Furthermore, evidence suggests that the use of mid‐upper‐arm circumference combined with weight‐for‐age Z score might effectively identify children at most risk of near‐term mortality. Wasting and stunting, driven by common factors, frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence of a process of accumulation of nutritional deficits and increased risk of mortality over a child's life demonstrates the pressing need for integrated policy, financing and programmatic approaches to the prevention and treatment of child malnutrition. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of inadequate gestational weight gain (GWG) and adverse pregnancy outcomes, very few studies have addressed the association between GWG and pregnancy outcomes in South Asia. Our objectives were to estimate the prevalence of GWG during the second and third trimesters within, below and above the Institute of Medicine (IOM) guidelines, and to estimate the effect of the rate and adequacy of GWG on gestational age at the time of delivery, weight, length, length‐for‐age z‐score (LAZ), weight‐for‐length z‐score (WLZ) and adverse pregnancy outcomes, namely prematurity, small‐for‐gestational age (SGA), low birth weight (LBW), stunting and wasting at birth. We analysed data from the intervention group of the Women and Infants Integrated Interventions for Growth Study (WINGS), which is an ongoing individually randomized factorial design study. Of the 1332 women analysed, 40.2% [95% confidence interval (CI) 37.5 to 42.8] had GWG below the IOM guidelines. For every 100‐g/week increase in GWG, birth weight increased by 61 g, birth length by 0.16 cm, LAZ score by 0.08 SD, WLZ score by 0.14 SD, and gestational age at birth by 0.48 days. Women with GWG below the IOM guidelines had a higher relative risk of adverse pregnancy outcomes (44% for LBW, 27% for SGA, 32% for stunting and 42% for wasting at birth) than women who had GWG within the IOM guidelines, except for prematurity. The association between GWG and LAZ scores at birth was modified by early pregnancy body mass index (BMI). GWG is a strong predictor of newborn anthropometric outcomes and duration of gestation but not prematurity. [ABSTRACT FROM AUTHOR]

Undernutrition is linked to almost half of all deaths in under‐five children. In 2019, 144 million under‐five children suffered from stunting and 47 million suffered from wasting. This study examined the factors that influence adverse nutritional status of children in sub‐Saharan Africa. The study used data from the Demographic and Health Surveys (DHS) of 31 countries, which involved 189,195 children under age 5. Binary logistic regression was used to examine the relationships between the independent variables and adverse nutritional status of children. About 26% of the children in the 31 countries in sub‐Saharan Africa considered in this study are stunted, 6% are wasted and 21% are underweight. Close to 31% of children whose mothers have no education are stunted, 9% are wasted and 28% are underweight. Adverse nutritional status of children is significantly associated with maternal age, education, household wealth, residence, antenatal care attendance, mass media exposure, child's sex and size of child at birth. This study has shown that adverse nutritional status of children is a major challenge in sub‐Saharan Africa. Efforts at improving nutritional status of children should include poverty alleviation initiatives at individual and household levels, increase in women's educational level and improvement in living conditions in rural areas. [ABSTRACT FROM AUTHOR]

Malnutrition is the leading cause of poor child health in Ethiopia, and progress to avert it is unacceptably slow. In addition, little is known about the magnitude and factors associated with concurrent wasting and stunting (WaSt). Therefore, this study aimed to assess the prevalence and factors associated with WaSt, wasting, stunting and underweight among children 6–59 months in Kersa Health and Demographic Surveillance System, Ethiopia. Data from a total of 1091 children and their parents' were analysed from a cross‐sectional study. Household questionnaires and anthropometric measurements were used for data collection. Height‐for‐age, weight‐for‐height and weight‐for‐age indices are expressed as standard deviation units from the mean for the reference group. Multivariate analyses were conducted to identify factors associated with WaSt, wasting, stunting and underweight. Statistical significance was declared at p < 0.05. The prevalence of indicators of malnutrition was WaSt (5.8%), wasting (16.8%), stunting (53.9%) and underweight (36.9%). Children aged 6–17 months had a higher odds of wasting (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.12–2.75) compared with those aged 36–59 months, whereas children aged 18–35 months (aOR 2.4, 95% CI 1.65–3.47) and 36–59 months (aOR 1.6, 95% CI 1.07–2.37) had higher odds of stunting compared with those aged 6–17 months. Similarly, children aged 18–35 months (aOR 1.6, 95% CI 1.07–2.37) and 36–59 months (aOR 2.2, 95% CI 1.52–3.10) had higher odds of underweight compared with children aged 6–17 months. Households that did not treat drinking water at point of use were at higher odds of WaSt (aOR 3.3, 95% CI 1.16–9.27) and stunting (aOR 1.9, 95% CI 1.31–2.85) compared with those who did treat drinking water. Boys were more likely to be WaSt, wasted, stunted and underweight. Cough was associated with WaSt, wasting and underweight. Furthermore, maternal education, maternal occupation and maternal age were significantly associated with wasting. Maternal body mass index (BMI) of less than 18.5 kg/m2 and maternal BMI between 18.5 and 25 kg/m2 were associated with child stunting. In Kersa, the prevalence of WaSt, wasting, stunting and underweight is very high and requires urgent public health intervention. This study highlights point‐of‐use water treatment, maternal education, hygiene and sanitation, child health service utilization and maternal BMI as important areas to improve to target child malnutrition. Furthermore, a community‐based programmatic and policy direction for early identification and management of WaSt in addition to other indicators of malnutrition is recommended. [ABSTRACT FROM AUTHOR]

Objective: To investigate the ability of phase angle (PA) and body composition for predicting protein energy wasting (PEW) in renal replacement therapy (RRT) patients. Methods: Renal replacement therapy (RRT) patients were enrolled in this study. Body composition was measured by direct segmental multi‐frequency biolectrical impedance analysis method (DSM‐BIA); phase angle (PA), fat‐free mass (FFM), fat mass (FM), mid‐arm circumference (MAC), WC (waist circumference), and ECW/TBW (extracellular water/total body water) were obtained. Biochemicals (serum albumin, triglyceride, and cholesterol) were tested. PEW patients were classified according to ISRNM (The International Society of Renal Nutrition and Metabolism) criteria. Cutoff value of PA and related variables was calculated by ROC analysis. The ability of body composition variables as indicators to predict PEW was evaluated. Results: Sixty‐four patients were enrolled in this study. Thirty‐three patients (52.6%) were males, and forty (62.5%) patients were diagnosed with PEW. The ROC curve showed that the optimal cutoff values of PA, FFMI (fat‐free mass index), MAC, WC, and BMI for PEW risk were 4.45°, 16.71, 29.7 cm, 86.4 cm, and 21.1 kg/m2, respectively. These indicators showed significant association with PEW; meanwhile, the PA and MAC can be used as the predictors for PEW with OR 6.333 (95% CI, 1.956–20.505) and 3.267 (95% CI, 1.136–9.394), respectively. Both groups have a lower BUN/Cr ratio (<20). Conclusion: In the RRT patients, over than 60% patients were diagnosed with PEW. PA, MAC, and other body composition can be used as the independent indicators for predicting PEW in renal replacement therapy kidney disease patients. [ABSTRACT FROM AUTHOR]

Temporal genetic studies of low‐dispersing organisms are rare. Marine invertebrates lacking a planktonic larval stage are expected to have lower dispersal, low gene flow, and a higher potential for local adaptation than organisms with planktonic dispersal. Leptasterias is a genus of brooding sea stars containing several cryptic species complexes. Population genetic methods were used to resolve patterns of fine‐scale population structure in central California Leptasterias species using three loci from nuclear and mitochondrial genomes. Historic samples (collected between 1897 and 1998) were compared to contemporary samples (collected between 2008 and 2014) to delineate changes in species distributions in space and time. Phylogenetic analysis of contemporary samples confirmed the presence of a bay‐localized clade and revealed the presence of an additional bay‐localized and previously undescribed clade of Leptasterias. Analysis of contemporary and historic samples indicates two clades are experiencing a constriction in their southern range limit and suggests a decrease in clade‐specific abundance at sites at which they were once prevalent. Historic sampling revealed a dramatically different distribution of diversity along the California coastline compared to contemporary sampling and illustrates the importance of temporal genetic sampling in phylogeographic studies. These samples were collected prior to significant impacts of Sea Star Wasting Disease (SSWD) and represent an in‐depth analysis of genetic structure over 117 years prior to the SSWD‐associated mass die‐off of Leptasterias. [ABSTRACT FROM AUTHOR]

Systematic reviews have highlighted that repeated severe wasting after receiving treatment is likely to be common, but standardised measurement is needed urgently. The Council of Research & Technical Advice for Acute Malnutrition (CORTASAM) released recommendations on standard measurement of relapse (wasting within 6 months after exiting treatment as per recommended discharge criteria), regression (wasting within 6 months after exiting treatment before reaching recommended discharge criteria) and reoccurrence (wasting after 6 months of exit from treatment as per recommended discharge criteria). We provide a theoretical framework of post‐treatment relapse and regression to severe wasting to guide discussions, risk factor analyses, and development and evaluations of interventions. This framework highlights that there are factors that may impact risk of relapse and regression in addition to the impact of contextual factors associated with incidence and reoccurrence of severe wasting more generally. Factors hypothesised to be associated with relapse and regression relate specifically to the nutrition and health status of the child on admission to, during and exit from treatment and treatment interventions, platforms and approaches as well as type of exit from treatment (e.g., before reaching recommended criteria). These factors influence whether children reach full recovery, and poorer nutritional and immunological status at exit from treatment are more proximate determinants of risk of severe wasting after treatment, although post‐treatment interventions may modify risks. The evidence base for many of these factors is weak. Our framework can guide research to improve our understanding of risks of relapse and regression and how to prevent them and inform programmes on what data to collect to evaluate relapse. Implementation research is needed to operationalise results in programmes and reduce post‐treatment severe wasting at scale. [ABSTRACT FROM AUTHOR]

To evaluate the effect of combined resistance and aerobic training (RT+AT) on regional bone mineral density (BMD) and physical performance in people living with HIV (PLWH). Forty PLWH (20 men and 20 women) were randomized into RT+AT group (n = 20; age = 38.3 ± 4.9) or non‐exercise control group (n = 20; age = 37.9 ± 5.1). The RT+AT group was required to perform a nonlinear periodized resistance training program targeting large muscle groups followed by 20 min aerobic exercise at 65‐80% of maximal heart rate. Participants in RT+AT performed three supervised sessions per week for 6‐months, whereas participants in the control group were instructed to continue with their current lifestyle habits. The primary outcome was bone mineral density (lumbar spine (L2‐L4), femoral neck, and distal 1/3 radius). Secondary outcomes included physical function, anthropometry, inflammatory markers, and growth factors. The RT+AT group demonstrated a significant increase in BMD at follow‐up for the Lumbar spine (L2‐L4), femoral neck, and 1/3 radius (all, P <.05), and There were no gender differences in the training response between men and women for any of the BMD regions. Similar findings were also observed for lean body mass, IGF1and Adiponectin (P <.001). We observed a decrease in percent body fat, fat mass, IL‐6, TNF‐α, and myostatin in the RT+AT group (P <.001). Finally, there was a significant increase in handgrip strength and gait speed for both women and men in the RT+AT group (P <.001). A combination of resistance and aerobic training appears to be a feasible and effective means for counteracting bone loss and improving various inflammatory markers, physical function, and growth hormones in PLWH. [ABSTRACT FROM AUTHOR]

Children with concurrent wasting and stunting (WaSt) and children with severe wasting have a similar risk of death. Existing evidence shows that wasting and stunting share similar causal pathways, but evidence on correlates of WaSt remains limited. Research on correlates of WaSt is needed to inform prevention strategies. We investigated the factors associated with WaSt in children 6–59 months in Karamoja Region, Uganda. We examined data for 33,054 children aged 6–59 months using June 2015 to July 2018 Food Security and Nutrition Assessment in Karamoja. We defined WaSt as being concurrently wasted (weight‐for‐height z‐scores <−2.0) and stunted (height‐for‐age z‐score <−2.0). We conducted multivariate mixed‐effect logistic regression to assess factors associated with WaSt. Statistical significance was set at p < 0.05. In multivariate analysis, being male (adjusted odds ratio [aOR] = 1.79; 95% confidence interval [CI] [1.60–2.00]), aged 12–23 months (aOR = 2.25; 95% CI [1.85–2.74]), 36–47 months (aOR = 0.65; 95% CI [0.50–0.84]) and 48–59 months (aOR = 0.71; 95% CI [0.54–0.93]) were associated with WaSt. In addition, acute respiratory infection (aOR = 1.30; 95% CI [1.15–1.48]), diarrhoea (aOR = 1.25; 95% CI [1.06–1.48]) and malaria/fever (aOR = 0.83; 95% CI [0.73–0.96]) episodes were associated with WaSt. WaSt was significantly associated with maternal underweight (body mass index <18.5 kg/m2), short stature (height <160 cm), low mid‐upper arm circumference (MUAC <23 cm) and having ≥4 live‐births. WaSt was prevalent in households without livestock (aOR = 1.30; 95% CI [1.13–1.59]). Preventing the occurrence of WaSt through pragmatic and joint approaches are recommended. Future prospective studies on risk factors of WaSt to inform effective prevention strategies are recommended. [ABSTRACT FROM AUTHOR]

The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of patients with cardiovascular illnesses. This interest originally started in the field of heart failure, but has recently been extended to other areas such as atrial fibrillation, coronary artery disease, peripheral artery disease as well as to patients after cardiac surgery or transcatheter aortic valve implantation. Tissue wasting and frailty are prevalent among many of the affected patients. The ageing process itself and concomitant cardiovascular illness decrease lean mass while fat mass is relatively preserved, making elderly patients particularly prone to develop wasting syndromes and frailty. The aim of this review is to provide an overview of the available knowledge of body wasting and physical frailty in patients with cardiovascular illness, particularly focussing on patients with heart failure in whom most of the available data have been gathered. In addition, mechanisms of wasting and possible therapeutic targets are discussed. [ABSTRACT FROM AUTHOR]

Young children in the East Asia and the Pacific region1 are failing to thrive, in large numbers, as indicated by stagnation in the decline of stunting, wasting, and micronutrient deficiencies and the fastest growing rates of overweight in the world. Eliminating the triple burden of malnutrition is essential to ensure that, as a matter of right, all children reach their full physical growth and development potential and actively contribute to equitable prosperity and the sustainable development of their communities and nations. Ending all forms of malnutrition will only be achieved through the implementation of effective policies and programmes soundly based on an understanding of the leading contextual drivers of child malnutrition. To address the lack of data on these drivers in the region, the UNICEF regional office for East Asia and the Pacific commissioned a series of papers in 2017–2019 to fill gaps in the current body of evidence on the triple burden of maternal and child malnutrition. This series includes analyses of the determinants of child malnutrition including maternal nutrition status, dietary quality of children, inequity, and poverty. Additionally, policy and programmatic actions associated with improved coverage and quality of nutrition interventions are reviewed. This overview paper summarizes the findings of these analyses and presents recommendations for the direction of future advocacy, policy, and programmatic actions to address the triple burden of malnutrition in East Asia and the Pacific. [ABSTRACT FROM AUTHOR]

Undernutrition is a major contributor to child morbidity and mortality and poses a large burden to the economy, in Cambodia. This study explored factors contributing to child stunting and wasting and their regional inequalities among 1,938 Cambodian children aged 6–23.9 months. Data were drawn from a longitudinal study (year 2017) conducted in six districts of two north‐eastern provinces and the capital and used as cross‐sectional. Socio‐demographic and household characteristics, children's feeding practices during the previous 24 hr, and children's length and weight measurements were collected. Gradient boosting models were used to calculate the contribution of determinants to child undernutrition whereas concentration index was used to assess the impact of those determinants on stunting and wasting inequalities among socioeconomic groups. It was found that low‐household wealth could predict 21% to 45% of child stunting and 23% to 36% of wasting across regions. After wealth, source and treatment of drinking water were found the second major predictor for stunting (15%) and wasting (21%). Combining child nutrition and household water, sanitation and hygiene indicators predicted around 30% of child undernutrition, either in the form of stunting or wasting. Mothers' education predicted >30% of stunting in the north‐eastern region. Results highlight that a complex interplay of factors contributes to child stunting and wasting. An integrated, intersectoral, equity‐focused approach that addresses children's dietary quality, household's water, sanitation and hygiene conditions, mother's education, and poverty is likely to yield the highest impact in achieving further gains in nutritional status among Cambodian children. [ABSTRACT FROM AUTHOR]

Child undernutrition is a public health and development problem in Myanmar that is jeopardizing children's physical and cognitive development and the country's social and economic progress. We identified key drivers of child stunting (low height‐for‐age) and wasting (low weight‐for‐height) in a nationally representative sample (n = 3,981) of children 0–59 months of age. The national prevalence of child stunting and wasting was 28% and 7%, respectively. Boys were more likely to be stunted or wasted than girls. Older children 24–35 months were at the highest risk of stunting compared with children under 6 months (risk ratios [RR] 10.34; 95% CI [6.42, 16.65]) whereas the youngest, under 6 months, were at the highest risk of wasting compared with children 36–59 months (RR 2.04; 95% CI [1.16, 3.57]). Maternal height <145 cm (RR 5.10; 95% CI [3.15, 8.23]), perceived small child size at birth (RR 2.08; 95% CI [1.62, 2.69]), and not benefiting from institutional delivery (RR 1.52; 95% CI [1.24, 1.87]) were associated with an increased risk of child stunting, as were maternal occupation, unimproved household drinking water, living in delta, coastal or upland areas, and poorer household wealth index quintile. Increased risk of child wasting was associated with maternal underweight (RR 1.64; 95% CI [1.11, 2.42]) and open defecation (RR 1.91; 95% CI [1.25, 2.92]) as well as maternal occupation and residence in a coastal area. Our findings indicate that the key drivers of child undernutrition in Myanmar are multifaceted and start in utero. Investing in scaling‐up multisectoral approaches that include nutrition‐specific and nutrition‐sensitive interventions with a focus on improving maternal nutrition is essential for reducing child undernutrition and contributing to further gains in the country's human and economic development. [ABSTRACT FROM AUTHOR]

We assessed prevalence of concurrently wasted and stunted (WaSt) and explored the overlaps between wasted, stunted, underweight and low mid‐upper arm circumference (MUAC) among children aged 6–59 months in Karamoja, Uganda. We also determined optimal weight‐for‐age (WAZ) and MUAC thresholds for detecting WaSt. We conducted secondary data analysis with 2015–2018 Food Security and Nutrition Assessment (FSNA) cross‐sectional survey datasets from Karamoja. Wasting, stunting and underweight were defined as <−2.0 z‐scores using WHO growth standards. Low MUAC was defined as <12.5 cm. We defined WaSt as concurrent wasting and stunting. Prevalence of WaSt was 4.96% (95% CI [4.64, 5.29]). WaSt was more prevalent in lean than harvest season (5.21% vs. 4.53%; p =.018). About half (53.92%) of WaSt children had low MUAC, and all were underweight. Younger children aged <36 months had more WaSt, particularly males. Males with WaSt had higher median MUAC than females (12.50 vs. 12.10 cm; p <.001). A WAZ <−2.60 threshold detected WaSt with excellent sensitivity (99.02%) and high specificity (90.71%). MUAC threshold <13.20 cm had good sensitivity (81.58%) and moderate specificity (76.15%) to detect WaSt. WaSt prevalence of 5% is a public health concern, given its high mortality risk. All children with WaSt were underweight and half had low MUAC. WAZ and MUAC could be useful tools for detecting WaSt. Prevalence monitoring and prospective studies on WAZ and MUAC cut‐offs for WaSt detection are recommended. Future consideration to integrate WAZ into therapeutic feeding programmes is recommended to detect and treat WaSt children. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of protein supplementation on muscle mass, strength and function in individuals at risk of muscle wasting disorders. Methods: A narrative overview of the literature based on a PubMed search. Results: Increasing protein intake beyond the recommended dietary intake may prevent or attenuate muscle loss in people at risk of muscle wasting disorders; however, there is inconsistent evidence for any benefits on muscle strength or physical function. This is likely due to the significant heterogeneity and bias regarding baseline demographics, basal protein/energy intakes and protein supplement type, dose, timing and compliance. Conclusion: Protein supplementation attenuates muscle loss in some populations at increased risk of muscle wasting, but there is no consistent evidence to support benefits on muscle strength or physical function. Further randomised controlled trials are needed that focus on whether there is an optimal type, dose and timing of protein intake, and potential interaction with other nutrients. [ABSTRACT FROM AUTHOR]

Aim: The associations between types of dietary protein intake and child anthropometric measurements have not been fully studied. Therefore, we examined dietary protein pattern in relation to anthropometric indicators among 6‐year‐old children. Methods: We carried out a cross‐sectional study of 788 randomly selected children from health centres in Tehran, Iran. Dietary intake was assessed using a food frequency questionnaire completed by the mothers. Anthropometric measurements were based on standard protocols. Principle component analysis was performed to identify different dietary protein patterns. We used multivariate logistic regression to evaluate how these patterns were associated with child anthropometry. Results: Three dietary protein patterns were identified: pattern 1 (rich in red and processed meats, dairy products and eggs), pattern 2 (rich in fish and poultry) and pattern 3 (rich in soy and legumes). After adjusting for potential confounders (energy intake, socioeconomic status and physical activity), being in the third compared to the first tertiles of pattern 2 was associated with increased (OR = 1.57; 95% CI: 1.09‐2.27; P =.01) and decreased (OR = 0.54; 95% CI: 0.32‐0.92; P =.02) risk of overweight/obesity and underweight/wasting, respectively. There was no association between other dietary patterns and risk of overweight/obesity or underweight/wasting. Conclusions: The present study showed inverse association between the fish/white meat pattern and underweight/wasting and also a positive association between higher fish/white meat protein intake and higher risk of overweight/obesity. Further studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

The new millennium brought renewed attention to improving the health of women and children. In this same period, direct deaths from conflicts have declined worldwide, but civilian deaths associated with conflicts have increased. Nigeria is among the most conflict‐prone countries in Sub‐Saharan Africa, especially recently with the Boko Haram insurgency in the north. This paper uses two data sources, the 2013 Demographic and Health Survey for Nigeria and the Social Conflict Analysis Database, linked by geocode, to study the effect of these conflicts on infant and young child acute malnutrition (or wasting). We show a strong association in 2013 between living close to a conflict zone and acute malnutrition in Nigerian children, with larger effects for rural children than urban children. This is related to the severity of the conflict, measured both in terms of the number of conflict deaths and the length of time the child was exposed to conflict. Undoubtedly, civil conflict is limiting the future prospects of Nigerian children and the country's economic growth. In Nigeria, conflicts in the north are expected to continue with sporadic attacks and continued damaged infrastructure. Thus, Nigerian children, innocent victims of the conflict, will continue to suffer the consequences documented in this study. [ABSTRACT FROM AUTHOR]