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Background: National estimates of childhood undernutrition display uncertainty; however, it is known that stunting is the most prevalent deficiency. Child undernutrition is manifest in poor communities but is a modifiable risk factor. The intention of the study was to quantify trends in the indicators of child undernutrition to aid policymakers., Objectives: To estimate the burden of diseases attributable to stunting, wasting and underweight and their aggregate effects in South African (SA) children under the age of 5 years during 2000, 2006 and 2012., Methods: The study applied comparative risk assessment methodology. Data sources for estimates of prevalence and population distribution of exposure in children under 5 years were the National Food Consumption surveys and the SA National Health and Nutrition Examination Survey conducted close to the target year of burden. Childhood undernutrition was estimated for stunting, wasting and underweight and their combined 'aggregate effect' using the World Health Organization (WHO) 2006 standard. Population-attributable fractions for the disease outcomes of diarrhoea, lower respiratory tract infections, measles and protein-energy malnutrition were applied to SA burden of disease estimates of deaths, years of life lost, years lived with a disability and disability-adjusted life years for 2000, 2006 and 2012., Results: Among children aged under 5 years between 1999 and 2012, the distribution of anthropometric measurements <‒2 standard deviations from the WHO median showed little change for stunting (28.4% v. 26.6%), wasting (2.6% v. 2.8%) and underweight (7.6% v. 6.1%). In the same age group in 2012, attributable deaths due to wasting and aggregated burden accounted for 21.4% and 33.2% of the total deaths, respectively. Attributable death rates due to wasting and aggregate effects decreased from ~310 per 100 000 in 2006 to 185 per 100 000 in 2012., Conclusion: The study shows that reduction of childhood undernutrition would have a substantial impact on child mortality. We need to understand why we are not penetrating the factors related to nutrition of children that will lead to reducing levels of stunting.

Background & Aims: Multiple definitions for malnutrition syndromes are found in the literature resulting in confusion. Recent evidence suggests that varying degrees of acute or chronic inflammation are key contributing factors in the pathophysiology of malnutrition that is associated with disease or injury., Methods: An International Guideline Committee was constituted to develop a consensus approach to defining malnutrition syndromes for adults in the clinical setting. Consensus was achieved through a series of meetings held at the ASPEN and ESPEN Congresses., Results: It was agreed that an etiology-based approach that incorporates a current understanding of inflammatory response would be most appropriate. The Committee proposes the following nomenclature for nutrition diagnosis in adults in the clinical practice setting. "Starvation-related malnutrition", when there is chronic starvation without inflammation, "chronic disease-related malnutrition", when inflammation is chronic and of mild to moderate degree, and "acute disease or injury-related malnutrition", when inflammation is acute and of severe degree., Conclusions: This commentary is intended to present a simple etiology-based construct for the diagnosis of adult malnutrition in the clinical setting. Development of associated laboratory, functional, food intake, and body weight criteria and their application to routine clinical practice will require validation., (Copyright 2009 European Society for Clinical Nutrition and Metabolism and ASPEN American Society for Parenteral and Enteral Nutrition. Published by Elsevier Ltd.. All rights reserved.)

Objective: There is an increase in the prevalence of overweight and obesity in children worldwide, including South Africa. We investigated the prevalences of overweight, obesity, and stunting in a current generation of children (ages 12 to 108 mo), which has a high prevalence of stunting, and evaluated the determinants of both nutritional disorders., Methods: Secondary data analysis of the weight and height measurements of 12- to 108-mo-old children (weighted n = 2200, non-weighted n = 2894) during the 1999 National Food Consumption Survey in South Africa is reported. The body mass index reference percentiles recommended for use in children by the International Obesity Task Force were used to determine the prevalence of overweight and obesity, and the National Center for Health Statistics (NCHS) percentiles were used to determine the prevalence of stunting., Results: Nationally, the prevalence of stunting (height-for-age < or = -2 standard deviations, NCHS 50th percentile) in these children was 19.3% (95% confidence interval [CI] = 17.49 to 21.16) and was highest in 1- to 3-y-old children (24.4%) and in children of farm workers on commercial farms (25.6%). The prevalence of combined overweight and obesity (body mass index > or = 25 kg/m(2) in 17.1%, 95% CI = 15.00 to 19.23) at the national level was nearly as high as that for stunting. Further, the types of determinants for stunting and overweight were generally similar (although directionally opposite in degree of risk conferred) and included type of housing, type of toilet in the home, fuel used in cooking, presence of a refrigerator or stove, presence of a television in the house, educational level of the caregiver, and maternal education level. An example of the directionally opposite degree of risk is exemplified by the use of paraffin as a fuel being protective against being overweight (odds ratio = 0.78, 95% CI = 0.63 to 0.97) but predictive of an increased risk for stunting (odds ratio = 1.24, 95% CI = 1.04 to 1.48). Stunting itself conferred an increased risk (odds ratio = 1.80, 95% CI = 1.48 to 2.20) of being overweight., Conclusion: Certain defined determinants appear to play important roles in children's nutritional outcomes in relation to stunting and to overweight and obesity.

The National Center for Health Statistics (NCHS) references were used to analyse anthropometric data from the 1999 National Food Consumption Survey (NFCS) of South Africa. Since then, however, The Centers for Disease Control and Prevention (CDC) 2000 reference and the World Health Organization (WHO) 2006 standards were released. It was anticipated that these reference and standards may lead to differences in the previous estimates of stunting, wasting, underweight and obesity in the study population. The aim was to compare the anthropometric status of children using the 1977 NCHS, the 2000 CDC growth references and the 2006 WHO standards. All children 12-60 months of age with a complete set of anthropometric data were included in the analyses. Data for 1,512 children were analysed with SAS 9.1 for Windows. A Z-score was calculated for each child for weight-for-age (W/A), weight-for-length/height (W/H), length/height-for-age (H/A) and body mass index (BMI)-for-age, using each of the three reference or standards for comparison. The prevalence of stunting, obesity and overweight were significantly higher and the prevalence of underweight and wasting were lower when using the WHO standards compared to the NCHS and the CDC references. The higher than previously established prevalence of stunting at 20.1% and combined overweight/obesity at 30% poses a challenge to South African policy makers to implement nutrition programmes to decrease the prevalence of both stunting and overweight. The 2006 WHO growth standard should be the standard used for assessment of growth of infants and children younger than 5 years in developing countries. [ABSTRACT FROM AUTHOR]

Abstract: Primary and secondary nutrition interventions are essential in SouthAfrica, a country with mortality rates of 45.2 deaths per 1000 livebirths and 61 per 1000 for children younger than 5 y and anestimated prevalence of 8.3% for low birth weight. In addition,the National Food Consumption Survey has recently reported thatapproximately one in five children 1 to 9 y of age in SouthAfrica are stunted (21.6%) and 1 in 10 (10.3%) isunderweight for age. The prevalence of stunting was highest in children1 to 3 y old (25.5%) and lowest in those 7 to9 y old (13%). In terms of overnutrition, the surveyalso reported overweight and obesity in 17.1% of the sample atthe national level. In this overview, the focus areas of the IntegratedNutrition Program are examined and critically discussed to determinewhether targets planned for 2002 were met and how they are envisionedto change by2007. [Copyright &y& Elsevier]