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Drs. Laéticia Céline Toé and Trenton Dailey-Chwalibóg discuss building North-South research partnerships, with a particular focus on promoting equality and autonomy between cooperating grantees. They present challenges they faced, and lessons learned, throughout the process of designing and launching the DenBalo study in Burkina Faso.

Background: The use of mid-upper arm circumference (MUAC) as the sole assessment tool for identifying children with severe acute malnutrition (SAM) is based on the assumption that those with low weight-for-height z-scores (WHZ) are at lower risk for morbidity and mortality than those with low MUAC. However, the pathophysiology and functional severity associated with different anthropometric phenotypes of SAM have not been well-characterized. Objective: The aim of this study was to describe and compare the response to medico-nutritional care in children with uncomplicated SAM identified among three anthropometric phenotypes: both low MUAC and low WHZ, low MUAC only, and low WHZ only. Methods: A multicentric cohort study was conducted in uncomplicated, non-edematous children aged 6-59 months with SAM in Bangladesh, Burkina Faso and Liberia. Alongside routine anthropometric measurements, a wide range of critical indicators of clinical and nutritional status and viability was collected at admission, two weeks and eight weeks, including serum leptin, a marker of adipose tissue reserves associated with mortality risk in SAM. Results: A total of 282 patients were included in the study (n=103 low MUAC only, n=89 low WHZ only, n=90 both deficits). Leptin levels at baseline were lower in children with combined defects in WHZ and MUAC and those with low WHZ only than in children with low MUAC alone. During eight weeks of treatment, the weight gain velocity and plasma leptin levels rose more quickly in children with combined defects than in children in the other two groups. At eight weeks those with combined defects and with low WHZ only had higher prevalence of pneumonia than children with low MUAC only. Leptin concentrations correlated far more strongly with WHZ (r=0.41, pConclusion: The correlation indicates that leptin has prognostic value for tracking adipose tissue accretion during the recovery process. Our previous analysis at admission showed that children with low WHZ only had equally or more severe deficits in nutritional and health status than children with low MUAC. The present analyses throughout recovery suggest that these children respond similarly to treatment compared with those with both deficits. Therefore, we suggest retaining WHZ as an independent criterion for diagnosing SAM, in line with current WHO recommendations. Presented at: The 11th Belgian Nutrition Society Annual Symposium; April 24th, 2023, Paleis der Academiën, Brussels, Belgium; “Nutrition and Physical Activity: from Basic Scientific to Daily Practice” Presenting Author: Lishi Deng, MSc, PhD Candidate Lishi.Deng@Ugent.be, © Deng, et al., 2023. This document is distributed under the terms of the Creative Commons Attribution Noncommercial License (CC BY-NC 4.0), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. We confirm that we have obtained permission to use images from the participants/patients/individuals included in this presentation. The data presented in this article are part of the OptiDiag study, which was funded by Action Contre la Faim France with financial support from the European Commission's Civil Protection and Humanitarian Aid Operations Enhanced Response Capacity (grant ECHO/ERC/BUD/2015/91002) and the Humanitarian Innovation Fund, a program managed by Enhanced Learning and Research for Humanitarian Assistance. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this work. We confirm that we have obtained permission to use images from the participants, patients, and individuals included in this presentation.

Undernourished pregnant and lactating women from food insecure settings, most commonly found in low- and middle-income countries, are at risk of adverse maternal and infant health outcomes. Often, undernourishment is characterized by low body mass index (BMI), low mid upper arm circumference (MUAC), short stature, and/or micronutrient deficiencies, which put pregnant women at risk for complications such intrauterine growth restriction and preterm birth (Kozuki et al. 2015). The World Health Organization recommends balanced energy-protein (BEP) supplementation in populations at risk of undernourishment (defined as more than 20% of women with a BMI less than 18.5 kg/m2) to reduce the risk of stillbirth and small for gestational age neonates (World Health Organization 2016). The consequences of undernourishment among lactating mothers have commonly been overlooked. Lactating mothers require additional calories to produce quality and quantity milk, which in turn confers health and development benefits to the infant (Nommsen et al. 1991; Dewey et al. 1991; American College of Obstetricians and Gynecologists 2016). There is a high prevalence of malnutrition in mothers and children from low- and middle-income countries, and research from randomized controlled trials is needed to clarify if BEP could be a valuable intervention during lactation. BEP supplementation products are ready-to-eat or prepared foods that provide protein (accounts for less than 25% of the total energy content) and energy. When given during pregnancy, BEP products are fortified with micronutrients or an additional micronutrient supplement is given (typically multiple micronutrients or iron-folic acid). The current evidence coming from systematic reviews and meta-analyses has focused on studies where BEP is given during pregnancy (Imdad and Bhutta 2012; Ota et al. 2015; Stevens et al. 2015; Lassi et al. 2020; Perumal et al. 2021) but not lactation. This evidence is difficult to disentangle because there is significant heterogeneity in the populations, comparison/control groups, study design, and BEP product formulations (i.e., energy and protein content). Given these limitations, in 2017, an expert panel organized by the Bill and Melinda Gates Foundation (BMGF) created guidelines for the macro- and micronutrient content of BEP supplements (Report of an Expert Consultation held at the Bill & Melinda Gates Foundation 2017). This group also suggested that these BEP products should be developed and tested on pregnant and lactating women in low-resource settings. A number of studies (all randomized interventions) were subsequently funded by BMGF. As these studies’ investigators were developing protocols independently, in 2020 BMGF convened the Maternal Nutrition Harmonization Workshop to harmonize key variables across these trials. This effort was expanded, and the Maternal BEP Studies Harmonization Initiative was formed to examine the pooled effect of BEP across pregnancy and lactation. The current protocol describes our prospective individual participant data (IPD) meta-analysis that focuses on BEP given during lactation. Subsequent work will examine BEP given during pregnancy. Given the high prevalence of infant stunting in low- and middle-income countries (World Health Organization 2018b; Local Burden of Disease Child Growth Failure Collaborators 2020), and the importance of supporting the nutrient intake of mothers providing breastmilk to infants, this IPD meta-analysis will focus on assessing the effect of BEP given to mothers during lactation on infant length-for-age z scores (LAZ) at 6 months of age. We will also examine additional infant and maternal anthropometric and health outcomes.

Introduction: While both WHZObjective: In order to elucidate this, the OptiDiag study aimed to describe the nutritional status and morbi-mortality risks associated with the different case definitions of SAM. Methods: We conducted a multi-centric cohort study in uncomplicated SAM children with low MUAC alone, low WHZ alone, and the combination of low MUAC and low WHZ, in Bangladesh, Burkina Faso, and Liberia. Alongside routine anthropometric measurements, we collected a range of indicators of clinical and nutritional status, among which some novel biomarkers of body metabolism and mortality risk, such as serum leptin. Indeed, hypoleptinemia has recently emerged as a powerful risk factor for acute mortality in children with SAM. Results: The 3 groups included patients with low MUAC only (n =161), low WHZ only (n =138), and both low MUAC & low WHZ (n =152). At diagnosis, leptin levels were lower in patients with reduced WHZ (308.8±28.8 pg/mL, p=0.019) and with both low MUAC & low WHZ (244.9±17.4 pg/mL, pPresented at: The 4th Federation of African Nutrition Societies (FANUS) Kigali Conference; August 26th - 29th, 2019, Lemigo Hotel Kigali, Rwanda; “Nutrition in Action for Sustainable Development in Africa”; theme: Malnutrition; forms, trends, causalities, innovations and cost. Presenting Author: Trenton Dailey-Chwalibóg, M.P.H., Ph.D. Candidate Trenton@Dailey-Chwalibog.com, © Dailey-Chwalibóg, et al., 2019. This document is distributed under the terms of the Creative Commons Attribution Noncommercial License (CC BY-NC 4.0), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. We confirm that we have obtained permission to use images from the participants/patients/individuals included in this presentation. The data presented in this article are part of the OptiDiag study, which is funded by Action Contre la Faim France with financial support from the European Commission's Civil Protection and Humanitarian Aid Operations Enhanced Response Capacity (grant ECHO/ERC/BUD/2015/91002) and the Humanitarian Innovation Fund, a program managed by Enhanced Learning and Research for Humanitarian Assistance. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this work.

Body composition can provide insights into children’s health and shows promise and exciting potential for improving the diagnosis of acute malnutrition and its treatment for an improved and longer term effectiveness. BIA is one way to estimate body composition. It is becoming easier to study since new methods have been developed, making the measurement quicker, easier and more reliable for field practitioners to perform in otherwise challenging settings. Because of its potential in providing important information on the true physiological status of malnourished children, body composition measurement should be systematically incorporated into research projects aiming to test the effectiveness of current or new diagnostics or treatment methods. Body composition data is also crucial in informing the long term health of children, an area that deserves much more attention. Finally, among edematous children, BIA measurements could provide insights on the distribution and extent of fluid imbalance and help optimize the treatment of this particularly vulnerable malnourished group. While BIA is relatively simple to measure it does require cooperation from the patient to remain calm and in a correct position, which is a challenge for young children. Particular attention and effort should be placed in standardizing a quality scale for BIA measurement in order to obtain valid results comparable across studies. Despite its great interest and added value in research settings, BIA remains a method that cannot be applied yet in field routine programmes. More simple, reliable and straightforward interpretation methods are needed in addition to population specific and validated reference values.

The results of the SQUEAC assessment lead to an estimate of period coverage for the Kirotshe health zone of 40.9% (95% CI ≈ 32.3%; 50.3%); Z-test: z = –0.33, p = 0.7434 for severe acute malnutrition (SAM). The final coverage estimate in the Kirotshe health zone is below the SPHERE international standard for community-based management of acute malnutrition (CMAM) programs in rural settings, which is 50%. The document focuses on the main barriers (the negative factors having the greatest impact on coverage) that were identified during the investigation. The recommendations made for program continuation focus largely on these elements. These recommendations are presented in the final section of the report in the format of an action plan which details the priority actions and follow-up and monitoring methods proposed. An exhaustive list of all observed barriers and boosters can be found in the appendix for information and reference., https://coverage-monitoring.org/wp-content/uploads/2015/04/COD-Kirotshe-14-Rapport-2015-02-23_VF.pdf