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Nutritional Status among Vulnerable Populations

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 60242

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Special Issue Editor

Dr. Gulam Khandaker

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Guest Editor

Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
Interests: childhood disability; infectious disease; early childhood development; child survival; maternal and childhood undernutrition; poverty dynamics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Globally, it is estimated 45% of deaths in under-fives are directly or indirectly linked to malnutrition (WHO, Malnutrition. Available from: https://www.who.int/news-room/fact-sheets/detail/malnutrition). Children born pre-term and those with low birthweights, congenital anomalies, neurodevelopmental disorders, and disabilities are at high risk of malnutrition and infection in both HICs and LMICs. In LMICs, food insecurity, in addition to poor environmental conditions, make the situation more complex. At the same time, children in countries affected by war or living in conflict zones or refugee camps are exposed to extreme environmental conditions, food insecurity, and inhumane circumstances, making their survival a challenge.

On 1st of April 2016, the General Assembly of United Nations (UN) declared 2016–2025 as the “United Nations Decade of Action on Nutrition”. The proclamation brought about the opportunity to work strategically toward the global agenda of the sustainable development goals (SDG 2 and SDG 3).

As Ban Ki-moon, United Nations 8th Secretary General, said, “Nutrition is both a maker and a marker of development. Improved nutrition is the platform for progress in health, education, employment, empowerment of women and the reduction of poverty and inequality, and can lay the foundation for peaceful, secure and stable societies.”

There is an urgent need for population-based observational and experimental studies and translational research in this area to tackle the burden of malnutrition among vulnerable children globally. This Special Issue aims to present a collection of the latest research on issues and initiatives around malnutrition among vulnerable children in both high income countries (HICs) and low- and middle-income countries (LMICs).

Prof. Gulam Khandaker
Guest Editor

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Keywords

childhood malnutrition
pre-term birth
low-birth weight
childhood disability
neurodevelopmental disorder
low income settings
displaced population
conflict zones

Published Papers (14 papers)

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Research

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15 pages, 446 KiB

Open AccessFeature PaperArticle

Impact of a Farm-to-School Nutrition and Gardening Intervention for Native American Families from the FRESH Study: A Randomized Wait-List Controlled Trial

by Tori Taniguchi, Alyson Haslam, Wenjie Sun, Margaret Sisk, Jann Hayman and Valarie Blue Bird Jernigan

Nutrients 2022, 14(13), 2601; https://doi.org/10.3390/nu14132601 - 23 Jun 2022

Cited by 5 | Viewed by 3873

Abstract

Establishing healthy eating habits during childhood is critical to prevent chronic diseases that develop in adulthood. Tribally owned Early Childhood and Education (ECE) programs signify fundamental influence in childhood obesity disparities. A strategy to improve diet is the use of school gardens; however, few studies have used rigorous methods to assess diet and health outcomes. The purpose of this manuscript is to describe results from the six-month Food Resource Equity for Sustainable Health (FRESH) study among Native American families. We aimed to recruit 176 families of children attending Osage Nation ECE programs in four communities. Two communities received the intervention and two served as wait-list controls. Outcomes included change in dietary intake, body mass index, health status, systolic blood pressure (adults only), and food insecurity in children and parents. There were 193 children (n = 106 intervention; n = 87 control) and 170 adults (n = 93 intervention; n = 77 control) enrolled. Vegetable intake significantly increased in intervention children compared to controls for squash (p = 0.0007) and beans (p = 0.0002). Willingness to try scores increased for beans in intervention children (p = 0.049) and tomatoes in both groups (p = 0.01). FRESH is the first study to implement a farm-to-school intervention in rural, tribally owned ECEs. Future interventions that target healthy dietary intake among children should incorporate a comprehensive parent component in order to support healthy eating for all household members. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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10 pages, 731 KiB

Open AccessArticle

Adolescent Afghan Refugees Display a High Prevalence of Hyperhomocysteinemia and Associated Micronutrients Deficiencies Indicating an Enhanced Risk of Cardiovascular Disease in Later Life

by Muhammad Shabir Khan, Anum Saeedullah, Simon C. Andrews, Khalid Iqbal, Syed Abdul Qadir, Babar Shahzad, Zahoor Ahmed and Muhammad Shahzad

Nutrients 2022, 14(9), 1751; https://doi.org/10.3390/nu14091751 - 22 Apr 2022

Cited by 3 | Viewed by 1930

Abstract

A growing body of research evidence suggests that elevated homocysteine level (hyperhomocysteinemia) is an independent risk factor for cardiovascular diseases. The current study aimed to investigate the prevalence and associated risk factors for hyperhomocysteinemia among adolescent Afghan refugees aged 10–19 years. In total, 206 healthy adolescent boys and girls were randomly recruited from a refugee village in Peshawar, Pakistan, in 2020. Socio-demographic data, anthropometric assessment, and blood sample collection were performed following standard methods. Serum homocysteine was assessed using a chemiluminescent microparticle immunoassay, with hyperhomocysteinemia defined as levels ≥ 15 µmol/L. The overall prevalence of hyperhomocysteinemia was 25%, with mean homocysteine levels significantly (p = 0.004) higher among boys (14.1 µmol/L) than girls (11.8 µmol/L). Multivariate logistic regression analysis revealed a significant association between hyperhomocysteineimia and serum levels of vitamin B12 (OR 0.29; 95% CI of 0.14 to 0.62; p < 0.01) and folate (OR 0.1; 95% CI of 0.03 to 0.27; p < 0.001). Overall, our study findings indicate high prevalence of hyperhomocysteinemia among adolescent Afghan refugees who are potentially at high risk of developing cardiovascular diseases in future. There is a dire need to develop and implement nutritional and public health strategies to control hyperhomocysteinemia, protect against related diseases and complications in future, and ensure healthy lives and well-being among these vulnerable populations. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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13 pages, 884 KiB

Open AccessArticle

Methods for Assessing Willingness to Try and Vegetable Consumption among Children in Indigenous Early Childcare Settings: The FRESH Study

by Marianna S. Wetherill, Mary B. Williams, Jessica Reese, Tori Taniguchi, Susan B. Sisson, Adrien D. Malek-Lasater, Charlotte V. Love and Valarie Blue Bird Jernigan

Nutrients 2022, 14(1), 58; https://doi.org/10.3390/nu14010058 - 24 Dec 2021

Cited by 7 | Viewed by 3027

Abstract

Food preferences begin in early childhood, and a child’s willingness to try (WTT) new vegetables is an important determinant of vegetable intake. Young children living in rural communities are at increased risk for food insecurity, which may limit exposure to and consumption opportunities for vegetables. This manuscript describes the validation of the Farfan-Ramirez WTT (FR-WTT) measure using baseline data from the FRESH study, a gardening intervention for Native American families with preschool-aged children in Osage Nation, Oklahoma. Individually weighed vegetable containers were prepared with six types of vegetables and ranch dip. Researchers presented children (n = 164; M = 4.3 years, SD = 0.8) with these vegetables preceding a snack- or lunch time and recorded the child’s FR-WTT for each vegetable using a 5-point scale, ranging from “did not remove food (0)” to “put food in mouth and swallowed (4)”. After the presentation period, contents were re-weighed to calculate vegetable consumption. Household parents/guardians completed the Child Food Neophobia Scale (CFNS) for their child. FR-WTT scores were positively correlated with consumption weights of all vegetables (r = 0.7613, p < 0.0001) and each vegetable individually (r = 0.2016–0.7664). The total FR-WTT score was inversely correlated with the CFNS score (r = 0.3268, p < 0.0001). Sensitivity analyses demonstrated similar relationships by BMI, food security, and age. In conclusion, the FR-WTT is a valid method for assessing young children’s vegetable eating behavior and intake. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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8 pages, 771 KiB

Open AccessArticle

Associations of Nutritional Status with Full Immunization Coverage and Safe Hygiene Practices among Thai Children Aged 12–59 Months

by Chisa Shinsugi and Ann Mizumoto

Nutrients 2022, 14(1), 34; https://doi.org/10.3390/nu14010034 - 23 Dec 2021

Cited by 9 | Viewed by 3116

Abstract

Prevailing prevention measures against morbidity, such as vaccination and safe hygiene practices, vary among local cultural contexts, and little is known about the extent to which these behaviors mitigate poor nutritional status in young children in Southeast Asia. We examined the associations between nutrition status with full immunization coverage, and water, sanitation and hygiene status among children aged 12–59 months in the 2015–2016 Thailand Multiple Indicator Cluster Survey (n = 9060). When adjusted for confounding factors, children with incomplete immunization status were more likely to be stunted (adjusted odds ratio (aOR) 1.47; 95% confidence interval (CI): 1.24–1.75, p < 0.001), wasted (aOR 1.67, 95% CI: 1.31–2.12, p < 0.001), and overweight (aOR 1.24, 95% CI: 1.01–1.51, p < 0.05), whereas children who used unimproved water sources were more likely to be overweight (aOR 2.43, 95% CI: 1.27–4.64, p < 0.01). The further implementation of simple and cost-effective health promotion activities and practices at the household level may be important interventions for healthy child growth and development, particularly under restricted living conditions due to COVID-19. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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14 pages, 1061 KiB

Open AccessArticle

Changes in Diet and Anthropometric Parameters in Children and Adolescents with Celiac Disease—One Year of Follow-Up

by Agnieszka Kozioł-Kozakowska, Dominika Salamon, Zofia Grzenda-Adamek, Agnieszka Krawczyk, Mariusz Duplaga, Tomasz Gosiewski and Kinga Kowalska-Duplaga

Nutrients 2021, 13(12), 4306; https://doi.org/10.3390/nu13124306 - 28 Nov 2021

Cited by 7 | Viewed by 2617

Abstract

Celiac disease (CD) may cause numerous nutrient deficiencies that a proper gluten-free diet (GFD) should compensate for. The study group consists of 40 children, aged 8.43 years (SD 3.5), on average, in whom CD was diagnosed on the basis of clinical symptoms, immunological and histopathological results. The patients’ height, weight, diet and biochemical tests were assessed three times: before diagnosis, after six months, and following one year of GFD. After one year, the patients’ weight and height increased but nutritional status (body mass index, BMI percentile) did not change significantly. The children’s diet before diagnosis was similar to that of the general Polish population: insufficient implementation of the dietary norm for energy, fiber, calcium, iodine, iron as well as folic acid, vitamins D, K, and E was observed. Over the year, the GFD of the children with CD did not change significantly for most of the above nutrients, or the changes were not significant for the overall assessment of the diet. Celiac patients following GFD may have a higher risk of iron, calcium and folate deficiencies. These results confirm the need for personalized nutritional education aimed at excluding gluten from the diet, as well as balancing the diet properly, in patients with CD. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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19 pages, 746 KiB

Open AccessArticle

Epidemiology of Malnutrition among Children with Cerebral Palsy in Low- and Middle-Income Countries: Findings from the Global LMIC CP Register

by Israt Jahan, Mohammad Muhit, Denny Hardianto, Francis Laryea, Samuel Kofi Amponsah, Amir Banjara Chhetri, Hayley Smithers-Sheedy, Sarah McIntyre, Nadia Badawi and Gulam Khandaker

Nutrients 2021, 13(11), 3676; https://doi.org/10.3390/nu13113676 - 20 Oct 2021

Cited by 19 | Viewed by 3474

Abstract

Background: This study aimed to describe the epidemiology of malnutrition among children with cerebral palsy (CP) in low- and middle-income countries (LMICs). Methods: Data from children with confirmed CP aged <18 years registered into the Global LMIC CP Register (GLM CPR) from Bangladesh, Indonesia, Nepal, and Ghana were included. Anthropometric measurements were collected, and nutritional status was determined following the WHO guidelines. Descriptive statistics and adjusted logistic regression were used to describe the nutritional status and identify predictors of malnutrition. Results: Between January 2015 and December 2020, 3619 children with CP were registered into the GLM CPR (median age at assessment: 7.0 years, 39% female). Overall, 72–98% of children from Bangladesh, Indonesia, Nepal, and Ghana had at least one form of undernutrition. The adjusted analysis showed, older age, low maternal education, spastic tri/quadriplegia, and Gross Motor Functional Classification System (GMFCS) levels III–V were significant predictors of underweight and stunting among children with CP in Bangladesh. In Nepal, female children, GMFCS III–V had higher odds of underweight and stunting. In Ghana, low maternal education was significantly associated with underweight, whereas older age and the presence of associated impairments were the significant predictors of stunting among children with CP. Having a GMFCS of III–V increased the odds of being underweight among children in Indonesia; however, no predictors were identified for stunting, as nearly all children with CP registered from Indonesia were stunted. Conclusion: Most children with CP in GLM CPR had undernutrition. Maternal education and moderate-to-severe motor impairment (GMFCS III–V) were significant predictors. Practical nutrition education to mothers/caregivers and management guidelines according to the motor severity using local resources could improve the nutritional outcome of children with CP in LMICs. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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12 pages, 1486 KiB

Open AccessArticle

Nutritional Status of Adolescent Afghan Refugees Living in Peshawar, Pakistan

by Anum Saeedullah, Muhammad Shabir Khan, Simon C. Andrews, Khalid Iqbal, Zia Ul-Haq, Syed Abdul Qadir, Haris Khan, Ishawu Iddrisu and Muhammad Shahzad

Nutrients 2021, 13(9), 3072; https://doi.org/10.3390/nu13093072 - 31 Aug 2021

Cited by 8 | Viewed by 4135

Abstract

Pakistan has hosted millions of Afghan refugees over the last several decades. Due to poor socioeconomic status, food insecurity and inadequate access to health care, these refugees are considered to be at high risk of malnutrition. Previous studies on nutritional assessment of high-risk populations (refugees) have focused mainly on women and children (0–59 months). The current study aims to assess nutritional status of adolescent Afghan refugees; the population who are equally vulnerable to malnutrition and its consequences. In this cross sectional study, the nutritional status of 206 adolescent (10–19 years old) Afghans boys and girls living in a refugee camp in Peshawar, Pakistan was assessed using standard methods. The results indicate a prevalence of stunting, thinness, and overweight and obesity at 35.3%, 4.4% and 14.8%, respectively. Furthermore, there was a significantly high prevalence of micronutrient deficiencies (vitamin D, 80.5%; vitamin B12, 41.9%; and folate, 28.2%); and anemia (10.1%). Together, these findings indicate that this vulnerable population group suffers from the double burden of malnutrition and are thus at serious risk of impaired psychosocial cognitive development, general ill-health and diminished wellbeing. This study therefore highlights the urgent need to include adolescents in regular screening and intervention programs of such at-risk populations. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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15 pages, 560 KiB

Open AccessArticle

Nutritional Status of Children with Cerebral Palsy in Gorkha, Nepal: Findings from the Nepal Cerebral Palsy Register

by Israt Jahan, Mohammad Muhit, Mahmudul Hassan Al Imam, Ratul Ghose, Amir Banjara Chhetri, Nadia Badawi and Gulam Khandaker

Nutrients 2021, 13(8), 2537; https://doi.org/10.3390/nu13082537 - 25 Jul 2021

Cited by 11 | Viewed by 3010

Abstract

Background: The study aimed to define the burden and underlying risk factors of malnutrition among children with cerebral palsy (CP) in Gorkha district, Nepal. Methods: The first population-based register of children with CP in Gorkha, Nepal (i.e., Nepal CP Register—NCPR) was established in 2018. Children aged <18 years with confirmed CP were registered following standard protocol. Nutritional status was determined based on anthropometric measurements (height/length, weight, mid-upper-arm-circumference) following WHO guidelines. Descriptive analyses and adjusted logistic regression were completed. Results: Between June–October 2018, 182 children with CP were registered into the NCPR (mean (SD) age at assessment: 10.3 (5.0) years, 37.4% female). Overall, 51.7%, 64.1%, and 29.3% children were underweight, stunted, and thin, respectively. Furthermore, 14.3% of children with CP aged <5 years had severe wasting. Underweight and stunting were significantly higher among children with spastic CP (p = 0.02, p < 0.001) and/or Gross Motor Function Classification System (GMFCS) level (III–V) (p = 0.01, p < 0.001) and/or who were not enrolled in school (p = 0.01, p < 0.001). In adjusted analysis, GMFCS level III–V and non-attendance to school significantly increased the odds of stunting by 8.2 (95% CI 1.6, 40.8) and 4.0 (95% CI 1.2, 13.2) times, respectively. Conclusions: the high rate of different forms of undernutrition among children with CP in Gorkha, Nepal is concerning. Need-based intervention should be taken as priority to improve their nutritional outcome. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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21 pages, 1156 KiB

Open AccessArticle

Mapping Geographical Differences and Examining the Determinants of Childhood Stunting in Ethiopia: A Bayesian Geostatistical Analysis

by Kedir Y. Ahmed, Kingsley E. Agho, Andrew Page, Amit Arora, Felix Akpojene Ogbo and on behalf of the Global Maternal and Child Health Research Collaboration (GloMACH)

Nutrients 2021, 13(6), 2104; https://doi.org/10.3390/nu13062104 - 19 Jun 2021

Cited by 11 | Viewed by 4607

Abstract

Understanding the specific geographical distribution of stunting is essential for planning and implementing targeted public health interventions in high-burdened countries. This study investigated geographical variations in the prevalence of stunting sub-nationally, and the determinants of stunting among children under 5 years of age in Ethiopia. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) dataset for children aged 0–59 months with valid anthropometric measurements and geographic coordinates (n = 9089). We modelled the prevalence of stunting and its determinants using Bayesian geospatially explicit regression models. The prevalence of stunting among children under five years was 36.3% (95% credible interval (CrI); 22.6%, 51.4%) in Ethiopia, with wide variations sub-nationally and by age group. The prevalence of childhood stunting ranged from 56.6% (37.4–74.6%) in the Mekelle Special zone of the Tigray region to 25.5% (10.5–48.9%) in the Sheka zone of the Southern Nations, Nationalities and Peoples region. Factors associated with a reduced likelihood of stunting in Ethiopia included non-receipt of breastmilk, mother’s BMI (overweight/obese), employment status (employed), and higher household wealth, while the enablers were residence in the “arid” geographic areas, small birth size of the child, and mother’s BMI (underweight). The prevalence and determinants of stunting varied across Ethiopia. Efforts to reduce the burden of childhood stunting should consider geographical heterogeneity and modifiable risk factors. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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9 pages, 242 KiB

Open AccessArticle

Micronutrient Deficiencies and Stunting Were Associated with Socioeconomic Status in Indonesian Children Aged 6–59 Months

by Fitrah Ernawati, Ahmad Syauqy, Aya Yuriestia Arifin, Moesijanti Y. E. Soekatri and Sandjaja Sandjaja

Nutrients 2021, 13(6), 1802; https://doi.org/10.3390/nu13061802 - 26 May 2021

Cited by 10 | Viewed by 5679

Abstract

Micronutrient deficiencies and stunting are known as a significant problem in most developing countries, including Indonesia. The objective of this study was to analyze the association between micronutrient deficiencies and stunting with socioeconomic status (SES) among Indonesian children aged 6–59 months. This cross-sectional study was part of the South East Asian Nutrition Surveys (SEANUTS). A total of 1008 Indonesian children were included in the study. Anemia, iron deficiency, vitamin A deficiency, vitamin D deficiency, and stunting were identified in this study. Structured questionnaires were used to measure SES. Differences between micronutrient parameters and anthropometric indicators with the SES groups were tested using one-way ANOVA with post-hoc test after adjusted for age, area resident (rural and urban), and sex. The highest prevalence of anemia, stunting, and severe stunting were found to be most significant in the lowest SES group at 45.6%, 29.3%, and 54.5%, respectively. Children from the lowest SES group had significantly lower means of Hb, ferritin, retinol, and HAZ. Severely stunted children had a significantly lower mean of Hb concentration compared to stunted and normal height children. Micronutrient deficiencies, except vitamin D, and stunting, were associated with low SES among Indonesian children aged 6–59 months. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

21 pages, 283 KiB

Open AccessArticle

Impacts of a School-Based Intervention That Incorporates Nutrition Education and a Supportive Healthy School Canteen Environment among Primary School Children in Malaysia

by Choon Huey Teo, Yit Siew Chin, Poh Ying Lim, Shahril Azian Haji Masrom and Zalilah Mohd Shariff

Nutrients 2021, 13(5), 1712; https://doi.org/10.3390/nu13051712 - 18 May 2021

Cited by 13 | Viewed by 8854

Abstract

In this study, a school nutrition program (SNP) that incorporates nutrition education and a healthy school canteen environment was developed to improve nutrition knowledge among intervention respondents and provide a healthier environment for them to practice healthy eating. In the current study, we evaluated the impacts of the SNP on eating behaviors, physical activity, body mass index-for-age (BAZ), and cognitive performance at pre-intervention, post-intervention, and 3-month follow-up points between intervention and comparison groups. This intervention study involved 523 primary school children (7–11 years old) from six selected schools in Batu Pahat District, Malaysia. Each respondent completed anthropometric and cognitive performance assessments and a set of standardized questionnaire at pre-intervention, post-intervention, and 3-month follow-up points. Multiple linear mixed model analysis was performed to determine the impacts of that SNP after being adjusted for covariates. After the program, the intervention group increased their frequency of breakfast, lunch, and dinner consumption and morning tea snacking and showed more frequent physical activity and better cognitive performance as compared to the comparison group overtime (p < 0.05). At 3-month follow-up, the intervention group showed lower BAZ scores than their comparison counterparts (p < 0.05). The SNP showed positive effects on eating behaviors, physical activity, BAZ, and cognitive performance in school children. Hence, the SNP is highly recommended for all primary school children. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

9 pages, 1542 KiB

Open AccessArticle

A High Prevalence of Vitamin D Deficiency Observed in an Irish South East Asian Population: A Cross-Sectional Observation Study

by Eamon Laird, James Bernard Walsh, Susan Lanham-New, Maria O’Sullivan, Rose Anne Kenny, Helena Scully, Vivion Crowley and Martin Healy

Nutrients 2020, 12(12), 3674; https://doi.org/10.3390/nu12123674 - 28 Nov 2020

Cited by 11 | Viewed by 3674

Abstract

At northern latitudes, non-ethnic population groups can be at an increased risk of vitamin D deficiency (defined as a 25-hydroxyvitamin D [25(OH)D] status ≤30 nmol/L). The vitamin D status of ethnic minority groups has been examined both in UK and European populations, but not in the Irish context. The aim of this study is to assess the vitamin D status from a selection of the Dublin population of South East Asian descent. A search was conducted, using the laboratory information system of St James’s Hospital, Dublin, for vitamin D requests by General practitioners. From 2013 to 2016, 186 participants were identified and 25(OH)D analysis was quantified using liquid chromatography-tandem mass spectrometry (LC-MS-MS). Overall, the median age was 32 years, 51% were male, and the 25(OH)D concentration ranged from 10 to 154 nmol/L. In total, 66.7% of the total sample were vitamin D deficient and 6.7% had a 25(OH)D status greater than 50 nmol/L (the 25(OH)D concentration defined by the EU as ‘sufficient’). Females had a significantly higher 25(OH)D concentration than males (25.0 vs. 18.0 nmol/L; p = 0.001) but both groups had a significant proportion with deficient status (56% and 76.8%, respectively). Seasonal variation of 25(OH)D was not evident while high rates of deficiency were also observed in those aged <18 years and >50 years. Given the importance of vitamin D for health, this sub-population could be at a significantly increased risk of rickets, impaired bone metabolism, and osteoporosis. In addition, vitamin D deficiency has been associated with several non-bone related conditions, including cardiovascular disease and diabetes. Currently, there is no unique vitamin D intake or vitamin D status maintenance guidelines recommended for adults of non-Irish descent; this needs to be considered by the relevant public health bodies in Ireland. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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Review

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16 pages, 590 KiB

Open AccessReview

Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review

by Israt Jahan, Risad Sultana, Mohammad Muhit, Delwar Akbar, Tasneem Karim, Mahmudul Hassan Al Imam, Manik Chandra Das, Hayley Smithers-Sheedy, Sarah McIntyre, Nadia Badawi and Gulam Khandaker

Nutrients 2022, 14(6), 1211; https://doi.org/10.3390/nu14061211 - 12 Mar 2022

Cited by 8 | Viewed by 4003

Abstract

Background: Malnutrition is substantially higher among children with cerebral palsy (CP) in low- and middle-income countries (LMICs) when compared with the general population. Access to appropriate interventions is crucial for better management of malnutrition and nutritional outcomes of those children. We aimed to review the existing evidence on nutrition interventions for children with CP in LMICs. Methods: Online databases, i.e., PubMed and Scopus, and Google Scholar were searched up to 10 January 2022, to identify peer-reviewed publications/evidence on LMIC focused nutritional management guidelines/interventions. Following title screening and abstract review, full articles that met the inclusion/exclusion criteria were retained for data charting. Information about the study characteristics, nutrition interventions, and their effectiveness were extracted. Descriptive data were reported. Results: Eight articles published between 2008 and 2019 were included with data from a total of n = 252 children with CP (age range: 1 y 0 m–18 y 7 m, 42% female). Five studies followed experimental design; n = 6 were conducted in hospital/clinic/center-based settings. Four studies focused on parental/caregiver training; n = 2 studies had surgical interventions (i.e., gastrostomy) and n = 1 provided neurodevelopmental therapy feeding intervention. Dietary modification as an intervention (or component) was reported in n = 5 studies and had better effect on the nutritional outcomes of children with CP compared to interventions focused on feeding skills or other behavioral modifications. Surgical interventions improved nutritional outcomes in both studies; however, none documented any adverse consequences of the surgical interventions. Conclusion: There is a substantial knowledge gap on nutrition interventions for children with CP in LMICs. This hinders the development of best practice guidelines for the nutritional management of children with CP in those settings. Findings suggest interventions directly related to growth/feeding of children had a better outcome than behavioral interventions. This should be considered in planning of nutrition-focused intervention or comprehensive services for children with CP in LMICs. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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14 pages, 5828 KiB

Open AccessReview

Burden of Malnutrition among Children and Adolescents with Cerebral Palsy in Arabic-Speaking Countries: A Systematic Review and Meta-Analysis

by Sami Mukhdari Mushta, Israt Jahan, Risad Sultana, Sarah McIntyre, Al-Mamoon Badahdah, Nihad A. Almasri, Catherine King, Harunor Rashid, Nadia Badawi and Gulam Khandaker

Nutrients 2021, 13(9), 3199; https://doi.org/10.3390/nu13093199 - 15 Sep 2021

Cited by 5 | Viewed by 6254

Abstract

Background: We aimed to estimate the burden and underlying risk factors of malnutrition among children and adolescents with cerebral palsy in Arabic-speaking countries. Methods: OVID Medline, OVID Embase, CINAHL via EBSCO, Cochrane Library, and SCOPUS databases were searched up to 3 July 2021. Publications were reviewed to identify relevant papers following pre-defined inclusion/exclusion criteria. Two reviewers independently assessed the studies for inclusion. Data extraction was independently completed by two reviewers. Descriptive and pooled analysis has been reported. Results: From a total of 79 records screened, nine full-text articles were assessed for eligibility, of which seven studies met the inclusion criteria. Study characteristics, anthropometric measurements used, and nutritional outcome reported varied between the studies. The included studies contained data of total 400 participants aged 1–18 years. Overall, (mean: 71.46%, 95% confidence interval: 55.52–85.04) of children with cerebral palsy had at least one form of malnutrition. Severe gross motor function limitation, feeding difficulties, cognitive impairment and inadequate energy intake were the commonly reported underlying risk factors for malnutrition among children with cerebral palsy. Conclusions: The burden of malnutrition is high among children with cerebral palsy in Arabic-speaking countries. More research is needed for better understanding of this public health issue in these countries. Full article

(This article belongs to the Special Issue Nutritional Status among Vulnerable Populations)

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