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The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia

Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of was...

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Autores principales: Tsegaye, Adino Tesfahun, Pavlinac, Patricia B., Turyagyenda, Lynnth, Diallo, Abdoulaye H., Gnoumou, Blaise S., Bamouni, Roseline M., Voskuijl, Wieger P., van den Heuvel, Meta, Mbale, Emmie, Lancioni, Christina L., Mupere, Ezekiel, Mukisa, John, Lwanga, Christopher, Atuhairwe, Michael, Chisti, Mohammod J., Ahmed, Tahmeed, Shahid, Abu S.M.S.B., Saleem, Ali F., Kazi, Zaubina, Singa, Benson O., Amam, Pholona, Masheti, Mary, Berkley, James A., Walson, Judd L., Tickell, Kirkby D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9460249/
https://www.ncbi.nlm.nih.gov/pubmed/36079736
http://dx.doi.org/10.3390/nu14173481
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author Tsegaye, Adino Tesfahun
Pavlinac, Patricia B.
Turyagyenda, Lynnth
Diallo, Abdoulaye H.
Gnoumou, Blaise S.
Bamouni, Roseline M.
Voskuijl, Wieger P.
van den Heuvel, Meta
Mbale, Emmie
Lancioni, Christina L.
Mupere, Ezekiel
Mukisa, John
Lwanga, Christopher
Atuhairwe, Michael
Chisti, Mohammod J.
Ahmed, Tahmeed
Shahid, Abu S.M.S.B.
Saleem, Ali F.
Kazi, Zaubina
Singa, Benson O.
Amam, Pholona
Masheti, Mary
Berkley, James A.
Walson, Judd L.
Tickell, Kirkby D.
author_facet Tsegaye, Adino Tesfahun
Pavlinac, Patricia B.
Turyagyenda, Lynnth
Diallo, Abdoulaye H.
Gnoumou, Blaise S.
Bamouni, Roseline M.
Voskuijl, Wieger P.
van den Heuvel, Meta
Mbale, Emmie
Lancioni, Christina L.
Mupere, Ezekiel
Mukisa, John
Lwanga, Christopher
Atuhairwe, Michael
Chisti, Mohammod J.
Ahmed, Tahmeed
Shahid, Abu S.M.S.B.
Saleem, Ali F.
Kazi, Zaubina
Singa, Benson O.
Amam, Pholona
Masheti, Mary
Berkley, James A.
Walson, Judd L.
Tickell, Kirkby D.
author_sort Tsegaye, Adino Tesfahun
collection PubMed
description Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6–23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.
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spelling pubmed-94602492022-09-10 The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia Tsegaye, Adino Tesfahun Pavlinac, Patricia B. Turyagyenda, Lynnth Diallo, Abdoulaye H. Gnoumou, Blaise S. Bamouni, Roseline M. Voskuijl, Wieger P. van den Heuvel, Meta Mbale, Emmie Lancioni, Christina L. Mupere, Ezekiel Mukisa, John Lwanga, Christopher Atuhairwe, Michael Chisti, Mohammod J. Ahmed, Tahmeed Shahid, Abu S.M.S.B. Saleem, Ali F. Kazi, Zaubina Singa, Benson O. Amam, Pholona Masheti, Mary Berkley, James A. Walson, Judd L. Tickell, Kirkby D. Nutrients Article Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6–23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery. MDPI 2022-08-24 /pmc/articles/PMC9460249/ /pubmed/36079736 http://dx.doi.org/10.3390/nu14173481 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Tsegaye, Adino Tesfahun
Pavlinac, Patricia B.
Turyagyenda, Lynnth
Diallo, Abdoulaye H.
Gnoumou, Blaise S.
Bamouni, Roseline M.
Voskuijl, Wieger P.
van den Heuvel, Meta
Mbale, Emmie
Lancioni, Christina L.
Mupere, Ezekiel
Mukisa, John
Lwanga, Christopher
Atuhairwe, Michael
Chisti, Mohammod J.
Ahmed, Tahmeed
Shahid, Abu S.M.S.B.
Saleem, Ali F.
Kazi, Zaubina
Singa, Benson O.
Amam, Pholona
Masheti, Mary
Berkley, James A.
Walson, Judd L.
Tickell, Kirkby D.
The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia
title The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia
title_full The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia
title_fullStr The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia
title_full_unstemmed The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia
title_short The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia
title_sort role of food insecurity and dietary diversity on recovery from wasting among hospitalized children aged 6–23 months in sub-saharan africa and south asia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9460249/
https://www.ncbi.nlm.nih.gov/pubmed/36079736
http://dx.doi.org/10.3390/nu14173481
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