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191 result(s)
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191 result(s)
Journal Article > ResearchFull Text

Body mass index trajectories and association with tuberculosis risk in a cohort of household contacts in Southern Africa

Clin Infect Dis. 28 April 2025; DOI:doi: 10.1093/cid/ciaf222
Larsson L, Calderwood CJ, Marambire ET, Held K, Banze D,  et al.
Clin Infect Dis. 28 April 2025; DOI:doi: 10.1093/cid/ciaf222

BACKGROUND

Studies have demonstrated an inverse log-linear relationship between body mass index (BMI) and tuberculosis incidence. However, a person’s BMI is dynamic and longitudinal changes may be more informative than cross-sectional assessments. We evaluate the association between cross-sectional and changing BMI and risk of tuberculosis and describe longitudinal trajectories in a high-risk cohort.


METHODS

ERASE-TB was a prospective longitudinal cohort study of household contacts ≥10 years in Southern Africa (Zimbabwe, Tanzania, and Mozambique), with 6-monthly follow-up up to 24 months. Associations between BMI and tuberculosis were investigated based on baseline (including haemoglobin) and changing BMI, using logistic, Poisson, and Cox models. Prevalent tuberculosis was defined as diagnosis during <30 days after recruitment. Growth mixture modelling (GMM) was used to model longitudinal latent trajectories.


RESULTS

Of 2,107 recruited household contacts (621 [29.5%] adolescents and 1,310 [62.2%] female), 520 (24.7%) were underweight. There were 21 and 41 people diagnosed with prevalent and incident tuberculosis, of whom 5/21 (23.8%) and 12/41 (29.3%) were underweight. Being underweight and anaemic (aHR: 3.77, 95% CI: 1.50-9.51) and >10% negative change in BMI during follow-up (aIRR: 2.27 (95% CI: 0.22-22.9) were associated with increased risk of incident tuberculosis. The association between continuous BMI-for-age Z-scores were non-linear, with increased risk of tuberculosis with lower BMI. Four latent groups were defined in the GMM: increasing, decreasing, and low/high stable BMI.


CONCLUSIONS

Declining BMI, regardless of absolute value, is a strong predictor of tuberculosis among household contacts. Longitudinal measurements should be considered in active case finding among tuberculosis-affected households.

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Journal Article > CommentaryFull Text

Leveraging nutritional rehabilitation and tuberculosis programmes to tackle tuberculosis and severe acute malnutrition in children

Lancet Child Adolesc Health. 23 March 2025; Online ahead of print; DOI:10.1016/S2352-4642(25)00062-8
Vonasek BJ, Marcy O, Armour J, Casenghi M, Cazes C,  et al.
Lancet Child Adolesc Health. 23 March 2025; Online ahead of print; DOI:10.1016/S2352-4642(25)00062-8

Each day more than 500 children younger than 15 years die from tuberculosis. Considerable progress has been made to control tuberculosis, but the impact on reducing the burden of childhood tuberculosis lags behind that in adults. A key barrier to decreasing morbidity and mortality associated with childhood tuberculosis is the paucity of accurate and feasible diagnostic tools for this population. WHO estimates that 58% of children younger than 5 years with tuberculosis are never diagnosed or reported.



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Journal Article > ResearchFull Text

Understanding the medical challenges for the diagnosis and treatment of bilateral pitting oedema in children: a qualitative study

PLOS Glob Public Health. 18 March 2025; Volume 5 (Issue 3); e0004125.; DOI:10.1371/journal.pgph.0004125
Scarpa G, Sagara J, Mambula C, Koudika MH, Loddo F,  et al.
PLOS Glob Public Health. 18 March 2025; Volume 5 (Issue 3); e0004125.; DOI:10.1371/journal.pgph.0004125

Severely malnourished patients can present with bilateral pitting oedema, which is a common sign of Kwashiorkor. However, bilateral pitting oedema can also be an expression of other pathologies. In Mali and DRC, the number of children presenting with bilateral pitting oedema at MSF (Médecins Sans Frontiers/Doctors Without Borders) hospitals are up to 30% (Mali) and 49% (DRC) higher than in other countries, however, the reasons underlying this trend are unknown. Through this qualitative study, we aimed to explore the perspectives and lived experiences of health professionals on the diagnosis and management of children with bilateral pitting oedema. Using a participatory approach, we conducted 21 in-depth interviews, and 2 focus groups with health professionals at MSF health facilities who had worked in the settings of Koutiala (Mali) and Rutshuru (DRC) for at least 6 months. The understanding of the bilateral pitting oedema phenomenon is complex. Health workers described clinical obstacles to reducing mortality, including: i) difficulties making the diagnosis due to a lack of specialized staff and insufficient resources, ii) challenges treating complications that may arise due to the complexity of the diseases associated with bilateral pitting oedema, and iii) lack of scientific evidence in the literature explaining the physiopathology of bilateral pitting oedema. Study participants shared several key recommendations for reducing mortality among children presenting with bilateral pitting oedema, including prevention of bilateral pitting oedema at the community level, standardization of the diagnostic process, strengthening of medical training, and better collaboration both within the medical teams and between teams and the children’s families.

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Journal Article > ResearchFull Text

Serum insulin-like growth factor 1 in young children with moderate acute malnutrition: Secondary analysis of a randomised trial in Burkina Faso

British Journal of Nutrition. 13 February 2025; Volume 133 (Issue 4); 481-490.; DOI:10.1017/S0007114525000212
Helt TW, Cichon B, Fabiansen C, Iuel-Brockdorff AS, Yaméogo CW,  et al.
British Journal of Nutrition. 13 February 2025; Volume 133 (Issue 4); 481-490.; DOI:10.1017/S0007114525000212

Insulin-like growth factor 1 (IGF-1) is an important growth factor in childhood. We aimed to investigate the impact of food supplements for the treatment of moderate acute malnutrition (MAM) on serum IGF-1 (sIGF-1). Secondary analysis of a randomised 2 × 2 × 3 factorial nutrition trial was performed. Children aged 6–23 months with MAM received 2093 kJ/d as lipid-based nutrient supplement (LNS) or corn soy blend (CSB), containing either dehulled soya or soya isolate and different quantities of dried skimmed milk (0 %, 20 % or 50 % of total protein) for 12 weeks. The trial was double-blind with regard to soya and milk but not to matrix (LNS v. CSB). sIGF-1 was measured at inclusion and after 12 weeks of supplementation. Of 1609 children enrolled, 1455 (90 %) had sIGF-1 measured at both time points. During supplementation, sIGF-1 increased 6·7 (95 % CI 6·1, 7·3) ng/ml compared with an expected age-dependent decrease of 0·3 (95 % CI 0·2, 0·4) ng/ml. Children who received LNS v. CSB had a lower increase in sIGF-1 (–8 %, 95 % CI − 12, −3). The effect of LNS was partly attenuated when sIGF-1 was corrected for inflammation. Children who received soya isolate compared with dehulled soya had a higher increase in sIGF-1 (6 %, 95 % CI 1, 12). Milk content did not affect sIGF-1. Overall, sIGF-1 increased during supplementation. The lower increase with LNS v. CSB was only partly explained by increased inflammation with LNS and needs further investigation. Isolate v. dehulled soya led to a higher increase which may be due to antinutrients in dehulled soya.

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Journal Article > ResearchFull Text

Serum insulin-like growth factor 1 in young children with moderate acute malnutrition: Secondary analysis of a randomized trial in Burkina Faso

British Journal of Nutrition. 13 February 2025; Online ahead of print; 1-22.; DOI:10.1017/S0007114525000212
Helt TW, Cichon B, Fabiansen C, Iuel-Brockdorff AS, Yaméogo CW,  et al.
British Journal of Nutrition. 13 February 2025; Online ahead of print; 1-22.; DOI:10.1017/S0007114525000212

Insulin-like growth factor 1 (IGF-1) is an important growth factor in childhood. We aimed to investigate the impact of food supplements for treatment of moderate acute malnutrition (MAM) on serum IGF-1 (sIGF-1). Secondary analysis of a randomized 2×2×3 factorial nutrition trial was performed. Children aged 6-23 months with MAM received 2093 kJ/day as lipid-based nutrient supplement (LNS) or corn-soy blend (CSB), containing either dehulled soy or soy isolate and different quantities of dried skimmed milk (0%, 20% or 50% of total protein) for 12 weeks. The trial was double-blind with regard to soy and milk, but not to matrix (LNS vs. CSB). sIGF-1 was measured at inclusion and after 12 weeks supplementation. Of 1609 children enrolled, 1455 (90%) had sIGF-1 measured at both time points. During supplementation sIGF-1 increased 6.7 (95%CI 6.1; 7.3) ng/ml compared with an expected age-dependent decrease of 0.3 (95%CI 0.2; 0.4) ng/ml. Children who received LNS vs. CSB had lower increase in sIGF-1 (-8%, 95%CI -12; -3). The effect of LNS was partly attenuated when sIGF-1 was corrected for inflammation. Children who received soy isolate compared with dehulled soy had higher increase in sIGF-1 (6%, 95%CI 1; 12). Milk content did not affect sIGF-1. Overall, sIGF-1 increased during supplementation. The lower increase with LNS vs. CSB was only partly explained by increased inflammation with LNS, and needs further investigation. Isolate vs. dehulled soy led to a higher increase which may be due to antinutrients in dehulled soy.


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Journal Article > ResearchAbstract Only

Tackling disease-related malnutrition in resource-limited settings: An international position paper

J Nutr Metab. 1 February 2025; DOI:10.1016/j.clnu.2025.02.028
Cardenas D, Ferreira IR, Toulson Davisson Correia MI, Barbaggallo M, Lal S,  et al.
J Nutr Metab. 1 February 2025; DOI:10.1016/j.clnu.2025.02.028

BACKGROUND

Considering the challenges of providing nutritional care in resource-limited settings (RLS), the International Working Group for Patients’ Right to Nutritional Care (WG) organized and expert meeting to propose recommendations and strategies to promote access to nutritional care and address disease-related malnutrition (DRM).


METHODS

During the ESPEN Congress in Milan, September 9 2024, a panel of 30 experts discussed the results of an online survey, and built consensus statements aimed at defining strategies and recommendations required to address barriers to accessing nutrition care in RLS. The online survey was developed to assess barriers to providing nutrition care in RLS and was completed by 58 respondents based in Low- and Middle-income Countries (LMIC), between July and August 2024.


RESULTS

Barriers to delivering quality nutrition care in these settings included low medical awareness and lack of the following: patient and family knowledge about DRM and its impact; nutrition risk screening and care implementation protocols; adequate reimbursement; medical nutrition dispositive; adapted diets; nutrition protocols; access to home medical and nutrition therapy. Gaps identified included: a) epidemiological data and evidence for best practices, b) education, training and capacity building and c) strengthening health systems.


CONCLUSIONS

Tackling DRM in resource-limited settings is challenging due to the high burden of malnutrition and the fact that current guidelines may not be fully applicable. The WG recommend a three-step strategy to promote access to nutrition care culminating in the development and implementation of resource –stratified guidelines.


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Journal Article > ResearchFull Text

Characteristics and treatment outcomes of malnutrition among infants aged less than 6 months in North–East Nigeria (2019–2022)

Matern Child Nutr. 4 June 2024; Online ahead of print; DOI:10.1111/mcn.13676
Amat Camacho N, Husain F, Bahya‐Batinda D, Aung E, Chara A,  et al.
Matern Child Nutr. 4 June 2024; Online ahead of print; DOI:10.1111/mcn.13676
Recommendations for the management of malnutrition among infants aged less than 6 months (<6 m) are based on limited evidence. This study aimed to describe the characteristics, treatment outcomes and outcome‐associated factors among malnourished infants <6 m admitted at Médecins Sans Frontières (MSF) inpatient and ambulatory therapeutic feeding centres (ITFC and ATFC) in North–East Nigeria, 2019–2022. We conducted a descriptive analysis of the cohorts and logistic regression to measure the association between two selected outcomes—inpatient mortality and defaulting from the ambulatory programme—and possible factors associated. In total, 940 infants <6 m were admitted at ITFC. Most of them presented severe acute malnutrition and comorbidities, with diarrhoea being the most frequent. On discharge, 13.3% (n = 125) of infants were cured, 72.9% (n = 684) stabilized (referred to ATFC), 6.5% (n = 61) left against medical advice and 4.2% (n = 39) died. The median length of hospital stay was 10 days [IQR 7–14]. A hospital stay shorter than 10 days was significantly associated with inpatient mortality (aOR = 12.51, 95% confidence interval [CI] = 3.72–42.11, p ≤ 0.01). Among 561 infants followed up at the ATFC, only 2.8% reported comorbidities. On discharge, 80.9% (n = 429) were cured, 16.2% (n = 86) defaulted and 1.1% (n = 6) died. Male sex (aOR = 1.94, 95% CI = 1.15–3.27, p = 0.01), internally displaced status (aOR = 1.70, 95% CI = 1.05–2.79, p = 0.03) and <−3 WLZ (aOR = 1.95, 95% CI = 1.05–3.63, p = 0.03) were significantly associated with programme defaulting. Stabilization and recovery rates among malnourished infants <6 m in the studied project align with acceptable standards in this humanitarian setting. Notable defaulting rates from outpatient care should be further explored.More
Conference Material > Poster

A nutrition linelist

Mousset M, Grellety E
Epicentre Scientific Day 2024. 23 May 2024
Conference Material > Poster

Enquête de mortalité, de prévalence nutritionnelle et de couverture vaccinale rougeole sur 3 camps de réfugiés soudanais et de retournés tchadiens à l’est du Tchad

Ouedraogo P, Simons E, Grellety E
Epicentre Scientific Day 2024. 23 May 2024
Français
Conference Material > Slide Presentation

Morbidity patterns and factors associated with mortality in the Inpatient Therapeutic Feeding Centre in Abs General Hospital, Yemen- an unmatched case-control study

Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E,  et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/Rcembdt4Bk