Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M et al.. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371, 243-260

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
The Lancet (Impact Factor: 45.22). 02/2008; 371(9608):243-60. DOI: 10.1016/S0140-6736(07)61690-0
Source: PubMed


Maternal and child undernutrition is highly prevalent in low-income and middle-income countries, resulting in substantial increases in mortality and overall disease burden. In this paper, we present new analyses to estimate the effects of the risks related to measures of undernutrition, as well as to suboptimum breastfeeding practices on mortality and disease. We estimated that stunting, severe wasting, and intrauterine growth restriction together were responsible for 2·2 million deaths and 21% of disability-adjusted life-years (DALYs) for children younger than 5 years. Deficiencies of vitamin A and zinc were estimated to be responsible for 0·6 million and 0·4 million deaths, respectively, and a combined 9% of global childhood DALYs. Iron and iodine deficiencies resulted in few child deaths, and combined were responsible for about 0·2% of global childhood DALYs. Iron deficiency as a risk factor for maternal mortality added 115 000 deaths and 0·4% of global total DALYs. Suboptimum breastfeeding was estimated to be responsible for 1·4 million child deaths and 44 million DALYs (10% of DALYs in children younger than 5 years). In an analysis that accounted for co-exposure of these nutrition-related factors, they were together responsible for about 35% of child deaths and 11% of the total global disease burden. The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.

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    • "They benefit humans by acting as powerful free-radical scavengers and providing pro vitamin A activity. Tragically, over half a million deaths of children underage the age five group are reported annually due to β-carotene (provitamin A) deficiency, a major carotenoid found in plants [3] [4]. Carotenoids are also implicated in decreasing the incidence of various eye diseases [5]. "
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    ABSTRACT: A high-throughput, robust and reliable method for simultaneous analysis of five carotenoids, four chlorophylls and one tocopherol was developed for rapid screening large sample populations to facilitate molecular biology and plant breeding. Separation was achieved for 10 known analytes and four unknown carotenoids in a significantly reduced run time of 10min. Identity of the 10 analytes was confirmed by their UV-Vis absorption spectras. Quantification of tocopherol, carotenoids and chlorophylls was performed at 290nm, 460nm and 650nm respectively. In this report, two sub two micron particle core-shell columns, Kinetex from Phenomenex (1.7μm particle size, 12% carbon load) and Cortecs from Waters (1.6μm particle size, 6.6% carbon load) were investigated and their separation efficiencies were evaluated. The peak resolutions were >1.5 for all analytes except for chlorophyll-a' with Cortecs column. The ruggedness of this method was evaluated in two identical but separate instruments that produced CV<2 in peak retentions for nine out of 10 analytes separated.
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    • "Because the development of caries or periodontitis is usually slow, a 3-to 6-month long dietary supplementation would not be likely to have detectable dental effects under most situations. However, the impact might be intensified during pregnancy and especially among women in lowincome contexts due to the impaired immune responses (Barak et al. 2003), and the high prevalence of both nutritional deficiencies (Black et al. 2008) and untreated oral diseases (Petersen et al. 2005; Marcenes et al. 2013). The scarcity of preventive interventions and available dentistry services (Petersen 2005; Beaglehole et al. 2009) in resource-poor settings may further reinforce the effects. "
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    ABSTRACT: Nutritional supplementation during pregnancy is increasingly recommended especially in low-resource settings, but its oral health impacts have not been studied. Our aim was to examine whether supplementation with multiple micronutrients (MMN) or small-quantity lipid-based nutrient supplements affects dental caries development or periodontal health in a rural Malawian population. The study was embedded in a controlled iLiNS-DYAD trial that enrolled 1391 pregnant women <20 gestation weeks. Women were provided with one daily iron-folic acid capsule (IFA), one capsule with 18 micronutrients (MMN) or one sachet of lipid-based nutrient supplements (LNS) containing protein, carbohydrates, essential fatty acids and 21 micronutrients. Oral examination of 1024 participants was conducted and panoramic X-ray taken within 6 weeks after delivery. The supplement groups were similar at baseline in average socio-economic, nutritional and health status. At the end of the intervention, the prevalence of caries was 56.7%, 69.1% and 63.3% (P = 0.004), and periodontitis 34.9%, 29.8% and 31.2% (P = 0.338) in the IFA, MMN and LNS groups, respectively. Compared with the IFA group, women in the MMN group had 0.60 (0.18-1.02) and in the LNS group 0.59 (0.17-1.01) higher mean number of caries lesions. In the absence of baseline oral health data, firm conclusions on causality cannot be drawn. However, although not confirmatory, the findings are consistent with a possibility that provision of MMN or LNS may have increased the caries incidence in this target population. Because of the potential public health impacts, further research on the association between gestational nutrient interventions and oral health in low-income settings is needed. © 2015 John Wiley & Sons Ltd.
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    • "Improvements in height-for-age relative to the global reference group are never fully recovered after the second year and the effects of stunting are largely irreversible. While there is some evidence of potential height catch-up during adolescence in children with early childhood stunting (Adair, 1999; Prentice et al., 2013), the interpretation of observed catch-up growth has been disputed (Leroy et al. 2013; Lundeen et al. 2014) and the most recent and comprehensive reviews of the nutrition literature call for continued focus on the period from pregnancy through the first two years of life—the crucial period during which a child's stunting status can have lasting impacts from growth and development through adulthood (Black et al. 2008; Victora et al. 2008; Ruel et al. 2013). "
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    ABSTRACT: Data from the 2011 Nepal Demographic Health Survey are combined with satellite remotely sensed Normalized Difference Vegetation Index (NDVI) data to evaluate whether interannual variability in weather is associated with child health. For stunting, we focus on children older than 24 months of age. NDVI anomaly averages during cropping months are evaluated during the year before birth, the year of birth, and the second year after birth. For wasting, we assess children under 59 months of age and relate growth to NDVI averages for the current and most recent growing periods. Correlations between short-run indicators of child growth and intensity of green vegetation are generally positive. Regressions that control for a range of child-, mother- and household-specific characteristics produce mixed evidence regarding the role of NDVI anomalies during critical periods in a child's early life and the subsequent probability of stunting and wasting. Overall findings suggest that the relationship between environmental conditions and child growth are heterogeneous across the landscape in Nepal and, in many cases, highly non-linear and sensitive to departures from normality. Copyright © 2015 Elsevier Ltd. All rights reserved.
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