Underweight and stunting are highly prevalent public health problems in developing countries, particularly among populations exposed to food insecurity and chronic malnutrition. Underweight results from relatively recent malnutrition whereas empirical research has shown that early childhood malnutrition is a strong predictor of stunting. Dietary diversity has been recognized as an indicator of food security, with consumption of more food groups suggesting better nourishment. Greater dietary diversity has been associated with better nutritional outcomes and improved micronutrient intake. Zinc, an essential mineral, plays a critical role in child growth and development. A deficiency in Zinc may contribute to increased risk for stunting in childhood and adolescence. This cross-sectional study examined the independent associations between underweight, stunting, dietary diversity, and dietary intake of zinc among a sample of never-married adolescent girls (n=307) living in Kilosa District, Tanzania. Dietary, anthropometric, physical activity, morbidity and demographic data were collected. The associations between underweight (determined as weight by age less than 5th percentile of WHO reference) and dietary diversity (defined by the number of food groups consumed by adolescent girls); as well as stunting (determined as height by age less than 3rd percentile of WHO reference) and dietary intake of zinc were tested using multivariate analyses. We found that adolescent girls’ diets were largely deficient in macronutrients and micronutrients, with the mean intake of energy and protein being 810kcals/d and 21.9g/d, respectively. The rates of underweight and stunting were 16.2% and 62.2%, respectively. Greater dietary diversity was associated with decreased risk of underweight among adolescent girls, after adjusting for confounders including age, village location, school enrollment, pubertal status, socioeconomic status and energy intake, (OR, 0.55, 95%CI 0.39-0.98, p<0.05). Similarly, higher intake of zinc was found to be associated with lower risk of stunting, after controlling for age, physical activity, BMI, energy intake and individual’s dietary diversity (OR, 0.87; 95%CI, 0.76-0.99, p<0.05). In conclusion, these findings suggest that dietary diversity and nutrient intake, especially intake of zinc, may play an important role in the long-term nutritional health of adolescent girls. Longitudinal studies examining these associations in developing countries settings are needed.

Adolescent Nutritional Status and its Association with Village-level Factors in Tanzania Undernutrition is associated with multiple risk factors operating at different levels, from the individual level to household and community levels. Empirical research has shown that contextual or environmental factors influence nutritional status, but very few studies have examined association between these factors and undernutrition among adolescents. This cross-sectional study used a two-level hierarchical nonlinear model to investigate the association between village-level factors and undernutrition (BMI for Age < 5th percentile of the WHO reference) among a sample of adolescents, (n=670) from 28 villages in Kilosa District, Tanzania. Our hypothesis that contextual factors are associated with undernutrition was supported. The odds of undernutrition were more than twice as high among adolescents from villages with low income expenditure values compared to villages with middle or high income expenditure values (OR: 2.28; CI: 1.429,3.645). Similarly, community food insecurity was a significant predictor of undernutrition (OR: 0.63; CI: 0.467, 0.847; p < 0.05). We also observed a positive association between improved nutritional status and dietary diversity. The multilevel analytic framework employed in this study has demonstrated that both individual-level and community-level characteristics are important predictors of undernutrition in adolescents. Our findings have important policy implications in relation to developing targeted intervention strategies that improve village SES and diversified diets, which in turn may contribute to improved nutritional health for adolescents and their household members.

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Yes / Background: National guidelines emphasize healthy eating to promote wellbeing and prevention of non-communicable diseases. The perceived healthiness of food is determined by many factors affecting food intake. A positive perception of healthy eating has been shown to be associated with greater diet quality. Internet-based methodologies allow contact with large populations. Our present study aims to design and a short nutritional perception questionnaire, to be used as a screening tool for assessing nutritional status, and to predict an optimal level of personalisation in nutritional advice delivered via the Internet. Methods: Data from all participants who were screened and then enrolled into the Food4Me proof-of-principle study (n=2369) were used to determine the optimal items for inclusion in a novel screening tool, the Nutritional Perception Screening Questionnaire-9 (NPSQ9). Exploratory and confirmatory factor analyses were performed on anthropometric and biochemical data and on dietary indices acquired from participants who had completed the Food4Me dietary intervention (n=1153). Baseline and intervention data were analysed using linear regression and linear mixed regression, respectively. Results: A final model with 9 NPSQ items was validated against the dietary intervention data. NPSQ9 scores were inversely associated with BMI (β=-0.181, p<0.001) and waist circumference (Β=-0.155, p<0.001), and positively associated with total carotenoids (β=0.198, p<0.001), omega-3 fatty acid index (β=0.155, p<0.001), Healthy Eating Index (HEI) (β=0.299, p<0.001) and Mediterranean Diet Score (MDS) (β=0. 279, p<0.001). Findings from the longitudinal intervention study showed a greater reduction in BMI and improved dietary indices among participants with lower NPSQ9 scores. Conclusions: Healthy eating perceptions and dietary habits captured by the NPSQ9 score, based on 9 questionnaire items, were associated with reduced body weight and improved diet quality. Likewise, participants with a lower score achieved greater health improvements than those with higher scores, in response to personalised advice, suggesting that NPSQ9 may be used for early evaluation of nutritional status and to tailor nutritional advice. / European Union’s Seventh Framework Programme for 23 research, technological development and demonstration (grant agreement no. 265494). "la Caixa" Banking Foundation through a grant.

Increasing rates of overweight, obesity, and related metabolic diseases documented among refugee communities across the United States necessitate greater attention to how processes of integration impact refugee health. These nutritional health trends (e.g., increasing rates of obesity) suggest potential disconnects between refugees' past environments and their conditions after re-settlement, which may contribute to adverse changes in energy balance (diet and exercise). While Bhutanese refugees were among the largest refugee groups entering the US during the five years leading up to this research, very few studies have examined how they have responded to integration and the impact of this transition on their health. Grounded in human adaptability and political economic theories, and adopting a biocultural approach, this dissertation investigates how Bhutanese refugees in “Prospect City” (pseudonym) negotiate changing and unfamiliar structural and sociocultural conditions after resettlement and the consequences for energy balance and nutritional status. The results reveal high rates of overweight and obesity compared to US averages. Age and caste related differences in nutritional status were also found. High rates of overweight and obesity corresponded with an energy imbalance due to over consumption of energy dense traditional foods and limited understanding of the importance of regular exercise. Over consumption of energy dense traditional foods stemmed from several interrelated factors: the abundance of foods in the US, prior experiences with food deprivation, a history of political exile that reinforced desires to preserve cultural food preferences, and joint family efforts to accommodate work-related time constraints by increasing food production and availability. Decreases in exercise appeared to stem from more sedentary lifestyles in the US as a result of work environments and available transportation, coupled with a lack of health knowledge regarding health benefits of physical activity. This dissertation’s findings are being reported to Prospect City’s Bhutanese Community Organization to help develop strategies for improving nutritional health in the community.

Der Ernährungsstatus ist ein wichtiger Einflussfaktor auf den Gesundheitszustand von Kindern und Jugendlichen. Sowohl Unter- als auch Übergewicht können den Krankheitsverlauf beeinflussen und stellen einen Risikofaktor für die Entwicklung weiterer Erkrankungen dar. Über die Prävalenz von Über- und Untergewicht bei hospitalisierten Kindern und Jugendlichen in Deutschland ist wenig bekannt. In der vorliegenden Arbeit werden die Daten von 906 Patienten zwischen 0 und 17 Jahren, die auf eine allgemein-pädiatrische Station mit neuropädiatrischem Schwerpunkt der Universitätsmedizin Göttingen im Jahr 2012 aufgenommen wurden, erhoben. Die Prävalenz und der Zusammenhang zwischen Über- und Untergewicht, eingeteilt nach BMI-Perzentilen und sozialen Faktoren, individuellen Faktoren und Erkrankung wurden untersucht und mit einem gesunden Referenzkollektiv aus der KiGGS-Studie des Robert Koch-Instituts verglichen. Von den 906 Patienten sind 458 männlich und 448 weiblich. 15,45% der Patienten sind mit einem BMI unter der 10. Perzentile untergewichtig, davon ist etwa die Hälfte (8,72%) mit einem BMI unter der 3. Perzentile stark untergewichtig. Übergewichtig (BMI >90. Perzentile) sind 16,56% der Kinder und Jugendlichen, davon 6,91% mit einem BMI über der 97. Perzentile adipös. Die am häufigsten von Untergewicht betroffene Altersgruppe ist die von 0-2 Jahren (25,34%, OR: 2,29-3,65), Übergewicht und Adipositas treten am häufigsten in der Altersgruppe zwischen 14 und 17 Jahren auf (21,15%). Kinder mit niedrigem Geburtsgewicht und Frühgeborene sind auch später häufiger untergewichtig (32,79%, p=0,013 und 22,7%, p=0,082). Mentale Retardierung und schwere körperliche Beeinträchtigung sind signifikant häufiger mit Untergewicht assoziiert (OR=2,1 und OR=3,6) ebenso wie infektiöse und parasitäre Erkrankungen (OR=6,27), Entwicklungsstörungen allgemein (OR=5,4), zerebrale Lähmungen und sonstige Lähmungssyndrome (OR=5,26) und Verletzungen des Kopfes (OR=2,59). Dagegen sind Kinder und Jugendliche mit Multipler Sklerose häufiger von Übergewicht betroffen (OR=2,14). Erkrankungsgruppen mit vermehrtem Vorkommen von sowohl Unter- als auch Übergewicht sind Neubildungen (OR=5,12 und OR=3,32) und angeborene Fehlbildungen, Deformitäten und Chromosomenanomalien (OR=3,76 und OR=1,49). Im Gesamtvergleich zwischen hospitalisierten Kindern und Jugendlichen und der gesunden Referenzgruppen zeigt sich kein signifikanter Unterschied in der Prävalenz von Unter- und Übergewicht. Einzelne Erkrankungsgruppen sind jedoch besonders häufig mit Unter- oder Übergewicht assoziiert. Um eine optimale Versorgung dieser betroffenen Kinder und Jugendlichen sicherzustellen, muss die Identifikation und Betreuung von akut und chronisch kranken Kindern und Jugendlichen mit Ernährungsstörungen verbessert und zu einem integralen Bestandteil im klinischen Alltag werden.