ABSTRACT Children with cerebral palsy (CP) are at increased risk of malnutrition, yet no population‐level data exist for this group in Malawi. This study aimed to estimate the prevalence of undernutrition among children with CP in Malawi compared to peers without CP, and to explore contributing factors. This cross‐sectional case‐control study was conducted in Mangochi District, Malawi. A total of 260 children aged 2–18 years with clinician‐confirmed CP were enroled alongside 259 age‐ and sex‐matched controls. Nutritional status was assessed using standard anthropometric measures. Feeding difficulties and household food security were captured using existing tools. Linear regression examined factors associated with weight‐for‐age (WAZ) and BMI‐for‐age z‐scores (BMIZ). Children with CP had significantly worse nutritional status across all anthropometric indicators compared to controls. Stunting (90.9% vs. 45.6%), underweight (81.5% vs. 33.2%), and wasting (42.2% vs. 12.3%) were substantially higher in the CP group (all p < 0.05). Feeding dependency was prevalent in 64.7% of children with CP versus 14.5% of controls. Severe motor impairment (GMFCS IV–V), spastic CP subtype, and greater feeding difficulties, were independently associated with lower WAZ and BMIZ scores. In conclusion, malnutrition is highly prevalent among children with CP in rural Malawi, far exceeding national and regional estimates. Disability‐inclusive nutrition guidelines, caregiver feeding support, and integration of CP‐specific care into existing nutrition programmes are urgently needed.
ABSTRACT The first 1000 days of life are widely recognised as an important period for growth, development and the establishment of dietary preferences and eating behaviours that may persist across the life course. In Australia, the food regulator (Food Standards Australia New Zealand, FSANZ) recently abandoned Proposal P1058—Nutrition labelling about added sugars, which considered an amendment to the Australia New Zealand Food Standards Code to include ‘added sugars’ information in the Nutrition Information Panel (NIP). This decision provides an opportunity to examine implications for products manufactured and marketed for infants and toddlers. At present, the NIP requires declaration of total sugars, but this does not distinguish between intrinsic sugars naturally present in foods and sugars contributed through ingredients such as fruit juice concentrates, fruit purees, syrups, or other sweetening ingredients. This distinction is relevant in the context of the rapidly expanding market for commercial infant and toddler foods, including squeeze pouches, fruit‐based snacks, toddler yoghurts and sweetened snack‐style products that often utilise extruded fruit juice products as an ingredient to create a sweeter taste profile. In addition, parents often assume that commercial infant and toddler foods are healthy and low in sugar. While the broader evidence base for the general population did not support mandatory reform across all packaged foods, the implications for infant and toddler products remain relevant to ongoing policy discussions. The recent FSANZ decision provides an opportunity to consider whether foods marketed to infants and young children represent a distinct regulatory context in which greater labelling clarity, alongside other policy approaches, may contribute to early‐life nutrition objectives.
ABSTRACT In Benin, malnutrition is the main risk factor for mortality and morbidity among young children. Women's decision‐making power within the household appears to be a factor that promotes adequate nutrition for children, both in terms of quantity and quality. The objective of this study is to analyze the effect of women's decision‐making power within the household on the nutritional status of children under 5 in Benin. The data used come from the 2017‐2018 Benin Demographic and Health Survey, and a total of 4,093 children under the age of 5 were included in the analysis. We use the composite index of anthropometric failure as a measure of children's nutritional status because of its ability to estimate the full extent of child malnutrition in the population. Women's decision‐making power is measured using women's own responses and cross‐referenced responses from both spouses on household decision‐making. For the empirical modeling of the study, we use the recursive bivariate probit model to account for the endogeneity of women's decision‐making power. Overall, women's decision‐making power does not significantly reduce the probability of experiencing anthropometric failure among children, but it increases this probability when the husband grants decision‐making power to his wife. This type of power reflecting a disagreement between spouses regarding decision‐making within the household, undercuts, rather than improve women's ability to influence their children's nutritional status. The authority granted by the husband may involve a transfer of responsibility in a context of economic vulnerability. Thus, a woman may be recognized as a decision‐maker but still lack sufficient resources, namely the financial or material means, to ensure adequate food for her children or improve their nutritional status. Policies aimed at strengthening women's decision‐making power should be accompanied by mechanisms to improve access to and control over economic resources, so that this power may lead to better child nutritional status.
ABSTRACT Food insecurity (FI) is a critical yet under‐identified social determinant of health among pregnant populations. Prior research links FI to adverse perinatal outcomes, but few studies have examined whether these associations are modified by participation in food assistance programs such as the USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study assessed the association between prenatal FI and four perinatal outcomes—postpartum depression (PPD), gestational hypertension, gestational diabetes, and gestational weight gain (GWG)—and examined whether prenatal WIC participation moderated these relationships. We conducted a cross‐sectional analysis using state‐representative data from Phase 8 of the Pregnancy Risk Assessment Monitoring System (PRAMS). Ten states with relevant data were included. The sample was limited to WIC‐eligible mothers (income < 185% of the federal poverty level or Medicaid enrollment). Logistic regression models estimated associations between FI and each outcome in unadjusted and adjusted models, with interaction terms used to assess moderation by WIC participation. Models adjusted for sociodemographic and pregnancy‐related characteristics. Among WIC‐eligible mothers, 13.65% reported FI during pregnancy. After adjustment, FI was associated with higher odds of PPD (OR: 2.47, 95% CI: 2.16–2.82), gestational diabetes (OR: 1.22, 95% CI: 1.00–1.49), gestational hypertension (OR: 1.38, 95% CI: 1.18–1.60), and GWG below recommendations (OR: 1.29, 95% CI: 1.09–1.52). Adjusting for depression before and during pregnancy attenuated associations. WIC participation did not significantly moderate these relationships. Prenatal FI remains associated with adverse perinatal outcomes, suggesting that while WIC provides nutritional support, additional stressors linked to food insecurity may persist.
ABSTRACT Malnutrition is a major global challenge with both short‐ and long‐term health impacts. Studies of historical famines have provided evidence of an association between famine exposure and risk of non‐communicable diseases (NCDs) in later life. However, whether famine exposure has heterogeneous effects on different later‐life NCDs remains unclear. In this study, we investigated whether the effects of exposure to the Chinese Famine of 1959–1961 on later‐life NCDs were disease‐specific, age‐specific, and sex‐specific. We conducted a secondary analysis of data from a large‐scale, nationally representative panel study, i.e., the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020, N = 11,047 adults aged 45 years and older). We measured famine exposure using self‐reported famine experience, life stage using age at famine exposure, and NCDs using 14 chronic conditions. Three main findings emerged. First, the effects of famine exposure for developing NCDs in later life were disease‐specific, with 20%–29% higher odds of digestive disease, memory‐related disease, arthritis, kidney disease and dyslipidemia, versus 10% higher odds of heart disease and diabetes. Second, the effects of famine exposure were age‐specific, with exposure in utero or at ages 0–2 years having the largest impacts on 8 of the 14 later‐life conditions (diabetes, stroke, lung disease, liver disease, digestive disease, cancer, kidney disease, and arthritis), whereas exposure at ages 3–5 years having the largest impact on psychiatric disease and memory‐related disease in later life. Conversely, famine exposure during adulthood was associated with lower odds of various NCDs. This divergence reflects a balance of competing forces: for individuals exposed prior to adulthood, severe developmental damage overshadows the healthy survivor effect, increasing later‐life NCD risk; for individuals exposed during adulthood, completed physiological development minimized programming damage, allowing the healthy survivor effect to dominate. Third, the famine effects were sex‐specific for later‐life cardiometabolic diseases (dyslipidemia, heart disease and stroke), with famine exposure having larger impacts on women than men, pointing to the survivor advantage among men. Future studies should investigate underlying biological mechanisms, intergenerational pathways of transmission, and long‐term growth and body composition in survivors.
