Background Skeletal age assessment using hand and wrist X-rays is commonly used to determine the biological maturity of children. It is invaluable when the chronological age is not known or in diagnosing and treating various endocrine, genetic, and developmental disorders as well as in a forensic context. Skeletal age is affected by both internal and external factors, leading to differences in skeletal maturity between children of different ethnicities. Regional studies have even questioned the applicability of current international skeletal age references across ethnicities.Methods A comprehensive literature search will be conducted utilising the PubMed, Scopus, Web of Science, EMBASE, and Ovid online databases to identify existing publications. A combination of Medical Subject Headings (MeSH) terms and keywords, including "Skeletal age", "bone age", "radiograph", and "hand", will be used. Data screening and extraction will be done with Covidence software. Two independent reviewers will screen literature against predefined inclusion and exclusion criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. The process will be reported in whole and presented in a PRISMA flow diagram. Study quality will be assessed by using the JBI critical appraisal tool. A meta-analysis will be conducted.Discussion This review will present a comprehensive analysis of existing literature on the applicability of skeletal age assessment methods using hand and wrist radiographs across different ethnicities. Further, this will be highlighting both strengths and gaps in existing knowledge. The inclusion of high-quality data will facilitate a quantitative meta-analysis for the exploration of ethnic differences in skeletal age assessments, ultimately laying the foundation for the development of population-specific reference standards.Systematic review registration PROSPERO registration ID CRD42025646662.

Study Objectives To examine (1) multidimensional sleep profiles in preschoolers (3-6 years) across geocultural regions and (2) differences in sleep characteristics and family practices between Majority World regions (Pacific Islands, Sub-Saharan Africa, Eastern Europe, Northeast Asia, Southeast Asia, South Asia, the Middle East and North Africa, and Latin America) and the Minority World (the Western world).Methods Participants were 3507 preschoolers from 37 countries. Nighttime sleep characteristics and nap duration (accelerometer: n = 1950) and family practices (parental questionnaire) were measured. Mixed models were used to estimate the marginal means of sleep characteristics by region and examine the differences.Results Geocultural region explained up to 30% of variance in sleep characteristics. A pattern of short nighttime sleep duration, low sleep efficiency, and long nap duration was observed in Eastern Europe, Northeast Asia, and Southeast Asia. The second pattern, with later sleep midpoints and greater night-to-night sleep variability, was observed in South Asia, the Middle East and North Africa, and Latin America. Compared to the Minority World, less optimal sleep characteristics were observed in several Majority World regions, with medium-to-large effect sizes (divided by d divided by=0.48-2.35). Several Majority World regions reported more frequent parental smartphone use during bedtime routines (Northeast Asia, Southeast Asia: 0.77-0.99 units) and were more likely to have electronic devices in children's bedroom (Eastern Europe, Latin America, South Asia: OR = 5.97-16.57) and co-sleeping arrangement (Asia, Latin America: OR = 7.05-49.86), compared to the Minority World.Conclusions Preschoolers' sleep profiles and related family practices vary across geocultural regions, which should be considered in sleep health promotion initiatives and policies.

Background and objective: Valid and cost-effective approaches are essential to assess physical activity and sedentary behaviors in individuals of all ages. This study aimed to validate a physical activity recall questionnaire (PAR-Q) and a physical activity log against the doubly labelled water (DLW) technique in 11-13-year-old Sri Lankan children. Method: Total energy expenditure (TEE) was determined using the criterion DLW technique (TEEDLW) and physical activity energy expenditure (PAEEDLW) was estimated. Subsequently, physical activity assessment methods were validated in a group of children (n=96). PAR-Q was adapted from the adolescent physical activity questionnaire and the physical activity log from the Bouchard activity diary. The youth physical activity compendium was used to calculate PAEE from both PAR-Q (PAEEPAR-Q) and activity log (PAEEPALog). Statistical analysis included Spearman’s correlation coefficient and Bland-Altman analyses. Results: Mean age of the study sample was 12.0 ± 0.8 years where the greater proportion were males (51.9%, n=41). PAEEPAR-Q and PAEEPALog were significantly correlated with the PAEEDLW (r=0.63 and r=0.49, p < 0.05). PAR-Q and activity log underestimated PAEE by 304.2 ± 1223.8 kJ/day and 375.3 ± 1087.4 kJ/day, respectively. Using Bland-Altman analysis, the majority of data points were within the limits of agreement in both PAR-Q and activity log. Conclusion: PAR-Q is a valid tool for predicting PAEE in Sri Lankan children whereas the physical activity log was not. Researchers and practitioners can confidently use the PAR-Q to assess physical activity in this population, with potential applications in various research and intervention settings.

BACKGROUND:Few questionnaires with established measurement properties can globally measure sleep in preschoolers and sleep-related family practices. OBJECTIVE:To examine (1) concurrent validity of the SUNRISE parent questionnaire against an accelerometer for measuring sleep in preschoolers and (2) test-retest reliability of the questionnaire for sleep and related family practices. METHODS:Sleep was measured using the questionnaire and Actigraph GTX3+ accelerometer using a decision-tree algorithm and the Sadeh algorithm in 1737 preschoolers (4.4±0.6years) from 30 countries. Concurrent validity was examined using correlation analysis (duration, timing, and quality), paired t test or the Wilcoxon signed-rank test, Bland-Altman plot (duration, timing), and analysis of sensitivity, specificity, and accuracy (variability). Test-retest variability was examined for sleep and family practice variables in a subsample of 163 participants (4.3±0.6years) from eight countries. RESULTS:Questionnaire measures of sleep timing and duration were correlated with the accelerometer measures (r=0.43-0.75; p<.001). Although statistically significant mean differences were observed between questionnaire and accelerometer measures of sleep timing and duration variables, the difference in nighttime sleep duration had a small effect size (-14 min/d; Cohen's d=-0.2). The questionnaire was less able to provide adequate measurement for sleep quality and variability. High levels of reliability were observed for sleep (ICC=0.63-0.83; Kappa=0.53-0.62) and family practice (ICC=0.81-0.94; Kappa=0.73-0.86) variables. CONCLUSION:The SUNRISE questionnaire appears reliable in assessing preschooler sleep characteristics and related family practices, particularly in disadvantaged settings. It could be used in global surveillance of nighttime sleep duration and in studies examining associations of sleep timing and duration with health indicators in preschoolers.

BACKGROUND:The evidence on associations between sedentary behaviour (SB) and motor skills in 3- to 4-year-olds is unclear and mostly from high-income countries. OBJECTIVE:The objective of this study is to examine associations between (1) screen time (h/day) and total daily SB (h/day), and gross and fine motor skills, and (2) meeting the restraint, screen time and overall SB (restraint and screen time) guidelines and fine and gross motor skills. METHODS:Cross-sectional study of 1394 3- to 4-year-olds from the pilot phase of the SUNRISE International study. Time spent in SB was measured using the activPAL accelerometer, whereas screen time and restraint were measured using a parent questionnaire. Fine and gross motor skills were measured using parent-reported Ages and Stages Questionnaire (ASQ-3). Associations between SB and motor skills were determined using linear and logistic regression, adjusting for sex and socioeconomic status. RESULTS:Every additional 1 h of screen time was associated with 0.50-point reduction in gross motor skills scores (p = 0.008). More screen time was associated with decreased odds of being on track for fine and gross motor skill development (p < 0.001 and p = 0.017, respectively). Meeting the screen time (p = 0.009) and overall SB guidelines (p = 0.006) were favourably associated with fine motor skills scores. Meeting the screen time, restraint and overall SB guidelines were favourably associated with gross motor skills scores (p = 0.007, p < 0.001 and p < 0.001, respectively), higher odds of being on track for fine (p = 0.033, p = 0.015 and p < 0.001, respectively) and gross motor skills (p = 0.006, p < 0.001 and p < 0.001, respectively) development. CONCLUSION:The present study adds to the evidence on the importance of sedentary behaviour for the motor development of 3- to 4-year-olds. It is important that policy makers and health educators develop strategies that will encourage and promote adherence to sedentary behaviour guidelines among 3- and 4-year-olds.

IntroductionUndernutrition continues to be a significant public health concern, particularly among children under 5 years.ObjectivesThis study evaluated the efficacy of an additional nutritional intervention in improving growth parameters, dietary diversity and hemoglobin levels in children aged 6 to 59 months with moderate acute malnutrition (MAM) during the 2023 economic crisis in Sri Lanka.MethodsThis was a randomized-controlled trial, and children with MAM were randomly allocated to either the intervention group, receiving additional food transfers and nutrition education, or the control group, receiving standard care. The outcomes were improvement in growth parameters, dietary diversity, and hemoglobin levels. Regression analysis was used to adjust for potential confounding variables. A total of 510 children were enrolled and followed for 6 months. The intervention group showed a significant proportion of children improving to normal weight-for-height Z-scores than the control group in addition to the improvement in dietary diversity. However, the 2 groups had no significant difference in stunting and underweight.ConclusionsThe nutritional intervention improved weight for height z-scores and dietary diversity in this cohort of children with MAM. The study highlights the importance of targeted nutrient-adequate food security interventions in undernourished children during crises to support their nutrition rehabilitation effectively.

Obesity among the young is an emerging health problem with many metabolic changes including liver damage. Our objective was to investigate the association of fatty liver with serum uric acid (UA) and gamma-glutamyltransferase (GGT) in a cohort of obese children in Sri Lanka. A cross-sectional analytical study was conducted among 5-15-year-old obese children (based on WHO 2007 standards). After a 12-hour overnight fast, blood was drawn for glucose, lipid profile, alanine aminotransferase (ALT), aspartate aminotransferase (AST), insulin, UA and GGT. Height, weight, waist circumference, blood pressure and fat mass were measured. Ultrasound scan of abdomen was performed to determine fatty liver. We studied 146 obese children with a mean age (SD) 9.86 (2.1) years. The fatty liver group showed significantly elevated levels (p < 0.05) of UA, oral glucose tolerance test (OGTT), triglycerides (TG), AST, ALT, GGT, insulin resistance (HOMA-IR) and a reduced AST/ALT ratio, compared to the non-fatty liver group. Chi square test showed statistically significant associations between fatty liver and AST, ALT, AST/ALT ratio, HOMA-IR, UA and GGT. With existing cut offs, GGT (> 30 U/L) and UA (> 330 µmol/L) the sensitivity and specificity of GGT in predicting fatty liver was 26.9

SummaryObjectiveAssess longer‐term changes in food habits and anthropometry among Grades 1–2 primary school students from four public schools in Colombo, Sri Lanka, following a 3‐week programme including a classroom‐based motivational storybook discussion and self‐monitoring food diary (FD).MethodsThis follow‐up study assessed changes from baseline (pre‐intervention) BMI z‐scores and food habits (increased healthy food‐item consumption/decreased unhealthy food‐item consumption reflected by an increase in FD score) and parental perceptions (anonymous questionnaires) among 863 students (aged 6–8 years), between 9 and 12 months after completing the programme (November 2019–February 2020).ResultsFood habits showed sustained improvement from baseline mean FD score (baseline vs. follow‐up: 51 ± 23% vs. 67 ± 22%, p < 0.001), with children from all BMI subgroups (underweight [UW], normal weight [NW], overweight [OW] and obesity [OB]) showing a significant increase in FD scores (ranging from 14.1% to 17.2%, p < 0.001). BMI z‐scores increased in children living with UW (−2.85 to −2.21, p < 0.00) and NW (−0.70 to −0.57, p < 0.001), but did not change in children with OW (+1.5 to +1.49, p = 0.83) and OB (+2.85 to +2.21, p = 0.19). Most parents (n = 497, 97.8%) reported satisfaction with programme outcomes.ConclusionThis programme led to sustained improvement in food habits among young primary school children from all BMI categories, increase in BMI towards the median among children living with UW and NW, and stabilization of BMI in children with OW and OB, suggesting it as a useful tool for improving nutritional status of young children in low‐ and middle‐income countries (LMIC) facing the double burden of under‐ and overnutrition.

Background: There is extensive evidence that rapid infant weight gain increases the risk of childhood obesity, but this is normally based on childhood body mass index (BMI) only and whether or not this is because infants with rapid weight gain accrue greater fat mass is unknown. Objective: The primary objective of our study was to test whether the proportion of infant weight gain due to concurrent increases in fat mass is greater in infants with rapid weight gain as compared to those with normal growth. Methods: Body composition was assessed by (1) air-displacement plethysmography (ADP) at 0 and 6 months in 342 infants from Australia, India, and South Africa and (2) deuterium dilution (DD) at 3 and 24 months in 555 infants from Brazil, Pakistan, South Africa, and Sri Lanka. Weight gain and length growth were each categorized as slow, normal, or rapid using cut-offs of <-0.67 or >+0.67 Z-scores. Regression was used to estimate and contrast the percentages of weight change due to fat mass change. Results: Approximately 40% of the average weight gain between 0 and 6 months and 20% of the average weight gain between 3 and 24 months was due to increase in fat mass. In both samples, compared to the normal group, the proportion of weight gain due to fat mass was higher on average among infants with rapid weight gain and lower among infants with slow weight gain, with considerable individual variability. Conversely, slow and rapid length growth was not associated with differential gains in fat mass. Conclusions: Pediatricians should monitor infant growth with the understanding that, while crossing upward through the weight centiles generally is accompanied by greater adiposity gains (not just higher BMI), upward crossing through the length centiles is not.

Background. We explored the impact of prior yellow fever (YF) or Japanese encephalitis (JE) vaccination on the efficacy of Takeda's dengue vaccine candidate, TAK-003. Methods. Children 4-16 years of age were randomized 2:1 to receive TAK-003 or placebo and were under active febrile surveillance. Symptomatic dengue was confirmed by serotype-specific reverse-transcription polymerase chain reaction. YF and JE vaccination history was recorded. Results. Of the 20 071 children who received TAK-003 or placebo, 21.1% had a YF and 23.9% had a JE vaccination history at randomization. Fifty-seven months after vaccination, vaccine efficacy (95% confidence interval) was 55.7% (39.7%-67.5%) in those with YF vaccination, 77.8% (70.8%-83.1%) for JE vaccination, and 53.5% (45.4%-60.4%) for no prior YF/JE vaccination. Regional differences in serotype distribution confound these results. The apparent higher vaccine efficacy in the JE vaccination subgroup could be largely explained by serotype-specific efficacy of TAK-003. Within 28 days of any vaccination, the proportions of participants with serious adverse events in the YF/JE prior vaccination population were comparable between the TAK-003 and placebo groups. Conclusions. The available data do not suggest a clinically relevant impact of prior JE or YF vaccination on TAK-003 performance. Overall, TAK-003 was well-tolerated and efficacious in different epidemiological settings.

BackgroundOutbreaks of dengue can overburden hospital systems, drastically reducing capacity for other care. The 2017 dengue serotype 2 (DENV-2) outbreak in Sri Lanka coincided with vaccination in an ongoing phase 3 efficacy trial of a tetravalent dengue vaccine, TAK-003 (NCT02747927). Here, we present data on the efficacy of TAK-003 following two doses of the vaccine administered 3 months apart in participants aged 4-16 years in Sri Lanka. In addition, we have used the 2017 outbreak dynamics to model the potential impact of TAK-003 on virologically confirmed dengue (VCD) cases and hospitalizations during an outbreak situation.Methodology/principal findingsModeling was performed using an age-structured, host-vector, spatial and stochastic transmission model, assuming 65% vaccine coverage and 30 days until initiation of vaccination. Efficacy of TAK-003 against VCD and hospitalized VCD cases was based on data against DENV-2 from the first year of the phase 3 trial. Vaccine efficacy and safety findings in Sri Lanka were in line with those of the overall trial population. The efficacy estimates in Sri Lanka up to the first 12 months after the second dose of TAK-003 were 94.7% and 95.7% against VCD and hospitalized VCD cases, respectively. Modeling of the trial data over an extended geographic area showed a substantial reduction in cases and a flattening of outbreak curves from TAK-003 use. The baseline vaccination scenario (initiation at 30 days, 65% target coverage, vaccine effective at 14 days, 70% hospitalization rate, VE of 95% for VCD and 97% for hospitalized VCD, and 47% for asymptomatic) resulted in a 69.1% reduction in VCD cases and 72.7% reduction in VCD hospitalizations compared with no vaccination. An extreme high scenario (vaccination initiated at Day 15, 80% coverage rate, baseline VE) resulted in 80.3% and 82.3% reduction in VCD and VCD hospitalizations, respectively. Vaccine performance, speed of vaccination campaign initiation, and vaccine coverage were key drivers in reducing VCD cases and hospitalizations.Conclusions/significanceOverall, the study and modeling results indicate that TAK-003 has the potential of meaningful utility in dengue outbreaks in endemic areas.

BACKGROUND:About half of the world's population lives in dengue-endemic areas. We aimed to evaluate the long-term efficacy and safety of two doses of the tetravalent dengue vaccine TAK-003 in preventing symptomatic dengue disease of any severity and due to any dengue virus (DENV) serotypes in children and adolescents. METHODS:In this ongoing double-blind, randomised, placebo-controlled trial, we enrolled healthy participants aged 4-16 years at 26 medical and research centres across eight dengue-endemic countries (Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). The main exclusion criteria were febrile illness (body temperature ≥38°C) at the time of randomisation, hypersensitivity or allergy to any of the vaccine components, pregnancy or breastfeeding, serious chronic or progressive disease, impaired or altered immune function, and previous receipt of a dengue vaccine. Participants were randomly assigned 2:1 (stratified by age and region) using an interactive web response system and dynamic block assignment to receive two subcutaneous doses of TAK-003 or placebo 3 months apart. Investigators, participants, and their parents or legal guardians were blinded to group assignments. Active febrile illness surveillance and RT-PCR testing of febrile illness episodes were performed for identification of virologically confirmed dengue. Efficacy outcomes were assessed in the safety analysis set (all randomly assigned participants who received ≥1 dose) and the per protocol set (all participants who had no major protocol violations), and included cumulative vaccine efficacy from first vaccination to approximately 4·5 years after the second vaccination. Serious adverse events were monitored throughout. This study is registered with ClinicalTrials.gov, NCT02747927. FINDINGS:Between Sept 7, 2016, and March 31, 2017, 20 099 participants were randomly assigned (TAK-003, n=13 401; placebo, n=6698). 20 071 participants (10 142 [50·5%] males; 9929 [49·5%] females; safety set) received TAK-003 or placebo, with 18 257 (91·0%) completing approximately 4·5 years of follow-up after the second vaccination (TAK-003, 12 177/13 380; placebo, 6080/6687). Overall, 1007 (placebo: 560; TAK-003: 447) of 27 684 febrile illnesses reported were virologically confirmed dengue, with 188 cases (placebo: 142; TAK-003: 46) requiring hospitalisation. Cumulative vaccine efficacy was 61·2% (95% CI 56·0-65·8) against virologically confirmed dengue and 84·1% (77·8-88·6) against hospitalised virologically confirmed dengue; corresponding efficacies were 53·5% (41·6-62·9) and 79·3% (63·5-88·2) in baseline seronegative participants (safety set). In an exploratory analysis, vaccine efficacy was shown against all four serotypes in baseline seropositive participants. In baseline seronegative participants, vaccine efficacy was shown against DENV-1 and DENV-2 but was not observed against DENV-3 and low incidence precluded evaluation against DENV-4. During part 3 of the trial (approximately 22-57 months after the first vaccination), serious adverse events were reported for 664 (5·0%) of 13 380 TAK-003 recipients and 396 (5·9%) of 6687 placebo recipients; 17 deaths (6 in the placebo group and 11 in the TAK-003 group) were reported, none were considered study-vaccine related. INTERPRETATION:TAK-003 demonstrated long-term efficacy and safety against all four DENV serotypes in previously exposed individuals and against DENV-1 and DENV-2 in dengue-naive individuals. FUNDING:Takeda Vaccines. TRANSLATIONS:For the Portuguese, Spanish translations and plain language summary of the abstract see Supplementary Materials section.

Objective Systematic Literature review conducted to observe changes in the epidemiological pattern of dengue disease in Sri Lanka during the period of 2000- 2020. Methods The review followed Cochrane Handbook and PRISMA guidelines. To identify articles on Sri Lankan epidemiology, databases like PubMed, Embase, Cochrane, and DARE were searched using MeSH, Emtree, and free-text terms, focusing on English articles from 2000-2020. The search included national and international sources, targeting epidemiological data from 2000-2020. The keywords used were dengue epidemiology, incidence, Sri Lanka, serotype prevalence, seroprevalence, case fatality rate. The extracted data were synthesized descriptively and presented through tables and figures. Results For the epidemiology SLR, 149 publications (68 peer-reviewed journals and 81 grey literature) were included. Data indicate that dengue is endemic in Sri Lanka, with increasing incidence during major epidemics. The highest incidence was recorded in 2017 (866 per 100,000 population; 186,101 cases) and 2019 (479.7 per 100,000 population; 105,049 cases). Dengue cases were reported in all 26 districts, with Colombo and Gampaha having the highest notifications. Infections occurred year-round, peaking between May-August and October-January, coinciding with the monsoon season. The highest proportions of cases from 2012-2016 and 2018 were in the 25–49-year-olds, followed by 15–24-year-olds, and 5–14-year-olds. All four DENV serotypes co-circulated, with DENV-2 predominating since 2017. None of the studies or Sri Lanka MoH bulletins reported expansion factors. Case fatality rates ranged from 0.11% to 1.0%, peaking in 2009. Conclusion Dengue fever is hyperendemic in Sri Lanka, and its incidence and morbidity are on the rise, which is potentially being underestimated. To effectively mitigate and control dengue, it is crucial to follow appropriate guidelines, implement comprehensive strategies, including vaccination, aimed at alleviating the burden of the disease.

Importance The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain. Objective To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries. Design, Setting, and Participants Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023. Exposures Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers. Main Outcomes and Measures The proportion of children who met the World Health Organization guidelines for physical activity (>= 180 min/d of total physical activity and >= 60 min/d of moderate- to vigorous-intensity physical activity), screen time (<= 1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis. Results Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle-income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle-income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8). Conclusions and Relevance Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.

PurposeThis paper aims to describe the study design and baseline characteristics of the Sri Lanka Child Growth Cohort (SLCGC), which was established to assess the timing, pattern and determinants of growth faltering in infants and young children in Sri Lanka.ParticipantsA retrospective cohort study was conducted among term-born babies (≥37-week gestation), currently aged between 12 and 24 months. A sample of 1875 mother–child pairs were recruited using two-stage stratified cluster sampling method. Data on sociodemographic characteristics, pregnancy care, feeding practices, childhood illnesses and home risk factors were collected through direct interviews with the caregivers. Pregnancy-related data were obtained from the pregnancy record. Birth weight, serial weight and length records and growth pattern were extracted from the Child Health and Development Record. Current weight and length of the children were measured directly.Findings to dateThe SLCGC serves as a comprehensive cohort study with a countrywide distribution in Sri Lanka, covering the three main residential sectors, namely the urban, rural and estate sectors in equal proportions. The majority of mothers were housewives (76.8%) and aged <35 years (77.9%). The proportions achieved secondary education in mothers and fathers were 69.0% and 63.7%, respectively. Approximately 30% of mothers were overweight or obese, while 15% were underweight on entry to antenatal care. Of the children, 49.2% were girls, 42.5% were the first-born children in their family and 34.2% were born by caesarean section. Mean birth weight was 2917 g (SD 0.406), with the proportion of low birth weight (less than 2500 g) being 13%.Future plansThis data enables investigation of the effects of single exposures on child growth, as well as, more complex epidemiological analyses on multiple simultaneous and time-varying exposures. Data will be available for researchers for further analysis. The next wave of assessment is expected to be done after 12 months.

BackgroundAccurate assessment of body composition during infancy is an important marker of early growth. This study aimed to develop anthropometric models to predict body composition in 3-24-month-old infants from diverse socioeconomic settings and ethnic groups.MethodsAn observational, longitudinal, prospective, multi-country study of infants from 3 to 24 months with body composition assessed at three monthly intervals using deuterium dilution (DD) and anthropometry. Linear mixed modelling was utilized to generate sex-specific fat mass (FM) and fat-free mass (FFM) prediction equations, using length(m), weight-for-length (kg/m), triceps and subscapular skinfolds and South Asian ethnicity as variables. The study sample consisted of 1896 (942 measurements from 310 girls) training data sets, 941 (441 measurements from 154 girls) validation data sets of 3-24 months from Brazil, Pakistan, South Africa and Sri Lanka. The external validation group (test) comprised 349 measurements from 250 (185 from 124 girls) infants 3-6 months of age from South Africa, Australia and India.ResultsSex-specific equations for three age categories (3-9 months; 10-18 months; 19-24 months) were developed, validated on same population and externally validated. Root mean squared error (RMSE) was similar between training, validation and test data for assessment of FM and FFM in boys and in girls. RMSPE and mean absolute percentage error (MAPE) were higher in validation compared to test data for predicting FM, however, in the assessment of FFM, both measures were lower in validation data. RMSE for test data from South Africa (M/F-0.46/0.45 kg) showed good agreement with validation data for assessment of FFM compared to Australia (M/F-0.51/0.33 kg) and India(M/F-0.77/0.80 kg).ConclusionsAnthropometry-based FFM prediction equations provide acceptable results. Assessments based on equations developed on similar populations are more applicable than those developed from a different population.

BACKGROUND:Insufficient physical activity, excessive screen time and short sleep duration among young children are global public health concerns; however, data on prevalence of meeting World Health Organisation 24-h movement behaviour guidelines for 3-4-year-old children in low- and middle-income countries (LMICs) are limited, and it is unknown whether urbanisation is related to young children's movement behaviours. The present study examined differences in prevalence of meeting 24-h movement behaviour guidelines among 3-4-year-old children living in urban versus rural settings in LMICs. METHODS:The SUNRISE Study recruited 429, 3-4-year-old child/parent dyads from 10 LMICs. Children wore activPAL accelerometers continuously for at least 48 h to assess their physical activity and sleep duration. Screen time and time spent restrained were assessed via parent questionnaire. Differences in prevalence of meeting guidelines between urban- and rural-dwelling children were examined using chi-square tests. RESULTS:Physical activity guidelines were met by 17% of children (14% urban vs. 18% rural), sleep guidelines by 57% (61% urban vs. 54% rural), screen time guidelines by 50% (50% urban vs. 50% rural), restrained guidelines by 84% (81% urban vs. 86% rural) and all guidelines combined by 4% (4% urban vs.4% rural). We found no significant differences in meeting the guidelines between urban and rural areas. CONCLUSIONS:Only a small proportion of children in both rural and urban settings met the WHO 24-h movement guidelines. Strategies to improve movement behaviours in LMICs should consider including both rural and urban settings.

Background Accurate assessment of body composition during infancy is important, especially for understanding the effects of early growth on later health. This study aimed to develop an anthropometry-based approach to predict body composition in 3–24 month old infants from diverse socioeconomic settings and ethnic groups. Methods An observational, longitudinal, prospective, multinational study of infants from birth to 24 months. Body composition was assessed at 3, 6, 9, 12, 18, and 24 months using deuterium dilution (DD) and anthropometry. Linear mixed modelling was utilized to generate sex-specific fat mass(FM) and fat-free mass(FFM) prediction equations. Length(m), weight-for-length(kg/m), triceps and subscapular skinfolds and Asian ethnicity were used as predictor variables. The study sample consisted of 1896(942 measurements from 310 girls) training data sets, 941(441 measurements from 154 girls) validation data sets from Brazil, Pakistan, South Africa and Sri Lanka, and 349(185 measurements from 124 girls) data sets of infants at 6 months from South Africa, Australia and India of external validation group. Results Sex-specific equations for three age categories (3-9 months; 10-18 months; 19-24 months) were developed and validated and an external validation was performed on the test group. The root mean squared error(RMSE) was similar between validation and test data for assessment of FM and FFM. Root mean squared percentage error(RMSPE) and mean absolute percentage error(MAPE) in validation data were higher for predicting FM but lower for FFM compared to test data. Conclusions Anthropometry-based FFM prediction equations provide acceptable results which have the potential to be developed as a field tool.