Colleen Doak

: Undernutrition is a major public health challenge in Mozambique, requiring a better understanding of changes in weight and body composition. In the present study, changes in weight and body composition were analyzed in undernourished children, and predictors of these changes were identified during and after hospitalization. A longitudinal cohort study was conducted in Maputo, Mozambique (2018–2020), in children aged 6 to 58 months hospitalized for malnutrition. On hospital admission, clinical data, including anemia, edema, and HIV infection status, were collected. Anthropometric measurements, height, weight, and skinfold thickness, were obtained during hospital and community follow-ups. Stool samples were collected to assess intestinal parasitic infections. Longitudinal linear mixed-effects models were used to identify factors associated with changes in weight and proxies of body composition (sum of skinfolds and percentage body fat [%BF]) over time. A total of 217 children were included, with a mean age of 19.2 ± 8.4 months. On admission, 43.7% (94/215) of patients had kwashiorkor, 88.7% (188/212) had anemia, and 55.8% (121/217) had edema. HIV infection was diagnosed in 25.7% (55/214) of patients, and 26.7% (58/217) were positive for intestinal parasitic infections. HIV infection was a strong predictor associated with lower weight gain and body composition change over time (sum of skinfold and estimated %BF), whereas edema was associated with increased gains ( P P <0.05). HIV infection and edema at admission were major determinants of recovery, emphasizing targeted HIV care and continued edema monitoring.

Mozambique has one of the highest child undernutrition rates in Sub-Saharan Africa. The aim of this study was to characterize the profile of children from 1 to 14 years old hospitalized for undernutrition and to explore associated risk factors. Clinical, demographic, socioeconomic, and environmental data were collected. Anthropometric measurements and stool samples were collected from a child and their caretaker. The wealth index was determined using Principal Components Analysis. A total of 449 children and their caretakers were enrolled. The children had a median age of 1.0 year [IQR: 1.0–2.0], and 53.9% (242/449) were male. Most were admitted with severe undernutrition (35.7%, 159/449 kwashiorkor and 82.0%, 368/449 with −3SD Z-score indexes). The most common co-morbidities were HIV (30.0%, 120/400), diarrhea (20.0%; 80/400), and anemia (12.5%; 50/400). Among the caretakers, 9.5% (39/409) were underweight, 10.1% (40/397) were overweight, and 14.1% (56/397) were obese. Intestinal parasites were found in 24.8% (90/363) children and in 38.5% (77/200) caretakers. The majority of children (60.7%, 85/140) came from low- to middle-wealth households. Most were severely undernourished, suggesting that they seek medical care too late. The finding of overweight/obese caretakers in combination with undernourished children confirms that Mozambique is facing a double burden of malnutrition.

Organizations such as the World Health Organization, Centers for Disease Control and Prevention, and American Medical Association all recognize the limitations of using body mass index (BMI) to define obesity (BMI ≥ 30 kg/m²). However, BMI is commonly used for screening and is also used in clinical practice as a standalone measure to define “overweight” (BMI, 25-29.9 kg/m²) and “obesity” (BMI ≥ 30 kg/m²). This review describes the genesis of the use of BMI and its value in research and description of populations, while showing that when it is used for diagnosis at the individual level, it falls down at certain age, sex, and race/ethnic groups. A brief history of the BMI, from its inception to its current use in identifying “obesogenic” environments, is provided. Although BMI is currently used in screening, for clinical assessment and management, many other indices are more accurate and useful. This report summarizes the benefits of BMI, in monitoring the ongoing global obesity epidemic, and its limitations as a screening or diagnostic tool in clinical settings.

It has long been recognized that intestinal parasite infections and undernutrition are closely linked. However, little is known about the role of intestinal parasite infections (IPIs), or parasite clearance, in these processes. The aim of this scoping review was to summarize published evidence on the association between IPIs and body composition. PRISMA guidelines, PubMed/MEDLINE, EMBASE and Cochrane Library databases were searched up until June 2021. Studies reporting on IPIs in relation to (proxies for) body composition were eligible. Study quality and risk of bias were assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Twenty-four studies were included, two Randomized Control Trials (RCTs) and 22 observational. Most observational studies showed IPIs to be associated with lower Body Mass Index (BMI) or being underweight as proxies for body composition. One RCT showed no effect of antiparasitic treatment on body composition, while the other one showed a significant post-treatment increase in body fat, as measured by BMI z-scores and skinfolds. This review lends support to distinct associations between IPIs and body composition. More longitudinal studies are needed using direct measures of body composition to investigate whether weight gained after antiparasitic treatment concerns an increase in body fat or healthy weight gain.