The unified global efforts to mitigate the high burden of vitamin and mineral deficiency, known as hidden hunger, in populations around the world are crucial to the achievement of most of the Millennium Development Goals (MDGs). We developed indices and maps of global hidden hunger to help prioritize program assistance, and to serve as an evidence-based global advocacy tool. Two types of hidden hunger indices and maps were created based on i) national prevalence data on stunting, anemia due to iron deficiency, and low serum retinol levels among preschool-aged children in 149 countries; and ii) estimates of Disability Adjusted Life Years (DALYs) attributed to micronutrient deficiencies in 136 countries. A number of countries in sub-Saharan Africa, as well as India and Afghanistan, had an alarmingly high level of hidden hunger, with stunting, iron deficiency anemia, and vitamin A deficiency all being highly prevalent. The total DALY rates per 100,000 population, attributed to micronutrient deficiencies, were generally the highest in sub-Saharan African countries. In 36 countries, home to 90% of the world’s stunted children, deficiencies of micronutrients were responsible for 1.5-12% of the total DALYs. The pattern and magnitude of iodine deficiency did not conform to that of other micronutrients. The greatest proportions of children with iodine deficiency were in the Eastern Mediterranean (46.6%), European (44.2%), and African (40.4%) regions. The current indices and maps provide crucial data to optimize the prioritization of program assistance addressing global multiple micronutrient deficiencies. Moreover, the indices and maps serve as a useful advocacy tool in the call for increased commitments to scale up effective nutrition interventions.

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ObjectivesIncreasing evidence suggests that water, sanitation and hygiene (WASH) practices affect linear growth in early childhood. We determined the association between household access to water, sanitation and personal hygiene practices with stunting among children aged 0–23 months in rural India.SettingIndia.ParticipantsA total of 10 364, 34 639 and 1282 under-2s who participated in the 2005–2006 National Family Health Survey (NFHS-3), the 2011 Hunger and Malnutrition Survey (HUNGaMA) and the 2012 Comprehensive Nutrition Survey in Maharashtra (CNSM), respectively, were included in the analysis.Primary outcome measuresThe association between WASH indicators and child stunting was assessed using logistic regression models.ResultsThe prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16–39% reduced odds of stunting among children aged 0–23 months, after adjusting for all potential confounders (NHFS-3 (OR=0.84, 95% CI 0.71 to 0.99); HUNGaMA (OR=0.84, 95% CI 0.78 to 0.91); CNSM (OR=0.61, 95% CI 0.44 to 0.85)). Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver's self-reported practices of washing hands with soap before meals (OR=0.85, 95% CI 0.76 to 0.94) or after defecation (OR=0.86, 95% CI 0.80 to 0.93) were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water (all interaction terms, p<0.05).ConclusionsImproved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal association.

Double burden is not exclusive to urban areas. Future policies and interventions should address under- and overweight simultaneously in both rural and urban developing country settings.

Adolescent pregnancy is associated with adverse birth outcomes. Less is known about its influence on maternal growth and nutritional status. We determined how pregnancy and lactation during adolescence affects postmenarcheal linear and ponderal growth and body composition of 12-19 y olds in rural Bangladesh. In a prospective cohort study, anthropometric measurements were taken among primigravidae (n = 229) in the early first trimester of pregnancy and at 6 mo postpartum. Randomly selected never-pregnant adolescents (n = 458) of the same age and time since menarche were measured within 1 wk of these assessments. Annual changes in anthropometric measurements were compared between the 2 groups adjusting for confounders using mixed effects regression models. The mean +/- SD age and age at menarche of adolescents were 16.3 +/- 1.6 y and 12.7 +/- 1.2 y, respectively. Unlike pregnant girls who did not grow in height (-0.09 +/- 0.08 cm/y), never-pregnant girls increased in stature by 0.35 +/- 0.05 cm/y. The adjusted mean difference between the 2 groups was 0.43 +/- 0.1cm (P < 0.001). Similarly, whereas never-pregnant girls gained BMI, mid-upper arm circumference, and percent body fat, pregnant girls declined in every measurement by 6 mo postpartum, resulting in adjusted mean +/- SD differences in annual changes of 0.62 +/- 0.11 kg/m(2), 0.89 +/- 0.12 cm, and 1.54 +/- 0.25%, respectively (all P < 0.001). Differences in changes in all anthropometric measurements except height were greater among adolescents whose first pregnancy occurred <24 mo vs. > or =24 mo since menarche (BMI, -1.40 +/- 0.18 vs. -0.60 +/- 0.11 kg/m(2); all interaction terms, P < 0.05). Pregnancy and lactation during adolescence ceased linear growth and resulted in weight loss and depletion of fat and lean body mass of young girls.

A successful micronutrient powder program requires careful design, with emphasis on conducting thorough formative research, ensuring the involvement and commitment of all stakeholders from the outset, investigating the role of cultural factors, and ensuring provision of sufficient, adequate, and timely information to the beneficiaries.

ObjectiveTo conduct a secondary data analysis detailing overweight prevalence and associations between key hypothesised determinants and overweight.DesignThis observational study used publicly available data from the Indonesian Family Life Survey (IFLS) (1993–2014). The IFLS is a home-based survey of adults and children that collected data on household characteristics (size, physical infrastructure, assets, food expenditures), as well as on individual-level educational attainment, occupation type, smoking status and marital status. These analyses used data on the self-reported consumption of ultra-processed foods and physical activity. Anthropometrics were measured.SettingIndonesia.Primary outcome measuresWe described the distribution of overweight by gender among adults (body mass index (BMI) ≥25 kg/m2) and by age among children, over time. Overweight was defined as weight-for-height z-score >2 among children aged 0–5 years and as BMI-for-age z-score >1 among children aged 6–18 years. We also described individuals who were overweight by selected characteristics over time. Finally, we employed multivariable logistic regression models to investigate risk factors in relation to overweight in 2014.ResultsOne-third of adults were overweight in 2014. Between 1993 and 2014, the prevalence of overweight among adults doubled from 17.1% to 33.0%. The prevalence of overweight among children under 5 years increased from 4.2% to 9.4% between 1993 and 2007, but then remained relatively stagnant between 2007 and 2014. Among children aged 6–12 years and 13–18 years, the prevalence of overweight increased from 5.1% to 15.6% and from 7.1% to 14.1% between 1993 and 2014, respectively. Although overweight prevalence remains higher in urban areas, the increase in overweight prevalence was larger among rural (vs urban) residents, and by 2014, the proportions of overweight adults were evenly distributed in each wealth quintile. Data suggest that the consumption of ultra-processed foods was common and levels of physical activity have decreased over the last decade. In multivariable models, urban area residence, higher wealth, higher education and consumption of ultra-processed foods were associated with higher odds of overweight among most adults and children.ConclusionUrgent programme and policy action is needed to reduce and prevent overweight among all ages.

Adolescent pregnancies are a concern worldwide. We assessed annual changes in linear and ponderal size and body composition among pregnant and never‐pregnant 12–19 yr olds in rural Bangladesh. Primigravidae (n=218) were measured for anthropometry in the early 1st and 3rd trimesters of pregnancy and at 6‐mo postpartum (PP). Randomly selected never‐pregnant controls (n=436), matched on age and time since menarche, were measured within a week of these assessments. Present analyses include adolescents who had live births and their counterparts. The mean (SD) age and age at menarche were 16.3y (1.6) and 12.7y (1.7), respectively. Except for TSF, baseline measurements did not differ between the 2 groups. Unlike pregnant girls who did not grow in height, non‐pregnant controls increased in stature (0.02±0.7 vs. 0.3±0.8 cm/y, p<0.001). Whereas controls gained weight, BMI, and MUAC, pregnant girls declined in each measurement by 6‐mo PP (0.8±2.3 vs. −0.9±2.5 kg/y; 0.3±1.0 vs. −0.4±1.1 kg/m2/y; 0.2±0.9 vs. −0.5±1.1 cm/y, all p<0.001). Annual losses in TSF and % body fat were greater and gain in SSF less among pregnant vs. non‐pregnant girls (−1.4±2.2 vs. −0.2±2.2 mm/y; −0.69±0.12 vs. 0.04±0.11 %/y; 0.1±0.2 vs. 0.5±1.8 mm/y, all p<0.01). All differences remained significant after adjusting for confounding factors. Adolescent pregnancy slows post‐menarcheal growth that may result in 0.6–2.7cm deficits in attained height in rural Bangladeshi women. Funders: USAID & Gates Foundation