Introduction Women and infants are among the most vulnerable groups for micronutrient deficiencies. Pregnancy micronutrient status can affect birth outcomes and subsequent infants’ growth. Methods We determined the relationship between maternal iron and vitamin A status at delivery using several biomarkers (ferritin, soluble transferrin receptor [sTFR], body iron stores [BIS], hemoglobin and retinol binding protein [RBP]) and birth outcomes (body weight, Z-scores, head circumference, small-for-gestational-age and preterm birth) in rural Uganda. We investigated women who had serum results at the point of delivery and paired them to their infants at birth (n = 1244). We employed multivariable linear and logistic regression, adjusting for clustering at the subcounty level to determine the relationship between maternal micronutrients and birth outcomes. Results After adjusting for relevant factors, we found that maternal iron status (ferritin and BIS) and anemia (hemoglobin) were not significantly associated with the assessed birth outcomes. However, there was a significant association between serum sTFR and preterm births (AOR: 0.67; 95% CI 0.48–0.94). For Vitamin A, we observed a significant positive association between RBP and length-for-age (LAZ) at birth (β = 0.12, p < 0.030). Discussion These findings indicate that the relationship between maternal iron status and birth outcomes needs to be further investigated, because depending on the biomarker used the associations were either in favor of an adverse birth outcome or not significant. Additionally, they confirm that higher maternal RBP levels could be beneficial for birth outcomes. Clinicaltrials.gov as NCT04233944.

BackgroundIn Egypt, rates of child overweight and obesity are consistently increasing. While progress has been made in the reduction of stunting, Egypt's rate of 21% is still higher than countries in the region that have the same GDP.ObjectivesThe objectives were to to examine and understand the trends and variability of malnutrition in all its forms (over and under nutrition) in Egyptian children under five, across time, regions and socio‐economic status and examine associated factors.MethodsDHS data from 1988 to 2014 were downloaded cleaned and analyzed using SAS (Statistical Analysis Software). Anthropometric indicators for children under five were calculated using the WHO 2006 growth reference. Descriptive statistics of dependent variables (stunting, overweight, overweight in stunted children, wasting, Z‐scores of HAZ, WAZ and WHZ) and independent variables (maternal BMI, occupation, education, birth size, birth order, maternal age at first birth, wealth index, infant and young child feeding practices) were computed. Bivariate analysis was conducted using logistic regression models. Multi‐variate analysis utilized the log‐binomial regression model (PROC GENMOD) to adjust for complex variation structures in the data.ResultsRates of stunting steadily decreased from 36% in 1988 to 20% in 2014. Severe stunting reduced from 16.5% to 9.6%. Overweight went from 7 % in 1988 to 13% in 2014. The percentage of stunted children who are overweight went from 9% in 1988 to 34% in 2014. Stunting across wealth categories changed over time with rates being higher in the low socio‐economic categories until 2005 while 2008 and 2014, the data show a flat line across wealth index. Multivariate analysis shows that boys were more likely to be stunted (Prevalence ratio PR= 1.11, p <0.001). Factors associated with stunting were birth order (PR =1.02, p<0.05) and number of children under five. Factors protective against stunting included location (rural PR=0.86, p<0.001), secondary school education in the mother (PR=0.90, P<0.001), obese BMI category (compared to underweight), birth size (very large to smaller than average compared to very small), and household size (p<0.05).Factors that were protective against being overweight as a stunted child included being a boy (PR=0.88, p<0.001) and age of the child (PR=0.995, p<0.0001). Factors that increased the risk of being overweight as a stunted child included secondary education in mothers (PR=1.11, p<0.05), maternal occupation (PR=1.01, p<0.001), BMI category (all categories compared to underweight), household size, very large to normal birth size compared to very small birth size and ever being breast fed.ConclusionIn Egypt, stunting has decreased but overweight has increased in the population over time. More concerning is the increased prevalence of overweight in a stunted child. In recent surveys, wealth is not a factor associated with either stunting or being overweight in a stunted child. Key factors such as birth size and maternal BMI that have traditionally been used in policy initiatives, as markers of reducing stunting on the other hand are associated with increased overweight.Support or Funding InformationThis study is supported by the USAID Feed the Future Innovation Lab for Nutrition, USAID Bureau for Food Security and USAID Egypt.

Objectives We aimed to assess prevalence of iron and vitamin A deficiencies in Ugandan mothers and infants using the BRINDA (Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia) adjustment and to ascertain any differences by prevalence of malaria. Methods From a prospective birth cohort (N = 5000) conducted in rural Uganda (2014–2016), samples from mothers (n = 1652, at birth) and infants (n = 695, 5–7 m/o) were analyzed for ferritin (FER), soluble transferrin receptor (sTFR), retinol binding protein (RBP), CRP, AGP, hemoglobin (Hb) and malaria. FER, sTFR and RBP were adjusted for inflammation using CRP and AGP. Depleted iron stores were defined as: FER <12 µg/L and <15 µg/L in children and mothers respectively; sTFR >8.3 mg/L for Fe-deficient erythropoiesis; RBP <1.05 µmol/L for vitamin A deficiency; and Hb <110 g/L for anemia. Prevalence estimates were stratified by malaria status. Results Adjustment for inflammation in mothers increased depleted iron stores (FER) from 7 to 12%, and decreased iron-deficient erythropoiesis (sTFR) from 27 to 22%. For children, adjustment increased depleted Fe stores from 17 to 40%, and iron-deficient erythropoiesis from 76 to 64%. Vitamin A deficiency in mothers was 9% and in infants decreased after adjustment (15% vs 4%). The prevalence of altitude adjusted anemia was 18% in mothers and 72% in infants. The prevalence of tissue iron deficiency (BIS <0 mg/kg) using adjusted sTFR and FER was 10% for mothers and 50% for infants compared to 8% and 34% using unadjusted markers respectively (Tables 1,2). Almost 14% of children (n = 75) were diagnosed with malaria. Malaria prevalence in mothers was low (5%), possibly due to the high (82%) prevalence of IPT prophylaxis reported during pregnancy. No significant differences were found in adjusted versus unadjusted estimates for Fe markers stratifying by malaria. Conclusions Fe deficiency adjusted estimates varied by biomarker and were not correlated with malaria in line with BRINDA recommendations. For mothers and children, the prevalence of Fe deficiency (sTFR) and anemia (Hb) were similar, suggesting that a big part of anemia in Uganda could be due to Fe deficiency as opposed to other micronutrients. Funding Sources Support provided by Feed the Future Innovation Lab for Nutrition, funded by the United States Agency for International Development (USAID). Supporting Tables, Images and/or Graphs

We describe the lessons learned in building nutrition capacity through the development and implementation of the first dietetics training program in Malawi.