The nutrient composition and safety of complementary foods have recently become areas of concern, especially with regard to aflatoxin contamination which has been found to adversely affect health outcomes. This study presents the nutrient and aflatoxin contents of complementary foods consumed by children (6–24 months) and infants and young child feeding practices of mothers from two districts in eastern and southern Zambia. A total of 400 mother–child pairs were recruited from Monze and Chipata districts, and data on breastfeeding and complementary feeding practices were collected twice at 3‐month interval using a structured questionnaire. Samples of two traditional complementary foods (Maize Nshima and Maize porridge) were collected from the mothers and analyzed for nutrient contents and aflatoxin contamination. The results showed that there is a high level of awareness on exclusive breastfeeding among mothers. Fat, protein, carbohydrate, and ash contents of Maize nshima from Chipata were significantly lower (p < .05) compared to those from Monze district except for starch and sugar. Monze mothers preferred to prepare a thicker Maize nshima and Maize porridge compared to their Chipata counterparts. The aflatoxin contamination showed that the Maize porridge samples from Chipata were the most contaminated with mean aflatoxin content of 5.8 ± 15.93 mg/100 g, while Maize nshima was the most contaminated of the two complementary foods from Monze districts with mean aflatoxin level of 3.8 ± 6.41 mg/100 g. There were significant (p < .05) positive correlations between fat and aflatoxin contents for Chipata samples (r = .12409) and for Monze samples (r = .13666). The traditional complementary foods studied were found to be low in fat and protein and high in aflatoxin contamination. Thus, it is imperative that best practices and interventions are designed and introduced to reduce the possible lethal health implications of consumption of such complementary foods by children under 5 years.

Early life exposures and growth patterns may affect long-term risk of chronic non-communicable diseases (NCDs). We followed up in adolescence two Zambian cohorts (N=322) recruited in infancy to investigate how two early exposures – maternal HIV exposure without HIV infection (HEU), and early growth profile – were associated with later anthropometry, body composition, blood lipids, haemoglobin (Hb) and HbA1c, blood pressure and grip strength. Although in analyses controlled for age and sex, HEU children were thinner, but not shorter, than HIV-unexposed, uninfected (HUU) children, with further control for sociodemographic factors, these differences were not significant. HEU children had higher HDL cholesterol than HUU children and marginally lower HbA1c but no other biochemical or clinical differences. We identified three early growth profiles – adequate growth, declining and malnourished – which tracked into adolescence when differences in anthropometry and body fat were still seen. In adolescence, the early malnourished group, compared with the adequate group, had lower blood triglycerides and higher HDL, lower grip strength (difference: -1.87 kg, 95% CI: -3.47, -0.27; P=0.02) and higher HbA1c (difference: 0.5%, 95% CI 0.2, 0.9, P=0.005). Lower grip strength and higher HbA1c suggest the early malnourished children could be at increased risk of NCDs in later life. Including early growth profile in analyses of HIV exposure reduced the associations between HIV and outcomes. The results suggest that perinatal HIV exposure may have no long-term effects unless accompanied by poor early growth. Reducing the risk of young child malnutrition may lessen children’s risk of later NCDs.

There is limited information as to whether people who experience severe acute malnutrition (SAM) as young children are at increased risk of overweight, high body fat, and associated chronic diseases in later life. We followed up, when aged 7-12 years, 100 Zambian children who were hospitalised for SAM before age 2 years and 85 neighbourhood controls who had never experienced SAM. We conducted detailed anthropometry, body composition assessment by bioelectrical impedance (BIA) and deuterium dilution (D2O), and measured blood lipids, haemoglobin (Hb) and haemoglobin A1c (HbA1c). Groups were compared by linear regression following multiple imputation for missing variables. Children with prior SAM were slightly smaller than controls but differences, controlling for age, sex, socioeconomic status, and HIV exposure or infection, were significant only for hip circumference, suprailiac skinfold, and fat-free mass index by D2O. Blood lipids and HbA1c did not differ between groups but Hb was lower by 7.8 (95% CI 0.8, 14.7) g/L and systolic blood pressure was 3.4 (95% CI 0.4, 6.4) mmHg higher among the prior SAM group. Both anaemia and high HbA1c were common among both groups, indicating a population at risk for the double burden of over- and under-nutrition and associated infectious and chronic diseases. The prior SAM children may have been at slightly greater risk than the controls; this was of little clinical significance at this young age but the children should be followed when older and chronic diseases manifest.

BackgroundZambia is a sub-Saharan country with one of the highest prevalence rates of HIV, currently estimated at 14%. Poor nutritional status due to both protein-energy and micronutrient malnutrition has worsened this situation. In an attempt to address this combined problem, the government has instigated a number of strategies, including the provision of antiretroviral (ARV) treatment coupled with the promotion of good nutrition. High-energy protein supplement (HEPS) is particularly promoted; however, the impact of this food supplement on the nutritional status of people living with HIV/AIDS (PLHA) beyond weight gain has not been assessed. Techniques for the assessment of nutritional status utilising objective measures of body composition are not commonly available in Zambia. The aim of this study is therefore to assess the impact of a food supplement on nutritional status using a comprehensive anthropometric protocol including measures of skinfold thickness and circumferences, plus the criterion deuterium dilution technique to assess total body water (TBW) and derive fat-free mass (FFM) and fat mass (FM).Methods/DesignThis community-based controlled and longitudinal study aims to recruit 200 HIV-infected females commencing ARV treatment at two clinics in Lusaka, Zambia. Data will be collected at four time points: baseline, 4-month, 8-month and 12-month follow-up visits. Outcome measures to be assessed include body height and weight, body mass index (BMI), body composition, CD4, viral load and micronutrient status.DiscussionThis protocol describes a study that will provide a longitudinal assessment of the impact of a food supplement on the nutritional status of HIV-infected females initiating ARVs using a range of anthropometric and body composition assessment techniques.Trial RegistrationPan African Clinical Trial Registry PACTR201108000303396.

Background Malnutrition is a public health problem, as wasting affects 7.5% of children worldwide. The harmful effects of severe acute malnutrition (SAM) can last a lifetime, but how SAM in childhood affects later breastfeeding ability is not clear. In the present study, we assessed the human milk output and body composition among mothers with a history of childhood SAM. Methods This retrospective cohort study was carried out in Miti-Murhesa Health Zone (Democratic Republic of Congo) from January 15 to March 17, 2020. We selected lactating mothers with breastfed infants aged 2–12 months. Two categories of mothers were included: those who had been treated for SAM during their childhood (years 1988–2003; n = 39) and a community control with no history of SAM (n = 40). The weight, height, and mid-upper arm circumference were measured and body mass index (BMI) calculated as weight/height2. Body composition and human milk output were assessed using standard deuterium dilution methods. Student t and chi2 tests ware applied to compare two groups. Results The mean age ± standard deviation of the mothers was 24.4 ± 5.1 and 26.0 ± 6.1 years for the SAM and control groups, respectively (p = 0.186). The age of their infants was 5.4 ± 2.3 months in both groups (p = 0.962). In the SAM and control groups, the mean maternal BMI was 23.8 ± 2.3 and 23.6 ± 3.7 kg/m2 (p = 0.849), mean Fat Mass 27.1% ± 5.0 and 27.1% ± 5.8% (p = 0.708), and the mean Fat Free mass 72.9% ± 5.0 and 72.9% ± 5.8% (p = 0.998), respectively. Human milk output was 833.7 ± 152.1 g/d in SAM group and 827.4 ± 171.4 g/d in the control group (p = 0.864). Conclusions We found no significant difference in human milk output and body composition in mothers treated for SAM during childhood compared to community controls.