PhD defence Idalécia Cossa Moiane
Supervisors
Prof. dr. Katja Polman (ITM)
Prof. dr. Jean-Pierre Van geertruyden (University of Antwerp)
Prof. dr. Nilsa de Deus (Instituto Nacional de Saúde, Maputo, Mozambique)
Prof. dr. Colleen Doak (St. Ambrose University, Davenport, United States of America)
Abstract
Child undernutrition remains one of the most pressing public health issues in low- and middle-income countries (LMICs), especially in sub-Saharan Africa. In Mozambique, the burden of undernutrition remains alarmingly high, having the highest rates of stunting in the sub-Saharan region among children under 5 years of age. While acute interventions often lead to weight gain, there is growing concern about the quality of this recovery, especially in terms of body composition. Recent evidence suggests that rapid weight gain may disproportionately consist of fat mass rather than lean mass, potentially increasing long-term metabolic risk. Consequently, it may lead to the development of overweight or obesity at a later age. This issue is particularly relevant and pressing in Mozambique and other LMICs, where obesity is also on the rise. This creates a “double burden of malnutrition” (DBM), with the country simultaneously affected by both undernutrition and overnutrition. The coexistence of these issues complicates public health efforts and underscores the need for interventions that promote not only weight gain but also healthy body composition.
The role of intestinal parasitic infections (IPIs) in changing body composition has so far been understudied. Nevertheless, IPIs are very common in LMICs and are known to be reciprocally associated with child undernutrition. Additionally, they have been linked to overweight/obesity. Mozambique is an example of a country in transition, with high parasite endemicity, high rates of child undernutrition, and rapidly emerging overweight, obesity, and related chronic disease risks. In this context, this thesis explores the role of IPIs and other factors in relation to undernutrition and (changes in) body composition in children in Mozambique. To this end, the thesis combines insights from three interlinked studies (two published and one under review):
Chapter 2 - a scoping review exploring the association between IPIs and body composition.
Chapter 3 - a cross-sectional study on the profile of 449 hospitalized undernourished children aged 1 to 14 years in Maputo, including associated risk factors.
Chapter 4 - a longitudinal study of 217 hospitalized undernourished children aged 6 to 58 months in Maputo, monitoring changes in body composition over time and identifying their predictors, including IPIs.
The findings of the scoping review revealed that direct measures of body composition are rarely assessed in clinical practice, with most studies relying on proxies such as weight-for-height, Body Mass-Index (BMI) or skinfold thickness (SK). The cross-sectional study in Maputo showed that children with undernutrition often present to the hospital in critical condition, and many suffer from co-infections with IPIs and/or HIV. The longitudinal study confirmed that HIV infection is a strong negative predictor of both weight and fat recovery, whereas edema at hospital admission is associated with improved weight and skinfold outcomes. Age and sex also emerged as significant predictors of body composition changes. Noteworthy is that IPIs were significantly associated with body fat in univariate analysis, but this association attenuated after adjusting for other variables. SKs in addition to mid-upper arm circumference (MUAC), height and weight provided valuable insights into the body composition changes during nutritional recovery.
These findings underscore the complexity of nutritional recovery and illustrate the importance of adopting a more refined approach to monitoring and intervention. This includes the prioritization of more proximal actions, such as providing close follow-up care for children in their home environment after hospital discharge, in addition to the care provided during hospitalization. The findings demonstrate the need for a shift towards integrated strategies that consider body composition, particularly body fat. It also calls for reflection on the integration of child healthcare, simultaneously considering nutrition, infectious diseases and a family-centered approach.
Ultimately, this research aligns with global efforts to achieve the Sustainable Development Goals (SDGs), particularly SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-being). It challenges policymakers and health systems to move beyond treating undernutrition as a condition of weight deficiency and to recognize the importance of weight recovery. Attention should be paid to infection management, body composition outcomes, continued follow-up of the child (particularly when back home), as well as education of household members on nutritional behaviors and prevention of IPIs.
More information
Venue: ITM, Auditorium Nationalestraat, Nationalestraat 133, 2000 Antwerpen
Defence: 4 pm – 6 pm CEST. Please be on time, doors open at 3:45 and close at 4 pm.
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Antwerp is a Low Emission Zone and parking availabilities are limited. See for travelling information and parking regulations: https://www.itg.be/en/travelling-to-itm & https://www.slimnaarantwerpen.be/en/home.
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