{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:44:05Z","timestamp":1792046645384,"version":"4.4.0"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Nutr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Malnutrition in its various forms remains a serious public health concern worldwide. This ecological study, based on a secondary analysis of Global Burden of Disease (GBD) 2023 data, examines prevalence trends of protein\u2013energy malnutrition (PEM) among children under 5 years of age in the WHO South-East Asia Region (SEAR) from 1990 to 2023. We utilised Joinpoint regression analysis to identify temporal shifts and calculated the average annual percentage change (AAPC) to summarise overall trends. Regional results show the number of prevalent cases declined from 32\u00b74 million (95 % uncertainty intervals (UI): 32\u00b72\u201332\u00b77) in 1990 to 18\u00b79 million (95 % UI: 18\u00b77\u201319\u00b71) in 2023. The prevalence rate per 100\u00a0000 population declined from 22\u00a0141 to 13\u00a0463 over the same period. India maintained the highest prevalence in 2023 at 14\u00b78 % (95 % UI: 14\u00b76\u201315\u00b70). Joinpoint analysis indicated a significant overall reduction across all countries (\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0\u00b705), with the most substantial decline in the Democratic People\u2019s Republic of Korea (AAPC: -4\u00b705 % (95 % CI -4\u00b708 to -4\u00b701)) and the most modest in Timor-Leste (AAPC: -0\u00b766 % (95 % CI -0\u00b767 to -0\u00b765)). Sex-stratified analysis revealed higher prevalence rates in males than females across the study period. Age-specific findings identified children aged 6\u201323 months as the most vulnerable group. Furthermore, prevalence was negatively associated with the Socio-demographic Index (SDI), though country-specific trajectories remained heterogeneous. Despite progress, PEM remains a major public health burden in SEAR. These findings highlight the need for targeted, age-specific nutrition strategies and continued socio-economic investment to accelerate progress.\n                  <\/jats:p>","DOI":"10.1017\/s0007114526108538","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:46:16Z","timestamp":1792043176000},"page":"1-9","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Burden and trends of protein\u2013energy malnutrition among children under 5 years in WHO South-East Asia Region Countries: an ecological study using the Global Burden of Disease data, 1990\u20132023"],"prefix":"10.1017","author":[{"given":"Midhun","family":"Sasikumar","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00c7kvd80","id-type":"ROR","asserted-by":"publisher"}],"name":"Christian Medical College Vellore"},{"name":"Tampere Universities"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kedar","family":"Mehta","sequence":"additional","affiliation":[{"name":"GMERS Medical College Gotri Vadodara"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Jose","sequence":"additional","affiliation":[{"name":"Christian Medical College Vellore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreedevi","family":"Kotamreddy","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00c7kvd80","id-type":"ROR","asserted-by":"publisher"}],"name":"Christian Medical College Vellore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark Rohit","family":"Francis","sequence":"additional","affiliation":[{"name":"Tampere Universities"},{"name":"THL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6977-3288","authenticated-orcid":false,"given":"Sam Marconi","family":"David","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00c7kvd80","id-type":"ROR","asserted-by":"publisher"}],"name":"Christian Medical College Vellore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"S0007114526108538_ref2","doi-asserted-by":"publisher","DOI":"10.3390\/nu14132592"},{"key":"S0007114526108538_ref3","first-page":"3","article-title":"Interactions of nutrition and infection","volume":"57","author":"Scrimshaw","year":"1968","journal-title":"Monogr Ser World Health Organ"},{"key":"S0007114526108538_ref15","doi-asserted-by":"publisher","DOI":"10.1596\/978-0-8213-6953-1"},{"key":"S0007114526108538_ref17","unstructured":"17. FAO (2023) I. The State of Food Security and Nutrition in the World 2023. Urbanization, agrifood systems transformation and healthy diets across the rural\u2013urban continuum [Internet]. Rome, Italy: FAO; IFAD; UNICEF; WFP; WHO. 316 p. (The State of Food Security and Nutrition in the World (SOFI); no. 2023). https:\/\/openknowledge.fao.org\/handle\/20.500.14283\/cc3017en (accessed September 2026)."},{"key":"S0007114526108538_ref14","unstructured":"14. World Health Organization. WHO. (2013) Guideline: updates on the management of severe acute malnutrition in infants and children. https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/0c5e1662-a300-4827-90fa-962ac21360dd\/content (accessed September 2026)."},{"key":"S0007114526108538_ref1","unstructured":"1. UNICEF\/WHO\/World Bank Group (2025) Levels and trends in child malnutrition. https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/a0aad785-4ff8-43d7-bdf9-be6c9a221e8e\/content (accessed September 2026)."},{"key":"S0007114526108538_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60843-0"},{"key":"S0007114526108538_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30977-6"},{"key":"S0007114526108538_ref11","unstructured":"11. Methodology for Characterizing Trends (2024). https:\/\/progressreport.cancer.gov\/methodology (accessed September 2026)."},{"key":"S0007114526108538_ref19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1740-8709.2007.00124.x"},{"key":"S0007114526108538_ref20","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.113.064584"},{"key":"S0007114526108538_ref4","unstructured":"4. World Health Organization (2024) meeting-report-regional-meeting-on-climate-change-and-nutrition 2024. https:\/\/cdn.who.int\/media\/docs\/default-source\/nutritionlibrary\/meeting-report-regional-meeting-on-climate-change-and-nutrition2024.pdf?sfvrsn=246279ec_2 (accessed September 2026)."},{"key":"S0007114526108538_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31647-0"},{"key":"S0007114526108538_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32497-3"},{"key":"S0007114526108538_ref16","article-title":"Global burden of children and adolescents\u2019 nutritional deficiencies from 1990 to 2021","volume":"13","author":"Zhou","year":"2025","journal-title":"Front Pediatr"},{"key":"S0007114526108538_ref13","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12274"},{"key":"S0007114526108538_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32506-1"},{"key":"S0007114526108538_ref6","unstructured":"6. 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