{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T13:12:35Z","timestamp":1777641155230,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T00:00:00Z","timestamp":1621382400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Food Nutr Bull"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In middle-income countries, malnutrition concentrates in marginalized populations with a lack of effective preventive strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Identify risk factors for undernutrition in a peri-urban Ecuadorian community of children aged 12 to 59 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data from a cross-sectional survey in 2011 of children 1 to 5 years were analyzed including demographic data, medical history and examination, food frequency questionnaire (FFQ), anthropometric measurements, and blood for complete blood count, C-reactive protein, vitamin A, iron, and zinc levels. Dietary Diversity Score (DDS) was calculated from FFQ. Bivariate and multivariate analysis assessed effects on primary outcome of undernutrition by DDS, vitamin deficiencies, and demographic and nutritional data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      N = 67, 52.2% undernourished: 49.3% stunted, 25.4% underweight, and 3% wasted; 74.6% (n = 50) were anemic and 95.1% (n = 39) had low serum zinc. Dietary Diversity Score was universally low (mean 4.91 \u00b1 1.36, max 12). Undernutrition was associated with lower vitamin A levels (20 306, IQR: 16605.25-23973.75 vs 23665, IQR: 19292-26474 ng\/mL, P = .04); underweight was associated with less parental report of illness (43.8%, n = 7 vs 80% n = 40, P = .005) and higher white blood count (13.7, IQR: 11.95-15.8 vs 10.9, IQR: 7.8-14.23 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L, P = .02). In multiple regression, risk of undernutrition decreased by 4% for every $10 monthly income increase (95 CI%: 0.5%-7.4%, P = .02, n = 23); risk of underweight decreased by 0.06 for every increased DDS point (adjusted odds ratio: 0.06; 95 CI%: 0.004-0.91, P = .04, n = 23).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this peri-urban limited-resource, mostly Indigenous Ecuadorian community, stunting exceeds national prevalence, lower monthly income is the strongest predictor of undernutrition, lower DDS can predict some forms of undernutrition, and vitamin deficiencies are associated with but not predictive of undernutrition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0379572120982500","type":"journal-article","created":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T05:11:46Z","timestamp":1621401106000},"page":"210-224","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Identifying Targets for the Prevention of Childhood Undernutrition in a Resource-Limited Peri-Urban Ecuadorian Community"],"prefix":"10.1177","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2689-3340","authenticated-orcid":false,"given":"Suzanna L.","family":"Attia","sequence":"first","affiliation":[{"name":"University of Kentucky, Lexington, KY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolf-Peter","family":"Schmidt","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janeth Ceballos","family":"Osorio","sequence":"additional","affiliation":[{"name":"University of Kentucky, Lexington, KY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Young","sequence":"additional","affiliation":[{"name":"University of Kentucky, Lexington, KY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aric","family":"Schadler","sequence":"additional","affiliation":[{"name":"University of Kentucky, Lexington, KY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2143-3844","authenticated-orcid":false,"given":"Julie","family":"Plasencia","sequence":"additional","affiliation":[{"name":"University of Kentucky, Lexington, KY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,5,19]]},"reference":[{"key":"bibr1-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60937-X"},{"key":"bibr2-0379572120982500","unstructured":"United Nations Children\u2019s Fund (UNICEF). World Health Organization, International Bank for Reconstruction and Development\/The World Bank. Levels and trends in child malnutrition: key findings of the 2018 Edition of the Joint Child Malnutrition Estimates. Geneva: World Health Organization; 2018."},{"key":"bibr3-0379572120982500","unstructured":"Bain R, Beise J, Benali N, et al. Progress for every child in the SDG era. 2018. www.data.unicef.org"},{"issue":"2","key":"bibr4-0379572120982500","first-page":"138","volume":"40","author":"Galicia L","year":"2016","journal-title":"Rev Panam Salud Publica"},{"key":"bibr5-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2015.11.002"},{"key":"bibr6-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-06-508325"},{"key":"bibr7-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/6067283"},{"key":"bibr8-0379572120982500","unstructured":"WHO. The global prevalence of anaemia in 2011. 2015. Geneva: World Health Organization."},{"key":"bibr9-0379572120982500","unstructured":"United Nations Children\u2019s Fund. Vitamin A deficiency. 2018. Accessed October 29, 2018. https:\/\/data.unicef.org\/topic\/nutrition\/vitamin-a-deficiency\/. Updated February 2019."},{"key":"bibr10-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5094"},{"key":"bibr11-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-S3-S22"},{"key":"bibr12-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(15)32138-7"},{"key":"bibr13-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1016\/j.vph.2015.03.005"},{"key":"bibr14-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-013-0375-y"},{"key":"bibr15-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2013.06.002"},{"key":"bibr16-0379572120982500","volume-title":"Household Dietary Diversity Score (HDDS) for Measurement of Household Food Access: Indicator Guide (v.2)","author":"Swindale A","year":"2006"},{"key":"bibr17-0379572120982500","volume-title":"Dietary Assessment: A Resource Guide to Method Selection and Application in Low Resource Settings","author":"Food and Agriculture Organization","year":"2018"},{"key":"bibr18-0379572120982500","volume-title":"Guidelines for Measuring Household and Individual Dietary Diversity","author":"Kennedy, Gina; Ballard, Terri","year":"2011"},{"key":"bibr19-0379572120982500","volume-title":"Efecto del suplemento de micronutrientes en el estado nutricional y anemia en ni\u00f1os, Los rios-Ecuador; 2014-2015","author":"Chuquimarca R","year":"2017"},{"key":"bibr20-0379572120982500","volume-title":"(Chispitas Nutricionales) Para Uso En Los Beb\u00e9s y Ni\u00f1os Peque\u00f1os: Directrices Sobre Las Recomendaciones de Uso y Un Programa de Seguimiento y Evaluaci\u00f3n","author":"\u201cSprinkles\u201d","year":"2010"},{"key":"bibr21-0379572120982500","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.114.083766"},{"key":"bibr22-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/138.2.379"},{"key":"bibr23-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12231"},{"key":"bibr24-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-020760"},{"key":"bibr25-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-3459"},{"key":"bibr26-0379572120982500","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.116.130518"},{"key":"bibr27-0379572120982500","doi-asserted-by":"publisher","DOI":"10.1301\/00296640260130722"},{"key":"bibr28-0379572120982500","doi-asserted-by":"publisher","DOI":"10.3390\/nu5020579"},{"key":"bibr29-0379572120982500","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.17-0130"}],"container-title":["Food and Nutrition Bulletin"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0379572120982500","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0379572120982500","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0379572120982500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:19:30Z","timestamp":1777443570000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0379572120982500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,19]]},"references-count":29,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1177\/0379572120982500"],"URL":"https:\/\/doi.org\/10.1177\/0379572120982500","relation":{},"ISSN":["0379-5721","1564-8265"],"issn-type":[{"value":"0379-5721","type":"print"},{"value":"1564-8265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,19]]}}}