{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:00:12Z","timestamp":1784865612438,"version":"3.55.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite Malawi facing a high burden of multiple nutrient deficiencies arising mostly from low dietary supplies, nutrition assessments focus largely on micronutrients (e.g., minerals and vitamins), ignoring macronutrients such as protein. This study aimed to assess prevalence of inadequate dietary intake of protein and two essential amino acids lysine and tryptophan and their relation to stunting among Malawian under five children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We extracted data on household food consumption, expenditure and anthropometry for 5,952 children aged 6\u201359 months from the 2019\/20 Malawi\u2019s Fifth Integrated Household Survey. Household food consumption and expenditure data were processed in R Studio with outliers replaced using median values, edible portions derived using conversion factors and all data standardized using Adult Female Equivalent (AFE). Relevant Food Composition Tables and database were utilized to estimate apparent intake of total and available protein, lysine, and tryptophan. Nutrient adequacy was assessed using the cut-off method based on Estimated Average Requirements, applying FAO thresholds. Anthropometric data were used to assess stunting, calculated using Z-scores in accordance with the 2006 WHO Growth Standards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Respectively, inadequate available protein, lysine and tryptophan were prevalent in 49.0%, 56.4% and 25.7% of the children. Stunted children faced worse deficits \u2013 52.5% inadequate available protein vs. 47.2% in non-stunted children (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Inadequate available lysine intake (61.5%) was most evident in the Central region, available protein inadequacy was higher in rural (50.7%) than urban areas (39.2%) (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), whereas available tryptophan gaps were significantly greater (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.009) in female- (28.7%) than male-headed households (24.6%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Inadequate intake of protein, lysine, and tryptophan was prevalent among children, particularly among those who were stunted and those living in rural areas. Regional variations were evident, with lysine inadequacy most pronounced in the Central region, while tryptophan inadequacy was more prevalent in female-headed households.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1744220","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T15:01:41Z","timestamp":1773846101000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence of protein, lysine, and tryptophan inadequacy and their relation to stunting among Malawian under five children: evidence from the 2019\/20 Integrated Household Survey"],"prefix":"10.3389","volume":"13","author":[{"given":"Keston Mwiwa","family":"Sinkhonde","sequence":"first","affiliation":[{"name":"Department of Human Nutrition and Health, Bunda College, Lilongwe University of Agriculture and Natural Resources","place":["Lilongwe, Malawi"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Innocent","family":"Pangapanga-Phiri","sequence":"additional","affiliation":[{"name":"Centre for Agricultural Research and Development, Bunda College, Lilongwe University of Agriculture and Natural Resources","place":["Lilongwe, Malawi"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition and Health, Bunda College, Lilongwe University of Agriculture and Natural Resources","place":["Lilongwe, Malawi"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A.","family":"Kalimbira","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition and Health, Bunda College, Lilongwe University of Agriculture and Natural Resources","place":["Lilongwe, Malawi"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"B1","volume-title":"Malawi Demographic Health Survey. Vol. 3, Official Government Report.","year":"2024"},{"key":"B2","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1017\/S1368980018002434","article-title":"Prevalence thresholds for wasting, overweight and stunting in children under 5 years.","volume":"22","author":"de Onis","year":"2019","journal-title":"Public Health Nutr."},{"key":"B3","volume-title":"Levels and trends in child malnutrition: UNICEF\/WHO\/World Bank Group Joint Child Malnutrition Estimates: key findings of the 2023 edition","year":"2023"},{"key":"B4","volume-title":"Malawi Demographic Health Survey.","year":""},{"key":"B5","doi-asserted-by":"publisher","first-page":"2430","DOI":"10.3390\/nu14122430","article-title":"Limited supply of protein and lysine is prevalent among the poorest households in malawi and exacerbated by low protein quality.","volume":"14","author":"Muleya","year":"2022","journal-title":"Nutrients."},{"key":"B6","first-page":"1","volume-title":"Present Knowledge in Nutrition.","author":"Marriot","year":"2020"},{"key":"B7","volume-title":"Protein and Amino Amino Acid Requirements Nutrition; Technical Report Series.","year":"2007"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1642S","DOI":"10.1093\/jn\/137.6.1642S","article-title":"Lysine requirement through the human life cycle.","volume":"137","author":"Tom\u00e9","year":"2007","journal-title":"J Nutr."},{"key":"B9","doi-asserted-by":"publisher","first-page":"2548","DOI":"10.1080\/10408398.2020.1855101","article-title":"Protein, lysine and vitamin D: critical role in muscle and bone health.","volume":"62","author":"Aggarwal","year":"2022","journal-title":"Crit Rev Food Sci Nutr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"102049","DOI":"10.1016\/j.cdnut.2023.102049","article-title":"Local sources of protein in low- and middle-income countries: how to improve the protein quality?","volume":"8","author":"Vissamsetti","year":"2024","journal-title":"Curr Dev Nutr."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1178646918802282","DOI":"10.1177\/1178646918802282","article-title":"Analysis, nutrition, and health benefits of tryptophan.","volume":"11","author":"Friedman","year":"2018","journal-title":"Int J Tryptophan Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.livsci.2007.07.002","article-title":"Biological roles of tryptophan and its metabolism: potential implications for pig feeding.","volume":"112","author":"Le Floc\u2019h","year":"2007","journal-title":"Livest Sci."},{"key":"B13","first-page":"159","article-title":"Role of tryptophan in health and disease: systematic review of the anti-oxidant, anti-inflammation, and nutritional aspects of tryptophan and its metabolites.","author":"Nayak","year":"2019","journal-title":"World Heart J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"20503121231165562","DOI":"10.1177\/20503121231165562","article-title":"Study of the importance of protein needs for catch-up growth in Indonesian stunted children: a narrative review.","volume":"11","author":"Endrinikapoulos","year":"2023","journal-title":"SAGE Open Med."},{"key":"B15","volume-title":"The Fifth Integrated Household Survey (IHS5) 2020 Report.","year":"2020"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e000812","DOI":"10.1136\/bmjsem-2020-000812","article-title":"Physical activity and sedentary time in a rural adult population in Malawi compared with an age-matched US urban population.","volume":"6","author":"Pratt","year":"2020","journal-title":"BMJ Open Sport Exerc Med."},{"key":"B17","volume-title":"Government of Malawi Malawian Food Composition Table 2019.","year":""},{"key":"B18","volume-title":"SAMRC Food Composition Tables for South Africa.","year":"2017"},{"key":"B19","volume-title":"Human energy requirements: Report of a Joint FAO\/WHO\/UNU Expert Consultation, Rome, 17\u201324 October 2001","year":"2004"},{"key":"B20","volume-title":"Food Data Central.","year":"2019"},{"key":"B21","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/nyas.14697","article-title":"Modeling food fortification contributions to micronutrient requirements in Malawi using household consumption and expenditure surveys.","volume":"1508","author":"Tang","year":"2021","journal-title":"Ann N Y Acad Sci."},{"key":"B22","first-page":"166","article-title":"Human energy requirements: report of a joint FAO\/ WHO\/UNU expert consultation.","volume":"26","year":"2004","journal-title":"Food Nutr Tech Reportutrition Tech Rep."},{"key":"B23","volume-title":"Malawi Micronutrient Survey.","year":"2015"},{"key":"B24","volume-title":"Complementary Feeding of Young Children in Developing Countries.","year":"1998"},{"key":"B25","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1093\/ajcn\/71.2.605a","article-title":"Complementary feeding of young children in developing countries: a review of current scientific knowledge.","volume":"71","author":"Hathcock","year":"1995","journal-title":"Am J Clin Nutr."},{"key":"B26","doi-asserted-by":"publisher","first-page":"20230018","DOI":"10.1515\/em-2023-0018","article-title":"Outliers in nutrient intake data for U.S. adults: national health and nutrition examination survey 2017-2018.","volume":"12","author":"Burcham","year":"2023","journal-title":"Epidemiol Methods."},{"key":"B27","first-page":"1","volume-title":"World Health Organization. AnthroPlus for Personal Computers. Manual: Software for Assessing Growth of the World \u2018 s Children.","year":"2009"},{"key":"B28","volume-title":"Nutrient Consumption and Dietary Patterns in Malawi.","year":"2020"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/nu13031039","article-title":"Multinutrient biofortification of Maize (Zea mays L.) in Africa: current status, opportunities and limitations.","volume":"13","author":"Goredema-Matongera","year":"2021","journal-title":"Nutrients."},{"key":"B30","doi-asserted-by":"publisher","first-page":"220","DOI":"10.4081\/jphr.2021.2161","article-title":"Low intake of essential amino acids and other risk factors of stunting among under-five children in Malang City, East Java, Indonesia.","volume":"10","author":"Rizky Maulidiana","year":"2021","journal-title":"J Public Health Res."},{"key":"B31","volume-title":"National Agriculture Policy.","year":"2024"},{"key":"B32","first-page":"1","volume-title":"IFPRI Key Facts Series: Agricultural Commercialization 1.","year":"2022"},{"key":"B33","doi-asserted-by":"publisher","first-page":"217","DOI":"10.3945\/an.110.000182","article-title":"Quality protein maize for Africa: closing the protein inadequacy gap in vulnerable populations.","volume":"2","author":"Nuss","year":"2011","journal-title":"Adv Nutr."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1467632","DOI":"10.3389\/fnut.2024.1467632","article-title":"Determinants of adoption of quality protein maize varieties in Misrak Badewacho District, Southern Ethiopia: policy implications.","volume":"11","author":"Jambo","year":"2024","journal-title":"Front Nutr."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1021906","DOI":"10.3389\/fsufs.2023.1021906","article-title":"A sustainability analysis of environmental impact, nutritional quality, and price among six popular diets.","volume":"7","author":"Bach","year":"2019","journal-title":"Front Sustain Food Syst."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.3390\/nu17091493","article-title":"Understanding stunting: impact, causes, and strategy to accelerate stunting reduction-a narrative review.","volume":"17","author":"Mulyani","year":"2025","journal-title":"Nutrients."},{"key":"B37","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1177\/0379572119892408","article-title":"Dietary magnesium, vitamin d, and animal protein intake and their association to the linear growth trajectory of children from birth to 24 months of age: results from MAL-ED birth cohort study conducted in Dhaka, Bangladesh.","volume":"41","author":"Das","year":"2020","journal-title":"Food Nutr Bull."},{"key":"B38","doi-asserted-by":"publisher","first-page":"3948","DOI":"10.3390\/nu14193948","article-title":"Quantity and source of protein during complementary feeding and infant growth: evidence from a population facing double burden of malnutrition.","volume":"14","author":"Kittisakmontri","year":"2022","journal-title":"Nutrients."},{"key":"B39","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1017\/S136898001600210X","article-title":"Child height gain is associated with consumption of animal-source foods in livestock-owning households in Western Kenya.","volume":"20","author":"Mosites","year":"2017","journal-title":"Public Health Nutr."},{"key":"B40","volume-title":"Malawi Poverty Report.","year":"2020"},{"key":"B41","volume-title":"Afikepo Programme Endline Survey.","year":"2024"},{"key":"B42","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1186\/s41043-025-01075-y","article-title":"Socio-economic and rural-urban disparities in the double burden of childhood malnutrition in sub-Saharan Africa.","volume":"44","author":"Marume","year":"2025","journal-title":"J Health Popul Nutr."},{"key":"B43","doi-asserted-by":"publisher","first-page":"e0290199","DOI":"10.1371\/journal.pone.0290199","article-title":"How do gender norms contribute to stunting in Ntchisi District, Malawi? a qualitative study.","volume":"19","author":"Mphangwe","year":"2023","journal-title":"PLoS One."},{"key":"B44","volume-title":"Livelihood Coping Strategies Indicator for Food Security: Guidance Note.","year":"2023"},{"key":"B45","volume-title":"Agriculture Sector Food and Nutrition Strategy 2020\u20132024.","year":""},{"key":"B46","volume-title":"A Closer Look at Hunger and Undernutrition in Malawi: Progress Despite Formidable Challenges","author":"Bernstein","year":"2019"},{"key":"B47","article-title":"Are female-headed households less food secure? evidence from Nigeria and Ethiopia.","volume-title":"Proceedings of the Allied Social Science Association Annual Conference.","author":"Akadiri","year":"2018"},{"key":"B48","unstructured":"1\n          73\n          Towards Gender-Just Food and Nutrition: Overview Report.\n          \n          2014"},{"key":"B49","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1007\/s12571-012-0215-y","article-title":"Female-headed households and food insecurity in Brazil.","volume":"4","author":"Felker-Kantor","year":"2012","journal-title":"Food Secur."},{"key":"B50","doi-asserted-by":"publisher","first-page":"73","DOI":"10.5539\/jas.v13n9p73","article-title":"Gender-differentiated contribution of goat farming to household income and food security in semi-arid areas of Msinga, South Africa.","volume":"13","author":"Tsvuura","year":"2021","journal-title":"J Agric Sci."},{"key":"B51","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.nutos.2022.01.009","article-title":"Prevalence of child stunting in Sub-Saharan Africa and its risk factors.","volume":"42","author":"Quamme","year":"2022","journal-title":"Clin Nutr Open Sci."},{"key":"B52","doi-asserted-by":"publisher","first-page":"S235","DOI":"10.1177\/15648265120333S213","article-title":"Should household consumption and expenditures surveys (HCES) be used for nutritional assessment and planning?","volume":"33","author":"Murphy","year":"2012","journal-title":"Food Nutr Bull."},{"key":"B53","doi-asserted-by":"publisher","first-page":"2485","DOI":"10.3390\/nu17152485","article-title":"Use of household apparent food intake data to estimate micronutrient inadequacy in comparison to the 24-h recall data among women of reproductive age in Kasungu District, Malawi.","volume":"17","author":"Kalimbira","year":"2025","journal-title":"Nutrients."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1744220\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T15:01:47Z","timestamp":1773846107000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1744220\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":53,"alternative-id":["10.3389\/fnut.2026.1744220"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1744220","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]},"article-number":"1744220"}}