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Objective: Childhood stunting is a significant health issue in Rwanda, particularly within the Northern Province. While demographic and socio-economic factors have been more extensively studied, the impact of environmental and climatic factors on stunting prevalence has received less attention. This study aimed to determine if these factors could be used to better predict localized variations in height-for-age z-scores (HAZ).

Study design: A population-based, cross-sectional study.

Methods: Data were collected on child and maternal characteristics, household socioeconomic status, climate, and environmental predictors. An eXtreme Gradient Boosting (XGBoost) algorithm was used, complemented by GeoShapley for spatial analyses, to explain the spatial variability between low height-for-age and its risk factors.

Results: The model performed well, with the coefficient of determination (R2) value of 0.83, the root mean standardized error (RMSE) of 0.13, and the mean absolute error (MAE) of 0.10. Key predictors of HAZ included rainfall, childcare practices, food insecurity, elevation, and soil fertility. Considering the location feature, environmental and climatic factors significantly contributed to the spatial variability in HAZ.

Conclusion: Many environmental, climatological, and socio-economic factors emerge as predictors for HAZ variability. It is essential to consider their complexity for comprehensive interventions targeting childhood stunting in Rwanda and similar settings.

Background: Protein intake among children in resource-rich countries often exceeds current recommendations. Higher protein consumption during infancy has been associated with an increased risk of obesity later in life.

Objectives: We conducted a secondary analysis of a randomized controlled trial where 250 infants were randomly assigned to receive either a protein-reduced Nordic diet or a conventional Swedish complementary diet. Our aims were to examine the metabolic responses to the intervention using plasma metabolomics and to test the pathways proposed by the Early Protein Hypothesis by linking cumulative protein intake to circulating branched-chain amino acids (BCAAs), insulin-like growth factor-1 (IGF-1), and growth outcomes using structural equation modeling (SEM).

Methods: Targeted proton nuclear magnetic resonance (1H-NMR) metabolomics was performed on plasma samples collected at 12 and 18 mo. Two SEM models were constructed: one modeled body weight and the other modeled BMI as growth outcomes using data collected up to age 18 mo. Model fit indices were assessed, and path diagrams were used to visualize relationships.

Results: The Nordic diet led to reduced-protein intake and a distinct infant plasma metabolomic profile. Circulating BCAAs and their catabolites were significantly lower in the reduced-protein Nordic diet compared with the conventional diet. Cumulative protein intake positively correlated with plasma IGF-1 concentrations {weight-based SEM: β = 0.40 [95% confidence interval (CI): 0.03, 0.48]; BMI-based SEM: β = 0.43 [95% CI: 0.05, 0.50]}. Plasma total BCAAs were positively associated with plasma IGF-1 levels [weight-based SEM: β = 0.16 (95% CI: 0.00, 0.76); BMI-based SEM: β = 0.17 (95% CI: 0.02, 0.78)]. After accounting for metabolite-mediated effects on IGF-1 and insulin, cumulative protein intake remained significantly associated with infant body weight [β=0.36 (95% CI: 0.02, 0.99)], but not BMI.

Conclusions: Complementary feeding during infancy substantially shapes the plasma metabolome. Reducing protein intake from complementary feeding helps attenuate rapid infant weight gain, a well-established early-life predictor of later obesity.

Background: Childhood stunting, defined as a height-for-age Z-score below − 2 standard deviations, remains a major public health issue in Rwanda, with one in three children under-five affected. Although national prevalence of stunting has declined over the past two decades, less is known about how trends compare across population groups. This study assessed trends in childhood stunting inequalities in Rwanda from 2000 to 2019 using absolute and relative inequality measures across five equity dimensions (wealth, women’s education, place of residence, sex, and regions or provinces).

Methods: We analyzed data from five rounds of the Rwanda Demographic and Health Surveys (2000–2019). Stunting prevalence was disaggregated by wealth quintiles, women’s education, place of residence, child’s gender, and region/province. Absolute and relative inequality measures included the slope index of inequality (SII), concentration index (CIX), absolute difference, and the weighted mean difference to the mean (WMDM). Population attributable risk (PAR) and population attributable fraction (PAF) were estimated to assess public health impact.

Results: Stunting prevalence in Rwanda decreased by 31.0% from 2000 (47.9%) to 2019 (33.1%). However, inequalities widened, with faster progress among the wealthiest, reaching their peak in 2019 (SII = -41.7, CIX = -21.9). Women’s education inequalities persisted in favor of the highly educated (SII = − 29.7 and CIX worsening to -9.2 in 2019), urban areas (16-point absolute difference), and boys (7.8-point absolute difference). Regional disparities were relatively stable, with WMDM around 5.0% points, Kigali having the lowest rate. The measures of impact show wealth had the strongest effect, with a PAR of 23.2% points and PAF of 69.0%; respectively reflecting the amount of stunting rates that are attributable to being in the poorest categories and what could be eliminated if all children were in the wealthiest categories.

Conclusion: Despite overall national progress in reducing stunting, social and economic inequalities remained apparent and widened between 2000 and 2019. Children from the poorest households and those with less educated mothers remain disproportionately affected. To achieve the global nutrition target by 2030, Rwanda must strengthen equity-focused interventions to reach the most vulnerable groups.

Despite national progress, stunting remains prevalent in specific regions of Rwanda, highlighting the limitations of coarse-resolution data for effective mapping and intervention planning. This study explored optimal spatial resolution and analytical approach to capture localised dynamics and the multifactorial nature of stunting. A cross-sectional, population-based study was conducted in the Northern Province of Rwanda, focusing on children aged 1–36 months. Data were collected using structured questionnaires covering socio-demographic, economic, health, childcare, livestock factors and anthropometric measurements. Environmental characteristics were obtained from national datasets, while household geographic coordinates were captured using a customized mobile geodata platform (emGeo). After data cleaning, predictors were analysed using univariable and multivariable logistic regression as well as geographically weighted logistic regression (GWLR) to account for spatial heterogeneity. Among 601 children, stunting prevalence was 27% (boys 33.8%; girls 20.9%). GWLR improved model fit, increasing adjusted deviance explained from 34% to 39%. Significant predictors included child age (adjusted OR = 2.46; 95% CI: 1.78–3.39), male sex (OR = 2.83; 95% CI: 1.65–4.86), birthweight (OR = 0.71; 95% CI: 0.54–0.94), maternal autonomy (ability to refuse sexual intercourse; OR = 0.48; 95% CI: 0.27–0.86), inconsistent maternal social support (OR = 2.30; 95% CI: 1.20–4.42), household electricity access (OR = 0.48; 95% CI: 0.27–0.84) and handwashing facilities (OR = 0.21; 95% CI: 0.07–0.67). GWLR revealed substantial spatial heterogeneity in these factors, delineating areas where each factor matters most. This household-level, spatially explicit analysis reveals localised risk patterns often masked by aggregated national data. Prioritising context-specific interventions (such as electrification, hygiene promotion, and enhanced maternal social support), can enhance effectiveness. The proposed analytical workflow provides a model for addressing persistent stunting in other resource-limited settings.

Background: Childhood stunting, defined as height-for-age below − 2 standard deviations (SD), disproportionately affects the Northern Province of Rwanda. We investigated risk factors contributing to stunting in this region at individual, household, and societal/community levels to inform future interventions. Methods: We conducted a population-based, cross-sectional study using a quantitative questionnaire in households with children aged 1–36 months in the Northern Province. Anthropometric measurements of children and mothers were taken to estimate nutritional status. Multivariable logistic regressions were performed to identify independent risk factors of stunting, reporting odds ratios, 95% confidence intervals and p-values. Results: Overall, stunting prevalence was 27.1% in children aged 1–36 months. At the individual level, boys exhibited 82% higher risk of stunting compared to girls (aOR: 1.82, 95% CI: 1.19, 2.78). Household-level factors such as maternal height and BMI were inversely associated with the risk of childhood stunting (aOR: 0.94, 95% CI: 0.90, 0.97 and aOR: 0.92, 95% CI: 0.86, 0.99, respectively). Other risk factors included no breastfeeding at the time of interview (aOR: 2.00, 95% CI: 1.23, 3.25), presence of twins or triplets aged 1–36 months (aOR: 2.60, 95% CI: 1.21, 5.57), female-headed (single parent) households (aOR: 2.07, 95% CI: 1.00, 4.26), and absence of handwashing facilities near the toilet (aOR: 3.30, 95% CI: 1.36, 7.98). No societal/community factors were significantly associated with childhood stunting in the Northern Province. Conclusion: Childhood stunting in the Northern Province of Rwanda is associated with several factors that could lend themselves to interventions, e.g., improved handwashing facilities, improved childcare practices and targeting vulnerable groups such as boys, households with twins or single parents. Additionally, a thorough exploration of identified risk factors through qualitative approaches involving all stakeholders in child and maternal nutrition is warranted.

Introduction: This study aimed to investigate if individuals with childhood-onset type 1 diabetes having a parent with the same condition (parental diabetes) had worse metabolic control and an increased risk of death and renal failure compared with those with parents without type 1 diabetes (sporadic diabetes).

Research design and methods: We conducted a population-based cohort study using data from the Swedish Childhood Diabetes Register, including cases with onset of type 1 diabetes before the age of 15 and recorded between 1977 and 2010. The cohort was linked to national registers to compare mortality, renal failure, and glycated hemoglobin (HBA1c) levels.

Results: We identified 16 572 incident cases of childhood-onset type 1 diabetes. Of these, 15 701 had data on parental diabetes status, with 1390 (8.9%) having at least one parent with this condition. HbA1c data were available in 9105 individuals at 20-30 years of age, with the parental group showing higher levels compared with the sporadic diabetes group (8.4% (68 mmol/mol) vs 8.2% (66 mmol/mol), p=0.004). The Cox proportional HR for death in parental diabetes was 1.33 (95% CI 1.00 to 1.75), and the competing risk HR for renal failure was 1.27 (95% CI 1.08 to 1.50). Women in the parental diabetes group had a higher risk of early death (HR 1.79, 95% CI 1.17 to 2.72) compared with the sporadic diabetes group.

Conclusions: Individuals with parental diabetes had slightly higher HbA1c and elevated risks of renal failure and death compared with those with sporadic diabetes, especially pronounced in women. Although the exact mechanisms behind these differences are unclear, we suggest that individualized care may benefit individuals with parental type 1 diabetes.

Background: Childhood stunting remains a public health challenge, especially in sub-Saharan Africa. In Rwanda, it is the highest in the Northern province, with a prevalence of 40.5% in children under five. Given that poverty is a key determinant of stunting, we aimed to investigate wealth inequalities in childhood stunting and to identify its contributing determinants in the province.

Methods: We included 601 children aged 1 to 36 months. We estimated the concentration index to quantify wealth-related inequalities in stunting, which we further decomposed it by applying the Wagstaff decomposition approach.

Results: The overall concentration index of child stunting was relatively high (-0.190; 95% CI: -0.295, -0.084), suggesting that stunting was concentrated in poorer households. Its decomposition revealed that socio-economic determinants (147.9%), namely wealth index, partner’s unemployment or non-skilled occupation, and household food insecurity, contributed most to the wealth inequalities of childhood stunting. The demographic determinants contributed in the second order, especially living in Musanze district. Psychosocial determinants came last, namely maternal social support.

Conclusion: This study revealed significant wealth inequalities in childhood stunting in the Northern Province of Rwanda, with socio-economic factors being the primary contributors to these inequalities. Targeted interventions, such as household economic strengthening programs, robust food security policies, improved conditions and salaries in non-skilled jobs, and social support programs for the most disadvantaged communities, are essential to reducing these disparities.

Background: In Northern Province, Rwanda, stunting is common among children aged under 5 years. However, previous studies on spatial analysis of childhood stunting in Rwanda did not assess its randomness and clustering, and none were conducted in Northern Province. We conducted a spatial-pattern analysis of childhood undernutrition to identify stunting clusters and hotspots for targeted interventions in Northern Province.

Methods: Using a household population-based questionnaire survey of the characteristics and causes of undernutrition in households with biological mothers of children aged 1–36 months, we collected anthropometric measurements of the children and their mothers and captured the coordinates of the households. Descriptive statistics were computed for the sociodemographic characteristics and anthropometric measurements. Spatial patterns of childhood stunting were determined using global and local Moran's I and Getis-Ord Gi* statistics, and the corresponding maps were produced.

Results: The z-scores of the three anthropometric measurements were normally distributed, but the z-scores of height-for-age were generally lower than those of weight-for-age and weight-for-height, prompting us to focus on height-for-age for the spatial analysis. The estimated incidence of stunting among 601 children aged 1–36 months was 27.1 %. The sample points were interpolated to the administrative level of the sector. The global Moran's I was positive and significant (Moran's I = 0.403, p < 0.001, z-score = 7.813), indicating clustering of childhood stunting across different sectors of Northern Province. The local Moran's I and hotspot analysis based on the Getis-Ord Gi* statistic showed statistically significant hotspots, which were strongest within Musanze district, followed by Gakenke and Gicumbi districts.

Conclusion: Childhood stunting in Northern Province showed statistically significant hotspots in Musanze, Gakenke, and Gicumbi districts. Factors associated with such clusters and hotspots should be assessed to identify possible geographically targeted interventions.

Aims/Hypotheses: To investigate the frequency and characteristics of partial remission in Swedish children with type 1 diabetes and whether the insulin delivery method, that is, continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDIs), affects incidence and duration of this period, 2007-2011. Factors that increase the proportion of subjects who enter partial remission and extend this period can improve long-term metabolic control and reduce the risk of severe hypoglycemia, improve quality of life, and, in the long run, reduce late complications.

Methods: Longitudinal data from 2007 to 2020 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with all reported newly diagnosed children. Data on C-peptide from the participants in the Better Diabetes Diagnosis study from 2007 to 2010 were used. The definition of partial remission was insulin dose-adjusted HbA1c: HbA1c (%) + [4 × total daily insulin dose (U/kg/day)] ≤9.

Results: Of the 3887 patients, 56% were boys. More boys than girls were in partial remission throughout the follow-up period until 24 months after diabetes onset. Fewer children 0-6 years old had partial remission at 3 and 12 months but not at 24 months compared with older age-groups. A larger proportion of patients using CSII at 12 and 24 months remained in partial remission compared with those with MDI (37% vs. 33%, P = 0.02 and 31% vs. 27%, P = 0.01, respectively). The level of C-peptide was higher in the group with partial remission and mean HbA1c was lower (both P < 0.001). Partial remission at 12 months after diabetes onset was associated with CSII (odds ratio [OR]: 1.39, confidence interval [CI]:1.13, 1.71), shorter diabetes duration (OR: 0.80, CI: 0.76, 0.84), and male sex (OR: 1.23, CI: 1.04, 1.46).

Conclusions/Interpretation: Insulin through MDI, longer duration of diabetes, and female sex were associated with lower frequency of partial remission. Use of CSII seems to contribute to longer partial remission among Swedish children with type 1 diabetes.

Background: High intake of protein and low intake of plant-based foods during complementary feeding can contribute to negative long-term health effects.

Objectives: To investigate the effects of a protein-reduced, Nordic complementary diet on body composition, growth, biomarkers, and dietary intake, compared with current Swedish dietary recommendations for infants at 12 and 18 mo.

Methods: Healthy, term infants (n = 250) were randomly allocated to either a Nordic group (NG) or a conventional group (CG). From 4 to 6 mo, NG participants received repeated exposures of Nordic taste portions. From 6 to 18 mo, NG was supplied with Nordic homemade baby food recipes, protein-reduced baby food products, and parental support. CG followed the current Swedish dietary recommendations. Measurements of body composition, anthropometry, biomarkers, and dietary intake were collected from baseline and at 12 and 18 mo.

Results: Of the 250 infants, 82% (n = 206) completed the study. There were no group differences in body composition or growth. In NG, protein intake, blood urea nitrogen and plasma IGF-1 were lower compared to CG at 12 and 18 mo. Infants in NG consumed 42% to 45% more fruits and vegetables compared to CG at 12 and 18 mo, which was reflected in a higher plasma folate at 12 and 18 mo. There were no between-group differences in EI or iron status.

Conclusions: Introduction of a predominantly plant-based, protein-reduced diet as part of complementary feeding is feasible and can increase fruit and vegetable intake.

This trial was registered at clinicaltrials.gov as NCT02634749.