The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation in support of the etiologic criterion for inflammation. A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified-Delphi review. A multi-round review and revision process served to develop seven guidance statements. The final round of review was highly favorable with 99 % overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (mg/dL or mg/L) for the clinical laboratory that is being used. Confirmation of inflammation should be guided by clinical judgement based upon underlying diagnosis or condition, clinical signs, or CRP.

Background: The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation, and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation.Methods: A GLIM‐constituted working group with 36 participants developed consensus‐based guidance through a modified Delphi review. A multiround review and revision process served to develop seven guidance statements.Results: The final round of review was highly favorable, with 99% overall “agree” or “strongly agree” responses. The presence of acute or chronic disease, infection, or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C‐reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (milligrams per deciliter or milligram per liter) for the clinical laboratory that is being used.Conclusion: Confirmation of inflammation should be guided by clinical judgment based on underlying diagnosis or condition, clinical signs, or CRP.

Objectives: To determine changes and factors associated with child malnutrition, obesity in women and household food insecurity before and after the first wave of COVID-19 pandemic.Design: A prospective follow-up study.Setting: In 2019, the baseline Urban Health and Nutrition Study 2019 (UHNS-2019) was conducted in 603 households, which were selected randomly from 30 clusters to represent underserved urban settlements in Colombo. In the present study, 35 % of households from the UHNS-2019 cohort were randomly selected for repeat interviews, 1 year after the baseline study and 6 months after COVID-19 pandemic in Sri Lanka. Height/length and weight of children and women were re-measured, household food insecurity was reassessed, and associated factors were gathered through interviewer-administered questionnaires. Differences in measurements at baseline and follow-up studies were compared.Participants: A total of 207 households, comprising 127 women and 109 children were included.Results: The current prevalence of children with wasting and overweight was higher in the follow-up study than at baseline UHNS-2019 (18·3 % v. 13·7 %; P = 0·26 and 8·3 % v. 3·7 %; P = 0·12, respectively). There was a decrease in prevalence of child stunting (14·7 % v. 11·9 %; P = 0·37). A change was not observed in overall obesity in women, which was about 30·7 %. Repeated lockdown was associated with a significant reduction in food security from 57 % in UHNS-2019 to 30 % in the current study (P < 0·001).Conclusions: There was an increase in wasting and overweight among children while women had a persistent high prevalence of obesity. This population needs suitable interventions to improve nutrition status of children and women to minimise susceptibility to COVID-19.

Despite an increasing trend in labour migration and economic dependence on foreign migrant workers in Sri Lanka, very little is known about the child care and nutritional status of “children left behind”. The aim of this study was to examine the factors influencing the nutritional status and care practices of children left behind. A sample of 321 children, 6–59 months old of international migrant workers from a cross-sectional nationally represented study were included. Care practices were assessed using ten caregiving behaviours on personal hygiene, feeding, and use of health services. Results revealed the prevalence of stunting, wasting and underweight to be 11.6, 18.2 and 24.0 percent, respectively. Father being a migrant worker has a positive effect on childcare practices and birthweight of the child. This study indicates that undernutrition remains a major concern, particularly in the poorest households where the mother is a migrant worker, also each additional 100 g increase in the birthweight of a child in a migrant household, decreases the probability of being wasted, stunted and underweight by 6%, 8% and 23% respectively. In depth study is needed to understand how labour migration affects household level outcomes related to child nutrition and childcare in order to build skills and capacities of migrant families.

Sri Lanka has been identified as one of the world’s biodiversity hotspots with a rich array of fruits; however, most of them remain underutilized. The present study was carried out to investigate the nutritional composition and to assess the bioactivity of six underutilized fruits collected from three provinces of Sri Lanka. The selected fruit species were Màdan (Syzygium cumini), Maha Karamba (Carissa carandas), Himbutu (Salacia chinensis), Ugurassa (Flacourtia indica), Barbados cherry (Malpighia emarginata), and Ceylon gooseberry (Dovyalis hebecarpa). The proximate composition, total dietary fiber content, mineral content, total phenolic content, and vanillin contents were determined using standard methods. The antioxidant activity of methanolic extracts of fruits was assessed using FRAP and DPPH assays. Uguressa extract exhibited the highest dietary fiber content (12.25 ± 0.29 of fresh fruit weight) while the lowest was observed in Barbados cherry (6.01 ± 1.10 g/100 g). The total phenolic content (TPC) of fruits ranged from 6.8 ± 0.4 to 10.3 ± 0.3 milligram gallic acid equivalents/g fruit. Barbados cherry showed the highest antioxidant activity (AOA) as measured by FRAP (0.022 ± 0.003 mM Fe ²⁺/g fruit) and the highest vanillin content (2.4 mg/kg). The highest potassium (434.60 ± 0.36 mg/kg), phosphorous (16.69 ± 0.46), and calcium contents (23.43 ± 0.45) were observed in Uguressa. Màdan had the highest content of magnesium (13.25 ± 0.38 mg/kg), sodium (5.28 ± 0.30), iron (0.65 ± 0.12 mg/kg), and aluminum (1.15 ± 0.16 mg/kg). The highest manganese content (0.98 ± 0.18 mg/kg) was observed in Himbutu while the highest copper content was found in Uguressa (0.11 ± 0.04 mg/kg) and Maha Karamba (0.11 ± 0.03 mg/kg). The study reveals that six underutilized fruits tested possess high nutritional value and are rich in antioxidant activity.

Background: Sri Lanka introduced universal salt iodization (USI) in 1995 after which we demonstrated a high thyroglobulin antibody (TgAb) prevalence in 1998. However, it is unclear whether thyroid autoimmunity persists in the long term in populations exposed to sustained USI and whether such populations have an excess of thyroid dysfunction. We evaluated the prevalence of thyroid autoantibodies and dysfunction in Sri Lankan children and adolescents after more than two decades of sustained USI. Methods: We selected 10- to 18-year-old subjects of both sexes (randomized cluster sampling) from all 9 provinces of Sri Lanka in this cross-sectional study. Blood, urine, and anthropometric data were collected and thyroid ultrasound scans were performed. Validated statistical methods were used to derive local population-specific reference ranges for all thyroid parameters. We also measured urine iodine concentration (UIC), salt, and water iodine concentrations. Results: Blood and urine samples from 2507 and 2473 subjects respectively, and ultrasound scans from 882 subjects were analyzed. Population-derived upper limits for thyroid peroxidase antibody (TPOAb) and TgAb, and reference ranges for triiodothyronine, thyroxine, and thyrotropin (total and age-year-related groups) were significantly different from manufacturer's reference ranges. Using these derived ranges, the prevalence of TPOAb was 10.3% and TgAb was 6.4%. Of the TPOAb-positive subjects, TPOAb were of low concentration in 66.2% (1–3 times the upper limit of the reference range [ULRR]) and showed the strongest association with subclinical hypothyroidism (SCH) at the highest concentrations (>4 ULRR). The prevalence of SCH was 3%. Median UIC (interquartile range) was 138.5 μg/L (79.4–219.0) with regional variability, and median thyroglobulin was 8.3 ng/mL (4.1–13.5). Goiter prevalence was 0.6% and 1.93% (thyroid volume compared to age and body surface area, respectively). Salt and water iodine concentrations were satisfactory. Conclusions: Sri Lanka has safely and effectively implemented USI with good sources of iodine, leading to sustained iodine sufficiency over more than two decades. The early postiodization TgAb surge (42.1%) has settled (6.4%), and despite a persistently high TPOAb prevalence (10.3%), SCH prevalence remains low (3%). Further studies should be undertaken to monitor thyroid autoimmune dysfunction in Sri Lankan children, using age-specific, population-derived reference ranges.