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Deteriorated Dietary Patterns with Regards to Health and Environmental Sustainability among Hungarian Roma Are Not Differentiated from Those of the General Population. Nutrients 2021; 13:nu13030721. [PMID: 33668386 PMCID: PMC7996132 DOI: 10.3390/nu13030721] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
Nutritional epidemiology studies on Roma people are scarce and, to date, their nutrient-based dietary patterns with regards to both healthy and sustainable dietary considerations have never been reported. We report, for the first time, adherence to healthy and sustainable dietary patterns using scoring and regression models, based on recommendations defined by the World Health Organization, in the Dietary Approaches to Stop Hypertension (DASH) study and the EAT-Lancet report, as well as dietary quality based on Dietary Inflammatory Index (DII) among the Hungarian Roma (HR) population living in North East Hungary, with Hungarian general (HG) adults as reference. Data were obtained from a complex, comparative health survey involving dietary assessment, structured questionnaire-based interview, physical and laboratory examinations on 359 HG and 344 HR subjects in Northeast Hungary. Poisson regressions were fit to models that included DASH, EAT, DII and Healthy Diet Indicator as dependent variables to assess the influence of ethnicity on healthy and sustainable nutrient-based patterns. Adjusted models controlled for all relevant covariates using the residual method indicated poor dietary quality with regards to the selected dietary patterns. These associations were not ethnicity-sensitive, except for DII, where Roma ethnicity was linked to a decrease of DII score (β = −0.455, 95%CI: −0.720; −0.191, p < 0.05). Currently, HR dietary patterns appear to be relatively unhealthy and unsustainable, rendering them vulnerable to elevated risk of ill-health. Nevertheless, their dietary patterns did not strongly differ from HG, which may contribute to Hungarians being one of the most obese and malnourished nations in Europe. Further prospective research on the potential public and environmental health effects of these findings is warranted.
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Xu YY, Sawadogo-Lewis T, King SE, Mitchell A, Roberton T. Integrating nutrition into the education sector in low- and middle-income countries: A framework for a win-win collaboration. MATERNAL AND CHILD NUTRITION 2021; 17:e13156. [PMID: 33590645 PMCID: PMC8189246 DOI: 10.1111/mcn.13156] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 12/01/2022]
Abstract
Malnutrition—both undernutrition and overnutrition—is a public health concern worldwide and particularly in low‐ and middle‐income countries (LMICs). The education sector has high potential to improve immediate nutrition outcomes by providing food in schools and to have more long‐term impact through education. We developed a conceptual framework to show how the education sector can be leveraged for nutrition. We reviewed the literature to identify existing frameworks outlining how nutrition programs can be delivered by and through the education sector and used these to build a comprehensive framework. We first organized nutrition programs in the education sector into (1) school food, meals, and food environment; (2) nutrition and health education; (3) physical activity and education; (4) school health services; and (5) water, sanitation, and hygiene (WASH) sector. We then discuss how each one can be successfully implemented. We found high potential in improving nutrition standards and quality of school foods, meals and food environment, especially through collaboration with the agriculture sector. There is a need for well‐integrated, culturally appropriate nutrition and health education into the existing school curriculum. This must be supported by a skilled workforce—including nutrition and public health professionals and school staff. Parental and community engagement is cornerstone for program sustainability and success. Current monitoring and evaluation of nutrition programming in schools is weak, and effectiveness, including cost‐effectiveness, of interventions is not yet adequately quantified. Finally, we note that opportunities for leveraging the education sector in the fight against rising overweight and obesity rates are under‐researched and likely underutilized in LMICs.
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Affiliation(s)
- Yvonne Yiru Xu
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Talata Sawadogo-Lewis
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shannon E King
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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53
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Torto NM, Brownell KD. Role of food aid and assistance in addressing the double burden of malnutrition in Ghana: a qualitative policy analysis. BMJ Nutr Prev Health 2021; 3:196-204. [PMID: 33521529 PMCID: PMC7841835 DOI: 10.1136/bmjnph-2020-000136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
Background and aims In many low-income and middle-income countries, the double burden of malnutrition threatens public health and economic progress, urging a re-evaluation of the roles and responsibilities of nutrition actors, both traditional and non-traditional. This study examines the food aid and assistance activities of the United Nations World Food Programme (WFP)-one non-traditional actor in the double burden conversation-and the potential for these activities to reach beyond their traditional mandate on undernutrition to also address overweight and obesity in Ghana. Methods Information on WFP activities in Ghana from 2012 up through its planning into 2023 was extracted from 11 WFP planning, operations and evaluation documents. WFP activities were then judged against the WHO's framework on the determinants of the double burden of malnutrition to determine their potential to address the double burden. Semistructured interviews were also conducted with 17 key informants in the global nutrition landscape to identify challenges that may complicate the role of WFP and other actors in addressing the double burden. Results The analysis demonstrates that WFP activities in Ghana can serve as a platform on which to address the double burden, particularly by targeting the food access, food systems and socioeconomic disadvantage determinants of the double burden. Actors' uncertainty with what role WFP should play in addressing the double burden, insufficient government attention to malnutrition and poor data on overweight and obesity were identified as potential challenges that complicate addressing the double burden. Conclusion The findings suggest that integrating WFP as a partner in the effort to address the double burden in Ghana might help amplify progress. To better address the double burden, WFP might prioritise retrofitting existing activities rather than implementing new interventions.
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Affiliation(s)
- Niisoja M Torto
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Kelly D Brownell
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
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Jackson-Morris AM, Nugent R, Ralston J, Barata Cavalcanti O, Wilding J. Strengthening resistance to the COVID-19 pandemic and fostering future resilience requires concerted action on obesity. Glob Health Action 2020; 13:1804700. [PMID: 32835634 PMCID: PMC7480569 DOI: 10.1080/16549716.2020.1804700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022] Open
Abstract
Initial observations showed that people with chronic noncommunicable diseases were at heightened risk of severe COVID-19 and adverse outcomes. Subsequently, data from various countries have revealed obesity as an independent and significant factor, with people who are overweight/have obesity significantly more likely to be hospitalized, require ICU treatment, and to die. Notably, this additional risk applies to younger people relative to the general COVID-19 risk profile. This paper sets out the evidence of greater risk of poor COVID outcomes for people who are overweight/have obesity, indication of reduced treatment and support for obesity self-management where it existed prior to COVID-19, and highlights the dearth of specific guidance and measures to mitigate the impacts of COVID-19 upon people with obesity. We identify the health, social and economic impacts that this specific vulnerability creates relative to COVID-19 outcomes. Reduced national and global pandemic resilience due to high obesity prevalence should spur governments and funders to provide urgent specific protection and support for people with overweight/obesity, and to commission rapid research to identify effective prevention and reduction measures. We set out priorities for action on obesity to begin compensating for years of underfunding and inadequate policy attention in the face of escalating obesity across countries of all income groups and world regions.
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Affiliation(s)
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Seattle, WA, USA
| | | | | | - John Wilding
- World Obesity Federation, London, UK
- Department of Obesity and Endocrinology, University of Liverpool, Liverpool, UK
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Jeyakumar A, Jungari S, Nair R, Menon P, Babar P, Bhushan B, Yogita H, Ali J, Saddichha M, Bhagyashree M, Monika P, Sakshi S. Prevalence and Determinants of Early Initiation (EI), Exclusive Breastfeeding (EBF), and Prelacteal Feeding among Children Aged 0-24 Months in Slums of Pune City, in Maharashtra. Ecol Food Nutr 2020; 60:377-393. [PMID: 33334182 DOI: 10.1080/03670244.2020.1858407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Infant and young child feeding practices remain a public health challenge in India. We determined the socio-demographic risk factors for early initiation, exclusive breastfeeding and prelacteal feeding in the urban slums of Pune city.A cross sectional survey of mother (N=1443) children (< 2 years) dyads was performed. Socio-demographic, maternal and child characteristics were recorded. Breastfeeding practices were assessed using WHO indicators. Multiple logistic regression was employed to model associations between socio-demographic factors and breastfeeding indicators.Early initiation was reported by 45.2%, prelacteal feeding by 37.5% and exclusive breastfeeding by 23.7%. Caesarean delivery decreased the odds of early initiation (AOR: 0.403; 95% CI; 0.303.-0.536) and exclusive breastfeeding (OR: 0.675; 95% CI: 0. 478-0.953), while it increased the odds of prelacteal feeding (AOR: 3.525; 95% CI: 2.653-4.683). Delivery in a public health care facility increased the odds of early initiation (AOR: 1.439; 95% CI: 1.095-1.891) and exclusive breastfeeding (OR: 0.514; 95% CI: 0.366-0.720), while it decreased the odds of prelacteal feeding (AOR: 0.421; 95% CI: 0.318-0.559). Odds of early initiation decreased significantly in very low-birth-weight (AOR: 0.209; CI: 0.76-0.567) whereas, it increased odds of prelacteal feeding (AOR: 1.389; 95% CI: 0.640-3.019), (AOR: 0.483; 95% CI: 0.262-0.889). Religion other than Hindu or Muslim, age of the mother between 26-30 years increased the odds of exclusive breastfeeding and parity <2 increased the odds of prelacteal feeding.Interventions that address setting specific determinants, focusing on local contexts are essential to improve child feeding practices in urban slums.
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Affiliation(s)
- Angeline Jeyakumar
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India.,School of Tourism and Hospitality Management, University of Johannesburg, Johannesburg, South Africa
| | - Suresh Jungari
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Raji Nair
- Department of Paediatrics, UNICEF, Mumbai, India
| | - Pramila Menon
- Dr. D.Y. Patil Medical College and Hospital, Pimpri - Chinchwad, India
| | - Prasad Babar
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Barai Bhushan
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Hulsurkar Yogita
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Janan Ali
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Marathe Saddichha
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Mitragotri Bhagyashree
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Phadake Monika
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
| | - Sneha Sakshi
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
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Adherence to healthy and sustainable diets is not differentiated by cost, but rather source of foods among young adults in Albania. Br J Nutr 2020; 126:591-599. [PMID: 33143757 DOI: 10.1017/s0007114520004390] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
High cost of nutritious foods and eating out of home (OH) might be barriers to healthy and sustainable diets. We examined adherence to Dietary Approaches to Stop Hypertension (DASH), EAT-Lancet reference diet (EAT) and Mediterranean diet score (MDS) and the associations with dietary cost and eating OH. We evaluated cross-sectional data from single multiple-pass 24-h diet recalls from 289 young adults (18-24 years) in Tirana, Albania. Dietary cost (in Albanian Lek (ALL)) was estimated by matching food consumption data with retail prices from local fast-food chains, supermarkets, restaurants and food vendors. Poisson regression was fitted to models that included DASH, EAT and MDS as dependent variables to assess associations between healthy sustainable diet indicators and dietary cost and eating OH. Adjusted models were controlled for BMI, sex and total energy intake (kJ) using the residual method. Our findings indicate relatively poor adherence to healthy and sustainable dietary patterns among young men and women in Albania. Furthermore, better adherence to DASH, EAT or MDS was not associated with dietary cost (per 100 ALL; range incidence rate ratios (IRR): 0·97-1·00; all (un-)adjusted P > 0·05). Nonetheless, eating OH was related to lower adherence to DASH (IRR: 0·79; P = 0·003) and MDS (IRR: 0·69; P < 0·001). In conclusion, adherence to health and sustainable dietary patterns was poor and not differentiated by cost, but rather source of foods (i.e. OH or at home). Further research on the potential public and environmental health effects of these findings is warranted in Albania.
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Schwinger C, Chandyo RK, Ulak M, Hysing M, Shrestha M, Ranjitkar S, Strand TA. Prevalence of Underweight, Overweight, and Obesity in Adults in Bhaktapur, Nepal in 2015-2017. Front Nutr 2020; 7:567164. [PMID: 33072798 PMCID: PMC7536337 DOI: 10.3389/fnut.2020.567164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/18/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction: There is an increase in the double burden of malnutrition globally, with a particular rise documented in Asia. In Nepal, undernutrition has been prevalent for decades. Today, however, the incidence of overweight and obesity (OWOB) in the country has increased substantially. There is a need to conduct local studies reporting on the concurrent burden of both underweight and OWOB across adult populations. This study addresses this need by describing the distribution of body mass index (BMI) in a defined population of adults living in the peri-urban community of Bhaktapur, Nepal. Material and methods: For this cross-sectional analysis, we used data that were available from 600 women and 445 men whose children were enrolled in an individually randomized, double-blind, placebo-controlled trial assessing the effect of daily vitamin B12 supplementation. Upon enrolment of their 6–11-month old children, mothers and fathers were interviewed about their socio-demographic details. In addition, their weight and height were measured by trained field workers. Each parent's BMI was calculated as the ratio of body weight (in kg) and height squared (in m), expressed as kg/m2, and categorized according to the WHO recommendation. We used linear and multinomial logistic regression models to assess associations between the BMI of the mothers and fathers, and their baseline characteristics. Results: The mean BMI was 23.7 kg/m2 for both the mothers and fathers with a standard deviation (SD) of 3.6 and 3.7, respectively. The proportion categorized as underweight, overweight, and obese was also similar in the two groups with around 5% being underweight, 30% being overweight and 5% being obese. Age was positively associated with BMI in both groups. Those categorized as daily wage earner had a lower mean BMI than those in other occupational groups. Conclusion: Our results contribute to documenting the burden of both under- and overnutrition in a selected group of young adults living in a peri-urban community in Nepal. As Nepal is undergoing an improvement in its economic situation, as well as a nutrition transition, it is important to provide sufficient information to enable timely action, and evidence-based decision-making to prevent a further increase in Nepal's growing double burden of malnutrition.
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Affiliation(s)
- Catherine Schwinger
- Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Ram K Chandyo
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Manjeswori Ulak
- Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway.,Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Merina Shrestha
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Suman Ranjitkar
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Tor A Strand
- Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway.,Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
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Skouteris H, Bergmeier HJ, Berns SD, Betancourt J, Boynton-Jarrett R, Davis MB, Gibbons K, Pérez-Escamilla R, Story M. Reframing the early childhood obesity prevention narrative through an equitable nurturing approach. MATERNAL AND CHILD NUTRITION 2020; 17:e13094. [PMID: 33067918 PMCID: PMC7729646 DOI: 10.1111/mcn.13094] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/29/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022]
Abstract
High‐quality mother–child interactions during the first 2,000 days, from conception to age 5 years, are considered crucial for preventing obesity development during early life stages. However, mother–child dyads interact within and are influenced by broader socio‐ecological contexts involved in shaping child development outcomes, including nutrition. Hence, the coexistence of both undernutrition and obesity has been noted in inequitable social conditions, with drivers of undernutrition and overnutrition in children sharing common elements, such as poverty and food insecurity. To date, a holistic life‐course approach to childhood obesity prevention that includes an equitable developmental perspective has not emerged. The World Health Organization (WHO) Nurturing Care Framework provides the foundation for reframing the narrative to understand childhood obesity through the lens of an equitable nurturing care approach to child development from a life‐course perspective. In this perspective, we outline our rationale for reframing the childhood narrative by integrating an equitable nurturing care approach to childhood obesity prevention. Four key elements of reframing the narrative include: (a) extending the focus from the current 1,000 to 2,000 days (conception to 5 years); (b) highlighting the importance of nurturing mutually responsive child‐caregiver connections to age 5; (c) recognition of racism and related stressors, not solely race/ethnicity, as part of adverse child experiences and social determinants of obesity; and (d) addressing equity by codesigning interventions with socially marginalized families and communities. An equitable, asset‐based engagement of families and communities could drive the transformation of policies, systems and social conditions to prevent childhood obesity.
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Affiliation(s)
- Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia.,Warwick Business School, University of Warwick, Coventry, UK
| | - Heidi J Bergmeier
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Scott D Berns
- National Institute for Children's Health Quality, Boston, MA, USA
| | | | | | | | - Kay Gibbons
- Institute for Health and Sport, Victoria University, Footscray, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Mary Story
- Duke Global Health Institute, Duke University, Durham, NC, USA
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59
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Song J, Zhang J, Fawzi W, Huang Y. Double Burden of Malnutrition among Chinese Women of Reproductive Age and Their Social Determinants. Nutrients 2020; 12:E3102. [PMID: 33053638 PMCID: PMC7601850 DOI: 10.3390/nu12103102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/12/2023] Open
Abstract
This study aimed to examine the impact of a wide range of demographic, socioeconomic, and community factors on the double burden of malnutrition among women of reproductive age using longitudinal data. We used data about 11,348 women of reproductive age who participated in the China Health and Nutrition Survey (CHNS), a longitudinal survey, between 1989 and 2015. Nutritional outcomes were categorized into four groups, namely underweight, normal weight, overweight, and obesity, with normal weight as reference. A multinomial logit model was fitted due to geographic clustering and repeated observations of individuals. The prevalence of underweight decreased over time from 1991 but has tended to rise again since 2004, while the prevalence of overweight/obesity continued to rise between 1991 and 2015. Improved individual factors, socioeconomic status, and community urbanization reduced the risk of underweight but elevated the risk of overweight and obesity. The medium levels, rather than the highest levels, of household income and community urbanization are associated with a higher risk of overweight and obesity. The notable increase in underweight prevalence is a cause for concern to be addressed along with efforts to curb the rising tide of overweight. In order to enhance the nutritional status of women of reproductive age, it is essential to improving the community environment, levels of education, and living environment from a wider context. Long-term and targeted plans are urgently needed for nutrition improvements among the different populations.
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Affiliation(s)
- Jingqi Song
- School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.S.); (J.Z.)
| | - Ji Zhang
- School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.S.); (J.Z.)
| | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA;
| | - Yangmu Huang
- School of Public Health, Peking University Health Science Center, Beijing 100191, China; (J.S.); (J.Z.)
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60
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Huang Q, Wang L, Jiang H, Wang H, Zhang B, Zhang J, Jia X, Wang Z. Intra-Individual Double Burden of Malnutrition among Adults in China: Evidence from the China Health and Nutrition Survey 2015. Nutrients 2020; 12:nu12092811. [PMID: 32937736 PMCID: PMC7551383 DOI: 10.3390/nu12092811] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/16/2022] Open
Abstract
Few studies have focused on quantifying the double burden of malnutrition (DBM) phenomenon in China. We aimed to clarify the prevalence of DBM among Chinese adults as well as to examine whether usual daily dietary micronutrient status varies by body mass index (BMI) categories. In this study, a sample of 6602 adults aged 18-59 years from the China Health and Nutrition Survey (CHNS) was analyzed. Information was obtained on dietary intake and anthropometric measurements. Dietary intakes of 11 micronutrients were estimated based on the data collected by three consecutive days of 24 h recalls combined with the weighing of household seasonings. Dietary micronutrient deficiency was defined according to the cutoff of the Chinese estimated average requirement (EARs). 44% of Chinese adults faced the problem of DBM, of which nearly 40% experienced overweight/obesity and micronutrient deficiency simultaneously. Comparable percentages (>50%) of Chinese adults had dietary intake less than the Chinese EARs for key micronutrients including retinol, thiamin, riboflavin, vitamin C, calcium, selenium, zinc, and magnesium, and the percentages varied by body weight status. More than 80% participants had at least two selected vitamin or mineral deficiencies in all BMI categories. These findings indicate that Chinese adults have a high DBM and micronutrient inadequacies prevail among and within gender and all BMI categories. All body weight groups need advice on the changing needs for dietary variety to ensure optimal health.
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Davis JN, Oaks BM, Engle-Stone R. The Double Burden of Malnutrition: A Systematic Review of Operational Definitions. Curr Dev Nutr 2020; 4:nzaa127. [PMID: 32885132 PMCID: PMC7456307 DOI: 10.1093/cdn/nzaa127] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions. OBJECTIVES To identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment. METHODS Following a structured search of peer-reviewed articles with terms describing "overnutrition" [e.g., overweight/obesity (OW/OB)] and "undernutrition" (e.g., stunting, micronutrient deficiency), we screened 1920 abstracts, reviewed 500 full texts, and extracted 623 operational definitions from 239 eligible articles. RESULTS We organized three identified DBM dimensions (level of assessment, target population, and forms of malnutrition) into a framework for building operational DBM definitions. Frequently occurring definitions included coexisting: 1) OW/OB and thinness, wasting, or underweight (n = 289 occurrences); 2) OW/OB and stunting (n = 161); 3) OW/OB and anemia (n = 74); and 4) OW/OB and micronutrient deficiency (n = 73). CONCLUSIONS Existing DBM definitions vary widely. Putting structure to possible definitions may facilitate selection of fit-for-purpose indicators to meet public health priorities.
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Affiliation(s)
- Jennie N Davis
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
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Luo H, Zyba SJ, Webb P. Measuring malnutrition in all its forms: An update of the net state of nutrition index to track the global burden of malnutrition at country level. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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63
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Ahmed KY, Rwabilimbo AG, Abrha S, Page A, Arora A, Tadese F, Beyene TY, Seiko A, Endris AA, Agho KE, Ogbo FA. Factors associated with underweight, overweight, and obesity in reproductive age Tanzanian women. PLoS One 2020; 15:e0237720. [PMID: 32834011 PMCID: PMC7444815 DOI: 10.1371/journal.pone.0237720] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania. METHODS This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity. RESULTS Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13). CONCLUSION Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.
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Affiliation(s)
- Kedir Y. Ahmed
- College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- * E-mail:
| | - Abdon G. Rwabilimbo
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Chato District Council, Geita Region, Northwestern Tanzania
| | - Solomon Abrha
- School of Public Health, College of Medicine and Health Science, Wolayta Sodo University, Wolayta Sodo, Ethiopia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Fentaw Tadese
- College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tigistu Yemane Beyene
- CDT Africa, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Kingsley E. Agho
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- General Practice Unit, Prescot Specialist Medical Centre Makurdi, Makurdi, Benue State, Nigeria
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The double burden of malnutrition in under-five children at national and individual levels: observed and expected prevalence in ninety-three low- and middle-income countries. Public Health Nutr 2020; 24:2944-2951. [PMID: 32633230 PMCID: PMC7613087 DOI: 10.1017/s1368980020001226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective To assess whether the observed prevalence of the double burden of malnutrition (DBM) would be higher than expected on the basis of chance, through analyses at national, wealth quintile and individual child levels. Design We selected nationally representative surveys from low- and middle-income countries (LMIC) carried out since 2005 with anthropometric measures on children under 5 years of age. Household wealth was assessed through asset indices. The expected prevalence of DBM was estimated by multiplying the prevalence of stunting (low height/length for age) and overweight (high weight for height/length). The WHO recommended cut-offs (20% for stunting and 10% for overweight) that were used to define DBM at national level. DBM at individual level was defined as co-occurrence of stunting and overweight in the same child. Setting Nationally representative surveys from ninety-three LMIC. Participants A total of 825 633 children were studied. Results DBM at national level was observed in five countries, whereas it would be expected to occur in eleven countries. Six countries did not present evidence of DBM at national level but did so in at least one wealth quintile. At individual level, thirty countries (32·3%) showed higher prevalence of DBM than would be expected, but most differences were small except for Syria, Azerbaijan, Albania and Egypt. Conclusions The observed number of countries or socio-economic subgroups within countries with the DBM using recommended thresholds was below what would be expected by chance. However, individual-level analyses showed that one-third of countries presented higher prevalence of DBM than would be expected.
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Abstract
A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic. Fine-scale geospatial mapping of overweight and wasting (two components of the double burden of malnutrition) in 105 LMICs shows that overweight has increased from 5.2% in 2000 to 6.0% in children under 5 in 2017. Although overall wasting decreased over the same period, most countries are not on track to meet the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025.
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66
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Vaquero Alvarez M, Aparicio-Martinez P, Fonseca Pozo FJ, Valle Alonso J, Blancas Sánchez IM, Romero-Saldaña M. A Sustainable Approach to the Metabolic Syndrome in Children and Its Economic Burden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1891. [PMID: 32183278 PMCID: PMC7142435 DOI: 10.3390/ijerph17061891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 01/19/2023]
Abstract
The prevalence of obesity continues to grow, resulting in metabolic syndrome and increasing economic burden for health systems. The objectives were to measure the ability of the NIM-MetS test, previously used in the adults, for the early and sustainable detection of the Metabolic Syndrome (MetS) in children and adolescents. Moreover, to determine the economic burden of the children with MetS. Furthermore, finally, to use and implement the NIM-MetS test, via a self-created online software, as a new method to determine the risk of MetS in children. The method used was an observational study using different instruments (NIM-MetS test, International Diabetes Federation (IDF), or Cook) and measures (body mass index). Additionally, the economic burden was estimated via a research strategy in different databases, e.g., PubMed, to identify previous papers. The results (N = 265 children, age from 10-12) showed that 23.1% had obesity and 7.2% hypertension. The prevalence of MetS using the NIM-Mets was 5.7, and the cost of these children was approximate 618,253,99 euros. Finally, a model was obtained and later implemented in a web platform via simulation. The NIM-MetS obtained is a non-invasive method for the diagnosis of risk of MetS in children.
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Affiliation(s)
- Manuel Vaquero Alvarez
- Grupo Investigación GC09 Nutrigenomics, Metabolic Syndrome, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain; (M.V.A.); (I.M.B.S.)
| | - Pilar Aparicio-Martinez
- Grupo Investigación GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain;
- Departamento de Enfermería, Fisioterapia y Farmacología, Universidad de Córdoba, Campus de Menéndez Pidal, 14071 Córdoba, Spain;
| | - Francisco Javier Fonseca Pozo
- Grupo Investigación GC12 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain;
| | - Joaquín Valle Alonso
- Department of Emergency Medicine, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK;
| | - Isabel María Blancas Sánchez
- Grupo Investigación GC09 Nutrigenomics, Metabolic Syndrome, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain; (M.V.A.); (I.M.B.S.)
| | - Manuel Romero-Saldaña
- Departamento de Enfermería, Fisioterapia y Farmacología, Universidad de Córdoba, Campus de Menéndez Pidal, 14071 Córdoba, Spain;
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