Modernization and the onset of overweight and obesity in Bougainville and Solomon Islands children: cross-sectional and longitudinal comparisons between 1966 and 1986

Prevalence, causes and contexts of childhood overweight and obesity in the Pacific region: a scoping review

Background

Non-communicable diseases (NCDs) are a major threat to health and development and account for 75% of deaths in the Pacific Islands Countries and Territories (PICTs). Childhood obesity has been identified as a main risk factor for NCDs later in life. This review compiled overweight and obesity (OWOB) prevalence (anthropometric data) for children aged six to 12 years old living in the Pacific region and identified possible related causes.

Methods

We conducted a systematic search using PubMed, Google Scholar and ScienceDirect for articles published between January 1980 and August 2022. We also searched for technical reports from Ministries of Health. Guided by the eligibility criteria, two authors independently read the selected articles and reports to extract and summarise relevant information related to overweight and obesity.

Results

We selected 25 articles, two worldwide analyses of population-based studies and four national reports. Information revealed that childhood OWOB prevalence reached 55% in some PICTs. This review also indicated that age, gender and ethnicity were linked to children's weight status, while dietary practices, sleep time and level of physical activity played a role in OWOB development, as well as the living environment (socio-economic status and food availability), parenting practices and education level.

Conclusion

This review highlighted that anthropometric data are limited and that comparisons are difficult due to the paucity of surveys and non-standardized methodology. Main causes of overweight and obesity are attributed to individual characteristics of children and behavioural patterns, children's socio-economic environment, parenting practices and educational level. Reinforcement of surveillance with standardised tools and metrics adapted to the Pacific region is crucial and further research is warranted to better understand root causes of childhood OWOB in the Pacific islands. More robust and standardized anthropometric data would enable improvements in national strategies, multisectoral responses and innovative interventions to prevent and control NCDs.

Body size and weight status of adult Indian males born in the 1890s-1950s: Age and secular change in the context of demographic, economic, and political transformation

OBJECTIVES

To evaluate secular change in body size and weight status of adult Indian males born in 1891-1957 and surveyed in the 1970s.

METHODS

Data are from Anthropological Surveys. Only men were included in the surveys due to high female illiteracy and lack of female researchers. Indian society was also strongly conservative at the time, especially in rural areas, and the measurement of women by men was not permitted. Heights and weights of 43 950 males 18-84 years (born 1891-1957) were measured. The BMI was calculated; weight status of individuals was classified relative to WHO criteria and suggested criteria for the Asia-Pacific region. Heights of men 35+ years were also adjusted for age-related stature loss. Trends in measured and adjusted heights, body weight and the BMI, and in weight status were evaluated by age groups. Linear regression of measured height and adjusted height on year of birth was used to estimate secular effects.

RESULTS

Mean heights declined slightly with age to 50 years and declined sharply through 60+ years, while mean weights increased into the 40s and then declined. Mean BMIs were relatively stable from 30 to 60 years. The prevalence of thinness and normal weight was high, while that of overweight and obesity was low. Regression analyses indicated limited secular change across the total range of birth years but suggested a decline in adjusted heights among men born in 1891 through the 1930s, and little change among men born subsequently.

CONCLUSIONS

Age-related trends and results of the regression analyses by year of birth indicated negligible secular change in heights of Indian men 18-84 years born between 1891 and 1957. BMIs indicated a high prevalence of thinness and normal weight and low prevalence of overweight and obesity.

Food Systems Development: The Necessary Paradigm Shift for a Healthy and Sustainable Agrarian Transition, a Case Study from Bougainville, Papua New Guinea

Classical agricultural development paradigms prioritise basic requirements such as agronomic, caloric and economic needs for the target environment and for beneficiaries. As challenges associated with climate change, globalisation, and population growth compound and amplify one another, project scope must be broadened to take a holistic food systems approach that includes sociocultural and historical contexts, as well as climate impacts as underpinning project design. In this paper, we illustrate the importance of adopting a food systems development paradigm rather than a classical agricultural development paradigm through a case study in Bougainville, Papua New Guinea. The case uses Rich Picturing, targeted and focus-group interviews, and garden visits in remote Bougainville; it provides a poignant illustration of the importance of this more holistic perspective given the historical inefficacy of food systems development, as well as Papua New Guinea's exposure to a plethora of compounding environmental, social, economic, and political stresses and shocks that demonstrate the important linkages between ecosystem services and health. The study aims to demonstrate how including localised gender dynamics, climate vulnerability, rapidly morphing social norms, and climate analogue environments is critical in building food systems resilience and is key to designing policies, programs, and development projects that more effectively address environmental, sociocultural, and health considerations. Building on the inadequacies in agricultural development efforts previously documented for Papua New Guinea, we propose an improved framing for food systems development and identify areas for future research.

Association Between Major Adverse Cardiovascular Events and the Ratio of Subcutaneous Fat Area to Visceral Fat Area in Patients Who Have Undergone Multidetector Row Computed Tomography

Background: Obesity is a critical cardiovascular risk factor that has been defined in terms of body mass index (BMI), abdominal circumference (AC), and fat area. In this study, we examined which markers of obesity are most closely associated with major adverse cardiovascular events (MACE).

Methods and Results: This prospective cohort study enrolled 529 consecutive patients who initially underwent coronary computed tomography angiography for screening of coronary atherosclerosis at Fukuoka University Hospital (FU-CCTA Registry) and either were clinically suspected of having coronary artery disease (CAD) or had at least 1 cardiovascular risk factor with a follow-up of up to 5 years. Measurements of subcutaneous fat area (SFA), visceral fat area (VFA), and AC were quantified using multidetector row computed tomography. The primary endpoint was MACE. SFA and the SFA to VFA ratio (SFA/VFA) were significantly lower in the MACE than non-MACE group. SFA, AC, BMI, and SFA/VFA were each independently associated with MACE. Receiver operating characteristic curve analysis revealed a greater area under the curve for SFA/VFA than for the other parameters. The cut-off level of SFA/VFA with the greatest sensitivity and specificity for the diagnosis of MACE was 1.45 (sensitivity 0.849, specificity 0.472).

Conclusions: Our results suggest that SFA/VFA may be a marker for evaluating the presence of MACE.

Measuring Wasting and Stunting Prevalence Among Children Under 5 Years of Age and Associated Risk Factors in Papua New Guinea: New Evidence From the Comprehensive Health and Epidemiological Surveillance System

Background: Papua New Guinea (PNG) has undergone a significant health transition, with the prevalence of non-communicable diseases increasing. Many children under 5 years of age suffer from the burden of malnutrition. While wasting and stunting still remain high, children who are overweight and obese are reportedly increasing.

Objective: This study reports the prevalence of wasting, stunting, underweight, and overweight children under five in PNG and explores potential household and maternal socioeconomic factors associated with malnutrition.

Method: Data were drawn from the Comprehensive Health and Epidemiological Surveillance System (CHESS) in PNG. Height and weight were directly measured, and wasting, stunting, overweight, and underweight statistics were determined using the 2006 WHO Standard Growth Standards. Household and maternal factors were assessed with parent interviews conducted by trained data collectors. Multivariate logistic regression analyses were conducted to report associations between selected socioeconomic correlates and child malnutrition outcomes.

Result: The prevalence of wasting, stunting, underweight, and overweight children was 13.8, 46.5, 18.2, and 18%, respectively. Children from households with food shortage were more likely to be wasted than those from households without such an experience [OR: 1.43 (95% CI: 0.93–2.21)]. Children from the poor quintile were more likely to be stunted than those from the richest quintile [OR: 1.2 (95% CI: 0.79–1.82)]. Other factors associated with wasting included living in an urban vs. rural area [OR: 1.36 (0.77–2.4)], middle household wealth quintile vs. richest quintile [OR: 0.77 (0.38–1.55)], mothers in union with a man vs. mother unmarried or live in union [OR: 0.76 (0.4–1.42)], and male children vs. female [OR: 0.77 (0.53–1.11)]. Factors associated with stunting included residing in urban vs. rural areas [OR: 1.13 (0.8–1.6)], mother in union vs. single mother [OR: 0.86 (0.59–1.24)], and mothers with preparatory/elementary vs. mothers with vocational/college education [OR: 0.15 (0.02–1.01)].

Conclusion: An integrated approach is needed to comprehensively address the household socioeconomic factors at the household level, contributing to the improvement of child health and development in PNG.

Body Mass Index and Major Adverse Cardiovascular Events: A Secondary Analysis Based on a Retrospective Cohort Study

Background

The association between body mass index (BMI) and major adverse cardiovascular events (MACE) has not been clarified and is controversial. Therefore, the purpose of present study is to explore the association between BMI and MACE.

Material/Methods

This was a secondary analysis of a retrospective cohort study in which 204 participants who were diagnosed with stable coronary artery disease (CAD) and received elective percutaneous coronary intervention (PCI) were recruited. According to the BMI, patients were divided into 3 categories – underweight (BMI <18.5 kg/m²), normal BMI (18.5 ≤BMI <25 kg/m²), and overweight (BMI ≥25 kg/m²)], and the patients were followed up. The primary endpoint was MACE.

Results

After a median follow-up of 783 days, MACE events had occurred in 18 participants. After controlling for potential confounding factors, no difference was observed in MACE between the underweight group and the normal BMI group (OR=1.73, 95% CI 0.42 to 7.17); but there were significantly fewer MACE in the overweight group than in the normal BMI group (OR=0.17; 95% CI: 0.03 to 0.84). Pearson correlation analysis showed that BMI was positively correlated with hemoglobin (r=0.2102) and albumin (r=0.2780), but negatively correlated with high-density lipoprotein cholesterol (r=−0.2052). The receiver operating characteristic curve (ROC) showed that the best threshold for BMI to predict MACE was 24.23, the area under the curve was 0.729, sensitivity was 0.893, and the specificity was 0.460.

Conclusions

Our study shows that overweight patient with stable CAD have lower risk of MACE after PCI, and the optimal threshold for predicting MACE is 24.23.

Secular trends are associated with the demographic and epidemiologic transitions in an indigenous community in Oaxaca, Southern Mexico

OBJECTIVE

To test the hypothesis that secular changes in body size and age at menarche are related to the demographic and epidemiologic transitions in an indigenous community in Oaxaca, southern Mexico.

METHODS

Data were derived from surveys of a Zapotec-speaking community conducted between 1968 and 2000. Segmented linear regressions of height, weight, BMI and recalled age at menarche on year of birth in cohorts of adults born before and after the demographic transition were used to evaluate secular changes. Corresponding comparisons of body size (MANCOVA controlling for age) and age at menarche (status quo, probit analysis) were done for samples of children and adolescents born before and after the epidemiological transition.

RESULTS

Height and weight increased in adults born after the demographic transition (mid-1950s), and especially in children and adolescents born after the epidemiological transition (mid-1980s). Age at menarche also decreased significantly in women born after the demographic transition, but at a more rapid estimated rate in adolescents born after the epidemiological transition. Secular gains in body weight were proportional to those for height among children and adolescents, but adults, males more so than females, gained proportionally more weight.

CONCLUSIONS

The secular trend in height in adults of both sexes was associated with the decade of the demographic transition in the mid-1950s. Significant secular gains in size attained and age at menarche occurred in children and youth born after the epidemiologic transition which likely reflected improved health and nutritional conditions since the mid-1980s.

Adult lipids associated with early life growth in traditional Melanesian societies undergoing rapid modernization: a longitudinal study of the mid-20th century

Both poor fetal development and accelerated post-natal growth have been linked to adult dyslipidemias in many studies conducted in developed societies. It is not known, however, whether these relationships only characterize populations with typical Western diets or if they also may develop in groups at the early stages of a dietary transition. Our longitudinal study of traditional rural populations in the Southwest Pacific during a period of extremely rapid modernization in diet and life-styles shows a nascent association between child growth retardation, subsequent growth acceleration, and adult lipid values in spite of a continuing prevalence of very low lipid levels. However, our results do not entirely conform to results from populations with "modern" diets. Outcome (i.e., young adult) cholesterol and triglyceride levels are more consistently related to initial measures of body fat and growth in body fat measures than with stature, while outcome apo A-1 is more consistently related to initial stature or stature growth than to measures of body fat. We suggest this may reflect a pattern characteristic of the initial stages of "modernization" associated with dietary change, with stronger and more pervasive relationships emerging only later as populations complete the dietary transition.

Brief communication: Body mass index, body adiposity index, and percent body fat in Asians

Human obesity is a growing epidemic throughout the world. Body mass index (BMI) is commonly used as a good indicator of obesity. Body adiposity index (BAI = hip circumference (cm)/stature (m)(1.5) - 18), as a new surrogate measure, has been proposed recently as an alternative to BMI. This study, for the first time, compares BMI and BAI for predicting percent body fat (PBF; estimated from skinfolds) in a sample of 302 Buryat adults (148 men and 154 women) living in China. The BMI and BAI were strongly correlated with PBF in both men and women. The correlation coefficient between BMI and PBF was higher than that between BAI and PBF for both sexes. For the linear regression analysis, BMI better predicted PBF in both men and women; the variation around the regression lines for each sex was greater for BAI comparisons. For the receiver operating characteristic (ROC) analysis, the area under the ROC curve for BMI was higher than that for BAI for each sex, which suggests that the discriminatory capacity of the BMI is higher than the one of BAI. Taken together, we conclude that BMI is a more reliable indicator of PBF derived from skinfold thickness in adult Buryats.