The double burden of malnutrition associated with poverty

Nutritional status of tribal and non-tribal adults in rural Bangladesh: A comparative study

BACKGROUND

Nutritional status is an important indicator of health status among adults. However, to date, there exists scanty information on the nutritional status of tribal populations of Bangladesh. The aim of the study was to investigate the nutritional status of tribal (T) and non-tribal (NT) adult people living in the rural area of Rajshahi district, Bangladesh.

METHODS

A total of 420 (72 T and 348 NT) households were studied. The samples were selected using multistage stratified sampling with proportional allocation. The nutritional status of adults was measured using body mass index (BMI). Descriptive statistics, t-test, ANOVA and Z-proportional test were utilized for data analysis.

RESULTS

The study revealed that 8.3% and 9.2% of T and NT men were suffering from under nutrition respectively, while the corresponding figures in women were 12.5% and 10.1% respectively. Overall, 11.1% and 27.0% men, and 13.9% and 29.3% women T and NT were over-nourished respectively. The rate of over nutrition among T was significantly (p<0.05) higher than NT for both sexes. The mean weight and BMI of the NT men were significantly (p<0.01) higher than T men. The mean weight, height and BMI of NT women were higher (p<0.05) than T women. ANOVA demonstrated that the variation in BMI among education levels of NT men and the variation among occupation for both ethnicities were significant (p<0.01). The variation in BMI among education levels and occupation of T and NT women were significant (p<0.05), moreover ordinal logistic regression model demonstrated that hygienic toilet facilities and father's occupation were predictors of nutritional status. The interaction effects of education and occupation, and education and household monthly income on BMI were significant (p<0.01) for T men and both T and NT women (p<0.05).

CONCLUSIONS

The prevalence of over-nutrition among NT is higher than T for both sexes. Some socio-economic and demographic factors were found as predictors of malnutrition. At least 12 of the 17 Sustainable Development Goals (SDGs) contain indicators that are highly related to nutrition, our findings can help Bangladesh Government for achieving SDGs by 2030. Appropriate nutritional intervention and awareness programmes can be initiated by the Government to ameliorate the burden of malnutrition among adults in the country.

Double Burden of Malnutrition: A Population Level Comparative Cross-Sectional Study across Three Sub-Saharan African Countries-Malawi, Namibia and Zimbabwe

BACKGROUND

The double burden of malnutrition in sub-Saharan African countries at different levels of economic development was not extensively explored. This study investigated prevalence, trends, and correlates of undernutrition and overnutrition among children under 5 years and women aged 15-49 years in Malawi, Namibia, and Zimbabwe with differing socio- economic status.

METHODS

Prevalence of underweight, overweight, and obesity were determined and compared across the countries using demographic and health surveys data. Multivariable logistic regression was used to ascertain any relationships between selected demographic and socio-economic variables and overnutrition and undernutrition.

RESULTS

An increasing trend in overweight/obesity in children and women was observed across all countries. Zimbabwe had the highest prevalence of overweight/obesity among women (35.13%) and children (5.9%). A decreasing trend in undernutrition among children was observed across all countries, but the prevalence of stunting was still very high compared to the worldwide average level (22%). Malawi had the highest stunting rate (37.1%). Urban residence, maternal age, and household wealth status influenced maternal nutritional status. The likelihood of undernutrition in children was significantly higher with low wealth status, being a boy, and low level of maternal education.

CONCLUSIONS

Economic development and urbanization can result in nutritional status shifts.

Globalization and Disability Addiction in Working Populations: Unlocking the Global Correlates to Disability Addiction Calls for the Healthicization of Society

Addiction behavior and the resulting short-term or long-term disabilities continue to increase globally, especially during the current COVID pandemic. We analyze how national measures of 38 global indices correlate with national addiction-related disability rates resulting from four primary addictive substances: alcohol, tobacco, drugs, and food. We utilized a canonical correspondence analysis to explore the relationships between 38 political, economic, and cultural characteristics and years of life lived with a short-term or long-term health loss in 78 countries. The model selection approach reduced 38 global indices to 13 explanatory variables (final model: F 13 = 5·64, p < 0.001 after 1000 permutations). Results show that the following factors are correlated with increased addiction disabilities stemming from obesity, alcohol, drug, and tobacco use: political stability; voice and accountability; control of corruption; economic freedom; women economic opportunity; Human Development Index; individuality; masculinity; long-term orientation; indulgence; uncertainty avoidance; personal contact; and religious diversity. Health care policy makers should consider that national culture, political attributes, and economic characteristics can influence national disability rates resulting from addictions.

The Analysis of Trends of Preschool Child Stunting, Wasting and Overweight in the Eastern Mediterranean Region: Still More Effort Needed to Reach Global Targets 2025

BACKGROUND

This study was undertaken to analyze and compare Eastern Mediterranean (EM) countries in achievement of WHO nutrition global targets for children growth indicators by 2025.

METHODS

A total of 108 national surveys from 20 countries in EM region were analyzed to estimate the prevalence of stunting and wasting and 93 surveys to estimate the prevalence of overweight/obesity in children. These data were obtained from national surveys included in the WHO Global Database on Child Growth and Malnutrition.

RESULTS

In EM region, the prevalence of childhood stunting was estimated to have a 38% decline from 2000 (34.7%) to 2025 (21.2%). Only three countries in EM region (Iran and Jordan, Saudi Arabia) were anticipated to achieve the expected WHO target by 2025. From 2000 to 2020, the prevalence of wasting decreased from 6.9 to 5.3. Six countries were presumed to achieve the expected WHO target by 2025. Nine countries will presumably have overweight rates >5% (Djibouti, Egypt, Iraq, Kuwait, Lebanon, Libya, Morocco, Syrian Arab Republic and Tunisia) in 2025 whereas five countries will have overweight rates above 10% (Egypt, Libya, Morocco, Syrian Arab Republic and Tunisia).

CONCLUSION

Despite descending trends of child stunting and wasting and a secular trend of child obesity in EM region, it is expected that WHO targets will not be achieved by 2025. A diverse socio-economic condition in EM countries necessitates different action plans. International determination, political commitment and, above all, involvement of the families are needed to achieve 2025 targets for child stunting, wasting and overweight/obesity.

Dental caries and anthropometrics of children living in an informal floating Amazonian community: a cross-sectional pilot study

Aims: Increasing evidence supports a relationship between poor oral health and growth in children. Our objective was to assess the association between the presence of dental caries and anthropometric measurements of children residing in Claverito, a floating slum community in the Peruvian Amazon. Methods: For this cross-sectional study, presence of caries was assessed using dmft/DMFT (decayed, missing, filled teeth) scores and the SiC Index (mean dmft/DMFT of one-third of the study group with the highest caries score). Anthropometric categories for age-sex-specific z-scores for height and weight were calculated based on WHO standardized procedures and definitions. The association between SiC (measured by dmft/DMFT) and anthropometric measures was estimated using unadjusted and adjusted multivariable linear regression models. Critical value was established at 5%. Results: Our study population consisted of 67 children between the ages of 1 and 18 years old. Mean age was 9.5 years old (SD: 4.5), and the majority were female (52.2%). Almost all had dental caries (97.0%) and the mean dmft/DMFT score was 7.2 (SD: 4.7). The SiC Index of this population was 9.0. After adjusting for confounding variables, participants who had permanent dentition with the highest dmft/DMFT levels had statistically significant decreased height-for-age z-scores (HAZ) (p=0.04). Conclusions: We found an inverse linear association between SiC Index and height-for-age z-scores (HAZ) among children living in poverty in a floating Amazonian community in Peru. Children from under-resourced communities, like floating slums, are at high risk for oral disease possibly negatively impacting their growth and development.

Sucrose subjective response and eating behaviors among individuals with opioid use disorder

BACKGROUND

While opioid agonists represent the most efficacious treatment for opioid use disorder (OUD), they may enhance the reinforcing effects of sweets, placing individuals at risk for weight gain and associated consequences. We examined sucrose subjective response among adults receiving opioid agonist treatment vs. a comparison sample without OUD.

METHODS

Forty adults with (OUD+) and 40 without OUD (OUD-) completed an intake battery of eating behaviors and body mass index. During two same-day sessions, participants sampled six experimenter-administered sucrose solutions (0, 0.10, 0.25, 0.50, 0.75, 1.0 M), each three times, under double-blind conditions and rated the pleasantness and intensity of each.

RESULTS

OUD + participants presented with a higher prevalence of obesity and unhealthy eating behaviors vs. OUD- participants (p's < 0.05). They rated sucrose solutions as less pleasant than OUD- participants (p < 0.001), though this effect was limited to the three lowest concentrations (0, 0.10, 0.25M). There were no group differences on intensity ratings (p = 0.35). A change from baseline (placebo) analysis indicated a higher magnitude of change in pleasantness ratings and a lower magnitude of change in intensity ratings from 0M in OUD+ vs. OUD- (p's < 0.05).

CONCLUSIONS

OUD+ participants exhibited a higher magnitude of change in pleasantness ratings from placebo vs. OUD-, which was largely driven by pronounced differences in perceived pleasantness of essentially unsweet solutions. OUD+ participants presented with a consistently more severe profile in regard to eating behaviors. These data highlight the risk factors experienced by OUD+ individuals that extend beyond drug-related risks and may inform future efforts to improve health outcomes.

Economic Status Moderates the Association Between Early-Life Famine Exposure and Hyperuricemia in Adulthood

CONTEXT

The double burden of malnutrition (DBM), undernutrition in early life and an obesogenic environment later on, influences later risk of chronic disorders. The Great Famine in China from 1959 to1962 and remarkable economic development from the 1980s provided such a burden for a large number of people in their 60s.

OBJECTIVE

We aimed to analyze the effect of economic status on the association between famine exposure in early life and hyperuricemia in adulthood.

DESIGN AND SETTING

Participants numbering 12 666 were enrolled in China based on the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) Study from 2014 to 2016.

PARTICIPANTS

Participants with fetal or childhood famine exposure (birth year 1949-1962) formed the exposure group.

MAIN OUTCOME MEASURE

Hyperuricemia was defined as uric acid (UA) > 420 μmol/L for men and > 360 μmol/L for women. The association of famine with hyperuricemia was assessed via regression analyses.

RESULTS

Early-life famine exposure was negatively associated with UA levels (P = .045) but was not associated with hyperuricemia (P = .226) in the whole study population. Economic status could moderate the association of famine exposure with UA and hyperuricemia (P ≤ .001). In participants with high economic status, early-life famine exposure was positively associated with UA levels (unstandardized coefficients 7.61, 95% CI 3.63-11.59, P < .001), and with hyperuricemia (odds ratio 1.47, 95% CI 1.19-1.81, P < .001).

CONCLUSIONS

Economic status could moderate the association between exposure to famine in early life and hyperuricemia in adulthood, indicating that the DBM might affect hyperuricemia in an opposite direction of the effects of undernutrition in early life alone.

Associations between Child Snack and Beverage Consumption, Severe Dental Caries, and Malnutrition in Nepal

The global nutrition transition and increased consumption of sugar-sweetened beverages and ultra-processed snacks have contributed to increasing rates of child obesity and dental caries in developing countries. In Nepal, where child malnutrition rates are high, the relationship between malnutrition and dental caries is poorly understood. This cross-sectional study aims to assess this relationship among a convenience sample of 273 children age six months to less than 12 years in three communities in Nepal, using parent/caregiver interviews, child dental exams, and anthropometric measurements. Fisher’s exact test and independent t-tests examined associations between dietary practices and severe caries and between severe caries and malnutrition, respectively. Children consumed sugar-sweetened beverages and processed snacks frequently: 80% consumed tea with sugar, 60% consumed sweet snacks, and 65% consumed processed savory snacks daily. Overall, 74% of children had untreated tooth decay, and 21% exhibited stunting malnutrition, 14% were underweight, and 6% presented wasting. Significant associations were found between daily consumption of sweets and processed snacks with severe caries and between severe caries and poorer nutritional status. These findings underscore the need to incorporate nutrition and oral health promotion and dental treatment into maternal–child health services and schools and to strengthen policies to reduce children’s access to junk food.

Risk factors modifying the double burden of malnutrition of young children in Thailand

Thailand is now faced with a double burden of malnutrition. Using nationally representative data from the 2015-2016 Multiple Indicator Cluster Survey, we utilized multinomial logistic regression models to examine factors associated with stunting only, wasting only, overweight only, concurrent stunting and overweight, and concurrent stunting and wasting among children 0-59 months of age (n = 11,068). The prevalences of <5 stunting only (height-for-age Z score < -2 SD) and wasting only (WHZ < -2 SD) were 8.5% and 4.7%, respectively. The prevalence of <5 overweight only (WHZ > +2 SD) was 7.8%. Children 12-23 months (risk ratio [RR], 95% confidence interval [CI]: 1.47 [1.18, 1.83]; p < .01) and 24-35 months (RR, 95% CI: 1.56 [1.26, 1.94]; p < .001) were at increased risk for stunting only, compared with children 48-59 months. The strongest risk factor for stunting only was low birth weight (RR, 95% CI: 3.42 [2.86, 4.10]; p < .001). Children 0-5 months were at highest risk for wasting only, compared with children 48-59 months (RR, 95% CI: 2.91 [2.16, 3.92]; p < .001). Children 48-59 months and male children were more likely to be overweight only. Higher household wealth and smaller household size were also significant predictors of overweight only. A small proportion of children were concurrently stunted and overweight (1.3%) and concurrently stunted and wasted (0.6%). A multipronged approach focused on adequate prenatal care, improving breastfeeding and complementary feeding practices, and mitigating the growing burden of overweight is needed to address the double burden of malnutrition in Thailand.

The Intertwined Relationship Between Malnutrition and Poverty

Despite social and economic development, the burden of malnutrition across the globe remains unacceptably high. A vital relationship exists between nutritional status, human capital, and economic standing. Malnutrition adversely affects the physiological and mental capacity of individuals; which in turn hampers productivity levels, making them and their respective countries more susceptible to poverty. A two-way link exists between malnutrition and poverty, creating a vicious cycle with each fueling the other. Malnutrition produces conditions of poverty by reducing the economic potential of the population and likewise, poverty reinforces malnutrition by increasing the risk of food insecurity. The aim of the paper is to describe the interconnection between malnutrition and poverty, and to highlight how both serve as the cause and consequence of each other. The paper also discusses ways to move ahead to tackle these issues in a parallel manner rather than in separate silos.

Association of all forms of malnutrition and socioeconomic status, educational level and ethnicity in Colombian children and non-pregnant women

OBJECTIVE

To examine the association of all forms of malnutrition and socioeconomic status (SES), educational level and ethnicity in children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years) in Colombia.

DESIGN

Cross-sectional analysis of data from the 2010 Colombian National Nutrition Survey. The prevalence of malnutrition was compared across categories of SES, educational level and ethnicity.

SETTING

Colombia.

PARTICIPANTS

The sample for the current analysis comprised children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years).

RESULTS

In children <5 years, a low SES and maternal educational level were significantly associated with a lower prevalence of overweight/obesity compared with high levels of SES and maternal education, that is, the prevalence of overweight/obesity was 1·4 and 1·6 times lower in categories of low SES and educational levels, respectively. In contrast, the prevalence of wasting, stunting and anaemia was higher in the lowest SES and maternal educational categories (the prevalence was between 1·1 and 1·8 times higher for these indicators). In women, the lowest SES (11 and 19 years) and educational levels (20 and 49 years) exhibited a higher prevalence in all forms of malnutrition compared with their counterparts in the highest categories (i.e. overweight/obesity, stunting and anaemia). Additionally, indigenous or Afro-Colombian children and women had the highest prevalence of malnutrition in comparison with other ethnicities.

CONCLUSIONS

These results suggest that public policies should address all forms of malnutrition that occur in the most vulnerable populations in Colombia using multiple strategies.

Double burden of malnutrition at household level: A comparative study among Bangladesh, Nepal, Pakistan, and Myanmar

BACKGROUND

The coexistence of overweight mother and stunted child at the same household is a type of Double Burden of Malnutrition at Household Level (DBMHL). This particular public health concern is now emerging at an alarming rate among most of the South Asian and its neighboring lower-and-middle income countries which are going through nutritional transition. This study has examined the prevalence rate and the risk factors of DBMHL along with the socio-economic inequality in DBMHL among Bangladesh, Nepal, Pakistan, and Myanmar.

METHODS

Latest Demographic and Health Survey datasets were used in this study. To identify the significant association of DBMHL with socio-demographic characteristics, a multivariate technique named as logistic regression model, and for measuring socio-economic inequalities in DBMHL prevalence, relative index of inequality (RII) and slope index of inequality (SII) were used.

RESULTS

The prevalence rates of DBMHL were 4.10% (urban: 5.57%, rural: 3.51%), 1.54% (urban: 1.63%, rural: 1.42%), 3.93% (urban: 5.62%, rural: 3.20%), and 5.54% (urban: 6.16%, rural: 5.33%) respectively in Bangladesh, Nepal, Pakistan, and Myanmar. The risk ratios (RR) obtained from RII for Bangladesh, Nepal, Pakistan and Myanmar were 1.25, 1.25, 1.14, and 1.09, respectively, and β coefficient from SII were 0.01, 0.004, 0.005, and 0.006 unit respectively. In addition to not breastfeeding [Bangladesh (AOR: 1.55; 95% CI: 1.11-2.15), Myanmar (AOR: 1.74; 95% CI: 1.02-2.95)], respondent's older age (in Bangladesh, Nepal, and Myanmar), child's older age (in Pakistan and Myanmar), and middle and rich groups of wealth-index (in Bangladesh and Pakistan) were strong risk factors for DBMHL. On the other hand, female child [Nepal (AOR: 0.50; 95% CI: 0.26-0.95), Pakistan (AOR: 0.58; 95% CI: 0.41-0.84)], higher education [in Pakistan], respondent not participated in decision making [in Bangladesh and Nepal] and media access [Nepal (AOR: 0.44; 95% CI: 0.20-0.98)] had negative association with DBMHL.

CONCLUSION

The DBMHL persists in all selected countries, with a higher prevalence in urban areas than in rural areas. In order to control the higher prevalence of DBMHL in urban areas, respective countries need urgent implementation of multisectoral actions through effective policies and empowering local communities.

Early life disadvantage, phenotypic programming, and health disparities

Much research finds that early life socioeconomic disadvantage predicts poorer health later in life, even among those whose conditions improve in adulthood. Although there are numerous factors that contribute to this association, recent research suggests that growing up in adverse socioecological environments may promote developmental patterns that facilitate pre-reproductive survival in harsh environments, but can also come at the cost of reduced longevity. Here, we review recent research demonstrating that early life exposure to low socioeconomic status can become embedded in the mechanisms that regulate (a) bodily inflammatory activity and (b) energy regulation in ways that contribute to poor health. This research offers new insights into ways that early life environments can get under one's skin to impact health and longevity.

The Role of Cultural Factors in Sustainable Food Consumption—An Investigation of the Consumption Habits among International Students in Hungary

Food consumption plays a pivotal role in the economy and the health of individuals. Foods and meals, in addition to sustaining life, also have many functions in society, such as human bonding. The purpose of our study is to present a qualitative research method to show the role of food consumption in the culture of several ethnic groups, and to introduce the ways in which cultural factors influence eating habits and local food supply conditions. In the first part of the research, the sample was a mix of multiple nationalities. During our investigations, the main questions were: What do you think about the culture and value food consumption? What kind of food do you consume the most? What differences do you find in the habits of different ethnic groups, especially regarding their eating habits? In the second part, we asked the main actors of the local supply system (restaurants, buffets, shops) about the ways they track the demand of foreign students. Our results have been implemented into two different SWOT matrixes. We can conclude that such research on food consumption attitudes and community behavior is essential. Most of the interviewed students are interested in comparing their diet and cultural traditions to those of other nations’, and prefer local foods. The study proved that eating habits in Hungary have an impact on the eating habits of international students, and they changed them from several perspectives. The study found that dietary choices are complex decisions that have a significant environmental and social impact, but we need to add that thanks to the strong cultural background, the students can keep their sustainable eating and community values abroad, which can also strongly influence the development of the local food supply practices.

Prevalence and determinants of food insecurity in migrant Sub-Saharan African and Caribbean households in Ottawa, Canada

Purpose

Food insecurity (FI) is an important social determinant of health and is linked with higher health care costs. There is a high prevalence of FI among recent migrant households in Canada. The purpose of this paper is to evaluate the prevalence of FI in Sub-Saharan African and Caribbean migrants in Ottawa, and to explore determinants of FI in that population.

Design/methodology/approach

A cross-sectional study was conducted among 190 mothers born in Sub-Saharan Africa or the Caribbean living in Ottawa and having a child between 6 and 12 years old. Health Canada’s Household Food Security Survey Module was used to evaluate participants’ food security in the past 12 months. χ2 tests and multivariate logistic regression analyses were used to measure determinants of FI (n=182).

Findings

A very high rate of FI (45.1 percent) was found among participants. When numerous determinants of FI were included in a multivariate model, household FI was associated with Caribbean origin, low education attainment, lone motherhood, living in Canada for five years or less and reliance on social assistance.

Originality/value

These findings highlight the need for FI to be explicitly addressed in migrant integration strategies in order to improve their financial power to purchase sufficient, nutritious and culturally acceptable foods. Enhancing migrants’ access to affordable child care and well-paid jobs, improving social assistance programs and providing more affordable subsidized housing programs could be beneficial.

How poverty affects diet to shape the microbiota and chronic disease

Here, we discuss the link between nutrition, non-communicable chronic diseases and socio-economic standing, with a special focus on the microbiota. We provide a theoretical framework and several lines of evidence from both animal and human studies that support the idea that income inequality is an underlying factor for the maladaptive changes seen in the microbiota in certain populations. We propose that this contributes to the health disparities that are seen between lower-income and higher-income populations in high-income countries.