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Hanley‐Cook G, Argaw A, Dahal P, Chitekwe S, Rijal S, Bichha RP, Parajuli KR, Kolsteren P. Elucidating the sustained decline in under-three child linear growth faltering in Nepal, 1996-2016. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 1:e12982. [PMID: 32141213 PMCID: PMC8770651 DOI: 10.1111/mcn.12982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
Childhood linear growth faltering remains a major public health concern in Nepal. Nevertheless, over the past 20 years, Nepal sustained one of the most rapid reductions in the prevalence of stunting worldwide. First, our study analysed the trends in height-for-age z-score (HAZ), stunting prevalence, and available nutrition-sensitive and nutrition-specific determinants of linear growth faltering in under-three children across Nepal's Family Health Survey 1996 and Nepal's Demographic and Health Surveys 2001, 2006, 2011, and 2016. Second, we constructed pooled multivariable linear regression models and decomposed the contributions of our time-variant determinants on the predicted changes in HAZ and stunting over the past two decades. Our findings indicate substantial improvements in HAZ (38.5%) and reductions in stunting (-42.6%) and severe stunting prevalence (-63.9%) in Nepalese children aged 0-35 months. We also report that the increment in HAZ, across the 1996-2016 period, was significantly associated (confounder-adjusted p < .05) with household asset index, maternal and paternal years of education, maternal body mass index and height, basic child vaccinations, preceding birth interval, childbirth in a medical facility, and prenatal doctor visits. Furthermore, our quantitative decomposition of HAZ identified advances in utilisation of health care and related services (31.7% of predicted change), household wealth accumulation (25%), parental education (21.7%), and maternal nutrition (8.3%) as key drivers of the long-term and sustained progress against child linear growth deficits. Our research reiterates the multifactorial nature of chronic child undernutrition and the need for coherent multisectoral nutrition-sensitive and nutrition-specific strategies at national scale to further improve linear growth in Nepal. [Correction added on 6 November 2020, after first online publication: in abstract, the citation year in the fourth sentence has been changed from '2001' to '2011'.].
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Affiliation(s)
- Giles Hanley‐Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
- Department of Population and Family Health, Institute of HealthJimma UniversityJimmaEthiopia
| | - Pradiumna Dahal
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | - Stanley Chitekwe
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | - Sanjay Rijal
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | - Ram Padarath Bichha
- Department of Health Services, Ministry of Health and PopulationGovernment of NepalKathmanduNepal
| | - Kedar Raj Parajuli
- Department of Health Services, Ministry of Health and PopulationGovernment of NepalKathmanduNepal
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
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Taghizadeh S, Khodayari-Zarnaq R, Farhangi MA. Childhood obesity prevention policies in Iran: a policy analysis of agenda-setting using Kingdon's multiple streams. BMC Pediatr 2021; 21:250. [PMID: 34044800 PMCID: PMC8155654 DOI: 10.1186/s12887-021-02731-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric obesity is one of the most important health challenges of the twenty-first century. Primary prevention of childhood obesity, can lessen its consequences. This study aims to assess childhood obesity prevention policies in Iran through a policy analysis of agenda-setting using Kingdon's multiple streams. METHODS A qualitative study was conducted using in-depth interviews with 39 key informants and document review from different stages of the policymaking process of childhood and adolescent obesity prevention programs in Iran. The analysis of documents and interviews were guided based on Kingdon's multiple streams (problem, policy and political streams). RESULTS The important factors of the problem stream were the high prevalence of childhood and adolescent obesity and its risk factors in Iran. In the policy stream, a focus on preventing non-communicable diseases in the health system, increasing the workforce in health centers, promoting health school programs, and creating healthy eating buffets in schools was identified. Under the political stream, the impact of the WHO ECHO program in 2015 and the implementation of the health system transformation plan in Iran in the new government took place after 2013, caused the Iran ECHO program entered the agenda and implemented from 2016. CONCLUSIONS Now that a window of opportunity for childhood and adolescent obesity prevention policymaking has been created, the problems such as the therapeutic approach in the health system, the existence of sanctions against Iran and outbreak of coronavirus disease-19 (COVID-19), have hindered the successful implementation of this policy and the opportunity window has not been well used. However, actors need political support from the high levels of government to keep this policy on the agenda.
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Affiliation(s)
- Shahnaz Taghizadeh
- Department of Community Nutrition, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdieh Abbasalizad Farhangi
- Department of Community Nutrition, Tabriz University of Medical Sciences, 5166614711, Attar Nishabouri St, PO BOX: 14711, Tabriz, I. R Iran
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Chu CH, Chen HJ, Chang YK. Age, period and birth cohort effects on the prevalence of overweight and obesity among Taiwanese adolescents: a national population-based study. J Public Health (Oxf) 2020; 41:90-99. [PMID: 30973960 DOI: 10.1093/pubmed/fdy025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/09/2018] [Accepted: 01/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The age-period-cohort effects on youth overweight and obesity among junior and senior high school students in Taiwan is not clear. METHODS We utilized the 2006-14 nationally representative School Physical Fitness Dataset. Based on the International Obesity Task Force cut-off criteria, a log-linear age-period-cohort analysis was performed to determine the influence of age, period and cohort on the trend in being overweight, obese and severely obese for both sexes. RESULTS The final dataset included 1073173 individuals (n = 520 382 boys and 552 791 girls). For girls, the prevalence of overweight and obesity declined with age, and the prevalence of overweight declined over time. For boys, the prevalence of overweight and obesity declined with age and over time from 2006 to 2014. The prevalence of severe obesity declined over time and increased with age for the boys. The younger birth cohorts had greater odds of being overweight, obese and severely obese than the older birth cohorts. CONCLUSIONS After differentiating the age-period-cohort effects, the data suggested a decreasing temporal trend in overweight and obesity among adolescents in Taiwan from 2006 to 2014. Among the birth cohorts of the 1990s, the younger cohorts had greater odds of being overweight and obese than the older cohorts when they reached adolescence.
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Affiliation(s)
- Chien-Heng Chu
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, No. 250, Wenhua 1st Road, Guishan, Taoyuan County, Taiwan
| | - Hsin-Jen Chen
- Institute of Public Health, National Yang-Ming University, No.155, Sec. 2, Linong Street, Taipei, 112 Taiwan, ROC
| | - Yu-Kai Chang
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, No. 250, Wenhua 1st Road, Guishan, Taoyuan County, Taiwan
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Misclassification of stunting, underweight and wasting in children 0-5 years of South Asian and Dutch descent: ethnic-specific v. WHO criteria. Public Health Nutr 2020; 23:2078-2087. [PMID: 32476641 PMCID: PMC7358702 DOI: 10.1017/s1368980019004464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Several authors have questioned the suitability of WHO Child Growth Standards (WHO-CGS) for all ethnic groups. The aim of this study was to identify potential misclassification of stunting, underweight and wasting in children of Surinamese Asian Indian, South Asian (Pakistan/India) and Dutch descent. DESIGN A series of routine cross-sectional measurements, collected 2012-2015. South Asian-specific normative growth references for weight-for-age and weight-for-length/height were constructed using the LMS method based on historic growth data of Surinamese Asian Indians born between 1974 and 1976. WHO-CGS and ethnic-specific references were applied to calculate z-scores and prevalence of stunting, underweight and wasting. SETTING Youth HealthCare, providing periodical preventive health check-ups. PARTICIPANTS 11 935 children aged 0-5 years. RESULTS Considerable deviations from WHO-CGS were found, with higher-than-expected stunting rates, especially in the first 6 months of life. Surinamese Asian Indian children showed stunting rates up to 16·0 % and high underweight and wasting over the whole age range (up to 7·2 and 6·7 %, respectively). Dutch children consistently had mean WHO-CGS z-scores 0·3-0·5 sd above the WHO baseline (>6 months). The application of ethnic-specific references showed low rates for all studied indicators, although South Asian children were taller and larger than their Surinamese Asian Indian counterparts. CONCLUSIONS WHO-CGS misclassify a considerable proportion of children from all ethnic groups as stunted in the first 6 months of life. Underweight and wasting are considerably overestimated in Surinamese Asian Indian children. Ethnic-specific growth references are recommended for Surinamese Asian Indian and Dutch children. The considerable differences found between South Asian subpopulations requires further research.
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Headey D, Hoddinott J, Park S. Drivers of nutritional change in four South Asian countries: a dynamic observational analysis. MATERNAL AND CHILD NUTRITION 2017; 12 Suppl 1:210-8. [PMID: 27187917 PMCID: PMC5084796 DOI: 10.1111/mcn.12274] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 11/29/2022]
Abstract
This paper quantifies the factors explaining long-term improvements in child height for age z-scores in Bangladesh (1996/1997-2011), India (1992/1993-2005/2006), Nepal (1997-2011) and Pakistan (1991-2013). We apply the same statistical techniques to data from a common data source from which we have extracted a set of common explanatory variables that capture 'nutrition-sensitive' factors. Three are particularly important in explaining height for age z-score changes over these timeframes: improvements in material well-being; increases in female education; and improvements in sanitation. These factors have comparable associations across all four countries.
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Affiliation(s)
- Derek Headey
- International Food Policy Research Institute, Poverty, Health and Nutrition Division, Washington, District of Columbia, USA
| | - John Hoddinott
- Cornell University, Nutritional Sciences, Ithaca, New York, USA
| | - Seollee Park
- Cornell University, Applied Economics and Management, Ithaca, New York, USA
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Investigating the differences of body mass index and waist circumference in the follow-up assessment of patients to cardiac rehabilitation with acute coronary syndrome. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:1007-1027. [PMID: 27832460 DOI: 10.1007/s13246-016-0471-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/08/2016] [Indexed: 02/07/2023]
Abstract
Obesity management is a key point during cardiac rehabilitation. The effect of new index, waist circumference (WC), in the obesity management of cardiac rehabilitation is not clear yet. Therefore, our study compared the WC index to the body mass index (BMI) in the evaluation of obesity management for the patients with acute coronary syndrome (ACS) in a well-designed cardiac rehabilitation program (CRP). Totally 61 patients were enrolled into our study between October 2013 and January 2014 in our hospital. All these patients were requested to participate in the CRP actively for 6 months. We collected the BMI, WC, vital signs, fasting blood levels, the results from a sub-maximal exercise treadmill test (ETT) and ultrasonic cardiogram (UCG) through a follow-up visit conducted every 1, 3, and 6 months. We used two-tailed Pearson's test and linear regression to analyze the data from our experiment. Our results show that the grouping of obese individuals based on the WC results in the WC being significantly associated with high-density lipoprotein cholesterol (HDL_C), inter-ventricular septal thickness at diastole (IVSd) and left ventricular posterior wall at diastole (LVPwd) after 1 and 3 months of the CRP (HDL_C after1 month of CRP: r = -0.292, P = 0.022; HDL_C after 3 months of CRP: r = -0.289, P = 0.024; IVSd after1 month of CRP: r = 0.451, P = 0.004; IVSd after 3 months of CRP: r = 0.304, P = 0.035; LVPwd after1 month of CRP: r = 0.468, P = 0.002; LVPwd after 3 months of CRP: r = 0.290, P = 0.045). However, no similar regular associations were found when obesity was stratified using the BMI. In other words, WC could be better than the BMI for reflecting the cardiac status. In conclusion, obesity management using WC can benefit the clinical evaluation, diagnosis, treatment, prevention, and prognosis of obese individuals of ACS when participating in the CRP.
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Prepregnancy body mass and weight gain during pregnancy in India and sub-Saharan Africa. Proc Natl Acad Sci U S A 2015; 112:3302-7. [PMID: 25733859 DOI: 10.1073/pnas.1416964112] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite being wealthier, Indian children are significantly shorter and smaller than African children. These differences begin very early in life, suggesting that they may in part reflect differences in maternal health. By applying reweighting estimation strategies to the Demographic and Health Surveys, this paper reports, to my knowledge, the first representative estimates of prepregnancy body mass index and weight gain during pregnancy for India and sub-Saharan Africa. I find that 42.2% of prepregnant women in India are underweight compared with 16.5% of prepregnant women in sub-Saharan Africa. Levels of prepregnancy underweight for India are almost seven percentage points higher than the average fraction underweight among women 15-49 y old. This difference in part reflects a previously unquantified relationship among age, fertility, and underweight; childbearing is concentrated in the narrow age range in which Indian women are most likely to be underweight. Further, because weight gain during pregnancy is low, averaging about 7 kg for a full-term pregnancy in both regions, the average woman in India ends pregnancy weighing less than the average woman in sub-Saharan Africa begins pregnancy. Poor maternal health among Indian women is of global significance because India is home to one fifth of the world's births.
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Kelishadi R, Haghdoost AA, Sadeghirad B, Khajehkazemi R. Trend in the prevalence of obesity and overweight among Iranian children and adolescents: A systematic review and meta-analysis. Nutrition 2014; 30:393-400. [DOI: 10.1016/j.nut.2013.08.011] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 07/29/2013] [Accepted: 08/17/2013] [Indexed: 11/30/2022]
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de Wilde JA, van Dommelen P, Middelkoop BJC. Appropriate body mass index cut-offs to determine thinness, overweight and obesity in South Asian children in the Netherlands. PLoS One 2013; 8:e82822. [PMID: 24367559 PMCID: PMC3868582 DOI: 10.1371/journal.pone.0082822] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 11/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asian populations have an increased risk of developing cardiometabolic disorders at a lower body mass index (BMI) than other ethnic groups. Therefore, lower adult BMI cut-offs to determine overweight and obesity are recommended to assess the associated health risks for Asian (23 and 27.5 kg/m(2) respectively) and Asian Indian (23, 25 kg/m(2)) populations. The objective of this study was to develop BMI cut-offs for thinness, overweight, and obesity for South Asian children in the Netherlands, and to compare the BMI cut-offs and distribution with an Asian Indian reference, the WHO Child Growth Reference, and universal BMI cut-offs. METHODS A reference cohort of 546 Surinamese South Asian boys and 521 girls, born between 1974-1976 (during the pre-obesity era) with 3408 and 3267 BMI measurements respectively, was retrospectively analysed. BMI-for-age charts were created with the LMS method. BMI centile curves passing through the cut-off points of 15 (thinness), 23 (overweight), 25 and 27.5 kg/m(2) (obesity) at 18y were drawn as cut-off levels. RESULTS The BMI of Surinamese South Asian children had a similar distribution to the Asian Indian reference, apart from a lower mean and less variation. The BMI distribution differed considerably from the WHO reference and universal BMI criteria. The calculated BMI cut-offs corresponding to a BMI of 15, 23, 25, and 27.5 kg/m(2) at 18y were at the 7.1, 81.1, 89.8, and 95.5 percentile respectively in boys, and at the 2.7, 79.5, 89.2, and 95.2 percentile in girls. CONCLUSIONS This is the first study proposing BMI cut-offs for South Asian children based on measurements from a prosperous population unaffected by the obesity epidemic. We recommend the use of these cut-offs in South Asian children in the Netherlands as these better reflect the health risks associated with thinness, overweight and obesity, and therefore may prevent the development of cardiometabolic disorders.
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Affiliation(s)
- Jeroen A. de Wilde
- Department of Youth Health Care, Municipal Health Service The Hague (GGD Den Haag), The Hague, The Netherlands
- Department of Child Health, Netherlands Organisation for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Paula van Dommelen
- Department of Life Style, Netherlands Organisation for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Barend J. C. Middelkoop
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Epidemiology, Municipal Health Service The Hague (GGD Den Haag), The Hague, The Netherlands
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