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Monyeki MA, Veldsman T, Coetzee B, Sparks M, Moss SJ, Pienaar C, Swanepoel M, Malan L, Kruger HS. Relationships between Iron Status and Selected Physical Fitness Components of South African Adolescents: The PAHL-Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:659. [PMID: 38929238 PMCID: PMC11202035 DOI: 10.3390/children11060659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
Poor iron status is detrimental to physical and cognitive performance in adolescents. Due to the limited studies investigating the association between iron status and physical fitness components in adolescents from low- and middle-income countries, we aimed to determine the association of iron status with selected physical fitness components in South African adolescents. A cross-sectional study design, including 178 adolescents (102 girls and 76 boys) from the Physical Activity and Health Longitudinal Study (PAHLS), was followed. Height and weight were measured to calculate the body mass index (BMI). Subsequently, WHO BMI-for-age-specific categorised body fatness. Cardiorespiratory fitness was determined with a 20-m shuttle run test (V˙O2max), and lower-body explosive power by the standing broad jump (SBJ). Fasting haemoglobin (Hb) and ferritin were analysed from blood samples. Correlation analyses determine the association between iron status, explosive power and cardiorespiratory fitness. Of the 178 participants, 18.5% (n = 33) had low Hb, and 14% (n = 25) iron deficiency without anaemia. Significant positive correlations were found between the selected physical fitness components, ferritin, and Hb. In boys, a positive association was found between Hb and SBJ (r = 0.30, p = 0.006), whilst in girls, positive associations were found between ferritin (r = 0.25, p = 0.04) and SBJ, and Hb with both SBJ (r = 0.21, p = 0.03) and V˙O2max (r = 0.32, p = 0.001). Hb concentration remained associated with V˙O2max and SBJ in girls after adjustment for age, whilst in boys, Hb concentration was associated with SBJ. Higher iron status in South African adolescents is associated with higher lower-limb explosive power and cardiorespiratory fitness. We suggest monitoring of haematological parameters, and interventions to improve the iron status of South African adolescents.
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Affiliation(s)
- Makama Andries Monyeki
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa; (T.V.); (B.C.); (M.S.); (S.J.M.); (C.P.); (M.S.)
| | - Tamrin Veldsman
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa; (T.V.); (B.C.); (M.S.); (S.J.M.); (C.P.); (M.S.)
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD 4305, Australia
| | - Ben Coetzee
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa; (T.V.); (B.C.); (M.S.); (S.J.M.); (C.P.); (M.S.)
| | - Martinique Sparks
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa; (T.V.); (B.C.); (M.S.); (S.J.M.); (C.P.); (M.S.)
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD 4305, Australia
- Centre for Health Research, University of Southern Queensland, Ipswich, QLD 4305, Australia
| | - Sarah Johanna Moss
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa; (T.V.); (B.C.); (M.S.); (S.J.M.); (C.P.); (M.S.)
| | - Cindy Pienaar
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa; (T.V.); (B.C.); (M.S.); (S.J.M.); (C.P.); (M.S.)
- Department of Sport Studies, Durban University of Technology, Kwa-Zulu Natal 4000, South Africa
| | - Mariette Swanepoel
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa; (T.V.); (B.C.); (M.S.); (S.J.M.); (C.P.); (M.S.)
| | - Linda Malan
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa; (L.M.); (H.S.K.)
| | - Herculina Salome Kruger
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa; (L.M.); (H.S.K.)
- Medical Research Council Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom 2520, South Africa
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Yadav VK, Choudhary N, Gacem A, Verma RK, Abul Hasan M, Tarique Imam M, Almalki ZS, Yadav KK, Park HK, Ghosh T, Kumar P, Patel A, Kalasariya H, Jeon BH, Ali AlMubarak H. Deeper insight into ferroptosis: association with Alzheimer's, Parkinson's disease, and brain tumors and their possible treatment by nanomaterials induced ferroptosis. Redox Rep 2023; 28:2269331. [PMID: 38010378 PMCID: PMC11001282 DOI: 10.1080/13510002.2023.2269331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Ferroptosis is an emerging and novel type of iron-dependent programmed cell death which is mainly caused by the excessive deposition of free intracellular iron in the brain cells. This deposited free iron exerts a ferroptosis pathway, resulting in lipid peroxidation (LiPr). There are mainly three ferroptosis pathways viz. iron metabolism-mediated cysteine/glutamate, and LiPr-mediated. Iron is required by the brain as a redox metal for several physiological activities. Due to the iron homeostasis balance disruption, the brain gets adversely affected which further causes neurodegenerative diseases (NDDs) like Parkinson's and Alzheimer's disease, strokes, and brain tumors like glioblastoma (GBS), and glioma. Nanotechnology has played an important role in the prevention and treatment of these NDDs. A synergistic effect of nanomaterials and ferroptosis could prove to be an effective and efficient approach in the field of nanomedicine. In the current review, the authors have highlighted all the latest research in the field of ferroptosis, specifically emphasizing on the role of major molecular key players and various mechanisms involved in the ferroptosis pathway. Moreover, here the authors have also addressed the correlation of ferroptosis with the pathophysiology of NDDs and theragnostic effect of ferroptosis and nanomaterials for the prevention and treatment of NDDs.
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Affiliation(s)
- Virendra Kumar Yadav
- Department of Life Sciences, Hemchandracharya North Gujarat University, Patan, India
| | - Nisha Choudhary
- Department of Life Sciences, Hemchandracharya North Gujarat University, Patan, India
| | - Amel Gacem
- Department of Physics, Faculty of Sciences, University 20 Août 1955, Skikda, Algeria
| | - Rakesh Kumar Verma
- Department of Biosciences, School of Liberal Arts & Sciences, Mody University of Science and Technology, Sikar, India
| | - Mohd Abul Hasan
- Civil Engineering Department, College of Engineering, King Khalid University, Abha, Kingdom of Saudi Arabia (KSA)
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Ziyad Saeed Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Krishna Kumar Yadav
- Faculty of Science and Technology, Madhyanchal Professional University, Bhopal, India
- Environmental and Atmospheric Sciences Research Group, Scientific Research Center, Al-Ayen University, Nasiriyah, Iraq
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tathagata Ghosh
- Department of Arts, School of Liberal Arts & Sciences, Mody University of Science and Technology, Sikar, India
| | - Pankaj Kumar
- Department of Environmental Science, Parul Institute of Applied Sciences, Parul University, Vadodara, India
| | - Ashish Patel
- Department of Life Sciences, Hemchandracharya North Gujarat University, Patan, India
| | - Haresh Kalasariya
- Centre for Natural Products Discovery, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Byong-Hun Jeon
- Department of Earth Resources and Environmental Engineering, Hanyang University, Seoul, Republic of Korea
| | - Hassan Ali AlMubarak
- Division of Radiology, Department of Medicine, College of Medicine and Surgery, King Khalid University (KKU), Abha, Kingdom of Saudi Arabia
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Irache A, Anjorin SS, Caleyachetty R, Gill P. Trends in the Intraindividual Double Burden of Overweight/Obesity and Anemia among Adult Women Living in 33 Low- and Middle-Income Countries: A Secondary Analysis of Demographic and Health Surveys from 2000-2019. J Nutr 2023; 153:1111-1121. [PMID: 36796481 PMCID: PMC10196605 DOI: 10.1016/j.tjnut.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/02/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Changes in overweight/obesity and anemia among women have been investigated in multiple studies, but the rate at which their coexistence at the individual level has evolved remains unknown. OBJECTIVES We aimed to 1) document trends in the magnitude and inequalities of the co-occurrence of overweight/obesity and anemia; and 2) compare these with overall trends in overweight/obesity, anemia, and the co-occurrence of anemia with normal weight or underweight. METHODS For this cross-sectional series study, we used 96 Demographic and Health Surveys from 33 countries with available anthropometric and anemia data among nonpregnant adult women (20-49 y old; n = 1,648,308). The primary outcome was defined as the coexistence of overweight or obesity (BMI ≥25kg/m2) and anemia (hemoglobin concentrations <12.0 g/dL) within the same individual. We computed overall and regional trends through multilevel linear regression models and by sociodemographic characteristics (i.e., wealth, education, and residence). Estimates at the country level were calculated through ordinary least square regression models. RESULTS From 2000 to 2019, the co-occurrence of overweight/obesity and anemia increased modestly at an annual rate of 0.18 percentage points (95% CI: 0.08, 0.28 percentage points; P < 0.001), ranging from 0.73 percentage points in Jordan to -0.56 percentage points in Peru. This trend occurred in parallel with overall increases in overweight/obesity and reductions in anemia. The co-occurrence of anemia with normal weight or underweight was reducing in all countries, except Burundi, Sierra Leone, Jordan, Bolivia, and Timor-Leste. Stratified analyses yielded an upward trend in the co-occurrence of overweight/obesity and anemia across all subgroups but particularly in women from the 3 middle wealth groups, no education, and capital city or rural residents. CONCLUSIONS The rising trend in the intraindividual double burden suggests that efforts to reduce anemia among women living with overweight/obesity may need to be revisited to accelerate progress toward the 2025 global nutrition target of halving anemia.
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Affiliation(s)
- Ana Irache
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Medical School Building, Coventry, United Kingdom.
| | - Seun Stephen Anjorin
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Medical School Building, Coventry, United Kingdom
| | - Rishi Caleyachetty
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Medical School Building, Coventry, United Kingdom
| | - Paramjit Gill
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Medical School Building, Coventry, United Kingdom
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Castillo AN, Suarez-Ortegón MF. Dual burden of individual malnutrition in children 1-4 years: Findings from the Colombian nutritional health survey ENSIN 2015. Pediatr Obes 2023; 18:e13020. [PMID: 36919271 DOI: 10.1111/ijpo.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND To date there are no studies with estimation of multiple types of double burden of individual malnutrition (DBIM) and evaluation of associated determinants. OBJECTIVE To estimate the prevalence and social determinants associated with the double burden of individual malnutrition in children aged 1-4 years. METHODS A cross-sectional study was conducted using data from Colombian nutritional heath survey ENSIN 2015. Global DBIM was analysed on the basis of excess weight and the presence of one or more micronutrient deficiencies (vitamin A, D, zinc, or iron) and/or stunting. Specific DBIM pairs were also analysed. Logistic regression was used to evaluate variables associated with DBIM. RESULTS The sample consisted of 6807 children. The overall DBIM prevalence was 4%. The prevalence of DBIM in children affected by overweight or obesity was 75%. Male sex was associated with global DBIM (OR 2.19 (1.52-3.16) p = 0.000), indigenous children presented 6 times the DBIM due to stunting (OR 6.17 (1.67-22.7) p = 0.007). Children from the Atlantic (OR 3.95 (1.23-12.61) p = 0.021), central (OR 8.80 (2.38-32.49) p = 0.001) and Pacific (OR 4.19 (1.21-14.49) p = 0.024) regions, had a higher chance of DBIM due to iron deficiency. Children from east region (OR 3.03 (1.12-8.16) p = 0.029) and Bogotá city (OR 4.15 (1.65-12.32) p = 0.004) were associated with DBIM due to vitamin D deficiency. CONCLUSIONS Children with overweight or obesity had a high likelihood of presenting micronutrients deficiencies or stunting. Ethnicity, male sex and country region of residence were variables associated with overall DBIM or specific DBIM.
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Affiliation(s)
- Adriana N Castillo
- Institución Universitaria Escuela Nacional del Deporte, Cali-Colombia, Universidad del Valle, Cali, Colombia
| | - Milton F Suarez-Ortegón
- Departamento de Alimentación y Nutrición, Pontificia Universidad Javeriana Seccional Cali, Cali, Colombia
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Davis JN, Williams A, Arnold CD, Rohner F, Wirth JP, Addo Y, Flores-Ayala RC, Oaks BM, Young MF, Suchdev PS, Engle-Stone R. The Relationship Between Ferritin and BMI is Mediated by Inflammation Among Women in Higher-Income Countries, But Not in Most Lower-Income Countries Nor Among Young Children: A Multi-Country Analysis. Curr Dev Nutr 2022; 6:nzac139. [PMID: 36475018 PMCID: PMC9718651 DOI: 10.1093/cdn/nzac139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 10/03/2023] Open
Abstract
Background In the presence of inflammation, the serum or plasma ferritin concentration ("ferritin" hereafter) transiently increases, confounding its interpretation as an iron status marker. The extent to which adiposity-related inflammation may influence ferritin interpretation is uncertain. Objectives We describe relationships between weight status, inflammation, and ferritin among nonpregnant women of reproductive age (WRA; 15-49 years) and preschool-age children (PSC; 6-59 months) with normal weight to overweight or obesity (OWOB) in differing geographic settings. Methods Cross-sectional data were separately analyzed from 18 surveys (WRA) and 25 surveys (PSC) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, excluding observations with underweight, wasting, pregnancy, or malaria. Relationships were assessed between BMI (in WRA) or BMI-for-age z-score (BAZ; in PSC), inflammatory biomarkers of C-reactive protein (CRP) and/or α-1-acid glycoprotein (AGP), ferritin by linear regression, and potential mediation by CRP and/or AGP in relationships between BMI or BAZ and ferritin with structural equation modeling. Regression and mediation models accounted for complex survey designs. Results were grouped by World Bank income classifications. Results In 5 of 6 surveys among WRA from upper-middle and high-income countries, ferritin was significantly positively associated with BMI, and this relationship was partially (or fully, in the United States) mediated by CRP and/or AGP. Mediation was present in 4 of 12 surveys for WRA in low- and lower-middle income countries. Among PSC, ferritin was positively associated with CRP and/or AGP in all surveys, but there were no significant CRP- or AGP-mediated relationships between ferritin and BAZ, except a negative relationship in the Philippines. Conclusions Where having OWOB is common among WRA, measurements of inflammatory biomarkers and their uses in interpreting ferritin may improve iron status assessments. While these relationships were inconsistent among PSC, inflammation was common and should be measured to interpret iron status. Included Kenyan trial data are registered at clinicaltrials.gov as NCT01088958.
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Affiliation(s)
- Jennie N Davis
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | - Anne Williams
- University of Otago, Department of Human Nutrition, Dunedin, New Zealand
| | - Charles D Arnold
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | | | | | - Yaw Addo
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Melissa F Young
- Global Health Department, Emory University, Atlanta, GA, USA
| | - Parminder S Suchdev
- Department of Pediatrics and Global Health, Emory University, Atlanta, GA, USA
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reina Engle-Stone
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
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Nainggolan O, Hapsari D, Titaley CR, Indrawati L, Dharmayanti I, Kristanto AY. The relationship of body mass index and mid-upper arm circumference with anemia in non-pregnant women aged 19-49 years in Indonesia: Analysis of 2018 Basic Health Research data. PLoS One 2022; 17:e0264685. [PMID: 35239719 PMCID: PMC8893704 DOI: 10.1371/journal.pone.0264685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background and objectives Anemia remains a major public health problem worldwide. This study examined the relationship between anemia and the nutritional status of non-pregnant women aged 19–49 years in Indonesia. Methods and study design The data were derived from the 2018 Basic Health Research Data of Indonesia. We used information from 11,471 non-pregnant women aged 19–49 years. The dependent variable was anemia (hemoglobin level <12 g/dL). The independent variable was women’s nutritional status, a combined indicator of body mass index (BMI) and mid-upper arm circumference (MUAC). Our analysis controlled for women’s age, education, physical activity, fruit and vegetable consumption, and the presence of communicable or non-communicable diseases. We performed logistic regression analyses. Results The prevalence of anemia in non-pregnant women aged 19–49 years was 22.3% (95% confidence interval [CI]: 21.4–23.3). Women with overweight and obesity were less likely to develop anemia than those with a normal BMI, regardless of their MUAC score. The highest odds for developing anemia were observed in underweight women with low MUAC scores (adjusted odds ratio [aOR] = 2.83, 95%CI: 2.19–3.68). Higher odds ratios were also observed in women with insufficient physical activity, despite their sufficient consumption of fruits or vegetables (aOR = 1.87, 95%CI: 1.06–3.28). However, women who had been diagnosed with a non-communicable disease had a reduced likelihood of developing anemia (aOR = 0.75, 95%CI: 0.67–0.83). Conclusions Strengthening health promotion activities to improve nutritional status and healthy behaviors, particularly a healthy diet, remains important for women in Indonesia to reduce the prevalence of anemia and improve their overall health status.
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Affiliation(s)
- Olwin Nainggolan
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | - Dwi Hapsari
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | | | - Lely Indrawati
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | - Ika Dharmayanti
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
| | - Antonius Yudi Kristanto
- Centre for Research and Development of Public Health Efforts, National Institute Health Research and Development, Ministry of Health Republic of Indonesia, DKI Jakarta, Indonesia
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Metabolic syndrome may be associated with a lower prevalence of iron deficiency in Ecuadorian women of reproductive age. J Nutr Sci 2021; 10:e4. [PMID: 33889387 PMCID: PMC8057425 DOI: 10.1017/jns.2020.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to assess the associations of the stages of Fe deficiency (Fe deficiency without anaemia (ID) and Fe-deficiency anaemia (IDA)) and anaemia with metabolic syndrome (MetS) in Ecuadorian women. A cross-sectional study was conducted in 5894 women aged 20–59 years, based on data from the 2012 Ecuadorian National Health and Nutrition Survey. The sample was stratified by age. A χ2 test was used to assess the possible associations of ID, IDA and anaemia with MetS. The prevalence ratio (PR) for each stage of Fe deficiency and anaemia was estimated considering women without MetS as a reference. The total prevalence of MetS, ID, IDA and anaemia was 32⋅3 % (se 0⋅6), 6⋅2 % (se 0⋅3), 7⋅1 % (se 0⋅3) and 5⋅0 % (se 0⋅3), respectively. In women aged 20–29, 30–39 and 40–49 years, MetS was associated with a lower prevalence of ID (PR (95 % CI; P-value)): 0⋅17 (0⋅06, 0⋅46; P < 0⋅001), 0⋅69 (0⋅48, 0⋅99; P = 0⋅044) and 0⋅44 (0⋅29, 0⋅67; P < 0⋅001), respectively. In women aged 50–59 years, MetS was associated with IDA and anaemia (PR (95 % CI; P-value)): 0⋅12 (0⋅02, 0⋅96; P = 0⋅026) and 0⋅22 (0⋅07, 0⋅64; P = 0⋅002), respectively. In conclusion, Ecuadorian women of reproductive age with MetS have a lower prevalence of ID compared with those without MetS. Furthermore, the MetS and IDA coexist at the population level. These findings require an analysis from a dietary pattern approach, which could provide key elements for developing public policies that simultaneously address all forms of malnutrition.
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