Trends in overweight among women differ by occupational class: results from 33 low- and middle-income countries in the period 1992-2009

Modifying the maternal microbiota alters the gut-brain metabolome and prevents emotional dysfunction in the adult offspring of obese dams

Maternal obesity disturbs brain-gut-microbiota interactions and induces negative affect in the offspring, but its impact on gut and brain metabolism in the offspring (F1) are unknown. Here, we tested whether perinatal intake of a multispecies probiotic could mitigate the abnormal emotional behavior in the juvenile and adult offspring of obese dams. Untargeted NMR-based metabolomic profiling and gene-expression analysis throughout the gut-brain axis were then used to investigate the biology underpinning behavioral changes in the dams and their offspring. Prolonged high-fat diet feeding reduced maternal gut short-chain fatty acid abundance, increased markers of peripheral inflammation, and decreased the abundance of neuroactive metabolites in maternal milk during nursing. Both juvenile (postnatal day [PND] 21) and adult (PND112) offspring of obese dams exhibited increased anxiety-like behavior, which were prevented by perinatal probiotic exposure. Maternal probiotic treatment increased gut butyrate and brain lactate in the juvenile and adult offspring and increased the expression of prefrontal cortex PFKFB3, a marker of glycolytic metabolism in astrocytes. PFKFB3 expression correlated with the increase in gut butyrate in the juvenile and adult offspring. Maternal obesity reduced synaptophysin expression in the adult offspring, while perinatal probiotic exposure increased expression of brain-derived neurotrophic factor. Finally, we showed that the resilience of juvenile and adult offspring to anxiety-like behavior was most prominently associated with increased brain lactate abundance, independent of maternal group. Taken together, we show that maternal probiotic supplementation exerts a long-lasting effect on offspring neuroplasticity and the offspring gut-liver-brain metabolome, increasing resilience to emotional dysfunction induced by maternal obesity.

Dietary habits, physical activity, and sedentary behaviour of children of employed mothers: A systematic review

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Dietary pattern is poorer among children of employed mothers.

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Children of employed mothers are more physically active.

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Children of employed mothers experience greater prevalence of sedentary activity.

Since approximately 40% of the global workforce are women, a comprehensive understanding of association of maternal employment with child dietary patterns, physical activity and sedentary behaviour needs more focus. This systematic review aims to identify the association between maternal employment and dietary patterns (DP), physical activity (PA) and sedentary behaviour (SB) of children and adolescents (6 to 18 years). Searches were performed using electronic databases and manual searches. Peer reviewed journal articles, conference papers, theses at masters/doctoral levels in English were included. A total 42 studies met selection criteria, which indicated associations between maternal employment and at least one of the domains of interest: DP, PA and/or SB. Using individual samples of analysis, it was found that, 9 samples of DP, 11 samples of PA and 12 samples of SB were positively correlated with maternal employment, whereas 25 samples of DP, 5 samples of PA and 5 samples of SB showed an opposite association. Results suggest that PA and SB were positively related with maternal employment, whereas DP had an inverse relationship. Findings from this review provide evidence that children of employed mothers had poorer DP and greater prevalence of SB, however, their children are more physically active. Future interventions need to create a positive environment at the workplace and for families to support employed mothers and improve children’s dietary patterns and decrease sedentary behaviours. Future studies should prioritise the domains of DP, PA and SB that have been studied inadequately and have inconsistent results.

Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study

Aims: To explore the association between maternal origin and birthplace, and caesarean section (CS) by pre-pregnancy body mass index (BMI) and length of residence. Methods: We linked records from 118,459 primiparous women in the Medical Birth Registry of Norway between 2013 and 2017 with data from the National Population Register. We categorized pre-pregnancy BMI (kg/m²) into underweight (<18.5), normal weight (18.5–24.9) and overweight/obese (≥25). Multinomial regression analysis estimated crude and adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) for emergency and elective CS. Results: Compared to normal weight women from Norway, women from Sub-Saharan Africa and Southeast Asia/Pacific had a decreased risk of elective CS (aRRR = 0.57, 95% CI 0.37–0.87 and aRRR = 0.56, 0.41–0.77, respectively). Overweight/obese women from Europe/Central Asia had the highest risk of elective CS (aRRR = 1.42, 1.09–1.86). Both normal weight and overweight/obese Sub-Saharan African women had the highest risks of emergency CS (aRRR = 2.61, 2.28-2.99; 2.18, 1.81-2.63, respectively). Compared to women from high-income countries, the risk of elective CS was increasing with a longer length of residence among European/Central Asian women. Newly arrived migrants from Sub-Saharan Africa had the highest risk of emergency CS. Conclusion: Women from Sub-Saharan Africa had more than two times the risk of emergency CS compared to women originating from Norway, regardless of pre-pregnancy BMI.

Country of birth and county of residence and association with overweight and obesity—a population-based study of 219 555 pregnancies in Norway

Background

The aim was to study the effect of country of birth, educational level and county of residence on overweight and obesity among pregnant women in Norway.

Methods

Observational study based on Medical Birth Registry Norway and Statistics Norway. The study population consisted of 219 555 deliveries in 2006–2014. Body mass index (BMI) was registered at the first antenatal care visit. Multivariate regression analysis was used to explore the study aims.

Results

Overweight (BMI 25–29.9) was recorded in 22.3% of the women, obesity (BMI ≥30) in 12.2%. Highest rates of overweight (30.8%) and obesity (13.5%) was recorded among women from the Middle East and North Africa or with no education (30.7% and 17.2%). The prevalence of overweight and obesity was 39.5% in sparsely populated counties and 26.4% for women living in Oslo. Adjusted for country of birth, education level, age, parity, smoking and marital status, the relative odds of overweight and obesity were 65% (95% CI 59–72%) higher in sparsely populated counties compared to Oslo.

Conclusions

The prevalence of overweight (BMI ≥25) was 34.5%. The factors associated with overweight were living in rural districts in Norway, lower education and being born in countries in the Middle East or Africa.

Sociodemographic and behavioural factors associated with body mass index among men and women in Nairobi slums: AWI-Gen Project

Background: Body mass index (BMI) is rising globally with a faster increase in urban areas in low- and middle-income countries. It is critical to identify modifiable risk factors for BMI to prevent the occurrence of associated health consequences.

Objective: To investigate socio-demographic, behavioural and biological factors associated with BMI in Nairobi slums.

Methods: In 2014-2015, a cross sectional study of men and women aged 40–60 years in Nairobi slums (Korogocho and Viwandani) was conducted. Data were collected on socio-demographic, behavioural and biological characteristics. Mean BMI, overweight and obesity were computed. Hierarchical multiple linear regression analysis was conducted separately for men and women to explore factors associated with BMI.

Results: In total, 1942 study participants (54.4%, women) with a mean age (SD) of 48.3 (5.3) years and 48.8(5.6) years for women and men respectively were recruited. Mean BMI was higher among women than men (27.6 versus 22.8; p < 0.001). More women were overweight (30.9% versus 19.6%; p < 0.001) and obese (32.1% versus 5.1%; p < 0.001) than men. Among men, BMI was independently associated with wealth index, bread consumption and self-reported diabetes and was negatively associated with current tobacco smoking, HIV and TB infections. Among women, BMI was independently associated with wealth, current non-problematic drinking, and sedentary time, but was lower among other ethnicities compared to Kikuyu, among current smokers, women with longer sleep, and those with HIV infection and tuberculosis. Wealth index contributed the most variance in BMI among women and men (10.4%, 7.5%, respectively), but behavioural factors (7.4%) among men and biological factors (6.5%) among women accounted for most of the additional BMI variance.

Conclusions: Adults aged 40–60 years in the urban slums of Nairobi have a high BMI associated with wealth. Bread consumption by men and sedentary life among women are the main risky behaviours that need urgent targeted interventions.

Trends in the socioeconomic patterning of overweight/obesity in India: a repeated cross-sectional study using nationally representative data

OBJECTIVES

We aimed to examine trends in prevalence of overweight/obesity among adults in India by socioeconomic position (SEP) between 1998 and 2016.

DESIGN

Repeated cross-sectional study using nationally representative data from India collected in 1998/1999, 2005/2006 and 2015/2016. Multilevel regressions were used to assess trends in prevalence of overweight/obesity by SEP.

SETTING

26, 29 and 36 Indian states or union territories, in 1998/99, 2005/2006 and 2015/2016, respectively.

PARTICIPANTS

628 795 ever-married women aged 15-49 years and 93 618 men aged 15-54 years.

PRIMARY OUTCOME MEASURE

Overweight/obesity defined by body mass index >24.99 kg/m².

RESULTS

Between 1998 and 2016, overweight/obesity prevalence increased among men and women in both urban and rural areas. In all periods, overweight/obesity prevalence was consistently highest among higher SEP individuals. In urban areas, overweight/obesity prevalence increased considerably over the study period among lower SEP adults. For instance, between 1998 and 2016, overweight/obesity prevalence increased from approximately 15%-32% among urban women with no education. Whereas the prevalence among urban men with higher education increased from 26% to 34% between 2005 and 2016, we did not observe any notable changes among high SEP urban women between 1998 and 2016. In rural areas, more similar increases in overweight/obesity prevalence were found among all individuals across the study period, irrespective of SEP. Among rural women with higher education, overweight/obesity increased from 16% to 25% between 1998 and 2016, while the prevalence among rural women with no education increased from 4% to 14%.

CONCLUSIONS

We identified some convergence of overweight/obesity prevalence across SEP in urban areas among both men and women, with fewer signs of convergence across SEP groups in rural areas. Efforts are therefore needed to slow the increasing trend of overweight/obesity among all Indians, as we found evidence suggesting it may no longer be considered a 'diseases of affluence'.

Pathways of the association between maternal employment and weight status among women and children: Qualitative findings from Guatemala

The double burden of malnutrition, defined by the coexistence of undernutrition and overweight, is well documented in low- and middle-income countries. However, the mechanisms by which employment may be related to maternal and child weight status in low- and middle-income countries are not well understood. We conducted in-depth interviews among 20 mothers who participated in Project MIEL, a contemporary trial which evaluated the effects of an integrated micronutrient supplement and parenting intervention in rural Guatemala. We utilized semi-structured interviews to explore the pathways by which maternal employment might influence bodyweight. Interviews were structured to explore the factors that mothers considered when deciding whether or not to participate in the labor force and how mothers perceived the influence of employment on determinants of their own bodyweight and that of their children. Themes were used to develop a conceptual framework. Mothers described four pathways through which employment could lead to changes in weight status: changes in food purchasing; improved household well-being; changes in time allocation; and psychological effects. Mothers described purchasing increased quantities and more varied types of food, as well as the purchase of energy-dense foods. Less time to devote to food preparation resulted in mothers preparing quicker meals and relying on substitute childcare. Mothers also expressed feelings of worry and neglect in relation to being employed, and perceived that these feelings would affect weight. A better understanding of these mechanisms is important for developing policies and programs to support women in the workplace and also reducing maternal and child overweight in Guatemala.

The Socioeconomic Disparities in Intakes and Purchases of Less-Healthy Foods and Beverages Have Changed over Time in Urban Mexico

Background

To our knowledge, the association between diet and socioeconomic status (SES), using both purchase and intake data, in the Mexican population has not been examined, which is particularly important given the high prevalence of diet-related diseases in Mexico.

Objective

Our objective was to examine the SES-diet relation using household food purchases and individual food intake data.

Methods

We analyzed purchases of packaged food and beverages of 5240 households with the use of the 2012-2014 Nielsen Mexico Consumer Panel Service Dataset, representative of urban areas. Likewise, we examined 9672 individuals over 2 y with food and beverage intake information collected using a single 24-h recall as part of the Mexican National Health and Nutrition Survey 2012. Multivariate linear regression models were conducted to predict per capita daily purchases and intakes of food and beverages classified as healthy and less healthy by SES, and adjusting for sociodemographic variables.

Results

Per capita daily purchases of healthy and less-healthy foods were, on average, 142% and 55% higher in high- than in low-SES households, respectively, from 2012 to 2014 (P < 0.05). Intakes of healthy and less-healthy foods in urban areas were, on average, 7% and 136% higher in high- than in low-SES groups (P < 0.05). Per capita daily purchases of healthy beverages were, on average, 56% higher in high- than in low-SES households from 2012 to 2014 (P < 0.05), whereas purchases of less-healthy beverages were 27% and 17% higher in low- than in high-SES households in 2012 and 2014, respectively (P < 0.05). Per capita daily intake of healthy beverages was 33% higher in high- than in low-SES groups (P < 0.05).

Conclusion

Higher-SES groups from urban areas had greater purchases and intakes of less-healthy foods and healthy beverages. Lower-SES households had greater purchases of less-healthy beverages, but also had the largest reduction in these purchases from 2012 to 2014, which could be associated with the beverage tax implemented in Mexico in 2014.

The weight of work: the association between maternal employment and overweight in low- and middle-income countries

Background

Maternal employment has increased in low-and middle-income countries (LMIC) and is a hypothesized risk factor for maternal overweight due to increased income and behavioral changes related to time allocation. However, few studies have investigated this relationship in LMIC.

Methods

Using cross-sectional samples from Demographic and Health Surveys, we investigated the association between maternal employment and overweight (body mass index [BMI] ≥ 25 kg/m²) among women in 38 LMIC (N = 162,768). We categorized mothers as formally employed, informally employed, or non-employed based on 4 indicators: employment status in the last 12 months; aggregate occupation category (skilled, unskilled); type of earnings (cash only, cash and in-kind, in-kind only, unpaid); and seasonality of employment (all year, seasonal/occasional employment). Formally employed women were largely employed year-round in skilled occupations and earned a wage (e.g. professional), whereas informally employed women were often irregularly employed in unskilled occupations and in some cases, were paid in-kind (e.g. domestic work). For within-country analyses, we used adjusted logistic regression models and included an interaction term to assess heterogeneity in the association by maternal education level. We then used meta-analysis and meta-regression to explore differences in the associations pooled across countries.

Results

Compared to non-employed mothers, formally employed mothers had higher odds of overweight (pooled odds ratio [POR] = 1.3; 95% Confidence Interval [CI] 1.2, 1.4) whereas informally employed mothers, compared to non-employed mothers, had lower odds of overweight (POR = 0.72; 95% CI: 0.64, 0.81). In 14 LMIC, the association varied by education. In these countries, the magnitude of the formal employment-overweight association was larger for women with low education (POR = 1.5; 95% CI: 1.1, 1.9) compared to those with high education (POR = 1.2; 95% CI: 1.0, 1.3).

Conclusions

Formally employed mothers in LMIC have higher odds of overweight and the association varies by educational attainment in 14 countries. This knowledge highlights the importance of workplace initiatives to reduce the risk of overweight among working women in LMIC.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0522-y) contains supplementary material, which is available to authorized users.

Socioeconomic position and markers of adiposity among female teachers in Mexico

BACKGROUND

Occupation is often used as an indicator of socioeconomic position (SEP) in epidemiological studies, although it is unclear whether variation in SEP within a single occupational group is associated with health outcomes, including adiposity measures.

METHODS

We created a multidimensional SEP index using principal component analysis based on self-reported data from 36 704 female teachers in Mexico from 2008 to 2011. Multivariable Poisson regression models with robust variance were used to evaluate cross-sectional associations of SEP and markers of adiposity, including obesity (body mass index (BMI) ≥30 kg/m2), elevated waist-to-hip ratio (WHR >85) and high waist circumference (WC >88 cm).

RESULTS

The most relevant indicators of SEP in this study were internet access and private health insurance. We observed significant inverse trends in obesity, WHR and WC in relation to SEP (all ptrend<0.001). Compared with women with low SEP, women in the middle (prevalence ratio (PR) 0.97, 95% CI 0.93 to 1.02) and high (PR 0.85, 95% CI 0.81 to 0.90) SEP tertiles were less likely to be obese in multivariable models. Results were similar in models of WHR and WC adjusting for BMI. For example, women with high versus low SEP were 14% less likely to have an elevated WHR (PR 0.86, 95% CI 0.83 to 0.89) and 7% less likely to have a high WC (PR 0.93, 95% CI 0.89 to 0.97).

CONCLUSIONS

Our findings suggest that SEP remains relevant for adiposity within a single occupational setting and indicate that a stronger conceptualisation of SEP in epidemiological studies may be warranted.

Preconceptional and maternal obesity: epidemiology and health consequences

Obesity in women of reproductive age is increasing in prevelance worldwide. Obesity reduces fertility and increases time taken to conceive, and obesity-related comorbidities (such as type 2 diabetes and chronic hypertension) heighten the risk of adverse outcomes for mother and child if the woman becomes pregnant. Pregnant women who are obese are more likely to have early pregnancy loss, and have increased risk of congenital fetal malformations, delivery of large for gestational age infants, shoulder dystocia, spontaneous and medically indicated premature birth, and stillbirth. Late pregnancy complications include gestational diabetes and pre-eclampsia, both of which are associated with long-term morbidities post partum. Women with obesity can also experience difficulties during labour and delivery, and are more at risk of post-partum haemorrhage. Long-term health risks are associated with weight retention after delivery, and inherent complications for the next pregnancy. The wellbeing of the next generation is also compromised. All these health issues could be avoided by prevention of obesity among women of reproductive age, which should be viewed as a global public health priority. For women who are already obese, renewed efforts should be made towards improved management during pregnancy, especially of blood glucose, and increased attention to post-partum weight management. Effective interventions, tailored to ethnicity and culture, are needed at each of these stages to improve the health of women and their children in the context of the global obesity epidemic.

The prevalence of excessive weight in Balearic Islands' young and middle-aged women and its association with social and socioeconomic factors: a ten-year trend (2000-2010)

Background

Knowledge about trends in the socioeconomic patterning of overweight and obesity in women provides insights into the nature of the obesity epidemic. Therefore the aim was to assess a ten-year trend (2000–2010) in the prevalence of excessive weight in Balearic Islands’ women and its association with socioeconomic factors.

Method

Young (18–35 year-old) and middle-aged (36–55 year-old) women were selected from two population-based cross-sectional nutritional surveys carried out in the Balearic Islands, Spain. The participation rate was 80 % during 1999–2000 and 92.5 % during 2009–2010. Measured weight and height was obtained, and body mass index (kg/m²) was classified as follows: overweight (25.0 < 30), obese (≥30) and excessive weight (≥25). In both surveys, a general questionnaire including questions relating to socioeconomic status factors was used. Logistic regression was used to examine the association of excessive weight with socioeconomic variables and to test the interaction between the survey period and the socioeconomic factors.

Results

Overall, while the prevalence of obesity mainly remained stable over the study period, the prevalence of overweight increased from 21.0 to 24.8 %. Young women showed an increased prevalence of overweight and excessive weight, from 14.1 to 20.9 % and from 20.9 to 28.6 %, respectively. Significant differences were not found in middle-aged women. Over the whole period, the incidence of excessive weight was higher among middle-aged and foreign women, but lower in women with a high educational profile and in employment. The prevalence of excessive weight in young women was also around 2.5 times higher in women who were living with at least one child at home. The tendency towards excessive weight in employed women decreased significantly between 2000 and 2010 in the younger age group (OR: 0.42; 95 % CI: 0.22–0.82).

Conclusions

No significant increase in the prevalence of overweight/obesity was observed in middle-aged women, with a low level of education being the single socioeconomic variable associated with excessive weight in this target group. Overweight/obesity increased in young women with unemployment being the distinguishing socioeconomic factor associated with this increase.

Prevalence and correlates of adult overweight in the Muslim world: analysis of 46 countries

The primary objectives of the study were to calculate overweight prevalence (body mass index ≥ 25.0) and simple correlations between 10 demographic, social welfare and behavioural variables and overweight prevalence for Muslim countries (populations >50% Muslim; N = 46). Overweight data for a country's total, male and female populations were extracted from the World Health Organization's (WHO) STEPwise country reports and relevant publications. Country-level data for potential correlates were extracted from multiple sources: Central Intelligence Agency (literacy), Gallup Poll (religiosity), United Nations (agricultural employment, food supply, gender inequality, human development), World Bank (automobile ownership, Internet, labour force) and WHO (physical inactivity). The overall, male and female overweight prevalence was 37.4, 33.0 and 42.1%, respectively. Prevalence estimates significantly differed by economic classification, gender and ethnicity. Middle- and upper income countries were 1.54-7.76 (95% confidence interval [CI]: 1.49-8.07) times more likely overweight than low-income countries, females were 1.48 (CI: 1.45-1.50) times more likely overweight than males and Arab countries were 2.92 (CI: 2.86-2.97) times more likely overweight than non-Arab countries. All 10 of the potential correlates were significantly associated with overweight for at least one permutation (total, economic classification, gender, ethnicity). The greater percentage of poorer countries among non-Arab Muslim countries, which compared with Arab countries have not as rapidly been transformed by globalization, nutrition transition and urbanization, may partially explain prevalence differences. Evaluation of correlational data generally followed associations seen in non-Muslim countries but more complex analysis of subnational data is needed. Arab women are a particularly vulnerable subgroup and governments should act within religious and cultural parameters to provide environments that are conducive to negative energy balance.

Squeezing blood from a stone: how income inequality affects the health of the American workforce

Income inequality is very topical-in both political and economic circles-but although income and socioeconomic status are known determinants of health status, income inequality has garnered scant attention with respect to the health of US workers. By several measures, income inequality in the United States has risen since 1960. In addition to pressures from an increasingly competitive labor market, with cash wages losing out to benefits, workers face pressures from changes in work organization. We explored these factors and the mounting evidence of income inequality as a contributing factor to poorer health for the workforce. Although political differences may divide the policy approaches undertaken, addressing income inequality is likely to improve the overall social and health conditions for those affected.

Associations Between Orphan and Vulnerable Child Caregiving, Household Wealth Disparities, and Women's Overweight Status in Three Southern African Countries Participating in Demographic Health Surveys

This study examines whether orphan and vulnerable children (OVC) primary caregivers are facing absolute household wealth (AWI) disparities, the association between AWI and women's overweight status, and the modifying role of OVC primary caregiving status on this relationship. Demographic Health Surveys data (2006-2007) from 20 to 49 year old women in Namibia (n = 6,305), Swaziland (n = 2,786), and Zambia (n = 4,389) were analyzed using weighted marginal means and logistic regressions. OVC primary caregivers in Namibia and Swaziland had a lower mean AWI than other women in the same country. In Zambia, OVC primary caregivers had a lower mean AWI score than non-primary caregivers living with an OVC but a higher mean AWI score than non-OVC primary caregivers. In Swaziland and Zambia, even small increases in household wealth were associated with higher odds for being overweight regardless of women's caregiving status. Only in Namibia, OVC primary caregiving modified the effect of the previous association. Among Namibian OVC primary caregivers, women who had at least medium household wealth (4 or more AWI items) were more likely to be overweight than their poorest counterparts (0 or 1 AWI items). OVC primary caregivers are facing household wealth disparities as compared to other women from their communities. Future studies/interventions should consider using population-based approaches to reach women from every household wealth level to curb overweight in Swaziland and Zambia and to focus on specific household wealth characteristics that are associated with OVC primary caregivers' overweight status in Namibia.

Socioeconomic determinants of dietary patterns in low- and middle-income countries: a systematic review

BACKGROUND

In high-income countries, high socioeconomic status (SES) is generally associated with a healthier diet, but whether social differences in dietary intake are also present in low- and middle-income countries (LMICs) remains to be established.

OBJECTIVE

We performed a systematic review of studies that assessed the relation between SES and dietary intake in LMICs.

DESIGN

We carried out a systematic review of cohort and cross-sectional studies in adults in LMICs and published between 1996 and 2013. We assessed associations between markers of SES or urban and rural settings and dietary intake.

RESULTS

A total of 33 studies from 17 LMICs were included (5 low-income countries and 12 middle-income countries; 31 cross-sectional and 2 longitudinal studies). A majority of studies were conducted in Brazil (8), China (6), and Iran (4). High SES or living in urban areas was associated with higher intakes of calories; protein; total fat; cholesterol; polyunsaturated, saturated, and monounsaturated fatty acids; iron; and vitamins A and C and with lower intakes of carbohydrates and fiber. High SES was also associated with higher fruit and/or vegetable consumption, diet quality, and diversity. Although very few studies were performed in low-income countries, similar patterns were generally observed in both LMICs except for fruit intake, which was lower in urban than in rural areas in low-income countries.

CONCLUSIONS

In LMICs, high SES or living in urban areas is associated with overall healthier dietary patterns. However, it is also related to higher energy, cholesterol, and saturated fat intakes. Social inequalities in dietary intake should be considered in the prevention and control of noncommunicable diseases in LMICs.