Social and dietary determinants of body mass index of adult Jamaicans of African origin

Factors Associated With Being Overweight or Obese in Suriname

Objective: To identify the socio-demographic risk factors that are associated with adult Body Mass Index.

Methods: We apply probit and ordinal probit models to a sample of 3,803 adults aged 20 and above from the 2016/17 round of the Suriname Survey of Living Conditions.

Results: Women, the elderly, and couples who are either married and/or living together are more likely to be obese or overweight. This is also true for individuals who have chronic illnesses. We also find that individuals who engage in a sport or in other forms of exercise, even if modest, have lower odds of being overweight or obese. Interestingly, our findings indicate that individuals who benefit from government social safety net programs are less likely to be associated with being overweight or obese.

Conclusion: Obesity could become a serious public health issue if not addressed appropriately. Policymakers should promptly develop a national strategy to help health care systems cope with the outcomes of obesity and to tackle the risk factors that have the greatest impacts on individual Body Mass Index.

Associations of neighborhood physical and crime environments with obesity-related outcomes in Jamaica

OBJECTIVE

To examine whether proximity and density of public open spaces, public parks, street connectivity, and serious and violent crimes were associated with Body Mass Index (BMI) and Waist Circumference (WC) within and across levels of urbanicity, sex and socioeconomic status (SES) in Jamaica, a small island developing state (SIDS).

METHODS

Secondary analysis was conducted using data from the Jamaica Health and Lifestyle Survey 2008 (JHLS II). All respondents were geocoded to area of residence in Enumeration Districts (EDs). Intraclass correlation coefficients (ICCs) were derived and multilevel mixed effects regression models applied to 2529 participants nested within 101 EDs from all 14 parishes in Jamaica.

RESULTS

There was significant clustering across neighborhoods for mean BMI (ICC = 4.16%) and mean WC (ICC = 4.42%). In fully adjusted models statistically significant associations included: increased mean BMI among men, with increased intersection density/ km2 (β = 0.02; 95% CI = 1.96 x10-3, 0.04, p = 0.032); increased mean WC among urban residents with increased crimes/km2/yr (β = 0.09; 95% CI = 0.03, 0.16, p<0.01) and among persons in the middle class, with further distance away from public parks (β = 0.30; 95% CI = 0.08, 0.53, p<0.01).

CONCLUSIONS

Neighborhood physical and crime environments were associated with obesity-related outcomes in Jamaica. Policymakers in SIDS such as Jamaica should also note the important differences by urbanicity, sex and SES in prevention efforts designed to stem the growing obesity epidemic.

Using nutritional survey data to inform the design of sugar-sweetened beverage taxes in low-resource contexts: a cross-sectional analysis based on data from an adult Caribbean population

OBJECTIVE

Sugar-sweetened beverage (SSB) taxes have been implemented widely. We aimed to use a pre-existing nutritional survey data to inform SSB tax design by assessing: (1) baseline consumption of SSBs and SSB-derived free sugars, (2) the percentage of SSB-derived free sugars that would be covered by a tax and (3) the extent to which a tax would differentiate between high-sugar SSBs and low-sugar SSBs. We evaluated these three considerations using pre-existing nutritional survey data in a developing economy setting.

METHODS

We used data from a nationally representative cross-sectional survey in Barbados (2012-2013, prior to SSB tax implementation). Data were available on 334 adults (25-64 years) who completed two non-consecutive 24-hour dietary recalls. We estimated the prevalence of SSB consumption and its contribution to total energy intake, overall and stratified by taxable status. We assessed the percentage of SSB-derived free sugars subject to the tax and identified the consumption-weighted sugar concentration of SSBs, stratified by taxable status.

FINDINGS

Accounting for sampling probability, 88.8% of adults (95% CI 85.1 to 92.5) reported SSB consumption, with a geometric mean of 2.4 servings/day (±2 SD, 0.6, 9.2) among SSB consumers. Sixty percent (95% CI 54.6 to 65.4) of SSB-derived free sugars would be subject to the tax. The tax did not clearly differentiate between high-sugar beverages and low-sugar beverages.

CONCLUSION

Given high SSB consumption, targeting SSBs was a sensible strategy in this setting. A substantial percentage of free sugars from SSBs were not covered by the tax, reducing possible health benefits. The considerations proposed here may help policymakers to design more effective SSB taxes.

The Association of General and Central Obesity with Dietary Patterns and Socioeconomic Status in Adult Women in Botswana

Dietary patterns and their association with general and central obesity among adult women were studied using a cross-sectional survey with multistage cluster sampling in urban and rural areas nationwide in Botswana. The participants in the study were adult women (N = 1019), 18-75 years old. The dietary patterns were identified using principal component analysis, and their associations with the body mass index and the weight-for-height ratio were examined. Factor analysis with varimax rotation was used to identify six dietary patterns (fast foods, refined carbohydrates, vegetables and fruits, fish and nuts, Botswana traditional foods, and organ and red meat dietary pattern). Overall, 24.5% of the women were overweight (BMI 25.0-29.99 kg/m2) and 24.5% were obese (BMI > 30 kg/m2). A waist-to-height ratio greater than 0.5 was observed for 42.2% of the women. With adjustment for age and education, individuals in the highest tertile of the Botswana traditional food pattern had a significantly higher risk of general obesity (RR = 1.40, 95% CI: 1.07-1.84) and central obesity (RR = 1.20, 95% CI: 0.97-1.48). With respect to the fish and nut pattern, a significant association was observed with central obesity only (RR = 1.43, 95% CI: 1.18-1.72). The Botswana traditional food pattern, characterised by a high carbohydrate intake, was found to be associated with a high risk of obesity in this study. However, more research is required to assess other factors contributing to obesity in women so that appropriate intervention programs can be put in place to help control this epidemic.

THE RETURNS OF FAMILY PLANNING: MACRO-LEVEL ASSESSMENT OF THE EFFECT OF CONTRACEPTIVE USE ON WOMEN’S ANAEMIA AND CHILDHOOD UNDERNUTRITION

This study investigated the effect of family planning on the levels of women’s anaemia and child undernutrition at the aggregate level using the compiled databases of the World Bank, UNICEF and the Economist Intelligence Unit. Correlation scatter matrix plots and multivariate OLS regression models were employed to assess the effect of family planning on women’s anaemia and child nutritional status across countries. At the aggregate level, the bivariate correlation estimates found that the Contraceptive Prevalence Rate (CPR) was negatively associated with women’s anaemia (r=−0.62, p<0.01), child underweight (r=−0.57, p<0.01) and child stunting (r=−0.63, p<0.01). The results of the OLS regression showed that the independent effect of CPR on women’s anaemia (β=−0.35, p<0.01), child underweight (β=−0.13, p<0.01) and child stunting (β=−0.18, p<0.05) was negative, even after controlling for child marriage, female literacy, per capita GDP, poverty ratio, health expenditure and food security. The synthesis of these findings with the existing literature based on micro-data suggests pathways through which family planning influences the nutritional status of women and children. Family planning helps in avoiding shorter birth intervals, unintended pregnancy and unsafe abortion, which would otherwise result in nutrient depletion among mothers and further increase the risk of undernutrition in their children.

An Analysis of Contributors to Energy Intake Among Middle Aged and Elderly Adults

Adulthood and middle age is widely recognized as the time of life when unhealthy eating habits may develop. Data from various studies have demonstrated that changes in eating habits may also occur during old age. It is essential to acknowledge that a high consumption of certain food groups such as sweetened beverages, meat and eggs may contribute to an increased energy intake. This obviously results in high body mass index (BMI) and consequently an increased risk of non-communicable diseases (NCDs) and obesity. Energy intake among middle aged and elderly individuals may be influenced by socio demographic factors (for example: age, gender, socio economic status), social factors (for example: marital status), environmental factors like access to food commodities as well as nutrition knowledge and physical activity level. The present review highlights eating habits, contribution of specific food groups to energy intake and the influence of several factors on energy intake among the middle aged and elderly population.

Activities of daily living, instrumental activities for daily living and predictors of functional capacity of older men in Jamaica

Background:

An extensive search of the literature found no studies that have examined functional capacity [Activities of Daily Living (ADL) and Instrumental Activities for Daily Living (I) ADL)] of Jamaican older men as well as factors that determine their functional capacity.

Aims:

The current study examines 1) ADL, 2) (I) ADL), 3) self-reported health status, 4) functional capacity, and 5) factors that determine functional capacity of older men.

Methods and Method:

Stratified multistage probability sampling technique was used to draw a sample of 2,000 55+ year men. A132-item questionnaire was used to collect the data. Descriptive statistics provide background information on the sample, cross tabulations were used to examine non-metric variables and logistic regression provides a model of predictors of functional capacity.

Result:

Fifty-five percent of sample indicated good current health status. Four percent was mostly satisfied with life; 21.7% had moderate dependence; 77.1% had high dependence (i.e. independence); 1.2% had low dependence; 21.9% were ages 75 years and older; 35.6% were ages 65 to 74 years and 42.6% reported ages 55 to 64 years. Functional capacity can be determined by church attendance (β=0.245; 95% CI: 0.264, 1.291); social support (β=0.129; 95% CI: 0.129, 0.258), area of residence (β=-0.060; 95% CI: -0.427, -0.061) and lastly by age of respondents.

Conclusion:

Ageing in explains deterioration in their (I) ADL, suggesting the challenges of ageing men's independence. More rural men were rarely satisfied with life; but more of them had a greater functional capacity than urban men. Depression was found to negatively relate to functional capacity, and church attendees had a greater functional status than non-attendees.

Social determinants of physical exercise in older men in Jamaica

Background:

Background: Physical activity interventions have been demonstrated to improve health-related quality of life and to be of special benefit to older adults with specific chronic conditions including arthritis, hypertension, diabetes mellitus, and heart disease.

Aim:

This study examined the extent and social determinants of physical exercise in elderly men in Jamaica.

Materials and Methods:

A sample of 2,000 men 55 years of age and older was extracted from a total of 33,674 males in the parish of St. Catherine. A 132-item questionnaire was used to collect the data. A stratified random sampling technique was used to draw the sample. Descriptive statistics were used to provide background information on the sub-sample, and logistic regressions were utilized to model physical exercise.

Results:

Of the respondents, 55.4% indicated good health status, 51.0% lived in rural areas; 10.4% had moderate to high functional dependence and 67.3% reported that they did some form of physical exercise. Of those who indicated involvement in physical exercise (n = 1,345), 77.2% jogged, ran, and/or walked; 13.3% did aerobics; 4.7% swam; 2.0% cycled and 0.6% did push-ups or sit-ups. The variables that predicted being engaged in physical exercise were education; age of respondents; current good health status; household head; health plan; employment status, and social support.

Conclusion:

Most of the elderly men were engaged in some form of physical activity and had good health. Age and good health status were the most influential social determinants of physical exercise. However, effective interventions to promote physical activity in older men in Caribbean countries such as Jamaica deserve wide implementation.

Improving the Accuracy of Self-Reports on Diet and Physical Exercise: The Co-Twin Control Method

The objective was to examine the association between several obesity-related nongenetic behaviors and body mass index (BMI) and waist circumference (WC) in young adult twins using reports from both twins on their similarities and differences. A total of 713 monozygotic (MZ) and 698 same-sex dizygotic (DZ) twin pairs aged 22–28 years filled in structured questionnaires to compare their eating, physical activity and dieting behavior with their co-twin's behavior, and to report their own eating and exercise habits. In both MZ and DZ pairs, the co-twins for whom both twin pair members concordantly answered that this twin eats more, snacks more, eats more fatty foods and sweet and fatty delicacies, chooses less healthy foods, eats faster and exercises less, had significantly higher BMIs (0.6–2.9 kg/m2) and WCs (1.5–7.5 cm). Multivariate regression analysis identified co-twin differences in the amount of food consumed as the strongest independent predictor of intrapair differences in BMI (β = 0.63 and 1.21, for MZ and DZ, respectively,p< .001) and WC (β = 1.52 and 3.53, for MZ and DZ, respectively,p< .001). Higher leisure-time physical activity and healthier dietary choices clustered in the same subjects. The measurement of habitual dietary intake and physical activity has previously relied on subjective self-reports that are prone to misreporting. By using comparative measures within twin pairs we found that the amount of food consumed is the major contributor to obesity independent of genetic predisposition.

Use of a food frequency questionnaire to assess diets of Jamaican adults: validation and correlation with biomarkers

Background

Assessment of habitual diet is important in investigations of diet-disease relationships. Many epidemiological studies use the food frequency questionnaire (FFQ) to evaluate dietary intakes but few studies validate the instrument against biological markers. The aim of this study was to assess the validity and reproducibility of a previously validated 70-item food frequency questionnaire (FFQ) that was expanded to 120-items to assess diet - cancer relations.

Methods

Relative validity of the FFQ was assessed against twelve 24-hour recalls administered over 12 months in 70 subjects. The FFQ was repeated after one year (FFQ2) to assess reproducibility. The validity of the FFQ was evaluated by comparing nutrient and food group intakes from 24-hour recalls with the first and second FFQ. In addition, FFQ validity for cholesterol and folate were determined through correlation with biomarkers (serum cholesterol, serum folate and whole blood folate) in 159 control subjects participating in a case-control prostate cancer study.

Results

Compared to recalls the FFQ tended to overestimate energy and carbohydrate intakes but gave no differences in intake for protein and fat. Quartile agreement for energy-adjusted nutrient intakes between FFQ2 and recalls ranged from 31.8% - 77.3% for the lowest quartile and 20.8% - 81.0% in the highest quartile. Gross misclassification of nutrients was low with the exceptions of protein, vitamin E and retinol and weighted kappa values ranged from 0.33 to 0.64 for other nutrients. Validity correlations for energy-adjusted nutrients (excluding retinol) were moderate to high (0.38- 0.86). Correlation coefficients between multiple recalls and FFQ1 ranged from 0.27 (fruits) to 0.55 (red meat); the second FFQ gave somewhat higher coefficients (0.30 to 0.61). Reproducibility correlations for the nutrients ranged from 0.50 to 0.84.

Calibration of the FFQ with biochemical markers showed modest correlations with serum cholesterol (0.24), serum folate (0.25) and whole blood folate (0.33) adjusted for age, energy, body mass index and smoking.

Conclusions

The expanded FFQ had good relative validity for estimating food group and nutrient intakes (except retinol and vitamin E) and was a reliable measure of habitual intake. Associations with biomarkers were comparable to other studies.

Re-testing theories on the correlations of health status, life satisfaction and happiness

BACKGROUND

Empirical evidences have shown that happiness, life satisfaction and health status are strongly correlated with each other. In Jamaica, we continue to collect data on health status to guide policies and intervention programs, but are these wise?

AIMS

The current study aims to fill the gap in the literature by examining life satisfaction, health status, and happiness in order to ascertain whether they are equivalent concepts in Jamaica as well as the coverage of the estimates.

MATERIALS AND METHODS

The current study used a cross-sectional survey of 2000 men 55 years and older from the parish of St. Catherine in 2007 which is it also generalizable to the island. A132-item questionnaire was used to collect the data. The instrument was sub-divided into general demographic profile of the sample; past and Current Good Health Status; health-seeking behavior; retirement status; social and functional status. Ordinal logistic regression techniques were utilized to examine determinants of happiness, life satisfaction and health status.

RESULTS

Happiness was correlated with life satisfaction - Pseudo r-squared = 0.311, -2LL = 810.36, χ(2) = 161.60, P < 0.0001. Life satisfaction was determined by happiness - Pseudo r-squared = 0.321, -2LL = 1069.30, χ(2) = 178.53, P < 0.0001. H ealth status was correlated with health status age, income, education and area of residence - Pseudo r-squared = 0.313, -2LL = 810.36, χ(2) = 161.60, P < 0.0001.

CONCLUSION

The current study refuted the empirical finding that self-reported happiness depends on perceived health status for older men in Jamaica.

Fast-food and sweetened beverage consumption: association with overweight and high waist circumference in adolescents

Objective

Overweight and obesity have increased to epidemic proportions among adolescents and are associated with chronic non-communicable diseases and excess mortality in adulthood. The association of overweight/obesity with poor dietary habits has not been studied in adolescents in middle-income developing countries. The present study aimed to estimate the prevalence of overweight, obesity and high waist circumference (WC) in 15–19-year-old Jamaican adolescents and to investigate the association with fast-food and sweetened beverage consumption.

Design

The study enrolled 1317 (598 male, 719 female) adolescents aged 15–19 years using multistage, nationally representative sampling. Age-specific prevalence calculation used internal Z-score lines connecting with the WHO adult cut-off points. Logistic regression was used to examine the association of overweight or high WC with fast-food and sweetened beverage consumption, adjusting for potential confounders.

Results

The overall prevalence of overweight, obesity and high WC was approximately 15 %, 6 % and 10 %, respectively. Prevalence estimated using internal Z-scores was similar to that using the International Obesity Taskforce cut-off points. Obesity (8·0 % in females, 3·3 % in males) and high WC (16·2 % in females, 1·7 % in males) were significantly more prevalent in females when using internal Z-score cut-offs. High WC was associated with the absence of fruit consumption (P = 0·043) and overweight with high sweetened beverage consumption (P = 0·018).

Conclusion

Overweight occurs frequently among Jamaican 15–19-year-olds and is associated with increased consumption of sweetened beverages. High WC is more prevalent among females and is related to low consumption of fruits and vegetables. Measures to reduce the consumption of sweetened beverages and increase fruit intake may reduce the prevalence of excess body fat among adolescents.

Body mass index, socio-economic status and socio-behavioral practices among Tz'utujil Maya women

This study investigates the associations between body mass index (BMI), socio-economic status (SES) and related socio-behavioral practices including marriage and market visits in a population of adult Tz'utujil Maya women in Santiago Atitlán, Guatemala, aged 18-82. Mixed qualitative and quantitative methods include cross-sectional anthropometric measurements and semi-structured interviews gathered in 2007, as well as participant observation and purposive interviews conducted in 2007-2008. The regional quota sample of 53 semi-structured interviews was designed to be representative of the cantones (municipal divisions) of Santiago Atitlán. BMI was positively associated with years of schooling, income and literacy, all measures of SES. A statistical analysis of our data indicates that increased income, increased market visits and being married are significantly positively associated with BMI. Qualitative analysis based on the grounded theory method reveals relevant themes including a preoccupation with hunger and undernutrition rather than obesity, a preference for food quantity over dietary diversity, the economic and social influence of a husband, the effects of market distance and the increasing consumption of food from tiendas. These themes help to explain how SES, socio-behavioral practices and BMI are positively associated and can inform future public health interventions related to obesity and undernutrition.

Anthropometric reference values in an Afro-Caribbean adolescent population

Childhood and adolescent obesity is increasingly becoming a major public health issue in the Caribbean. In this study, we analyze patterns of growth in a population of Afro-Caribbean adolescents 12-18 years old and to compare these with those established for US adolescents. A cross-section of adolescent schoolchildren had weight and height measured using standardized procedures. In addition, percentage body fat (% BF) was measured using a foot-to-foot bioelectric impedance body fat analyzer (Tanita model 531). Selected age- and gender- specific percentiles of BMI, %BF, weight and height were derived and smoothed by cubic splines. These were compared with similar percentiles from US adolescent growth data. A total of 3,707 adolescents (1,585 males; 2,122 females) participated in the study. The age-specific correlation between BMI and %BF ranged from 0.75 to 0.87 in males and 0.79 to 0.87 in females. Females had significantly higher %BF than males in each age category. Overall, Tobagonian females were heavier and had higher BMI than their US counterparts especially levels above the median percentiles. Tobagonian males had similar height, weight, and BMI to their US counterparts over the range of percentiles. Overall, the pattern of growth in this group of adolescents suggests that they are growing at rates that are comparable to those seen in a more well-nourished population.

Poverty, obesity, and malnutrition: an international perspective recognizing the paradox

In the year 2000, multiple global health agencies and stakeholders convened and established eight tenets that, if followed, would make our world a vastly better place. These tenets are called the Millennium Development Goals. Most of these goals are either directly or indirectly related to nutrition. The United Nations has led an evaluation team to monitor and assess the progress toward achieving these goals until 2015. We are midway between when the goals were set and the year 2015. The first goal is to "eradicate extreme poverty and hunger." Our greatest responsibility as nutrition professionals is to understand the ramifications of poverty, chronic hunger, and food insecurity. Food insecurity is complex, and the paradox is that not only can it lead to undernutrition and recurring hunger, but also to overnutrition, which can lead to overweight and obesity. It is estimated that by the year 2015 noncommunicable diseases associated with overnutrition will surpass undernutrition as the leading causes of death in low-income communities. Therefore, we need to take heed of the double burden of malnutrition caused by poverty, hunger, and food insecurity. Informing current practitioners, educators, and policymakers and passing this information on to future generations of nutrition students is of paramount importance.

Diet and overweight and obesity in populations of African origin: Cameroon, Jamaica and the UK

OBJECTIVES

To determine the relationship of diet to overweight and obesity among populations of African origin.

DESIGN AND SETTING

Cross-sectional data were obtained from adults aged 25-74 years in rural Cameroon (n = 686), urban Cameroon (n = 975), Jamaica (n = 924) and Afro-Caribbeans in the UK (n = 257). Dietary data were collected using food-frequency questionnaires specifically designed for each site. Body mass index (BMI) was used as a measure of overweight.

RESULTS

The expected gradient in the distribution of overweight across sites was seen in females (rural Cameroon, 9.5%; urban Cameroon, 47.1%; Jamaica, 63.8%; UK, 71.6%); however, among males overweight was less prevalent in Jamaica (22.0%) than urban Cameroon (36.3%). In developing countries increased risks of overweight (BMI > or = 25 kg m(-2) were influenced by higher energy (urban Cameroonian men) and protein (Jamaican women) intakes. No dietary variables were associated with obesity (BMI > or = 30 kg m(-2) in Cameroon or Jamaica. In the UK, energy intakes were inversely related with overweight whereas increased risks of being overweight were associated with higher protein (men) and fat (women) intakes. Similarly, whereas higher protein and fat intakes in UK men and women were associated with obesity, carbohydrate intakes were associated with decreased risks of obesity in men.

CONCLUSIONS

Diet and overweight were associated in the UK but few dietary variables were related to overweight in Jamaica and the Cameroon. These findings suggest that associations between diet and overweight/obesity are not generalisable among populations.