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Wells JCK. The New "Obstetrical Dilemma": Stunting, Obesity and the Risk of Obstructed Labour. Anat Rec (Hoboken) 2017; 300:716-731. [PMID: 28297186 DOI: 10.1002/ar.23540] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/27/2016] [Accepted: 08/30/2016] [Indexed: 01/24/2023]
Abstract
The "obstetrical dilemma" refers to the tight fit between maternal pelvic dimensions and neonatal size at delivery. Most interest traditionally focused on its generic significance for humans, for example our neonatal altriciality and our complex and lengthy birth process. Across contemporary populations, however, the obstetrical dilemma manifests substantial variability, illustrated by differences in the incidence of cephalo-pelvic disproportion, obstructed labour and cesarean section. Beyond accounting for 12% of maternal mortality worldwide, obstructed labour also imposes a huge burden of maternal morbidity, in particular through debilitating birth injuries. This article explores how the double burden of malnutrition and the global obesity epidemic may be reshaping the obstetrical dilemma. First, short maternal stature increases the risk of obstructed labour, while early age at marriage also risks pregnancy before pelvic growth is completed. Second, maternal obesity increases the risk of macrosomic offspring. In some populations, short maternal stature may also promote the risk of gestational diabetes, another risk factor for macrosomic offspring. These nutritional influences are furthermore sensitive to social values relating to issues such as maternal and child nutrition, gender inequality and age at marriage. Secular trends in maternal obesity are substantially greater than those in adult stature, especially in low- and middle-income countries. The association between the dual burden of malnutrition and the obstetrical dilemma is therefore expected to increase, because the obesity epidemic is emerging faster than stunting is being resolved. However, we currently lack objective population-specific data on the association between maternal obesity and birth injuries. Anat Rec, 300:716-731, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
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Dhurandhar NV, Bailey D, Thomas D. Interaction of obesity and infections. Obes Rev 2015; 16:1017-29. [PMID: 26354800 DOI: 10.1111/obr.12320] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022]
Abstract
There is evidence that certain infections may induce obesity. Obese persons may also have more severe infections and have compromised response to therapies. The objective of this study is to review the available literature identifying infections that potentially contribute to greater body mass index (BMI) and differential responses of overweight and obese persons to infections. A systematic literature review of human studies examining associations between infections and weight gain, differential susceptibility, severity, and response to prevention and treatment of infection according to BMI status (January 1980-July 2014) was conducted. Three hundred and forty-three studies were eligible for inclusion. Evidence indicated that viral infection by human adenovirus Ad36 and antibiotic eradication of Helicobacter pylori were followed by weight gain. People who were overweight or obese had higher susceptibility to developing post-surgical infections, H1N1 influenza and periodontal disease. More severe infections tended to be present in people with a larger BMI. People with a higher BMI had a reduced response to vaccinations and antimicrobial drugs. Higher doses of antibiotics were more effective in obese patients. Infections may influence BMI, and BMI status may influence response to certain infections, as well as to preventive and treatment measures. These observations have potential clinical implications.
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Affiliation(s)
- N V Dhurandhar
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Bailey
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Thomas
- Center for Quantitative Obesity Research, Department of Mathematical Sciences, Montclair State University, Montclair, NJ, USA
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Olszowy KM, Pomer A, Dancause KN, Sun C, Silverman H, Lee G, Chan CW, Tarivonda L, Regenvanu R, Kaneko A, Weitz CA, Lum JK, Garruto RM. Impact of modernization on adult body composition on five islands of varying economic development in vanuatu. Am J Hum Biol 2015; 27:832-44. [DOI: 10.1002/ajhb.22734] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/30/2015] [Accepted: 04/11/2015] [Indexed: 12/28/2022] Open
Affiliation(s)
- Kathryn M. Olszowy
- Laboratory of Biomedical Anthropology and Neurosciences; SUNY Binghamton Binghamton New York
- Department of Anthropology; SUNY Binghamton Binghamton New York
| | - Alysa Pomer
- Laboratory of Biomedical Anthropology and Neurosciences; SUNY Binghamton Binghamton New York
- Department of Anthropology; SUNY Binghamton Binghamton New York
- Laboratory of Evolutionary Anthropology and Health; SUNY Binghamton Binghamton New York
| | - Kelsey N. Dancause
- Department of Kinanthropologie; Université du Québec à Montréal (UQAM); Montréal QC H2X 1Y4 Canada
| | - Cheng Sun
- Department of Anthropology; SUNY Binghamton Binghamton New York
- Laboratory of Evolutionary Anthropology and Health; SUNY Binghamton Binghamton New York
| | - Harold Silverman
- Department of Anthropology; SUNY Binghamton Binghamton New York
- Laboratory of Evolutionary Anthropology and Health; SUNY Binghamton Binghamton New York
| | - Gwang Lee
- Laboratory of Evolutionary Anthropology and Health; SUNY Binghamton Binghamton New York
| | - Chim W. Chan
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet; Stockholm Sweden
| | - Len Tarivonda
- Ministry of Health; PMB 042 Port Vila Republic of Vanuatu (Former)
| | - Ralph Regenvanu
- Ministry of Lands and Natural Resources; Port Vila Republic of Vanuatu
| | - Akira Kaneko
- Island Malaria Group, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet; Stockholm Sweden
- Department of Parasitology; Osaka City University Graduate School of Medicine; Sumiyoshi Ward Osaka Osaka Prefecture Japan
- Institute of Tropical Medicine, Nagasaki University; Nagasaki Nagasaki Prefecture Japan
| | - Charles A. Weitz
- Department of Anthropology; Temple University; Philadelphia Pennsylvania
| | - J. Koji Lum
- Department of Anthropology; SUNY Binghamton Binghamton New York
- Laboratory of Evolutionary Anthropology and Health; SUNY Binghamton Binghamton New York
- Department of Biological Sciences; SUNY Binghamton; Binghamton New York
| | - Ralph M. Garruto
- Laboratory of Biomedical Anthropology and Neurosciences; SUNY Binghamton Binghamton New York
- Department of Anthropology; SUNY Binghamton Binghamton New York
- Department of Biological Sciences; SUNY Binghamton; Binghamton New York
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Alexandre MAA, Benzecry SG, Siqueira AM, Vitor-Silva S, Melo GC, Monteiro WM, Leite HP, Lacerda MVG, Alecrim MDGC. The association between nutritional status and malaria in children from a rural community in the Amazonian region: a longitudinal study. PLoS Negl Trop Dis 2015; 9:e0003743. [PMID: 25928774 PMCID: PMC4415998 DOI: 10.1371/journal.pntd.0003743] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 04/06/2015] [Indexed: 11/18/2022] Open
Abstract
Background The relationship between malaria and undernutrition is controversial and complex. Synergistic associations between malnutrition and malaria morbidity and mortality have been suggested, as well as undernutrition being protective against infection, while other studies found no association. We sought to evaluate the relationship between the number of malaria episodes and nutritional statuses in a cohort of children below 15 years of age living in a rural community in the Brazilian Amazon. Methodology/Principal Findings Following a baseline survey of clinical, malaria and nutritional assessment including anthropometry measurements and hemoglobin concentration, 202 children ranging from 1 month to 14 years of age were followed for one year through passive case detection for malaria episodes. After follow-up, all children were assessed again in order to detect changes in nutritional indicators associated with malaria infection. We also examined the risk of presenting malaria episodes during follow-up according to presence of stunting at baseline. Children who suffered malaria episodes during follow-up presented worse anthropometric parameters values during this period. The main change was a reduction of the linear growth velocity, associated with both the number of episodes and how close the last or only malaria episode and the second anthropometric assessment were. Changes were also observed for indices associated with chronic changes, such as weight-for-age and BMI-for-age, which conversely, were more frequently observed in children with the last or only episode occurring between 6 and 12 months preceding the second nutritional assessment survey. Children with inadequate height-for-age at baseline (Z-score < -2) presented lower risk of suffering malaria episodes during follow-up as assessed by both the log-rank test (p =0.057) and the multivariable Cox-proportional hazards regression (Hazard Ratio = 0.31, 95%CI [0.10; 0.99] p=0.049). Conclusions Malaria was associated with impaired nutritional status amongst children in an endemic area of the Western Brazilian Amazon where P. vivax predominates. Our data all supports that the association presents differential effects for each age group, suggesting distinct pathophysiology pathways. We were also able to demonstrate that undernourishment at baseline was protective to malaria during follow-up. These findings support an intriguing interaction between these conditions in the rural Amazon and the need for a more integrative approach by health systems in endemic areas. Malaria is one of the most serious public health problems in the world, with 3.3 billion people at risk of contracting the disease and almost one million deaths annually, primarily in children younger than five years of age. Undernutrition is also a morbidity of importance to the public worldwide and primarily affects children in tropical regions. In the present study, we sought to analyze the relationship between malaria and undernutrition in children living in a rural Amazonian community where malaria is endemic. Children from 1 month to 14 years of age were followed-up for 12 months through passive case detection (i.e., the presence of malarial parasites in peripheral blood in case of fever). Anthropometric and hemoglobin measurements and active malaria case detection tests (to detect asymptomatic parasitaemia) were conducted at the beginning and end of the follow-up period of 12 months. Children who had at least one episode of malaria during this period presented lower mean anthropometric index scores compared to children who did not have malaria. We concluded that malaria had a negative impact on the nutritional status of children living in an endemic area at the Western Brazilian Amazon, where Plasmodium vivax predominates.
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Affiliation(s)
- Márcia Almeida Araújo Alexandre
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Silvana Gomes Benzecry
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Department of Pediatrics, Discipline of Nutrition and Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Andre Machado Siqueira
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Laboratório de Pesquisa Clínica em Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sheila Vitor-Silva
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Gisely Cardoso Melo
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Heitor Pons Leite
- Department of Pediatrics, Discipline of Nutrition and Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Centro de Pesquisas Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- * E-mail:
| | - Maria das Graças Costa Alecrim
- Gerência de Malaria, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
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Patterns of childhood and adolescent overweight and obesity during health transition in Vanuatu. Public Health Nutr 2011; 15:158-66. [PMID: 21835097 DOI: 10.1017/s1368980011001662] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Rapid economic development and subsequent changes in lifestyle and disease burdens ('health transition') is associated with increasing prevalence of obesity among both adults and children. However, because of continued infectious diseases and undernutrition during the early stages of transition, monitoring childhood obesity has not been prioritized in many countries and the scope of the problem is unknown. Therefore we sought to characterize patterns of childhood overweight and obesity in an early transitional area, the South Pacific archipelago of Vanuatu. DESIGN We completed an anthropometric survey among children from three islands with varying levels of economic development, from rural areas (where adult obesity prevalence is low) to urban areas (where adult obesity prevalence is high). SETTING The islands of Ambae (rural), Aneityum (rural with tourism) and Efate (urban). SUBJECTS Boys and girls (n 513) aged 6-17 years. RESULTS Height-, weight- and BMI-for-age did not vary among islands, and prevalence of overweight/obesity based on BMI was low. However, girls from Aneityum - a rural island where the tourism industry increased rapidly after malaria eradication - had increased central adiposity compared with girls from the other islands. This is contrary to adult patterns, which indicate higher obesity prevalence in urban areas. Multiple factors might contribute, including stunting, biological responses after malaria control, sleeping patterns, diet and physical activity levels. CONCLUSIONS Measures of central adiposity highlight an emerging obesity risk among girls in Vanuatu. The data highlight the synergistic relationship among infectious diseases, undernutrition and obesity during the early stages of health transition.
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