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Houweling TAJ, Grünberger I. Intergenerational transmission of health inequalities: towards a life course approach to socioeconomic inequalities in health - a review. J Epidemiol Community Health 2024; 78:641-649. [PMID: 38955463 PMCID: PMC11420752 DOI: 10.1136/jech-2022-220162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/19/2024] [Indexed: 07/04/2024]
Abstract
Adult health inequalities are a persistent public health problem. Explanations are usually sought in behaviours and environments in adulthood, despite evidence on the importance of early life conditions for life course outcomes. We review evidence from a broad range of fields to unravel to what extent, and how, socioeconomic health inequalities are intergenerationally transmitted.We find that transmission of socioeconomic and associated health (dis)advantages from parents to offspring, and its underlying structural determinants, contributes substantially to socioeconomic inequalities in adult health. In the first two decades of life-from conception to early adulthood-parental socioeconomic position (SEP) and parental health strongly influence offspring adult SEP and health. Socioeconomic and health (dis)advantages are largely transmitted through the same broad mechanisms. Socioeconomic inequalities in the fetal environment contribute to inequalities in fetal development and birth outcomes, with lifelong socioeconomic and health consequences. Inequalities in the postnatal environment-especially the psychosocial and learning environment, physical exposures and socialisation-result in inequalities in child and adolescent health, development and behavioural habits, with health and socioeconomic consequences tracking into adulthood. Structural factors shape these mechanisms in a socioeconomically patterned and time-specific and place-specific way, leading to distinct birth-cohort patterns in health inequality.Adult health inequalities are for an important part intergenerationally transmitted. Effective health inequality reduction requires addressing intergenerational transmission of (dis)advantage by creating societal circumstances that allow all children to develop to their full potential.
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Affiliation(s)
- Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ilona Grünberger
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Spiga F, Davies AL, Tomlinson E, Moore TH, Dawson S, Breheny K, Savović J, Gao Y, Phillips SM, Hillier-Brown F, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database Syst Rev 2024; 5:CD015328. [PMID: 38763517 PMCID: PMC11102828 DOI: 10.1002/14651858.cd015328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well-being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta-analyses. One hundred forty-six studies were based in high-income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty-six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non-industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short-term follow-up (mean difference (MD) 0, 95% confidence interval (CI) -0.10 to 0.10; 5 studies, 2107 participants; low-certainty evidence) and at medium-term follow-up (MD -0.01, 95% CI -0.15 to 0.12; 9 studies, 6815 participants; low-certainty evidence) or zBMI at long-term follow-up (MD -0.05, 95% CI -0.10 to 0.01; 7 studies, 5285 participants; low-certainty evidence). Dietary interventions, compared with control, probably have little to no effect on BMI at long-term follow-up (MD -0.17, 95% CI -0.48 to 0.13; 2 studies, 945 participants; moderate-certainty evidence) and zBMI at short- or medium-term follow-up (MD -0.06, 95% CI -0.13 to 0.01; 8 studies, 3695 participants; MD -0.04, 95% CI -0.10 to 0.02; 9 studies, 7048 participants; moderate-certainty evidence). Five studies (1913 participants; very low-certainty evidence) reported data on serious adverse events: one reported serious adverse events (e.g. allergy, behavioural problems and abdominal discomfort) that may have occurred as a result of the intervention; four reported no effect. Activity interventions versus control Activity interventions, compared with control, may have little to no effect on BMI and zBMI at short-term or long-term follow-up (BMI short-term: MD -0.02, 95% CI -0.17 to 0.13; 14 studies, 4069 participants; zBMI short-term: MD -0.02, 95% CI -0.07 to 0.02; 6 studies, 3580 participants; low-certainty evidence; BMI long-term: MD -0.07, 95% CI -0.24 to 0.10; 8 studies, 8302 participants; zBMI long-term: MD -0.02, 95% CI -0.09 to 0.04; 6 studies, 6940 participants; low-certainty evidence). Activity interventions likely result in a slight reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.18 to -0.05; 16 studies, 21,286 participants; zBMI: MD -0.05, 95% CI -0.09 to -0.02; 13 studies, 20,600 participants; moderate-certainty evidence). Eleven studies (21,278 participants; low-certainty evidence) reported data on serious adverse events; one study reported two minor ankle sprains and one study reported the incident rate of adverse events (e.g. musculoskeletal injuries) that may have occurred as a result of the intervention; nine studies reported no effect. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, may result in a slight reduction in BMI and zBMI at short-term follow-up (BMI: MD -0.11, 95% CI -0.21 to -0.01; 27 studies, 16,066 participants; zBMI: MD -0.03, 95% CI -0.06 to 0.00; 26 studies, 12,784 participants; low-certainty evidence) and likely result in a reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.21 to 0.00; 21 studies, 17,547 participants; zBMI: MD -0.05, 95% CI -0.07 to -0.02; 24 studies, 20,998 participants; moderate-certainty evidence). Dietary and activity interventions compared with control may result in little to no difference in BMI and zBMI at long-term follow-up (BMI: MD 0.03, 95% CI -0.11 to 0.16; 16 studies, 22,098 participants; zBMI: MD -0.02, 95% CI -0.06 to 0.01; 22 studies, 23,594 participants; low-certainty evidence). Nineteen studies (27,882 participants; low-certainty evidence) reported data on serious adverse events: four studies reported occurrence of serious adverse events (e.g. injuries, low levels of extreme dieting behaviour); 15 studies reported no effect. Heterogeneity was apparent in the results for all outcomes at the three follow-up times, which could not be explained by the main setting of the interventions (school, home, school and home, other), country income status (high-income versus non-high-income), participants' socioeconomic status (low versus mixed) and duration of the intervention. Most studies excluded children with a mental or physical disability. AUTHORS' CONCLUSIONS The body of evidence in this review demonstrates that a range of school-based 'activity' interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term, but not at long-term follow-up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. We identified a dearth of evidence for home and community-based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Sophie M Phillips
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Child Health and Physical Activity Laboratory, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Human Nutrition Research Centre and Population Health Sciences Institute, University of Newcastle, Newcastle, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Spiga F, Tomlinson E, Davies AL, Moore TH, Dawson S, Breheny K, Savović J, Hodder RK, Wolfenden L, Higgins JP, Summerbell CD. Interventions to prevent obesity in children aged 12 to 18 years old. Cochrane Database Syst Rev 2024; 5:CD015330. [PMID: 38763518 PMCID: PMC11102824 DOI: 10.1002/14651858.cd015330.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America, Australia, most of Europe, and the Gulf region. Interventions that aim to prevent obesity involve strategies that promote healthy diets or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective, and numerous new studies have been published over the last five years since the previous version of this Cochrane Review. OBJECTIVES To assess the effects of interventions that aim to prevent obesity in adolescents by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2023. SELECTION CRITERIA Randomised controlled trials in adolescents (mean age 12 years and above but less than 19 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our outcomes were BMI, zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS This review includes 74 studies (83,407 participants); 54 studies (46,358 participants) were included in meta-analyses. Sixty studies were based in high-income countries. The main setting for intervention delivery was schools (57 studies), followed by home (nine studies), the community (five studies) and a primary care setting (three studies). Fifty-one interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over 28 months. Sixty-two studies declared non-industry funding; five were funded in part by industry. Dietary interventions versus control The evidence is very uncertain about the effects of dietary interventions on body mass index (BMI) at short-term follow-up (mean difference (MD) -0.18, 95% confidence interval (CI) -0.41 to 0.06; 3 studies, 605 participants), medium-term follow-up (MD -0.65, 95% CI -1.18 to -0.11; 3 studies, 900 participants), and standardised BMI (zBMI) at long-term follow-up (MD -0.14, 95% CI -0.38 to 0.10; 2 studies, 1089 participants); all very low-certainty evidence. Compared with control, dietary interventions may have little to no effect on BMI at long-term follow-up (MD -0.30, 95% CI -1.67 to 1.07; 1 study, 44 participants); zBMI at short-term (MD -0.06, 95% CI -0.12 to 0.01; 5 studies, 3154 participants); and zBMI at medium-term (MD 0.02, 95% CI -0.17 to 0.21; 1 study, 112 participants) follow-up; all low-certainty evidence. Dietary interventions may have little to no effect on serious adverse events (two studies, 377 participants; low-certainty evidence). Activity interventions versus control Compared with control, activity interventions do not reduce BMI at short-term follow-up (MD -0.64, 95% CI -1.86 to 0.58; 6 studies, 1780 participants; low-certainty evidence) and probably do not reduce zBMI at medium- (MD 0, 95% CI -0.04 to 0.05; 6 studies, 5335 participants) or long-term (MD -0.05, 95% CI -0.12 to 0.02; 1 study, 985 participants) follow-up; both moderate-certainty evidence. Activity interventions do not reduce zBMI at short-term follow-up (MD 0.02, 95% CI -0.01 to 0.05; 7 studies, 4718 participants; high-certainty evidence), but may reduce BMI slightly at medium-term (MD -0.32, 95% CI -0.53 to -0.11; 3 studies, 2143 participants) and long-term (MD -0.28, 95% CI -0.51 to -0.05; 1 study, 985 participants) follow-up; both low-certainty evidence. Seven studies (5428 participants; low-certainty evidence) reported data on serious adverse events: two reported injuries relating to the exercise component of the intervention and five reported no effect of intervention on reported serious adverse events. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, do not reduce BMI at short-term follow-up (MD 0.03, 95% CI -0.07 to 0.13; 11 studies, 3429 participants; high-certainty evidence), and probably do not reduce BMI at medium-term (MD 0.01, 95% CI -0.09 to 0.11; 8 studies, 5612 participants; moderate-certainty evidence) or long-term (MD 0.06, 95% CI -0.04 to 0.16; 6 studies, 8736 participants; moderate-certainty evidence) follow-up. They may have little to no effect on zBMI in the short term, but the evidence is very uncertain (MD -0.09, 95% CI -0.2 to 0.02; 3 studies, 515 participants; very low-certainty evidence), and they may not reduce zBMI at medium-term (MD -0.05, 95% CI -0.1 to 0.01; 6 studies, 3511 participants; low-certainty evidence) or long-term (MD -0.02, 95% CI -0.05 to 0.01; 7 studies, 8430 participants; low-certainty evidence) follow-up. Four studies (2394 participants) reported data on serious adverse events (very low-certainty evidence): one reported an increase in weight concern in a few adolescents and three reported no effect. AUTHORS' CONCLUSIONS The evidence demonstrates that dietary interventions may have little to no effect on obesity in adolescents. There is low-certainty evidence that activity interventions may have a small beneficial effect on BMI at medium- and long-term follow-up. Diet plus activity interventions may result in little to no difference. Importantly, this updated review also suggests that interventions to prevent obesity in this age group may result in little to no difference in serious adverse effects. Limitations of the evidence include inconsistent results across studies, lack of methodological rigour in some studies and small sample sizes. Further research is justified to investigate the effects of diet and activity interventions to prevent childhood obesity in community settings, and in young people with disabilities, since very few ongoing studies are likely to address these. Further randomised trials to address the remaining uncertainty about the effects of diet, activity interventions, or both, to prevent childhood obesity in schools (ideally with zBMI as the measured outcome) would need to have larger samples.
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Affiliation(s)
- Francesca Spiga
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabel L Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa Hm Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katie Breheny
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Julian Pt Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science, Durham University, Durham, UK
- Fuse - Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Meisel JD, Esguerra V, Giraldo JK, Montes F, Stankov I, Meisel CA, Sarmiento OL, Valdivia JA. Understanding the dynamics of the obesity transition associated with physical activity, sedentary lifestyle, and consumption of ultra-processed foods in Colombia. Prev Med 2023; 177:107720. [PMID: 37802196 DOI: 10.1016/j.ypmed.2023.107720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE We investigate the obesity transition at the country- and regional-levels, by age, gender, and socioeconomic status (SES) and its relationship to three health behavior attributes, including physical activity (PA), sedentary activities (ST), and consumption of ultra-processed foods (CUPF) within the urban population of Colombia, from 20,010 to 2050. METHODS The study is informed by cross-sectional data from ENSIN survey. We used these data to develop a system dynamics model that simulates the dynamics of obesity by body mass index (BMI) categories, gender, and SES. This model also uses a conservative co-flow structure for three health-related behaviors (PA, ST, and CUPF). RESULTS At the national level, our results indicate that the burden of obesity is shifting towards populations with lower SES as the gross domestic product (GDP) increases, particularly women aged 20-59 years with lower SES. Among this group of women, the highest burden of obesity is among those who do not meet the PA, ST and CUPF recommendations. At the regional level, our findings suggest that the regions are at different stages in the obesity transition. CONCLUSIONS The burden of obesity is shifting towards women with lower SES as GDP increases at the national level and across several regions. This obesity transition is paralleled by a high prevalence of women from low SES groups who do not meet the minimum recommendations for PA, CUPF, and ST. Our findings can be used by decision-makers to inform age- and SES- specific policies seeking to tackle the obesity.
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Affiliation(s)
- Jose D Meisel
- Facultad de Ingeniería, Universidad de Ibagué, Carrera 22 Calle 67, 730001 Ibagué, Colombia; Social and Health Complexity Center, Bogotá, Colombia.
| | - Valentina Esguerra
- Universidad de Ibagué, Carrera 22 Calle 67, 730001 Ibagué, Colombia; Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Carrera 1 Este No. 19A-40, Bogotá, Colombia.
| | - John K Giraldo
- Facultad de Ingeniería, Universidad de Ibagué, Carrera 22 Calle 67, 730001 Ibagué, Colombia
| | - Felipe Montes
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Carrera 1 Este No. 19A-40, Bogotá, Colombia.
| | - Ivana Stankov
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St, 7th floor, Philadelphia, PA 19104, USA; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Carlos A Meisel
- Facultad de Ingeniería, Universidad de Ibagué, Carrera 22 Calle 67, 730001 Ibagué, Colombia.
| | - Olga L Sarmiento
- Department of Public Health, School of Medicine, Universidad de los Andes, Carrera 1 Este No. 19A-40, Bogotá, Colombia.
| | - Juan A Valdivia
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Las Palmeras 3425, Ñuñoa Santiago, Chile; Centro para el Desarrollo de la Nanociencia y la Nanotecnología, CEDENNA, Santiago, Chile.
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Daran B, Levasseur P, Clément M. Updating the association between socioeconomic status and obesity in low-income and lower-middle-income sub-Saharan African countries: A literature review. Obes Rev 2023; 24:e13601. [PMID: 37415279 DOI: 10.1111/obr.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
Globally, the literature tends to emphasize negative associations between socioeconomic status (SES) and bodyweight in countries improving their economic development. However, little is known about the social distribution of obesity in sub-Saharan Africa (SSA) where economic growth has been highly heterogeneous the last decades. This paper reviews an exhaustive set of recent empirical studies examining its association in low-income and lower-middle-income countries in SSA. Although there is evidence of a positive association between SES and obesity in low-income countries, we found mixed associations in lower-middle-income countries, potentially providing evidence of a social reversal of the obesity burden.
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Affiliation(s)
- Bertille Daran
- PSAE, INRAE, AgroParisTech, Université Paris-Saclay, Palaiseau, France
| | - Pierre Levasseur
- SADAPT, INRAE, AgroParisTech, Université Paris-Saclay, Palaiseau, France
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Alshaikh AA, Alqahtani AS, A AlShehri FA, Al Hadi AM, Alqahtani MMM, Alshahrani OM, Albraik MA, Alamri SA, Ghazy RM. Examining the Impact of Socioeconomic Factors and Lifestyle Habits on Obesity Prevalence Among Male and Female Adolescent Students in Asser, Saudi Arabia. Cureus 2023; 15:e43918. [PMID: 37746434 PMCID: PMC10512758 DOI: 10.7759/cureus.43918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Background Understanding the relationships between obesity and lifestyle factors is essential for the effective prevention and management of obesity in youth. This study aimed to investigate the association between sociodemographic factors, lifestyle elements such as physical activity and social stress, and the prevalence of overweight and obesity among Saudi adolescents in the Aseer region. Methodology From December 2022 to March 2023, we conducted a cross-sectional study using the multi-stage stratified random sampling technique. The study included Saudi male and female adolescents aged 12-19 years attending middle and high schools. Ordinal logistic regression was used to analyze the association between the ordinal dependent variable, classified into weight groups (normal, overweight, obese), and the independent variables. Results Of the total of 512 individuals, 90.4% were aged ≥18 years, 77.5% were males, and 76.8% were urban residents. Of the studied population, 33.6% were overweight, and 20.5% were obese. The prevalence of obesity and overweight was significantly higher among males compared to females (20.9% vs. 19.1% and 36.5% vs. 23.5%, respectively). Multivariate analysis revealed the following factors to be associated with obesity and overweight: female gender (2.31, 95% CI = 1.45-3.71), age 12-17 years (0.53, 95% CI = 0.28-0.97), place of delivery (Tanoma) (2.32, 95% CI = 1.13-4.75), family size of over eight members (0.43, 95% CI = 0.24-0.74), family monthly income of over 20,000 SAR (3.79, 95% CI = 1.38-11.35), being smokers (0.26, 95% CI = 1.31-2.93), experiencing social stress (1.96, 95% CI = 1.96-2.93), engagement in physical activity less than three times a week (0.49, 95% CI = 0.32-0.75), and engagement in physical activity more than three times a week (0.36, 95% CI = 0.22-0.58). Conclusions These findings emphasize the importance of addressing demographic, socioeconomic, and lifestyle factors in combating childhood and adolescent obesity through targeted interventions.
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Affiliation(s)
- Ayoub A Alshaikh
- Family & Community Medicine Department, King Khalid University, Abha, SAU
| | | | | | | | | | | | - Meteb A Albraik
- Abha Health Sector, General Directorate of Health Affairs, Abha, SAU
| | - Saad A Alamri
- Public Health Department, General Directorate of Health Affairs, Aseer Region, Abha, SAU
| | - Ramy M Ghazy
- Tropic Health Department, High Institute of Public Health - Alexandria University, Alexandria, EGY
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7
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Lister NB, Baur LA, Felix JF, Hill AJ, Marcus C, Reinehr T, Summerbell C, Wabitsch M. Child and adolescent obesity. Nat Rev Dis Primers 2023; 9:24. [PMID: 37202378 DOI: 10.1038/s41572-023-00435-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/20/2023]
Abstract
The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive-emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
- Weight Management Services, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Andrew J Hill
- Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Claude Marcus
- Division of Paediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm, Germany
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8
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Mizuno Y, Inaba Y, Masuoka H, Kibe M, Kosaka S, Natsuhara K, Hirayama K, Inthavong N, Kounnavong S, Tomita S, Umezaki M. Impact of modernization on oxidative stress among indigenous populations in northern Laos. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023. [PMID: 36919625 DOI: 10.1002/ajpa.24722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/30/2022] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To explore the impact of modernization on oxidative stress during a momentous health transition process, we investigated differences in oxidative stress among the indigenous populations of villages in northern Laos with different levels of modernization. METHODS We conducted a cross-sectional study of 380 adults in three villages with different levels of modernization. Three biomarkers related to oxidative stress were measured: urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-isoprostane concentrations (both measured by liquid chromatography-tandem mass spectrometry), and blood telomere length (measured with qPCR). We examined associations between village-level modernization and oxidative stress-related biomarkers in a multilevel analysis including a random effect and covariates. RESULTS The geometric means of urinary 8-OHdG and 8-isoprostane concentrations were 2.92 and 0.700 μg/g creatinine, respectively, in our study population. Higher urinary 8-OHdG concentrations and shorter telomeres were observed in participants from the more modernized villages, whereas urinary 8-isoprostane concentrations did not differ significantly among villages. CONCLUSIONS Our findings imply that modernization-induced changes in lifestyle may increase oxidative DNA damage. Baseline levels of oxidative lipid damage are expected to be high in the indigenous populations of northern Laos. Assessments of oxidative stress may provide valuable insights into the mechanisms of health transition in specific populations.
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Affiliation(s)
- Yuki Mizuno
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yohei Inaba
- Department of Environmental Health, National Institute of Public Health, Saitama, Japan
| | - Hiroaki Masuoka
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Mihoko Kibe
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Kosaka
- Department of Public Health and Nursing, Nagasaki University, Nagasaki, Japan
| | | | - Kazuhiro Hirayama
- Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Nouhak Inthavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Laos
| | | | - Shinsuke Tomita
- Graduate School of Environmental Studies, Nagoya University, Nagoya, Japan
| | - Masahiro Umezaki
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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9
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Ochola S, Kanerva N, Wachira LJ, Owino GE, Anono EL, Walsh HM, Okoth V, Erkkola M, Swindell N, Stratton G, Onywera V, Fogelholm M. Wealth and obesity in pre-adolescents and their guardians: A first step in explaining non-communicable disease-related behaviour in two areas of Nairobi City County. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000331. [PMID: 36962946 PMCID: PMC10021148 DOI: 10.1371/journal.pgph.0000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The prevalence of non-communicable diseases is increasing in lower-middle-income countries as these countries transition to unhealthy lifestyles. The transition is mostly predominant in urban areas. We assessed the association between wealth and obesity in two sub-counties in Nairobi City County, Kenya, in the context of family and poverty. This cross-sectional study was conducted among of 9-14 years old pre-adolescents and their guardians living in low- (Embakasi) and middle-income (Langata) sub-counties. The sociodemographic characteristics were collected using a validated questionnaire. Weight, height, mid-upper arm circumference, and waist circumference were measured using standard approved protocols. Socioeconomic characteristics of the residential sites were accessed using Wealth Index, created by using Principal Component Analysis. Statistical analyses were done by analysis of variance (continuous variables, comparison of areas) and with logistic and linear regression models.A total of 149 households, response rate of 93%, participated, 72 from Embakasi and 77 from Langata. Most of the participants residing in Embakasi belonged to the lower income and education groups whereas participants residing in Langata belonged to the higher income and education groups. About 30% of the pre-adolescent participants in Langata were overweight, compared to 6% in Embakasi (p<0.001). In contrast, the prevalence of adults (mostly mothers) with overweight and obesity was high (65%) in both study areas. Wealth (β = 0.01; SE 0.0; p = 0.003) and income (β = 0.29; SE 0.11; p = 0.009) predicted higher BMI z-score in pre-adolescents. In, pre-adolescent overweight was already highly prevalent in the middle-income area, while the proportion of women with overweight/obesity was high in the low-income area. These results suggest that a lifestyle promoting obesity is high regardless of socioeconomic status and wealth in Kenya. This provides a strong justification for promoting healthy lifestyles across all socio-economic classes.
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Affiliation(s)
- Sophie Ochola
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Noora Kanerva
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Lucy Joy Wachira
- Department of Physical Education, Exercise and Sport Science, Kenyatta University, Nairobi, Kenya
| | - George E. Owino
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
| | - Esther L. Anono
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Hanna M. Walsh
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Victor Okoth
- Department of Environmental Science, Kenyatta University, Nairobi, Kenya
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Nils Swindell
- Faculty of Science and Engineering, Applied Sport Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Gareth Stratton
- Faculty of Science and Engineering, Applied Sport Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Vincent Onywera
- Department of Physical Education, Exercise and Sport Science, Kenyatta University, Nairobi, Kenya
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
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10
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Funjika E, Colombo SAP, Hayes KS, Tozer MJ, Tyrrell KA, Cai S, Faniyi AA, Shears RK, Dooley M, Alshammari Y, Alhazmi W, Assas M, Almilaibary A, Jackson-Jones LH, Thornton DJ, Worthington JJ, Grencis RK. High-fat diet-induced resistance to helminth infection via alternative induction of type 2 immunity. Mucosal Immunol 2023; 16:27-38. [PMID: 36690078 DOI: 10.1016/j.mucimm.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
Gastrointestinal nematode infections cause morbidity and socioeconomic loss in the most deprived communities. The shift in the context of obesity has led to spatial overlap with endemic gastrointestinal nematode regions resulting in the emergence of a novel comorbidity. Despite this, the impact of a high-fat diet (HFD) on immune-regulated protection against gastrointestinal infections remains largely unknown. We employed the murine model of nematode infection, Trichuris muris, to investigate the effect of an HFD on the immune response against chronic infection. Surprisingly, diet-induced obesity drove parasite expulsion in both single and repeated trickle low doses of T. muris eggs. Mechanistically, an HFD increased the expression of the ST2 receptor on CD4+ T cells, priming an enhanced type 2 helper T (Th2) cell cytokine production following interleukin (IL)-33 stimulation ex vivo. Despite IL-33-/- mice demonstrating that IL-33 is not critical for host protective immunity to T. muris under a conventional diet, HFD-fed T-cell deplete mice adoptively transferred with ST2-/- CD4 T cells were unable to expel a T. muris infection unlike those transferred with ST2-sufficient cells. Collectively, this study demonstrates that an HFD primes CD4+ T cells to utilize the IL-33-ST2 axis in a novel induction of type 2 immunity, providing insights into the emerging comorbidities of obesity and nematode infection.
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Affiliation(s)
- Evelyn Funjika
- The Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, UK; School of Natural Sciences, Department of Chemistry, The University of Zambia, Lusaka, Zambia
| | - Stefano A P Colombo
- The Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, UK
| | - Kelly S Hayes
- The Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, UK
| | - Mary J Tozer
- Biomedical and Life Sciences, Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - Katrina A Tyrrell
- Biomedical and Life Sciences, Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - Shanshan Cai
- Biomedical and Life Sciences, Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - Aduragbemi A Faniyi
- Biomedical and Life Sciences, Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - Rebecca K Shears
- The Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, UK
| | - Megan Dooley
- Biomedical and Life Sciences, Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - Yasmine Alshammari
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait
| | - Wafaa Alhazmi
- Faculty of Applied Medical Sciences, Department of Medical laboratory technology, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Mushref Assas
- Faculty of Applied Medical Sciences, Department of Medical laboratory technology, King AbdulAziz University, Jeddah, Saudi Arabia
| | | | - Lucy H Jackson-Jones
- Biomedical and Life Sciences, Faculty of Health and Medicine, University of Lancaster, Lancaster, UK
| | - David J Thornton
- The Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, UK.
| | - John J Worthington
- Biomedical and Life Sciences, Faculty of Health and Medicine, University of Lancaster, Lancaster, UK.
| | - Richard K Grencis
- The Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, UK.
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11
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Moore THM, Phillips S, Heslehurst N, Hodder RK, Dawson S, Gao Y, Hesketh K, Summerbell CD. Interventions to prevent obesity in children under 2 years old. Hippokratia 2022. [DOI: 10.1002/14651858.cd015324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Theresa HM Moore
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Sophie Phillips
- Department of Sport and Exercise Sciences; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle Upon Tyne UK
| | - Nicola Heslehurst
- Fuse - Centre for Translational Research in Public Health; Newcastle Upon Tyne UK
- Population Health Sciences Institute; Newcastle University; Newcastle upon Tyne UK
| | - Rebecca K Hodder
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
- National Centre of Implementation Science; The University of Newcastle; Callaghan Australia
- Population Health Research Program; Hunter Medical Research Institute; New Lambton Heights Australia
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Yang Gao
- Department of Sport, Physical Education and Health; Hong Kong Baptist University; Kowloon Hong Kong
| | - Kathryn Hesketh
- MRC Epidemiology Unit; University of Cambridge; Cambridge UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Sciences; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle Upon Tyne UK
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12
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Otten HS, Seferidi P. Prevalence and socioeconomic determinants of the double burden of malnutrition in mother-child pairs in Latin America and the Caribbean. BMJ Nutr Prev Health 2022; 5:263-270. [PMID: 36619319 PMCID: PMC9813618 DOI: 10.1136/bmjnph-2022-000489] [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: 05/16/2022] [Accepted: 10/10/2022] [Indexed: 12/31/2022] Open
Abstract
Background The double burden of malnutrition (DBM), which refers to the coexistence of overnutrition and undernutrition among populations, households or individuals, is a growing problem in low/middle-income countries. The Latin America and the Caribbean (LAC) region has been particularly affected by the DBM, following a nutrition transition and a rapid increase in overweight, obesity and diet-related disease, while high levels of undernutrition persist. This study aims to describe the prevalence of four different DBM definitions in mother-child pairs across nine LAC countries and investigate the socioeconomic determinants of overweight mothers with at least one stunted child (SCOM). Methods We used cross-sectional data from the Demographic and Health Surveys for all analyses. We used descriptive statistics to obtain prevalence rates and conducted multiple logistic regression analyses to investigate the association between SCOM households and socioeconomic determinants, including wealth index, maternal education, place of residency and whether the mother was working, adjusted for a range of variables. Results Overweight/obese mothers with at least one anaemic child were the most common type of DBM, with a prevalence of 19.39%, followed by SCOM with a prevalence of 10.44%. Statistically significant socioeconomic predictors of SCOM were households with a lower wealth index, lower maternal education and living in rural areas. Conclusion This study showed that the overall prevalence of most DBM definitions examined was high, which points to the need for urgent interventions in the LAC region. The unique set of socioeconomic predictors of SCOM identified in this study calls for future double-duty policies that simultaneously target food affordability, nutrition education and access to healthy food.
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Affiliation(s)
| | - Paraskevi Seferidi
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
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13
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Bhattarai S, Nerhus Larsen R, Shrestha A, Karmacharya B, Sen A. Association between socioeconomic positions and overweight/obesity in rural Nepal. Front Nutr 2022; 9:952665. [PMID: 36159479 PMCID: PMC9501994 DOI: 10.3389/fnut.2022.952665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Obesity and its association with socioeconomic factors are well-established. However, the gradient of this relationship among rural populations in low- and middle-income countries such as Nepal is not fully understood. We sought to assess the association of socioeconomic factors (education, income, and employment status) with overweight/obesity. Methods This cross-sectional study analyzed data from 260 participants aged ≥18 years and attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors was collected, and weight and height were measured for all the study participants. Those with a body mass index of <25 kg/m2 were regarded as non-overweight/obese and those with ≥25 kg/m2 were regarded as overweight/obese. Poisson regression models were used to estimate prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and overweight/obesity. In addition, we assessed the effect of modification by age and gender to study the effect of socioeconomic factors on overweight/obesity. Results The age-standardized prevalence of overweight/obesity was higher for individuals with higher education (23%) and high-income (32%) and those who were unemployed (42%). Compared to the low-income and no formal education groups, the prevalence ratio of overweight/ obesity was 1.69 and 2.27 times more for those belonging to the high-income and high school and above groups, respectively. No evidence of effect modification by gender and age was observed. Conclusions Socioeconomic factors, education, and income were positively associated with overweight/obesity prevalence in rural Nepal. Further large studies using longitudinal settings are necessary to replicate our findings.
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Affiliation(s)
- Sanju Bhattarai
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Implementation Science and Health, Kathmandu, Nepal
| | | | - Archana Shrestha
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, United States
| | - Biraj Karmacharya
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Oral Health Services and Research Center, TkMidt, Trondheim, Norway
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14
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Moore THM, Phillips S, Hodder RK, O'Brien KM, Hillier-Brown F, Dawson S, Gao Y, Summerbell CD. Interventions to prevent obesity in children aged 2 to 4 years old. Hippokratia 2022. [DOI: 10.1002/14651858.cd015326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Theresa HM Moore
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- Methods Support Unit, Editorial Methods Department; Cochrane; London UK
| | - Sophie Phillips
- Department of Sport and Exercise Sciences; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle Upon Tyne UK
| | - Rebecca K Hodder
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
- National Centre of Implementation Science; The University of Newcastle; Callaghan Australia
| | - Kate M O'Brien
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
- National Centre of Implementation Science; The University of Newcastle; Callaghan Australia
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health; Newcastle Upon Tyne UK
- Population Health Sciences Institute; Newcastle University; Newcastle upon Tyne UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Yang Gao
- Department of Sport, Physical Education and Health; Hong Kong Baptist University; Kowloon Hong Kong
| | - Carolyn D Summerbell
- Department of Sport and Exercise Sciences; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle Upon Tyne UK
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15
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The Association of Socioeconomic Status With Hypertension in 76 Low- and Middle-Income Countries. J Am Coll Cardiol 2022; 80:804-817. [PMID: 35981824 DOI: 10.1016/j.jacc.2022.05.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Effective equity-focused health policy for hypertension in low- and middle-income countries (LMICs) requires an understanding of the condition's current socioeconomic gradients and how these are likely to change in the future as countries develop economically. OBJECTIVES This cross-sectional study aimed to determine how hypertension prevalence in LMICs varies by individuals' education and household wealth, and how these socioeconomic gradients in hypertension prevalence are associated with a country's gross domestic product (GDP) per capita. METHODS We pooled nationally representative household survey data from 76 LMICs. We disaggregated hypertension prevalence by education and household wealth quintile, and used regression analyses to adjust for age and sex. RESULTS We included 1,211,386 participants in the analysis. Pooling across all countries, hypertension prevalence tended to be similar between education groups and household wealth quintiles. The only world region with a clear positive association of hypertension with education or household wealth quintile was Southeast Asia. Countries with a lower GDP per capita had, on average, a more positive association of hypertension with education and household wealth quintile than countries with a higher GDP per capita, especially in rural areas and among men. CONCLUSIONS Differences in hypertension prevalence between socioeconomic groups were generally small, with even the least educated and least wealthy groups having a substantial hypertension prevalence. Our cross-sectional interaction analyses of GDP per capita with the socioeconomic gradients of hypertension suggest that hypertension may increasingly affect adults in the lowest socioeconomic groups as LMICs develop economically.
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16
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Moore THM, Tomlinson E, Spiga F, Higgins JPT, Gao Y, Caldwell DM, Nobles J, Dawson S, Ijaz S, Savovic J, Hodder RK, Wolfenden L, Jago R, Phillips S, Hillier-Brown F, Summerbell CD. Interventions to prevent obesity in children aged 12 to 18 years old. Hippokratia 2022. [DOI: 10.1002/14651858.cd015330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Theresa HM Moore
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Francesca Spiga
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Julian PT Higgins
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- NIHR Bristol Biomedical Research Centre; University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol; Bristol UK
| | - Yang Gao
- Department of Sport, Physical Education and Health; Hong Kong Baptist University; Kowloon Hong Kong
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - James Nobles
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Jelena Savovic
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Rebecca K Hodder
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
| | - Luke Wolfenden
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
| | - Russell Jago
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- NIHR Bristol Biomedical Research Centre; University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol; Bristol UK
- Centre for Exercise, Nutrition & Health Sciences; School for Policy Studies, University of Bristol; Bristol UK
| | - Sophie Phillips
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
- Department of Sport and Exercise Science; Durham University; Durham UK
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
- Human Nutrition Research Centre and Population Health Sciences Institute; University of Newcastle; Newcastle UK
| | - Carolyn D Summerbell
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
- Department of Sport and Exercise Science; Durham University; Durham UK
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17
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Moore THM, Tomlinson E, Spiga F, Higgins JPT, Gao Y, Caldwell DM, Nobles J, Dawson S, Ijaz S, Savovic J, Hodder RK, Wolfenden L, Jago R, Phillips S, Hillier-Brown F, Summerbell CD. Interventions to prevent obesity in children aged 5 to 11 years old. Hippokratia 2022. [DOI: 10.1002/14651858.cd015328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Theresa HM Moore
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Francesca Spiga
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Julian PT Higgins
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol; Bristol UK
| | - Yang Gao
- Department of Sport, Physical Education and Health; Hong Kong Baptist University; Kowloon Hong Kong
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - James Nobles
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- Population Health Sciences, Bristol Medical School, University of Bristol; Bristol UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- Population Health Sciences, Bristol Medical School, University of Bristol; Bristol UK
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Jelena Savovic
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Rebecca K Hodder
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
| | - Luke Wolfenden
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
| | - Russell Jago
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol; Bristol UK
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies; University of Bristol; Bristol UK
| | - Sophie Phillips
- Department of Sport and Exercise Science; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
| | - Frances Hillier-Brown
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
- Human Nutrition Research Centre and Population Health Sciences Institute; University of Newcastle; Newcastle UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Science; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle upon Tyne UK
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18
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Conde WL, Silva IVD, Ferraz FR. Undernutrition and obesity trends in Brazilian adults from 1975 to 2019 and its associated factors. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00149721. [PMID: 35613255 DOI: 10.1590/0102-311xe00149721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/04/2022] [Indexed: 12/15/2022] Open
Abstract
Nutritional status has evolved in a dual trend worldwide: underweight has become a minor or local issue while overweight or obesity has risen to play a major role in the global burden of disease. In 2014, Brazil was ranked as the third country with the highest absolute number of obese men. Our aim was to estimate trends of underweight and obesity among Brazilian adults using a comprehensive set of surveys from 1974 to 2019. The data used in the study originate from subjects aged ≥ 18 in six Brazilian national surveys, presented in chronological order: Brazilian National Survey on Household Expenses (ENDEF 1974-1975); Brazilian National Survey on Health and Nutrition (PNSN 1989); Brazilian Household Budget Survey (POF 2002-2003, 2008-2009); and Brazilian National Health Survey (PNS 2013 and 2019). All six surveys were designed to sample household complexes that were representative of the Brazilian population. Body mass index was calculated (kg/m2). The nutritional status of individuals was classified following the standards. We have modeled obesity trend according to income and education strata. The trajectories of underweight and obesity over time in Brazil draw the classical "X" of nutrition transition. From 1975 to 2019 underweight has decreased from 9.1% to 2.5% among men and 12.2% to 3.4% among women. On the other hand, obesity trajectories have scaled up from 3% to 22% among men and from 9% to 30% among women. The increase in obesity rate is directly and negatively proportional to income quintiles. Sociodemographic (income and education) improvement is associated with an increase in obesity. All public policies intending to stop the obesity spread in Brazil have been ineffective or too small to be effective.
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Fu H, Hawley NL, Carlson JC, Russell EM, Pomer A, Cheng H, Naseri T, Reupena MS, Deka R, Choy CC, McGarvey ST, Minster RL, Weeks DE. The missense variant, rs373863828, in CREBRF plays a role in longitudinal changes in body mass index in Samoans. Obes Res Clin Pract 2022; 16:220-227. [PMID: 35606300 DOI: 10.1016/j.orcp.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A missense variant, rs373863828, in CREBRF is associated with obesity in Polynesians. We investigate whether rs373863828 and other factors are associated with body mass index (BMI) rate-of-change between 2010 and 2017-19 in Samoans. METHODS We used sex-stratified models to test whether BMI rate-of-change was associated with rs373863828, baseline BMI, age, residence, physical activity, and household asset score in a cohort study of 480 Samoan adults measured in both 2010 (mean age 43.8 years) and 2017-19. RESULTS Mean BMI increased from 32.1 to 33.5 kg/m2 in males (n = 220, p = 1.3 ×10-8) and from 35.9 to 37.8 kg/m2 in females (n = 260, p = 1.2 ×10-13). In females, the A allele was associated with a higher rate-of-change (0.150 kg/m2/year/allele, p = 1.7 ×10-4). Across 10-year age groups, mean BMI rate-of-change was lower in older participants. The BMI rate of change differed by genotype: it was, in females with AA genotype, approximately half that seen in GG and AG participants. In females lower baseline household asset scores were associated with a higher rate-of-change (p = 0.002). CONCLUSIONS In Samoans, the minor A allele of rs373863828 is associated with an increased rate-of-change in BMI in females. On average, BMI of females with the AA genotype increased 0.30 kg/m2/year more than of those with the GG genotype.
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Affiliation(s)
- Haoyi Fu
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicola L Hawley
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Epidemiology (Chronic Disease), School of Public Health, Yale University, New Haven, CT, USA
| | - Jenna C Carlson
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily M Russell
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alysa Pomer
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Hong Cheng
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Take Naseri
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Ministry of Health, Apia, Samoa
| | | | - Ranjan Deka
- Department of Environmental & Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Courtney C Choy
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Epidemiology (Chronic Disease), School of Public Health, Yale University, New Haven, CT, USA
| | - Stephen T McGarvey
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; Department of Anthropology, Brown University, Providence, RI, USA
| | - Ryan L Minster
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel E Weeks
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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20
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Victora CG, Hartwig FP, Vidaletti LP, Martorell R, Osmond C, Richter LM, Stein AD, Barros AJD, Adair LS, Barros FC, Bhargava SK, Horta BL, Kroker-Lobos MF, Lee NR, Menezes AMB, Murray J, Norris SA, Sachdev HS, Stein A, Varghese JS, Bhutta ZA, Black RE. Effects of early-life poverty on health and human capital in children and adolescents: analyses of national surveys and birth cohort studies in LMICs. Lancet 2022; 399:1741-1752. [PMID: 35489358 PMCID: PMC9061872 DOI: 10.1016/s0140-6736(21)02716-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/14/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022]
Abstract
The survival and nutrition of children and, to a lesser extent, adolescents have improved substantially in the past two decades. Improvements have been linked to the delivery of effective biomedical, behavioural, and environmental interventions; however, large disparities exist between and within countries. Using data from 95 national surveys in low-income and middle-income countries (LMICs), we analyse how strongly the health, nutrition, and cognitive development of children and adolescents are related to early-life poverty. Additionally, using data from six large, long-running birth cohorts in LMICs, we show how early-life poverty can have a lasting effect on health and human capital throughout the life course. We emphasise the importance of implementing multisectoral anti-poverty policies and programmes to complement specific health and nutrition interventions delivered at an individual level, particularly at a time when COVID-19 continues to disrupt economic, health, and educational gains achieved in the recent past.
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Affiliation(s)
- Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
| | - Fernando P Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luis P Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Linda M Richter
- Department of Science and Innovation, National Research Foundation Centre of Excellence in Human Development, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Fernando C Barros
- Post-Graduate Program of Health in the Life Cycle, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Maria F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Nanette R Lee
- USC Office of Population Studies Foundation, University of San Carlos, Cebu, Philippines
| | - Ana Maria B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | - Shane A Norris
- SAMRC Pathways for Health Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alan Stein
- MRC-Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Health Research Institute, Durban, South Africa
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
| | - Robert E Black
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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21
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Irache A, Gill P, Caleyachetty R. Intra‐household double burden of overweight/obesity and anaemia: Evidence from 49 low‐and middle‐income countries. MATERNAL & CHILD NUTRITION 2022; 18:e13298. [PMID: 34935294 PMCID: PMC8932724 DOI: 10.1111/mcn.13298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 10/23/2021] [Accepted: 11/03/2021] [Indexed: 12/28/2022]
Abstract
Globally, overweight/obesity is rising rapidly while anaemia persists. Nevertheless, evidence on their coexistence at the household level remains limited. Using data from the Demographic and Health Surveys, we quantified the magnitude, distribution and inequalities (i.e., estimates by wealth, education level and residence) in the intra‐household double burden (DBM) of overweight/obesity and anaemia among mothers and their children living in 49 low‐ and middle‐income countries (LMICs). The pooled prevalence of total intra‐household DBM was 17.2% (95% confidence interval [CI]: 15.6, 18.8); 16.2% (95% CI: 14.6, 17.9) for mothers with overweight/obesity and children with anaemia; and 2.8% (95% CI: 2.5, 3.1) for mothers with anaemia and children with overweight/obesity. South Africa had the highest prevalence of total DBM at the household level, affecting almost one in three households. Households with mothers with overweight/obesity and children with anaemia followed an inverse social gradient, with higher estimates found in the richest quintile, highest maternal education level and in urban areas; although with some variation across regions. The opposite was observed for mothers with anaemia and children with overweight/obesity. The largest inequality gaps were found for mothers with overweight/obesity and children with anaemia in Togo by household wealth (29.3%‐points; p < 0.001), in Ghana by maternal education level (28.0%‐points; p = 0.001) and in Niger by area of residence (25.2%‐points; p < 0.001). Although double‐duty actions might help accelerate action towards reducing malnutrition in all its forms, a comprehensive assessment of the causes of anaemia is first warranted to design effective country‐specific programmes. Using anthropometric and anaemia data from 49 low‐ and middle‐income countries, we found an overall pooled prevalence of total intra‐household double burden of malnutrition of 17.2%, with South Africa bearing the highest burden. The prevalence of mothers with overweight/obesity and children with anaemia ranged from 3.1% (Ethiopia) to 42.2% (South Africa), and was higher in the richest quintile, highest maternal education level and in urban areas. Mothers with anaemia and children with overweight/obesity was low (<9.0% in all countries).
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Affiliation(s)
- Ana Irache
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School University of Warwick Coventry UK
| | - Paramjit Gill
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School University of Warwick Coventry UK
| | - Rishi Caleyachetty
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School University of Warwick Coventry UK
- Nuffield Department of Medicine University of Oxford Oxford UK
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22
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Riva-Moscoso A, Martinez-Rivera RN, Cotrina-Susanibar G, Príncipe-Meneses FS, Urrunaga-Pastor D, Salinas-Sedo G, Toro-Huamanchumo CJ. Factors Associated with Nutritional Deficiency Biomarkers in Candidates for Bariatric Surgery: A Cross-Sectional Study in a Peruvian High-Resolution Clinic. Nutrients 2021; 14:nu14010082. [PMID: 35010957 PMCID: PMC8747094 DOI: 10.3390/nu14010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) ≥30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 ± 10.3 years and mean hemoglobin and albumin values of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26–2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24–3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35–4.35; p = 0.003), participants with a BMI ≥40 kg/m2 (aPR = 1.68; 95%CI: 1.09–2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01–2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52–0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery.
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Affiliation(s)
- Adrian Riva-Moscoso
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru; (A.R.-M.); (F.S.P.-M.)
| | - Raisa N. Martinez-Rivera
- Facultad de Ciencias de la salud, Escuela Profesional de Medicina Humana, Universidad Nacional de Piura, Piura 20002, Peru;
| | | | | | - Diego Urrunaga-Pastor
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Carrera de Medicina Humana, Lima 15067, Peru
- Correspondence: (D.U.-P.); (C.J.T.-H.)
| | | | - Carlos J. Toro-Huamanchumo
- Unidad de Investigación Multidisciplinaria, Clínica Avendaño, Lima 15074, Peru;
- Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15012, Peru
- Correspondence: (D.U.-P.); (C.J.T.-H.)
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23
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Oluyombo R, Banjo Oguntade H, Soje M, Obajolowo O, Karim M. Obesity and CKD in Sub-Saharan Africa: A Narrative Review. Kidney Med 2021; 4:100403. [PMID: 35243313 PMCID: PMC8861962 DOI: 10.1016/j.xkme.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Obesity is a major public health problem in the developed world, where it has reached an epidemic status over the last few decades. In parallel with this, the prevalence of chronic kidney disease (CKD) has increased. Although obesity is a risk factor for hypertension and diabetes, it is also independently associated with the development and progression of CKD. Two-third of patients with CKD worldwide will be residents of developing countries by the year 2030. Risk factors for CKD are prevalent in the sub-Saharan Africa region; this review discusses the available data regarding the relationship between obesity and CKD. The prevalence of CKD appears to correlate with increasing adiposity in sub-Saharan Africa; however, limited data are currently available, and the analysis of this association is further complicated by a variety of parameters used to define obesity. (eg, body mass index vs waist circumference). Longer, large-scale studies are needed to inform the prevalence and kidney implications of obesity in sub-Saharan Africa.
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24
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Matos SMA, Amorim LDAF, Pitanga FJG, Patrão AL, Barreto SM, Chor D, Cardoso LDO, Molina MDCB, Barreto ML, Aquino EML. Social position and anthropometric status among adults in the ELSA-Brasil study: a latent class analysis. CAD SAUDE PUBLICA 2021; 37:e00168918. [PMID: 34669771 DOI: 10.1590/0102-311x00168918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/27/2020] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study was to evaluate the association between social position and anthropometric status in women and men Brazilian adult. This was a cross-sectional study that used baseline data collected from 2008 to 2010 for the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, in Portuguese), in the six major Brazilian state capital cities. A total of 15,105 active and retired civil servants aged from 35 to 74 years. Two latent variables were defined by latent class analysis, social position and anthropometric status. Both constructs and the analyses were separately evaluated by sex. Associations were assessed using multivariate logistic regression analysis with adjustment for age, self-reported skin color/race, and marital status. Around 44% of the women and 26% of the men were classified as overweight or obese. Social position tended to be lower in women (43.2%) and higher among men (40.4%). Heavier women were more likely to be black and brown-skinned, whereas slimmer women were more likely to be white. After adjustment, women's weight increased as social position decreased (OR = 1.52; 95%CI: 1.36-1.70), whereas in men weight decreased as social position decreased (OR = 0.87; 95%CI: 0.76-0.99). Social position affected the anthropometric status of women and men differently, with body patterns also being affected by ethnicity/skin color, showing the potentiality of taking the intersectional perspective when investigating the possible social determinants of the phenomenon.
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Affiliation(s)
| | | | | | - Ana Luísa Patrão
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Dora Chor
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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25
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Wells JCK, Marphatia AA, Amable G, Siervo M, Friis H, Miranda JJ, Haisma HH, Raubenheimer D. The future of human malnutrition: rebalancing agency for better nutritional health. Global Health 2021; 17:119. [PMID: 34627303 PMCID: PMC8500827 DOI: 10.1186/s12992-021-00767-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 09/15/2021] [Indexed: 01/11/2023] Open
Abstract
The major threat to human societies posed by undernutrition has been recognised for millennia. Despite substantial economic development and scientific innovation, however, progress in addressing this global challenge has been inadequate. Paradoxically, the last half-century also saw the rapid emergence of obesity, first in high-income countries but now also in low- and middle-income countries. Traditionally, these problems were approached separately, but there is increasing recognition that they have common drivers and need integrated responses. The new nutrition reality comprises a global ‘double burden’ of malnutrition, where the challenges of food insecurity, nutritional deficiencies and undernutrition coexist and interact with obesity, sedentary behaviour, unhealthy diets and environments that foster unhealthy behaviour. Beyond immediate efforts to prevent and treat malnutrition, what must change in order to reduce the future burden? Here, we present a conceptual framework that focuses on the deeper structural drivers of malnutrition embedded in society, and their interaction with biological mechanisms of appetite regulation and physiological homeostasis. Building on a review of malnutrition in past societies, our framework brings to the fore the power dynamics that characterise contemporary human food systems at many levels. We focus on the concept of agency, the ability of individuals or organisations to pursue their goals. In globalized food systems, the agency of individuals is directly confronted by the agency of several other types of actor, including corporations, governments and supranational institutions. The intakes of energy and nutrients by individuals are powerfully shaped by this ‘competition of agency’, and we therefore argue that the greatest opportunities to reduce malnutrition lie in rebalancing agency across the competing actors. The effect of the COVID-19 pandemic on food systems and individuals illustrates our conceptual framework. Efforts to improve agency must both drive and respond to complementary efforts to promote and maintain equitable societies and planetary health.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, Population Policy and Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | | | - Gabriel Amable
- Department of Geography, University of Cambridge, Cambridge, UK
| | - Mario Siervo
- School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hinke H Haisma
- Population Research Centre, Department of Demography, University of Groningen, Groningen, the Netherlands
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26
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Kim JM, Lee E. Association between Soft-Drink Intake and Obesity, Depression, and Subjective Health Status of Male and Female Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910415. [PMID: 34639714 PMCID: PMC8507828 DOI: 10.3390/ijerph181910415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/18/2022]
Abstract
This study explores the association between soft-drink intake and obesity, depression, and subjective health status in male and female adults. Soft-drink consumption has become a serious public health issue worldwide. Participants of this study were selected (n = 3086) from the respondents in the Seventh Korea National Health and Nutrition Examination Survey 2016 and divided into the non-soft-drink group (men, 502; women, 1117) and the soft-drink group (men, 684; women, 783). Soft-drink intake data were obtained, using a validated quantitative food frequency questionnaire and the 24 h dietary recall. Total energy intake and fat density were significantly higher, but the nutrient densities of carbohydrate, total dietary fiber, and micronutrients were significantly lower in the soft-drink group than in the non-soft-drink group. In men, soft-drink intake was found to be significantly associated with a lower risk of depression. Conversely, in women, soft-drink intake was found to be significantly associated with the higher risks of depression, obesity, and poor subjective health status. Therefore, less frequent soft-drink intake may prevent obesity and depression in Korean women.
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Affiliation(s)
- Ji-Myung Kim
- Food and Nutrition Major, Division of Food Science & Culinary Arts, Shinhan University, Uijeongbu-si 11644, Gyeonggi-do, Korea;
| | - EunJung Lee
- Food and Nutrition Major, School of Wellness Industry Convergence, Hankyong National University, Anseong-si 17579, Gyeonggi-do, Korea
- Correspondence: ; Tel.: +82-31-670-5185
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27
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Khaled K, Hundley V, Tsofliou F. Poor Dietary Quality and Patterns Are Associated with Higher Perceived Stress among Women of Reproductive Age in the UK. Nutrients 2021; 13:2588. [PMID: 34444749 PMCID: PMC8399887 DOI: 10.3390/nu13082588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to investigate the association between stress and diet quality/patterns among women of reproductive age in UK. In total, 244 reproductive aged women participated in an online survey consisting of the European Prospective into Cancer and Nutrition food frequency questionnaire in addition to stress, depression, physical-activity, adiposity, and socioeconomic questions. An a-priori diet quality index was derived by assessing the adherence to Alternate Mediterranean Diet (aMD). A-posteriori dietary-patterns (DPs) were explored through factor analysis. Regression models were used to assess the predictors of the DPs. Participants mainly had medium (n = 113) aMD adherence. Higher stress levels were reported by participants with low aMD adherence. Participants with high aMD adherence were of normal BMI. Factor analysis revealed three DPs: fats and oils, sugars, snacks, alcoholic-beverages, red/processed meat, and cereals (DP-1), fish and seafood, eggs, milk and milk-products (DP-2), and fruits, vegetables, nuts and seeds (DP-3). Regression models showed that DP-1 was positively associated with stress (p = 0.005) and negatively with age (p = 0.004) and smoking (p = 0.005). DP-2 was negatively associated with maternal educational-level (p = 0.01) while DP-3 was negatively associated with stress (p < 0.001), BMI (p = 0.001), and white ethnicity (p = 0.01). Stress was negatively associated with healthy diet quality/patterns among reproductive aged women.
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Affiliation(s)
- Karim Khaled
- Department of Rehabilitation & Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK;
| | - Vanora Hundley
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK;
| | - Fotini Tsofliou
- Department of Rehabilitation & Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK;
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK;
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Tumas N, Rodríguez López S, Bilal U, Ortigoza AF, Diez Roux AV. Urban social determinants of non-communicable diseases risk factors in Argentina. Health Place 2021; 77:102611. [PMID: 34210611 PMCID: PMC8714870 DOI: 10.1016/j.healthplace.2021.102611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022]
Abstract
We examined associations of individual-, neighborhood- and city-level education -as proxies of SES at different levels-, with diabetes, hypertension, obesity, smoking and binge drinking (non-communicable disease risk factors -NCD/RF) among Argentinian adults. We estimated mixed models based on 21,415 individuals from the 2013 National Survey of Risk Factors, living in 2,698 neighborhoods and 33 cities. Gradients by individual-level education differed by gender and NCD/RF, and some were modified by city education. In addition, we identified contextual effects of neighborhood and city education on some NCD/RF. Urban efforts to tackle NCD/RF in Argentina should be context- and gender-sensitive, and mainly focused on socially disadvantaged groups.
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Affiliation(s)
- Natalia Tumas
- Departament de Ciències Polítiques i Socials, Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Argentina.
| | - Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Argentina; Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Argentina.
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
| | - Ana F Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
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Jang HJ, Oh H. Trends and Inequalities in Overall and Abdominal Obesity by Sociodemographic Factors in Korean Adults, 1998-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084162. [PMID: 33920007 PMCID: PMC8070993 DOI: 10.3390/ijerph18084162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022]
Abstract
Few studies have comprehensively examined the nationwide trends in overall and abdominal obesity prevalence and related sociodemographic inequalities in Korea. In the Korea National Health and Nutrition Examination Survey 1998–2018, we estimated the age-standardized prevalence of overall (body mass index ≥ 25 kg/m2) and abdominal obesity (waist circumference ≥ 90 cm men, ≥85 cm women) in each sociodemographic subgroup of Korean adults (aged 19–79 years). For each survey year, weighted logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between obesity prevalence and sociodemographic factors. During the study period, the prevalence of overall and abdominal obesity increased in men (24.8% to 42.4%; 20.1% to 32.1%; respectively) but only a small change was observed in women (26.5% to 26.0%; 22.7% to 20.9%; respectively). Obesity prevalence increased in all sociodemographic groups of men but varied across groups in women. In women, income (4th vs. 1st quartiles in 2016–2018: OR (95% CI) = 0.66 (0.56–0.78) overall obesity; 0.60 (0.51–0.71) abdominal obesity) and education (college or higher vs. high school or less: 0.62 (0.54–0.72) overall obesity; 0.58 (0.50–0.68) abdominal obesity) were inversely associated with obesity prevalence, and the gaps became more pronounced since 2007. Our data suggest that the inequalities in obesity prevalence by sex and by socioeconomic status have become more apparent over time in Korea.
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Affiliation(s)
- Ha-Jin Jang
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Korea;
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Korea;
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul 02841, Korea
- Correspondence: ; Tel.: +82-2-3290-5678
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Thapa R, Dahl C, Aung WP, Bjertness E. Urban-rural differences in overweight and obesity among 25-64 years old Myanmar residents: a cross-sectional, nationwide survey. BMJ Open 2021; 11:e042561. [PMID: 33653748 PMCID: PMC7929804 DOI: 10.1136/bmjopen-2020-042561] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To investigate whether urban-rural location and socioeconomic factors (income, education and employment) are associated with body mass index (BMI) and waist-hip ratio (W/H-ratio), and to further explore if the associations between urban-rural location and BMI or W/H-ratio could be mediated through variations in socioeconomic factors. DESIGN Cross-sectional, WHO STEPS survey of non-communicable disease risk factors. SETTING Urban and rural areas of Myanmar. PARTICIPANTS A total of 8390 men and women aged 25 to 64 years included during the study period from September to December 2014. Institutionalised people (Buddhist monks and nuns, hospitalised patients) and temporary residents were excluded. RESULTS The prevalence of overweight and obesity was higher in the urban areas and increased with increasing socioeconomic status (SES) score. Mean BMI was higher among urban residents (ß=2.49 kg/m2; 95% CI 2.28 to 2.70; p<0.001), individuals living above poverty line, that is, ≥US$1.9/day (ß=0.74 kg/m2; 95% CI 0.43 to 1.05; p<0.001), and those with high education attainment (ß=1.48 kg/m2; 95% CI 1.13 to 1.82; p<0.001) when adjusting for potential confounders. Similarly, greater W/H-ratio was observed in participants living in an urban area, among those with earnings above poverty line, and among unemployed individuals. The association between urban-rural location and BMI was found to be partially mediated by a composite SES score (9%), income (17%), education (16%) and employment (16%), while the association between urban-rural location and W/H-ratio was found to be partially mediated by income (12%), education (6%) and employment (6%). CONCLUSION Residents living in urban locations had higher BMI and greater W/H-ratio, partially explained by differences in socioeconomic indicators, indicating that socioeconomic factors should be emphasised in the management of overweight and obesity in the Myanmar population. Furthermore, new national or subnational STEPS surveys should be conducted in Myanmar to observe the disparity in trends of the urban-rural differential.
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Affiliation(s)
- Rupa Thapa
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wai Phyo Aung
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Occupational and Environmental Health Division, Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Nowak-Szczepanska N, Gomula A, Chakraborty R, Koziel S. Nutritional and weight status of Indian mother-child dyads experienced by a natural disaster. MATERNAL AND CHILD NUTRITION 2021; 17:e13164. [PMID: 33630397 PMCID: PMC8189233 DOI: 10.1111/mcn.13164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 01/07/2023]
Abstract
Natural disasters have detrimental effects not only on local infrastructure in an affected population but may also have an impact on the human biological condition, particularly during critical periods of life. This study aimed to assess the nutritional and weight status of women and their children who had experienced cyclone Aila prenatally and postnatally in comparison with a non-affected neighbouring group. The study sample involved N = 597 dyads consisting of mothers and their prepubertal children prenatally or postnatally (during infancy) exposed to a natural disaster and a control group from a neighbouring region (West Bengal, India). The analysed anthropometric indices involved body mass index (BMI) and mid-upper arm circumference (MUAC). Moreover, several socioeconomic characteristics were collected (mother's and father's education, family size and family income). Analyses revealed that the group factor (Aila-exposed or non-exposed groups) had the highest impact on both children's and their mothers' BMI and MUAC (p < 0.001) in comparison with socioeconomic variables. Surprisingly, both mothers and their children revealed deteriorated nutritional and relative weight status several years after the occurrence of cyclone Aila, which is in opposition to the results obtained in developed countries, where prenatal maternal stress caused by the natural disaster led to the subsequent higher risk of excessive weight in affected children.
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Affiliation(s)
- Natalia Nowak-Szczepanska
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Aleksandra Gomula
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Raja Chakraborty
- Department of Anthropology, Dinabandhu Mahavidyalaya, Bongaon, West Bengal, India
| | - Slawomir Koziel
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
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Fooken J, Vo LK. Exploring the macroeconomic and socioeconomic determinants of simultaneous over and undernutrition in Asia: An analysis of stunted child - overweight mother households. Soc Sci Med 2021; 269:113570. [DOI: 10.1016/j.socscimed.2020.113570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/24/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
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Elia C, Karamanos A, Dregan A, O’Keeffe M, Wolfe I, Sandall J, Morgan C, Cruickshank JK, Gobin R, Wilks R, Harding S. Association of macro-level determinants with adolescent overweight and suicidal ideation with planning: A cross-sectional study of 21 Latin American and Caribbean Countries. PLoS Med 2020; 17:e1003443. [PMID: 33373361 PMCID: PMC7771665 DOI: 10.1371/journal.pmed.1003443] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/09/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Adolescents and young people (10-24 years old) in the Latin America and the Caribbean (LAC) region represent approximately 25% of the region's population. Since the 2008 global economic crisis, the pace of reduction in poverty and income inequality in the LAC region has stalled. The region is characterised by high levels of inequities and is also vulnerable to many natural disasters. Food systems are changing with increased availability and marketing of packaged and fast foods and sugar-sweetened drinks. Adolescence is a formative phase of the life course with multiple physical, emotional and social changes which can make them vulnerable to health problems. We assess the potential impact of macro-determinants, human and economic development as well as income inequality, on 2 top-ranking regional priorities for adolescent nutrition and mental health, using measures of overweight and suicidal ideation and planning which some have shown to be associated. METHODS AND FINDINGS The Global School-based Health Survey (GSHS) is a nationally representative self-administered, school-based survey. We examined overweight/obesity and suicidal ideation with planning by gross domestic product (GDP) per capita or human development index (HDI) in 10-19-year-old adolescents from 21 LAC countries between 2009 and 2013. Sample sizes varied from 943 in Anguilla to 27,988 in Argentina. A total of 55,295 adolescents had a measure of overweight/obesity status, and 59,061 adolescents reported about suicidal ideation with planning. There was equal representation by sex in the surveys (52% girls and 48% boys). A total of 28.8% of boys and 28.1% of girls had overweight/obesity, and 7.5% of boys and 17.5% of girls reported suicidal ideation with planning over the last 12 months. Adjusted for individual socioeconomic and risk behaviours, and relative to the highest GDP per capita tertile, the middle tertile was associated with 42% (95% confidence interval (CI) 59% to 17%, p = 0.003) and 32% (95% CI 60% to 5%, p = 0.023), and the lowest tertile with 40% (95% CI 55% to 19%, p = 0.001) and 46% (95% CI 59% to 29%, p < 0.001) lower chances of overweight/obesity for girls and boys, respectively. A similar positive effect was seen with HDI, with lowest chances of overweight in the lowest tertile compared with the highest tertile for both sexes. Overweight/obesity was positively related with suicidal ideation with planning for girls (odds ratio (OR) 1.12, 95% CI 1.02 to 1.22, p = 0.009) and weakly related for boys (OR 1.09, 95% CI 0.96 to 1.24, p = 0.182). In contrast to overweight/obesity status, suicidal ideation with planning was not related to macro-level indices despite both outcomes sharing common individual socioeconomic and risk behaviour correlates. Limitations include the dominance of Argentinians in the sample (40%), the exclusion of vulnerable adolescents who dropped out of school, and reporting bias due to stigma of mental health-related issues. CONCLUSIONS This study shows that economic and human development were positively associated with adolescent overweight/obesity but not with suicidal ideation with planning. We also observed an interconnectedness between overweight/obesity and suicide ideation with planning among girls. These findings highlight the importance of strategies that engage with both upstream and downstream determinants to improve adolescent nutrition and mental health.
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Affiliation(s)
- Christelle Elia
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Alexis Karamanos
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Alexandru Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Majella O’Keeffe
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Ingrid Wolfe
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Jane Sandall
- School of Life Course Sciences, Faculty of Life Sciences & Medicine, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Craig Morgan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - J. Kennedy Cruickshank
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
| | - Reeta Gobin
- Faculty of Medicine, University of Guyana, Guyana
| | - Rainford Wilks
- Faculty of Medicine, University of the West Indies, Jamaica
| | - Seeromanie Harding
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, United Kingdom
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Deprivation or discrimination? Comparing two explanations for the reverse income-obesity gradient in the US and South Korea. J Biosoc Sci 2020; 54:1-20. [PMID: 33153504 DOI: 10.1017/s0021932020000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In high-income countries, poverty is often associated with higher average body mass index (BMI). To account for this reverse gradient, deprivation theories posit that declining economic resources make it more difficult to maintain a healthy weight. By contrast, discrimination theories argue that anti-fat discrimination in hiring and marriage sorts heavier individuals into lower-income households. This study assesses competing predictions of these theories by examining how household income in representative samples from South Korea (2007-2014, N=20,823) and the US (1999-2014, N=6395) is related to BMI in two key contrasting groups: (1) currently-married and (2) never-married individuals. As expected by anti-fat discrimination in marriage, the reverse gradient is observed among currently-married women but not among never-married women in both countries. Also consistent with past studies no evidence was found for a reverse gradient among men. These findings are consistent with anti-fat discrimination in marriage as a key cause of the reverse gradient and raise serious challenges to deprivation accounts as well as explanations based on anti-fat discrimination in labour markets.
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Najafi F, Naderpour S, Moradinazar M, Khoramdad M, Vahedian-Azimi A, Jamialahmadi T, Sahebkar A. Percentiles for anthropometric measures in 11-18 years-old students of 73 developing countries. Diabetes Metab Syndr 2020; 14:1957-1962. [PMID: 33045540 DOI: 10.1016/j.dsx.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS one of the health concerns for any society is to have its own standard of growth. The aim of this study was to provide the age- and sex-specific percentile values of anthropometric measures for adolescents of developing countries. The use of global percentiles in developing countries overestimates underweight and stunting while underestimates overweight and obesity. METHODS The data were obtained from the Global School-based Student Health Survey (GSHS). This study was conducted on school students, selected by multistage random cluster sampling from 73 developing countries. A parametric method was used for constructing age-specific reference intervals (normal ranges). RESULTS In general, 210,045 11-18 years-old schoolchildren (14.38 ± 1.39) from 73 developing countries between 2003 and 2014 were included in this study, among which 103,080 (49.08%) were male and 106,965 (50.92%) were female. Calculation of body mass index (BMI) percentile showed that for all BMI percentile curves of both sexes, there was a gradual increase up to the age of around 15 years, and then remain stable (except for 95th percentile). Moreover in all weight percentile curves of boys, except 90th and above, there was a slight rise until the age of 18 years. In 10th height percentile curves and above in boys, there was a sharp increase up to the age of 17, followed by a decline. Similarly, this pattern was found for 50th height percentile and above in girls. CONCLUSION The use of global percentiles in developing countries overestimates underweight and stunting while underestimates overweight and obesity.
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Affiliation(s)
- Farid Najafi
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sara Naderpour
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moradinazar
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Malihe Khoramdad
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Tannaz Jamialahmadi
- Department of Food Science and Technology, Quchan Branch, Islamic Azad University, Quchan, Iran; Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Halal Research Center of IRI, FDA, Tehran, Iran
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Zhou L, Cao D, Si Y, Zhu X, Du L, Zhang Y, Zhou Z. Income-related inequities of adult obesity and central obesity in China: evidence from the China Health and Nutrition Survey 1997-2011. BMJ Open 2020; 10:e034288. [PMID: 33127627 PMCID: PMC7604817 DOI: 10.1136/bmjopen-2019-034288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 07/29/2020] [Accepted: 09/18/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES The aim of this study was to analyse the status regarding inequities in adult obesity and central obesity in China. Thus, income-related inequality for both diseases and the underlying factors were examined. METHODS AND DESIGN The China Health and Nutrition Survey (CHNS)-conducted from 1997 to 2011-included 128 307 participants; in this study, 79 566 individuals classified as obese and 65 250 regarded as suffering from central obesity according to the CHNS were analysed. A body mass index greater than 27 was considered indicative of obesity; men and women with a waist circumference of more than 102 cm and 80 cm, respectively, were considered as suffering from central obesity. The concentration index was employed to analyse inequality in adult obesity and central obesity. The decomposition of this index based on a probit model was used to calculate the horizontal inequality index. RESULTS The prevalence of adult obesity increased from 8.34% in 1997 to 17.74% in 2011, and that of central obesity increased from 6.52% in 1997 to 16.79% in 2011. The horizontal inequality index for adult obesity decreased from 0.1377 in 1997 to 0.0164 in 2011; for central obesity, it decreased from 0.0806 in 1997 to -0.0193 in 2011. The main causes of inequality for both diseases are, among others, economic status, marital status and educational attainment. CONCLUSIONS From 1997 to 2011, the prevalence of adult obesity and central obesity increased annually. The pro-rich inequalities in both adult and central obesity decreased from 1997 to 2011. The inequality in central obesity was more prominent in the low-income group in 2011. Future policies may need to address obesity reduction among the poor.
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Affiliation(s)
- Ling Zhou
- Health Science Center, School of Public Health, Xi'an Jiaotong University, Xi'an, China
- School of Public Health, Dalian Medical University, Dalian, China
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Yafei Si
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, New South Wales, Australia
| | - Xuexue Zhu
- School of Public Health, Dalian Medical University, Dalian, China
| | - Liang Du
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yu Zhang
- School of Public Health, Dalian Medical University, Dalian, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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Chung W, Kim R. A Reversal of the Association between Education Level and Obesity Risk during Ageing: A Gender-Specific Longitudinal Study in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186755. [PMID: 32948024 PMCID: PMC7559988 DOI: 10.3390/ijerph17186755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
This study aimed to examine and quantify obesity risk across different education levels during ageing using the dataset of a nationally representative longitudinal survey. A total of 45,391 observations of 9991 individuals aged ≥45 years were included in this study. Obesity was defined as a body mass index of ≥25, according to a guideline for Asians by the World Health Organization, and education level was grouped into three categories. Socio-demographics, lifestyles, and health conditions were used as covariates. Adjusted odds ratios and predicted probabilities of obesity were computed and adjusted for a complex survey design. With respect to gender, education level and age were significantly associated with obesity risk, and the association was stronger in women than in men. Furthermore, education level was negatively associated with obesity risk in the middle age in each gender. However, the association became positive in the old age, specifically among highly educated women. Therefore, policy efforts to reduce obesity risk and the resulting education gradients should be established based on studies considering their old age. Further longitudinal studies are required to examine whether these findings are valid in other socio-cultural or economic settings.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea;
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Roeul Kim
- Labor Welfare Research Institute, Korea Workers’ Compensation and Welfare Service, Seoul 07254, Korea
- Correspondence: ; Tel.: +82-2-2670-0448
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Differentiating effects of socio-economic factors on relative weight and nutritional status in Polish schoolchildren across intergenerational changes. Public Health Nutr 2020; 23:2904-2914. [PMID: 32662363 DOI: 10.1017/s1368980020001706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was an assessment of the effects of urbanisation level, family size and parental education on body mass index (BMI) and mid-upper arm circumference (MUAC) among Polish schoolchildren in cross-sectional surveys conducted between 1966 and 2012. DESIGN The analysis involved schoolchildren measured in four Polish Anthropological Surveys (1966, 1978, 1988 and 2012). Socio-economic factors involved: urbanisation level (city, town and village), family size (one child, two children, three children, four or more children), and father's and mother's education (lower and higher education). SETTING Regions in Poland - cities: Warsaw, Lodz and Wroclaw; towns: Bystrzyca Klodzka, Pinczow, Siemiatycze, Wolsztyn and their rural surroundings. PARTICIPANTS A total sample consisted of 63 757 children (31 774 boys and 31 983 girls) aged 7-18 years. RESULTS Between 1966 and 1988, both BMI and MUAC had significantly higher values in children from cities, in families with one child and with higher parental education (P < 0·05). However, MUAC revealed significant differences between particular socio-economic groups more frequently than BMI. In 2012, urbanisation level and parental education ceased to show a differentiating effect on both indicators, while family size remained a significant social factor for both measures (BMI: P < 0·05; MUAC: P < 0·01). CONCLUSIONS Since MUAC reflected socio-economic differences more frequently than BMI, it could be a more sensitive and reliable anthropometric measure revealing the effects of socio-economic factors on children's nutritional status.
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Adisasmito W, Amir V, Atin A, Megraini A, Kusuma D. Geographic and socioeconomic disparity in cardiovascular risk factors in Indonesia: analysis of the Basic Health Research 2018. BMC Public Health 2020; 20:1004. [PMID: 32586296 PMCID: PMC7318418 DOI: 10.1186/s12889-020-09099-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/12/2020] [Indexed: 01/19/2023] Open
Abstract
Background Cardiovascular diseases (CVDs) accounted for over 17 million deaths and 353 million disability-adjusted life years lost in 2016. The risk factors are also high and increasing with high blood pressure, smoking, and high body mass index contributed to up to 212 million disability-adjusted life years in 2016. To help reduce the burden, it is crucial to understand the geographic and socioeconomic disparities in CVD risk factors. Methods Employing both geospatial and quantitative analyses, we analyzed the disparities in the prevalence of smoking, physical inactivity, obesity, hypertension, and diabetes in Indonesia. CVD data was from Riskesdas 2018, and socioeconomic data was from the World Bank. Results Our findings show a very high prevalence of CVD risk factors with the prevalence of smoking, physical activity, obesity, hypertension ranged from 28 to 33%. Results also show the geographic disparity in CVD risk factors in all five Indonesian regions. Moreover, results show socioeconomic disparity with the prevalence of obesity, hypertension, and diabetes are higher among urban and the richest and most educated districts while that physical inactivity and smoking is higher among rural and the least educated districts. Conclusion The CVD burden is high and increasing in particularly among urban areas and districts with higher income and education levels. While the government needs to continue tackling the persistent burden from maternal mortality and infectious diseases, they need to put more effort into the prevention and control of CVDs and their risk factors.
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Affiliation(s)
- Wiku Adisasmito
- Faculty of Public Health, University of Indonesia, Depok, Indonesia.,Indonesia One Health University Network (INDOHUN), University of Indonesia, Depok, Indonesia
| | - Vilda Amir
- Indonesia One Health University Network (INDOHUN), University of Indonesia, Depok, Indonesia
| | - Anila Atin
- Indonesia One Health University Network (INDOHUN), University of Indonesia, Depok, Indonesia
| | - Amila Megraini
- Faculty of Public Health, University of Indonesia, Depok, Indonesia
| | - Dian Kusuma
- Centre for Health Economics and Policy Innovation, Imperial College Business School, South Kensington Campus, London, SW7 2AZ, UK.
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Meisel JD, Ramirez AM, Esguerra V, Montes F, Stankov I, Sarmiento OL, Valdivia JA. Using a system dynamics model to study the obesity transition by socioeconomic status in Colombia at the country, regional and department levels. BMJ Open 2020; 10:e036534. [PMID: 32499271 PMCID: PMC7282389 DOI: 10.1136/bmjopen-2019-036534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE We study the obesity transition by socioeconomic status (SES), gender and age within the Colombian urban population at the country, regional and department levels. DESIGN The study is informed by cross-sectional data from the 2005 and 2010 ENSIN survey. We used these data to develop a system dynamics model that simulates the dynamics of obesity by body mass index (BMI) categories, gender and SES at the country, regional and department levels from 2005 to 2030. PARTICIPANTS The sample size of the 2005 ENSIN comprised 8515 children younger than 5 years, 32 009 children and adolescents aged 5-17 years and 48 056 adults aged 18-64 years. In 2010, the corresponding numbers were 11 368, 32 524 and 64 425, respectively. PRIMARY AND SECONDARY OUTCOME MEASURE The obesity prevalence ratio and prevalence rates for each BMI category. RESULTS The results show, at the country level, transitions from overweight to obesity were projected to increase sharply among lower SES adults, particularly among women, suggesting that these groups will undergo an obesity transition by 2030. The model projections also indicate that the regions of Colombia are in different stages of the obesity transition. In the case of women, five out of the six regions were expected to undergo an obesity transition by SES over time. For men, only one region was expected to undergo an obesity transition. However, at the department level, trends in the burden of obesity varied. CONCLUSIONS We evidence that the Colombian population could be experiencing an obesity transition where the increase in the GDP could be related to shifts in the burden of obesity from higher to lower SES, especially in women. These patterns support the need for policy planning that considers SES and gender, at the national and subnational levels, as important determinants of overweight and obesity among adults in Colombia.
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Affiliation(s)
- Jose D Meisel
- Facultad de Ingeniería, Universidad de Ibague, Ibagué, Tolima, Colombia
| | - Angie M Ramirez
- Facultad de Ingeniería, Universidad de Ibague, Ibagué, Tolima, Colombia
| | - Valentina Esguerra
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Bogota, Colombia
| | - Felipe Montes
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de los Andes, Bogota, Colombia
| | - Ivana Stankov
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Olga L Sarmiento
- Department of Public Health, School of Medicine, Universidad de los Andes, Bogota, Colombia
| | - Juan A Valdivia
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Santiago de Chile, Chile
- Centro para el Desarrollo de la Nanociencia y la Nanotecnología, CEDENNA, Santiago de Chile, Chile
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Childhood Obesity and Overweight in Ghana: A Systematic Review and Meta-Analysis. J Nutr Metab 2020; 2020:1907416. [PMID: 32322414 PMCID: PMC7168721 DOI: 10.1155/2020/1907416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/28/2020] [Accepted: 03/10/2020] [Indexed: 12/26/2022] Open
Abstract
The increasing prevalence of childhood obesity and overweight is considered a public health issue in both developed and developing countries. This systematic review and meta-analysis estimates the prevalence of childhood obesity and overweight in Ghana. A multiple database search was conducted for articles published between January 1, 2001, and October 31, 2019, reporting the prevalence of childhood obesity and overweight in Ghana. Databases searched include PubMed, Google Scholar, Scopus, Cochrane Library, World Health Organization (WHO) Library Information System, and Africa Journals Online. Data were pooled from the articles to calculate an overall estimate of childhood obesity and overweight using a random-effects model after variance stabilization with Freeman–Tukey double arcsine transformation. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixteen studies with a combined sample size of 29,160 were included in the review. Analysis indicates that approximately 19% of children in Ghana either have obesity or are overweight. The prevalence of childhood obesity and overweight was 8.6% (95% CI: 4.8%–13.4%) and 10.7% (95% CI: 5.9%–16.6%), respectively. Although not significant, higher obesity (4.6% vs. 2.6%) and overweight (11.0% vs. 7.2%) prevalence were estimated for females than for males. There was a significantly higher obesity prevalence estimate (17.4% vs. 8.9%) in rural settings than in urban settings (p=0.0255). The high prevalence of childhood obesity and overweight estimated in this review is of worrying concern. It is a significant public health problem that has implications on the health of present and future generations in Ghana and as such calls for proactive measures to be put in place. Also, the driving forces behind the increasing prevalence of childhood obesity in Ghana need to be investigated.
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Choy CC, Hawley NL, Naseri T, Reupena MS, McGarvey ST. Associations between socioeconomic resources and adiposity traits in adults: Evidence from Samoa. SSM Popul Health 2020; 10:100556. [PMID: 32140541 PMCID: PMC7044745 DOI: 10.1016/j.ssmph.2020.100556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/16/2022] Open
Abstract
In low- and middle-income countries, earlier in economic development, obesity tends to be more prevalent in high socioeconomic resource groups compared to low. Later in development, the distribution of obesity tends to show the opposite pattern, becoming more prevalent in those with low socioeconomic resources. This shift in obesity prevalence tends to occur between a gross national income per capita (GNI) of US$1,000 to $4,000 dollars. Whether a similar pattern occurs in Pacific Island countries has not been well documented. In Samoa, the GNI rose to US$3,200 dollars in 2010 at which time over 80% of adults were overweight or obese. We aimed to understand the association of socioeconomic resources, assessed by household assets, with adult body mass index (BMI) and abdominal circumference (AC) in Samoa. Data were from a genome-wide association study for obesity among 3,370 Samoans aged 24.5-<65 years in 2010. Household asset scores were calculated based on ownership of consumer durables, housing construction, and access to basic services. Sex-stratified multivariate linear regressions were used to assess adiposity trait differences by household asset ownership, after controlling for age, education, and household urbanicity. Higher asset ownership was associated with higher BMI and AC and the positive relationship remained robust after controlling for potential confounders. Despite significant economic growth preceding the year 2010 in Samoa, the obesity burden had not shifted to low socioeconomic groups in a similar way that has been observed in countries further along in the economic transition. The mechanism by which socioeconomic resources influence adiposity is complex and may be particularly complicated in Samoa by migrant remittances received both as cash and household assets. Social and physical environments may constrain the positive health behavior change necessary to reduce obesity even in the context of high socioeconomic position, a situation that requires further investigation.
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Affiliation(s)
- Courtney C. Choy
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA
| | | | | | - Stephen T. McGarvey
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI, 02903, USA
- Department of Anthropology, Brown University, Providence, RI, 02912, USA
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Malnutrition prevalence among children and women of reproductive age in Mexico by wealth, education level, urban/rural area and indigenous ethnicity. Public Health Nutr 2020; 23:s77-s88. [PMID: 32148210 DOI: 10.1017/s1368980019004725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the prevalence of malnutrition (undernutrition and excess weight) by wealth, education level, ethnicity and urban/rural areas in Mexican children and women of reproductive age. DESIGN We compared the prevalence of overweight, obesity, wasting/underweight, stunting/short stature and anaemia by socioeconomic and ethnic indicators. For each indicator, we estimated prevalence ratios (PR) adjusted by all other socioeconomic and ethnic indicators. We analysed if results differed by urban/rural areas. SETTING Mexican National Health and Nutrition Survey 2012. PARTICIPANTS Children <5 years, non-pregnant women 11-19 years and non-pregnant women 20-49 years (n 33 244). RESULTS In most age groups, belonging to non-indigenous households, with high wealth, high education and in urban areas were inversely associated with stunting or short stature (PR ranging from 0·40 to 0·83), and wealth and education were inversely associated with anaemia (PR ranging from 0·53 to 0·78). The prevalence of overweight was similar across subgroups among children <5 years; however, among women 11-19 years, wealth, non-indigenous household and urban areas were positively associated (PR ranging from 1·16 to 1·33); and among women 20-49 years, education was inversely associated (PR 0·83). CONCLUSIONS Socially disadvantaged populations have a higher prevalence of undernutrition, whereas the prevalence of excess weight is either equal (children <5 years), slightly lower (women 11-19 years) or even higher (women 20-49 years) with lower education. These results highlight the need for specific actions to address social inequalities in malnutrition in the Mexican population.
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Gao L, Ma L, Xue H, Min J, Wang H, Wang Y. A 3-year longitudinal study of effects of parental perception of children's ideal body image on child weight change: The Childhood Obesity Study in China mega-cities. Prev Med 2020; 132:105971. [PMID: 31899255 PMCID: PMC7024657 DOI: 10.1016/j.ypmed.2019.105971] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 12/24/2022]
Abstract
This study examined prevalence of childhood overweight and obesity (ov/ob) and central obesity in five mega-cities across China (Beijing, Shanghai, Xi'an, Nanjing and Chengdu); described parental perceptions of children's ideal body image (IBI); and prospectively examined associations between parental perception of child IBI and child weight changes over 3 years. In this NIH-funded, open cohort study, data were collected from students and their parents in 2015, 2016 and 2017 (n = 3298, in 3 waves). Cross-sectional analysis included all 3298 children; longitudinal data analysis used mixed effects models and included 1691 children aged 6-17 years with ≥two body mass index (BMI) measurements during 2015-2017. Ov/ob prevalence based on Chinese age-sex-specific BMI cut-points was 30.0%. Based on waist-to-height ratio (WHtR), the abdominal obesity rate was 19.8%. Parents reported different preferred IBI for boys vs girls, being about 3 times more likely to select ov/ob as ideal for boys than for girls (4.5% vs 1.5%, respectively, P < .001). In longitudinal analysis, children whose parents selected ov/ob as ideal had higher BMI Z-scores and WHtR increase over time than those whose parents selected an average body image (β [SE] = 0.042 [0.011], and β [SE] = 0.010 [0.004], respectively, all P < .05). Ov/ob rates were high among children in major cities in China. Chinese parents preferred a heavier ideal body image for their boys. Health promotion programs should help empower parents and their children to develop appropriate body images and maintain healthy body weight.
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Affiliation(s)
- Liwang Gao
- Global Health Institute, Xi'an Jiaotong University Health Science Center, China; School of Public Health, Xi'an Jiaotong University Health Science Center, China
| | - Lu Ma
- Global Health Institute, Xi'an Jiaotong University Health Science Center, China; School of Public Health, Xi'an Jiaotong University Health Science Center, China
| | - Hong Xue
- Department of Health Behavior and Policy, Virginia Commonwealth University, USA
| | - Jungwon Min
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, USA; Fisher Institute of Health and Well-Being, Department of Nutrition and Health Science, College of Health, Ball State University, USA
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, China
| | - Youfa Wang
- Global Health Institute, Xi'an Jiaotong University Health Science Center, China; School of Public Health, Xi'an Jiaotong University Health Science Center, China; Fisher Institute of Health and Well-Being, Department of Nutrition and Health Science, College of Health, Ball State University, USA.
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da Silva WR, Neves AN, Ferreira L, Campos JADB, Swami V. A psychometric investigation of Brazilian Portuguese versions of the Caregiver Eating Messages Scale and Intuitive Eating Scale-2. Eat Weight Disord 2020; 25:221-230. [PMID: 30076529 DOI: 10.1007/s40519-018-0557-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/27/2018] [Indexed: 11/27/2022] Open
Abstract
The Caregiver Eating Messages Scale (CEMS) was developed to assess perceived restrictive or critical caregiver messages in relation to food intake and pressure to eat, whereas the Intuitive Eating Scale-2 (IES-2) measures one's tendency to follow internal cues of hunger and satiety when making eating-related decisions. Both scales are useful in the arsenal of eating behaviour scholars. Here, we developed Brazilian Portuguese translations of both scales and assessed their psychometric properties in Brazilian adults. A total of 288 participants (men = 52.8%) completed the CEMS, IES-2, Body Appreciation Scale (BAS), and a demographic questionnaire. The results of confirmatory factor analysis indicated that the factor structure of both scales had adequate fit following the elimination of items and addition of covariances. Evidence of adequate factorial, convergent and discriminant validity, as well as reliability was identified. Furthermore, correlations of CEMS and IES-2 with BAS scores and body mass index were obtained. Both instruments' models were found to be invariant across sex, with men having significantly higher scores on three subscales of the IES-2 only. These results provide evidence for the psychometric properties of the CEMS and IES-2 in Brazilian Portuguese-speaking adults.Level of Evidence: V, cross-sectional descriptive study.
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Affiliation(s)
- Wanderson Roberto da Silva
- Department of Food and Nutrition, School of Pharmaceutical Sciences, São Paulo State University (UNESP, Campus Araraquara), Araraquara-Jau Road Km1, Araraquara, SP, 14800-903, Brazil.
| | | | - Lucilene Ferreira
- Department of Health Sciences, University of Sagrado Coração, Bauru, Brazil
| | - Juliana Alvares Duarte Bonini Campos
- Department of Food and Nutrition, School of Pharmaceutical Sciences, São Paulo State University (UNESP, Campus Araraquara), Araraquara-Jau Road Km1, Araraquara, SP, 14800-903, Brazil
| | - Viren Swami
- Department of Psychology, Anglia Ruskin University, Cambridge, UK
- Centre for Psychological Medicine, Perdana University, Serdang, Malaysia
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The Intersectionality of Gender and Wealth in Adolescent Health and Behavioral Outcomes in Brazil: The 1993 Pelotas Birth Cohort. J Adolesc Health 2020; 66:S51-S57. [PMID: 31866038 PMCID: PMC6928574 DOI: 10.1016/j.jadohealth.2019.08.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/19/2019] [Accepted: 08/27/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Brazilian society is characterized by deep socioeconomic inequalities. Using data from a population-based birth cohort, we explored how the intersectionality of family income and gender may affect adolescent health and behavioral outcomes. METHODS Children born in 1993 in the Brazilian city of Pelotas have been followed up prospectively at the age of 15 years when the follow-up rate was 85.7% of the original cohort. Participants answered standardized questionnaires, and anthropometric measures were obtained. Outcomes in five domains were studied: overweight (body mass index above +1 SD of the World Health Organization standard for age and sex), cigarette smoking (in the previous month), violence (fight in which someone was injured, in the past year), self-reported unhappiness (based on a face scale), and psychological symptoms (Strengths and Difficulties Questionnaire). Monthly family income was recoded in quintiles. RESULTS Results were available for more than 4,101-4,334 adolescents, depending on the outcome. Overweight was more common among boys than girls (29.7% and 25.6%; p = .004) and was directly related to family income among boys (p < .001), but not among girls (p = .681). Smoking was less common among boys than girls (12.3% and 21.0%, p < .001) and showed strong inverse association with income among girls (p < .001), but not among boys (p = .099). Reported violence was twice as common among boys than girls (16.4% vs. 8.0%; p < .001); an inverse association with income was present among girls (p < .001), but not for boys (p = .925). Boys and girls were similarly likely to report being unhappy (18.4% and 20.1%; p = .176), with an inverse association with family income in girls. Psychological symptoms were slightly less common among boys than girls (25.3% and 28.3%; p = .014), with strong inverse associations with income in both sexes (p < .001). Adolescent girls from poor families were the group with the highest prevalence for three of the five outcomes: smoking, unhappiness, and psychological problems. CONCLUSIONS Gender norms influence adolescent health and behavioral outcomes, but the direction and strength of the associations are modified by socioeconomic position. Preventive strategies must take into account the intersectionality of gender and wealth.
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Gebrie A, Tesfaye B, Gebru T, Adane F, Abie W, Sisay M. Diabetes mellitus and its associated risk factors in patients with human immunodeficiency virus on anti-retroviral therapy at referral hospitals of Northwest Ethiopia. Diabetol Metab Syndr 2020; 12:20. [PMID: 32158504 PMCID: PMC7057570 DOI: 10.1186/s13098-020-00527-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The use of highly active anti- retroviral therapy (HAART) as well as human immunodeficiency virus (HIV) per se have been shown to be related with diabetes among patients living with HIV. There is limited evidence on the prevalence of diabetes among HIV-infected patients in developing countries like Ethiopia. Therefore, the aim of this study is to determine the prevalence of diabetes among patients living with HIV/AIDS at referral hospitals of Northwest Ethiopia. MATERIALS AND METHODS a hospital based cross-sectional study was conducted at referral hospitals of Northwest Ethiopia between February 2019 and April 2019. Using WHO stepwise approach, sociodemographic, behavioral and clinical data were collected from 407 included adult patients. Simple random sampling methods was used to select the study participants. Lipid profiles, fasting blood sugar as well as anthropometric indicators were also measured. SPSS version 25 was used for analysis of data; bivariate and multivariate binary logistic regression analysis was performed. RESULT From a total of 415 patients living with HIV deemed eligible for inclusion, 407 with complete data were included in the final analysis giving a response rate of 98%. From 407 study subjects included in the analysis, 161 (39.6%) were men. The prevalence of diabetes mellitus was found to be 8.8% (95% CI 6.05, 11.55). Multivariate logistic regression analysis revealed that age [AOR (95% CI) 1.04 (1.001,1.084), p < 0.05], educational status [AOR (95% CI) 6.27 (1.72, 22.85), p < 0.05, diploma; AOR (95% CI) 9.64 (2.57, 36.12), p < 0.05, degree and above], triglyceride level [AOR (95% CI) 1.007 (1.003, 1.010), p < 0.01] have shown statistically significant association with odds of diabetes mellitus. CONCLUSION The prevalence of diabetes was notably high in patients living with HIV/AIDS. Factors such as increased age, educational status and higher level of serum triglyceride were found to contribute to this high prevalence of diabetes.
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Affiliation(s)
- Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Bekele Tesfaye
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tensae Gebru
- Department of Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fentahun Adane
- Department of Biomedical Science, School of Medicine, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Worku Abie
- Department of Biomedical Science, School of Medicine, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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Reyes Matos U, Mesenburg MA, Victora CG. Socioeconomic inequalities in the prevalence of underweight, overweight, and obesity among women aged 20-49 in low- and middle-income countries. Int J Obes (Lond) 2019; 44:609-616. [PMID: 31852998 PMCID: PMC7046525 DOI: 10.1038/s41366-019-0503-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/08/2019] [Accepted: 12/01/2019] [Indexed: 11/09/2022]
Abstract
Objective To analyze socioeconomic inequalities in the prevalence of underweight and overweight or obesity in women from low and middle-income countries (LMICs). Methods Using the last available Demographic Health Survey between 2010 and 2016 from 49 LMICs, we estimated the prevalence of underweight (BMI < 18.5 kg/m2) and overweight or obesity combined (BMI ≥ 25 kg/m2) for women aged 20–49 years. We used linear regression to explore the associations between the two outcomes and gross national income (GNI). We assess within-country socioeconomic inequalities using wealth deciles. The slope index of inequality (SII) and the inequality pattern index (IPI) were calculated for each outcome. Negative values of the latter express bottom inequality (when inequality is driven by the poorest deciles) while positive values express top inequality (driven by the richest deciles). Results In total, 931,145 women were studied. The median prevalence of underweight, overweight or obesity combined, and obesity were 7.3% (range 0.2–20.5%), 31.5% (8.8–85.3%), and 10.2% (1.9–48.8%), respectively. Pearson correlation coefficients with log GNI were −0.33 (p = 0.006) for underweight, 0.72 (p < 0.001) for overweight or obesity, and 0.66 (p < 0.001) for obesity. For underweight, the SII was significantly negative in 38 of the 49 countries indicating a higher burden among poor women. There was no evidence of top or bottom inequality. Overweight or obesity increased significantly with wealth in 44 of the 49 countries. Top inequality was observed in low-prevalence countries, and bottom inequality in high-prevalence countries. Conclusion Underweight remains a problem among the poorest women in poor countries, but overweight and obesity are the prevailing problem as national income increases. In low-prevalence countries, overweight or obesity levels are driven by the higher prevalence among the richest women; as national prevalence increases, only the poorest women are relatively preserved from the epidemic.
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Affiliation(s)
- Ursula Reyes Matos
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, Pelotas, Rio Grande do Sul, Brazil.
| | - Marilia Arndt Mesenburg
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, Pelotas, Rio Grande do Sul, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, Pelotas, Rio Grande do Sul, Brazil
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Jiwani SS, Carrillo-Larco RM, Hernández-Vásquez A, Barrientos-Gutiérrez T, Basto-Abreu A, Gutierrez L, Irazola V, Nieto-Martínez R, Nunes BP, Parra DC, Miranda JJ. The shift of obesity burden by socioeconomic status between 1998 and 2017 in Latin America and the Caribbean: a cross-sectional series study. Lancet Glob Health 2019; 7:e1644-e1654. [PMID: 31708145 PMCID: PMC7613084 DOI: 10.1016/s2214-109x(19)30421-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The burden of obesity differs by socioeconomic status. We aimed to characterise the prevalence of obesity among adult men and women in Latin America and the Caribbean by socioeconomic measures and the shifting obesity burden over time. METHODS We did a cross-sectional series analysis of obesity prevalence by socioeconomic status by use of national health surveys done between 1998 and 2017 in 13 countries in Latin America and the Caribbean. We generated equiplots to display inequalities in, the primary outcome, obesity by wealth, education, and residence area. We measured obesity gaps as the difference in percentage points between the highest and lowest obesity prevalence within each socioeconomic measure, and described trends as well as changing patterns of the obesity burden over time. FINDINGS 479 809 adult men and women were included in the analysis. Obesity prevalence across countries has increased over time, with distinct patterns emerging by wealth and education indices. In the most recent available surveys, obesity was most prevalent among women in Mexico in 2016, and the least prevalent among women in Haiti in 2016. The largest gap between the highest and lowest obesity estimates by wealth was observed in Honduras among women (21·6 percentage point gap), and in Peru among men (22·4 percentage point gap), compared with a 3·7 percentage point gap among women in Brazil and 3·3 percentage points among men in Argentina. Urban residents consistently had a larger burden than their rural counterparts in most countries, with obesity gaps ranging from 0·1 percentage points among women in Paraguay to 15·8 percentage points among men in Peru. The trend analysis done in five countries suggests a shifting of the obesity burden across socioeconomic groups and different patterns by gender. Obesity gaps by education in Mexico have reduced over time among women, but increased among men, whereas the gap has increased among women but remains relatively constant among men in Argentina. INTERPRETATION The increase in obesity prevalence in the Latin American and Caribbean region has been paralleled with an unequal distribution and a shifting burden across socioeconomic groups. Anticipation of the establishment of obesity among low socioeconomic groups could provide opportunities for societal gains in primordial prevention. FUNDING None.
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Affiliation(s)
- Safia S Jiwani
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Akram Hernández-Vásquez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Laura Gutierrez
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Vilma Irazola
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Ramfis Nieto-Martínez
- South Florida Veterans Affairs Foundation for Research and Education and Geriatric Research, Education and Clinical Center, Miami VA Healthcare System, Miami, FL, USA; Foundation for Clinical, Public Health, and Epidemiology Research in Venezuela, Caracas, Venezuela
| | - Bruno P Nunes
- Postgraduate Program of Nursing, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Diana C Parra
- Program of Physical Therapy and Department of Surgery, Institute for Public Health, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Nowak-Szczepanska N, Gomula A, Koziel S. Mid-upper arm circumference and body mass index as different screening tools of nutritional and weight status in Polish schoolchildren across socio-political changes. Sci Rep 2019; 9:12399. [PMID: 31455783 PMCID: PMC6712029 DOI: 10.1038/s41598-019-48843-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022] Open
Abstract
Intergenerational changes in many biological traits are indicators of environmental conditions. One of such anthropometric measures is the mid-upper arm circumference (MUAC) which estimates nutritional status. Likewise, Body Mass Index (BMI) is widely used as an anthropometric indicator of relative weight. The aim of this study was to reveal secular trends in MUAC and BMI, as biological indicators of changing living conditions, between 1966 and 2012 among Polish children from different socioeconomic groups. Total sample involved 64 393 schoolchildren aged 7–18 years, investigated in 4 Surveys (1966, 1978, 1988, 2012). Overall socioeconomic status (SES) was divided into two categories: lower and higher (including: urbanization, family size, parental education). Results showed that MUAC and BMI differed significantly with respect to the year of survey, sex and SES category. Both measures were higher within higher SES group compared to the lower one until 1988, while in 2012 convergence of these indicators in both SES categories was observed. Both the year of survey, sex, SES category and interactions between them had higher impact on MUAC than BMI (measured by effect size). Our findings revealed that long-term socioeconomic changes affect MUAC more noticeably than BMI. Therefore MUAC may be a more accurate screening tool.
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Affiliation(s)
- Natalia Nowak-Szczepanska
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy Polish Academy of Sciences, Podwale 75, 50-449, Wroclaw, Poland.
| | - Aleksandra Gomula
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy Polish Academy of Sciences, Podwale 75, 50-449, Wroclaw, Poland
| | - Slawomir Koziel
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy Polish Academy of Sciences, Podwale 75, 50-449, Wroclaw, Poland
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