Gender and adult undernutrition in developing countries

Undernutrition and associated factors among adult prisoners in Fiche town, central Ethiopia: a facility-based cross-sectional study

Background

Undernutrition is a major public health problem worldwide, particularly in developing countries like Ethiopia. However, nutritional problems are frequently overlooked in low-income countries, especially among vulnerable populations such as imprisoned people. The scientific data on the rate of undernutrition among imprisoned people in Ethiopia is limited. Hence, this study aimed to assess the magnitude and associated factors of undernutrition among adult prisoners in Fiche town, central Ethiopia.

Methods

A facility-based cross-sectional study was conducted from August 15 to September 15, 2020. A systematic random sampling technique was used to select participants. All prisoners whose age was 18 years and above who have been in prison for at least 6 months were included. Data were collected using interviewer-administered pretested semi-structured questionnaires and standard anthropometric measurements. A cut-off point of body mass index <18.5 kg/m² was used to measure undernutrition. Data were coded, entered into Epi-data version 3.1, and analyzed using Statistical Package for Social Sciences version 20.0. A binary logistic regression analysis was conducted to identify factors associated with undernutrition. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was calculated to measure the strength of the association and a p-value of less than 0.05 was considered statistically significant.

Results

The overall magnitude of undernutrition among adult prisoners was 20% (95% CI: 16.5-23.6). Duration of imprisonment, incarcerated for 25 to 59 months (AOR = 3.07; 95% CI: 1.33, 7.04) and for greater than 59 months (AOR = 4.56; 95% CI: 2.0, 10.45), mild and moderate depression (AOR = 1.9; 95% CI: 1.05, 3.45), and moderately severe and severe depression (AOR = 2.78; 95% CI: 1.17, 6.60) were significantly associated with increased odds of undernutrition. However, being female (AOR = 0.51; 95% CI: 0.26, 0.98), having financial support (AOR = 0.36; 95% CI: 0.15, 0.87), engaging in income-generating work within the prison (AOR = 0.27; 95% CI: 0.15, 0.47), having medium dietary diversity (AOR = 0.35; 95% CI: 0.15, 0.80), and having good dietary diversity (AOR = 0.23; 95% CI: 0.08, 0.61) significantly decreased the odds of undernutrition.

Conclusion

The magnitude of undernutrition among adult prisoners was high, with one in five prisoners in Fiche town prison having undernutrition. Sex, financial support, duration of imprisonment, income-generating work in the prison, dietary diversity, and depression were predictors of undernutrition. Hence, access to healthy food and diversified diets should be ensured for prisoners, and implementing early screening and treatment of depression, as well as encouraging prisoners to engage in income-generating work within the prison is recommended to reduce the burden of undernutrition.

Health-Related Lifestyles in Relation to Body Mass Index Among Young and Middle-Aged Women in Japan

BACKGROUND

Being underweight, overweight, or obese can lead to adverse health effects. Hence, it is important to understand the specific factors that change the burden of underweight and overweight to target appropriate disease control strategies. This study was designed to examine the prevalence and factors associated with underweight and overweight among young and middle-aged women in Japan.

MATERIALS AND METHODS

A cross-sectional study was conducted among women aged 20-59 years who participated in health checkups at a regional health care center in 2018 and 2019 (N = 1722). The assessments included anthropometric, blood pressure measurements, and a standardized self-administered questionnaire. Multivariable logistic regression analysis assessed lifestyle factors associated with body mass index for underweight <18.5 kg/m²) and overweight/obesity (25.0 kg/m² and above).

RESULTS

The prevalence of underweight and overweight/obesity were 12.3%, and 22.5%, respectively. No lifestyle factors were found to be significantly associated with being underweight. Having dinner within 2 hours before bed was positively associated with being overweight/obese [adjusted odds ratio (AOR): 1.448, 95% confidence interval (CI): 1.014-2.068]. Women who gained 10 kg since their 20s were more likely to fall into overweight/obesity category (AOR: 9.674, 95% CI: 1.014-2.068). Women who were using a lipid-lowering medication (AOR: 3.150, CI: 1.892-5.246) were associated with three times higher risk of being overweight/obese. Hypertension and dyslipidemia were significantly associated with overweight/obesity (AOR: 3.094, 95% CI: 2.201-4.351 and AOR: 2.498, 95% CI: 1.831-3.409, respectively).

CONCLUSION

One in five middle-aged women was overweight or obese, whereas one in eight was underweight. In relation to the prevention of overweight/obesity, specific health promotion messages regarding eating timing should be developed.

Prevalence and Correlates of Underweight among Women of Reproductive Age in Nepal: A Cross-Sectional Study

This study aimed to examine the prevalence of underweight and determine the sociodemographic and household environmental correlates of underweight among women of reproductive age in Nepal. This study also compared the time trends in the prevalence of underweight with the trends in the prevalence of overweight and obesity. This cross-sectional study was a secondary data analysis of the nationally representative population-based Nepal Demographic and Health Surveys (NDHSs). Firstly, the time trends of the prevalence of underweight (body mass index (BMI) < 18.5 kg/m2) among women aged 15-49 years were examined at five-year intervals, from the 1996, 2001, 2006, 2011, and 2016 NDHSs (n = 33,507). Secondly, the sociodemographic and household environmental correlates of underweight were examined from the latest NDHS 2016 (n = 6165). Univariable and multivariable logistic regression analyses were performed to examine the sociodemographic and household environmental correlates of underweight. From 1996 to 2016, the prevalence of underweight decreased from 25.3% (95% confidence interval (CI) 23.8%, 26.8%) to 16.9% (95%CI 16.0%, 17.8%), while the prevalence of overweight and obesity increased from 1.6% (95%CI 1.2%, 2.1%) to 15.6% (95%CI 14.7%, 16.5%) and 0.2% (95%CI 0.1%, 0.4%) to 4.1% (95%CI 3.6%, 4.6%), respectively. Sociodemographic factors, such as age, educational status, marital status, wealth index, and religion, were independently associated with the risk of underweight. Similarly, household environmental factors, such as province of residence, ecological zone, type of toilet facility, and household possessions, including television and mobile phone, were independently associated with the risk of underweight. Despite the declining trends, the prevalence of underweight among Nepalese women remains a public health challenge. Understanding the key sociodemographic and household environmental correlates of underweight may assist in streamlining the content of health promotion campaigns to address undernutrition and potentially mitigate adverse health outcomes.

Subclinical Kwashiorkor in Adults: A New Age Paradigm

Childhood protein-energy undernutrition (PEU) is a well-recognized problem and therefore a lot of work has been done to identify and manage paediatric PEU. Though there have been several reports of low protein consumption in adults from developing countries, PEU and its subtle forms (subclinical PEU) are not yet recognized as adult disorders. Physicians and public perception do not favour easy recognition and action. In this review, the authors provide a scoping review of the existing literature on this entity providing insights into its recognition, pathogenesis and management. Adult subclinical PEU is an enormous under-recognized challenge that can have detrimental consequences if not recognized and corrected in time. PEU has grave health and economic impact on the patient and society. Therefore, it is important to recognize subclinical PEU and prevent its progression to full-blown form.

Plasma Kynurenine to Tryptophan Ratio Is Not Associated with Undernutrition in Adults but Reduced after Nutrition Intervention: Results from a Community-Based Study in Bangladesh

Infections and persistent immunological activation are linked to increased kynurenine (KYN) and the KYN-to-Tryptophan (TRP) or KT ratio and may be critical factors in undernutrition. We sought to determine the association between the KT ratio and adult malnutrition, as well as investigate if nutritional supplementation had any influence on the decrease of the KT ratio. A total of 525 undernourished adults aged 18–45 years were recruited and provided a nutrition intervention for 60 feeding days. TRP and KYN concentrations were determined from plasma samples using LC-MS/MS. At baseline, the median (interquartile range (IQR)) TRP, KYN and KT ratios were 24.1 (17.6, 34.3) µmol/L, 0.76 (0.53, 1.18) µmol/L and 30.9 (24.5, 41.7), respectively. Following intervention, the median (IQR) KYN and KT ratios were significantly reduced to 0.713 (0.46, 1.12) µmol/L and 27.5 (21.3, 35.8). The KT ratio was found to be inversely linked with adult BMI (coefficient: −0.09; 95% CI: −0.18, 0.004; p-value = 0.06) but not statistically significant. Additionally, Plasma CRP was correlated positively, while LRP1 was inversely correlated with the KT ratio. Our data suggest that in Bangladeshi adults, the KT ratio is not related to the pathophysiology of malnutrition but correlated with inflammatory and anti-inflammatory biomarkers, and the ratio can be reduced by a nutrition intervention.

Association of plasma low-density lipoprotein receptor-related protein-1 (LRP1) with undernutrition: a case-control study in Bangladeshi adults

PURPOSE

Studies revealed that silencing of low-density lipoprotein receptor-related protein-1 (LRP1) expression can cause inhibition of adipogenesis in animal model and contribute to reduced body size. But there is no study that has explored the association of LRP1 with body mass index (BMI) of human adults. Therefore, the aim of this study was to investigate the relationship of LRP1 with undernutrition.

METHODS

A total of 270 Bangladeshi slum-dwelling adults were enrolled as case control design. Their socio-economic, demographic, anthropometric and biomedical data were collected. Plasma LRP1, C-reactive protein (CRP), alpha-1 acid glycoprotein (AGP) and ferritin levels were measured by ELISA, haemoglobin by HemoCue and zinc by atomic absorption spectrometry.

RESULTS

The median (IQR) values of plasma LRP1 were 1673.1 (1382.5-1886.2) ng/mL in healthy participants and 707.7 (588.6-839.9) ng/mL in undernourished participants, respectively. A strong positive correlation (r = 0.70, p < 0.05) between LRP1 and BMI was found. Multivariable logistic regression analysis revealed a positive association between low plasma LRP1 (Adj. OR = 0.98, CI = 0.98, 0.99 and p < 0.05) and undernutrition.

CONCLUSIONS

The study found that increased level of LRP1 is associated with increased BMI, whereas lower level is associated with low BMI.

Underweight and overweight/obesity among adults in Afghanistan: prevalence and correlates from a national survey in 2018

BACKGROUND

The study aimed to estimate the prevalence and correlates of underweight and overweight/obesity among adults in Afghanistan.

METHODS

National cross-sectional survey data of 3779 persons aged 18-69 years were analysed. Multinomial logistic regression was used to estimate factors associated with underweight and overweight/obesity relative to normal weight.

RESULTS

In all, 7.8% of the study sample was underweight (BMI < 18.5 kg/m²), 49.5% had normal weight (BMI 18.5-24.9 kg/m²), 25.5% overweight (25.0-29.9 kg/m²), and 17.2% obesity. In adjusted multinomial logistic regression, factors negatively associated with underweight were male sex (adjusted relative risk ratio (ARRR): 0.30, 95% confidence interval (CI): 0.15-0.58) and hypertension (ARRR: 0.51, 95% CI: 0.27-0.95) and factors positively associated with underweight were sedentary behaviour (ARRR: 1.85, 95% CI: 1.11-3.10) and current tobacco use (ARRR: 2.58, 95% CI: 1.08-6.16). Factors positively associated with overweight/obesity were aged 30-44 years (ARRR: 2.00, CI: 1.51-2.66) and aged 45-69 years (ARRR: 1.58, CI: 1.09-2.31) (compared to 18-29 years) (ARRR: 1.28, CI: 1.14-2.18), hypertension (ARRR: 2.74, CI: 1.89-3.96), and type 2 diabetes (ARRR: 1.82, CI: 1.13-2.94), and high physical activity (ARRR: 0.70, CI: 0.50-0.98) was negatively associated with overweight/obesity.

CONCLUSION

Almost one in ten adult respondents were underweight and more than two in five were overweight/obese, confirming a dual burden of malnutrition in Afghanistan.

The prevalence and associated factors of underweight and overweight/obesity among adults in Kenya: evidence from a national cross-sectional community survey

INTRODUCTION

the study aimed to investigate the prevalence and factors associated with underweight and overweight or obesity in an adult population in Kenya.

METHODS

data from a cross-sectional nationally representative community-based study in Kenya (N=4283, 18-69 years) conducted in 2015 was utilized. Assessments included anthropometric, interview, blood pressure and biochemistry mesures. Multinomial logistic regression was used to assess the determinants of underweight and overweight or obesity relative to normal weight.

RESULTS

in all, 11.9% of the study sample was underweight (BMI <18.5kg/m2), 60.1% had normal weight (BMI 18.5-24.9kg/m2), 18.9% overweight (25.0-29.9kg/m2) and 9.1% obesity (BMI ≥30.0kg/m2). In adjusted multinomial logistic regression, male sex (adjusted relative risk ratio-ARRR: 1.47, confidence interval-CI: 1.01, 2.13), lower education (ARRR: 0.63, CI: 0.46, 0.88), lower wealth status (ARRR: 0.47, CI: 0.29, 0.78), inadequate fruit and vegetable consumption (ARRR: 1.79, CI: 1.19, 2.70), adding daily sugar into beverages (ARRR: 1.49, CI: 1.01, 2.22) and having no hypertension (ARRR: 0.54, CI: 0.40, 0.74) were associated with underweight. Factors associated with overweight or obesity were middle and older age (ARRR: 2.15, CI: 1.46, 3.80), being female (ARRR: 0.30, CI: 0.22, 0.41), higher education (ARRR: 1.61, CI: 1.26, 2.24), greater wealth (ARRR: 2.38, CI: 1.41, 3.50), being a Kikuyu by ethnic group (ARRR: 1.68, CI: 1.19, 2.37), urban residence (ARRR: 1.45, CI: 1.06, 1.99), no current tobacco use (ARRR: 0.39, CI: 0.24, 0.54), low physical activity (ARRR: 1.49, CI: 1.02, 2.18) and having hypertension (ARRR: 1.96, CI: 1.54, 2.50).

CONCLUSION

more than one in ten were underweight and almost three in ten were overweight or obese among adults in Kenya. Several risk factors, including sociodemographic, lifestyle and health status risk variables, were identified for underweight and overweight or obesity, which can assist in developing intervention strategies targeting both these conditions.

Nutritional Status and Associated Factors among Adult Psychiatric Patients in Dessie Referral Hospital, Northeast Ethiopia

BACKGROUND

Psychiatric illnesses involve alterations in the brain or nervous system function and result in altered perception, responses to the environment, and daily functioning, which ultimately diminish the capacity to cope with the regular demands of life, including nutritional intake. Little is known about nutritional status in psychiatric patients in our setup, particularly in northeast Ethiopia. Thus, this study is aimed at assessing the nutritional status and associated factors among adult psychiatric patients in Dessie referral hospital, northeast Ethiopia.

METHODS

A facility-based cross-sectional study was employed among 530 psychiatric patients using an interviewer-administered structured questionnaire, and anthropometric measurements were taken from April 10 to June 20, 2018. Multinomial logistic regression analysis was used to identify the associated factors with the nutritional status of adult psychiatric patients.

RESULTS

The study revealed that the proportion of undernutrition and overnutrition was 20.0% (95% CI: 16.80-23.60) and 23.4% (95% CI: 19.80-27.00), respectively. Being male (AOR: 2.39, 95% CI: 1.28-4.47), private employed (AOR: 0.08, 95% CI: 0.02-0.31), and not consuming alcohol (AOR: 0.20, 95% CI: 0.56-0.74) were factors associated with undernutrition. Whereas not involved in physical activity (AOR: 2.98, 95% CI: 1.37-6.49), being newly diagnosed patient (AOR: 1.86, 95% CI: 1.01-3.42), and not chewing Khat (AOR: 3.92, 95% CI: 1.63-9.42) were factors associated with overnutrition of adult psychiatric patients.

CONCLUSION

The proportion of both undernutrition and overnutrition was above the national average. Notably, nutrition significantly affects the production and use of neurotransmitters, and this may result in significant effects on physical, mental, or emotional processes. This undoubtedly affects the stabilization processes of neuropsychiatric patients. Therefore, healthcare managers, supervisors, and policymakers identify those vulnerable groups early and thereby design effective nutritional strategies to intervene in malnutrition among adult patients with a psychiatric disorder.

The prevalence of underweight and overweight/obesity and its correlates among adults in Laos: a cross-sectional national population-based survey, 2013

PURPOSE

The study aimed to assess the prevalence of underweight and overweight or obesity and their sociodemographic, lifestyle, and health factors in a national adult population in Lao People's Democratic Republic (PDR) (Laos).

METHODS

A national cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The total sample included 2531 individuals 18-64 years, (females = 59.3%; mean age 38.7 years, SD = 12.8) from Laos. Questionnaire interview, blood pressure and anthropometric measurements, and biochemistry tests were conducted. Multinomial logistic regression was utilized to determine the association between sociodemographic, lifestyle and health status factors, and underweight and overweight or obesity relative to normal weight.

RESULTS

Using Asian criteria for body mass index (BMI) classification, 9.7% of the population was underweight (BMI < 18.5, kg/m²), 47.5% had normal weight (BMI 18.5-22.9 kg/m²), 17.5% overweight (23.0-24.9 kg/m²), 19.6% class I obesity (BMI 25.0-29.9 kg/m²), and 5.6% class II obesity (BMI ≥ 30.0 kg/m²) (or 42.8% overweight, class I or class II obesity). In adjusted multinomial logistic regression, female sex (adjusted relative risk ratio-ARRR 0.67, confidence interval-CI 0.45, 0.99), current tobacco use (ARRR 1.57, CI 1.02, 2.41), and having no hypertension (ARRR 0.50, CI 0.26, 0.97) were associated with underweight, and middle and older age (ARRR 1.79, CI 1.41, 2.25), being Lao-Tai (ARRR 1.37, CI 1.06, 1.76), urban residence (ARRR 1.62, CI 1.20, 2.17), having meals outside home (ARRR 1.36, CI 1.04, 1.77), no current tobacco use (ARRR 0.57, CI 0.34, 0.59), low physical activity (ARRR 1.39, CI 1.01, 1.92), having hypertension (ARRR 2.52, CI 1.94, 3.26), and dyslipidaemia (ARRR 1.56, CI 1.21, 2.00) were associated with overweight or obesity.

CONCLUSION

A dual burden of both adult underweight and overweight or obesity was found in Laos. Sociodemographic, lifestyle, and health status risk factors were identified for underweight and overweight or obesity, which can help in guiding public health programmes to address both these conditions.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Evidence of gut enteropathy and factors associated with undernutrition among slum-dwelling adults in Bangladesh

BACKGROUND

Adult undernutrition (BMI <18.5 kg/m2) is responsible for immune deficits, increased risk of disease burden, and higher rates of mortality. The prevalence of adult undernutrition in Bangladesh is substantial, but there have been few studies on the etiology of this condition for the inhabitants of urban slums.

OBJECTIVE

The aim of this study was to identify the factors associated with undernutrition among slum-dwelling adults in Bangladesh.

METHODS

A case-control study was conducted in the Bauniabadh area of Dhaka, Bangladesh. 270 adult participants (135 cases with a BMI <18.5 and 135 controls with a BMI between 18.5 and 24.9) aged 18-45 y were enrolled between October 2018 and January 2019. Sociodemographic variables, dietary diversity, micronutrient deficiencies, psychological symptoms, infection, and biomarkers of gut health were assessed to identify the factors associated with undernutrition using multivariable logistic regression analysis.

RESULTS

A higher number of siblings [adjusted odds ratio (aOR): 1.39; 95% CI: 1.11, 1.77], increased self-reporting questionnaire-20 score (an instrument to screen mental health disorders and detect psychological symptoms) (aOR: 1.12; 95% CI: 1.04, 1.23), elevated fecal concentration of α-1 antitrypsin (aOR: 4.82; 95% CI: 1.01, 25.29), and anemia (aOR: 3.63; 95% CI: 1.62, 8.58) were positively associated with undernutrition in adults. Age (aOR: 0.90; 95% CI: 0.84, 0.96), dietary diversity score (aOR: 0.75; 95% CI: 0.56, 0.99), C-reactive protein (aOR: 0.82; 95% CI: 0.73, 0.92), Helicobacter pylori infection (aOR: 0.11; 95% CI: 0.05, 0.23), and always washing hands before eating or preparing foods (aOR: 0.33; 95% CI: 0.12, 0.87) were associated with reduced odds of undernutrition among the study population.

CONCLUSIONS

Our results indicate that undernutrition in slum-dwelling adults in Bangladesh is associated with numerous physiological and sociodemographic factors, including evidence of gastrointestinal inflammation and altered intestinal permeability.

Demographic, Socio-economic and Lifestyle Determinants of Under- and Over-nutrition among Bangladeshi Adult Population: Results from a Large Cross-Sectional Study

Bangladesh is currently going through a nutritional transition with rapid increase in overnutrition while undernutrition is still remaining prevalent. Nevertheless, population-based data on demographic, socio-economic and lifestyle factors associated with underweight and overweight among adult population is scarce. Employing a nationwide cross-sectional survey, we collected anthropometric, demographic, socio-economic, lifestyle and dietary information from 12,180 adults aged ≥35 years. Body Mass Index (BMI) was calculated using standard formula and categorized into underweight (<18.50), normal weight (18.50–22.99), and overweight (≥23.00). Multivariable multinomial logistic regression was performed to identify factors associated with underweight and overweight. Overall, prevalence of underweight and overweight was 18.1% (95% CI: 17.5–18.8) and 33.7% (95% CI: 32.9–34.6), respectively. All the demographic, socio-economic, dietary and lifestyle factors showed significant association with nutritional status in bivariate analysis. In adjusted analysis, factors showing significant positive association with underweight included female gender (ARRR-1.38, 95% CI: 1.11–1.71), older age [compared to 35–39 years age group, ARRR (95% CI) for ≥ 70 years is 2.32 (1.89–2.86), for 60–69 years is 1.62 (1.36–1.93), for 50–59 years 1.34 (1.13–1.58) and for 40–49 years 1.05 (0.87–1.15)] and smoking habit (ARRR-1.32, 95% CI: 1.14–1.52) while factors showing significant inverse association with underweight included higher household wealth [compared to lowest wealth quintile, ARRR (95% CI) for highest quintile is 0.68 (0.55–0.84), for second highest quintile 0.77 (0.65–0.91), for middle quintile 0.81 (0.69–0.94) and for second lowest quintile 0.89 (0.77–1.03)], urban residence (ARRR-0.66, 95% CI: 0.66–0.90), and more frequent meat/fish and fruits consumption (ARRR-0.76, 95% CI: 0.65–0.90). On the other hand, factors significantly associated with increased risk of overweight included female gender (ARRR-1.35, 95% CI: 1.12–1.63), higher household wealth [compared to lowest wealth quintile, ARRR (95% CI) for highest quintile is 2.27 (1.93–2.68), for second highest quintile 1.67 (1.44–1.94), for middle quintile 1.26 (1.10–1.46) and for second lowest quintile 1.07 (0.93–1.24), excess food availability [compared to food shortage, ARRR (95% CI) for excess food in the household is 1.29 (1.12–1.47) and for no shortage/no excess is 1.23 (1.09–1.38) and more frequent fruits consumption [compared to no fruits, ARRR (95% CI) for 5–7 days per week consumption is 1.61 (1.41–1.83) and for 3–4 days per week is 1.28 (1.16–1.41) and factors significantly associated with decreased risk of overweight included older age [compared to 35–39 years age group, ARRR (95% CI) for ≥ 70 years is 0.77 (0.64–0.93), for 60–69 years is 0.82 (0.71–0.94), for 50–59 years 0.91 (0.80–1.04) and for 40–49 years 1.01 (0.89–1.15)] and smoking (ARRR-0.76, 95% CI: 0.68–0.86). Both underweight and overweight are prevalent in Bangladeshi adult population. Several demographic, socio-economic, dietary and lifestyle factors are associated with underweight and overweight in Bangladesh. Population level impact of these factors should be examined to design suitable public health and nutrition interventions to address this dual challenge.

Prevalence and correlates of underweight and overweight/obesity among women in India: results from the National Family Health Survey 2015-2016

Objective: The study aimed to assess the prevalence and correlates of underweight and overweight or obesity among women in India. Subjects and methods: In a population-based cross-sectional 2015-2016 National Family Health Survey, ever married non-pregnant women (18-49 years) were interviewed and assessed with anthropometric, blood pressure and biochemical measures. Results: The total sample included 5,82,320 non-pregnant women 18-49 years, median age 31 years, interquartile range =16 years, from India. Overall, 20.1% of the women were underweight [body mass index (BMI) <18.5 kg/m²] and 36.3% were overweight, or had class I or class II obesity (BMI ≥23.0 kg/m²). In adjusted multinomial logistic regression, younger age, lower education, lower wealth status, not eating daily fruits, vegetables, fried food, belonging to the scheduled tribe and tobacco use were associated with underweight, while older age, higher education, higher wealth, belonging to other backward class or other, urban residence, daily fruit consumption, daily fried food consumption, having hypertension, heart disease and high or very high blood glucose levels were associated with overweight or obesity. Belonging to the scheduled caste and tobacco use were negatively associated with overweight or obesity. Conclusions: A high dual burden of both underweight and overweight or obesity was observed among women in India. Sociodemographic and health variables were identified as risk factors for both underweight and overweight or obesity, which can be utilized in informing intervention strategies.

Body mass index and waist circumference of Latin American adult athletes with intellectual disability

OBJECTIVES

To examine both body mass index (BMI) status and waist circunference (WC) in a large international sample of adult Special Olympics participants from Latin America. It also explored the association of age and sex with obesity in this population.

MATERIALS AND METHODS

BMI and WC records from a total of 4174 (2683 male and 1491 female) participant records from the Special Olympics International Health Promotion database were examined.

RESULTS

The prevalence of overweight and obesity was quite high (i.e. > 40%), but generally lower than studies involving adults with intellectual disabilities from Europe and the USA. Chi-square analyses revealed that both increasing age and being female significantly predicted levels of overweight, obesity, and WC.

CONCLUSIONS

These results suggest that efforts need to be made to prevent and reduce rates of overweight and obesity among Latin American Special Olympics participants, particularly women.

The prevalence of underweight, overweight and obesity and their related socio-demographic and lifestyle factors among adult women in Myanmar, 2015-16

BACKGROUND

The aim of the study was to estimate the prevalence of underweight and overweight or obesity and their socio-demographic and lifestyle factors in a female adult population in Myanmar.

MATERIAL AND METHODS

In a national cross-sectional population-based survey in the 2015-16 Myanmar Demographic and Health Survey, 12,160 women aged 18-49 years and not currently pregnant completed questionnaires and anthropometric measurements. Nutritional status was determined using Asian body mass index cut-offs: underweight (BMI<18.5 kg/m2), overweight (23.0-27.4 kg/m2), and obesity (≥27.5 kg/m2). Multinomial logistic regression modelling was used to determine the association between socio-demographic and lifestyle factors and weight status.

RESULTS

The prevalence of underweight was 14.1%, overweight 28.1% and obesity 13.1%. Among different age groups, the prevalence of underweight was the highest among 18 to 29 year-olds (20.2%), while overweight or obesity was the highest in the age group 30 to 49 years (around 50%). In multinomial logistic regression, being 30 to 49 years old, poorer and richer wealth status, living in all the other regions of Myanmar and ever contraceptive use were inversely and current tobacco use, not working and having less than two children ever born were positively associated with underweight relative to normal weight. Older age, having secondary education, urban residence, wealthier economic status, living with a partner, living in the Northern and Southern regions of Myanmar, having less than two children ever born and having ever used contraceptives were positively and current tobacco use was negatively associated with overweight or obesity relative to normal weight.

CONCLUSIONS

A dual burden of both underweight and overweight or obesity among female adults was found in Myanmar. Sociodemographic and health risk behaviour factors were identified for underweight and overweight or obesity that can guide public health interventions to address both of these conditions.

The Prevalence of Underweight, Overweight/Obesity and Their Related Lifestyle Factors in Indonesia, 2014-2015

Objective

To quantify the prevalence of underweight and overweight or obesity and its related factors (socio-demographic, health behavior, health status) in a national adult population in Indonesia.

Material and Methods

In a national cross-sectional population-based survey in 2014–15 in Indonesia, 29509 adults (median age 41.0 years, Inter Quartile Range = 22.0, age range of 18–103 years) completed questionnaires and anthropometric measurements. Multinomial logistic regression modelling was used to determine the association between socio-demographic, health behavior and health status factors and underweight and overweight or obesity.

Results

Of total sample (n = 29509), 11.2% measured underweight (13.5% among men and 9.1% among women) (<18.5 kg/m²), 39.8% normal weight (48.1% among men and 32.0% among women) and 49.0% had overweight or obesity (≥23 kg/m²) (38.3% among men and 58.9% among women); 24.6% of the overall sample had class I obesity (25–29.9 kg/m²), and 8.5% had class II obesity (30 or more kg/m²). Among different age groups, underweight was the highest among 18–29 year-olds (20.0%) and those 70 years and older (29.8%), while overweight or obesity was the highest in the age group 30 to 59 years (more than 53%). In adjusted multinomial logistic regression, having less education, living in rural areas and not having chronic conditions were associated with underweight status. While better education, higher economic status, urban residency, dietary behavior (infrequent meals, frequent meat, fried snacks and fast food consumption), physical inactivity, not using tobacco, having chronic conditions (diabetes, hypertension, hypercholesterol), and better perceived health and happiness status were associated with overweight or obesity.

Conclusions

A dual burden of both adult underweight and having overweight or obesity was found in Indonesia. Sociodemographic, health risk behavior and health status risk factors were identified, which can guide public health interventions to address both these conditions.

The prevalence of underweight, overweight and obesity in Bangladeshi adults: Data from a national survey

BACKGROUND

Over the two last decades Bangladesh, a low-income country, has experienced a rapid demographic and epidemiological transition. The population has increased substantially with rapid urbanization and changing pattern of disease, which at least in part, can be explained by nutritional changes. However, the nutritional status of the adult population has not been previously described. Hence, the objective of this study was to estimate the prevalence and explore socio-demographic determinants of underweight, overweight and obesity among the Bangladeshi adult population.

METHODS

This study is a secondary data analysis of the national 2011 Bangladesh Demographic and Health Survey. We determined the nutritional status of adults aged ≥35 years of age, who had a measured weight and height, using the Asian body mass index (BMI) cut-offs for underweight (BMI <18.5 kg/m2), overweight (BMI 23 to <27.5 kg/m2) and obesity (BMI ≥27.5 kg/m2). Logistic regression modeling was used to determine the association between socio-demographic factors and nutritional status.

RESULT

Of total sample (n = 5495), 30.4% were underweight, 18.9% were overweight and 4.6% were obese. Underweight was associated with age, education and wealth. The adjusted odd ratios for underweight were higher for older people (≥70 years) compared to younger, the least educated compared to the most educated and the poorest compared to the wealthiest were 2.51 (95%CI: 1.95-3.23, p<0.001), 3.59 (95%CI: 2.30-5.61, p<0.001) and 3.70 (95%CI: 2.76-4.96, p<0.001), respectively. Younger age (35-44 years), being female, higher education, wealthier and living in urban areas were associated with overweight/obesity with adjusted odds ratios of 1.73 (95%CI: 1.24-2.41, p<0.001), 2.48 (95%CI: 1.87-3.28, p<0.001), 3.98 (95%CI: 2.96-5.33, p<0.001), 7.14 (95%CI: 5.20-9.81, p<0.001) 1.27 (95%CI: 1.05-1.55, p-0.02), respectively.

CONCLUSION

Underweight and overweight/obesity are prevalent in Bangladeshi adults. Both conditions are associated with increased morbidity and mortality and increase the risk of developing non-communicable diseases. Effective public health intervention approaches are necessary to address both these conditions.

Secular Trends in Heights and Weights in Boys and Girls Over 3 Decades in Rural India

BACKGROUND

Secular trends in height reported from developing countries are few and scarce.

OBJECTIVE

To assess secular trends in linear growth in boys and girls from birth to 18 years of life in rural households of India based on periodical cross-sectional surveys conducted over a period of 35 years.

MATERIALS AND METHODS

The present study uses data from baseline and final surveys of National Nutrition Monitoring Bureau from 1975 to 1979 (N = 6043) to 2012 to 2013 (N = 11 910) on anthropometry from birth to 18 years from 7 states in households of rural India.

RESULTS

The overall improvement in 18+ boys and girls was 3.1 and 1.0 cm, respectively, over a period of 35 years. The increments in height of 18+ were highest for both boys (7.4 cm) and girls (4.8 cm) in the state of Kerala followed by Tamil Nadu (boys, 7.3 cm and girls, 3.8 cm). Under-5 stunting rates reduced from 82% in the baseline survey to 45.7% in the final survey at 1.35% per year in the pooled states and was similar in both boys and girls. The recovery in stunting was highest in Tamil Nadu (1.63% per year) followed by Kerala (1.46% per year).

CONCLUSION

The pattern of secular trends in height in rural India seen over 3 decades was strikingly similar to that of developed countries. The phenomenal improvement in linear growth in Kerala and Tamil Nadu in children younger than 5 years and adolescents suggests that growth potential for Indians is similar to that of developed countries.

Age-related factors influencing the occurrence of undernutrition in northeastern Ethiopia

Background

Undernutrition is a major public health problem on the globe particularly in the developing regions. The objective of the current study was to assess the prevalence of undernutrition in different age groups and examine the relationship of the disease to parasitic and socioeconomic factors among communities in Harbu Town, northeastern Ethiopia.

Methods

Stool samples of the study participants were examined for intestinal helminth infections using the Kato-Katz method. Blood specimens were diagnosed for Plasmodium infection using CareStartTM Malaria Pf/Pv Combo test. The blood type was determined from blood samples using antisera A and antisera B. In addition, the height and weight of the study participants was measured and information about their socioeconomic and sociodemographic characteristics was collected.

Results

Out of 484 individuals examined, 31.8% were undernourished and 32.0% were infected with intestinal helminths. The odds of undernutrition significantly decreased with an increase in the age of individuals. The prevalence of undernutrition in adults was significantly higher in males than in females and in those who had latrines than in those who did not have the facility. The odds of undernutrition in the 5 to 19 years age group was significantly higher in those who did not wash their hands before eating than in those who did. The prevalence of undernutrition in children younger than five years was significantly lower in those whose families were educated and had less than 5 family size compared to those with illiterate families and family size of greater than 5, respectively. However, the prevalence of undernutrition was similar in individuals who were infected and not infected with intestinal helminths. The intensity of Schistosoma mansoni infection was significantly higher among individuals of blood type A compared to those of type O.

Conclusions

Prevalence of undernutrition was higher in children than in adults and the association of sex and socioeconomic factors with undernutrition showed variation with age. However, helminth infection was not related with undernutrition in all age groups.

Compositional analysis of genetically modified corn events (NK603, MON88017×MON810 and MON89034×MON88017) compared to conventional corn

Compositional analysis of genetically modified (GM) crops continues to be an important part of the overall evaluation in the safety assessment for these materials. The present study was designed to detect the genetic modifications and investigate the compositional analysis of GM corn containing traits of multiple genes (NK603, MON88017×MON810 and MON89034×MON88017) compared with non-GM corn. Values for most biochemical components assessed for the GM corn samples were similar to those of the non-GM control or were within the literature range. Significant increases were observed in protein, fat, fiber and fatty acids of the GM corn samples. The observed increases may be due to the synergistic effect of new traits introduced into corn varieties. Furthermore, SDS-PAGE analysis showed high similarity among the protein fractions of the investigated corn samples. These data indicate that GM corn samples were compositionally equivalent to, and as nutritious as, non-GM corn.

Prevalence and determinants of adult under-nutrition in Botswana

Background

To estimate the prevalence and determinants of adult under-nutrition in Botswana.

Methods

A cross-sectional survey was conducted where a nationally representative sample of people aged 20 to 49 years was used for the analysis. The outcome measure of under-nutrition was measured as BMI<18.5 kg/m².

Results

Of the total sample, 19.5% of males and 10.1% of females were underweight (BMI<18.5 kg/m²). The wealth index showed that 30.9% of the adult population with low a BMI belongs to the poorest 20% of the households while only 9.6% comprised of the richest 20% of the households. Results from logistic regression analysis indicated that both adult men and women who had no education and belonged to the low socioeconomic group had a statistically significant association with low BMI. Among the female adult population, being young and not having watched TV at least once a week were significantly associated with low BMI. For the male adult population, being unmarried was significantly associated with low BMI.

Conclusions

Programme interventions aimed at improving the nutritional status of adults can use these findings to make appropriate policy, to establish baselines and study nutritional changes over time and its covariates.

Comorbidities, polypharmacy, functionality and nutritional status in Turkish community-dwelling female elderly

BACKGROUND AND AIMS

Most elderly persons live in developing countries where current geriatric epidemiological data are scarce. We aimed to study major comorbidities, polypharmacy, functional and nutritional status in a Turkish community-dwelling female elderly clinic population.

METHODS

Female geriatrics outpatient clinic patients were assessed cross-sectionally. Patients underwent comprehensive geriatric cassessment, including identification of chronic diseases, drugs, functionality, and nutrition. Comorbidities and drugs were defined by the review of patients' self-reports and current medications. Geriatric depression and cognition were assessed by 30-item geriatric depression scale and Folstein mini-mental-state-examination. Functional status was assessed by the evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Nutritional assessment was performed by mini-nutritional-assessment-short form.

RESULTS

Five-hundred and fifteen patients were included in this study over an 8-year period. Mean age was 73.4 ± 6.9 years. Mean number of chronic diseases was 2.8. 61.1 % had >3 chronic diseases. Most common 3 diagnoses were hypertension (75.3 %), depression (45.5 %) and dementia (39.4 %). Mean number of drugs was 4.8. Polypharmacy was noted as 63.2 and 47.6 % by definitions as >4 or >5 chronic drug use, respectively. Subjects with at least one dependency of ADL and IADL were 23.4 and 64.0 %. Prevalence of poor nutrition was 39.1 %. In patients with at least one ADL or IADL dependency, undernutrition (p < 0.001), dementia (p < 0.001), cerebrovascular accident, Parkinson's disease, diabetes were more prevalent (p < 0.05) and were taking higher number of drugs (p < 0.01).

CONCLUSIONS

Polypharmacy and functional dependency seem to be prevalent among female elders in our country. Nutritional status was worse than the other reported urban area of Turkey and also than among males of same region but better than among Iranian counterparts. This study illustrates geographical differences in and between the individual countries and supports the continued need for comprehensive geriatric assessment worldwide.

Estimation of undernutrition and mean calorie intake in Africa: methodology, findings and implications

Background

As poverty and hunger are basic yardsticks of underdevelopment and destitution, the need for reliable statistics in this domain is self-evident. While the measurement of poverty through surveys is relatively well documented in the literature, for hunger, information is much scarcer, particularly for adults, and very different methodologies are applied for children and adults. Our paper seeks to improve on this practice in two ways. One is that we estimate the prevalence of undernutrition in sub-Saharan Africa (SSA) for both children and adults based on anthropometric data available at province or district level, and secondly, we estimate the mean calorie intake and implied calorie gap for SSA, also using anthropometric data on the same geographical aggregation level.

Results

Our main results are, first, that we find a much lower prevalence of hunger than presented in the Millennium Development reports (17.3% against 27.8% for the continent as a whole). Secondly, we find that there is much less spread in mean calorie intake across the continent than reported by the Food and Agricultural Organization (FAO) in the State of Food and Agriculture, 2007, the only estimate that covers the whole of Africa. While FAO estimates for calorie availability vary from a low of 1760 Kcal/capita/day for Central Africa to a high of 2825 Kcal/capita/day for Southern Africa, our estimates lay in a range of 2245 Kcal/capita/day (Eastern Africa) to 2618 Kcal/capita/day for Southern Africa. Thirdly, we validate the main data sources used (the Demographic and Health Surveys) by comparing them over time and with other available data sources for various countries.

Conclusion

We conclude that the picture of Africa that emerges from anthropometric data is much less negative than that usually presented. Especially for Eastern and Central Africa, the nutritional status is less critical than commonly assumed and also mean calorie intake is higher, which implies that agricultural production and hence income must also have been growing at a pace at least high enough to keep up with population growth. In terms of methodology, our estimates form a base line for 2005 for the whole continent that can be easily updated with far less information for individual countries, as we show in an example for Ethiopia.

Link between Epilepsy and Malnutrition in a Rural Area of Benin

PURPOSE

Epilepsy and malnutrition are both important public health problems in sub-Saharan Africa. A relationship between epilepsy and malnutrition has been suspected for many years. Our objective was to investigate the association between epilepsy and malnutrition in Djidja, Benin.

METHODS

A matched population-based cross-sectional case-control survey was performed: cases (patients with epilepsy) were matched to controls according to sex, age +/- 5 years, and village of residence. The World Health Organization's criteria for malnutrition was used. Anthropometric measurements (weight, height, mid arm upper circumference, triceps skinfold thickness) were taken. Bioelectrical impedance analysis, a standardized food and social questionnaire and a clinical examination were done. Statistical analysis (conditional logistic regression) was performed using SAS 8.0.

RESULTS

A total of 131 cases and 262 controls were included. The prevalence of malnutrition was higher in cases than in controls (22.1% vs. 9.2%, p = 0.0006). Social factors were significantly different between cases and controls. Feeding difficulties were more frequent and health status was worse in cases. Seven variables were associated with epilepsy: (i) nutritional factors: mid arm upper circumference (prevalence odds ratio (pOR) = 0.7, CI: 0.6-0.9), cereal consumption <3 times during the 3 days before the study (pOR = 4.2, CI: 1.8-10.0), <3 meals/day (pOR = 4.2, CI: 1.6-10.9), tooth decay (pOR = 2.9, CI: 1.1-7.4), food taboos (pOR = 25.0, CI: 8.3-100.0), (ii) social factors: surrogate respondent (pOR = 16.8, CI: 3.1-90.3) and no second job (pOR = 7.1, CI: 2.3-22.3).

CONCLUSION

Epilepsy and nutritional status are linked in sub-Saharan Africa. Programs to improve the nutritional status of people with epilepsy are needed.

Gender differences in factors associated with nutritional status of older medical patients

OBJECTIVES

To evaluate gender differences in nutritional risk of older people admitted to an acute-care general medical department, and identify gender-specific risk factors.

DESIGN

Cross-sectional study.

SETTING

Internal Medicine Department in an acute care, university-affiliated hospital in southern Israel.

SUBJECTS

204 cognitively intact patients aged 65 and over, admitted during a 12-month period to a general medical department.

MEASURES OF OUTCOME

Evaluation included demographic and clinical data consisting of the sum of medical conditions and of prescribed medications, evaluation of nutritional status, cognitive status, depression assessment and functional ability. Statistical analyses were conducted to evaluate the gender specific risk factors for under-nutrition.

RESULTS

32.5% of the men and 48.1% of the women admitted to an internal medicine department were at risk for under-nutrition. Those at nutritional risk had a higher rate of depression, lower cognitive and physical ability, poorer reported health status and more diagnosed diseases. Nutritional risk for men was associated with higher depression score, longer hospitalization, and poor appetite. For women, nutritional risk was associated with lower functional status and more diagnosed diseases. In a multivariate analysis, being a female increased the risk of under-nutrition by 3.3 fold.

CONCLUSION

Risk of under-nutrition is prevalent among older in-patients and is gender-related. Female inpatients are at markedly increased risk for under-nutrition. The mechanism of the gender discrepancy in factors related to nutritional deterioration is complex and poorly understood.

Relationships between undernutrition prevalence among children and adult women at national and subnational level

OBJECTIVES

The objective of this study is to analyze the relationships between undernutrition prevalence rates among children and adults, both at the level of countries and at the level of smaller geographical subunits within countries (districts, provinces). Results are considered of relevance for evaluation and proper usage of anthropometric information in poverty and food security assessment.

DESIGN

Anthropometric information on both children and adults, as reported in the Demographic and Health Surveys, has been the primary source of data. In addition, data published by WHO, FAO, and data from some country specific reports have been used. The final analysis is based on data from 289 subnational geographical units divided over 56 countries in Africa, Asia and Latin America. Ordinary least squares has been used for regression analysis and F-tests for testing differences of variances.

RESULTS

At the level of countries, results reveal a strong positive relationship between undernutrition prevalence rates among children and adults. At the level of smaller geographical units, high levels of undernutrition in adult women are almost invariably associated with high levels of undernutrition in children. At the same time, however, low or intermediate levels of undernutrition among adult women are no guarantee that undernutrition levels among children are also low or moderate.

CONCLUSION

At the level of countries, information on undernutrition prevalence in children can be considered a proximate of the overall nutritional and food security conditions in a country. At the level of smaller geographical units, relationships are less straightforward, and are hypothesized to depend, at least partially, on the relative importance of food and nonfood factors in the causation of undernutrition.

Excess male chronic energy deficiency among adolescents: a cross-sectional study in the context of patrilineal and matrilineal societies in Northeast India

OBJECTIVE

To determine the sex differences in chronic energy deficiency (CED) among adolescents in the context of patrilineal and matrilineal societies in Northeast India.

DESIGN

Cross-sectional, community-based study of the Hmar patrilineal society and the Khasi (War and Khynriam) matrilineal society.

SETTING

Mizoram and Meghalaya in Northeast India.

SUBJECTS

In total, 1733 adolescent boys and girls aged 9-16 y: Khynriam Khasis (n = 1005), War Khasis (n = 305) and Hmars (n = 423).

MEASUREMENTS

Weight, height, and socio-economic characteristics. Body mass index (weight in kg/height in m2) was used for assessing CED relative to the international reference values.

RESULTS

The overall prevalence of CED was significantly greater in boys than in girls. The sex differences in the prevalence of CED were 5, 10 and 6% points in the Khynriam Khasis, War Khasis and Hmars, respectively. Allowing for age and socio-economic variables, the risks of CED were about 1.82 (95% CI 1.14-2.90), 1.83 (95% CI 1.19-3.33) and 1.78 (95% CI 1.10-3.25) times greater in boys than in girls among the Khynriam Khasis, War Khasis and Hmars, respectively. Using logistic regression analysis, the prevalence of CED was negatively associated with family income across study populations. No significant association was found between CED and religion.

CONCLUSION

Patrilineal and matrilineal forms of society were not reflected in the prevalence of CED among adolescents. Subject to further studies of the research problems concerning the nutritional status of adolescents, girls fare better than boys with respect to the prevalence of CED.