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Sagastume D, Barrenechea-Pulache A, Ruiz-Alejos A, Polman K, Beňová L, Ramírez-Zea M, Peñalvo JL. Quantifying Overlapping Forms of Malnutrition Across Latin America: A Systematic Literature Review and Meta-Analysis of Prevalence Estimates. Adv Nutr 2024; 15:100212. [PMID: 38493876 PMCID: PMC11015105 DOI: 10.1016/j.advnut.2024.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Estimating the prevalence of double burden of malnutrition (DBM) is challenging in the Latin American and Caribbean (LAC) region where various DBM typologies (e.g., obesity and stunting) are heterogeneous and estimates are scattered across literature This study aimed to assess the prevalence of DBM typologies in the LAC region. We searched PubMed, Embase, Scopus, and Web of Science to identify studies on the prevalence of DBM published between 1 January, 2000, and 23 January, 2023. Outcomes were the prevalence of the identified DBM typologies at the household, individual, or across life course levels. Random-effect meta-analyses of proportions were used to estimate pooled period prevalence for all outcomes. Heterogeneity was explored using meta-regressions. From 754 records identified, 60 (8%) studies were eligible, with a median of 4379 individuals. Studies reported data from 27 LAC countries collected between 1988 and 2017. Most studies used nationally representative surveys (68%) and scored as low risk of bias (70%). We identified 17 DBM typologies for which 360 estimates were analyzed. The prevalence of the identified DBM typologies ranged between 0% and 24%, with the DBM typology of "adult with overweight and child with anemia" having the highest prevalence (24.3%; 95% CI: 18.8%, 30.2%). The most frequently reported DBM typology was "adult with overweight and child with stunting," with a prevalence of 8.5% (95% CI: 7.7, 9.3). All prevalences carried large heterogeneity (I2>90%), modestly explained by subregions and countries. DBM across the life course could not be estimated owing to insufficient estimates. In conclusion, using available data, our study suggests that the burden of DBM in the LAC region ranges between 0% and 24%. In the most frequent DBM typologies, overweight was a common contributor. Substantial progress can be made in curbing the burden of DBM in the LAC region through strategies addressing excess weight within these population groups. This study was registered at PROSPERO as CRD42023406755.
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Affiliation(s)
- Diana Sagastume
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Global Health Institute, University of Antwerp, Wilrijk, Belgium.
| | | | | | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Department of Health Sciences, Vrije Universiteit (VU) Amsterdam, Netherlands
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - José L Peñalvo
- Global Health Institute, University of Antwerp, Wilrijk, Belgium; National Center for Epidemiology, Carlos III Institute of Health (ISCIII), Madrid, Spain
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Getnet M, Sisay WS, Alem AZ. Spatial distribution and associated factors of co-occurrence of overweight/obesity and Anemia among women in the reproductive age in sub-Saharan Africa: A multilevel analysis, DHS 2016-2021. PLoS One 2024; 19:e0299519. [PMID: 38635643 PMCID: PMC11025742 DOI: 10.1371/journal.pone.0299519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/13/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Overweight/obesity is one of the major public health problems that affect both developed and developing nations. The co-occurrence of overweight/obesity and anemia is thought to be largely preventable if detected early. To date, no spatial analyses have been performed to identify areas of hotspots for the co-occurrence of overweight/obesity and anemia among reproductive women in sub-Saharan Africa. Therefore, this study aimed to assess the spatial distribution and associated factors of the co-occurrence of overweight/obesity and anemia among women of reproductive age. METHODS Data for the study were drawn from the Demographic and Health Survey, a nationally representative cross-sectional survey conducted in the era of Sustainable Development Goals, in which the World Health Assembly decided and planned to cease all forms of malnutrition by 2030. Seventeen sub-Saharan African countries and a total weighted sample of 108,161 reproductive women (15-49 years) were included in our study. The data extraction, recoding and analysis were done using STATA V.17. For the spatial analysis (autocorrelation, hot-spot and interpolation), ArcGIS version 10.7 software, and for the SaTScan analysis, SaTScan version 10.1 software was used. Descriptive statistics were presented using frequency tables and percentages. We employed multilevel logistic regression to investigate associated factors. In the multivariable analysis, variables with a p-value of ≤0.05 are considered as a significant factor associated with co-occurrence of overweight/obesity and anemia among women aged 15-49 years. RESULTS The overall co-occurrence of overweight/obesity and anemia among women in sub-Saharan Africa was 12% (95%CI: 9-14%). The spatial analysis revealed that the co-occurrence of overweight/obesity and anemia among women significantly varied across sub-Saharan Africa. (Global Moran's I = 0.583163, p<0.001). In the spatial window, the primary-cluster was located in Liberia, Guinea, Gambia, Sira Leon, Mauritania, Mali, Cameron and Nigeria with a Log-Likelihood Ratio (LRR) of 1687.30, and Relative Risk (RR) of 2.58 at a p-value < 0.001. In multilevel analysis, women aged 25-34 years (AOR = 1.91, 95%CI: 1.78, 2.04), women aged 35-49 years (AOR = 2.96, 95% CI: 2.76, 3.17), married (AOR = 1.36, 95% CI: 1.27, 1.46), widowed (AOR = 1.22, 95%CI: 1.06, 1.40), divorced (AOR = 1.36, 95% CI: 1.23, 1.50), media exposure (AOR = 1.31, 95%CI: 1.23, 1.39), middle income (AOR = 1.19, 95%CI: 1.11, 1.28), high income/rich (AOR = 1.36, 95%CI: 1.26, 1.46), not working (AOR = 1.13, 95% CI:1.07, 1.19), traditional contraceptive utilization (AOR = 1.39, 95%CI: 1.23, 1.58) and no contraceptive use (AOR = 1.27, 95%CI: 1.20, 1.56), and no health insurance coverage (AOR = 1.36, 95%CI: 1.25, 1.49), were individual level significant variables. From community-level variables urban residence (AOR = 1.61, 95%CI: 1.50, 1.73), lower middle-income country (AOR = 2.50, 95%CI: 2.34, 2.66) and upper middle-income country (AOR = 2.87, 95%CI: 2.47, 3.34), were significantly associated with higher odds of co-occurrence of overweight/ obesity and anemia. CONCLUSION AND RECOMMENDATIONS The spatial distribution of the co-occurrence of overweight/obesity and anemia was significantly varied across the sub-Saharan African country. Both individual and community-level factors were significantly associated with the co-occurrence of overweight/obesity and anemia. Therefore, public health programmers and other stalk holders who are involved in maternal healthcare should work together and give priority to hotspot areas of co-occurrence in sub-Saharan Africa.
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Affiliation(s)
- Mihret Getnet
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wullo Sisay Sisay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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3
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Seifu BL, Mare KU, Legesse BT, Tebeje TM. Double burden of malnutrition and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel multinomial logistic regression analysis. BMJ Open 2024; 14:e073447. [PMID: 38341217 PMCID: PMC10862289 DOI: 10.1136/bmjopen-2023-073447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Globally, malnutrition among women of reproductive age is on the rise and significantly contributing to non-communicable disease, deaths and disability. Even though the double burden of malnutrition (DBM) is a common problem among women in sub-Saharan Africa (SSA), there are limited studies examining the factors contributing to underweight, overweight, and obesity at the SSA level. OBJECTIVE To determine the factors associated with the DBM, and their relative magnitude, among women of reproductive age in SSA. DESIGN Cross-sectional study design. SETTING 33 SSA countries. PARTICIPANTS 240 414 women of reproductive age. PRIMARY AND SECONDARY OUTCOME MEASURES A multilevel multinomial logistic regression model was applied to identify factors associated with malnutrition. The adjusted relative risk ratio with 95% CI was used to declare the statistical significance of the association. RESULTS The pooled prevalence of underweight, overweight and obesity among women in SSA were 8.87%, 16.47% and 6.10%, respectively. Women who are from rural residence and smoke cigarettes were more likely to be underweight. Conversely, women between the age of 24-34 and 35-49, who have higher education, belong to a middle and rich household, are ever married, have high parity, use contraceptives, have media exposure and smoke cigarettes were more likely to be overweight and/or obese. CONCLUSION The findings of our study suggest that certain factors such as residence, education status, wealth, marital status, occupation, cigarette smoking, and contraceptive use have a significant assocation with malnutrition among women. Therefore, it is important for public health programs aimed at preventing the double burden of malnutrition to focus on these factors through comprehensive public awareness and cost-effective operational health interventions.
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Affiliation(s)
- Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of health sciences and Medicine, Dilla University, Dilla, Ethiopia
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Holt RR, Munafo JP, Salmen J, Keen CL, Mistry BS, Whiteley JM, Schmitz HH. Mycelium: A Nutrient-Dense Food To Help Address World Hunger, Promote Health, and Support a Regenerative Food System. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:2697-2707. [PMID: 38054424 PMCID: PMC10853969 DOI: 10.1021/acs.jafc.3c03307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023]
Abstract
There is a need for transformational innovation within the existing food system to achieve United Nations Sustainable Development Goal 2 of ending hunger within a sustainable agricultural system by 2030. Mycelium, the vegetative growth form of filamentous fungi, may represent a convergence of several features crucial for the development of food products that are nutritious, desirable, scalable, affordable, and environmentally sustainable. Mycelium has gained interest as technology advances demonstrate its ability to provide scalable biomass for food production delivering good flavor and quality protein, fiber, and essential micronutrients urgently needed to improve public health. We review the potential of mycelium as an environmentally sustainable food to address malnutrition and undernutrition, driven by food insecurity and caloric dense diets with less than optimal macro- and micronutrient density.
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Affiliation(s)
- Roberta R. Holt
- Department
of Nutrition, University of California,
Davis, Davis, California 95616, United States
| | - John P. Munafo
- Department
of Food Science, University of Tennessee, Knoxville, Tennessee 37996, United States
| | - Julie Salmen
- Nutritious
Ideas, LLC, Saint John, Indiana 46373, United States
| | - Carl L. Keen
- Department
of Nutrition, University of California,
Davis, Davis, California 95616, United States
| | - Behroze S. Mistry
- Meati
Foods, 6880 Winchester
Cir Unit D, Boulder, Colorado 80301, United States
| | - Justin M. Whiteley
- Meati
Foods, 6880 Winchester
Cir Unit D, Boulder, Colorado 80301, United States
| | - Harold H. Schmitz
- March
Capital US, LLC, Davis, California 95616, United States
- T.O.P.,
LLC, Davis, California 95616, United States
- Graduate
School of Management, University of California,
Davis, Davis, California 95616, United States
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Diakité D, Sidibé S, Kolié F, Camara F, Camara DM, Kourouma M, Délamou A. Prevalence and factors associated with the coexistence of overweight/obesity and anaemia among women of reproductive age in Guinea. Public Health Nutr 2023; 26:2748-2757. [PMID: 37855236 PMCID: PMC10755430 DOI: 10.1017/s1368980023002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To determine the prevalence and associated factors of the coexistence of overweight or obesity (OWOB) and anaemia among non-pregnant Guinean women aged 15-49 years. DESIGN The analysis was performed using data from the 2018 Guinean Demographic and Health Survey. Multivariate logistic regression was used to identify factors associated with the coexistence of OWOB and anaemia (OWOB + anaemia) among non-pregnant Guinean women. SETTING Guinea. PARTICIPANTS A total of 4783 non-pregnant women aged 15-49 years with valid data on the nutritional status (BMI and Hb level) were included in the analysis. RESULTS The prevalence of coexistence of OWOB and anaemia among non-pregnant women was 11·16 % (95% CI: 10·05, 12·37). The following variables were associated with OWOB + anaemia in multivariate models (adjusted OR (AOR) 95% CI): higher wealth index (AOR = 4·69; 95% CI: 2·62, 8·39), middle wealth index (AOR = 1·96; 95% CI: 1·31, 2·93), four or more antenatal visits (AOR = 1·62; CI: 1·16, 2·28), having four or more children (AOR = 2·47; 95% CI: 1·37, 4·43) and the rural areas (AOR = 0·59; 95% CI: 0·37, 0·95). CONCLUSION The current study's findings reveal that OWOB + anaemia concerned one-tenth of non-pregnant women. Associated factors were household wealth index, multiparity, antenatal visits and rural areas. Thus, there is a need to design specific interventions to prevent the double burden of malnutrition among women of reproductive age. Interventions should include promoting physical exercise, family planning, healthy eating and raising awareness of behavioural change.
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Affiliation(s)
- Djiba Diakité
- Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Sidikiba Sidibé
- CEA-PCMT_Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Fassou Kolié
- Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Facely Camara
- Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | | | - Mory Kourouma
- Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alexandre Délamou
- CEA-PCMT_Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
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Suarez-Ortegón MF, Ordoñez-Betancourth JE, Ortega-Ávila JG, Yibby Forero A, Fernández-Real JM. Excess adiposity and iron-deficient status in Colombian women of reproductive age. Obesity (Silver Spring) 2023; 31:3025-3042. [PMID: 37814827 DOI: 10.1002/oby.23871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Information about excess adiposity markers different from BMI and iron status is limited and more so about the shape of these associations. This study evaluated the relationship between three adiposity markers and iron-deficient status in reproductive-age women. METHODS Cross-sectional analysis in 6357 non-pregnant women from the Colombian nutritional health survey (ENSIN) 2010. Exposures were the following: waist circumference (WC), waist-to-height ratio (W-HtR), BMI, and WC > 80 cm, W-HtR > 0.5, and BMI ≥ 25 and ≥30. Outcomes were the following: iron deficiency (ID) as serum ferritin <15 μg/L, ID as ferritin <30 μg/L, anemia, and continuous values of ferritin and hemoglobin. Logistic and linear regressions adjusted for sociodemographic/inflammation covariates were conducted. RESULTS All the adiposity markers, continuous or categorical, were inversely and significantly associated with both ID thresholds in fully adjusted models (p < 0.05). W-HtR reported stronger effect estimates for ID (odds ratios < 0.5) and for prediction of log-ferritin levels (fully adjusted β-coefficient [95% CI] 0.61 [0.39-0.82], p < 0.01) and was also inversely associated with anemia (p < 0.05). In cubic splines analyses, W-HtR, WC, and BMI were linearly associated with ID from values closer to international thresholds of general or central obesity, and the patterns of WC and BMI tended toward flatness. A significant decline in the likelihood of anemia was steeper by increasing W-HtR than by increasing BMI. After exclusion of women with C reactive protein > 5 mg/L or adjustment for C reactive protein, adiposity markers remained significantly related to ferritin levels and W-HtR with anemia. CONCLUSIONS Women with higher adiposity were less likely to have an iron-deficient status. W-HtR was the strongest and most consistently associated marker. Inflammation would not be involved in the associations found.
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Affiliation(s)
- Milton Fabián Suarez-Ortegón
- Departamento de Alimentación y Nutrición, Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Seccional Cali, Cali, Colombia
| | | | - José Guillermo Ortega-Ávila
- Departamento de Ciencias Básicas, Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Seccional Cali, Cali, Colombia
| | | | - José Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi) and Hospital Trueta, Girona, Spain
- CIBERobn Fisiopatología de la Obesidad y Nutrición, Girona, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Girona, Spain
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Vahid F, Rahmani W, Davoodi SH, Bohn T. The micronutrient content of the diet is correlated with serum glucose biomarkers and lipid profile and is associated with the odds of being overweight/obese-a case-control study. Front Nutr 2023; 10:1148183. [PMID: 37457985 PMCID: PMC10338876 DOI: 10.3389/fnut.2023.1148183] [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] [Received: 01/19/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Background A low micronutrient intake has been reported to contribute to the double-burden of obesity, increasing the risk for chronic diseases such as cardiovascular disease, diabetes, cancer, and mental disorders. This case-control study compared micronutrient intake profiles in overweight/obese vs. normal-weight individuals. We hypothesized that a low intake of certain micronutrients would increase the odds of being overweight/obese. Methods The case group (n = 812 adults) consisted of individuals with a BMI of ≥25 kg/m2, and the control group (n = 793) had BMIs of 17.9-24.9 kg/m2. A validated 124-item food frequency questionnaire was used to determine micronutrient-related dietary-quality, using the index of nutritional quality (INQ), calculated as the fraction of a micronutrient consumed vs. its dietary requirement. In addition, body surface area (BSA) was calculated according to the Mosteller formula. Results The control group had significantly higher INQ-scores of vitamin A, vitamin C, calcium, magnesium, and selenium compared to the case group. Furthermore, individuals with normal BSA (≤1.91 m2 for men; ≤1.71 m2 for women) had significantly higher INQ scores of vitamin C, calcium, magnesium, and zinc compared to participants with high BSA. In multivariable adjustment regression models, INQs of vitamin C (ORBMI = 0.79, 95%CI: 0.64-0.97; ORBSA = 0.81, 95%CI, 0.68-0.97) and magnesium (ORBMI = 0.69, 95%CI: 0.47-0.99; ORBSA = 0.71, 95%CI: 0.52-0.97) were significantly associated with the odds of obesity/overweight (in both BMI and BSA categories). Conclusion The significant association between micronutrient levels of the diet, especially of vitamin C and magnesium, with both obesity criteria, emphasized the importance of certain micronutrients in the obesity/overweight causal network.
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Affiliation(s)
- Farhad Vahid
- Nutrition and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Wena Rahmani
- Nutrition Group, School of Health, Arak University of Medical Science, Arak, Iran
| | - Sayed Hossein Davoodi
- Department of Cellular and Molecular Nutrition, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Torsten Bohn
- Nutrition and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Datta S, Montoya R, Franco J, Haro M, Tapia P, Pozo C, Quispe J, Lozano A, Quevedo Cruz L, Evans C. A prospective cohort study of economic and nutritional changes during the COVID-19 pandemic in urban Callao, Lima, Peru. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18536.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Background: Peru followed strict quarantine measures to control COVID-19 but reported excess mortality rates during the pandemic that were the highest globally. High obesity prevalence in Peru may have contributed to COVID-19 mortality, although economic hardship during the pandemic could have reduced obesity. To investigate these potential associations, we updated surveys of economic status, nutritional status, and risk factors for severe COVID-19 in residents of Callao, in the Lima metropolitan area of Peru. Methods: We attempted in December 2021 to invite members of households selected randomly from a map that had provided data in previous surveys 2016-2018 and 2019-2020 to participate in another survey. Households were contacted by telephone and, if uncontactable, were visited. Demographic, economic, and health-related data were collected using the Kobo toolbox platform. Results. We interviewed 83% (305/369) of censused household members for 65% (90/138) of previously participating households. Dissaving activities were reported by all households during the pandemic, more than 2016-2018 (51%, 95% confidence interval, CI=41-62%) and 2019-2020 (44%, 95%CI=33-53%, both p<0.0001). Moreover, 90% (81/90, 95%CI=82-95%) of households reported inability to afford sufficient food and hunger rates increased 1.4 times compared with 2016-2018 (95%CI=1.02, 2.0, p=0.04). Despite financial and food insecurity during the pandemic, the mean adult body mass index was maintained unchanged from the 2019-2020 survey at 27 kg/m2 (standard deviation, SD=4.5 kg/m2), having increased (p=0.0001) from 26 kg/m2 (SD=4.1 kg/m2) in 2016-2018. Overweight/obesity was the most common risk factor for severe COVID-19, and adults were 3.1 times (95%CI=2.3-4.2, p<0.0001) more likely to be overweight/obese than they were to have a co-morbid illness. There was considerable dietary diversity and only 23% of participants had taken micronutrient supplements and 11% probiotics in the past year. Conclusion: Obesity was the most prevalent risk factor for severe COVID-19 despite economic pressure, food insecurity, and hunger during the pandemic.
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Jayalakshmi R, Sewor C, Kannan S. Intraindividual double burden of malnutrition among women (15-49 years) in India, Myanmar, and Nepal: evidence from the recent Demographic and Health Surveys. Eur J Clin Nutr 2023; 77:603-610. [PMID: 36754976 DOI: 10.1038/s41430-023-01269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND There is a concurrent increase in anaemia and overweight/obesity among women in the South and South East Asia regions. Despite these, studies on the co-existence of anaemia and overweight/obesity in these countries are abysmally limited. This secondary analysis sought to estimate the burden of the intraindividual double burden of malnutrition (IDBM), i.e., co-existence of anaemia and overweight/obesity among women of reproductive age (15-49 years) in India, Myanmar, and Nepal, and explore the impact of socio-demographic and economic factors on this health outcome. METHODS A secondary analysis of the Demographic and Health Surveys (DHS) of India (2019-2021), Myanmar (2015-2016), and Nepal (2016) was conducted. A descriptive analysis of the health outcomes and the risk factors was done with frequencies and percentages. The association between selected socio-demographic (women's age, education status, number of children and place of residence) and economic (occupation status, and wealth quintile) variables with IDBM was found with binary logistic regression analysis. RESULTS Around one in ten women of reproductive age group in India and Myanmar had IDBM. In Nepal, it occurs in one in nearly 15 women. Maternal age, education, household wealth, number of children, place of residence, and occupation were found to be significant predictors of IDBM. CONCLUSION There is a high prevalence of IDBM in South Asian women and it varies substantially across different socio-demographic and economic predictors. Sufficient evidence from prospective studies is needed to establish causal association and also to implement need-based prevention and curative strategies.
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Affiliation(s)
- Rajeev Jayalakshmi
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India.
| | - Christian Sewor
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India.,Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Srinivasan Kannan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Seifu CN, Fahey PP, Atlantis E. Micronutrient deficiencies and anaemia associated with body mass index in Australian adults: a cross-sectional study. BMJ Open 2022; 12:e061442. [PMID: 36521896 PMCID: PMC9809261 DOI: 10.1136/bmjopen-2022-061442] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/23/2022] Open
Abstract
AIM To estimate the prevalence of micronutrient deficiencies and anaemia, and their association with body mass index (BMI) categories among Australian adults. METHOD We analysed data from the 2011-2013 Australian Health Survey from 3539 participants aged 18 years and over (without known pregnancy) with measured weight and height, and nutrient biomarkers. To address complex sampling, survey weights were used when estimating the prevalence of micronutrient deficiencies (vitamin B12 deficiency; serum vitamin B12<145 pmol/L; iron deficiency; ferritin<30 µg/L and vitamin D deficiency; 25-hydroxyvitamin D<50 nmol/L) and anaemia (haemoglobin <120 g/L for females and <130 g/L for males) and when assessing associations with logistic regression models with adjusted ORs (AORs) for BMI categories: healthy weight (BMI 18.5 to <25.0 kg/m2), reference; overweight (BMI 25.0 to <30.0 kg/m2), obesity class I (BMI 30.0 to <35.0 kg/m2), obesity class II/III (BMI 35.0 kg/m2 or more). RESULT The prevalence of vitamin B12 deficiency (range 0.9%─2.8%) and anaemia (range 3.9%─6.7%) were variable across BMI groups. The prevalence of iron deficiency in the obesity class I group was 12.0 percentage points lower than healthy weight group with an AOR of 0.50 (95% CI 0.30 to 0.83). The prevalence of vitamin D deficiency in the obesity class II/III group was 7.9 percentage points higher than the healthy weight group with an AOR of 1.62 (95% CI 1.01 to 2.60). Vitamin B12 deficiency and anaemia were not consistently associated with BMI groups. CONCLUSION We found a consistent association between severe obesity and vitamin D deficiency in Australian adults. We also found obesity class I was negatively associated with iron deficiency, whereas there was no consistent association between BMI groups and vitamin B12 deficiency and anaemia. Public health strategies are needed to prevent vitamin D deficiency in this high-risk population.
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Affiliation(s)
- Canaan Negash Seifu
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Paul Patrick Fahey
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Discipline of Medicine, Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Guardiola-Márquez CE, Santos-Ramírez MT, Segura-Jiménez ME, Figueroa-Montes ML, Jacobo-Velázquez DA. Fighting Obesity-Related Micronutrient Deficiencies through Biofortification of Agri-Food Crops with Sustainable Fertilization Practices. PLANTS (BASEL, SWITZERLAND) 2022; 11:3477. [PMID: 36559589 PMCID: PMC9784404 DOI: 10.3390/plants11243477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Obesity is a critical medical condition worldwide that is increasingly involved with nutritional derangements associated with micronutrient deficiencies, including iron, zinc, calcium, magnesium, selenium, and vitamins A, C, D, and E. Nutritional deficiencies in obesity are mainly caused by poor-quality diets, higher nutrient requirements, alterations in micronutrient metabolism, and invasive obesity treatments. The current conventional agricultural system is designed for intensive food production, focusing on food quantity rather than food quality, consuming excessive agricultural inputs, and producing nutrient-deficient foods, thus generating severe health and environmental problems; agricultural food products may worsen obesity-related malnutrition. Therefore, modern agriculture is adopting new biofortification technologies to combat micronutrient deficiencies and improve agricultural productivity and sustainability. Biofertilization and nanofertilization practices are increasingly used due to their efficiency, safety, and reduced environmental impact. Biofertilizers are preparations of PGP-microorganisms that promote plant growth by influencing plant metabolism and improving the nutrient uptake, and nanofertilizers consist of synthesized nanoparticles with unique physicochemical properties that are capable of increasing plant nutrition and enriching agricultural products. This review presents the current micronutrient deficiencies associated with obesity, the modern unsustainable agri-food system contributing to obesity progression, and the development of bio- and nanofertilizers capable of biofortifying agri-food crops with micronutrients commonly deficient in patients with obesity.
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Affiliation(s)
| | - María Teresa Santos-Ramírez
- Tecnologico de Monterrey, Escuela de Ingenieria y Ciencias, Ave. General Ramon Corona 2514, Zapopan 45138, Jalisco, Mexico
| | - M. Eugenia Segura-Jiménez
- Tecnologico de Monterrey, Escuela de Ingenieria y Ciencias, Ave. General Ramon Corona 2514, Zapopan 45138, Jalisco, Mexico
| | - Melina Lizeth Figueroa-Montes
- Tecnologico de Monterrey, Escuela de Ingenieria y Ciencias, Ave. General Ramon Corona 2514, Zapopan 45138, Jalisco, Mexico
| | - Daniel A. Jacobo-Velázquez
- Tecnologico de Monterrey, Escuela de Ingenieria y Ciencias, Ave. General Ramon Corona 2514, Zapopan 45138, Jalisco, Mexico
- Tecnologico de Monterrey, The Institute for Obesity Research, Ave. General Ramon Corona 2514, Zapopan 45201, Jalisco, Mexico
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12
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Davis JN, Williams A, Arnold CD, Rohner F, Wirth JP, Addo Y, Flores-Ayala RC, Oaks BM, Young MF, Suchdev PS, Engle-Stone R. The Relationship Between Ferritin and BMI is Mediated by Inflammation Among Women in Higher-Income Countries, But Not in Most Lower-Income Countries Nor Among Young Children: A Multi-Country Analysis. Curr Dev Nutr 2022; 6:nzac139. [PMID: 36475018 PMCID: PMC9718651 DOI: 10.1093/cdn/nzac139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 10/03/2023] Open
Abstract
Background In the presence of inflammation, the serum or plasma ferritin concentration ("ferritin" hereafter) transiently increases, confounding its interpretation as an iron status marker. The extent to which adiposity-related inflammation may influence ferritin interpretation is uncertain. Objectives We describe relationships between weight status, inflammation, and ferritin among nonpregnant women of reproductive age (WRA; 15-49 years) and preschool-age children (PSC; 6-59 months) with normal weight to overweight or obesity (OWOB) in differing geographic settings. Methods Cross-sectional data were separately analyzed from 18 surveys (WRA) and 25 surveys (PSC) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, excluding observations with underweight, wasting, pregnancy, or malaria. Relationships were assessed between BMI (in WRA) or BMI-for-age z-score (BAZ; in PSC), inflammatory biomarkers of C-reactive protein (CRP) and/or α-1-acid glycoprotein (AGP), ferritin by linear regression, and potential mediation by CRP and/or AGP in relationships between BMI or BAZ and ferritin with structural equation modeling. Regression and mediation models accounted for complex survey designs. Results were grouped by World Bank income classifications. Results In 5 of 6 surveys among WRA from upper-middle and high-income countries, ferritin was significantly positively associated with BMI, and this relationship was partially (or fully, in the United States) mediated by CRP and/or AGP. Mediation was present in 4 of 12 surveys for WRA in low- and lower-middle income countries. Among PSC, ferritin was positively associated with CRP and/or AGP in all surveys, but there were no significant CRP- or AGP-mediated relationships between ferritin and BAZ, except a negative relationship in the Philippines. Conclusions Where having OWOB is common among WRA, measurements of inflammatory biomarkers and their uses in interpreting ferritin may improve iron status assessments. While these relationships were inconsistent among PSC, inflammation was common and should be measured to interpret iron status. Included Kenyan trial data are registered at clinicaltrials.gov as NCT01088958.
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Affiliation(s)
- Jennie N Davis
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | - Anne Williams
- University of Otago, Department of Human Nutrition, Dunedin, New Zealand
| | - Charles D Arnold
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | | | | | - Yaw Addo
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Melissa F Young
- Global Health Department, Emory University, Atlanta, GA, USA
| | - Parminder S Suchdev
- Department of Pediatrics and Global Health, Emory University, Atlanta, GA, USA
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reina Engle-Stone
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
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Datta BK, Haider MR. The double burden of overweight or obesity and anemia among women married as children in India: A case of the Simpson’s paradox. Obes Res Clin Pract 2022; 16:364-372. [DOI: 10.1016/j.orcp.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/28/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022]
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The co-occurrence of overweight/obesity and anaemia among adult women, adolescent girls and children living in fifty-two low- and middle-income countries. Public Health Nutr 2022; 25:1595-1606. [PMID: 34103123 PMCID: PMC9991775 DOI: 10.1017/s1368980021002512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the magnitude and distribution of concurrent overweight/obesity and anaemia among adult women, adolescent girls and children living in low- and middle-income countries (LMIC). DESIGN We selected the most recent Demographic and Health Surveys with anthropometric and Hb level measures. Prevalence estimates and 95 % CI of concurrent overweight/obesity and anaemia were calculated for every country, overall and stratified by household wealth quintile, education level, area of residence and sex (for children only). Regional and overall pooled prevalences were estimated using a random-effects model. We measured gaps, expressed in percentage points, to display inequalities in the distribution of the double burden of malnutrition (DBM). SETTING Nationally representative surveys from fifty-two LMIC. PARTICIPANTS Adult women (n 825 769) aged 20-49 years, adolescent girls (n 192 631) aged 15-19 years and children (n 391 963) aged 6-59 months. RESULTS The pooled prevalence of concurrent overweight/obesity and anaemia was 12·4 % (95 % CI 11·1, 13·7) among adult women, 4·5 % (95 % CI 4·0, 5·0) among adolescent girls and 3·0 % (95 % CI 2·7, 3·3) among children. Overall, the DBM followed an inverse social gradient, with a higher prevalence among the richest quintile, most educated groups and in urban areas; however, important variations exist. The largest inequality gaps were observed among adult women in Yemen by household wealth (24·0 percentage-points) and in Niger by education level (19·6 percentage-points) and area of residence (11·9 percentage-points). Differences were predominantly significant among adult women, but less among girls and children. CONCLUSIONS Context-specific, multifaceted, responses with an equity lens are needed to reduce all forms of malnutrition.
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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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Co-Occurrence of Overweight/Obesity, Anemia and Micronutrient Deficiencies among Non-Pregnant Women of Reproductive Age in Ghana: Results from a Nationally Representative Survey. Nutrients 2022; 14:nu14071427. [PMID: 35406039 PMCID: PMC9002982 DOI: 10.3390/nu14071427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 12/10/2022] Open
Abstract
Overweight/obesity (OWOB) often co-occurs with anemia or micronutrient deficiencies (MNDs) among women of reproductive age (WRA) in Ghana; identifying the risk factors of these conditions is essential for prevention. We aimed to examine the prevalence of OWOB, anemia, and MNDs and their co-occurrence and risk factors among non-pregnant women 15–49 years of age in Ghana. Data were from a 2017 two-stage national survey of 1063 women. We estimated the weighted prevalence of single and co-occurring malnutrition, and used logistic regression to explore risk factors. The prevalence of OWOB, anemia, and ≥1 MND was 39%, 22%, and 62%, respectively; that of OWOB co-occurring with anemia was 6.7%, and OWOB co-occurring with ≥1 MND was 23.6%. There was no significant difference between observed and expected prevalence of co-occurrence OWOB with anemia or MND. Risk factors were: living in southern (vs. northern) belt, high- (vs. low-) wealth household, being ≥ 25 years old, and being married (vs. single) for OWOB, and living in northern (vs. southern) belt and medium- (vs. low-) wealth household for anemia and ≥1 MND, respectively. Different interventions are required for addressing OWOB in WRA than those for anemia and MNDs.
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Chen S, Yang M, Wang R, Fan X, Tang T, Li P, Zhou X, Qi K. Suppression of high-fat-diet-induced obesity in mice by dietary folic acid supplementation is linked to changes in gut microbiota. Eur J Nutr 2022; 61:2015-2031. [PMID: 34993642 DOI: 10.1007/s00394-021-02769-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 12/03/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate whether the effects of dietary folic acid supplementation on body weight gain are mediated by gut microbiota in obesity. METHODS Male C57 BL/6J conventional (CV) and germ-free (GF) mice both aged three to four weeks were fed a high-fat diet (HD), folic acid-deficient HD (FD-HD), folic acid-supplement HD (FS-HD) and a normal-fat diet (ND) for 25 weeks. Faecal microbiota were analyzed by 16S rRNA high-throughput sequencing, and the mRNA expression of genes was determined by the real-time RT-PCR. Short-chain fatty acids (SCFAs) in faeces and plasma were measured using gas chromatography-mass spectrometry. RESULTS In CV mice, HD-induced body weight gain was inhibited by FS-HD, accompanied by declined energy intake, smaller white adipocyte size, and less whitening of brown adipose tissue. Meanwhile, the HD-induced disturbance in the expression of fat and energy metabolism-associated genes (Fas, Atgl, Hsl, Ppar-α, adiponectin, resistin, Ucp2, etc.) in epididymal fat was diminished, and the dysbiosis in faecal microbiota was lessened, by FS-HD. However, in GF mice with HD feeding, dietary folic acid supplementation had almost no effect on body weight gain and the expression of fat- and energy-associated genes. Faecal or plasma SCFA concentrations in CV and GF mice were not altered by either FD-HD or FS-HD feeding. CONCLUSION Dietary folic acid supplementation differently affected body weight gain and associated genes' expression under HD feeding between CV and GF mice, suggesting that gut bacteria might partially share the responsibility for beneficial effects of dietary folate on obesity.
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Affiliation(s)
- Si Chen
- Laboratory of Nutrition and Development, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institutue, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-li-shi Road, Beijing, 100045, China
| | - Mengyi Yang
- Laboratory of Nutrition and Development, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institutue, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-li-shi Road, Beijing, 100045, China
| | - Rui Wang
- Laboratory of Nutrition and Development, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institutue, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-li-shi Road, Beijing, 100045, China
| | - Xiuqin Fan
- Laboratory of Nutrition and Development, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institutue, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-li-shi Road, Beijing, 100045, China
| | - Tiantian Tang
- Laboratory of Nutrition and Development, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institutue, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-li-shi Road, Beijing, 100045, China
| | - Ping Li
- Laboratory of Nutrition and Development, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institutue, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-li-shi Road, Beijing, 100045, China
| | - Xinhui Zhou
- Laboratory of Nutrition and Development, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institutue, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-li-shi Road, Beijing, 100045, China
| | - Kemin Qi
- Laboratory of Nutrition and Development, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Pediatric Research Institutue, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-li-shi Road, Beijing, 100045, China.
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de Juras AR, Hsu WC, Hu SC. Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey. Nutrients 2021; 13:2339. [PMID: 34371849 PMCID: PMC8308505 DOI: 10.3390/nu13072339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 01/20/2023] Open
Abstract
The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.
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Affiliation(s)
- Aileen R. de Juras
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan; (A.R.d.J.); (W.-C.H.)
- Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines Los Baños, Laguna 4031, Philippines
| | - Wan-Chen Hsu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan; (A.R.d.J.); (W.-C.H.)
| | - Susan C. Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan; (A.R.d.J.); (W.-C.H.)
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Kerkadi A, Mohsen Ali R, A. H. Shehada A, Abdelnasser AbouHassanein E, Moawad J, Bawadi H, Shi Z. Association between central obesity indices and iron status indicators among Qatari adults. PLoS One 2021; 16:e0250759. [PMID: 33914792 PMCID: PMC8084168 DOI: 10.1371/journal.pone.0250759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
Co-existence of iron deficiency and obesity in adults has been reported in many countries. However, little is known on the association between obesity and iron deficiency in Qatar. This study aimed to investigate the link between abdominal obesity indices and iron status among adults in Qatar. A random sample of 1000 healthy Qatari adults, aged 20-50 years, was obtained from Qatar Biobank study. Body weight, waist circumference, dual x-ray absorptiometry (DXA) parameters and iron status indicators were measured using standard techniques. Multiple regression analysis was used to examine the associations. The prevalence of iron deficiency and anaemia were 35.4 and 25%, respectively. Of the participants with a large waist circumference, 31.7% had anaemia. Ferritin significantly increased with the increase in the android fat to gynoid fat ratio and visceral fat in both genders. Serum iron and transferring saturation decreased significantly with the increase in waist circumference in women. In both genders, C-reactive protein increased with the increase in all obesity indices. Standardized values of waist circumference, android fat, gynoid fat ratio and visceral fat were significantly associated with log transformed ferritin in men and women. Waist circumference was inversely related to serum iron (β:-0.95, 95% CI:-1.50,-0.39) and transferrin saturation (β:-1.45, 95%CI:-2.46, -0.43) in women. In men, waist circumference was positively associated with haemoglobin level (β: 0.16, 95% CI:0.04, 0.29). Central obesity coexists with anaemia among the study population. Elevated central obesity indices were associated with an increase in ferritin concentration. The increased ferritin concentration may be attributed to the increase in inflammatory status as a result of an increase in c-reactive protein concentration associated with central obesity.
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Affiliation(s)
- Abdelhamid Kerkadi
- Human Nutrition Department, College of Health Sciences, Qu-Health, Qatar University, Doha, Qatar
| | - Reem Mohsen Ali
- Human Nutrition Department, College of Health Sciences, Qu-Health, Qatar University, Doha, Qatar
| | - Alaa A. H. Shehada
- Human Nutrition Department, College of Health Sciences, Qu-Health, Qatar University, Doha, Qatar
| | | | - Joyce Moawad
- Human Nutrition Department, College of Health Sciences, Qu-Health, Qatar University, Doha, Qatar
| | - Hiba Bawadi
- Human Nutrition Department, College of Health Sciences, Qu-Health, Qatar University, Doha, Qatar
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, Qu-Health, Qatar University, Doha, Qatar
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Intraindividual double-burden of anthropometric undernutrition and "metabolic obesity" in Indian children: a paradox that needs action. Eur J Clin Nutr 2021; 75:1205-1217. [PMID: 33893450 PMCID: PMC7612996 DOI: 10.1038/s41430-021-00916-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/04/2021] [Accepted: 03/29/2021] [Indexed: 12/16/2022]
Abstract
Background Intraindividual coexistence of anthropometrically defined undernutrition and “metabolic obesity”, characterised by presence of at least one abnormal cardiometabolic risk factor, is rarely investigated in young children and adolescents, particularly in Low-and-Middle-Income-Countries undergoing rapid nutrition transition. Methods Prevalence of biomarkers of metabolic obesity was related to anthropometric and socio-demographic characteristics in 5-19 years old participants from the population-based Comprehensive National Nutrition Survey in India (2016-2018). The biomarkers, serum lipid-profile (total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides), fasting glucose, and glycosylated hemoglobin (HbA1C), and all jointly were analysed in 22567, 23192, 25962 and 19143 participants, respectively. Results Overall (entire dataset), the prevalence of abnormalities was low (4.3-4.5%) for LDL and TC, intermediate for dysglycemia (10.9-16.1%), and high for HDL and triglycerides (21.725.8%). Proportions with ≥1 abnormal metabolic obesity biomarker(s) were 56.2% overall, 54.2% in thin (BMI-for-age <-2SD) and 59.3% in stunted (height-for-age <-2SD) participants. Comparable prevalence was evident in mild undernutrition (-1 to -2 SD). Clustering of two borderline abnormalities occurred in one-third, warranting active life-style interventions. Metabolic obesity prevalence increased with BMI-for-age. Among those with metabolic obesity, only 9% were overweight/obese (>1SD BMI-for-age). Among poor participants, triglyceride, glucose and HDL abnormalities were higher. Conclusions A paradoxical, counter-intuitive prevalence of metabolic obesity biomarker(s) exists in over half of anthropometrically undernourished and normal-weight Indian children and adolescents. There is a crucial need for commensurate investments to address overnutrition along with undernutrition. Nutritional status should be characterized through additional reliable biomarkers, instead of anthropometry alone.
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Davis JN, Oaks BM, Engle-Stone R. The Double Burden of Malnutrition: A Systematic Review of Operational Definitions. Curr Dev Nutr 2020; 4:nzaa127. [PMID: 32885132 PMCID: PMC7456307 DOI: 10.1093/cdn/nzaa127] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions. OBJECTIVES To identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment. METHODS Following a structured search of peer-reviewed articles with terms describing "overnutrition" [e.g., overweight/obesity (OW/OB)] and "undernutrition" (e.g., stunting, micronutrient deficiency), we screened 1920 abstracts, reviewed 500 full texts, and extracted 623 operational definitions from 239 eligible articles. RESULTS We organized three identified DBM dimensions (level of assessment, target population, and forms of malnutrition) into a framework for building operational DBM definitions. Frequently occurring definitions included coexisting: 1) OW/OB and thinness, wasting, or underweight (n = 289 occurrences); 2) OW/OB and stunting (n = 161); 3) OW/OB and anemia (n = 74); and 4) OW/OB and micronutrient deficiency (n = 73). CONCLUSIONS Existing DBM definitions vary widely. Putting structure to possible definitions may facilitate selection of fit-for-purpose indicators to meet public health priorities.
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Affiliation(s)
- Jennie N Davis
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
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Engle-Stone R, Guo J, Ismaily S, Addo OY, Ahmed T, Oaks B, Suchdev PS, Flores-Ayala R, Williams AM. Intraindividual double burden of overweight and micronutrient deficiencies or anemia among preschool children. Am J Clin Nutr 2020; 112:478S-487S. [PMID: 32743648 PMCID: PMC7396269 DOI: 10.1093/ajcn/nqaa101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/16/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Child overweight prevalence is increasing globally, but micronutrient deficiencies persist. OBJECTIVES We aimed to 1) describe the prevalence and distribution of intraindividual double burden of malnutrition (DBM), defined as coexistence of overweight or obesity (OWOB) and either micronutrient deficiencies or anemia, among preschool children; 2) assess the independence of DBM components, e.g., whether the prevalence of DBM is greater than what would be expected by chance; and 3) identify predictors of intraindividual DBM, to guide intervention targeting. METHODS We analyzed data from 24 population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (separately by survey; n = 226 to n = 7166). We defined intraindividual DBM as coexisting OWOB and ≥1 micronutrient deficiency [e.g., Micronutrient Deficiency Index (MDI) > 0; DBM-MDI] or anemia (DBM-Anemia). We assessed independence of DBM components with the Rao-Scott chi-square test and examined predictors of DBM and its components with logistic regression. RESULTS DBM prevalence ranged from 0% to 9.7% (median: 2.5%, DBM-MDI; 1.4%, DBM-Anemia), reflecting a lower prevalence of OWOB (range: 0%-19.5%) than of micronutrient deficiencies and anemia, which exceeded 20% in most surveys. OWOB was generally not significantly associated with micronutrient deficiencies or anemia. In more than half of surveys, children 6-23 mo of age, compared with ≥24 mo, had greater adjusted odds of DBM-Anemia, anemia, and micronutrient deficiencies. Child sex and household socioeconomic status, urban location, and caregiver education did not consistently predict DBM or its components. CONCLUSIONS Intraindividual DBM among preschool children was low but might increase as child OWOB increases. The analysis does not support the hypothesis that DBM components cluster within individuals, suggesting that population-level DBM may be addressed by programs to reduce DBM components without targeting individuals with DBM.
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Affiliation(s)
| | - Junjie Guo
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Sanober Ismaily
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - O Yaw Addo
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA,McKing Consulting Corporation, Atlanta, GA, USA
| | - Tahmeed Ahmed
- Nutrition & Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Brietta Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Parminder S Suchdev
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA,Emory Global Health Institute and Department of Pediatrics, Emory University, Atlanta, GA, USA,Division of Nutrition, Physical Activity and Obesity, US CDC, Atlanta, GA, USA
| | - Rafael Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, US CDC, Atlanta, GA, USA
| | - Anne M Williams
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA,McKing Consulting Corporation, Atlanta, GA, USA
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