Globalization and modernization: an obesogenic combination

Associations between depression and diabetes among Latinx patients from low-income households in New Mexico

Depression and diabetes are co-occurring epidemics. This article explores the association between depression and diabetes in a cohort of Latinx patients with diabetes from low-income households. Data were gathered in Albuquerque, New Mexico (U.S.) between 2016 and 2020 as part of a patient-engaged comparative effectiveness trial comparing two culturally appropriate diabetes self-management programs-the Chronic Care Model (CCM) and the standard of care, Diabetes Self-Management Support Empowerment Model (DSMS). We proposed that the program most culturally and contextually situated in the life of the patient would have the greatest impact on diabetes self-management. Participants were enrolled as dyads-226 Latinx diabetes patient participants (PPs) from low-income households and 226 social support participants (SSPs). Data gathered at baseline, 3, 6, and 12 months included a measure of depression and A1c testing. Outcomes between programs were analyzed using longitudinal linear mixed modeling, adjusted for patient demographic characteristics and other potential confounding covariates. Patient A1c had an initial slight decrease at 3 months in both programs. At CCM, patients with a very high A1c (greater than 10%) demonstrated a clinically meaningful decrease in A1c over time. Patients at CCM experienced a large initial decrease in depression and continued to decrease throughout the study, while patients at DSMS showed a slight initial decrease through 6 months, but depression increased again by 12 months, nearly rebounding to baseline levels. A subgroup analysis revealed that a higher baseline A1c was associated with higher depression, and patients with higher A1c achieved greater reductions in depression at CCM than at DSMS. CCM scored higher on Consumer Assessment of Healthcare Providers and Systems cultural competence (CAHPS-CC). Interpretation of results suggests that the more culturally, contextually situated program, CCM, had better outcomes. This study demonstrates that culturally and contextually situating a diabetes intervention can deliver improved benefits for Latinx patients.

Innovative seated vertical lumbar traction allows simultaneous computer work while inducing spinal height changes similar to supine lying

BACKGROUND

Lumbar intervertebral disc height loss has been associated with spinal height change (SHC) and low back pain (LBP), including stenosis. Non-invasive methods to improve disc height loss require forms of lying down, which are unconducive to computer work.

OBJECTIVE

Intermittent vertical traction (VT) integrated with seated computer work may provide ergonomic alternatives for increasing SHC to promote LBP relief. The primary aim was to develop and introduce a safe VT prototype and dosage to induce and measure SHC. Prototype comfort and LBP ratings were exploratory secondary aims.

METHODS

Forty-one participants were stadiometry-measured for pre- and post-intervention SHC from seated VT at 35% body weight removed, supine lying (SL), and sitting at a computer (SIT) without VT. Pain ratings were recorded for those self-reporting LBP. VT prototype evaluations were compiled from a 3-question, 7-point Likert-style survey.

RESULTS

SHC increased by 3.9 ± 3.4 mm in VT, 1.7 ± 3.4 mm in SIT, and 4.3 ± 3.1 mm in SL (P< 0.000). Post hoc findings were significant between VT and SIT (P< 0.000), and SL and SIT (P< 0.000). VT and SL LBP ratings both decreased, but not SIT.

CONCLUSION

Intermittent seated VT is a promising alternative for postural relief during seated computer work, producing SHC similar to lying down without compromising workflow.

Socioeconomic status effects on health vary between rural and urban Turkana

Background and objectives

Understanding the social determinants of health is a major goal in evolutionary biology and human health research. Low socioeconomic status (often operationalized as absolute material wealth) is consistently associated with chronic stress, poor health and premature death in high-income countries. However, the degree to which wealth gradients in health are universal—or are instead made even steeper under contemporary, post-industrial conditions—remains poorly understood.

Methodology

We quantified absolute material wealth and several health outcomes among a population of traditional pastoralists, the Turkana of northwest Kenya, who are currently transitioning toward a more urban, market-integrated lifestyle. We assessed whether wealth associations with health differed in subsistence-level versus urban contexts. We also explored the causes and consequences of wealth-health associations by measuring serum cortisol, potential sociobehavioral mediators in early life and adulthood, and adult reproductive success (number of surviving offspring).

Results

Higher socioeconomic status and greater material wealth predicts better self-reported health and more offspring in traditional pastoralist Turkana, but worse cardiometabolic health and fewer offspring in urban Turkana. We do not find robust evidence for either direct biological mediators (cortisol) or indirect sociobehavioral mediators (e.g. adult diet or health behaviors, early life experiences) of wealth–health relationships in either context.

Conclusions and implications

While social gradients in health are well-established in humans and animals across a variety of socioecological contexts, we show that the relationship between wealth and health can vary within a single population. Our findings emphasize that changes in economic and societal circumstances may directly alter how, why and under what conditions socioeconomic status predicts health.

Lay Summary

High socioeconomic status predicts better health and more offspring in traditional Turkana pastoralists, but worse health and fewer offspring in individuals of the same group living in urban areas. Together, our study shows that under different economic and societal circumstances, wealth effects on health may manifest in very different ways.

Urbanization and market integration have strong, nonlinear effects on cardiometabolic health in the Turkana

The "mismatch" between evolved human physiology and Western lifestyles is thought to explain the current epidemic of cardiovascular disease (CVD) in industrialized societies. However, this hypothesis has been difficult to test because few populations concurrently span ancestral and modern lifestyles. To address this gap, we collected interview and biomarker data from individuals of Turkana ancestry who practice subsistence-level, nomadic pastoralism (the ancestral way of life for this group), as well as individuals who no longer practice pastoralism and live in urban areas. We found that Turkana who move to cities exhibit poor cardiometabolic health, partially because of a shift toward "Western diets" high in refined carbohydrates. We also show that being born in an urban area independently predicts adult health, such that life-long city dwellers will experience the greatest CVD risk. By focusing on a substantial lifestyle gradient, our work thus informs the timing, magnitude, and evolutionary causes of CVD.

Predicting nationwide obesity from food sales using machine learning

The obesity epidemic progresses everywhere across the globe, and implementing frequent nationwide surveys to measure the percentage of obese population is costly. Conversely, country-level food sales information can be accessed inexpensively through different suppliers on a regular basis. This study applies a methodology to predict obesity prevalence at the country-level based on national sales of a small subset of food and beverage categories. Three machine learning algorithms for nonlinear regression were implemented using purchase and obesity prevalence data from 79 countries: support vector machines, random forests and extreme gradient boosting. The proposed method was validated in terms of both the absolute prediction error and the proportion of countries for which the obesity prevalence was predicted satisfactorily. We found that the most-relevant food category to predict obesity is baked goods and flours, followed by cheese and carbonated drinks.

Economic globalization, nutrition and health: a review of quantitative evidence

Background

Unhealthy dietary patterns have in recent decades contributed to an endemic-level burden from non-communicable disease (NCDs) in high-income countries. In low- and middle-income countries rapid changes in diets are also increasingly linked to malnutrition in all its forms as persistent undernutrition and micronutrient deficiencies continue to coexist with a rising prevalence of obesity and associated NCDs. Economic globalization and trade liberalization have been identified as potentially important factors driving these trends, but the mechanisms, pathways and actual impact are subject to continued debate.

Methods

We use a ‘rigorous review’ to synthesize evidence from empirical quantitative studies analysing the links between economic globalization processes and nutritional outcomes, with a focus on impact as well as improving the understanding of the main underlying mechanisms and their interactions.

Findings

While the literature remains mixed regarding the impacts of overall globalization, trade liberalization or economic globalization on nutritional outcomes, it is possible to identify different patterns of association and impact across specific sub-components of globalization processes. Although results depend on the context and methods of analysis, foreign direct investment (FDI) appears to be more clearly associated with increases in overnutrition and NCD prevalence than to changes in undernutrition. Existing evidence does not clearly show associations between trade liberalization and NCD prevalence, but there is some evidence of a broad association with improved dietary quality and reductions in undernutrition. Socio-cultural aspects of globalization appear to play an important yet under-studied role, with potential associations with increased prevalence of overweight and obesity. The limited evidence available also suggests that the association between trade liberalization or globalization and nutritional outcomes might differ substantially across population sub-groups.

Overall, our findings suggest that policymakers do not necessarily face a trade-off when considering the implications of trade or economic liberalization for malnutrition in all its forms. On the contrary, a combination of nutrition-sensitive trade policy and adequate regulation of FDI could help reduce all forms of malnutrition. In the context of trade negotiations and agreements it is fundamental, therefore, to protect the policy space for governments to adopt nutrition-sensitive interventions.

Electronic supplementary material

The online version of this article (10.1186/s12992-019-0456-z) contains supplementary material, which is available to authorized users.

Sex-dependent effect on mitochondrial and oxidative stress parameters in the hypothalamus induced by prepubertal stress and access to high fat diet

OBJECTIVE

Some factors related to lifestyle, including stress and high-fat diet (HFD) consumption, are associated with higher prevalence of obesity. These factors can lead to an imbalance between ROS production and antioxidant defenses and to mitochondrial dysfunctions, which, in turn, could cause metabolic impairments, favoring the development of obesity. However, little is known about the interplay between these factors, particularly at early ages, and whether long-term sex-specific changes may occur. Here, we evaluated whether social isolation during the prepubertal period only, associated or not with chronic HFD, can exert long-term effects on oxidative status parameters and on mitochondrial function in the whole hypothalamus, in a sex-specific manner.

METHODS

Wistar male and female rats were divided into two groups (receiving standard chow or standard chow + HFD), that were subdivided into exposed or not to social isolation during the prepubertal period. Oxidative status parameters, and mitochondrial function were evaluated in the hypothalamus in the adult age.

RESULTS

Regarding antioxidant enzymes activities, HFD decreased GPx activity in the hypothalamus, while increasing SOD activity in females. Females also presented increased total thiols; however, non-protein thiols were lower. Main effects of stress and HFD were observed in TBARS levels in males, with both factors decreasing this parameter. Additionally, HFD increased complex IV activity, and decreased mitochondrial mass in females. Complex I-III activity was higher in males compared to females.

CONCLUSION

Stress during the prepubertal period and chronic consumption of HFD had persistent sex-specific effects on oxidative status, as well as on its consequences for the cell and for mitochondrial function. HFD had more detrimental effects on females, inducing oxidative imbalance, which resulted in damage to the mitochondria. This HFD-induced imbalance may be related to the development of obesity.

The energy requirements and metabolic benefits of wilderness hunting in Alaska

The purported healthy aspects of subsistence foods have led to the popularity of the Paleo diet. There has been very little focus, surprisingly, on health benefits derived from the nomadic nature of humans during the Paleolithic era. The purpose of our study was to examine total energy expenditure (TEE), total energy intake (TEI), body composition, blood lipids, and intrahepatic lipid in humans during a 12-day Alaskan backcountry expeditionary hunting (ABEH) immersion. Four healthy men (age: 42 ± 3 year, BMI: 27 ± 1 kg/m2 ) were recruited for the study. TEE was measured using the doubly labeled water method and a food diary was utilized to assess TEI. Body composition was measured using dual energy X-ray absorptiometry (DXA); cross-sectional area of the thigh (XT) and intrahepatic lipid (IHL) were measured using molecular imaging. Blood samples were collected for the measurement of blood lipids. DXA, XT, IHL, and blood data were collected pre- and immediately post-ABEH. Results were analyzed using paired t-tests and considered significant at P < 0.05. TEE and TEI averaged 18.1 ± 1.2 and 9.1 ± 2.5 MJ/day, respectively, indicating substantial negative energy balance (-9.0 ± 1.3 MJ/day). There was a reduction in percent body fat (∆-3.3 ± 0.2%), total fat mass (∆-3.3 ± 0.4 kg), and visceral fat volume (Δ-261 ± 188 cm3 ). Lean tissue mass and XT was unchanged. There was a decrease in IHL (Δ-0.5 ± 0.1% water peak), and a trend (P = 0.055) toward reduction in LDL-cholesterol. We conclude that constancy of physical activity during negative energy balance may provide metabolic benefits above and beyond variations in diet that exist with the hunter-gatherer lifestyle.

Media use and excess body weight among women in Nigeria: a cross-sectional study

OBJECTIVES

To investigate the (1) time trends in body mass index (BMI) and (2) relationship between media use and body weight status among adult women in Nigeria. We hypothesise that higher frequency of media use is associated with higher likelihood of being overweight and obesity among adult women.

STUDY DESIGN

Cross-sectional.

SETTING

Urban and rural settings in Nigeria.

PARTICIPANTS

Adult non-pregnant women aged between 15 and 49 years.

METHODS

Data were derived from Nigeria Demographic and Health Surveys conducted in 2003, 2008 and 2013. The outcome variable was excess body weight (overweight and obesity), and main explanatory variables were frequency of reading newspaper, listening to radio and television (TV) viewing. Datasets were merged to perform pooled analysis, and were analysed using bivariate and multivariable regression techniques.

RESULTS

Of the 69 401 participants, 16.2% had a BMI of 25.0-29.9 kg/m² (95% CI 15.8 to 16.6) and 6.6% had >30 kg/m² (95% CI 6.3 to 6.9). Between 2003 and 2013, the prevalence of overweight women increased by 4.1%, and that of obesity by 2.2%. Overall, radio was the most popular media followed by TV and newspaper. Respectively, 15.6% and 11.7% of the women reported using radio and TV almost every day and 30.6% and 25.1% at least once a week. In multivariable analysis, watching TV almost every day and at least once a week were associated with, respectively, 1.6 and 1.2 times higher odds of being overweight, and 2.7 and 1.5 times higher odds of being obese compared with those who never used radio. Similarly, significant associations were observed for newspaper and radio use as well.

CONCLUSION

The prevalence of overweight and obesity is noticeably high among Nigerian women and has been increasing steadily over the past decade. A statistically significant association exists between BMI and the use of newspaper, radio and TV. Further studies are required to develop a better understanding of the mechanisms that underlie this relationship.

Is What Low-Income Brazilians Are Eating in Popular Restaurants Contributing to Promote Their Health?

This study evaluates the healthfulness of the meals offered to and consumed by low-income Brazilians in Popular Restaurants (PR). It is a cross-sectional, exploratory study. The final sample includes 36 PRs, respecting the stratification criteria for each of the five Brazilian regions. To identify the quantity and quality of food consumption, consumers’ meals are evaluated. The sample calculation uses a minimum of 41 consumers in each PR. Consumption evaluation is carried out by weighing and direct observation of the meal that each consumer served to his plate. Each dish of the meals had its Technical preparation files (TPF) developed by observing the production and weighing all the ingredients. Evaluations of Energy density (ED), meal’s weight components and sodium composition are conducted. Plate’s composition is compared to “My plate” guidelines United States Department of Agriculture (USDA). The final sample includes 1771 low-income Brazilians consumers. The plate of PRs consumers is adequate only for the “protein group” in comparison to “My plate”. Rice and beans compose more than 50% of the plate’s weight, as expected, since it is a Brazilian habit of consumption at lunch. Thus, grains are the major group consumed by PRs consumers. The average ED for all PRs is 1.34 kcal/g. Regarding sodium content, rice and main courses presented the highest values and are classified as high, according to Food and Drug Administration (FDA). Concerning sodium, PRs are putting Brazilian low-income population at risk for chronic diseases. However, in general, PRs are good choices because they promote access to cheap and quality traditional Brazilian foods.

Obesity Management: What Should We Do If Fat Gain Is Necessary to Maintain Body Homeostasis in a Modern World?

The prevalence of overweight has substantially increased over the last decades despite the intent of health professionals and the general population to prevent this trend. Traditionally, this phenomenon has been attributed to unhealthy dietary macronutrient composition and/or to the decrease in physical activity participation. Beyond the influence of these factors, it is more than likely that other factors have influenced energy balance in a context of modernity. These include inadequate sleep, demanding cognitive effort, chemical pollution, and probably others which also have the potential to promote a positive energy balance but which are also part of the reality of success and productivity in a globalized world. As discussed in this paper, many individuals may become conflicted with themselves if they wish to prevent weight gain while influencing factors which are determinants of their socioeconomic success. In this regard, this paper reminds us of the contribution of adipose tissue gain in body homeostasis which is essential to permit energy balance, especially under lifestyle conditions promoting overfeeding. From a clinical standpoint, this imposes the consideration of a weight loss program as a search for compromise between what can be changed to promote a negative energy balance and what can be tolerated by the body in terms of fat loss. Furthermore, if we also consider the impact of pollution on energy balance for which we currently do not hold solutions of reversibility, we probably must accept that the mankind of today will have to be more corpulent than its ancestors. In this pessimistic environment, there are still possibilities to do better; however, this will probably require the revisiting of lifestyle practices according to what the human body and planet can tolerate as deviation from optimal functioning.

Adolescents' perception of parental feeding practices: Adaptation and validation of the Comprehensive Feeding Practices Questionnaire for Brazilian adolescents-The CFPQ-Teen

BACKGROUND

Parental feeding practices may play a key role in dietary habits and nutritional status of adolescents, but research from adolescents' point of view on this topic is scarce.

OBJECTIVE

To adapt and validate an instrument of parental feeding practices as perceived by adolescents in a Brazilian setting.

METHODS

The Comprehensive Feeding Practices Questionnaire was translated into Portuguese and adapted to be answered by adolescents (ages 12 to 18). Content analysis and FACE validity to assess cultural equivalence was undertaken by experts in the adolescent nutritional and psychological fields. Pilot study was evaluated in 23 adolescents. The final version was administered to 41 students to assess instrument reproducibility (Intraclass Correlation Coefficient). Internal consistency (Cronbach's Alpha) and construct validity (Confirmatory Factor Analysis) were assessed in a third sample of 307 adolescents.

RESULTS

Experts and adolescents considered content validity as appropriate. In reproducibility analysis (Intraclass Correlation Coefficient), 10 of the 12 factors were above 0.7. The factors "teaching about nutrition" and "food as reward" obtained values of 0.60 and 0.68, respectively. The Cronbach's Alpha of the whole scale was 0.83 and alphas for subscales ranged from 0.52 to 0.85; the factors "teaching about nutrition" and "food as a reward" had the lowest values (0.52). After removing these two factors, the Confirmatory Factor Analysis indicated that the structural model was appropriate. The final scale was made up of 10 factors with 43 questions.

CONCLUSIONS

The Comprehensive Feeding Practices Questionnaire-Teen demonstrates validity and reliability, and is a suitable tool to evaluate the perceptions of adolescents regarding parental feeding practices.

Association between obesity and asthma - epidemiology, pathophysiology and clinical profile

Obesity is a risk factor for asthma, and obese asthmatics have lower disease control and increased symptom severity. Several putative links have been proposed, including genetics, mechanical restriction of the chest and the intake of corticosteroids. The most consistent evidence, however, comes from studies of cytokines produced by the adipose tissue called adipokines. Adipokine imbalance is associated with both proinflammatory status and asthma. Although reverse causation has been proposed, it is now acknowledged that obesity precedes asthma symptoms. Nevertheless, prenatal origins of both conditions complicate the search for causality. There is a confirmed role of neuro-immune cross-talk mediating obesity-induced asthma, with leptin playing a key role in these processes. Obesity-induced asthma is now considered a distinct asthma phenotype. In fact, it is one of the most important determinants of asthma phenotypes. Two main subphenotypes have been distinguished. The first phenotype, which affects adult women, is characterised by later onset and is more likely to be non-atopic. The childhood obesity-induced asthma phenotype is characterised by primary and predominantly atopic asthma. In obesity-induced asthma, the immune responses are shifted towards T helper (Th) 1 polarisation rather than the typical atopic Th2 immunological profile. Moreover, obese asthmatics might respond differently to environmental triggers. The high cost of treatment of obesity-related asthma, and the burden it causes for the patients and their families call for urgent intervention. Phenotype-specific approaches seem to be crucial for the success of prevention and treatment.

Independent and joint effects of prenatal maternal smoking and maternal exposure to second-hand smoke on the development of adolescent obesity: a longitudinal study

AIM

To examine associations of prenatal maternal smoking and second-hand smoke (SHS) exposure with the development of adolescent obesity.

METHODS

Longitudinal data (1991-2007) from National Institute of Child Health and Human Development Study of Early Child Care and Youth Development involving mothers that smoked and or exposed to SHS during the year before birth were analysed. Adolescent obesity in ages 12.0-15.9 years was defined as a BMI ≥ 95th percentile. Generalised estimating equations (GEE) were used for the analyses.

RESULTS

Obesity was more prevalent among adolescents whose mothers smoked or had SHS exposure than those that did not smoke or exposed to SHS. After adjusting for maternal and child factors, GEE models showed that odds of adolescent obesity increased with prenatal maternal smoking (OR = 1.57, 95% CI = 1.03-2.39) and SHS exposure (OR = 1.53, 95% CI = 1.04-2.27). The odds for obesity increased more than two times among adolescents exposed to both maternal smoking and SHS (OR = 2.10, 95% CI = 1.24, 3.56) compared with those without exposure. Additionally, not breastfeeding, maternal obesity, and longer screen viewing hours per day were associated with increased odds of obesity.

CONCLUSIONS

There is possibly a long-term joint effect of prenatal maternal smoke (smoking and SHS) exposure on obesity among adolescent offspring, and the effect is independent of birthweight. These findings suggest that adolescent obesity could possibly be curtailed with the development and promotion of smoking cessation programmes for families during the year before birth.

Calorie-labelling in catering outlets: acceptability and impacts on food sales

OBJECTIVE

Obesity is the biggest challenge facing preventive medicine. Calorie-labelling has been suggested as a way of changing the architecture of an 'obesogenic' environment without limiting consumer choice. This study examined the effect of calorie-labelling on sales of food items at catering outlets on a city-centre university campus.

METHODS

Sales data were collected for two consecutive months in 2013 on three UK university sites (two with calorie-labelling during second month, one control) and analysed with chi-square 'Goodness-of-Fit' tests. A questionnaire seeking consumers' views and use of the calorie-labelling was administered and analysed at group-level with chi-square tests.

RESULTS

In intervention vs control sites, total sales of all labelled items fell significantly (-17% vs -2%, p<0.001) for the month with calorie-labelling. Calorie-labelling was associated with substantially reduced sales of high-calorie labelled items, without any compensatory changes in unlabelled alternative items. Among 1166 student- and 646 staff-respondents, 56% reported using the calorie-labels, 97% of them to make lower-calorie choices. More females (63%) than males (40%) reported being influenced by calorie-labels when choosing foods (p=0.01).

CONCLUSIONS

This study provides evidence, beyond that from single-meal exposures, for the acceptability of meal calorie-labelling and its potential as an effective low-cost anti-obesity measure.

Chronic psychological stress and racial disparities in body mass index change between Black and White girls aged 10-19

BACKGROUND

One of the largest health disparities in the USA is in obesity rates between Black and White females.

PURPOSE

The objective of this study was to test the hypothesis that the stress-obesity link is stronger in Black females than in White females aged 10-19.

METHODS

Multilevel modeling captured the dynamic of acute (1 month) and chronic (10 years) stress and body mass index (BMI; weight in kilograms divided by height in meters squared) change in the National Heart, Lung, and Blood Institute Growth and Health Study, which consists of 2,379 Black and White girls across a span of socioeconomic status. The girls were assessed longitudinally from ages 10 to 19.

RESULTS

Higher levels of stress during the 10 years predicted significantly greater increases in BMI over time compared to lower levels of stress. This relationship was significantly stronger for Black compared to White girls.

CONCLUSION

Psychological stress is a modifiable risk factor that may moderate early racial disparities in BMI.

Trends in overweight among women differ by occupational class: results from 33 low- and middle-income countries in the period 1992-2009

OBJECTIVE

There has been an increase in overweight among women in low- and middle-income countries but whether these trends differ for women in different occupations is unknown. We examined trends by occupational class among women from 33 low- and middle-income countries in four regions.

DESIGN

Cross-national study with repeated cross-sectional demographic health surveys.

SUBJECTS

Height and weight were assessed at least twice between 1992 and 2009 in 248,925 women aged 25-49 years. Interviews were conducted to assess occupational class, age, place of residence, educational level, household wealth index, parity, age at first birth and breastfeeding. We used logistic and linear regression analyses to assess the annual percent change in overweight (body mass index >25 kg m(-2)) by occupational class.

RESULTS

The prevalence of overweight ranged from 2.2% in Nepal in 1992-1997 to 75% in Egypt in 2004-2009. In all the four regions, women working in agriculture had consistently lower prevalence of overweight, while women from professional, technical, managerial as well as clerical occupational classes had higher prevalence. Although the prevalence of overweight increased in all the occupational classes in most regions, women working in agriculture and production experienced the largest increase in overweight over the study period, while women in higher occupational classes experienced smaller increases. To illustrate, overweight increased annually by 0.5% in Latin America and the Caribbean and by 0.7% in Sub-Saharan Africa among women from professional, technical and managerial classes, as compared with 2.8% and 3.7%, respectively, among women in agriculture.

CONCLUSION

The prevalence of overweight has increased in most low- and middle-income countries, but women working in agriculture and production have experienced larger increases than women in higher occupational classes.

Negotiating the demands of active ageing: longitudinal findings from Germany

The challenges of population ageing and globalisation have been addressed by many welfare states in terms of active ageing policies, which in turn confront individuals with new demands such as keeping up to date with technological developments. The purpose of this paper is to analyse how individuals negotiate the demands of active ageing. The outcome variable was change in primary and secondary control strategies with regard to demands of active ageing over the course of one year. In a German sample of N = 602 men and women aged 55–75 years, we found a strong preference for engagement with these demands and a low preference for disengagement. Furthermore, a higher load of demands of active ageing was associated with an increase in engagement with these demands. However, when people perceived their everyday surroundings as unfavourable, their disengagement with demands of active ageing increased. Higher internal control beliefs concerning demands of active ageing were associated with an increase in engagement and a decrease in disengagement. We conclude that individuals strengthen their efforts to master demands of active ageing when they believe that they can control them. When the everyday ecology seems unfavourable, though, strategies are preferred that enable people to avoid a presumably lost case.

Fat free mass explains the relationship between stunting and energy expenditure in urban Mexican Maya children

BACKGROUND

Childhood stunting has been associated with an increased risk of obesity in adulthood, but the causes are unclear. This study hypothesizes that stunting significantly reduces both resting and activity energy expenditure.

AIM

To assess and describe energy expenditure of low socio-economic Maya children and to determine whether stunting is independently related to energy expenditure after controlling for lean mass.

SUBJECTS AND METHODS

Thirty-three urban Maya children, 17 boys, aged 7-9 years, living in Merida, Mexico, were measured for height, weight and bioelectrical impedance analysis (BIA). Body composition was estimated from BIA. Energy expenditure was measured for one week using the Actiheart (combined heart rate and accelerometer).

RESULTS

Stunting (height-for-age below the 5(th) percentile of NHANES III based references) affected 35% of these physically active children. Using multiple linear regression analysis, greater lean body mass predicted higher resting and activity energy expenditure. Stature was not a significant predictor of resting energy expenditure. A lower height-for-age z-score, but not stunting as a categorical variable, significantly predicted lower activity energy expenditure.

CONCLUSION

The hypothesis that stunting reduces total energy expenditure (resting + active) in children is not supported. Rather, children with shorter stature and less lean body mass have lower total energy expenditure. Complex interactions between body size, body composition, and metabolic activity appear to elevate the risk for later life obesity in these Maya children.

Obesity: lessons from evolution and the environment

The 9th Stock Conference acknowledged the complex background of genetic, cultural, environmental and evolutionary factors of obesity. Gene-environment interactions underlie the flexibility in body-weight and body-fat regulation, illustrated by the hunter-gatherers' feast and famine lifestyle, the variation in physical activity over the lifespan being highest at reproductive age, the variation in energy intake through 'eating in the absence of hunger', while running the risk of exceeding the capacity of triacylglyceride storage, leading to lipotoxicity and metabolic problems. Perinatal metabolic programming for obesity via epigenetic changes in response to a 'Western diet' results in production of lipid-poor milk and metabolically efficient pups, contributing to the perpetuation of obesity throughout generations. Evolutionary insight from comparative physiology and ecology indicates that over generations activity-induced energy expenditure has remained the same compared to wild mammals, that energy balance might be dependant on protein balance, while the function of taste changed from detection of poison or energy to social drinking and social behaviour. At present, the impact of assortative mating on obesity prevalence is unambiguously positive. The complexity that appeared can only be fully appreciated by setting the data into the context of our evolutionary history.

U.S. Migration, Translocality, and the Acceleration of the Nutrition Transition in Mexico

Migrant flows are generally accompanied by extensive social, economic, and cultural links between origins and destinations, transforming the former's community life, livelihoods, and local practices. Previous studies have found a positive association between these translocal ties and better child health and nutrition. We contend that focusing on children only provides a partial view of a larger process affecting community health, accelerating the nutrition transition in particular. We use a Mexican nationally-representative survey with socioeconomic, anthropometric, and biomarker measures, matched to municipal-level migration intensity and marginalization measures from the Mexican 2000 Census to study the association between adult body mass and community migration intensity. Our findings from multi-level models suggest a significant and positive relationship between community-level migration intensity and the individual risk of being overweight and obese, with significant differences by gender and with remittance intensity playing a preponderant role.

The long-term cost-effectiveness of obesity prevention interventions: systematic literature review

Obesity prevention provides a major opportunity to improve population health. As health improvements usually require additional and scarce resources, novel health technologies (interventions) should be economically evaluated. In the prevention of obesity, health benefits may slowly accumulate over time and it can take many years before an intervention has reached full effectiveness. Decision-analytic simulation models (DAMs), which combine evidence from diverse sources, can be utilized to evaluate the long-term cost-effectiveness of such interventions. This literature review summarizes long-term economic findings (defined as ≥ 40 years) for 41 obesity prevention interventions, which had been evaluated in 18 cost-utility analyses, using nine different DAMs. Interventions were grouped according to their method of delivery, setting and risk factors targeted into behavioural (n=21), community (n=12) and environmental interventions (n=8). The majority of interventions offered good value for money, while seven were cost-saving. Ten interventions were not cost-effective (defined as >50,000 US dollar), however. Interventions that modified a target population's environment, i.e. fiscal and regulatory measures, reported the most favourable cost-effectiveness. Economic findings were accompanied by a large uncertainty though, which complicates judgments about the comparative cost-effectiveness of interventions.