Programme and policy issues related to promoting positive early nutritional influences to prevent obesity, diabetes and cardiovascular disease in later life: a developing countries view

Climate change and declining fertility rate in Malaysia: the possible connexions

Climate change is an incessant global phenomenon and has turned contentious in the present century. Malaysia, a developing Asian country, has also undergone significant vicissitudes in climate, which has been projected with significant deviations in forthcoming decades. As per the available studies, climate changes may impact on the fertility, either via direct effects on the gonadal functions and neuroendocrine regulations or via several indirect effects on health, socioeconomic status, demeaning the quality of food and water. Malaysia is already observing a declining trend in the Total fertility rate (TFR) over the past few decades and is currently recorded below the replacement level of 2.1 which is insufficient to replace the present population. Moreover, climate changes reportedly play a role in the emergence and cessation of various infectious diseases. Besides its immediate effects, the long-term effects on health and fertility await to be unveiled. Despite the huge magnitude of the repercussion of climate changes in Malaysia, research that can explain the exact cause of the present reduction in fertility parameters in Malaysia or any measures to preserve the national population is surprisingly very scarce. Thus, the present review aims to elucidate the possible missing links by which climate changes are impairing fertility status in Malaysia.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

PURPOSE OF REVIEW

Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes.

RECENT FINDINGS

The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.

Association of serum uric acid concentration with components of pediatric metabolic syndrome: A systematic review and meta-analysis

Background:

Hyperuricemia is implicated in the pathogenesis of inflammatory diseases and metabolic disorders. Metabolic syndrome (MetS) in childhood is one of the most important causes of different noncommunicable diseases in adulthood. This study aimed to systematically review the association between serum uric acid (UA) concentration and components of pediatric MetS.

Materials and Methods:

In this meta-analysis and systematic review, related articles were gathered by searching English databases including PubMed, Web of Science, Scopus, and Google Scholar. We used the following keywords: uric acid, metabolic syndrome, hypertension, fasting blood sugar (FBS), hyperglycemia; the search was limited to English language and included observational and cohort studies performed among children or adolescents. Pooled relative risks (odds ratio [OR]) and corresponding 95% confidence interval (95% CI) were extracted. A random-effect model was used.

Results:

On the basis of 34 eligible studies, the pooled correlation between UA with metabolic components including FBS (r = 0.24, 95% CI = 0.09–0.40), fasting insulin (r = 0.26, 95% CI = 0.15–0.37), and hyperglycemia (r for triglyceride and UA = 0.23, 95% CI = 0.19–0.38) (r for high-density lipoprotein and UA = −0.28, 95% CI = −0.37 to −0.20) was statistically significant. The association of both diastolic blood pressure (DBP) and systolic blood pressure (SBP) was statistically significant with UA (r for SBP and UA = 0.34, 95% CI = 0.24–0.43; r for DBP and UA = 0.18, 95% CI = 0.11–0.25). The OR between risk of abdominal obesity with UA was statistically significant (OR = 2.62, 95% CI = 1.41–3.84).

Conclusion:

Serum UA concentration is associated with major components of the pediatric MetS. Its measurement and control should be underscored in at-risk children and adolescents.

Do sex differences in reported weight loss intentions and behaviours persist across demographic characteristics and weight status in youth? A systematic review

Background

Evidence suggests that young females are more likely to try to lose weight than young males, however whether this sex difference persists across demographic characteristics and weight status is unclear. Further, whether females are more likely than males to try to lose weight using unhealthy weight loss strategies has never been systematically assessed. The objective of this systematic review was to examine the literature on sex differences in weight loss intentions and strategies in children and adolescent observational studies to determine whether sex differences persisted across demographic characteristics (race/ethnicity, grade level) and weight status.

Methods

Relevant articles published after 1990 were identified using PubMED, Web of Science, and PsycInfo. Searches were conducted in May of 2015 and again in May of 2017. Studies conducted in the US and Canada with participants 18-years old or younger who measured weight loss strategies in the context of weight loss intention were selected. Descriptive statistics were extracted from 19 studies.

Results

Almost two-thirds of youth reported trying to lose weight. High-school and middle-school aged females reported consistently higher prevalence of weight loss intentions compared to male counterparts, as did Caucasian, African-American, and Hispanic females. The proportion of youth using unhealthy or extreme strategies reached 44 and 13%, respectively, with a similar proportion of males and females endorsing the use of each category of weight loss strategies across studies. Native-American youth reported the highest prevalence (27%) of using extreme strategies.

Conclusions

Researchers should consider demographic characteristics when reporting prevalence information for weight loss intentions and behaviours, as certain groups might require more targeted public health initiatives. Across characteristics, prevalence ranges were broad for weight loss intentions and use of particular strategies, suggesting the need to standardize and refine data collection and reporting practices in this literature.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6179-x) contains supplementary material, which is available to authorized users.

Intersystem Implications of the Developmental Origins of Health and Disease: Advancing Health Promotion in the 21st Century

The developmental origins of health and disease (DOHaD) theory and life course theory (LCT) are emerging fields of research that have significant implications for the public health and health promotion professions. Using a DOHaD/LCT perspective, social determinants of health (SDH) take on new critical meaning by which health promotion professionals can implement DOHaD/LCT guided interventions, including recommended policies. Through these interventions, public health could further address the sources of worldwide chronic disease epidemics and reduce such disease rates substantially if related policy, programs, and interdisciplinary and multi-sector collaboration are emphasized. Additional characteristics of the most effective interventions involve context-specific adaptation and societal structures that impact upstream, early life environments on a broad scale, influencing multiple locations and/or diseases.

Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia

We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

Non-Communicable Disease Mortality and Risk Factors in Formal and Informal Neighborhoods, Ouagadougou, Burkina Faso: Evidence from a Health and Demographic Surveillance System

The expected growth in NCDs in cities is one of the most important health challenges of the coming decades in Sub-Saharan countries. This paper aims to fill the gap in our understanding of socio-economic differentials in NCD mortality and risk in low and middle income neighborhoods in urban Africa. We use data collected in the Ouagadougou Health and Demographic Surveillance System. 409 deaths were recorded between 2009–2011 among 20,836 individuals aged 35 years and older; verbal autopsies and the InterVA program were used to determine the probable cause of death. A random survey asked in 2011 1,039 adults aged 35 and over about tobacco use, heavy alcohol consumption, lack of physical activity and measured their weight, height, and blood pressure. These data reveal a high level of premature mortality due to NCDs in all neighborhoods: NCD mortality increases substantially by age 50. NCD mortality is greater in formal neighborhoods, while adult communicable disease mortality remains high, especially in informal neighborhoods. There is a high prevalence of risk factors for NCDs in the studied neighborhoods, with over one-fourth of the adults being overweight and over one-fourth having hypertension. Better-off residents are more prone to physical inactivity and excessive weight, while vulnerable populations such as widows/divorced individuals and migrants suffer more from higher blood pressure. Females have a significantly lower risk of being smokers or heavy drinkers, while they are more likely to be physically inactive or overweight, especially when married. Muslim individuals are less likely to be smokers or heavy drinkers, but have a higher blood pressure. Everything else being constant, individuals living in formal neighborhoods are more often overweight. The data presented make clear the pressing need to develop effective programs to reduce NCD risk across all types of neighborhoods in African cities, and suggest several entry points for community-based prevention programs.

No association between perfluoroalkyl chemicals and hypertension in children

Background

Hypertension is a leading cause of cardiovascular disease worldwide. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are perfluoroalkyl chemicals (PFCs) used in the manufacture of common consumer products and detected in the blood of the majority of Americans. Emerging biological data suggest that PFC exposure may have a role in the development of hypertension. However, the association between PFCs and hypertension has not yet been explored in humans. Therefore, we examined this association in a representative sample of US children.

Methods

A cross-sectional study was performed on 1,655 children from the National Health and Nutrition Examination Survey, 1999–2000 and 2003–2008. The main outcome of interest was hypertension, defined as age, height, and sex specific systolic and/or diastolic blood pressure level at the 95th percentile.

Results

We found no association between serum levels of PFOA and PFOS and hypertension in either unadjusted or multivariable-adjusted analyses controlling for age, sex, race-ethnicity, body mass index, annual household income, moderate activity, total serum cholesterol, and serum cotinine. Compared with the lowest quartile, the multivariable-adjusted odds ratio (95% confidence interval) of hypertension in the highest quartile of exposure was 0.69 (0.41–1.17) for PFOA and 0.77 (0.37–1.61) for PFOS (all P-trend values >0.30).

Conclusion

Our findings indicate that exposure to PFOA or PFOS is not significantly associated with hypertension in children at the lower PFC exposure levels typical of the general population.

Not just for poor kids: The impact of universal free school breakfast on meal participation and student outcomes

This paper examines the impact of the implementation of a universal free school breakfast policy on meals program participation, attendance, and academic achievement. In 2003, New York City made school breakfast free for all students regardless of income, while increasing the price of lunch for those ineligible for meal subsidies. Using a difference-indifference estimation strategy, we derive plausibly causal estimates of the policy's impact by exploiting within and between group variation in school meal pricing before and after the policy change. Our estimates suggest that the policy resulted in small increases in breakfast participation both for students who experienced a decrease in the price of breakfast and for free-lunch eligible students who experienced no price change. The latter suggests that universal provision may alter behavior through mechanisms other than price, highlighting the potential merits of universal provision over targeted services. We find limited evidence of policy impacts on academic outcomes.

Positive association between perfluoroalkyl chemicals and hyperuricemia in children

Hyperuricemia in children is associated with increased risk of high blood pressure, metabolic syndrome, and future cardiovascular disease. Serum perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) levels have been shown to be positively associated with hyperuricemia in adults, but the association in children remains unexplored. We therefore examined the association between serum PFOA and PFOS levels and hyperuricemia in a representative sample of US children. A cross-sectional study was performed on 1,772 participants ≤18 years of age from the National Health and Nutrition Examination Survey 1999-2000 and 2003-2008. The main outcome of interest was hyperuricemia, defined as serum uric acid levels ≥6 mg/dL. We found that serum levels of PFOA and PFOS were positively associated with hyperuricemia, independent of age, sex, race/ethnicity, body mass index, annual household income, physical activity, serum total cholesterol, and serum cotinine levels. Compared with subjects in quartile 1 (referent), subjects in quartile 4 had multivariable-adjusted odds ratios for hyperuricemia of 1.62 (95% confidence interval: 1.10, 2.37) for PFOA and 1.65 (95% confidence interval: 1.10, 2.49) for PFOS. Our findings indicate that serum perfluoroalkyl chemical levels are significantly associated with hyperuricemia in children even at the lower "background" exposure levels of the US general population.

An investigation into utilising gestational body mass index as a screening tool for adverse birth outcomes and maternal morbidities in a group of pregnant women in Khayelitsha

OBJECTIVE

The aim of this study was to investigate the ability of the gestational body mass index (BMI) method to screen for adverse birth outcomes and maternal morbidities.

DESIGN

This was a substudy of a randomised controlled trial, the Philani Mentor Mothers' study.

SETTING AND SUBJECTS

The Philani Mentor Mothers' study took place in a peri-urban settlement, Khayelitsha, between 2009 and 2010. Pregnant women living in the area in 2009-2010 were recruited for the study.

OUTCOME MEASURES

Maternal anthropometry (height and weight) and gestational weeks were obtained at baseline to calculate the gestational BMI, which is maternal BMI adjusted for gestational age. Participants were classified into four gestational BMI categories: underweight, normal, overweight and obese. Birth outcomes and maternal morbidities were obtained from clinic cards after the births.

RESULTS

Pregnant women were recruited into the study (n = 1 058). Significant differences were found between the different gestational BMI categories and the following birth outcomes: maternal (p-value = 0.019), infant hospital stay (p-value = 0.03), infants staying for over 24 hours in hospital (p-value = 0.001), delivery mode (p-value = 0.001), birthweight (p-value = 0.006), birth length (p-value = 0.007), birth head circumference (p-value = 0.007) and pregnancy-induced hypertension (p-value = 0.001).

CONCLUSION

To the best of our knowledge, this is the first study that has used the gestational BMI method in a peri-urban South African pregnant population. Based on the findings that this method is able to identify unfavourable birth outcomes, it is recommended that it is implemented as a pilot study in selected rural, peri-urban and urban primary health clinics, and that its ease and effectiveness as a screening tool is evaluated. Appropriate medical and nutritional advice can then be given to pregnant women to improve both their own and their infants' birth-related outcomes and maternal morbidities.

Comparison of blood levels of riboflavin and folate with dietary correlates estimated from a semi-quantitative food-frequency questionnaire in older persons in Portugal

Since information regarding biochemical parameters of riboflavin and folate status is limited in some populations of older adults, a food-frequency questionnaire is often used to estimate riboflavin and folate status. However, the performance of this type of questionnaire among this age group has not been comprehensively evaluated. Thus, we sought to assess riboflavin and folate status in older adults living in Portugal and to validate findings from a semiquantitative food-frequency questionnaire (FFQ), by comparison to these blood measures. We used a cross-sectional study to investigate riboflavin in red blood cells (as Glutathione Reductase Activity Coefficient; EGRAC) and folate in the serum of 88 older persons (66.7% female), aged between 60 and 94 years, recruited from seven adult day care community centers in Porto, Portugal. Forty-six subjects had low EGRAC levels (<1.2), with a group mean concentration of 1.17 and median of 1.10 (range 1.00-2.10). For daily riboflavin dietary intakes from FFQ, the mean was 3.34 mg, the median 3.37 mg, and range 0.66-4.81 mg. The Spearman correlation between these two measures was r = 0.073, (P = 0.497) and Pearson correlation, after adjustment for energy, was r = 0.263, P = 0.013. All participants were above the 7 nmol/L serum folate cut-off for adequacy. Spearman correlation coefficient between serum and FFQ measures was r = -0.10, (P = 0.359), and the Pearson correlation, after adjustment for energy and following log(e) transformation, was r = -0.58, (P = 0.593). Thus riboflavin and folate intakes estimated by FFQ correlated poorly with EGRAC and folate serum values.

Developmental origins of health and disease: concepts, caveats, and consequences for public health nutrition

The purpose of this article is to define the concept of developmental origins of health and disease (DOHaD) as an emerging paradigm for relating evolutionary biology to contemporary health issues. As illustrated, several paradoxes emerge related to adaptations initiated in utero and in early life. Epigenetics is a concept that must be incorporated in order to understand plasticity adaptations, such as programming. The public health consequence of DOHaD challenges the one-size-fits-all norm and shows the need for prescreening prior to some interventions and for the eventuality of individualized, rather than collectively applied, preventive or remedial measures as the safest option.

Obesity, stigma and public health planning

Given the rise in obesity rates in North America, concerns about obesity-related costs to the health care system are being stressed in both the popular media and the scientific literature. With such constant calls to action, care must be taken not to increase stigmatization of obese people, particularly of children. While there is much written about stigma and how it is exacerbated, there are few guidelines for public health managers and practitioners who are attempting to design and implement obesity prevention programs that minimize stigma. We examine stigmatization of obese people and the consequences of this social process, and discuss how stigma is manifest in health service provision. We give suggestions for designing non-stigmatizing obesity prevention public health programs. Implications for practice and policy are discussed.

Reductions in the energy content of meals served in the Chilean National Nursery School Council Program did not consistently decrease obesity among beneficiaries

In 2001, the Chilean National Nursery Schools Council Program reduced by 10% the energy content (approximately 418.7 kJ) of meals served to children to reduce obesity. We assessed the impact of this measure on obesity and stunting among beneficiaries 2-5 y old. The energy reduction was staggered over 3 y, allowing for a quasi-experimental design involving early (2001), mid (2002), and late (2003) intervention groups. Routine anthropometric measurements (approximately 64,000/y) taken from 1996-2005 were obtained from registries; obesity (BMI-for-age Z-score > or = 2 SD) and stunting (height-for-age Z-score < or = 2 SD) were defined using the 2006 growth standards. Segmented regression analyses were conducted by intervention group to contrast pre- and postintervention trends. Overall, obesity was high (15.9%), with levels consistently higher in fall and winter as reported in other studies. Preintervention obesity trends increased in the early group (P = 0.001) but decreased in the late intervention group (P = 0.02). The impact of the energy reduction on obesity was inconsistent, with reductions in the early group (P < 0.01) but with no change in mid and late intervention groups (P > 0.05). Stunting prevalence was almost as low as in the growth standard (3.2 vs. 2.3%) and decreased preintervention in all groups (P < 0.05). Stunting prevalence increased postintervention (P < 0.05) in all but the late intervention group, where there was no change. Despite a robust design and the ability to detect small seasonal changes in obesity, our analyses showed that the 10% energy reduction did not consistently decrease obesity. The intervention may have slowed improvements in linear growth, but concern is tempered by the near absence of growth failure.

Social networks and infant feeding in Oaxaca, Mexico

The health benefits of delaying the introduction of complementary foods to infants' diets are widely known. Many studies have shown that mothers with the support of close social network members are more compliant with medical recommendations for infant feeding. In our study, we examine the effects of a broader spectrum of network members (40 people) on mothers' infant feeding decisions. The survey was conducted in Oaxaca, Mexico as part of a follow-up to a nationwide Mexican Social Security Institute survey of infant health. Sixty mothers were interviewed from a stratified random sample of the original respondents. Multivariate tests were used to compare the efficacy of network-level variables for predicting the introduction of 36 foods into infants' diets, when compared with respondent-level variables. The study yields four findings. First, network-level variables were better predictors of the timing of food introduction than socio-demographic variables. Second, mothers with more indigenous networks delayed the introduction of some grains (oatmeal, cereal, noodle soup, rice) and processed pork products (sausage and ham) to the infant's diet longer than mothers with less indigenous networks. Third, mothers who had stronger ties to their networks delayed the introduction of rice and processed pork products (sausage and ham) to the infant's diet longer than mothers who had weaker ties to their networks. Fourth, mothers who heeded the advice of distant network members introduced some grains (rice and cereal) earlier than mothers who did not heed the advice of distant network members.

Anthropometric reference values in an Afro-Caribbean adolescent population

Childhood and adolescent obesity is increasingly becoming a major public health issue in the Caribbean. In this study, we analyze patterns of growth in a population of Afro-Caribbean adolescents 12-18 years old and to compare these with those established for US adolescents. A cross-section of adolescent schoolchildren had weight and height measured using standardized procedures. In addition, percentage body fat (% BF) was measured using a foot-to-foot bioelectric impedance body fat analyzer (Tanita model 531). Selected age- and gender- specific percentiles of BMI, %BF, weight and height were derived and smoothed by cubic splines. These were compared with similar percentiles from US adolescent growth data. A total of 3,707 adolescents (1,585 males; 2,122 females) participated in the study. The age-specific correlation between BMI and %BF ranged from 0.75 to 0.87 in males and 0.79 to 0.87 in females. Females had significantly higher %BF than males in each age category. Overall, Tobagonian females were heavier and had higher BMI than their US counterparts especially levels above the median percentiles. Tobagonian males had similar height, weight, and BMI to their US counterparts over the range of percentiles. Overall, the pattern of growth in this group of adolescents suggests that they are growing at rates that are comparable to those seen in a more well-nourished population.

Nutrition, child growth, and chronic disease prevention

Countries undergoing the nutrition transition are experiencing a progressive increase in obesity and nutrition-related chronic diseases (NRCDs). In transitional countries, stunting (shortness for age) and micronutrient deficiencies (iron, vitamin A, and zinc) in children coexist with obesity and NRCDs originating the double burden of nutritional disease. The causal web for obesity and NRCDs is complex and multifaceted; changes in diet and physical activity of the population are likely the main concurrent determinant factors. However, recent evidence suggests that specific patterns of prenatal and postnatal growth are also potential contributors. Evidence indicates that intervention strategies to prevent malnutrition should emphasize improvements in linear growth in the first 2-3 years of life rather than aim at gaining weight. Avoiding excessive weight gain relative to height gain (BMI) is especially relevant after the first 2 years of life. Routine assessment of child growth based on the new World Health Organization (WHO) standard, defining energy needs based on the recent Food and Agricultural Organization (FAO)/WHO norms, and providing critical micronutrients to support lean mass growth are critical to prevent obesity and NRCDs starting early in the life course. These actions should contribute in the prevention and control of obesity in childhood and thus help prevent NRCDs in future generations of adults.

Poverty, malnutrition, underdevelopment and cardiovascular disease: a South African perspective

This article explores possible mechanisms to explain the known relationships between poverty, undernutrition, underdevelopment and cardiovascular disease (CVD) in developing countries. Poverty is a multidimensional concept. It is both a cause and consequence of undernutrition. The article shows how malnutrition during pregnancy could lead to low birth-weight babies, who are not only at increased risk of mental and physical underdevelopment, but also 'programmed' to be at increased risk of CVD and other non-communicable diseases in adult life. The underdevelopment leads to decreased 'human capital and competence' with an inability to create food security and an enabling environment for self and family to escape poverty and undernutrition in the next generation. It is accepted that a lack of education and knowledge in the poor for primary prevention of CVD through healthy eating patterns and lifestyles, as well as limited access to healthcare services for secondary prevention and treatment contribute to CVD. This article postulates that the link between poverty and CVD in South Africa can be explained by the high prevalence of undernutrition in one- to nine year- old children (9% underweight, 23% stunted and 3% wasted), the high prevalence of overweight and obesity in adults (54.5% in white men and 58.5% in African women) as well as the negative trends in nutrient intakes when Africans (the population group with the largest numbers of poor people) urbanise, acculturate and adopt westernised eating patterns that will increase CVD risk. In conclusion, we plead for a holistic, integrated but transdisciplinary and multisectorial approach to break the vicious circle of poverty and undernutrition for the longterm prevention of CVD.