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Ahsan MN, Thakur S. The great Indian demonetization and gender gap in health outcomes: Evidence from two Indian states. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101369. [PMID: 38447319 DOI: 10.1016/j.ehb.2024.101369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 12/11/2023] [Accepted: 02/07/2024] [Indexed: 03/08/2024]
Abstract
We utilize the timing of India's 2016 demonetization policy to examine whether a negative macroeconomic shock disproportionately affects women's health outcomes relative to men's. Our empirical framework considers women as the treated group and men as the comparison group. Using data from the National Family Health Survey-4 and a household fixed effects model, we find that the induced income shock leads to a 4% decline in hemoglobin for women as compared to the pre-demonetization level. This corresponds to a 21% increase in the gender gap in hemoglobin. The result is further validated with an event study and a variety of robustness checks. An examination of food consumption suggests that this pattern is possibly driven by a widening male-female gap in the consumption of iron-rich foods.
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Liu L, Melse-Boonstra A, van der Werf W, Zhang F, Cong WF, Stomph TJ. The potential of biofortification technologies for wheat and rice to fill the nutritional Zn intake gap in China. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2024; 104:2651-2659. [PMID: 37985380 DOI: 10.1002/jsfa.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/02/2023] [Accepted: 11/21/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Zinc (Zn) deficiency in humans is of worldwide concern. The objective of this study was to investigate the Zn intake gap in Chinese adults and identify the potential role of biofortification technologies for wheat and rice, including crop nutrient management and breeding, in filling the gap. RESULTS We use data from the China Health and Nutrition Survey in 2011 to identify food consumption patterns and dietary Zn intake of 4512 adults to define and quantify the Zn intake gap in the population. The dietary Zn intake gap of surveyed adults ranged from -0.8 to 6.53 mg day-1 across nine provinces and differences were associated with differences in food consumption patterns. Both dietary Zn intake and Zn gap for males were higher than for females. The potential of changes in five management strategies (improved nitrogen fertilization, improved phosphorus fertilization, foliar Zn fertilization, improved water management and growing varieties reaching the grain Zn breeding target) was analyzed. Breeding and foliar Zn fertilization were shown to be the two most effective management strategies that could increase dietary intake by 1.29 to 5 mg Zn day-1 dependent on sex and province. CONCLUSION This study shows that the Zn gap varied across regions in China, with some large enough to warrant interventions. Wheat and rice as two major Zn sources could be targeted without a direct need for dietary diversification. By promoting both biofortification breeding of wheat and rice and Zn fertilization, dietary Zn intake could be enhanced to contribute to human health improvement in China. © 2023 Society of Chemical Industry.
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Affiliation(s)
- Lu Liu
- State Key Laboratory of Nutrient Use and Management, College of Resources and Environmental Sciences, China Agricultural University, Beijing, 100193, China
- Centre for Crop Systems Analysis, Plant Sciences Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Wopke van der Werf
- Centre for Crop Systems Analysis, Plant Sciences Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Fusuo Zhang
- State Key Laboratory of Nutrient Use and Management, College of Resources and Environmental Sciences, China Agricultural University, Beijing, 100193, China
| | - Wen-Feng Cong
- State Key Laboratory of Nutrient Use and Management, College of Resources and Environmental Sciences, China Agricultural University, Beijing, 100193, China
| | - Tjeerd Jan Stomph
- Centre for Crop Systems Analysis, Plant Sciences Group, Wageningen University & Research, Wageningen, The Netherlands
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Trilok‐Kumar G, Malik A, Gusain Y, Millerot E, Pathak R, Filteau S. Dietary patterns of Indian school-aged children and associations with markers of chronic disease risk. Food Sci Nutr 2023; 11:7070-7079. [PMID: 37970425 PMCID: PMC10630838 DOI: 10.1002/fsn3.3631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 11/17/2023] Open
Abstract
There is an increasing burden of noncommunicable diseases (NCDs) in India which may be related to changing dietary patterns. We aimed to assess dietary patterns in children since they have time to change unhealthy patterns before NCDs develop. Participants were 665 children, 9-12 years old, born with low birth weight and 77 similarly aged normal birth weight controls. We collected data on sociodemography, anthropometry, body composition, and markers of risk for NCDs: grip strength, long jump, hemoglobin A1c (HbA1c). A food frequency questionnaire was used to collect dietary data from which dietary patterns were derived using principal component analysis (PCA). Fourteen food groups were included in the PCA analysis, resulting in three components: 'fruits and vegetables', 'protein', and 'sugar and fat'. Higher socioeconomic status and maternal education were associated with lower adherence to the fruit and vegetable pattern and higher adherence to the protein and sugar and fat patterns. Adherence to the fruits and vegetables pattern was associated with lower height-for-age, whereas the fat and sugar pattern was associated with higher indicators of body fat. In linear regression analyses adjusted for age, sex, religion, socioeconomic status, maternal education, and season of data collection, adherence to the 'fruits and vegetables' pattern was associated with lower grip strength, shorter long jump, and lower HbA1c. Adherence to the other patterns was not associated with NCD risk factors. Higher consumption of fruits and vegetables, achievable even by poorer families in the cohort, may lower HbA1c, a risk factor for diabetes.
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Affiliation(s)
| | - Anku Malik
- Institute of Home Economics, University of DelhiNew DelhiIndia
| | - Yamini Gusain
- Institute of Home Economics, University of DelhiNew DelhiIndia
| | - Eve Millerot
- London School of Hygiene and Tropical MedicineLondonUK
| | - Renuka Pathak
- Institute of Home Economics, University of DelhiNew DelhiIndia
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Neufingerl N, Eilander A. Nutrient Intake and Status in Children and Adolescents Consuming Plant-Based Diets Compared to Meat-Eaters: A Systematic Review. Nutrients 2023; 15:4341. [PMID: 37892416 PMCID: PMC10609337 DOI: 10.3390/nu15204341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
Health authorities increasingly recommend sustainable and healthy diets rich in plant foods and with moderate amounts of animal foods. However, there are concerns about whether such diets can meet all nutrient requirements, especially in children and adolescents, who have relatively high nutrient needs for growth and development. Therefore, we aimed to evaluate the nutrient intake and status of children and adolescents (2-18 y) consuming plant-based (i.e., vegetarian and vegan) diets compared to those of meat-eating children following a systematic literature review of studies published between 2000 and 2022. Mean intake and status data of nutrients were calculated across studies and benchmarked to dietary reference values and cut-off values for nutrient deficiencies. A total of 30 studies were included (15 in children 2-5 y, 24 in children 6-12 y, and 11 in adolescents 13-18 y). In all diets, there were risks of inadequate intakes of vitamin D and calcium. Children consuming meat had a risk of inadequate folate and vitamin E intake; and mean fiber, SAFA, and PUFA intakes were not in line with the recommendations. Children consuming plant-based diets risked inadequate vitamin B12, iron, and zinc intakes. In contrast to vegans, vegetarian children may not meet the recommended intakes of fiber, SAFA, and possibly PUFA, but their mean intakes were more favorable than in meat-eating children. Although the data are limited and need further validation, our findings indicate that there are risks of nutritional inadequacies in all diet groups. Therefore, increasing consumption of a variety of plant-based foods, in combination with food fortification and supplementation where needed, is recommended for children and adolescents to have sustainable and nutritionally adequate diets.
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Affiliation(s)
| | - Ans Eilander
- Unilever Foods Innovation Centre, 6708 WH Wageningen, The Netherlands;
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Kundu S, Sharma P, Singh S, Kumar P. District-level heterogeneity in overweight or obesity among women of reproductive age: A geo-spatial analysis in India. PLoS One 2023; 18:e0290020. [PMID: 37590188 PMCID: PMC10434895 DOI: 10.1371/journal.pone.0290020] [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: 06/02/2022] [Accepted: 08/01/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Globally by 2030, 38% of the world's population would be overweight, and another 20% would be obese. This has led to rising concerns regarding how swiftly and substantially the world is moving towards this epidemic of "globesity". India too is facing an increased burden of overweight and obese population. The changing dietary patterns are significantly associated with the increasing prevalence of overweight/obesity and related complications, especially among women. Hence, the present study aims to observe the spatial patterns of overweight or obesity among women in reproductive age group in India and factors associated with it. METHODS The study analyzed data from a cross-sectional nationwide household survey, i.e. National Family Health Survey (NFHS-4), 2015-16. The primary outcome variable of this study was overweight/obesity among reproductive-age women, which was measured through the body mass index (BMI) of the women. Bivariate and multivariate logistic regression analysis was used to analyze the data. Additionally, for spatial analysis in terms of overweight/obesity among women in India, univariate and bivariate Moran's I index measurements were used along with the usage of spatial regression models. RESULTS The value of spatial-autocorrelation for overweight or obese was 0.64, which depicts the moderately high prevalence of the overweight/obesity coverage over districts of India. The overall prevalence overweight/obesity among women in India is around 25% and higher proportion of women from urban areas (37.8%), and non-poor (33.4%) economic group reported to be overweight or obese. From spatial lag model, the lag coefficient was found to be 0.28, implying that a change in the prevalence of overweight/obesity among women in a certain district may statistically lag the prevalence of overweight/obesity by 28% in the neighbouring districts. There were significantly high clustering of overweight/obese women and non-poor wealth quintiles in 132 districts, mainly from states of Punjab, Haryana, Gujarat, Maharashtra, Kerala, Tamil Nadu, Karnataka and Andhra Pradesh. Additionally, there was high-high clustering of overweight/obese women and those who ever had caesarean in 82 districts, mostly from Kerala, Tamil Nadu, Andhra Pradesh and Karnataka. CONCLUSION The spatial patterns on the prevalence of overweight and obesity in India show that the women belonging to the southern states' districts are more overweight or obese in comparison to other states. The determinants like older age, higher education, urban residence, higher economic status are the key factors contributing to the prevalence of overweight or obesity among women in the reproductive age group. The study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status, to reduce the risks of health consequences due to overweight and obesity.
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Affiliation(s)
- Sampurna Kundu
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi, India
| | - Pratima Sharma
- School of Health System Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Shivani Singh
- Specialist- Monitoring and Evaluation, India Health Action Trust (IHAT), Lucknow, India
| | - Pradeep Kumar
- Specialist- Monitoring and Evaluation, India Health Action Trust (IHAT), Lucknow, India
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Jensen CF. Vitamin B12 levels in children and adolescents on plant-based diets: a systematic review and meta-analysis. Nutr Rev 2023; 81:951-966. [PMID: 36413044 DOI: 10.1093/nutrit/nuac096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
CONTEXT The popularity of plant-based diets, characterized by a partial or complete exclusion of animal products, has increased significantly over the last 10 years. The exclusion of animal products removes the most common sources of vitamin B12, which can lead to vitamin B12 deficiency and result in irreversible damage, such as growth stunting. OBJECTIVE This aim of this systematic review and meta-analysis was to qualitatively evaluate all studies on this subject and to quantify the potential difference in vitamin B12 levels in healthy children and adolescents aged 5 to 18 years. DATA SOURCES PubMed and Embase databases were searched for relevant studies investigating vitamin B12 levels in healthy children and adolescents aged 5 to 18 years on plant-based diets. DATA EXTRACTION Studies were assessed qualitatively with the AXIS tool and quantitatively with Stata 16.0 software. DATA ANALYSIS Overall, children and adolescents on plant-based diets had a significantly lower vitamin B12 level than omnivorous children and adolescents (-97 pmol/L; 95%CI, -187 to -7; I2 = 98.5%), a difference that remained statistically significant after adjusting for methodological confounders. After subgroup analyses, this effect was not statistically significant for children and adolescents on vegetarian diets but remained significant in children and adolescents on vegan or macrobiotic diets. Moreover, total vitamin B12 intake nullified the mean difference in vitamin B12 levels. CONCLUSION Despite high heterogeneity across studies, these results indicate that children and adolescents on plant-based diets, especially those on vegan and macrobiotic diets, may be at risk of developing vitamin B12 deficiency.
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Affiliation(s)
- Christopher F Jensen
- master's student with the Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Kumar P, Mangla S, Kundu S. Inequalities in overweight and obesity among reproductive age group women in India: evidence from National Family Health Survey (2015-16). BMC Womens Health 2022; 22:205. [PMID: 35655261 PMCID: PMC9161460 DOI: 10.1186/s12905-022-01786-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background In developing nations like India, fertility and mortality have decreased, and diseases related to lifestyle have become more common. Females in India are more prone to being overweight and obese than their male counterparts, more specifically in affluent families than the poor ones. Understanding the overweight and obesity trend may help develop feasible public health interventions to reduce the burden of obesity and associated adverse health outcomes. Methods The study utilizes the fourth round of the National Family Health Survey (NFHS-4), 2015–16. Descriptive statistics, bivariate and multivariate analysis was used to check the significant relationship between overweight and obesity, and other background characteristics. Income-related inequality in overweight and obesity among women was quantified by the concentration index and the concentration curve. Further, Wagstaff decomposition analysis was done to decompose the concentration index, into the contributions of each factor to the income-related inequalities. Results Overweight & obesity among women had a significant positive association with their age and educational level. The odds of overweight and obesity were 57% more likely among women who ever had any caesarean births than those who did not [AOR: 1.57; CI: 1.53–1.62]. The likelihood of overweight and obesity was 4.31 times more likely among women who belonged to richest [AOR: 5.84; CI: 5.61–6.08] wealth quintile, than those who belonged to poor wealth quintile. Women who ever terminated the pregnancy had 20% higher risk of overweight and obesity than those who did not [AOR: 1.20; CI: 1.17–1.22]. The concentration of overweight and obesity among women was mostly in rich households of all the Indian states and union territories. Among the geographical regions of India, the highest inequality was witnessed in Eastern India (0.41), followed by Central India (0.36). Conclusion The study results also reveal a huge proportion of women belonging to the BMI categories of non-normal, which is a concern and can increase the risks of developing non-communicable diseases. Hence, the study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status which can reduce the risks of health consequences due to overweight and obesity. Development nutrition-specific as well as sensitive interventions can be done for mobilization of local resources that addresses the multiple issues under which a woman is overweight or obese.
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Affiliation(s)
- Pradeep Kumar
- International Institute of Population Sciences, Deonar, Mumbai, 400088, India
| | - Sherry Mangla
- International Institute of Population Sciences, Deonar, Mumbai, 400088, India
| | - Sampurna Kundu
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi, 110067, India.
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Mahendra A, Kehoe SH, Crozier SR, Kumaran K, Krishnaveni GV, Arun N, Padmaja, Kini P, Taskeen U, Kombanda KT, Johnson M, Osmond C, Fall CHD. Peri-conceptional diet patterns and the risk of Gestational diabetes mellitus in South Indian women. Public Health Nutr 2022; 26:1-34. [PMID: 35620916 PMCID: PMC10131144 DOI: 10.1017/s1368980022001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/22/2022] [Accepted: 05/12/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify peri-conceptional diet patterns among women in Bangalore, and examine their associations with risk of gestational diabetes mellitus. DESIGN BANGLES, started in June 2016, was a prospective observational study, in which women were recruited at 5-16 weeks' gestation. Peri-conceptional diet was recalled at recruitment, using a validated 224-item food frequency questionnaire. GDM was assessed by a 75-gram oral glucose tolerance test at 24-28 weeks' gestation, applying WHO 2013 criteria. Diet patterns were identified using principal component analysis and diet pattern-GDM associations were examined using multivariate logistic regression, adjusting for 'a priori' confounders. SETTING Antenatal clinics of two hospitals, Bangalore, South India. PARTICIPANTS 785 pregnant women of varied socio-economic status. RESULTS GDM prevalence was 22%. Three diet patterns were identified: a) High-diversity, urban (HDU) characterised by diverse, home-cooked and processed foods was associated with older, more affluent, better-educated and urban women; b) Rice-fried snacks-chicken-sweets (RFCS), characterised by low diet-diversity, was associated with younger, less-educated, and lower income, rural and joint families; c) Healthy, traditional vegetarian (HTV), characterised by home-cooked-vegetarian and non-processed foods was associated with less-educated, more affluent, and rural and joint families. The HDU pattern was associated with a lower GDM risk (aOR: 0.80 per SD, 95% CI: 0.64, 0.99, p=0.04) after adjusting for confounders. BMI was strongly related to GDM risk and possibly mediated diet-GDM associations. CONCLUSIONS The findings support global recommendations to encourage women to attain a healthy pre-pregnancy BMI and increase diet-diversity. Both healthy and unhealthy foods in the patterns indicate low-awareness about healthy foods and a need for public-education.
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Affiliation(s)
- Anvesha Mahendra
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Sarah H Kehoe
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
| | - Kalyanaraman Kumaran
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - GV Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Nalini Arun
- Department of Obstetrics and Gynaecology, Bangalore Baptist Hospital, Bangalore, India
| | - Padmaja
- Department of Obstetrics and Gynaecology, Bangalore Baptist Hospital, Bangalore, India
| | - Prakash Kini
- Department of Obstetrics and Gynaecology, Cloudnine Hospital, Bangalore, India
| | - Unaiza Taskeen
- Previously Affiliated to Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India
| | - Krupa T Kombanda
- School of Exercise and Nutrition, Deakin University, Geelong, Australia
| | - Matthew Johnson
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
| | - Caroline HD Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, SouthamptonSO16 6YD, UK
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Fledderjohann J, Channon M. Gender, nutritional disparities, and child survival in Nepal. BMC Nutr 2022; 8:50. [PMID: 35606833 PMCID: PMC9125883 DOI: 10.1186/s40795-022-00543-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This paper examines seemingly contradictory evidence from extant research that son preference is high, but male disadvantage in mortality is increasing in Nepal. To do so, we documented the timing, geographic patterning, and extent of gendered patterns in mortality and feeding practices for children under-five. METHODS We applied pooled multilevel regression models and survival analysis to five rounds of data from Nepal's nationally representative Demographic and Health Surveys (1996-2016). We controlled for potential sociodemographic confounders, including child, maternal, household, and regional correlates, and disaggregated findings by birth order and sibling gender. RESULTS We found evidence of regional variation in mortality, with girls in wealthy urban areas faring the worst in terms of mortality rates. Girls' comparative mortality advantage compared to boys in the neonatal period masks their mortality disadvantage in later periods. Mortality has fallen at a faster rate for boys than girls in most cases, leading to widening of gender inequalities. We also found evidence of female disadvantage in breastfeeding duration, which was linked to higher mortality risks, but no gender disparities in the consumption of other food items. Sibling gender and birth order also mattered for breastfeeding duration: Young girls with older sisters but with no brothers were most disadvantaged. CONCLUSION While we did not find evidence of postnatal discrimination in access to solid and semi-solid foods, girls in Nepal face a disadvantage in breastfeeding duration. Girls with older sisters but no older brothers facing the greatest disadvantage, with risks being particularly concentrated for girls aged 1-4 years. This disadvantage is linked to an increased risk of mortality. To address this, community-based health programs could be expanded to continue targeted healthcare for children beyond 12 months of age, with particular focus on nutrition monitoring and health service provision for girls.
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Affiliation(s)
| | - Melanie Channon
- Department of Social & Policy Sciences, University of Bath, Bath, UK
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Kazembe LN, Nickanor N, Crush J. Food Insecurity, Dietary Patterns, and Non-Communicable Diseases (NCDs) in Windhoek, Namibia. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2021.1901822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lawrence N. Kazembe
- Department of Statistics and Population Studies, University of Namibia, Windhoek, Namibia
| | - Ndeyapo Nickanor
- Department of Statistics and Population Studies, University of Namibia, Windhoek, Namibia
| | - Jonathan Crush
- Balsillie School of International Affairs, Wilfrid Laurier University, Waterloo, Canada
- Department of Geography, Environmental Studies & Tourism, University of the Western Cape, Cape Town, South Africa
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Cao Y, Huynh Q, Kapoor N, Jeemon P, de Mello GT, Oldenburg B, Thankappan KR, Sathish T. Associations between Dietary Patterns and Cardiometabolic Risk Factors—A Longitudinal Analysis among High-Risk Individuals for Diabetes in Kerala, India. Nutrients 2022; 14:nu14030662. [PMID: 35277021 PMCID: PMC8838960 DOI: 10.3390/nu14030662] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 12/07/2022] Open
Abstract
The association between dietary patterns and cardiometabolic risk factors is not well understood among adults in India, particularly among those at high risk for diabetes. For this study, we analyzed the data of 1007 participants (age 30–60 years) from baseline and year one and two follow-ups from the Kerala Diabetes Prevention Program using multi-level mixed effects modelling. Dietary intake was measured using a quantitative food frequency questionnaire, and dietary patterns were identified using principal component analysis. Two dietary patterns were identified: a “snack-fruit” pattern (highly loaded with fats and oils, snacks, and fruits) and a “rice-meat-refined wheat” pattern (highly loaded with meat, rice, and refined wheat). The “snack-fruit” pattern was associated with increased triglycerides (mg/dL) (β = 6.76, 95% CI 2.63–10.89), while the “rice-meat-refined wheat” pattern was associated with elevated Hb1Ac (percentage) (β = 0.04, 95% CI 0.01, 0.07) and central obesity (OR 1.16, 95% CI 1.01, 1.34). These findings may help inform designing dietary interventions for the prevention of diabetes and improving cardiometabolic risk factors in high-diabetes-risk individuals in the Indian setting.
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Affiliation(s)
- Yingting Cao
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia; (N.K.); (B.O.); (T.S.)
- Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne 3004, Australia
- Correspondence: or
| | - Quan Huynh
- Imaging Research, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
| | - Nitin Kapoor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia; (N.K.); (B.O.); (T.S.)
- Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne 3004, Australia
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore 632004, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India; (P.J.); (K.R.T.)
| | - Gabrielli Thais de Mello
- Research Centre for Physical Activity and Health (NuPAF), Federal University of Santa Catarina, Florianópolis 88040-900, Brazil;
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia; (N.K.); (B.O.); (T.S.)
- Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne 3004, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia
| | - Kavumpurathu Raman Thankappan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India; (P.J.); (K.R.T.)
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod 671316, India
| | - Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia; (N.K.); (B.O.); (T.S.)
- Population Health Research Institute (PHRI), McMaster University, Hamilton, ON L8L 2X2, Canada
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Subramanyam D, Selvaraju G, Shankari SV, Parthasarathi S, Thomas P, Settu S. Incidence of dental caries in relation to sweet taste perception and dietary habits among students – A cross sectional study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S662-S665. [PMID: 36110626 PMCID: PMC9469261 DOI: 10.4103/jpbs.jpbs_862_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/04/2022] Open
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Sharma S, Maheshwari S, Kuwatada J, Chandrashekhar, Mehra S. Assessing Dietary Intake Patterns Through Cluster Analysis Among Adolescents in Selected Districts of Bihar and Assam From India: A Cross-Sectional Survey. Front Nutr 2021; 8:592581. [PMID: 34901099 PMCID: PMC8655107 DOI: 10.3389/fnut.2021.592581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background: In the recent decade, dietary pattern assessment has evolved as a promising tool to describe the whole diet and represent inter-correlations between different dietary components. We aimed to derive the dietary patterns of adolescents (10–19 years) using cluster analysis on food groups and evaluate these patterns according to their socio-demographic profile. Methods: This community-based cross-sectional study was conducted in two districts, each from Bihar and Assam in India. Adolescents (10–19 years) were enrolled from both rural and urban areas. The dietary intake was assessed through a pre-validated single food frequency questionnaire. Cluster analysis was performed by a 2-step procedure to explore dietary patterns, pre-fixed at 2 clusters. Clusters were analyzed with respect to socio-demographic characteristics using binomial logistic regression. Results: A total of 826 girls and 811 boys were enrolled in the study. We found two major dietary patterns, namely a low- and high-mixed diet. The low-mixed diet (76.5% prevalence) had daily consumption of green vegetables, including leafy vegetables, with less frequent consumption of other foods. The high-mixed diet (23.5% prevalence) had more frequent consumption of chicken, meat, egg, and milk/curd apart from green vegetables. Adolescent boys had 3.6 times higher odds of consuming a low-mixed diet compared to girls. Similarly, adolescents with lower education grades and from marginalized social classes had two times higher odds of taking a low-mixed diet than their respective counterparts. Conclusions: The high consumption of a low-mixed diet and relatively less milk consumption limit the comprehensive growth of adolescents. Improvement in dietary intake of adolescents from marginalized sections of society can prove to be an important deterrent in mitigating India's nutritional challenges.
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Affiliation(s)
- Shantanu Sharma
- Department of Clinical Sciences, Lund University, Malmo, Sweden.,Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Sonali Maheshwari
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Jitesh Kuwatada
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Chandrashekhar
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Sunil Mehra
- Department of Reproductive, Maternal, Child, and Adolescent Health, MAMTA Health Institute for Mother and Child, New Delhi, India
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14
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Suri S, Dutta A, Raghuvanshi RS, Singh A, Shahi NC, Chopra CS. Study on Dietary Pattern, Nutritional Status and Socio-Demographic Determinants of the Preschool Children Aged 3-6 Years. Ecol Food Nutr 2021; 61:144-161. [PMID: 34428117 DOI: 10.1080/03670244.2021.1969926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study was undertaken to analyze the dietary pattern and nutritional status of preschool children and to check the association between diet and socio-demographic factors. Dietary Pattern of 390 preschool children from Udham Singh Nagar district of Uttarakhand state of India was assessed. 24-Hour dietary recall and food frequency questionnaire (FFQ) was used for collecting information regarding dietary intake for three consecutive days. Nutritional indices (weight for age, height for age, weight for height, and BMI for age Z score) were studied using WHO Anthro software. Results indicated that the nutrient intake was inadequate, with major children consuming less than 60% of the recommended intake. Family income, community, type of family, birth order (ordinal position), and the number of siblings were associated with dietary insufficiency (p < 0.05). Stunting and wasting were commonly prevalent in more number of girls as compared to boys, on the contrary; more boys were underweight as compared to girls. A higher proportion of girls 18% (95% C.I. 10.8, 25.3) were thin as compared to boys 15% (95% C.I. 8.4, 21.6).
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Affiliation(s)
- Shweta Suri
- Department of Foods and Nutrition, G. B. Pant University of Agriculture and Technology, Pantnagar, India
| | | | - Rita Singh Raghuvanshi
- Department of Foods and Nutrition, G. B. Pant University of Agriculture and Technology, Pantnagar, India
| | - Anupama Singh
- Department of Foods and Nutrition, G. B. Pant University of Agriculture and Technology, Pantnagar, India.,Department of Post-Harvest Process and Food Engineering, G. B. Pant University of Agriculture and Technology, Pantnagar, India
| | - Navin Chandra Shahi
- Department of Post-Harvest Process and Food Engineering, G. B. Pant University of Agriculture and Technology, Pantnagar, India
| | - C S Chopra
- Department of Food Science and Technology, G. B. Pant University of Agriculture and Technology, Pantnagar, India
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15
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Assassi P, Selwyn BJ, Lounsbury D, Chan W, Harrell M, Wylie-Rosett J. Baseline dietary patterns of children enrolled in an urban family weight management study: associations with demographic characteristics. CHILD AND ADOLESCENT OBESITY 2021; 4:37-59. [PMCID: PMC9608350 DOI: 10.1080/2574254x.2020.1863741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective: Design: Setting: Results: Conclusion:
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Affiliation(s)
- Parisa Assassi
- Department of Epidemiology, Human Genetics and Environmental Science, UT-Health School of Public Health, Houston, TX, US
| | - Beatrice J. Selwyn
- Department of Epidemiology, Human Genetics and Environmental Science, UT-Health School of Public Health, Houston, TX, US
| | - David Lounsbury
- Albert Einstein College of Medicine, Albert Einstein College of Medicine, Bronx, NY, US
| | - Wenyaw Chan
- Department of Epidemiology, Human Genetics and Environmental Science, UT-Health School of Public Health, Houston, TX, US
| | - Melissa Harrell
- Department of Epidemiology, Human Genetics and Environmental Science, UT-Health School of Public Health, Houston, TX, US
| | - Judith Wylie-Rosett
- Albert Einstein College of Medicine, Albert Einstein College of Medicine, Bronx, NY, US
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16
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Puri P, Kothavale A, Singh S, Pati S. Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India. Wellcome Open Res 2021; 5:275. [PMID: 34131591 PMCID: PMC8182697 DOI: 10.12688/wellcomeopenres.16398.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/07/2023] Open
Abstract
Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.
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Affiliation(s)
- Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Ajinkya Kothavale
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - S.K. Singh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Bhubaneswar, Odisha, 751023, India
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17
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Madhari RS, Boddula S, Ravindranadh P, Jyrwa YW, Boiroju NK, Pullakhandam R, Mamidi RS, Nimmathota A, Kulkarni B, Thingnganing L. High dietary micronutrient inadequacy in peri-urban school children from a district in South India: Potential for staple food fortification and nutrient supplementation. MATERNAL & CHILD NUTRITION 2020; 16 Suppl 3:e13065. [PMID: 33347729 PMCID: PMC7752122 DOI: 10.1111/mcn.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/04/2022]
Abstract
Multiple micronutrient deficiencies (MNDs) co-exist, often because of poor intakes and adversely impact health. Habitual diets were assessed in 300 school children (6-17 years old) recruited from two government schools by simple random sampling. Probability of adequacy (PA) for 11 micronutrients and mean probability of adequacy (MPA) was calculated. Haemoglobin, plasma ferritin, folic acid, vitamin B12 and C-reactive protein were estimated. Descriptive statistics and regression analysis were used to estimate magnitude and factors associated with MNDs. The contribution of fortified foods and/or supplements in addressing inadequacies and excessive intakes was modelled. The PA ranged from 0.04 for folate to 0.70 for zinc, and the MPA was 0.27. Prevalence of anaemia (53%), iron deficiency (57%; ID), iron deficiency anaemia (38%; IDA), folate deficiency (24%) and B12 deficiency (43%) was high. Dietary inadequacy of iron, zinc and a low MPA was associated with anaemia and IDA. Inclusion of double fortified salt (DFS), fortified rice (FR) or iron folic acid (IFA) supplements individually in habitual diet reduced probability of iron inadequacy significantly from 82% to ≤13%. Inclusion of DFS and FR simultaneously led to disappearance of iron inadequacy, but risk of excessive intake increased to 16%. Inclusion of DFS, FR and IFA together increased risk of excess iron intake to 40%. Nevertheless, intakes of folate and B12 remained inadequate even with FR and/or IFA. These results indicate a high risk of dietary MNDs in children and suggest need for more systematic intake measurements in representative sample and adjustment of iron dosages to avoid excessive intakes.
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Affiliation(s)
- Radhika S. Madhari
- Department of DieteticsICMR‐National Institute of NutritionHyderabadIndia
| | - Swetha Boddula
- Department of DieteticsICMR‐National Institute of NutritionHyderabadIndia
| | | | | | | | | | - Raja Sriswan Mamidi
- Division of Clinical EpidemiologyICMR‐National Institute of NutritionHyderabadIndia
| | - Arlappa Nimmathota
- Division of Public Health NutritionICMR‐National Institute of NutritionHyderabadIndia
| | - Bharati Kulkarni
- Division of Maternal and Child HealthICMR‐National Institute of NutritionHyderabadIndia
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18
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Puri P, Kothavale A, Singh S, Pati S. Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India. Wellcome Open Res 2020; 5:275. [PMID: 34131591 PMCID: PMC8182697 DOI: 10.12688/wellcomeopenres.16398.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 08/23/2023] Open
Abstract
Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.
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Affiliation(s)
- Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Ajinkya Kothavale
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - S.K. Singh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Bhubaneswar, Odisha, 751023, India
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19
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Sharma S, Akhtar F, Singh RK, Mehra S. Dietary Intakes, Patterns, and Determinants of Children Under 5 Years from Marginalized Communities in Odisha: A Cross-sectional Study. J Epidemiol Glob Health 2020; 10:315-325. [PMID: 32959613 PMCID: PMC7758846 DOI: 10.2991/jegh.k.200515.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/07/2020] [Indexed: 11/04/2022] Open
Abstract
Pre-school age (3–5 years) children are vulnerable to malnutrition due to poor dietary intake, dietary habits, and socio-economic conditions. Children from marginalized families are more vulnerable than non-marginalized families due to limited access to health- and nutrition-related services, besides other socio-economic factors. This study was done to assess the dietary intakes, patterns, and determinants of pre-school age (3–5 years) children from marginalized populations in two districts of Odisha. We used three different questionnaires, namely general demographic information, single 24-h recall dietary survey, and food frequency questionnaire, to collect data. Dietary patterns were obtained using principal component analysis, and the recommended dietary allowance (RDA) method was applied to estimate the prevalence of inadequate intake. A general linear model of regression was used to investigate the relationship of dietary patterns scores with independent variables. A total of 86 boys (57.3%) and 64 girls (42.7%) were recruited for the study. The majority (more than two-third) of the children had <70% of RDA of iron, vitamin C, and zinc. The three dietary components that best described the dietary patterns among children in the study were vegetarian, non-vegetarian, and mixed patterns. They explained 54.9% of the variability. The ‘vegetarian’ dietary pattern was inversely associated with children whose mothers were illiterate (p = 0.005), who lived in families having per capita family monthly income less than INR 786 (10.3 US$) (p = 0.007), and who were first born (p = 0.04). The dietary patterns may help interventionists in designing programs aimed at preventing malnutrition and chronic diseases among children in marginalized communities.
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Affiliation(s)
- Shantanu Sharma
- Department of Clinical Sciences, Lund University, Skåne University Hospital, S-20502 Malmö, Sweden.,Reproductive, Maternal, Newborn, Child and Adolescent Health Division, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Faiyaz Akhtar
- Reproductive, Maternal, Newborn, Child and Adolescent Health Division, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Rajesh Kumar Singh
- Reproductive, Maternal, Newborn, Child and Adolescent Health Division, MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Sunil Mehra
- Reproductive, Maternal, Newborn, Child and Adolescent Health Division, MAMTA Health Institute for Mother and Child, New Delhi, India
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20
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Santhi D, Kalaikannan A, Natarajan A. Characteristics and composition of emulsion‐based functional low‐fat chicken meat balls fortified with dietary fiber sources. J FOOD PROCESS ENG 2019. [DOI: 10.1111/jfpe.13333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Dhanasekar Santhi
- Veterinary College and Research InstituteTamil Nadu Veterinary and Animal Sciences University Namakkal Tamil Nadu India
| | - Athiappan Kalaikannan
- Veterinary College and Research InstituteTamil Nadu Veterinary and Animal Sciences University Namakkal Tamil Nadu India
| | - Amirthalingam Natarajan
- Veterinary College and Research InstituteTamil Nadu Veterinary and Animal Sciences University Namakkal Tamil Nadu India
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21
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Pries AM, Ferguson EL, Sharma N, Upadhyay A, Filteau S. Exploratory Analysis of Nutritional Quality and Metrics of Snack Consumption among Nepali Children during the Complementary Feeding Period. Nutrients 2019; 11:E2962. [PMID: 31817203 PMCID: PMC6950298 DOI: 10.3390/nu11122962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 11/17/2022] Open
Abstract
The World Health Organization recommends feeding snacks between meals to young children. This study explored nutritional quality of snacks consumed between meals and consumption metrics (% total energy intakes (%TEI) and amount of kcal from snacks) to understand correlations with dietary outcomes (total energy intakes and dietary adequacy) and body-mass-index-for-age z-scores (BMIZ). Data used were 24-h dietary recalls and anthropometric measurements among a representative sample (n = 679) of one-year-olds in Nepal. Nepali meal patterns for young children were identified through formative research and all foods/beverages consumed outside of meals were categorized as snacks. A nutrient profiling model was used to categorize snacks as healthy or unhealthy, based on positive and negative nutrient content. Snacks consumed between meals provided half of all energy consumed, and were associated with increased energy and nutrient intakes. The positive effect of snacks between meals on dietary adequacy was greater when these snacks were healthy, while increasing %TEI from unhealthy snacks consumed between meals was negatively associated with dietary adequacy. Consumption of snacks between meals was not associated with mean BMIZ among the children. These findings indicate that the provision of and nutritional quality of snacks are important considerations to communicate to caregivers. Discouragement of unhealthy, nutrient-poor snacks is critical for complementary feeding dietary guidelines in contexts experiencing nutrition transition.
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Affiliation(s)
- Alissa M. Pries
- Helen Keller International USA, One Dag Hammarskjold Plaza, Floor 2, New York, NY 10017, USA
| | - Elaine L. Ferguson
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK; (E.L.F.); (S.F.)
| | - Nisha Sharma
- Helen Keller International Nepal, Green Block, Ward No 10, Chakupat, Patandhoka Road, Lalitpur 44700, Nepal; (N.S.); (A.U.)
| | - Atul Upadhyay
- Helen Keller International Nepal, Green Block, Ward No 10, Chakupat, Patandhoka Road, Lalitpur 44700, Nepal; (N.S.); (A.U.)
| | - Suzanne Filteau
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK; (E.L.F.); (S.F.)
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22
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Al Kibria GM, Swasey K, Hasan MZ, Sharmeen A, Day B. Prevalence and factors associated with underweight, overweight and obesity among women of reproductive age in India. Glob Health Res Policy 2019; 4:24. [PMID: 31517064 PMCID: PMC6729094 DOI: 10.1186/s41256-019-0117-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/12/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Although the prevalence of underweight is declining among Indian women, the prevalence of overweight/obesity is increasing. This study examined the prevalence and factors associated with underweight and overweight/obesity among reproductive-aged (i.e., 15-49 years) women in India. METHODS This cross-sectional study analyzed data from the 2015-16 National Family Health Survey. The Asian and World Health Organization (WHO) recommended cutoffs for body mass index (BMI) were used to categorize body weight. The Asian and WHO BMI cutoffs for combined overweight/obesity were ≥ 23 and ≥ 25 kg/m2, respectively. Both recommendations had the same cutoff for underweight, < 18.5 kg/m2. After prevalence estimation, logistic regression was applied to investigate associated factors. RESULTS Among 647,168 women, the median age and BMI was 30 years and 21.0 kg/m2, respectively. Based on the Asian cutoffs, the overall prevalence of underweight was 22.9%, overweight was 22.6%, and obesity was 10.7%, compared to 15.5% overweight and 5.1% obesity as per WHO cutoffs. The prevalence and odds of underweight were higher among young, nulliparous, contraceptive non-user, never-married, Hindu, backward castes, less educated, less wealthy, and rural women. According to both cutoffs, women who were older, ever-pregnant, ever-married, Muslims, castes other than backwards, highly educated, wealthy, and living in urban regions had higher prevalence and odds of overweight/obesity. CONCLUSION The prevalence of both non-normal weight categories (i.e., underweight and overweight/obesity) was high. A large proportion of women are possibly at higher risks of cardiovascular and reproductive adverse events due to these double nutrition burdens. Implementing large-scale interventions based on these results is essential to address these issues.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD-21201 USA
| | - Krystal Swasey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD-21201 USA
| | - Md Zabir Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD-21205 USA
| | - Atia Sharmeen
- School of Community Health and Policy, Morgan State University, Baltimore, MD-21251 USA
| | - Brendan Day
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD-21201 USA
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23
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Thorne-Lyman AL, Shaikh S, Mehra S, Wu LSF, Ali H, Alland K, Schultze KJ, Mitra M, Hur J, Christian P, Labrique AB, West KP. Dietary patterns of >30,000 adolescents 9-15 years of age in rural Bangladesh. Ann N Y Acad Sci 2019; 1468:3-15. [PMID: 31403718 PMCID: PMC7318683 DOI: 10.1111/nyas.14207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
Little is known of the usual food intakes of rural adolescents in South Asia. This study describes dietary patterns, based on >91,000 7‐day food frequencies among 30,702 girls and boys, aged 9–15 years in rural northwest Bangladesh. Three intake assessments per child, taken across a calendar year, were averaged to represent individual annual intake patterns for 22 food groups. Latent class analysis was used to assign individuals to dietary patterns based on class membership probabilities. The following five dietary patterns (class membership probabilities) were identified: (1) “least diverse” (0.20); (2) “traditional” (0.28); (3) “low vegetable/low fish” (0.23), (4) “moderately high meat” (0.20); and (5) “most diverse” (0.09). The least diverse pattern had the lowest median consumption of most foods and traditional had a relatively higher intake of most vegetables and fish. The most diverse pattern consumed both healthy and processed foods much more often than other patterns. The two most diverse patterns (4 and 5) were associated with higher socioeconomic status, body mass index, height‐for‐age Z‐score, and male gender, and the least diverse pattern showed inverse associations with these characteristics. The most diverse pattern may represent an early wave of the nutrition transition in rural Bangladesh.
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Affiliation(s)
- Andrew L Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Sucheta Mehra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lee S F Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hasmot Ali
- The JiVitA Project, Gaibandha, Bangladesh
| | - Kelsey Alland
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kerry J Schultze
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maithilee Mitra
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jinhee Hur
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Bill and Melinda Gates Foundation, Seattle, Washington
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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24
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Socio-economic patterning of food consumption and dietary diversity among Indian children: evidence from NFHS-4. Eur J Clin Nutr 2019; 73:1361-1372. [PMID: 30809007 DOI: 10.1038/s41430-019-0406-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/19/2019] [Accepted: 01/30/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Most interventions to foster child growth and development in India focus on improving food quality and quantity. We aimed to assess the pattern in food consumption and dietary diversity by socioeconomic status (SES) among Indian children. SUBJECTS/METHODS The most recent nationally representative, cross-sectional data from the National Family Health Survey (NFHS-4, 2015-16) was used for analysis of 73,852-74,038 children aged 6-23 months. Consumption of 21 food items, seven food groups, and adequately diversified dietary intake (ADDI) was collected through mother's 24-h dietary recall. Logistic regression models were conducted to assess the association between household wealth and maternal education with food consumption and ADDI, after controlling for covariates. RESULTS Overall, the mean dietary diversity score was low (2.26; 95% CI:2.24-2.27) and the prevalence of ADDI was only 23%. Both household wealth and maternal education were significantly associated with ADDI (OR:1.28; 95% CI:1.18-1.38 and OR:1.75; 95% CI:1.63-1.90, respectively), but the SES gradient was not particularly strong. Furthermore, the associations between SES and consumption of individual food items and food groups were not consistent. Maternal education was more strongly associated with consumption of essential food items and all food groups, but household wealth was found to have significant influence on intake of dairy group only. CONCLUSIONS Interventions designed to improve food consumption and diversified dietary intake among Indian children need to be universal in their targeting given the overall high prevalence of inadequate dietary diversity and the relatively small differentials by SES.
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Saeedi P, Shavandi A, Skidmore PML. What Do We Know about Diet and Markers of Cardiovascular Health in Children: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E548. [PMID: 30769798 PMCID: PMC6406429 DOI: 10.3390/ijerph16040548] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 02/07/2023]
Abstract
Chronic diseases such as cancer, diabetes, and cardiovascular diseases (CVD) are the main health concerns in the 21st century, with CVD as the number one cause of mortality worldwide. Although CVD hard endpoints such as stroke or heart attack do not usually occur in children, evidence shows that the manifestation of CVD risk factors begins in childhood, preceding clinical complications of CVD in adulthood. Dietary intake is a modifiable risk factor that has been shown to make a substantial contribution to the risk of CVD in adulthood. However, less is known about the association between dietary intake and markers of cardiovascular health in children. This review summarises the current evidence on the relationship between dietary intake and markers of cardiovascular health including traditional CVD risk factors, physical fitness, and indices of arterial stiffness and wave reflection in children. Original research published in English, between January 2008 and December 2018 fulfilling the objective of this review were screened and included. Findings show that adaptation of a healthy lifestyle early in life can be beneficial for reducing the risk of CVD later in life. Furthermore, keeping arterial stiffness low from a young age could be a potential CVD prevention strategy. However, limited studies are available on diet-arterial stiffness relationship in children, and future research is required to better understand this association to aid the development and implementation of evidence-based strategies for preventing CVD-related complications later in life.
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Affiliation(s)
- Pouya Saeedi
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
| | - Amin Shavandi
- BioMatter Unit-Biomass Transformation Lab (BTL), École interfacultaire de Bioingénieurs (EIB), Université Libre de Bruxelles, Avenue F.D. Roosevelt, 50-CP 165/61, 1050 Brussels, Belgium.
| | - Paula M L Skidmore
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
- Department of Medicine, University of Otago, Christchurch 8140, New Zealand.
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Santivañez-Romani A, Carbajal-Vega V, Pereyra-Elías R. Association between a vegetarian diet and emotional symptoms: a cross-sectional study among adolescents in four developing countries. Int J Adolesc Med Health 2018; 33:/j/ijamh.ahead-of-print/ijamh-2018-0130/ijamh-2018-0130.xml. [PMID: 30352033 DOI: 10.1515/ijamh-2018-0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 08/06/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies assessing the association between vegetarianism and mental health have found divergent results. Evidence from adolescents in developing countries is scarce. OBJECTIVE To evaluate the association between a vegetarian diet and emotional symptoms in 15-year-old adolescents from Ethiopia, India, Peru and Vietnam. METHODS A cross-sectional, secondary analysis of the Young Lives cohort study was used. The exposure variable was the self-report of being a vegetarian (yes or no). The outcome was the level of emotional symptoms, numerically evaluated using the score obtained in the subscale "Emotional Symptoms" of the Strengths and Difficulties Questionnaire (SDQ). We calculated crude and adjusted coefficients (β) with 95% confidence intervals (95% CIs), using generalized linear models of the Gaussian family, considering each sentinel site as a cluster. The analysis was stratified by country. Additionally, we made a global analysis including the four countries. RESULTS A total of 3484 adolescents were analyzed. The overall prevalence of vegetarianism was 4.4%, but it varied between countries (from 0.4% in Vietnam to 11.5% in India). The average emotional symptoms score was 3.5 [standard deviation (SD) 2.3] points. The scores were not statistically different between vegetarians and non-vegetarians (p > 0.05). In the adjusted analysis, in Vietnam, vegetarians had lower emotional symptoms scores on average than non-vegetarians [β: -1.79; 95% CI: -3.05 to -0.55]. No differences were found neither in the other countries nor in the overall sample. CONCLUSION There was no association between a vegetarian diet and emotional symptoms in the analyzed adolescents of four developing countries.
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Affiliation(s)
- Alejandra Santivañez-Romani
- School of Nutrition and Dietetics, Universidad Peruana de Ciencias Aplicadas, Av. Alameda San Marcos cda. 2 - Urb. Los Cedros de Villa, Chorrillos, Lima 09, Peru
| | - Valeria Carbajal-Vega
- School of Nutrition and Dietetics, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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Ecological and social patterns of child dietary diversity in India: a population-based study. Nutrition 2018; 53:77-84. [DOI: 10.1016/j.nut.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/28/2017] [Accepted: 01/07/2018] [Indexed: 11/22/2022]
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Snack cost and percentage of body fat in Chinese children and adolescents: a longitudinal study. Eur J Nutr 2018; 58:2079-2086. [PMID: 29987575 DOI: 10.1007/s00394-018-1769-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Only a few studies examined the relationship between snack cost and change in the percentage of body fat in children. We thus conducted a longitudinal study to investigate whether high snack cost is associated with fast increase in the percentage of body fat in Chinese children. METHODS The study included 2368 children (1126 girls and 1242 boys, aged 6-14 years). Percentage of body fat was repeatedly assessed by bioelectrical impedance analysis in 2014 (baseline), 2015 and 2016. Snack cost in 2014 was estimated by self-report associated with purchasing snacks at school and classified into low, moderate, and high group. Association between snack cost and repeated percentage of body fat was analyzed with linear mixed models, adjusting for demographic factors, diet, physical activity, and parental BMI and education. RESULTS High snack cost was significantly associated with a fast increase in the percentage of body fat over time (p trend = 0.04). Adjusted difference in annual increase rate in percentage of body fat between the high and low snack cost group was 0.31% [95% confident interval (CI) 0.04%, 0.58%], after adjusting for potential confounders. The impacts of snack cost on change in the percentage of body fat were more pronounced in boys, younger participants and those with higher BMI z-score at the baseline, relative to their counterparts (p interaction < 0.001 for all). CONCLUSIONS High snack cost was associated with more gain of body fat in Chinese school-aged children.
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Dietary Patterns, Cardiorespiratory and Muscular Fitness in 9⁻11-Year-Old Children from Dunedin, New Zealand. Nutrients 2018; 10:nu10070887. [PMID: 29996543 PMCID: PMC6073327 DOI: 10.3390/nu10070887] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 01/16/2023] Open
Abstract
Research shows that cardiorespiratory (CRF) and muscular fitness in childhood are associated with a healthier cardiovascular profile in adulthood. Identifying factors associated with measures of fitness in childhood could allow for strategies to optimize cardiovascular health throughout the lifecourse. The aim of this study was to examine the association between dietary patterns and both CRF and muscular fitness in 9⁻11-year-olds. In this study of 398 children, CRF and muscular fitness were assessed using a 20-m shuttle run test and digital hand dynamometer, respectively. Dietary patterns were derived using principal component analysis. Mixed effects linear regression models were used to assess associations between dietary patterns and CRF and muscular fitness. Most children had healthy CRF (99%, FITNESSGRAM) and mean ± SD muscular fitness was 15.2 ± 3.3 kg. Two dietary patterns were identified; “Snacks” and “Fruit and Vegetables”. There were no significant associations between either of the dietary patterns and CRF. Statistically significant but not clinically meaningful associations were seen between dietary patterns and muscular fitness. In an almost exclusively fit cohort, food choice is not meaningfully related to measures of fitness. Further research to investigate diet-fitness relationships in children with lower fitness levels can identify key populations for potential investments in health-promoting behaviors.
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Iglesia I, Huybrechts I, Mouratidou T, Santabárbara J, Fernández-Alvira JM, Santaliestra-Pasías AM, Manios Y, De la O Puerta A, Kafatos A, Gottrand F, Marcos A, Sette S, Plada M, Stehle P, Molnár D, Widhalm K, Kersting M, De Henauw S, Moreno LA, González-Gross M. Do dietary patterns determine levels of vitamin B 6, folate, and vitamin B 12 intake and corresponding biomarkers in European adolescents? The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Nutrition 2018; 50:8-17. [PMID: 29518603 DOI: 10.1016/j.nut.2017.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 10/04/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine dietary patterns (DPs) and explain the highest variance of vitamin B6, folate, and B12 intake and related concentrations among European adolescents. METHODS A total of 2173 adolescents who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence study met the eligibility criteria for the vitamin B intake analysis (46% boys) and 586 adolescents for the biomarkers analysis (47% boys). Two non-consecutive, 24-h, dietary recalls were used to assess the mean intakes. Concentrations were measured by chromatography and immunoassay testing. A reduced rank regression was applied to elucidate the combined effect of food intake of vitamin B and related concentrations. RESULTS The identified DPs (one per vitamin B intake and biomarker and by sex) explained a variability between 34.2% and 23.7% of the vitamin B intake and between 17.2% and 7% of the biomarkers. In the reduced rank regression models, fish, eggs, cheese, whole milk and buttermilk intakes were loaded positively for vitamin B intake in both sexes; however, soft drinks and chocolate were loaded negatively. For the biomarkers, a higher variability was observed in the patterns in terms of food loads such as alcoholic drinks, sugars, and soft drinks. Some food items were loaded differently between intakes and biomarkers such as fish products, which was loaded positively for intakes but negatively for plasma folate in girls. CONCLUSIONS The identified DPs explained up to 34.2% and 17.2% of the variability of the vitamin B intake and plasma concentrations, respectively, in European adolescents. Further studies are needed to elucidate the factors that determine such patterns.
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Affiliation(s)
- Iris Iglesia
- Growth, Exercise, NUtrition and Development (GENUD) Research group, Universidad de Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Aragón, Spain; Red de Salud Materno-infantil y del Desarrollo (SAMID), Barakaldo, Spain.
| | - Inge Huybrechts
- Department of Public Health, Ghent University, Ghent, Belgium; International Agency for Research on Cancer (IARC), Lyon, France
| | - Theodora Mouratidou
- Growth, Exercise, NUtrition and Development (GENUD) Research group, Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Santabárbara
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | - Juan M Fernández-Alvira
- Growth, Exercise, NUtrition and Development (GENUD) Research group, Universidad de Zaragoza, Zaragoza, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Alba M Santaliestra-Pasías
- Growth, Exercise, NUtrition and Development (GENUD) Research group, Universidad de Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Aragón, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | | | | | - Ascensión Marcos
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain
| | - Stefania Sette
- CREA, Research Centre for Food and Nutrition, Rome, Italy
| | - Maria Plada
- University of Crete School of Medicine, Crete, Greece
| | - Peter Stehle
- Department of Nutrition and Food Science, University of Bonn, Bonn, Germany
| | - Dénes Molnár
- Department of Pediatrics, University of Pécs, Pécs, Hungary
| | - Kurt Widhalm
- Division of Clinical Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mathilde Kersting
- Research Institute of Child Nutrition, Pediatric University Clinic, Ruhr University, Bochum, Germany
| | | | - Luis A Moreno
- Growth, Exercise, NUtrition and Development (GENUD) Research group, Universidad de Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Aragón, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Marcela González-Gross
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
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Krishnaveni GV, Kumaran K, Krishna M, Sahariah S, Chandak G, Kehoe S, Jones A, Bhat D, Danivas V, Srinivasan K, Suguna Shanthi J, Karat SC, Barker M, Osmond C, Yajnik C, Fall C. Life course programming of stress responses in adolescents and young adults in India: Protocol of the Stress Responses in Adolescence and Vulnerability to Adult Non-communicable disease (SRAVANA) Study. Wellcome Open Res 2018; 3:56. [PMID: 30027123 PMCID: PMC6039920 DOI: 10.12688/wellcomeopenres.14583.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 01/04/2023] Open
Abstract
Background: Early life nutrition may affect individuals' susceptibility to adult non-communicable diseases (NCD). Psychological stress is a well-recognised NCD risk factor. Recent evidence suggests that impaired foetal nutrition alters neuro-endocrine pathways, and hypothalamic-pituitary-adrenal axis feedback systems, resulting in abnormal stress responses, and NCD risk. This study aims to examine adolescent cortisol and cardiovascular stress responses in relation to maternal nutrition and contemporaneous NCD risk markers. Methods: The study sample will be drawn from three well-established birth cohorts in India; the Parthenon cohort, Mysore (N=550, age~20y), the SARAS KIDS prenatal intervention cohort, Mumbai (N=300, age~10-12y) and the Pune Rural Intervention in Young Adults/ PRIYA cohort, Pune (N=100, age~22y). We will perform the 'Trier Social Stress Test (TSST)', a well-accepted stress-test module which involves participants performing 5-minutes each of public speaking and mental arithmetic tasks in front of unfamiliar 'judges' (stressor). Repeated measures of salivary cortisol and autonomic cardiovascular outcomes relative to the stressor will be assessed. Measures of psychological stress, cognitive function, blood pressure, glucose-insulin metabolism and depression will be carried out. Mechanistic studies including DNA methylation in gluco-corticoid receptor ( NR3C1) and 11β-HSD2 gene loci and neuroimaging will be carried out in a subsample. Qualitative interviews and focus group discussions in a subsample of the Parthenon cohort will explore the perception of stress and stressors among the youth. We will convert repeated measures into time-weighted averages before analysis. We will carry out multivariable regression analysis to test the associations. We will further refine the analyses using the mixed-model regression and conditional analyses for the association with repeated measures. Ethics and dissemination: This study has been approved by the research ethics committee of CSI Holdsworth Memorial Hospital, Mysore. The findings will be disseminated locally and at international meetings, and reports will be submitted to open access peer reviewed journals.
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Affiliation(s)
- GV Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospitol, Mysore, India
| | | | - Murali Krishna
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospitol, Mysore, India
| | | | | | - Sarah Kehoe
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Dattatray Bhat
- Diabetes Unit, KEM Hospital Research Centre, Pune, India
| | - Vijay Danivas
- Mysore Medical College and Research Institute, Mysore, India
| | | | - J Suguna Shanthi
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospitol, Mysore, India
| | - SC Karat
- Department of Pediatrics, Jerudong Park Medical Centre, Jerudong Park, Brunei
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Hinnig PDF, Monteiro JS, de Assis MAA, Levy RB, Peres MA, Perazi FM, Porporatti AL, Canto GDL. Dietary Patterns of Children and Adolescents from High, Medium and Low Human Development Countries and Associated Socioeconomic Factors: A Systematic Review. Nutrients 2018; 10:E436. [PMID: 29601553 PMCID: PMC5946221 DOI: 10.3390/nu10040436] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 01/07/2023] Open
Abstract
The purpose of this systematic review is to assess the associations among education, income and dietary pattern (DP) in children and adolescents from high, medium and low human development countries (HHDC, MHDC and LHDC, respectively). Observational studies that evaluated the association between family income or education with the DP are obtained through electronic database searches. Forty articles are selected for review. In HHDC, education is inversely associated with "unhealthy" DP and positively associated with "healthy" DP. In cross-sectional studies from HHDC, higher income is negatively associated with "unhealthy" DP. In MHDC, there is no association between the socioeconomic variables (SE) and the DPs, although, in some studies, the unhealthy diet is positively associated with SE. Only one study conducted in LHDC showed an inverse association between income/education with "unhealthy" DP and there is no association between the SE and "healthy" DP. In conclusion, children and adolescents living in HHDC with high parental education tend to have a healthier diet. In MHDC, although an unhealthy diet is found among the high-income and educated population, the associations are not clear. Additional research is needed to clarify the associations between income and education with "unhealthy" and "healthy" DPs in MHDC and LHDC.
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Affiliation(s)
- Patrícia de Fragas Hinnig
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
| | - Jordanna Santos Monteiro
- Postgraduate Program in Human Nutrition, Faculty of Health Sciences, University of Brasília (UnB), Brasilia-DF 70910-900, Brazil.
| | - Maria Alice Altenburg de Assis
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
| | - Renata Bertazzi Levy
- Preventive Medicine Department, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Marco Aurélio Peres
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA 5005, Australia.
| | - Fernanda Machado Perazi
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
| | - André Luís Porporatti
- Brazilian Centre for Evidence-Based Research Department of Dentistry, Federal University of Santa Catarina CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
| | - Graziela De Luca Canto
- Brazilian Centre for Evidence-Based Research Department of Dentistry, Federal University of Santa Catarina CCS/UFSC, Campus Trindade, Florianopolis 88040-900, Brazil.
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UNHEALTHY WEIGHT IN INDIAN FAMILIES: THE ROLE OF THE FAMILY ENVIRONMENT IN THE CONTEXT OF THE NUTRITION TRANSITION. POPULATION RESEARCH AND POLICY REVIEW 2018; 37:157-180. [PMID: 29962562 DOI: 10.1007/s11113-017-9455-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
India faces a dual burden of increasing obesity and persistent underweight as it experiences the nutrition transition-the dietary and lifestyle changes that accompany globalization, economic development, and technological change. Yet, the nutrition transition is not solely a top-down process; rather, global forces converge with local practices at multiple levels of the social ecology. The family environment, a key site for the transmission of local customs and norms, remains largely unexplored in India. We examined the extent to which opposite-gender siblings and mother-child pairs were concordant or discordant in body weight, and whether domains of the family environment, specifically, food practices, food-related gender norms, and household resources, were associated with patterns of unhealthy weight within and between families. Multilevel dyadic analysis and logistic regression were conducted using survey data from a representative sample of 400 families in a Southern Indian city. We identified substantial clustering of weight among opposite-gender sibling pairs (ICC=0.43) and mother-child pairs, as well as important patterns of discordance, including 11% of families experiencing a dual burden of underweight and overweight. Household resources, including mother's education and income, were salient in explaining the distribution of body weight within and between families. Importantly, less examined domains of the family environment were also relevant, including food practices (e.g. grocery shopping frequency), and food-related gender norms (e.g. mother's control of food served at home). Continued exploration of how global and local practices converge in households will be necessary to develop programming that effectively addresses India's dual burden of unhealthy weight.
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Aurino E. Do boys eat better than girls in India? Longitudinal evidence on dietary diversity and food consumption disparities among children and adolescents. ECONOMICS AND HUMAN BIOLOGY 2017; 25:99-111. [PMID: 27810442 DOI: 10.1016/j.ehb.2016.10.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 09/20/2016] [Accepted: 10/22/2016] [Indexed: 06/06/2023]
Abstract
This paper examines the dynamics of gender-based disparities in the intra-household allocation of food during childhood and adolescence in Andhra Pradesh and Telangana by using three rounds of longitudinal data from two cohorts. While boys are advantaged at all ages (except for the Younger Cohort at 12 years old), the pro-boy gap widens markedly at 15 years old. Specifically, mid-adolescent girls tend to consume fewer protein- and vitamin-rich foods such as eggs, legumes, root vegetables and fruit. This result is robust to gender differences between adolescents in terms of puberty onset, school enrolment, time use and dietary behaviours. Finally, gender disparities in dietary diversity during early and mid-adolescence do not vary by maternal education, poverty or place of residence, whilst they are moderated by levels of caregiver's educational aspirations at 15 years old.
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Affiliation(s)
- Elisabetta Aurino
- School of Public Health, Imperial College London, Norfolk Place, London W2 1NY, United Kingdom; Department of International Development, University of Oxford, United Kingdom.
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Dietary patterns and non-communicable disease risk in Indian adults: secondary analysis of Indian Migration Study data. Public Health Nutr 2017; 20:1963-1972. [PMID: 28367791 PMCID: PMC5560196 DOI: 10.1017/s1368980017000416] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective Undernutrition and non-communicable disease (NCD) are important public health issues in
India, yet their relationship with dietary patterns is poorly understood. The current
study identified distinct dietary patterns and their association with micronutrient
undernutrition (Ca, Fe, Zn) and NCD risk factors (underweight, obesity, waist:hip ratio,
hypertension, total:HDL cholesterol, diabetes). Design Data were from the cross-sectional Indian Migration Study, including semi-quantitative
FFQ. Distinct dietary patterns were identified using finite mixture modelling;
associations with NCD risk factors were assessed using mixed-effects logistic regression
models. Setting India. Subjects Migrant factory workers, their rural-dwelling siblings and urban non-migrants.
Participants (7067 adults) resided mainly in Karnataka, Andhra Pradesh, Maharashtra and
Uttar Pradesh. Results Five distinct, regionally distributed, dietary patterns were identified, with
rice-based patterns in the south and wheat-based patterns in the north-west. A
rice-based pattern characterised by low energy consumption and dietary diversity (‘Rice
& low diversity’) was consumed predominantly by adults with little formal
education in rural settings, while a rice-based pattern with high fruit consumption
(‘Rice & fruit’) was consumed by more educated adults in urban settings. Dietary
patterns met WHO macronutrient recommendations, but some had low micronutrient contents.
Dietary pattern membership was associated with several NCD risk factors. Conclusions Five distinct dietary patterns were identified, supporting sub-national assessments of
the implications of dietary patterns for various health, food system or environment
outcomes.
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Green R, Milner J, Joy EJM, Agrawal S, Dangour AD. Dietary patterns in India: a systematic review. Br J Nutr 2016; 116:142-8. [PMID: 27146890 PMCID: PMC4890343 DOI: 10.1017/s0007114516001598] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/09/2016] [Accepted: 03/19/2016] [Indexed: 11/15/2022]
Abstract
Dietary patterns analysis is an emerging area of research. Identifying distinct patterns within a large dietary survey can give a more accurate representation of what people are eating. Furthermore, it allows researchers to analyse relationships between non-communicable diseases (NCD) and complete diets rather than individual food items or nutrients. However, few such studies have been conducted in developing countries including India, where the population has a high burden of diabetes and CVD. We undertook a systematic review of published and grey literature exploring dietary patterns and relationships with diet-related NCD in India. We identified eight studies, including eleven separate models of dietary patterns. Most dietary patterns were vegetarian with a predominance of fruit, vegetables and pulses, as well as cereals; dietary patterns based on high-fat, high-sugar foods and more meat were also identified. There was large variability between regions in dietary patterns, and there was some evidence of change in diets over time, although no evidence of different diets by sex or age was found. Consumers of high-fat dietary patterns were more likely to have greater BMI, and a dietary pattern high in sweets and snacks was associated with greater risk of diabetes compared with a traditional diet high in rice and pulses, but other relationships with NCD risk factors were less clear. This review shows that dietary pattern analyses can be highly valuable in assessing variability in national diets and diet-disease relationships. However, to date, most studies in India are limited by data and methodological shortcomings.
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Affiliation(s)
- Rosemary Green
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London WC1H 0PD, UK
| | - James Milner
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Edward J. M. Joy
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London WC1H 0PD, UK
| | - Sutapa Agrawal
- Public Health Foundation of India, Delhi NCR, Plot No. 47, Sector 44, Institutional Area Gurgaon 122002, India
| | - Alan D. Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London WC1H 0PD, UK
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de Lanerolle-Dias M, Lanerolle P, Atukorala S, de Silva A. Urbanisation, dietary patterns and body composition changes in adolescent girls: a descriptive cross sectional study. BMC Nutr 2015. [DOI: 10.1186/s40795-015-0027-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Contribution of food sources to the vitamin B12 status of South Indian children from a birth cohort recruited in the city of Mysore. Public Health Nutr 2014; 18:596-609. [PMID: 24866058 DOI: 10.1017/s1368980014000974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There is evidence that subclinical vitamin B12 (B12) deficiency is common in India. Vegetarianism is prevalent and therefore meat consumption is low. Our objective was to explore the contribution of B12-source foods and maternal B12 status during pregnancy to plasma B12 concentrations. DESIGN Maternal plasma B12 concentrations were measured during pregnancy. Children's dietary intakes and plasma B12 concentrations were measured at age 9.5 years; B12 and total energy intakes were calculated using food composition databases. We used linear regression to examine associations between maternal B12 status and children's intakes of B12 and B12-source foods, and children's plasma B12 concentrations. SETTING South Indian city of Mysore and surrounding rural areas. SUBJECTS Children from the Mysore Parthenon Birth Cohort (n 512, 47.1 % male). RESULTS Three per cent of children were B12 deficient (<150 pmol/l). A further 14 % had 'marginal' B12 concentrations (150-221 pmol/l). Children's total daily B12 intake and consumption frequencies of meat and fish, and micronutrient-enriched beverages were positively associated with plasma B12 concentrations (P=0.006, P=0.01 and P=0.04, respectively, adjusted for socio-economic indicators and maternal B12 status). Maternal pregnancy plasma B12 was associated with children's plasma B12 concentrations, independent of current B12 intakes (P<0.001). Milk and curd (yoghurt) intakes were unrelated to B12 status. CONCLUSIONS Meat and fish are important B12 sources in this population. Micronutrient-enriched beverages appear to be important sources in our cohort, but their high sugar content necessitates care in their recommendation. Improving maternal B12 status in pregnancy may improve Indian children's status.
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