New dynamics in global obesity facing low- and middle-income countries

Sex differences in the secular change in waist circumference relative to BMI in five countries from 1997 to 2020

OBJECTIVE

The objective of this study was to quantify changes over time in waist circumference (WC) relative to BMI by sex in the Americas (United States, Mexico, Chile, and Peru) and England.

METHODS

Data from adults aged 25 to 64 years between 1997 and 2020 were analyzed, and US data were stratified by race and ethnicity groups. Sex-specific BMI and WC means and obesity and abdominal obesity prevalence were compared between the first and last surveys. Using data from all survey years, secular changes across the BMI and WC distributions were estimated, applying quantile regression models. BMI was added as a predictor of WC to estimate secular changes in WC relative to BMI. Interaction terms were included in all models to evaluate differences by sex.

RESULTS

BMI and WC (except for Peru) showed larger secular increases at the upper-tails of the distributions in both sexes. Increases at the 50th and 75th WC percentiles relative to BMI were more pronounced in women than in men, with larger increases in US non-Hispanic White individuals and in England. In men, increases in WC independent of BMI were most evident in Mexico.

CONCLUSIONS

Disease risk associated with visceral fat is potentially underestimated by national surveillance efforts that quantify only secular changes in BMI.

Challenges for global antibiotic regimen planning and establishing antimicrobial resistance targets: implications for the WHO Essential Medicines List and AWaRe antibiotic book dosing

SUMMARYThe World Health Organisation's 2022 AWaRe Book provides guidance for the use of 39 antibiotics to treat 35 infections in primary healthcare and hospital facilities. We review the evidence underpinning suggested dosing regimens. Few (n = 18) population pharmacokinetic studies exist for key oral AWaRe antibiotics, largely conducted in homogenous and unrepresentative populations hindering robust estimates of drug exposures. Databases of minimum inhibitory concentration distributions are limited, especially for community pathogen-antibiotic combinations. Minimum inhibitory concentration data sources are not routinely reported and lack regional diversity and community representation. Of studies defining a pharmacodynamic target for ß-lactams (n = 80), 42 (52.5%) differed from traditionally accepted 30%-50% time above minimum inhibitory concentration targets. Heterogeneity in model systems and pharmacodynamic endpoints is common, and models generally use intravenous ß-lactams. One-size-fits-all pharmacodynamic targets are used for regimen planning despite complexity in drug-pathogen-disease combinations. We present solutions to enable the development of global evidence-based antibiotic dosing guidance that provides adequate treatment in the context of the increasing prevalence of antimicrobial resistance and, moreover, minimizes the emergence of resistance.

Pre-Gestational Obesity and Gestational Weight Gain as Predictors of Childhood Obesity

OBJECTIVE

To evaluate the associations of pre-gestational body mass index (BMI) and gestational weight gain (GWG) with the risks of overweight, obesity, and adiposity in the first seven years of life in the offspring of a cohort of pregnant women.

METHODS

Analysis of 751 mothers and their children participating in the PROGRESS cohort. These women were recruited in Mexico City between 2007 and 2010. Pre-gestational BMI was classified as normal, overweight, and obesity according to the WHO. GWG was calculated as the difference between the last reported pre-pregnancy weight and the pre-gestational weight and categorized as inadequate, adequate, or excessive, according to US IOM recommendations. Children's anthropometry was evaluated at 4-5 and 6-7 years of age. Adiposity was classified into three groups: normal (BMI z-score and waist circumference), overweight (BMI z-score>1), and overweight plus abdominal obesity (OW+AO). A generalized structural equation model (GSEM) was constructed to account for the temporal relationship between variables and to assess direct and indirect effects.

RESULTS

A total of 49.3% of the women had excessive (13.8 ± 4.2 kg) and 19.8% inadequate (3.15 ± 3.4 kg) GWG. Women with pre-gestational overweight or obesity were more likely to have excessive GWG (OR 1.9 [95% CI: 1.32, 2.74] and 3.50 [95% CI: 1.83, 6.69], respectively). In the GSEM, excessive GWG was directly associated with OW+AO at 4-5 years. At 6-7 years, pre-gestational obesity was associated with OW+AO.

CONCLUSION

Pre-gestational obesity and excessive GWG were independent predictors of childhood obesity.

Overweight and obesity among female adolescents in Nigeria; an emerging, but under-reported epidemic

BACKGROUND

Overweight and obesity are increasing at epidemic levels in all ages globally, but there is little nationally representative data on female adolescents in Nigeria. The focus on female adolescents is important because of the negative implications of overweight and obesity on their health and survival, and that of their unborn children.

AIM

To estimate the prevalence and identify the determinants of overweight and obesity among female adolescents in Nigeria.

METHODS

Cross-sectional study using data from the Nigeria demographic and health survey, 2018. A total of 2,721 female adolescents aged 15-19 years were selected using cluster sampling technique. Overweight and obesity were determined using BMI-for-age reference values of World Health Organization and different explanatory variables at the individual, household and community levels were included. Binary logistic regression analysis was used to identify the determinants of overweight/obesity using five models.

RESULTS

The mean age of the respondents was 16.8 ± 1.4 years. The prevalence rate of overweight/obesity was 10.2%, but with a large variation in the geographical and socio-economic distribution. At the crude/unadjusted rate, nearly all the explanatory variables showed a statistically significant association with overweight and obesity, but at the full model which controlled for all the explanatory variables, only the household wealth index retained its statistically significant association, such that female adolescents who were from richer and richest households had about 3 times higher odds of being obese compared to those from the poorest households. (OR: 2.7; p = 0.018; CI: 1.18-6.18), (OR: 2.8; p = 0.027; CI: 1.13-7.06) respectively.

CONCLUSION

The prevalence of overweight/obesity among female adolescents in Nigeria was 10.2%. The household wealth index remained the only factor with a statistically significant association with overweight and obesity after controlling for confounders. Efforts at addressing overweight and obesity among female adolescents in Nigeria should target those from the richer/richest households.

Preconception Micronutrient Supplementation Affects Maternal BMI and Body Composition Postpartum: A Randomized Controlled Trial in Vietnam

BACKGROUND

Although there is growing evidence on the role of preconception nutrition for birth outcomes, limited evidence exists for its effects on maternal health.

OBJECTIVES

This study evaluates the impact of preconception micronutrient supplementation on maternal BMI (kg/m2) and body composition at 6 to 7 y postpartum (PP).

METHODS

We followed females who participated in a randomized controlled trial of preconception supplementation in Vietnam and delivered live offspring (n = 1599). Females received weekly supplements containing either 2800 μg folic acid (FA) only, 60 mg iron and 2800 μg FA (IFA), or multiple micronutrients (MMs) (15 micronutrients including IFA) from baseline until conception followed by daily prenatal IFA supplements until delivery. Height, weight, mid-upper arm circumference, triceps skinfold, and waist-hip circumference were measured at recruitment and at 1, 2, and 6 to 7 y PP. Body fat was assessed using bioelectric impedance at 6 to 7 y PP (n = 867). Group comparisons were made using analysis of variance or chi-square tests and general linear models for adjusted models.

RESULTS

At 6 to 7 y PP, we found significant differences (P < 0.05) by treatment group for mean percent fat (MM: 29.2%; IFA: 27.6%; FA: 27.8%), absolute fat mass (MM: 15.1 kg; IFA: 14.0 kg; FA: 14.3 kg), and prevalence of underweight based on BMI < 18.5 (MM: 5.8%; IFA: 10.3%; FA: 14.3%). Mean BMI and triceps skinfold thickness were higher in the MM group, but these differences were not statistically significant; the differences in absolute fat mass were also attenuated after controlling for body weight. No differences were observed for fat-free mass, prevalence of overweight (BMI >23), or other anthropometric measurements.

CONCLUSIONS

Preconception MM supplementation was associated with lower prevalence of underweight and higher percent fat when compared with IFA and/or FA only. Preconception micronutrient interventions may have long-term effects on maternal health and merit further examination. This trial was registered at clinicaltrials.gov as NCT01665378.

Abdominal obesity and associated factors among urban adults in Southwest Ethiopia: a community-based cross-sectional study

Introduction

the obesity epidemic is growing faster in developing countries with no exception of Ethiopia. Currently, abdominal obesity is identified as a major risk factor for chronic diseases due to the accumulation of liable fat. However, despite the evidence of certain documented data, abdominal obesity has been on the rise in Ethiopia, especially in urban areas. Therefore, this study aimed to assess the prevalence and factors associated with abdominal obesity among adults in Jimma town, Southwest Ethiopia.

Methods

a community-based cross-sectional study was employed on 845 adults selected using a multi-stage sampling technique. Data were collected using a pretested interviewer-administered questionnaire. Data were entered using Epi-data version 3.1 and exported to STATA version 14 for analysis. Simple linear regression was conducted to identify candidate variables. A multivariable linear regression model was fitted to identify factors associated with abdominal obesity. P-value<0.05 was used to declare statistical significance.

Results

a total of 806 respondents participated in this study, making a response rate of 95.4%. The magnitude of abdominal obesity was found to be 24.6% (95% CI: 21.5, 27.5). Physical activity (β= -2.053; 95%CI: -3.353, -0.454), alcohol consumption (β=1.631; 95%CI: 0.176, 3.087), and age (β=0.319; 95%CI: 0.250, 0.389) were significantly associated with abdominal obesity.

Conclusion

the magnitude of abdominal obesity among adults in the study area was high compared to previous studies. Alcohol drinking, being physically inactive, and age were predictors of abdominal obesity. There is a need for intervention for adults with physical inactivity and alcohol consumption to reduce abdominal obesity.

Sex differences in the secular change in waist circumference relative to body mass index in the Americas and England from 1997 to 2020

Objective

To quantify changes over time in waist circumference (WC) relative to body mass index (BMI) by sex in the Americas (United States of America, Mexico, Chile, Peru) and England.

Methods

Data from adults aged 25-64 years between 1997 and 2020 was analysed; US data was stratified by racial-ethnic groups. Sex-specific BMI and WC means, and obesity and abdominal obesity prevalence, were compared between the first and last surveys. Using data from all survey years, secular changes across the BMI and WC distributions were estimated applying quantile regression models. BMI was added as a predictor of WC to estimate secular changes in WC relative to BMI. Interaction terms were included in all models to evaluate differences by sex.

Results

BMI and WC (except Peru) showed larger secular increases at the upper-tails of the distributions in both sexes. Increases at the 50th and 75th WC centiles relative to BMI were more pronounced in women than in men, with larger increases in US non-Hispanic whites and in England. In men, increases in WC independently of BMI were most evident in Mexico.

Conclusions

Disease risk associated with visceral fat, is potentially underestimated by national surveillance efforts that quantify secular changes only in BMI.

Nutrition transition, double burden of malnutrition, and urbanization patterns in secondary cities of Bangladesh, Kenya and Rwanda

BACKGROUND

By 2050, approximately 68% of the global population will live in cities, but nutrition data on urban populations of low- and middle-income countries are scarce. Fast growing secondary cities, combining characteristics and hurdles of urban and rural settings, are hotspots for the double burden of malnutrition. The Nutrition in City Ecosystems (NICE) project focuses on 6 secondary cities in Bangladesh, Kenya and Rwanda, to improve health and nutrition, and reduce poverty. To assess the baseline situation and guide future interventions, food insecurity, dietary diversity, nutrition status, and food production and purchasing patterns were explored.

METHODS

In a cross-sectional study design, data were collected from urban and peri-urban households of Dinajpur and Rangpur in Bangladesh, Bungoma and Busia in Kenya, and Rubavu and Rusizi in Rwanda. Approximately 1200 households, in neighborhoods prone to malnutrition, were involved from April to June 2021. We assessed Household Food Insecurity Access Score (HFIAS), both current and before COVID-19, Household Dietary Diversity Score (HDDS), Minimum Dietary Diversity for Women (MDD-W), anthropometric measurements, household and socioeconomic information, and questions related to food production and consumer behavior. Further we collected secondary data on low birthweight and anemia during pregnancy.

RESULTS

All cities experienced a substantial increase in food insecurity during the COVID-19 pandemic. Stunting rates in children under 5 years varied among the cities and ranged from 7.8% in Busia to 46.6% in Rubavu, while half of adult women were overweight (between 42.1% in Rusizi and 55.8% in Bungoma). Furthermore, many women did not consume an adequately diverse diet (MDD-W < 5 for 29.3% in Bangladesh, 47.5% in Kenya, and 67.0% in Rwanda), however many of the urban and peri-urban households were engaged in farming (58-78%).

CONCLUSIONS

The double burden of malnutrition is high in secondary cities and the COVID-19 pandemic has exacerbated levels of food insecurity. Demand for, and access to, an affordable healthy diverse diet that comprises local, nutritious, and agroecologically produced foods present a pathway for overcoming the complex challenges of malnutrition.

Intermittent fasting for adults with overweight or obesity

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To assess the effects of intermittent fasting for adults with overweight or obesity.

Spatial and temporal trends of overweight/obesity and tobacco use in East Africa: subnational insights into cardiovascular disease risk factors

BACKGROUND

Cardiovascular disease (CVD) is increasing in Sub-Saharan Africa (SSA). Overweight/obesity and tobacco use are modifiable CVD risk factors, however literature about the spatiotemporal dynamics of these risk factors in the region at subnational or local scales is lacking. We describe the spatiotemporal trends of overweight/obesity and tobacco use at subnational levels over a 13-year period (2003 to 2016) in five East African nations.

METHODS

Cross-sectional, nationally representative Demographic and Health Surveys (DHS) were used to explore the subnational spatiotemporal patterns of overweight/obesity and tobacco use in Burundi, Kenya, Rwanda, Tanzania, and Uganda, five East African Community (EAC) nations with unique cultural landscapes influencing CVD risk factors. Adaptive kernel density estimation and logistic regression were used to determine the spatial distribution and change over time of CVD risk factors on a subnational and subpopulation (rural/urban) scale.

RESULTS

Subnational analysis shows that regional and national level analysis masks important trends in CVD risk factor prevalence. Overweight/obesity and tobacco use trends were not similar: overweight/obesity prevalence increased across most nations included in the study and the inverse was true for tobacco use prevalence. Urban populations in each nation were more likely to be overweight/obese than rural populations, but the magnitude of difference varied widely between nations. Spatial analysis revealed that although the prevalence of overweight/obesity increased over time in both urban and rural populations, the rate of change differed between urban and rural areas. Rural populations were more likely to use tobacco than urban populations, though the likelihood of use varied substantially between nations. Additionally, spatial analysis showed that tobacco use was not evenly distributed across the landscape: tobacco use increased in and around major cities and urban centers but declined in rural areas.

CONCLUSIONS

We highlight the importance of de-homogenizing CVD risk factor research in SSA. Studies of national or regional prevalence trends mask important information about subpopulation and place-specific behavior and drivers of risk factor prevalence. Spatially explicit studies should be considered as a vital tool to understand local drivers of health, disease, and associated risk factor trends, especially in highly diverse yet low-resourced, marginalized, and often homogenized regions.

Exploring factors associated with obesity in Argentinian children using structural equation modeling

Habits and behaviors related to obesity risk are strongly associated with the family environment and are affected by socioeconomic factors. Structural equation modeling (SEM) allows us to hypothesize on how the relationships between these factors occur and measure their impact. This study aimed to explore the relationship between family socioeconomic indicators and childhood obesity, mediated by habits linked to energy balance, applying a SEM. A cross sectional study was performed on 861 Argentinian schoolchildren aged 6-12 years, from 2015 to 2016. The model included three latent variables: socioeconomic status, healthy habits, and obesity. Socioeconomic status indicators and healthy habits were surveyed by self-administered parental questionnaires, whereas obesity indicators were evaluated with anthropometry. The applied model showed an acceptable fit (NFI = 0.966; CFI = 0.979; RMSEA = 0.048). Socioeconomic status positively influenced parental education, health insurance, and car possession, while negatively influenced crowding (p < 0.001). Healthy habits significantly influenced physical activity, meals frequency, and sleep hours, while negatively influenced sedentary hours and mother's nutritional status (p < 0.001). Obesity factor positively influenced body mass index, body fat, and waist-to-height ratio (p < 0.001). Finally, socioeconomic status positively influenced health habits, which in turn negatively influenced obesity factor. Healthy habits (especially physical activity and mother's nutritional status) mediated the relationship between socioeconomic status and child obesity. Further research should include other indicators related to diet, eating habits, and physical activity like neighborhood characteristics.

Behavioural and environmental risk factors associated with primary schoolchildren's overweight and obesity in urban Indonesia

OBJECTIVES

To aid the design of nutrition interventions in low- and middle-income countries undergoing a nutrition transition, this study examined behavioural and environmental risk factors associated with childhood overweight and obesity in urban Indonesia.

DESIGN

Body height and weight of children were measured to determine BMI-for-age Z-scores and childhood overweight and obesity status. A self-administered parental survey measured socio-economic background, children's diet, physical activity, screen time and parental practices. Logistic and quantile regression models were used to assess the association between risk factors and the BMI-for-age Z-score distribution.

SETTING

Public primary schools in Central Jakarta, sampled at random.

PARTICIPANTS

Children (n 1674) aged 6-13 years from 18 public primary schools.

RESULTS

Among the children, 31·0 % were overweight or obese. The prevalence of obesity was higher in boys (21·0 %) than in girls (12·0 %). Male sex and height (aOR = 1·67; 95 % CI 1·30, 2·14 and aOR = 1·16; 95 % CI 1·14, 1·18, respectively) increased the odds of being overweight or obese, while the odds reduced with every year of age (aOR = 0·43; 95 % CI 0·37, 0·50). Maternal education was positively associated with children's BMI at the median of the Z-score distribution (P = 0·026). Dietary and physical activity risk scores were not associated with children's BMI at any quantile. The obesogenic home food environment score was significantly and positively associated with the BMI-for-age Z-score at the 75th and 90th percentiles (P = 0·022 and 0·023, respectively).

CONCLUSIONS

This study illustrated the demographic, behavioural and environmental risk factors for overweight and obesity among primary schoolchildren in a middle-income country. To foster healthy behaviours in primary schoolchildren, parents need to ensure a positive home food environment. Future sex-responsive interventions should involve both parents and children, promote healthy diets and physical activity and improve food environments in homes and schools.

Long-term health effects of a school construction program

Non-communicable diseases (NCDs) disproportionately affect people in low- and middle-income countries (LMICs), yet context-specific evidence on policies that impact NCD risk factors is lacking. We estimate the impact of a massive Indonesian primary school expansion program in the 1970s on NCD risk factors in later life using data from two surveys with very large sample sizes. We find that in non-Java regions of Indonesia, the program led to significant increases in the likelihood of overweight and high waist circumference among women, but not among men. The increase for women can be partly explained by increased consumption of high-calorie packaged and take-away meals. We find no meaningful impacts on high blood pressure for either sex. Despite the increase in body weight, the program had a negligible impact on diabetes and cardiovascular disease diagnosis. It led to an improvement in women's self-reported health outcomes in their early-40s, but these benefits largely disappeared once they reached their mid-40s.

The association of intrauterine and postnatal growth patterns and nutritional status with toddler body composition

BACKGROUND

Growth patterns may be indicative of underlying changes in body composition. However, few studies have assessed the association of growth and body composition in poorly resourced regions experiencing the double-burden of malnutrition exists. Thus, the aims of this study were to investigate the association of intrauterine and postnatal growth patterns with infant body composition at 2 years in a middle-income country.

METHODS

Participants were from the International Atomic Energy Agency Multicentre Body Composition Reference study. Fat mass (FM), fat free mass (FFM), Fat mass index (FMI), fat free mass index (FFMI), and percentage fat mass (%FM) were measured in 113 infants (56 boys and 57 girls), from Soweto, South Africa, using deuterium dilution from 3 to 24 months. Birthweight categories were classified using the INTERGROWTH-21 standards as small (SGA), appropriate (AGA), and large-for gestational age (LGA). Stunting (> -2 SDS) was defined using the WHO child growth standards. Birthweight z-score, conditional relative weight and conditional length at 12 and 24 mo were regressed on body composition at 24 mo.

RESULTS

There were no sex differences in FM, FFM, FMI and FFMI between 3 and 24 mo. SGA and AGA both had significantly higher %FM than LGA at 12 mo. LGA had higher FM at 24 mo. Children with stunting had lower FM (Mean = 1.94, 95% CI; 1.63-2.31) and FFM (Mean = 5.91, 95% CI; 5.58-6.26) at 12 mo than non-stunting, while the reverse was true for FFMI (Mean = 13.3, 95% CI; 12.5-14.2) at 6 mo. Birthweight and conditionals explained over 70% of the variance in FM. CRW at both 12 and 24 mo was positively associated with FM and FMI. CRW at 12 mo was also positively associated with FMI, while CH at 24 mo was negatively associated with both FFMI and FMI in boys.

CONCLUSION

Both LGA and SGA were associated with higher body fat suggesting that both are disadvantaged nutritional states, likely to increase the risk of obesity. Growth patterns through infancy and toddler period (1-2 years) are indicative of body fat, while growth patterns beyond infancy are less indicative of fat-free mass.

Polyfunctional antibodies: a path towards precision vaccines for vulnerable populations

Vaccine efficacy determined within the controlled environment of a clinical trial is usually substantially greater than real-world vaccine effectiveness. Typically, this results from reduced protection of immunologically vulnerable populations, such as children, elderly individuals and people with chronic comorbidities. Consequently, these high-risk groups are frequently recommended tailored immunisation schedules to boost responses. In addition, diverse groups of healthy adults may also be variably protected by the same vaccine regimen. Current population-based vaccination strategies that consider basic clinical parameters offer a glimpse into what may be achievable if more nuanced aspects of the immune response are considered in vaccine design. To date, vaccine development has been largely empirical. However, next-generation approaches require more rational strategies. We foresee a generation of precision vaccines that consider the mechanistic basis of vaccine response variations associated with both immunogenetic and baseline health differences. Recent efforts have highlighted the importance of balanced and diverse extra-neutralising antibody functions for vaccine-induced protection. However, in immunologically vulnerable populations, significant modulation of polyfunctional antibody responses that mediate both neutralisation and effector functions has been observed. Here, we review the current understanding of key genetic and inflammatory modulators of antibody polyfunctionality that affect vaccination outcomes and consider how this knowledge may be harnessed to tailor vaccine design for improved public health.

High unhealthy food and beverage consumption is associated with poor diet quality among 12-35-month-olds in Guédiawaye Department, Senegal

Background

High consumption of unhealthy foods and beverages (UFB) during early childhood is cause for concern, with growing evidence from low- and middle-income countries finding associations with poor diet quality and malnutrition. Research from sub-Saharan Africa remains limited, with no studies quantifying the contribution of UFB to total energy intakes among young children or exploring the relationship between such intakes and diet quality or anthropometric outcomes.

Objectives

Assess UFB consumption patterns and their contribution to total energy intake from non-breastmilk foods/beverages (TEI-NBF), assess the association between high UFB consumption and dietary/nutrition outcomes, and explore drivers of unhealthy food choice among young children in Guédiawaye Department, Senegal.

Methods

We conducted a cross-sectional study of a representative sample of 724 primary caregivers and their 12-35.9-month-old children. The study included a questionnaire, a quantitative four-pass 24-h dietary recall, and anthropometric measurements. The contribution of UFB to TEI-NBF was calculated and terciles generated. Logistic and linear models were used to compare outcomes of high versus low UFB consumption terciles.

Results

UFB contributed on average 22.2% of TEI-NBF, averaging 5.9% for the lowest tercile and 39.9% for the highest. Diets of high UFB consumers, as compared to low, were significantly less dense in protein, fiber, and seven of the 11 micronutrients assessed and significantly denser in total fat, saturated fat, and total sugar. No associations were found with anthropometric outcomes. High UFB consumers were older and more likely to be living in food insecurity. The most common drivers of commercial UFB consumption were related to child preference, the use of these products as behavior management tools, treats, or gifts, and the sharing of these products by someone else eating them.

Conclusion

High UFB consumption is associated with poor diet quality among 12-35-month-olds in Guédiawaye Department, Senegal. Addressing high UFB consumption during this critical developmental period should be prioritized in young child nutrition research, programming, and policy development.

Combining general and central measures of adiposity to identify risk of hypertension: a cross-sectional survey in rural India

AIM

In three socioeconomically diverse regions of rural India, we determined the optimal cut-offs for definition of overweight, the prevalence of overweight, and the relationships between measures of overweight and risk of hypertension.

SUBJECTS AND METHODS

Villages were randomly sampled within rural Trivandrum, West Godavari, and Rishi Valley. Sampling of individuals was stratified by age group and sex. Cut-offs for measures of adiposity were compared using area under the receiver operating characteristic curve. Associations between hypertension and definitions of overweight were assessed by logistic regression.

RESULTS

Of 11 657 participants (50 % male; median age 45 years), 29.8 % had hypertension. Large proportions were overweight as defined by body mass index (BMI) ≥ 23 kg/m2 (47.7 %), waist circumference (WC) ≥ 90 cm for men or ≥ 80 cm for women (39.6 %), waist-hip ratio (WHR) ≥ 0.9 for men or ≥ 0.8 for women (65.6 %), waist-height ratio (WHtR) ≥ 0.5 (62.5 %), or by BMI plus either WHR, WC or WHtR (45.0 %). All definitions of overweight were associated with hypertension, with optimal cut-offs being at, or close to, the World Health Organization (WHO) Asia-Pacific standards. Having overweight according to both BMI and a measure of central adiposity was associated with approximately twice the risk of hypertension than overweight defined by only one measure.

CONCLUSIONS

Overweight, as assessed by both general and central measures, is prevalent in rural southern India. WHO standard cut-offs are appropriate in this setting for assessing risk of hypertension. However, combining BMI with a measure of central adiposity identifies risk of hypertension better than any single measure. The risk of hypertension is significantly greater in those centrally and generally overweight than those overweight by a single measure.

Body mass index categories and anxiety symptoms among adults aged ≥ 50 years from low and middle income countries

BACKGROUND

Body weight may be a risk factor for anxiety; however, there is a scarcity of studies on this association in older adults especially from low and middle income countries (LMICs). Therefore, we investigated the association between body mass index (BMI) and anxiety symptoms among adults aged ≥ 50 years from 6 LMICs.

METHODS

Cross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analyzed. The BMI was based on measured weight and height and was categorized as: < 18.5 kg/m² (underweight), 18.5-24.9 kg/m² (normal weight), 25.0-29.9 kg/m² (overweight), 30.0-34.9 kg/m² (obesity class I), 35.0-39.9 kg/m² (obesity class II), and ≥ 40 kg/m² (obesity class III). Anxiety symptoms referred to severe/extreme problems with worry or anxiety in the past 30 days. Multivariable logistic regression analysis was conducted.

RESULTS

Data on 34,129 individuals aged ≥ 50 years (mean age 62.4 years, SD 16.0 years; 52.1% female) were analyzed. Overall, compared to normal weight, only underweight was significantly associated with anxiety symptoms (odds ratio, OR = 1.56; 95% confidence interval, CI = 1.26-1.95). Obesity class III (vs. normal weight) was associated with significantly increased odds for anxiety symptoms (OR = 4.15; 95%CI = 1.49-11.59) only among males.

CONCLUSION

In this large representative sample of older adults from LMICs, underweight was associated with anxiety symptoms in males and females. Class III obesity was associated with anxiety symptoms only in males. Future studies to shed light on the reason why severe obesity was associated with anxiety symptoms only among males in LMICs are needed.

Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults by Gender: Analysis of a Nationally Representative Survey

The objective of this study was to find the differences in prevalence and associated factors of underweight and overweight/obesity among Bangladeshi adults by gender, using the nationally representative Bangladesh Demographic and Health Survey 2017-2018 data. To identify the factors associated with underweight and overweight/obesity in both genders, multilevel multivariable logistic regression was conducted. The prevalence of underweight was 19.79% and 15.49% among males and females, respectively. The prevalence of overweight/obesity was 32.67% and 45.60% among males and females, respectively. Among both genders, participants with the highest likelihood of overweight/obesity were aged 30-49 years and 50-69 years, had the highest educational attainment up to primary and secondary level, resided in a household that belonged to the middle, richer, or richest wealth quintiles, and were currently married. On the other hand, among both genders, increased educational attainment and wealth index were inversely associated with being underweight. Health promotion programs in Bangladesh should focus on these high-risk groups to address the burden of underweight and overweight/obesity.

Association between exposure to intimate partner violence and the nutritional status of women and children in Nigeria

Background

Globally, intimate partner violence (IPV) epitomizes a greater proportion of the violence experienced by women, with more than a third of women (41.3%) in sub-Saharan Africa reporting IPV during their lifetime. This study examined the association between exposure to IPV and the nutritional status of women and their children in Nigeria.

Methods

The study analyzed secondary data obtained from the 2018 Nigeria Demographic and Health Survey. Data on women’s lifetime experience of psychological, physical, and sexual IPV, as well as demographic and socioeconomic characteristics, were collected. We used regression models to determine the association between exposure to IPV and women and child nutrition indicators. A weighted sample of 4,391 women aged 15–49 years and 2,145 children 6–59 months were analyzed.

Results

The lifetime experience of IPV in the study was 35.31% (95% CI: 33.35, 37.33), 30.43% (95% CI: 28.54, 32.38) experienced psychological IPV, 19.43% (95% CI: 17.79, 21.19) experienced physical IPV, and 6.03% (95% CI: 5.12, 7.09) experienced sexual IPV. After adjusting for a range of characteristics, maternal lifetime exposure to IPV was associated with underweight (ARRR = 0.63; 95% CI: 0.44, 0.91) and overweight/obesity (ARRR = 1.28; 95% CI: 1.04, 1.58). We also found that, children whose mothers experienced IPV were less likely to be underweight compared to their counterparts (ARRR = 0.69; 95% CI: 0.50, 0.96).

Conclusions

Overall, IPV against women, particularly psychological, physical, and sexual IPV, is common in Nigeria and has an association with the nutritional status of affected women and their children. According to the study, women with a lifetime experience of IPV were more likely to be overweight. On the other hand, affected women’s children were less likely to be underweight. A far-reaching effort is required to curb IPV against women, particularly policies, programs, and laws are needed to protect women and children from the unfavourable effects of IPV to reduce the prevalence and impact of such violence.

Epicardial adipose tissue, obesity and the occurrence of atrial fibrillation: an overview of pathophysiology and treatment methods

INTRODUCTION

Obesity is a chronic disease, which has significant health consequences and is a staggering burden to health care systems. Obesity can have harmful effects on the cardiovascular system, including heart failure, hypertension, coronary heart disease, and atrial fibrillation (AF). One of the possible substrates might be epicardial adipose tissue (EAT), which can be the link between AF and obesity. EAT is a fat deposit located between the myocardium and the visceral pericardium. Numerous studies have demonstrated that EAT plays a pivotal role in this relationship regarding atrial fibrillation.

AREAS COVERED

This review will focus on the role of obesity and the occurrence of atrial fibrillation (AF) and examine the connection between these and epicardial adipose tissue (EAT). The first part of this review will explain the pathophysiology of EAT and its association with the occurrence of AF. Secondly, we will review bariatric and metabolic surgery and its effects on EAT and AF.

EXPERT COMMENTARY

In this review, the epidemiology, pathophysiology, and treatments methods of AF are explained. Secondly the effects on EAT were elucidated. Due to the complex pathophysiological link between EAT, AF, and obesity, it is still uncertain which treatment strategy is superior.

The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable

The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.

Multimorbidity and obesity in older adults from six low- and middle-income countries

Prevalence of multimorbidity (i.e., ≥2 chronic conditions), chronic diseases, and obesity is increasing in low- and middle-income countries (LMICs), posing a potential threat to the health of older adults living in these areas. This study hence investigates the unexplored association between obesity and multimorbidity among older adults from LMICs. Cross-sectional, community-based data from the WHO Study on global Ageing and adult health (SAGE) were analysed. The sample consisted of 20,198 individuals aged ≥60 years [Mean age (SD) = 69.3 (13.1) years; 54.1% female] from China, India, Ghana, Mexico, Russia, South Africa. Twelve chronic conditions were assessed. Multivariable logistic regression was conducted to assess the association between BMI ≥ 30 kg/m², high waist circumference (WC, cut-points > 102 cm for males and > 88 cm for females) and multimorbidity. After adjusting for potential confounders, overall, BMI ≥ 30 kg/m² was associated with 1.43 (95%CI = 1.21-1.69) times higher odds for multimorbidity, while this estimate for high WC was 1.50 (95%CI = 1.21-1.86). Significant associations emerged between obesity measures and five out of twelve chronic conditions. Results from this study underline the need to reduce obesity among older adults in areas where its prevalence is increasing, as it is associated with increased odds for multimorbidity. Future longitudinal research in this setting is required to assess the impact of obesity reduction on multimorbidity incidence.

Socioeconomic gradients in the Westernization of diet in China over 20 years

Introduction

In low-middle income countries, urbanization leads to changes from traditional to Western diet, which are often accompanied by reductions in cardiometabolic health. Whether socioeconomic status buffers these urbanization-related diet changes over time is unknown.

Objective

To examine whether the association between urbanization and a key indicator of Western diet, percent of calories from animal-source foods (1) varies depending on income and (2) whether this association changes over time.

Materials and methods

We used data from nine waves of the longitudinal, population-based China Health and Nutrition Survey [n = 22,360 Chinese adults (1991-2015)], followed across 24 years, including diet data from 3 repeated 24-h dietary recalls. We used simultaneous year-stratified linear regression models to examine whether changes in the association between urbanization level and percent of calories from animal-source foods differed by income. Models allowed for variation in associations across the 24 years of urbanization, accounting for within-individual correlation over time and controlling for age, sex, region, physical activity, and caloric intake.

Results

In 1991, on average 15% of calories for Chinese adults came from animal source foods and by 2015, this percentage rose to approximately one quarter of total calories. Over the 24 years of follow-up, urbanization and income were each strongly related to percent of calories from animal-source foods with differential association across income levels (p < 0.0001). We also found evidence that this association changed over time (p < 0.0001). Income gradients in animal source food consumption were smallest in the most urban areas in early years with some temporal variation, but over time income gradients narrowed in some later years in low and moderately urbanized areas. However, by 2015 there were few income differences in animal source food consumption across urbanization levels.

Conclusions

Throughout 24-years of urbanization, income seemed to buffer the transition from traditional to Western diet. However, the degree to which income buffered these urbanization-related changes depended on the level and history of community urbanization. At later stages of urbanization when Western diet behaviors were more widespread, urban-rural differences in Western diet behaviors varied little by income.

Metabolic syndrome among individuals living with hypertension in Accra, Ghana

Metabolic syndrome (MetS) is a major risk factor to cardiovascular diseases. In this study, we investigate the prevalence and associated risky behaviour of MetS in resource-poor urban communities in Accra, Ghana. We analysed data on 111 persons with hypertension, screened and recruited for a therapeutic lifestyle intervention program in August 2015. MetS was measured using the International Diabetes Federation (IDF) and the World Health Organization definitions. The prevalence of MetS was 58.4% and 16.8% by the IDF and WHO definitions respectively. More women (61.8%) compared to men (31.8%) had MetS (p = 0.011). Approximately 31% of the hypertensive patients were engaged in moderate-intensity physical activity; 9.0% were current smokers, 42.0% consumed excess alcohol over the past month prior to the interview and 41.0% discontinued taking their antihypertensive medications without consulting with a doctor. About 42.0% and 37.0% of respondents always consumed fruits and vegetables respectively at least two times a day. The binary logistic regression showed that compared to women, men had lower odds of consuming two or more servings of vegetable in a day (OR: 0.2; 95% CI; 0.1, 0.8). Increase in age was associated with higher odds of consuming fruits at least twice a day (1.0; 1.0, 1.1) but with lower odds of engaging in moderate intensity physical activity (0.9; 0.8, 1.0). Being married was associated with higher odds of engaging in moderate physical activity (2.8; 1.0, 8.2). Therapeutic methods essential for the management of patients with hypertension and MetS should include non-pharmacological remedies targeting the promotion of medication adherence, Dietary Approaches to Stop Hypertension (DASH) and physical activities; these are vital to changing unhealthy lifestyle which worsens the underlying pathology.

Increasing obesity odds among foreign-born New Yorkers are not explained by eating out, age at arrival, or duration of residence: results from NYC HANES 2004 and 2013/2014

BACKGROUND

Among the foreign-born in the United States (US) dietary acculturation and eating out may increase obesity risk. Using the 2004 (N = 1952) and 2013/14 (N = 1481) New York City (NYC) Health and Nutrition Examination Surveys, we compared for the foreign-born and US-born by survey year: 1) odds of obesity; 2) association between eating out and obesity and 3) effect of age at arrival and duration of residence among the foreign-born. Weighted logistic regression estimated odds of obesity.

RESULTS

Compared to the US-born, the foreign-born had lower odds of obesity in 2004, (aOR = 0.51 (95%CI 0.37-0.70), P = <.0001). Odds were no different in 2013/14. In 2013/14 the foreign-born who ate out had lower obesity odds (aOR = 0.49 (95%CI 0.31-0.77), P = 0.0022). The foreign-born living in the US≥10 years had greater odds of obesity in 2004 (aOR = 1.73 (95%CI 1.08-2.79), P = 0.0233) but not in 2013/14.

CONCLUSIONS

Eating out does not explain increasing obesity odds among the foreign-born.

Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults

BACKGROUND

The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings.

METHODS

In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5-22·9 kg/m2], upper-normal [23·0-24·9 kg/m2], overweight [25·0-29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region.

FINDINGS

Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6-27·8), of obesity was 21·0% (19·6-22·5), and of diabetes was 9·3% (8·4-10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5-22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35-44 years and in men aged 25-34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean.

INTERPRETATION

The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines.

FUNDING

Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.

Consumption of Monounsaturated Fatty Acids Is Associated with Improved Cardiometabolic Outcomes in Four African-Origin Populations Spanning the Epidemiologic Transition

Long-chain omega-3 PUFAs, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are of increasing interest because of their favorable effect on cardiometabolic risk. This study explores the association between omega 6 and 3 fatty acids intake and cardiometabolic risk in four African-origin populations spanning the epidemiological transition. Data are obtained from a cohort of 2500 adults aged 25-45 enrolled in the Modeling the Epidemiologic Transition Study (METS), from the US, Ghana, Jamaica, and the Seychelles. Dietary intake was measured using two 24 h recalls from the Nutrient Data System for Research (NDSR). The prevalence of cardiometabolic risk was analyzed by comparing the lowest and highest quartile of omega-3 (EPA+ DHA) consumption and by comparing participants who consumed a ratio of arachidonic acid (AA)/EPA + DHA ≤4:1 and >4:1. Data were analyzed using multiple variable logistic regression adjusted for age, gender, activity, calorie intake, alcohol intake, and smoking status. The lowest quartile of EPA + DHA intake is associated with cardiometabolic risk 2.16 (1.45, 3.2), inflammation 1.59 (1.17, 2.16), and obesity 2.06 (1.50, 2.82). Additionally, consuming an AA/EPA + DHA ratio of >4:1 is also associated with cardiometabolic risk 1.80 (1.24, 2.60), inflammation 1.47 (1.06, 2.03), and obesity 1.72 (1.25, 2.39). Our findings corroborate previous research supporting a beneficial role for monounsaturated fatty acids in reducing cardiometabolic risk.

Prevalence and temporal trends in prepregnancy nutritional status and gestational weight gain of adult women followed in the Brazilian Food and Nutrition Surveillance System from 2008 to 2018

Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are the most investigated indicators of maternal nutritional status, which is a modifiable factor that plays a vital role in maternal and infant health. This study describes prepregnancy BMI and GWG of 840,243 women with 2,087,765 weight observations in the Brazilian Food and Nutrition Surveillance System from 2008 to 2018. Prepregnancy BMI was classified according to the World Health Organization cut‐offs. Total GWG was calculated from weight measurements taken after 36 weeks of pregnancy and classified according to the Institute of Medicine guidelines. Temporal trends in prepregnancy BMI status were examined, and maps were used to evaluate changes in excessive GWG in each Brazilian federation unit. On overall, prepregnancy overweight and obesity increased from 22.6% to 28.8% and from 9.8% to 19.8%, respectively, between 2008 and 2018. The prevalence of excessive GWG rose from 34.2% to 38.7% during the same period and in 11 of the 27 Brazilian federation units between 2008 and 2016. Women with underweight showed the highest values for mean total GWG for all the compared years (overall variation from 12.3 to 13.1 kg), followed by those with normal weight (11.9 to 12.5 kg), overweight (10.1 to 10.9 kg) and obesity (from 8.2 to 8.9 kg). Within each BMI group, values remained fairly stable throughout the studied period for first‐ and second‐trimester GWG and total GWG. These results help to fill a significant gap in understanding the distribution of prepregnancy BMI and GWG in Brazilian women.

Trends in body mass index among ever-married Bangladeshi women, 2004-14: evidence from nationally representative population-based surveys

Both high and low body weight are associated with adverse health risk for both mother and children. Studies evaluating trends in the coverage of undernutrition and overnutrition among ever-married Bangladeshi women are limited. The objective of the present study is to assess the trends and develop future projections of body weight status among Bangladeshi women and to estimate the smoothed mean BMI by women's age for the national level and across urban and rural areas. Data from Bangladesh Demographic and Health Surveys conducted between 2004 and 2014 were used. The annual rate of change in the prevalence of underweight, overweight, and obesity, and smoothed age-specific mean BMI was estimated. During 2004–14, the prevalence of underweight reduced with an annual rate of 5⋅9 % at the national level, while the prevalence of overweight and obesity increased with an annual rate of 8⋅6 and 9⋅6 %, respectively. With the recent trends, the prevalence of underweight is expected to reduce from 11⋅9 % in 2020 to 6⋅5 % by 2025. In 2020, the prevalence of overweight and obesity were 30⋅0 and 6⋅9 %, respectively, which are projected to increase to 38⋅5 and 9⋅0 %, respectively, by 2025, if present trends continue. By 2030, the prevalence of overweight was predicted to be much higher in urban areas (44⋅7 %) compared with rural areas (36⋅5 %). Multifaceted nutrition programme should be introduced for rapid reduction of undernutrition and to halt the rise of the prevalence of overweight and obesity.

Double Burden of Malnutrition in the Asia-Pacific Region-A Systematic Review and Meta-analysis

Background: Double Burden of Malnutrition (DBM)—the coexistence of undernutrition along with overnutrition—is a significant public health issue in the Asia-Pacific region. The scope of the DBM in this region is largely unknown. This review aims to determine the prevalence of under- and overnutrition as major DBM components and to investigate whether there has been a shift from under- to overnutrition in the Asia-Pacific region.

Methods: Online databases including PubMed and Web of Science were searched for original studies on DBM prevalence in the Asia-Pacific region; particularly, those published from January 2008 to December 2018 were screened for eligibility. We collected data on indicators of under- and overnutrition on the population level and adapted the ratio of prevalence of overweight/obesity versus prevalence of underweight as the main outcome indicator. Pooled prevalence estimates of DBM and the ratio of overnutrition versus undernutrition were generated using R (3.4.0).

Results: In total, 33 studies were included in this review. Pooled analysis demonstrated that DBM was generally presented among countries/areas in the Asia-Pacific region except in high-income countries (HICs). Overall, the prevalence of undernutrition was 8.8% (95% CI 7.3–10.6%) while overnutrition among the same population reached 23.0% (95% CI 20.3–26.0%). Countries in the Oceania region or HICs reported low level of undernutrition (less than 3%). All subgroup analysis (geolocation, income level, sex, age) reported pooled prevalence of overweight/obesity as more than 18%. Overall, the whole region and all subgroups were more likely to experience a higher prevalence of overnutrition than undernutrition, except that low- and lower-middle-income countries (L-MICs) had similar prevalence for over- and undernutrition.

Conclusion: DBM in the Asia-Pacific region is alarmingly high and is titled toward overnutrition. As a result, future interventions/policy targeting to maintain a healthy weight for the population should not just focus on prevention and treatment toward one direction.

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.

Obesity and COVID-19 in Latin America: A tragedy of two pandemics-Official document of the Latin American Federation of Obesity Societies

In May 2020, Latin America became the epicenter of the COVID-19 pandemic, a region already afflicted by social disparities, poor healthcare access, inadequate nutrition and a large prevalence of noncommunicable chronic diseases. Obesity and its comorbidities are increasingly prevalent in Latin America, with a more rapid growth in individuals with lower income, and currently a disease associated with COVID-19 severity, complications and death. In this document, the Latin American Association of Obesity Societies and collaborators present a review of the burden of two pandemics in Latin America, discuss possible mechanisms that explain their relationship with each other and provide public health and individual recommendations, as well as questions for future studies.

Comparative assessment of overweight/obesity among rural and urban reproductive-age women in Ethiopia: Evidence from a cross-sectional 2016 national survey

BACKGROUND

Overweight/obesity has become a global health problem for both developed and developing regions. Nowadays, overweight/obesity among childrearing-age women has become rapidly increasing in both urban and rural areas.

AIM

This study aimed to assess the variation of overweight/obesity among urban and rural reproductive-age women in Ethiopia.

METHODS

For this study, the 2016 Ethiopia Demographic and Health Survey data were used. The survey was a community-based cross-sectional study, which used a two-stage stratified cluster sampling technique to select the participants. A total of 13,451 reproductive-age women were included in the analysis. Both descriptive and analytical analysis was performed. A p-value of less than 0.05 was used as the measure of statistical significance.

RESULTS

The prevalence of overweight/obesity among urban reproductive-age women was statistically higher (p = 21.5%; 95% confidence interval (CI): 18.2-25.1) than the rural women (p = 3.5%; 95% CI: 2.9%-4.2%). Women who attend secondary or above education, women in the age groups 25-34 and ≥ 35 years, and high wealth index (rich) had higher odds of overweight/obesity in both urban and rural women. Moreover, women who were married, who had a large family size, and who have a history of alcohol intake had higher odds of overweight/obesity among urban women.

CONCLUSIONS

Overweight/obesity among reproductive-age women is a public health problem in Ethiopia, especially for women who are living in urban settings. Therefore, it is important to establish targeted overweight reduction programs with particular emphasis on urban, older aged, educated, and married women. Additionally, encouraging the limitation of the number of family size and alcohol intake can reduce women's overweight/obesity.

State-of-the-art of measures of the obesogenic environment for children

Various measures of the obesogenic environment have been proposed and used in childhood obesity research. The variety of measures poses methodological challenges to designing new research because methodological characteristics integral to developing the measures vary across studies. A systematic review has been conducted to examine the associations between different levels of obesogenic environmental measures (objective or perceived) and childhood obesity. The review includes all articles published in the Cochrane Library, PubMed, Web of Science and Scopus by 31 December 2018. A total of 339 associations in 101 studies have been identified from 18 countries, of which 78 are cross-sectional. Overall, null associations are predominant. Among studies with non-null associations, negative relationships between healthy food outlets in residential neighbourhoods and childhood obesity is found in seven studies; positive associations between unhealthy food outlets and childhood obesity are found in eight studies, whereas negative associations are found in three studies. Measures of recreational or physical activity facilities around the participants' home are also negatively correlated to childhood obesity in nine out of 15 studies. Results differ by the types of measurement, environmental indicators and geographic units used to characterize obesogenic environments in residential and school neighbourhoods. To improve the study quality and compare reported findings, a reporting standard for spatial epidemiological research should be adopted.

Allostatic Load Among U.S.- and Foreign-Born Whites, Blacks, and Latinx

INTRODUCTION

The objective of this study is to examine how allostatic load, a multidimensional measure of the body's cumulative response to stressors experienced throughout the life course, has changed over time and by age among U.S.- and foreign-born Whites, Blacks, and Latinx.

METHODS

Data were from 26,818 adult participants in the 2005-2018 National Health and Nutrition Examination Survey, a national repeated cross-sectional study. Allostatic load was measured based on 10 indicators of cardiovascular, metabolic, and immunologic risk. The analyses were conducted in March 2020.

RESULTS

Allostatic load increased over time across all groups. The difference between the first and last survey cycle was greatest among U.S.-born Black women (from 2.74 in 2005-2006 to 3.02 in 2017-2018), U.S.-born Latino men (from 2.69 to 3.09) and foreign-born Latino men (from 2.58 to 2.87). Aging gradients in allostatic load were steepest among foreign-born Blacks of both genders and foreign-born Latina women and flattest among U.S.-born and foreign-born Whites.

CONCLUSIONS

Chronic exposure to stressors leads to an erosion of health that is particularly severe among foreign-born Blacks and Latinx. Policies should seek to reduce exposure to structural and environmental risks and to ensure equitable opportunities to achieve optimal health among racial/ethnic minorities and immigrants.

Integrating Food Sensitive Planning and Urban Design into Urban Governance Actions

Food access, stability and utilisation are key dimensions of food security at an urban scale. When the majority resided in rural areas, and lived predominantly agrarian lifestyles, it made sense for the state to govern food security through national agricultural ministries, focusing predominantly on the availability dimension of food security. With the transition to a majority urban world, coupled with the food security challenges currently experienced in urban areas, specifically in Africa, these historical policy and governance structures are increasingly inadequate in responding to essential food and nutrition needs. Problematically, urban areas, and specifically urban managers, cite unfunded mandates, and absent authority, as the reasons for not engaging food and nutrition governance responses. This paper argues that this is a false position. Drawing on recent data from household food security and poverty surveys, the paper calls for new and expanded planning and design approaches at the urban scale. The paper argues that spatial planning and urban design principles and actions provide an immediate and effective means through which to engage urban food system questions. Importantly these actions are essential to the transition from the current piecemeal project responses to urban food system inadequacies. Food sensitive planning and urban design is offered as a specific approach that could assist in programming food system–related challenges at the urban scale, responding to conceptual, analytical, organisational and design related dimensions of planning, and in so doing offering a longer term, systematic response to urban food insecurity.

An exploration of lifestyle/obesity programmes for adults with intellectual disabilities through a realist lens: Impact of a 'context, mechanism and outcome' evaluation

BACKGROUND

Obesity is higher in people with intellectual disabilities.

AIMS

There are two aims of this explorative paper. Firstly, using a realist lens, to go beyond 'what works' and examine the 'context, mechanisms and outcomes' (CMO) of lifestyle/obesity programmes for this population. Second, using a logic model framework to inform how these programmes could be implemented within practice.

METHOD

We explored six-review papers and the individual lifestyle/obesity programmes that these papers reviewed using the CMO framework.

RESULTS

There were few theoretically underpinned, multi-component programmes that were effective in the short to long-term and many failed to explore the 'context and mechanisms'. We developed a logic model and engaged in two co-production workshops to refine this model.

DISCUSSION

Using a realist approach, programmes need to be underpinned by both individual and systems change theories, be multi-component, have a closer understanding of the interplay of the 'context and mechanisms', and co-designed using a logic model framework.

"We only have the one": Mapping the prevalence of people with high body mass to aid regional emergency management planning in aotearoa New Zealand

INTRODUCTION

People have been left behind in disasters directly associated with their size, shape, and weight and are disproportionately impacted in pandemics. Despite alignment with known vulnerabilities such as poverty, age, and disability, the literature is inaudible on body mass. Emergency managers report little or no information on body mass prevalence. This exploratory study aimed to illustrate population prevalence of high body mass for emergency planning.

METHODS

Cross-sectional data from the New Zealand Health Survey were pooled for the years 2013/14-2017/18 (n = 68 053 adults aged ≥15 years). Height and weight were measured and used to calculate body mass index. The prevalence of high body mass were mapped to emergency management boundary shapefiles. The resulting maps were piloted with emergency managers.

RESULTS

Maps highlight the population prevalence of high body mass across emergency management regions, providing a visual tool. A pilot with 14 emergency managers assessed the utility of such mapping. On the basis of the visual information, the tool prompted 12 emergency managers to consider such groups in regional planning and to discuss needs.

CONCLUSIONS

Visual mapping is a useful tool to highlight population prevalence of groups likely to be at higher risk in disasters. This is believed to be the first study to map high body mass for the purposes of emergency planning. Future research is required to identify prevalence at a finer geographical scale. More features in the local context such as physical location features, risk and vulnerability features could also be included in future research.

Prevalence of Overweight and Obesity in US-Bound Refugees: 2009-2017

Refugees are an often understudied population and vulnerable to poor health outcomes. No large-scale analyses have evaluated the prevalence of overweight and obesity in US-bound refugees. Using data obtained from the Centers for Disease Control (CDC) Electronic Disease Notification system, we quantified the prevalence of overweight and obesity in adult US-bound refugees by nationality from 2009 through 2017. This repeated cross-sectional analysis used CDC data to quantify and examine body mass index (BMI) trends in US-bound adult refugees during 2009-2017. Utilizing data from an overseas medical exam required for all US-bound refugees, we determined BMI for 334,746 refugees ≥ 18 years old who arrived in the United States during January 1, 2009-December 31, 2017. We calculated and compared the prevalence of overweight and obesity as well as changes in demographic characteristics (age, sex, and nationality) by year. Adjusted prevalence and prevalence ratios (APR) for yearly trends were assessed using a modified Poisson regression model with robust error variances. After adjusting for age, sex, and nationality, we observed a significant linear trend in the prevalence of overweight/obesity with an average annual relative percent increase of 3% for refugees entering the United States from 2009 through 2017 (APR = 1.031; 95% CI 1.029-1.033). The adjusted prevalence of overweight/obesity increased from 35.7% in 2009 to 44.7% in 2017. The prevalence of overweight and obesity in US-bound refugees increased steadily over the analysis period. Investigation into pre-migration and post-resettlement interventions is warranted.

Spatial distribution and associated factors of underweight in Ethiopia: An analysis of Ethiopian demographic and health survey, 2016

Background

Underweight is one form of indicators of under-nutrition, which results from the poor nutrient intake and underlying health problems. Its impact is beyond an individual and extends to a country level. It has been known from the literature that underweight has a negative effect on income and development of a country. In the context of Ethiopia, factors predicting underweight remain unknown and there is a paucity of evidence on geographical distribution of underweight among individuals aged 15–49 years. Therefore, the aim of this study was to examine the geographic distribution of underweight and its associated factors among individuals aged 15–49 years in Ethiopia.

Methods

Secondary data analysis was done on a data set consisting of 28,450 individuals and obtained from the Ethiopian Demography and Health Survey (EDHS) 2016. The spatial distribution of underweight across the country was identified by ArcGIS software. Hotspots analysis was done using Getis-Ord Gi* statistic within ArcGIS. In SaTScan software, the Bernoulli model was fitted by Kulldorff’s methods to identify the purely spatial clusters of underweight. A binary logistic regression was applied to determine factors associated with being underweight.

Result

In Ethiopia, the spatial distribution of underweight was clustered with Global Moran’s I  =  0.79 at p-value < 0.0001. The highest underweight clusters were observed in Tigray, Gambella, eastern part of Amhara, and western and central part of Afar regions. Male individuals [AOR = 1.21; 95% CI: (1.15 1.28)], never married [AOR = 1.14; 95% CI: (1.05, 1.24)], rural residents [AOR = 1.32; 95% CI: (1.18, 1.47)], rich [AOR = 0.85; 95% CI: (0.76, 0.94)], cigarette smoking [AOR = 1.25; 95% CI: (1.07, 1.46)], drinking treated water [AOR = 0.91; 95% CI: (0.83, 0.99)] and open filed defecation [AOR = 1.17; 95% CI: (1.08, 1.26)] were found to have a significant association with being underweight.

Conclusions

There was a significant clustering of underweight among individuals aged 15–49 years. Gender, age, marital status, place of residence, wealth index, cigarette smoking, using untreated water and types of toilet were the significant factors of being underweight. Therefore, effective public health interventions like building safe and supportive environments for nutrition, providing socio-economic protection and nutrition-related education for poor and rural resident would be better to mitigate these situations and associated risk factors in hot spot areas. In addition, policymakers should strengthen and promote nutrition sensitive policies and activities in order to alleviate the underlying and basic causes of underweight.

Obesity and visceral fat in Indonesia: An unseen epidemic? A study using iDXA and surrogate anthropometric measures

OBJECTIVE

Indonesia's dramatic rise in chronic disease belies their relatively low obesity prevalence. This study provides normative iDXA and anthropometry measures in an Indonesian cohort. We also compare obesity prevalence determined by traditional measures.

METHODS

2623 Indonesian adults were measured by an iDXA and had waist and hip circumferences collected. Normative data were stratified by sex and age. Obesity prevalence was compared using body mass index (BMI) and body fat percentage (BF%). Specificity, sensitivity, and Youden's Index evaluated the ability of cut-off values to identify individuals with high visceral adipose tissue (VAT).

RESULTS

Overweight and obese prevalence by BF% was 72 % for males and 63 % for females. BMI incorrectly categorized 40 % of obese individuals as normal/overweight. Waist circumference provided the highest Youden's Index (0.69-0.73), identifying 91 % of Indonesians with high VAT mass.

CONCLUSIONS

Normative BF% and VAT mass are higher among Indonesians when compared with Caucasian populations. This highlights the rise of chronic disease is potentially due to high BF% and VAT mass. Compared with criterion iDXA BF%, obesity prevalence is severely underestimated by BMI. Measuring waist circumference is recommended in clinical settings due to its ability to identify participants with high VAT mass.

Associations of outdoor activity and screen time with adiposity: findings from rural Chinese adolescents with relatively low adiposity risks

Background

Whether and to what extent outdoor activity and screen time are relevant to adiposity among rural adolescents remain largely unknown as most of relevant evidence was generated from high-income countries and urban areas. This study aimed to investigate associations of outdoor activity and screen time with adiposity among early adolescents living in rural southwest China.

Methods

In this cross-sectional study, seventh graders (n = 2264) were recruited from 10 middle schools of a rural county. Overweight and obesity was assessed using adolescents’ body mass index and waist circumference. Adolescents’ outdoor activity and screen time were measured using self-reported daily time spending on outdoor activity, watching TV, playing video games, and computers on weekdays and weekends, respectively.

Results

The prevalence of overweight/obesity and high waist circumferences were 8.0 and 4.9% and were higher among those from one-child families and with parents having high school or higher education and whose fathers were not farmers. Adolescents who did not have ≥1 h outdoor activity on weekdays were more likely to be overweight/obese (OR: 1.86, 95% CI: 1.30, 2.66) and have high waist circumferences (OR: 2.22, 95%CI: 1.39, 3.57). Adolescents who had > 2 h screen time on weekends were more likely to have high waist circumferences (OR: 2.08, 95% CI: 1.14, 3.80). Lack of outdoor activity and excessive screen time also showed synergistic effects on overweight/obesity (OR: 1.93. 95% CI: 1.15, 3.24) and high waist circumferences (OR: 3.02, 95% CI: 1.54, 5.94).

Conclusions

Lack of outdoor activity and excessive screen time were relevant to adiposity among rural Chinese adolescents even when the obesity prevalence was low. Efforts to promote active lifestyles may help prevent rural adolescents from losing their advantage in the era of the global obesity epidemic.

Body mass index and body weight change during adjuvant chemotherapy in colon cancer patients: results from the AVANT trial

While obesity increases colorectal cancer incidence, there are inconsistent results in the prognostic role of obesity or body weight change on survival. This study investigated the prognostic impact of body weight and weight change in stage III or high risk stage II colon cancer patients. We used data from patients enrolled in the phase III AVANT trial. The AVANT trial investigated the efficacy of adding bevacizumab to standard adjuvant chemotherapy (FOFOX or XELOX). Weight change during the first 6 months of adjuvant chemotherapy was measured. Cox proportional hazard model was used to assess the prognostic influence of body weight and weight change. Among 3451 intention-to-treat population, body weight and weight change was measured in 3449 (99.9%) and 2455 (71.1%) patients, respectively. Among 2455 patients, 651 (26.5%) had weight gain over 5 kg and 179 (7.3%) had weight loss over 5 kg. Weight gain was more frequently observed in Asian and male. Neither baseline BMI nor weight change affected recurrence or survival in the Cox proportional hazard model.

Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships

The linkage of individuals with obesity and COVID-19 is controversial and lacks systematic reviews. After a systematic search of the Chinese and English language literature on COVID-19, 75 studies were used to conduct a series of meta-analyses on the relationship of individuals with obesity-COVID-19 over the full spectrum from risk to mortality. A systematic review of the mechanistic pathways for COVID-19 and individuals with obesity is presented. Pooled analysis show individuals with obesity were more at risk for COVID-19 positive, >46.0% higher (OR = 1.46; 95% CI, 1.30-1.65; p < 0.0001); for hospitalization, 113% higher (OR = 2.13; 95% CI, 1.74-2.60; p < 0.0001); for ICU admission, 74% higher (OR = 1.74; 95% CI, 1.46-2.08); and for mortality, 48% increase in deaths (OR = 1.48; 95% CI, 1.22-1.80; p < 0.001). Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID-19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals. Individuals with obesity are linked with large significant increases in morbidity and mortality from COVID-19. There are many mechanisms that jointly explain this impact. A major concern is that vaccines will be less effective for the individuals with obesity.

Obesity and Pancreatic Cancer: A Matched-Pair Survival Analysis

BACKGROUND

Morbid obesity is a risk factor for pancreatic ductal adenocarcinoma (PDAC). However, the impact of obesity on postoperative outcomes and overall survival in patients with PDAC remains a controversial topic.

METHODS

Patients who underwent pancreatic surgery for PDAC between 1997 and 2018 were included in this study. Matched pairs (1:1) were generated according to age, gender and American Society of Anesthesiologists status. Obesity was defined according to the WHO definition as BMI ≥ 30 kg/m². The primary endpoint was the difference in overall survival between patients with and without obesity.

RESULTS

Out of 553 patients, a total of 76 fully matched pairs were generated. Obese patients had a mean BMI-level of 33 compared to 25 kg/m² in patients without obesity (p = 0.001). The frequency of arterial hypertension (p = 0.002), intraoperative blood loss (p = 0.039), and perineural invasion (p = 0.033) were also higher in obese patients. Clinically relevant postoperative complications (p = 0.163) and overall survival rates (p = 0.885) were comparable in both study groups. Grade II and III obesity resulted in an impaired overall survival, although this was not statistically significant. Subgroup survival analyses revealed no significant differences for completion of adjuvant chemotherapy and curative-intent surgery.

CONCLUSIONS

Obesity did not affect overall survival and postoperative complications in these patients with PDAC. Therefore, pancreatic surgery should not be withheld from obese patients.

Accuracy of resting metabolic rate prediction equations among healthy adults in Trinidad and Tobago

BACKGROUND

Over 50% of adults in Latin America and the Caribbean have a body mass index (BMI) ≥ 25 suggesting excess energy intakes relative to energy expenditure. Accurate estimation of resting metabolic rate (RMR), the largest component of total energy requirements, is crucial to strategies aimed at reducing the prevalence and incidence of overweight and obesity.

AIM

We evaluated the accuracies of established and locally developed RMR prediction equations (RMR_P) among adults.

METHODS

Four hundred adult volunteers ages 20 to 65 years had RMR measured (RMR_M) with a MedGem® indirect calorimeter according to recommended procedures. RMR_P were compared to RMR_M with values ± 10% of RMR_M deemed accurate. Anthropometry was measured using standard procedure. Linear regression with bootstrap analyses was used to develop local RMR_P equations based on anthropometric and demographic variables. The University of the West Indies Ethics Committee approved the study.

RESULTS

Males had higher mean absolute RMR (p < 0.001) but similar mean age-adjusted measured RMR per kg of body (20.9 vs. 21.5 kcals/day; p = 0.1) to females. The top performing established anthropometry-based RMR_P among participants by sex, physical activity (PA) level and BMI status subgroups were Mifflin-St Jeor, Owen, Korth, Harris-Benedict, and Livingston, while Johnstone, Cunningham, Müller (body composition (BC)), Katch and McArdle, Mifflin-St Jeor (BC) were the most accurate BC-based RMR_P. Locally developed RMR_P had accuracies comparable to their top-ranked established RMR_P counterparts.

CONCLUSIONS

Accuracies of established RMR_P depended on habitual PA level, BMI status, BC and sex. Furthermore, locally developed RMR_P provide useful alternatives to established RMR_P.