How much do universal anthropometric standards bias the global monitoring of obesity and undernutrition?

Update on the Obesity Epidemic: After the Sudden Rise, Is the Upward Trajectory Beginning to Flatten?

PURPOSE OF REVIEW

To provide an update on current obesity prevalence trends and summarize the available evidence suggesting a possible plateau or stabilization in obesity rates after the previous sudden global rise.

RECENT FINDINGS

The escalating global obesity epidemic represents one of the most serious public health challenges. There have been some indications that in high-income populations, the rate of obesity increase in adults has been stabilized after the decade 2000-2010, suggesting a possible plateau. Current evidence also suggests that obesity rates have been stabilized in children and adolescents of most economically advanced countries since 2000, which is possibly related to healthier dietary habits and increased levels of physical activity. On the other hand, there is a steady uninterrupted rise in low-income nations, and the universal trend is obesity escalation rather than slowdown, mainly driven by sharp increases in the obesity prevalence of low-income populations. Furthermore, an increasing number of high- and middle-income countries are currently experiencing an epidemic of severe obesity. In high-income populations, severe obesity is expected to double its prevalence from 10 to 20% between 2020 and 2035, posing an enormous threat for healthcare systems. Even if transiently stabilized, the obesity prevalence remains globally at unacceptably high levels, and there is no guarantee that the current stability (if any) will be maintained for long. In this review, we explore the underlying drivers of the global obesity epidemic; we provide possible explanations for the reported slowdown of the obesity rates in some countries; and we overall take a critical perspective on the obesity plateau hypothesis, emphasizing the urgent need for immediate effective actions at population and regional level in order to halt the alarming obesity escalation and its serious health risks.

Validation of mid-arm circumference for surveillance of obesity in African adolescent girls and adult women

This study aimed to assess the validity of mid-arm circumference (MAC), also known as mid-upper arm circumference (MUAC), for classification of high body fatness in Namibian adolescent girls and women and to test whether classification accuracy of MUAC was higher than the traditional simple proxy for high fatness, the BMI. In 206 adolescent girls aged 13-19 years and 207 adult women aged 20-40 years, we defined obesity conventionally (BMI-for-age Z score ≥ 2·00, adolescents; adults BMI ≥ 30·0 kg/m2) and also defined obesity using published MAC cut-off values. 2H oxide dilution was used to measure total body water (TBW) to define high body fat percentage (≥ 30 % in the adolescents, ≥ 38 % in the adults), and we compared the ability of BMI and MAC to classify high body fatness correctly using sensitivity, specificity and predictive values. In the adolescents, obesity prevalence was 9·2 % (19/206) using BMI-for-age and 63·2 % (131/206) using TBW; sensitivity of BMI-for-age was 14·5 % (95 % CI 9·1, 22·0 %) but was improved significantly using MAC of 22·6 cm (sensitivity 96·9 %; 95 % CI 92·1 %, 99·3 %). In the adults, obesity prevalence was 30·4 % (63/207) using BMI and 57·0 % (118/207) using TBW, and sensitivity of BMI was 52·5 % (95 % CI 43·6, 62·2 %), but using a MAC of 30·6 cm sensitivity was 72·8 % (95 % CI 66·4, 82·6 %). Surveillance of obesity in African adolescent girls and adult women is likely to be improved substantially by use of MAC as an alternative to the BMI-for-age and BMI.

Interpreting error in the estimation of skeletal growth profiles from past populations: An example demonstrating skeletal growth in historic African American communities

OBJECTIVES

The study of growth in the past is a critical component of bioarcheological analyses. However, our understanding of growth in the past is subject to a number of methodological challenges. This study aims to model the skeletal growth of past populations by considering the challenges associated with the data collection process and the challenges associated with the age estimation procedures.

MATERIALS AND METHODS

We use skeletal remains from two historic African American cemeteries in the American South to model femoral diaphyseal length-for-age. We estimate the age of each individual using dental development techniques and present growth curves as both a product of the maximum likelihood (MLE) age estimate and the estimated posterior age distribution. Growth was compared against a reference sample from the University of Colorado Child Research Council Study.

RESULTS

The results of our analyses showed that femoral diaphyseal length in two historic African American communities is small-for-estimated age as compared to a modern reference sample. However, the magnitude and characterization of this difference is variable when taking into account the broader posterior age distribution.

DISCUSSION

Both samples may be small-for-age due to physiological stress associated with racism, inequality, and the compounding effects of early urbanization. However, the interpretation of growth in the past is muddled when considering the relationship between the study sample and the reference sample, when accounting for uncertainty in the age estimation procedure, and the error-inducing steps taken during the data collection process. Future interpretation of skeletal growth in the past must include a full account of the possible sources of error in order to present an accurate representation of growth.

Body norms and normative bodies in Highland Guatemala

OBJECTIVES

The concept of bionormalcy highlights the potential tensions between bodies defined clinically as normal or healthy, bodies that are normative (frequent) within a population, and bodies defined within a given social context as abnormal or devalued. Theories of resource scarcity predict preferences for larger bodies should deviate from what is biologically normative (i.e., most frequent) or clinically defined as healthy. Using the case of adult women in a Guatemalan community with chronically low food security, we test how food scarcity shapes individual views of smaller, larger, and clinically categorized normal bodies.

METHODS

Participants were 102 women from a community in the Central Highlands of Guatemala. Using the Stunkard figure scale and a word elicitation task, participants attributed positive and negative characteristics to male and female silhouettes clinically defined as underweight, normal, overweight, mildly obese, and obese. Mixed-effects models were used to compare attribution scores for figures relative to the clinically normal silhouette.

RESULTS

Silhouettes deviating from the clinically defined normal BMI category on both sides are stigmatized to varying degrees. Food insecurity exacerbates the degree of stigma, while also relatively preferencing overweight bodies.

CONCLUSIONS

In this pilot study, women exhibit a preference for body sizes that fall within the clinical normal and overweight categories and stigmatize bodies outside this range, but in distinct ways. We suggest the attachment of stigma to small and large bodies are not mirror processes, and require more detailed testing to untangle the likely complex ecological and social explanations.

What is normal, healthy growth? Global health, human biology, and parental perspectives

OBJECTIVES

The widespread variation seen in human growth globally stands at odds with the global health perspective that young child growth should not vary across populations if nutritional, environmental and care needs are met. This paper: (1) evaluates the idea that a single standard of "healthy" growth characterizes children under age 5, (2) discusses how variation from this standard is viewed in global health, in human biology and by parents, and (3) explores how views of "normal" growth shape biomedical and parental responses.

METHODS

This paper reviews the anthropological, public health and clinical literature on the nature of child growth and the applicability of World Health Organization Multicenter Growth Reference Study growth standards across contexts.

RESULTS

The considerable variability in child growth across contexts makes it unlikely that any one framework, with issues of sample selection and representativeness, can serve as the model of healthy growth. Global health, human biology and parents differ in the emphasis they place on heredity versus environmental context in understanding this variability, but human biologists and parents tend to view a wider range of growth as "normal." Since both biomedicine and parents base their care decisions on their perceptions of normal, healthy growth, the comparative framework used has important implications for medical treatment and feeding practices.

CONCLUSIONS

A more nuanced approach that incorporates the biology of growth and its association with health outcomes across contexts is critical to identify patterns of healthy growth and to avoid over-reliance on a single standard that may pathologize variability.

One size does not fit all. How universal standards for normal height can hide deprivation and create false paradoxes

Public health practitioners and social scientists frequently compare height against one-size-fits-all standards of human growth to assess well-being, deprivation, and disease risk. However, underlying differences in height can make some naturally tall populations appear well-off by universal standards, even though they live in severe states of deprivation. In this article, I describe the worldwide extent of these population differences in height and illustrate how using a universal yardstick to compare population height can create puzzling disparities (eg, between South Asia and sub-Saharan Africa) while also underestimating childhood stunting in specific world regions (eg, West Africa and Haiti). I conclude by discussing potential challenges of developing and implementing population-sensitive standards for assessing healthy development.

Deprivation or discrimination? Comparing two explanations for the reverse income-obesity gradient in the US and South Korea

In high-income countries, poverty is often associated with higher average body mass index (BMI). To account for this reverse gradient, deprivation theories posit that declining economic resources make it more difficult to maintain a healthy weight. By contrast, discrimination theories argue that anti-fat discrimination in hiring and marriage sorts heavier individuals into lower-income households. This study assesses competing predictions of these theories by examining how household income in representative samples from South Korea (2007-2014, N=20,823) and the US (1999-2014, N=6395) is related to BMI in two key contrasting groups: (1) currently-married and (2) never-married individuals. As expected by anti-fat discrimination in marriage, the reverse gradient is observed among currently-married women but not among never-married women in both countries. Also consistent with past studies no evidence was found for a reverse gradient among men. These findings are consistent with anti-fat discrimination in marriage as a key cause of the reverse gradient and raise serious challenges to deprivation accounts as well as explanations based on anti-fat discrimination in labour markets.

Taller but thinner: trends in child anthropometry in Senegal, 1990-2015

OBJECTIVE

To investigate trends in child anthropometry in Senegal between 1990 and 2015 and relate them with potential causes. Several hypotheses were tested: changes in health status, income, diet and socio-economic status.

DESIGN

Statistical analysis of trends in anthropometric data: height, weight, BMI and associated Z-scores calculated with the CDC-2000 standard (Centers for Disease Control and Prevention): height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ). Trends were fitted with linear regression models and were related with changes in health and socio-economic status.

SETTING

Nine nationally representative samples of Senegalese children aged 12-59 months, taken between 1986 and 2017 by Demographic and Health Surveys (DHS).

PARTICIPANTS

Children aged 12-59 months.

RESULTS

Over the 25 years of investigation, the average height of children increased by +1·88 cm, their average weight by +0·10 kg, but their BMI decreased by -0·53 kg/m2. Corresponding changes expressed in Z-scores were +0·454 in HAZ, +0·109 in WAZ and -0·302 in WHZ. This pattern of decreasing stunting while increasing wasting was correlated with decreasing child mortality, despite small changes in income per capita and in adult heights or BMI. Largest improvements in HAZ were among the lower socio-economic strata, while largest declines in WHZ were among higher socio-economic strata.

CONCLUSIONS

Decline in stunting appeared associated primarily with the control of infectious diseases, also responsible for the mortality decline. Increase in wasting was surprising. It appears associated with small changes in income per capita, and therefore in diet, in a context of increasing height.

Body Composition Findings by Computed Tomography in SARS-CoV-2 Patients: Increased Risk of Muscle Wasting in Obesity

Obesity is a characteristic of COVID-19 patients and the risk of malnutrition can be underestimated due to excess of fat: a paradoxical danger. Long ICU hospitalization exposes patients to a high risk of wasting and loss of lean body mass. The complex management precludes the detection of anthropometric parameters for the definition and monitoring of the nutritional status. The use of imaging diagnostics for body composition could help to recognize and treat patients at increased risk of wasting with targeted pathways. COVID-19 patients admitted to the ICU underwent computed tomography within 24 h and about 20 days later, to evaluate the parameters of the body and liver composition. The main results were the loss of the lean mass index and a greater increase in liver attenuation in obese subjects. These could be co-caused by COVID-19, prolonged bed rest, the complex medical nutritional therapy, and the starting condition of low-grade inflammation of the obese. The assessment of nutritional status, with body composition applied to imaging diagnostics and metabolic profiles in COVID-19, will assist in prescribing appropriate medical nutritional therapy. This will reduce recovery times and complications caused by frailty.

Classification Accuracy of Body Mass Index for Excessive Body Fatness in Kuwaiti Adolescent Girls and Young Adult Women

PURPOSE

Adolescent obesity, as defined by BMI, is amongst the highest in the world in Kuwait. This study aimed to determine the extent to which BMI might be underestimating obesity as defined by excessive fatness in Kuwaiti female adolescents and young adults.

METHODS

A total of 400 apparently healthy Kuwaiti female university students (mean age 18.0 years, SD 0.6) were recruited. Excessive fatness was defined as body fat percentage ≥30, measured using the Tanita model TBF-310 Bio-impedance system with the manufacturer's equation. Obesity was defined as recommended by the WHO in adult participants - those aged ≥19.1 years - as BMI≥30 kg/m². In the adolescent participants (age <19.1 years) obesity was defined as recommended by the WHO as a BMI-for-age Z score of ≥2.00. The accuracy of BMI-defined obesity to identify excessively fat individuals was determined by estimating the prevalence of obesity using high BMI and prevalence of excessive fatness, and by calculating sensitivity and specificity and predictive values.

RESULTS

Median BMI was 27.8 kg/m² (range 15.1-51.2) and median body fat percentage was 32.0 (range 5.0-54.0). The prevalence of excessive fatness was 62% (247/400 individuals were excessively fat), while the prevalence of obesity according to BMI was 42% (169/400 individuals were obese according to their BMI). The sensitivity of BMI to identify the excessively fat individuals was moderate (66%) but specificity was high (96%). The positive predictive value of BMI was 96% and the negative predictive value was 64%.

CONCLUSION

BMI-based measures substantially underestimate the prevalence of excessive fatness in Kuwaiti adolescent females. Obesity is even more prevalent, and requires more urgent attention, than is apparent from BMI-based measures used in most research and national surveys. BMI may also be too crude for use as an exposure or outcome variable in many epidemiological studies of Arab adolescent girls and adult women.

Relationship of sanitation, water boiling, and mosquito nets to health biomarkers in a rural subsistence population

OBJECTIVES

Throughout human evolutionary history, parasites and pathogens were a major cause of mortality-modern urban life with public health infrastructure has changed disease exposure. We examine associations between boiling water, using latrines, mosquito net usage, and biomarkers among the Tsimane, a nonindustrial subsistence population with little public health infrastructure.

METHODS

We conducted cross sectional surveys on water, latrines, and bed nets among 507 heads of households (aged 18-92 years, median age 41 years). Regression models estimated associations between behaviors and health biomarkers (ie, white blood cell count [WBC], hemoglobin, eosinophil count, and erythrocyte sedimentation rate) adjusting for age, sex, body mass index, wealth, schooling, and distance to the nearby market town.

RESULTS

Latrine use is associated with 6.5% lower WBC count (β = -679.6, P = .031, SE = 314.1), 17.4% lower eosinophil counts (β = -244.7, P = .023, SE = 107.2), and reduced odds of eosinophilia (adjusted OR = 0.40, P < .019, 95% CI = 0.18-0.86). Boiling water and mosquito net use are not significantly associated with any biomarkers measured.

CONCLUSIONS

In a subsistence population currently undergoing epidemiological transition, we find that latrine use was associated with several objective measures of health. This suggests that relatively low cost and low maintenance public health interventions may wish to focus on latrine use, as there is unmet need and potential health benefits for those who use latrines. Additionally, while the cost is higher, public health organizations aimed at improving sanitation may be able to use minimally invasive field-collected biomarkers as a diagnostic to objectively test the efficacy of interventions with greater specificity than anthropometric measurements.

Head Circumference of Babies at Birth in Nigeria

BACKGROUND AND OBJECTIVES

Measuring head circumference (HC) of newborns is an important tool for evaluating intra-uterine brain development. HC reference charts currently in use in Nigeria are not representative of the local population. We thus present locally derived HC reference data for Nigerian infants at birth.

SUBJECTS AND METHODS

We reviewed birth records of all infants at the Jos University Teaching Hospital (JUTH) over a 10 year period from January 2006. JUTH is a tertiary care center offering obstetric services to a large population of women in Jos and its environs. All births with gestational age between 28 and 42 weeks were included in the study. STATA version 14 was used to calculate gestational age associated HC percentile measurements.

RESULTS

We included 18 282 babies to generate the reference values. The mean HC value was 34.4 ± 2.1 cm (M = 34.6 ± 2.16 cm, F = 34.1 ± 2.02 cm, p < 0.001). Our HC reference values significantly differ from the USA and INTERGROWTH-21 charts currently in use in our country. Mean HC was higher in male infants compared with female infants. This difference was uniformly so across all gestational age groups.

CONCLUSIONS

The use of our locally derived HC reference values could be more appropriate in defining normal head growth in Nigerian infant populations thereby improving newborn care.

Assessment of Nutritional Status in Sri Lankan Children: Validity of Current Anthropometry Cutoffs?

Despite socioeconomic improvement, undernutrition rates stagnate in Sri Lanka, while a slow rise in obesity and noncommunicable diseases (NCD) is seen. Inability to improve undernutrition and detection of NCD could be due to overdiagnosing stunting/wasting and underdiagnosing overweight/obesity. Obesity, being a risk factor for NCDs, needs correct tools for early diagnosis. Although body mass index (BMI) is a commonly used surrogate index, the validity of universal cutoffs is questioned. Evidence shows that body composition varies with ethnic origin and cutoff value reflecting fat mass (FM) varies in different ethnic groups. This study was conducted in 12 788, 5- to 15-year-old children from 8 schools in Negombo, Sri Lanka, to identify the validity of current anthropometric cutoffs. Obesity prevalence identified by body fat content was high. International BMI cutoffs had high specificity but varied sensitivity. Locally developed BMI cutoffs had high sensitivity and specificity. Validity of internationally developed anthropometric cutoffs in South Asian children is unsatisfactory; hence, locally/regionally developed anthropometric tools should be used for screening of obesity.

Identifying the limits to socioeconomic influences on human growth

Contemporary humans occupy the widest range of socioeconomic environments in their evolutionary history, and this has revealed unprecedented environmentally-induced plasticity in physical growth. This plasticity also has limits, and identifying those limits can help researchers: (1) parse when population differences arise from environmental inputs or not and (2) determine when it is possible to infer socioeconomic disparities from disparities in body form. To illustrate potential limits to environmental plasticity, we analyze body mass index (BMI) and height data from 1,768,962 women and 207,341 men (20-49 y) living in households exhibiting 1000-fold variation in household wealth (51 countries, 1985-2017, 164 surveys) across four world regions-sub-Saharan Africa, South Asia, Latin America, and North Africa and the Middle East. We find that relationships of environmental inputs with both mean height and BMI bottom out at roughly 100-700 USD per capita household wealth (2011 international units, PPP), but at different basal BMIs and basal heights for different regions. The relationship with resources tops out for BMI at around 20 K-35 K USD for women, with growth potential due to environmental inputs in the range of 6.2-8.4 kg/m². By contrast, mean BMI for men and mean height for both sexes remains sensitive to environmental inputs even at levels far above the low- and middle-income samples studied here. This suggest that further work integrating comparable data from low- and high-income samples should provide a better picture of the full range of environmental inputs on human height and BMI. We conclude by discussing how neglecting such population-specific limits to human growth can lead to erroneous inferences about population differences.

The association of quantitative insulin sensitivity indices (HOMA-IR and QUICKI) with anthropometric and cardiometabolic indicators in adolescents

Introduction

Homoeostasis model assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) are used to evaluate insulin resistance. The aim of this study was to investigate the association between quantitative insulin sensitivity indices and anthropometric and cardiometabolic indicators in adolescents.

Material and methods

This descriptive-analytic cross-sectional study was conducted on 80 adolescents aged 12 to 13 years in Isfahan, Iran. Anthropometric, cardiometabolic and QUICKI and HOMA-IR indicators were measured. In the results analysis, Pearson correlation coefficient and regression analysis were used.

Results

There was a significant positive correlation between most of the anthropometric indicators and the HOMA-IR index and a significant negative correlation with QUICKI (all p < 0.0001). Moreover, serum triglyceride level had a significant negative correlation with QUICKI index (R = –0.33, p = 0.002) and systolic blood pressure (R = 0.44, p < 0.0001), and triglyceride level (R = 0.66, p < 0.0001) had a significant positive correlation with HOMA index. The results of these two indices were highly correlated in most of the anthropometric and biochemical indices, except for the waist circumference to the neck circumference ratio and systolic blood pressure, which had a significant positive association with HOMA-IR, but did not show a significant association with QUICKI index.

Conclusions

A significant correlation between anthropometric and cardiometabolic indicators with insulin resistance indices (HOMA-IR and QUICKI) was found. Moreover, the results of these two indices were highly correlated in most of the anthropometric and biochemical indices, except for the waist circumference to the neck circumference ratio and systolic blood pressure.

Anti-fat discrimination in marriage more clearly explains the poverty-obesity paradox

The target article proposes the insurance hypothesis as an explanation for higher levels of obesity among food-insecure women living in high-income countries. An alternative hypothesis based on anti-fat discrimination in marriage can also account for such correlations between poverty and obesity and is more consistent with finer-grained analyses by marital status, gender, and age.

Ethnical and sociocultural differences causing infertility are poorly understood-insights from the Arabian perspective

Infertility is acknowledged worldwide as a major health concern. Although global levels of primary and secondary infertility have hardly changed between 1990 and 2010, significant regional differences have been reported. The prevalence of infertility in women has been estimated to be one in every seven couples in the western world and one in every four couples in developing countries. Male infertility may be under-reported in some regions due to an unwillingness of the male partner to undergo fertility investigations. Geographical, sociocultural/religious and ethnical dissimilarities contribute to these global variations in infertility prevalence. Infertility has a major impact on family stability in many cultures, especially in developing countries, where childlessness can impact sociocultural status. Moreover, it is important to realise that most fertility treatment protocols are based on studies performed in Caucasian population. The purpose of this opinion paper is to critically appraise the existing evidence regarding the association between infertility and relevant sociocultural factors in Middle East countries focusing on aspects such as parental consanguinity, obesity and vitamin D deficiency. There may be reason to believe that in addition to the current standard evaluation of infertile couples, region-specific counselling and treatment modalities are required.

Body mass index vs deuterium dilution method for establishing childhood obesity prevalence, Ghana, Kenya, Mauritius, Morocco, Namibia, Senegal, Tunisia and United Republic of Tanzania

Objective

To compare the World Health Organization (WHO) body mass index (BMI)-for-age definition of obesity against measured body fatness in African children.

Methods

In a prospective multicentre study over 2013 to 2017, we recruited 1516 participants aged 8 to 11 years old from urban areas of eight countries (Ghana, Kenya, Mauritius, Morocco, Namibia, Senegal, Tunisia and United Republic of Tanzania). We measured height and weight and calculated BMI-for-age using WHO standards. We measured body fatness using the deuterium dilution method and defined excessive body fat percentage as > 25% in boys and > 30% in girls. We calculated the sensitivity and specificity of BMI z-score > +2.00 standard deviations (SD) and used receiver operating characteristic analysis and the Youden index to determine the optimal BMI z-score cut-off for classifying excessive fatness.

Findings

The prevalence of excessive fatness was over three times higher than BMI-for-age-defined obesity: 29.1% (95% CI: 26.8 to 31.4; 441 children) versus 8.8% (95% CI: 7.5 to 10.4; 134 children). The sensitivity of BMI z-score > +2.00 SD was low (29.7%, 95% CI: 25.5 to 34.2) and specificity was high (99.7%, 95% CI: 99.2 to 99.9). The receiver operating characteristic analysis found that a BMI z-score +0.58 SD would optimize sensitivity, and at this cut-off the area under the curve was 0.86, sensitivity 71.9% (95% CI: 67.4 to 76.0) and specificity 91.1% (95% CI: 89.2 to 92.7).

Conclusion

While BMI remains a practical tool for obesity surveillance, it underestimates excessive fatness and this should be considered when planning future African responses to the childhood obesity pandemic.

Interactions between general and central obesity in predicting gestational diabetes mellitus in Chinese pregnant women: A prospective population-based study in Tianjin, China

BACKGROUND

The aim of the present study was to define cut-off points of body mass index (BMI) and waist circumference (WC) for gestational diabetes mellitus (GDM) and to investigate any interactions between high BMI and high WC on the risk of GDM in pregnant Chinese women.

METHODS

From 2010 to 2012, 17 803 women in Tianjin, China, who were at 4-12 weeks gestation were recruited to the study. Gestational diabetes mellitus was diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Group at 24-28 weeks gestation. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for the confounding effects of traditional risk factors. Restricted cubic spline was used to identify cut-off points of WC and BMI, if any, for GDM.

RESULTS

Gestational diabetes mellitus developed in 1383 (7.8%) women. The risk of GDM increased steeply with increasing WC from ≥78.5 cm and BMI ≥22.5 kg/m² . If BMI <22.5 kg/m² and WC <78.5 cm were used as the reference, BMI between ≥22.5 and <24.0 kg/m² (multivariable OR 1.76; 95%CI 1.47-2.10) and WC between ≥78.5 and <85.0 cm (multivariable OR 1.53; 95%CI 1.31-1.78) were independently associated with increased risks of GDM. In addition, the presence of both BMI ≥22.5 kg/m² and WC ≥78.5 cm further increased the OR to 2.83 (95% CI 2.44-3.28), with significant additive interaction.

CONCLUSIONS

Body mass index ≥22.5 kg/m² and WC ≥78.5 cm measured up to 12 weeks of gestation were independently and synergistically associated with increased risks of GDM in Chinese pregnant women.

Material wealth in 3D: Mapping multiple paths to prosperity in low- and middle- income countries

Material wealth is a key factor shaping human development and well-being. Every year, hundreds of studies in social science and policy fields assess material wealth in low- and middle-income countries assuming that there is a single dimension by which households can move from poverty to prosperity. However, a one-dimensional model may miss important kinds of prosperity, particularly in countries where traditional subsistence-based livelihoods coexist with modern cash economies. Using multiple correspondence analysis to analyze representative household data from six countries-Nepal, Bangladesh, Ethiopia, Kenya, Tanzania and Guatemala-across three world regions, we identify a number of independent dimension of wealth, each with a clear link to locally relevant pathways to success in cash and agricultural economies. In all cases, the first dimension identified by this approach replicates standard one-dimensional estimates and captures success in cash economies. The novel dimensions we identify reflect success in different agricultural sectors and are independently associated with key benchmarks of food security and human growth, such as adult body mass index and child height. The multidimensional models of wealth we describe here provide new opportunities for examining the causes and consequences of wealth inequality that go beyond success in cash economies, for tracing the emergence of hybrid pathways to prosperity, and for assessing how these different pathways to economic success carry different health risks and social opportunities.

Anthropometric indices for non-pregnant women of childbearing age differ widely among four low-middle income populations

Background

Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).

Methods

Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m²) was calculated. Z-scores were determined using WHO reference data.

Results

A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North Karnataka, India (n = 1823); and Thatta, Sindh, Pakistan (n = 2009). Mean age was 23 y and mean parity 1.5. Median (P25-P75) height (cm) ranged from 145.5 (142.2–148.9) in Guatemala to 156.0 (152.0–160.0) in DRC. Median weight (kg) ranged from 44.7 (39.9–50.3) in India to 52.7 (46.9–59.8) in Guatemala. Median BMI ranged from 19.4 (17.6–21.9) in India to 24.9 (22.3–28.0) in Guatemala. Percent stunted (<−2SD height for age z-score) ranged from 13.9% in DRC to 80.5% in Guatemala; % underweight (BMI <18.5) ranged from 1.2% in Guatemala to 37.1% in India; % overweight/obese (OW, BMI ≥25.0) ranged from 5.7% in DRC to 49.3% in Guatemala. For all sites, indicators for higher SES and higher age were associated with BMI. Lower SES women were underweight more frequently and higher SES women were OW more frequently at all sites. Younger women tended to be underweight, while older women tended to be OW.

Conclusions

Anthropometric data for NPW varied widely among low-income rural populations in four countries located on three different continents. Global comparisons of anthropometric measurements across sites using standard reference data serve to highlight major differences among populations of low-income rural NPW and assist in evaluating the rationale for and the design of optimal intervention trials.

Trial registration

ClinicalTrials.gov #NCT01883193 (18 June 2013, retrospectively registered)

Measuring material wealth in low-income settings: A conceptual and how-to guide

Although wealth is consistently found to be an important predictor of health and well-being, there remains debate as to the best way to conceptualize and operationalize wealth. In this article, we focus on the measurement of economic resources, which is one among many forms of wealth. We provide an overview of the process of measuring material wealth, including theoretical and conceptual considerations, a how-to guide based on the most common approach to measurement, and a review of important theoretical and empirical questions that remain to be resolved. Throughout, we emphasize considerations particular to the settings in which anthropologists work, and we include variations on common approaches to measuring material wealth that might be better suited to anthropologists' theoretical questions, methodological approaches, and fieldwork settings.

Weight, gender, and depressive symptoms in South Korea

Objectives

Obesity consistently predicts depression risk, but the underlying mechanisms are poorly understood. Body concerns are proposed as key. South Korean society is characterized by extremely high levels of explicit weight stigma, possibly the highest globally. Using cross‐sectional Korean 2014 National Health Examination Survey (KNHANES) data, we test this proposition in a nationally representative sample of South Korean adults (N = 5,632).

Methods

Depressive symptoms (outcome variable), was based on the PHQ‐9. Weight status (predictor variable), was based on direct measures of height and weight converted to BMI. Weight concern was self‐reported. Mediation analyses tested how weight concern mediated the influence of weight status on depressive symptoms for women and men.

Results

Current weight status influenced depressive symptoms in Korean adults, but not always directly. Concerns of being “fat” mediated that relationship. The effect increased significantly as BMI increased within “normal” and overweight/obese categories for women, and in overweight/obese categories for men. Even though women classified as underweight were significantly more depressed than those in other weight categories, there was no similar mediation effect related to weight concerns.

Conclusion

For South Koreans, the stress of adhering to social norms and avoiding stigma related to body weight seems to explain the relationship between higher body weight and more depressive symptoms. Women are more vulnerable overall, but men are not immune. This study demonstrates that body concerns help explain why weight predicts depression, and more broadly supports the proposition that widespread weight‐related stigma is a potentially major, if unrecognized, driver of population‐level health disparities.