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Kapoor N, Bhattacharya S, Agarwal N, Das S, Bantwal G, Deshmukh V, Kalra S. Subclinical Kwashiorkor in Adults: A New Age Paradigm. Indian J Endocrinol Metab 2022; 26:213-222. [PMID: 36248046 PMCID: PMC9555378 DOI: 10.4103/ijem.ijem_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
Childhood protein-energy undernutrition (PEU) is a well-recognized problem and therefore a lot of work has been done to identify and manage paediatric PEU. Though there have been several reports of low protein consumption in adults from developing countries, PEU and its subtle forms (subclinical PEU) are not yet recognized as adult disorders. Physicians and public perception do not favour easy recognition and action. In this review, the authors provide a scoping review of the existing literature on this entity providing insights into its recognition, pathogenesis and management. Adult subclinical PEU is an enormous under-recognized challenge that can have detrimental consequences if not recognized and corrected in time. PEU has grave health and economic impact on the patient and society. Therefore, it is important to recognize subclinical PEU and prevent its progression to full-blown form.
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Affiliation(s)
- Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
- Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Saptarshi Bhattacharya
- Consultant Endocrinologist, Apollo Centre for Obesity, Diabetes and Endocrinology (ACODE), Indraprastha Apollo Hospitals, New Delhi, India
| | - Navneet Agarwal
- Department of Diabetology, DNA Sugar Clinic, Gwalior, Madhya Pradesh, India
| | - Sambit Das
- Department of Endocrinology, Hi Tech Medical College and Hospital, Bhubaneshwar, Odisha, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St Johns Medical College and Hospital, Bengaluru, Karnataka, India
| | - Vaishali Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Islam TU, Rizwan M. Comparison of correlation measures for nominal data. COMMUN STAT-SIMUL C 2021. [DOI: 10.1080/03610918.2020.1869984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tanweer Ul Islam
- Department of Economics, National University of Sciences & Technology, Islamabad, Pakistan
| | - Mahvish Rizwan
- Department of Economics, National University of Sciences & Technology, Islamabad, Pakistan
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Rahman A, Sathi NJ. Sociodemographic Risk Factors of Being Underweight Among Ever-Married Bangladeshi Women of Reproductive Age: A Multilevel Analysis. Asia Pac J Public Health 2020; 33:220-226. [PMID: 33291961 DOI: 10.1177/1010539520979924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study's primary goal is to identify a few sociodemographic risk factors associated with women's underweight status. We have applied multilevel binary logistic regression using the Bangladesh Demographic and Health Survey 2014 data, considering hierarchical effect. The model implies that age <30 years (odds ratio [OR]: 2.19; 95% CI: 1.82-2.63), no education (OR: 1.44; 95% CI: 1.28-1.61), oral contraceptive nonuser (OR: 1.26; 95% CI: 1.14-1.39), and not watching TV (OR: 1.56; 95% CI: 1.41-1.73) are significant risk factors associated with women's underweight status. Remarkably, women from rural areas and belonging to a community with poverty rates of 50% and higher are 46% and 52% more likely to be underweight, respectively. Policy makers and organizations should create a supportive environment for rural women by controlling education, media coverage, and poverty to enrich their knowledge about healthy weight to reduce community inequality and maintain a healthy life.
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Rising burden of overweight and obesity among Indian adults: empirical insights for public health preparedness. J Biosoc Sci 2020; 53:709-723. [PMID: 32962795 DOI: 10.1017/s0021932020000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With simultaneous efforts to address a huge burden of malnutrition, especially among children and younger women, India also encounters a mushrooming prevalence of overweight and obesity among the adult population. This study analysed data from two consecutive rounds of the National Family Health Survey (NFHS) conducted in 2005-06 and 2015-16, to present the burden of overweight and obesity among adult men and women in India. The findings highlight a rising burden of overweight and obesity, although the level and the extent of change over the study period varied across states. The district-wise analysis revealed geographical clusters of overweight and obesity. Further investigation suggests that overweight or obesity are not exclusive to urban areas, and economically well-off populations are more inclined to be overweight or obese. The trends and patterns of overweight and obesity in India argue for timely public health preparedness and interventions to avoid the rising incidence of non-communicable diseases in India.
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Davis JN, Oaks BM, Engle-Stone R. The Double Burden of Malnutrition: A Systematic Review of Operational Definitions. Curr Dev Nutr 2020; 4:nzaa127. [PMID: 32885132 PMCID: PMC7456307 DOI: 10.1093/cdn/nzaa127] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions. OBJECTIVES To identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment. METHODS Following a structured search of peer-reviewed articles with terms describing "overnutrition" [e.g., overweight/obesity (OW/OB)] and "undernutrition" (e.g., stunting, micronutrient deficiency), we screened 1920 abstracts, reviewed 500 full texts, and extracted 623 operational definitions from 239 eligible articles. RESULTS We organized three identified DBM dimensions (level of assessment, target population, and forms of malnutrition) into a framework for building operational DBM definitions. Frequently occurring definitions included coexisting: 1) OW/OB and thinness, wasting, or underweight (n = 289 occurrences); 2) OW/OB and stunting (n = 161); 3) OW/OB and anemia (n = 74); and 4) OW/OB and micronutrient deficiency (n = 73). CONCLUSIONS Existing DBM definitions vary widely. Putting structure to possible definitions may facilitate selection of fit-for-purpose indicators to meet public health priorities.
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Affiliation(s)
- Jennie N Davis
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
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Underweight among rural Indian adults: burden, and predictors of incidence and recovery. Public Health Nutr 2017; 21:669-678. [PMID: 29122038 DOI: 10.1017/s1368980017003081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To study the magnitude and predictors of underweight, incident underweight and recovery from underweight among rural Indian adults. DESIGN Prospective cohort study. Each participant's BMI was measured in 2008 and 2012 and categorized as underweight (BMI<18·5 kg/m2), normal (BMI=18·5-22·9 kg/m2) or overweight/obese (BMI ≥23·0 kg/m2). Incident underweight was defined as a transition from normal weight or overweight/obese in 2008 to underweight in 2012, and recovery from underweight as a transition from underweight in 2008 to normal weight in 2012. Bivariate and multivariable logistic regression analyses were employed. SETTING The Birbhum Health and Demographic Surveillance System, West Bengal, India. SUBJECTS Predominantly rural individuals (n 6732) aged ≥18 years enrolled in 2008 were followed up in 2012. RESULTS In 2008, the prevalence of underweight was 46·5 %. From 2008 to 2012, 25·8 % of underweight persons transitioned to normal BMI, 12·9 % of normal-weight persons became underweight and 0·1 % of overweight/obese persons became underweight. Multivariable models reveal that people aged 25-49 years, educated and wealthier people, and non-smokers had lower odds of underweight in 2008 and lower odds of incident underweight. Odds of recovery from underweight were lower among people aged ≥36 years and higher among educated (Grade 6 or higher) individuals. CONCLUSIONS The current study highlights a high incidence of underweight and important risk factors and modifiable predictors of underweight in rural India, which may inform the design of local nutrition interventions.
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Nethan S, Sinha D, Mehrotra R. Non Communicable Disease Risk Factors and their Trends in India. Asian Pac J Cancer Prev 2017; 18:2005-2010. [PMID: 28749643 PMCID: PMC5648412 DOI: 10.22034/apjcp.2017.18.7.2005] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: India is a populous country of about 1.3 billion. Non communicable diseases (NCDs) contribute to
around 5.87 million (60%) of all deaths in India. Hence, the objectives of this paper are to find baseline information
on different NCD risk factors coverage and to determine their trends in India. Methods: For this systematic review,
PubMed, Google and different surveillance systems were searched. Of the search results, 41 papers/survey reports were
eventually assessed for eligibility. National and state representative data on NCD risk factors (for the major NCDs like
cardiovascular diseases, chronic respiratory disease, cancer and diabetes) having World Health Organization(WHO)
indicator definitions, covering rural and urban population, were included in the study. Thereafter, state-wise population
proportion was added and divided by the total Indian population to determine the percentage of population coverage for
each risk factor by the surveys. Also, the old and current data of the periodic surveys were compared to assess prevalence
trends. Results: Various national/state level surveys in India include single or multiple risk factors. Nationwide coverage
is available for tobacco use, alcohol drinking, raised blood pressure and overweight and obesity. Periodic National
Family Health Surveys provide information on selected risk factors during 2005-16 among adults aged 15-49 years.
An overall significant increase was noted in overweight and obesity while decline was noted in tobacco and alcohol
use during the same period. From GATS 1 (2009-10) to 2 (2016-17) also, the prevalence of tobacco consumption
decreased in India. Conclusion: India has a much delayed response on NCD risk factors surveillance and information
of the same are sporadic and incomplete. In order to increase information comprehensiveness, standard WHO NCD
risk factors questions must be incorporated in the ongoing surveys. India should also plan for cost and time effective
NCD surveillance system.
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Affiliation(s)
- Suzanne Nethan
- Division of Clinical Oncology, ICMR - National Institute of Cancer Prevention and Research (NICPR),Noida, India.
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Zahangir MS, Hasan MM, Richardson A, Tabassum S. Malnutrition and non-communicable diseases among Bangladeshi women: an urban-rural comparison. Nutr Diabetes 2017; 7:e250. [PMID: 28319102 PMCID: PMC5380895 DOI: 10.1038/nutd.2017.2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/13/2016] [Accepted: 01/02/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aims at examining the urban-rural differentials in the effects of socioeconomic predictors on underweight and obesity of ever-married women in Bangladesh. The effect of malnutrition and other risk factors on non-communicable diseases is also examined. SUBJECTS/METHODS The information regarding nutritional status, socioeconomic and demographic background, and non-communicable diseases of ever-married women was extracted from the nationally representative, cross-sectional Bangladesh Demographic and Health Survey (BDHS 2011) data set. Both bivariate (χ2 test) and multivariate (multinomial logistic regression model) analyses were performed in determining the risk factors of malnutrition. The effect of malnutrition and associated risk factors on non-communicable diseases was determined using binary logistic regression models. RESULTS The overall prevalence as well as the effects of individual risk factors of malnutrition differ in urban and rural settings. Regional differentials in the prevalence of underweight were statistically significant only for rural areas. In rural and urban settings, women from households with poor economic status were 67% (odds ratio (OR) 0.33, 95% CI 0.26-0.43) and 81% (OR=0.19, 95% CI 0.13-0.29) less likely to be overweight, respectively, with respect to those from affluent households. Women from the Rangpur division were significantly more likely to suffer from anemia (OR=1.41, 95% CI 1.13-1.77) and hypertension (OR=1.67, 95% CI 1.19-2.34) than those from the Sylhet division (reference division). With respect to those considered as underweight, women who were categorized as overweight were 0.47 (OR=0.53, 95% CI 0.43-0.65) times less likely to suffer from anemia, and 1.83 (OR=2.83, 95% CI 1.99-4.02) and 1.70 (OR=2.70, 95% CI 2.09-3.50) times more likely to suffer from diabetes and hypertension, respectively. CONCLUSIONS Rural-urban differentials in the effects of individual risk factors of malnutrition were observed. Wealth status of households and nutritional status of women showed significant effect on the prevalence of anemia, diabetes and hypertension.
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Affiliation(s)
- M S Zahangir
- Department of Statistics, University of Chittagong, Chittagong, Bangladesh
| | - M M Hasan
- Department of Mathematics & Statistics, University of Canberra, Bruce, ACT, Australia
| | - A Richardson
- National Centre for Epidemiology & Population Health, Australian National University, Acton, ACT, Australia
| | - S Tabassum
- Department of Statistics, University of Chittagong, Chittagong, Bangladesh
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Hendriks AM, Gubbels JS, Jansen MWJ, Kremers SPJ. Health Beliefs regarding Dietary Behavior and Physical Activity of Surinamese Immigrants of Indian Descent in The Netherlands: A Qualitative Study. ISRN OBESITY 2012; 2012:903868. [PMID: 24533213 PMCID: PMC3914276 DOI: 10.5402/2012/903868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/12/2012] [Indexed: 11/23/2022]
Abstract
This study explored the health beliefs about eating habits and physical activity (PA) of Surinamese immigrants of Indian (Hindustani) descent to examine how health education messages to prevent obesity can be made more culturally sensitive. Indians are known for their increasing obesity incidence and are highly vulnerable for obesity-related consequences such as cardiovascular diseases and diabetes. Therefore they might benefit from culturally sensitive health education messages that stimulate healthy eating habits and increase PA levels. In order to examine how health education messages aimed at preventing obesity could be adapted to Indian culture, we interviewed eight Hindustanis living in The Netherland, and conducted two focus groups (n = 19) with members from a Surinamese Hindustani community. Results showed cultural implications that might affect the effectiveness of health education messages: karma has a role in explaining the onset of illness, traditional eating habits are perceived as difficult to change, and PA was generally disliked. We conclude that health education messages aimed at Hindustani immigrants should recognize the role of karma in explaining the onset of illness, include more healthy alternatives for traditional foods, pay attention to the symbolic meaning of food, and suggest more enjoyable and culturally sensitive forms of PA for women.
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Affiliation(s)
- A-M Hendriks
- Academic Collaborative Centre for Public Health Limburg, Regional Public Health Service, Geleen, The Netherlands ; CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ; Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - J S Gubbels
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - M W J Jansen
- Academic Collaborative Centre for Public Health Limburg, Regional Public Health Service, Geleen, The Netherlands ; CAPHRI School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ; Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - S P J Kremers
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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