Association between parity and obesity patterns in a middle-aged and older Chinese population: a cross-sectional analysis in the Tongji-Dongfeng cohort study

Prevalence and socio-demographic factors associated with double and triple burden of malnutrition among mother-child pairs in India: Findings from a nationally representative survey (NFHS-5)

Introduction

Improper consumption of food leads to various forms of malnutrition such as undernutrition, overnutrition and micronutrient deficiency. The coexistence of various malnutrition forms in the same household is a public health concern in developing countries. Very little research has been done on exploring the burden and risk factors associated with double (DBM) and triple burden of malnutrition (TBM).

Methods

Secondary analysis was done using data from India's National Family Health Survey-5 (NFHS-5), 2019-21. Mothers and under-five children were paired at the household level as a unit of analysis. DBM and TBM were interpreted from children's height-for-age, weight-for-height, weight-for-age and anaemia status and mothers' body-mass-index. Stratification and clustering in the sample design were accounted for during the analysis in STATA v14.2. DBM and TBM were summarized as weighted proportions with 95 % confidence interval (CI) and the risk factors associated were reported as adjusted odds ratio (aOR) with 95%CI using mixed effects logistic regression.

Results

We included 167,380 mother-child pairs for analysis. In India, the prevalence of DBM was 7.7 % (95 % CI: 7.5-7.9 %) and TBM was 5.1 % (5.0-5.3 %) at the household level among mother-child dyads. Mothers' age, age at first birth, educational levels, current breastfeeding habits, mode of delivery, child's age, gender, twin birth, birth weight, geographical region, residence, caste and religion, and wealth index were associated with both DBM and TBM.

Conclusion

Both DBM and TBM are public health concerns in India. Thus, scaling-up of health intervention, effective implementation of nutritional programmes and life-course approach are needed to control malnutrition.

Changes in Adipose Tissue and Circulating Concentrations of Persistent Organic Pollutants in Midlife Women

Polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) are persistent organic pollutants (POPs) that bioaccumulate in adipose tissue. We investigated the relationship between change in central adiposity and changes in circulating concentrations of POPs over a 12-year period during the midlife. Serum concentrations of 34 PCBs and 19 OCPs were measured at four time points (1999/2000, 2002/03, 2005/06, 2009/11) in a cohort of midlife women, the Study of Women's Health Across the Nation. Linear mixed models were used to test the association between a change in waist circumference and a change in serum POP concentrations. Sixty-five women contributed 181 PCB observations. Fifty-nine women contributed 151 OCP observations. After adjustment for covariates (study site, race and ethnicity, age at baseline, parity), a one-inch (2.54 cm) increase in the change in waist circumference between visits was associated with a 4.9% decrease in the change in serum concentration of PCB 194 (95% CI: -8.0%, -1.6%). No associations were observed for other PCB congeners or the presence of OCPs. An increase in the difference in waist circumference over time was not associated with a change in the difference in serum concentrations of PCBs and OCPs except for PCB 194, possibly due to the high lipophilicity.

Reproductive factors and risk of cardiovascular diseases and all-cause and cardiovascular mortality in American women: NHANES 2003-2018

BACKGROUND

The evidence regarding the association of reproductive factors with cardiovascular diseases (CVDs) is limited.

AIMS

To investigate the relationship of reproductive factors with the risk of CVDs, as well as all-cause and cardiovascular mortality.

METHODS

This study included 16,404 adults with reproductive factors from the National Health and Nutrition Examination Survey (NHANES) and followed up until 31 December 2019. Logistic models and restricted cubic spline models were used to assess the association of reproductive factors with CVDs. COX proportional hazards models and restricted cubic spline models, with adjustment for potential confounding, were employed to analyze the relation between reproductive factors and cardiovascular and all-cause death.

RESULTS

There is a nonlinear relationship between age at menarche and CVDs. Age at menopause ≤ 11(OR 1.36, 95% CI 1.10-1.69) was associated with an increased risk of CVDs compared to ages 12-13 years. Age at Menopause ≤ 44 (OR 1.69, 95% CI 1.40-2.03) was associated with increased CVDs compared to age 35-49 years. Number of pregnancies ≥ 5(OR 1.26, 95% CI 1.02-1.55) was associated with an increased risk of CVDs compared to one pregnancy. In continuous variable COX regression models, a later age at menopause (HR 0.98, 95% CI 0.97-0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97-0.99) were associated with a decreased risk of all-cause death. A later age at menopause (HR 0.98, 95% CI 0.97-0.99) and a longer reproductive lifespan (HR 0.98, 95% CI 0.97-0.99) were associated with a decreased risk of cardiac death.

CONCLUSIONS

Female reproductive factors are significant risk factors for CVDs American women.

Prevalence and factors associated with the coexistence of overweight/obesity and anaemia among women of reproductive age in Guinea

OBJECTIVE

To determine the prevalence and associated factors of the coexistence of overweight or obesity (OWOB) and anaemia among non-pregnant Guinean women aged 15-49 years.

DESIGN

The analysis was performed using data from the 2018 Guinean Demographic and Health Survey. Multivariate logistic regression was used to identify factors associated with the coexistence of OWOB and anaemia (OWOB + anaemia) among non-pregnant Guinean women.

SETTING

Guinea.

PARTICIPANTS

A total of 4783 non-pregnant women aged 15-49 years with valid data on the nutritional status (BMI and Hb level) were included in the analysis.

RESULTS

The prevalence of coexistence of OWOB and anaemia among non-pregnant women was 11·16 % (95% CI: 10·05, 12·37). The following variables were associated with OWOB + anaemia in multivariate models (adjusted OR (AOR) 95% CI): higher wealth index (AOR = 4·69; 95% CI: 2·62, 8·39), middle wealth index (AOR = 1·96; 95% CI: 1·31, 2·93), four or more antenatal visits (AOR = 1·62; CI: 1·16, 2·28), having four or more children (AOR = 2·47; 95% CI: 1·37, 4·43) and the rural areas (AOR = 0·59; 95% CI: 0·37, 0·95).

CONCLUSION

The current study's findings reveal that OWOB + anaemia concerned one-tenth of non-pregnant women. Associated factors were household wealth index, multiparity, antenatal visits and rural areas. Thus, there is a need to design specific interventions to prevent the double burden of malnutrition among women of reproductive age. Interventions should include promoting physical exercise, family planning, healthy eating and raising awareness of behavioural change.

Spatiotemporal variations and determinants of overweight/obesity among women of reproductive age in urban India during 2005-2021

BACKGROUND

India has witnessed rapid urbanization in recent decades, leading to a worrisome surge in non-communicable diseases, particularly overweight/obesity, which now present a critical public health concern. Therefore, this study seeks to examine spatiotemporal variations and determinants of overweight/obesity among women of reproductive age (WRA) in urban India and its states during 2005-2021.

METHODS

The study used 44,882, 171,443, and 135,272 WRA aged 15-49 from National Family Health Survey (NFHS)-3 (2005-06), NFHS-4 (2015-16), and NFHS-5 (2019-21), respectively. The outcome variable was overweight/obesity, defined as a Body Mass Index (BMI) of ≥ 25 kg/m2. Chi-squared test and multivariable logistic regression were used to identify the determinants of overweight/obesity.

RESULTS

Overweight/obesity prevalence among WRA in urban India has risen significantly, from 23% in 2005-06 to 33% in 2019-21. This increase is particularly pronounced among SC/ST women and women with lower educational levels. During the study period, overweight/obesity rates in different states exhibited varying increases, ranging from 3 percentage points (pp) in Rajasthan to 22 pp in Odisha. Certain southern (e.g., Tamil Nadu and Andhra Pradesh) and northeastern states saw a significant 15 pp or more increase. In contrast, several northern, central, and eastern states (e.g., Punjab, Haryana, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand, West Bengal) experienced relatively smaller increases ranging from 5 to 8 pp. As of 2019-21, two regions exhibited high prevalence rates of overweight/obesity, exceeding 35%: the southern region (Tamil Nadu, Andhra Pradesh, Kerala, and Karnataka) and the northern region (Punjab, Himachal Pradesh, Uttarakhand, and Haryana). In contrast, the Empowered Action Group states had relatively lower rates (25% or less) of overweight/obesity. Regression results showed that older women [AOR: 5.98, 95% CI: 5.71-6.27], those from the richest quintile [AOR: 4.23, 95% CI: 3.95-4.54], those living in south India [AOR: 1.77, 95% CI: 1.72-1.82], and those having diabetes [AOR: 1.92, 95% CI: 1.83-2.02] were more likely to be overweight/obese.

CONCLUSION

Considering the significant increase in overweight/obesity among urban WRA in India, along with substantial disparities across states and socioeconomic groups, it is imperative for the government to formulate state-specific strategies and policies based on determinants to effectively combat overweight/obesity.

Female Reproductive Factors and Risk of New-Onset Heart Failure: Findings From UK Biobank

BACKGROUND

A comprehensive evaluation of woman-specific risk factors in relation to incident heart failure (HF) is limited.

OBJECTIVES

This study sought to investigate the association of multiple female reproductive factors with the risk of HF.

METHODS

Between 2007 and 2010, 229,026 women (mean age: 56.5 years) without prevalent HF from the UK Biobank cohort were included and followed until December 2020. The relation between (self-reported) reproductive factors and HF was analyzed using Cox proportional hazards models with adjustment for potential confounding.

RESULTS

Menarche at age <12 years, compared to age 12-13 years, carried a 9% larger risk of HF (HR: 1.09 [95% CI: 1.01-1.18]). Younger age at menopause was associated with a higher risk of HF (HRage <45 y vs 50-51 y: 1.15 [95% CI: 1.03-1.28]; HRage 45-49 y vs 50-51 y: 1.11 [95% CI: 1.01-1.23]). Younger maternal age at first live birth (HRage <21 y vs 24-26 y: 1.42 [95% CI: 1.28-1.59]; HRage 21-23 y vs 24-26 y: 1.14 [95% CI: 1.03-1.26]) and at last live birth (HRage <26 y vs 29-31 y: 1.19 [95% CI: 1.07-1.33]) were associated with higher risk of HF. Compared to women with 1 or 2 children, having 3 or 4 children (HR: 1.09 [95% CI: 1.02-1.17]) or >4 children (HR: 1.24 [95% CI: 1.05-1.47]) was associated with higher HF risk. Experiencing miscarriages or abortions was not significantly associated with incident HF, whereas experiencing 1 stillbirth and recurrent stillbirths conferred a 20% and 43% larger risk of HF, respectively, compared to no stillbirth.

CONCLUSIONS

The findings emphasize the importance of female reproductive history in the assessment of HF risk.

Double burden of malnutrition and its associated factors among women in low and middle income countries: findings from 52 nationally representative data

BACKGROUND

Double burden of malnutrition (DBM) is an emerging global public health problem. The United Nations member states adopted eradicating all forms of malnutrition as an integral component of the global agenda. However, there is evidence of a high burden of undernutrition among women and rising rates of overweight and obesity, especially in low and middle income countries (LMICs). Therefore, this study aimed to investigate the prevalence and associated factors of underweight, overweight, and obesity among women of reproductive age in LMICs.

METHODS

Data for the study were drawn from a recent 52 Demographic and Health Surveys (DHS) conducted in LMICS. We included a sample of 1,099,187 women of reproductive age. A multilevel multinomial logistic regression model was used to identify factors associated with DBM. Adjusted relative risk ratio (RRR) with a 95% Confidence Interval (CI) was reported to show an association.

RESULTS

The prevalence of underweight, overweight, and obesity in LMICs among women of reproductive age was 15.2% (95% CI: 15.1-15.3), 19.0% (95% CI: 18.9- 19.1), and 9.1% (95% CI: 9.0-9.2), respectively. This study found that women aged 24-34 years, aged ≥ 35 years, with primary, secondary, and above educational level, from wealthy households, using modern contraceptives, exposed to media (radio and television), and with high parity (more than one birth) were more likely to have overweight and obesity and less likely to have underweight. Moreover, the risk of having obesity (RRR = 0.59; 95% CI = 0.58-0.60 and overweight (RRR = 0.78; 95% CI = 0.77-0.79) were lower among rural women, while the risk of being underweight was (RRR = 1.13; 95% CI = 1.11-1.15) higher among rural women compared to urban women.

CONCLUSION

The prevalence of underweight, overweight, and obesity was high among women of reproductive age in LMICs. Underweight, overweight, and obesity are influenced by sociodemographic, socioeconomic, and behavioral-related factors. This study shows that, in order to achieve Sustainable Development Goal 2, a multifaceted intervention approach should be considered to prevent both forms of malnutrition in women of reproductive age. This can be achieved by raising awareness and promoting healthy behaviors such as healthy eating and physical activity, especially among educated women, women from wealthy households, and women exposed to the media.

Parity and incident type 2 diabetes in older Chinese women: Guangzhou Biobank Cohort Study

This study examined the association between parity and incident type 2 diabetes in older Chinese women and estimated the mediation effect of adiposity indicators. A total of 11,473 women without diabetes at baseline from 2003 to 2008 were followed up until 2012. We used Cox proportional hazards regression to assess the association between parity and incident type 2 diabetes, and mediation analysis to estimate the mediation effect of adiposity indicators. Compared to women with one parity, the hazard ratio (HR) (95% confidence interval (CI)) for incident type 2 diabetes was 0.85 (0.44-1.63), 1.20 (1.11-1.30), 1.28 (1.16-1.41) and 1.27 (1.14-1.42) for women with parity of 0, 2, 3, and ≥ 4, respectively. The proportion of indirect effect (95% CI) mediated by body mass index, waist circumference, hip circumference, waist-to-hip ratio, waist-to-height ratio and body fat percentage was 26.5% (19.2-52.2%), 54.5% (39.4-108.7%), 25.1% (18.2-49.1%), 35.9% (25.6-74.1%), 50.3% (36.5-98.6%) and 15.1% (- 66.4 to 112.3%), respectively. Compared to women with one parity, women with multiparity (≥ 2) had a higher risk of incident type 2 diabetes and up to half of the association was mediated by abdominal obesity.

The association of parity number with multimorbidity and polypharmacy among Iranian women in the Azarcohort: a cross-sectional study

OBJECTIVE

We aimed to study the association of parity number with multimorbidity (MM) and polypharmacy among women in the Azar cohort population.

PATIENTS & METHODS

This cross-sectional investigation was based on data from the Azar Cohort Study. Information regarding demographics, personal habits, physical activity level, medical and reproductive history, and anthropometric measurements of 8,290 females (35-70 years) were evaluated. Ordinal logistic and logistic regression analyses were conducted to assess for associations of parity number with multimorbidity (MM), polypharmacy, chronic disease, and abdominal obesity.

RESULTS

More educated participants and people in the fifth quintile of the Wealth Score Index were less likely to have a higher parity number. With increasing parity numbers, the prevalence of MM, polypharmacy, hypertension, cardiovascular disease, fatty liver disease, stroke, rheumatoid diseases, chronic obstructive pulmonary disease, and cancers tended to rise. Moreover, we found that increasing parity numbers (especially when ≥ 5) enhanced the odds of abdominal obesity, waist-to-hip ratio ≥ 0.85, and waist-to-height ratio ≥ 0.5; these significant associations were more obvious in parity numbers ≥ 9 and WHtR ≥ 0.5.

CONCLUSION

The parity number is associated with MM and polypharmacy in Iranian women enrolled in the Azar Cohort Study. Further studies exploring the pathways (biological, social, and environmental) underlying these relationships will provide clues for preventing morbidity and premature mortality among susceptible andhighly parous women.

Retinal Venule Coverage by Pericytes Decreases in Multiparous Mice in a Time-Dependent Manner Post-Delivery

Structural changes in the retinal vasculature have been linked to increased cardiovascular risks and also change as a function of age. Because multiparity has been associated with poorer cardiovascular health scores, we hypothesized that changes in retinal vascular caliber would be observed in multiparous, compared to nulliparous, females and retired breeder males. Age-matched nulliparous (n = 6) and multiparous (n = 11, retired breeder females with 4 ± 1 litters), and male breeder (n = 7) SMA-GFP reporter mice were included for assessment of retinal vascular structure. Multiparous females had higher body mass, heart weight, and kidney weight compared to nulliparous mice, with lower kidney and higher brain weight compared to male breeders. There was no difference in number of retinal arterioles or venules, or arteriole or venule diameter among groups; however, venous pericyte density (number per venule area) decreased in multiparous vs. nulliparous mice and was negatively associated with the time since last litter and with age. Our results suggest that the time elapsed since delivery is an important factor to be considered in multiparity studies. Taken together, changes in vascular structure and potentially function, are time- and age-dependent. Ongoing and future work will determine whether structural changes are associated with functional consequences at the blood-retinal barrier.

Prevalence and Sociodemographic Profiles of Grand Multipara in Abu Dhabi, United Arab Emirates

The literature shows that grand multipara mothers are major contributors to poor maternal and perinatal health compared to multipara mothers. Data regarding parity profiles are essential, especially in rapidly transforming countries such as the United Arab Emirates (UAE). This study aimed to investigate the prevalence and factors associated with multipara mothers compared to multipara mothers in Abu Dhabi, UAE. The data were collected from seven health care centers located in Abu Dhabi.From1818 enrolled mothers, the prevalence of grand multipara was 135(7.4%, 95% Confidence Interval (CI) = 7.2, 7.6). In logistic regression analysis, factors associated positively with grand multipara were a higher maternal age (Adjusted Odd Ratio (AOR) = 1.28, 95% CI = 1.21, 1.34), Arab mothers (AOR = 5.66, 95% CI 2.81, 11.40), overweight pre-pregnancy (AOR = 2.01, 95% CI = 1.26, 3.21), and limited family support for breastfeeding (AOR = 2.05, 95% CI = 1.21, 3.50). The prevalence of grand multipara was low compared to previous researching the UAE. Sociodemographic factors were more prominent and associated with grand multipara mothers compared to obstetrical ones. Therefore, more programs (nutritional, physical activities, and psychosocial) are needed to improve maternal and perinatal health to support grand multipara mothers. Further, research is required to explore the difference in parity based on nationalities, especially from a sociocultural point of view.

Epidemiology of pre-pregnancy body mass index (BMI) among mothers in Abu Dhabi, the United Arab Emirates

Pre-pregnancy obesity is a risk factor for several health problems such as gestational diabetes, preeclampsia, labor induction, postpartum hemorrhage, and neonatal hypoglycemia. Being underweight is a risk factor for fetal growth restriction. Despite the negative impact of abnormal pre-pregnancy body mass index (BMI) (over and underweight) on pregnancy outcomes, a limited amount of studies has been conducted on the prevalence of pre-pregnancy over and underweight and associated factors in the United Arab Emirates (UAE). Thus, the aim of this study was to investigate the prevalence and factors associated with underweight, overweight, and obesity among mothers with children under the age of 2 years in Abu Dhabi, the UAE. A cross-sectional multicenter study was conducted in 2017 and included data from seven government health care centers in Abu Dhabi. Maternal pre-pregnancy BMI was calculated as the weight in kilograms (kg) divided by the square of the height in meters (m), (kg/m2). A total of 1,622 mother–child pairs were included in this study. Out of the 1,622 mothers, 43 (2.7%) were underweight, 1,068 (65.8%) were normal weight, 412 (25.4%) were overweight, and 99 (6.1%) were obese. Mothers with advanced maternal age (AMA) (≥35 years) were more likely to be overweight, odds ratio [OR] = 1.93, (95% confidence interval [CI] 1.52–2.3), p ≤ 0.001, and obese OR = 2.15 (95% CI 1.32–3.39), p = 0.001. Mothers with lower family income were more likely to be obese OR = 2.72 (95% CI 1.44–5.93), p = 0.002. Mothers with high parity (≥2) were more likely to be overweight OR = 1.91 (95% CI 1.49–2.50), p ≤ 0.001; obese OR = 1.76 (95% CI 1.06–2.92), p = 0.024; and less likely to be underweight OR = 0.52 (95% CI 0.27–0.94), p = 0.037. Obese mothers were more likely to deliver via cesarean section (CS) OR = 1.95 (95% CI 1.27–2.96), p = 0.002. This study provides valuable baseline information on the epidemiology of pre-pregnancy BMI in the UAE. The sociodemographic factors identified in the study can be used to target at-risk women. The study findings can also be used to develop contextualized strategies to prevent and manage complications associated with abnormal pre-pregnancy BMI in Emirati women.

Inequalities in overweight and obesity among reproductive age group women in India: evidence from National Family Health Survey (2015-16)

Background

In developing nations like India, fertility and mortality have decreased, and diseases related to lifestyle have become more common. Females in India are more prone to being overweight and obese than their male counterparts, more specifically in affluent families than the poor ones. Understanding the overweight and obesity trend may help develop feasible public health interventions to reduce the burden of obesity and associated adverse health outcomes.

Methods

The study utilizes the fourth round of the National Family Health Survey (NFHS-4), 2015–16. Descriptive statistics, bivariate and multivariate analysis was used to check the significant relationship between overweight and obesity, and other background characteristics. Income-related inequality in overweight and obesity among women was quantified by the concentration index and the concentration curve. Further, Wagstaff decomposition analysis was done to decompose the concentration index, into the contributions of each factor to the income-related inequalities.

Results

Overweight & obesity among women had a significant positive association with their age and educational level. The odds of overweight and obesity were 57% more likely among women who ever had any caesarean births than those who did not [AOR: 1.57; CI: 1.53–1.62]. The likelihood of overweight and obesity was 4.31 times more likely among women who belonged to richest [AOR: 5.84; CI: 5.61–6.08] wealth quintile, than those who belonged to poor wealth quintile. Women who ever terminated the pregnancy had 20% higher risk of overweight and obesity than those who did not [AOR: 1.20; CI: 1.17–1.22]. The concentration of overweight and obesity among women was mostly in rich households of all the Indian states and union territories. Among the geographical regions of India, the highest inequality was witnessed in Eastern India (0.41), followed by Central India (0.36).

Conclusion

The study results also reveal a huge proportion of women belonging to the BMI categories of non-normal, which is a concern and can increase the risks of developing non-communicable diseases. Hence, the study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status which can reduce the risks of health consequences due to overweight and obesity. Development nutrition-specific as well as sensitive interventions can be done for mobilization of local resources that addresses the multiple issues under which a woman is overweight or obese.

Socioeconomic status and body mass index life course models: the 1993 Pelotas (Brazil) birth cohort

This article aims to assess the relationship between an individual's socioeconomic status over their life-course and their body mass index (BMI) at 22 years of age, according to the hypotheses generated by risk accumulation, critical period, and social mobility models. This was a population-based prospective study based on the Pelotas (Brazil) 1993 birth cohort. The risk accumulation, critical period, and social mobility models were tested in relation to a saturated model and compared with a partial F-test. After the best model was chosen, linear regression was carried out to determine the crude and adjusted regression coefficients of the association between socioeconomic status over the life-course and BMI at 22 years of age. The sample was comprised of 3,292 individuals (53.3% women). We found dose-response effect for both men and women, although the results were opposite. Among men, a lower score in socioeconomic status accumulation model led to a lower BMI average at 22 years of age; whereas among women, a lower score in socioeconomic status accumulation model caused an increase in BMI at 22 years of age.

Risk factors for overweight and obesity among women of reproductive age in Dar es Salaam, Tanzania

Background

Overweight and obesity have increased considerably in low- and middle-income countries over the past few decades, particularly among women of reproductive age. This study assessed the role of physical activity, nutrient intake and risk factors for overweight and obesity among women in Dar es Salaam, Tanzania.

Methods

We conducted a cross-sectional survey among 1004 women aged 15–49 years in the Dar es Salaam Urban Cohort Study (DUCS) from September 2018 to January 2019. Dietary intake was assessed using a food frequency questionnaire (FFQ). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) using metabolic equivalent tasks (MET). Modified poison regression models were used to evaluate associations between physical activity and nutrient intake with overweight/obesity in women, controlling for energy and other factors.

Results

The mean (±SD) age of study women was 30.2 (±8.1) years. Prevalence of overweight and obesity was high (50.4%), and underweight was 8.6%. The risk of overweight/obesity was higher among older women (35–49 vs 15–24 years: PR 1.59; 95% CI: 1.30–1.95); women of higher wealth status (PR 1.24; 95% CI: 1.07–1.43); and informally employed and married women. Attaining moderate to high physical activity (≥600 MET) was inversely associated with overweight/obesity (PR 0.79; 95% CI: 0.63–0.99). Dietary sugar intake (PR 1.27; 95% CI: 1.03–1.58) was associated with increased risk, and fish and poultry consumption (PR 0.78; 95% CI: 0.61–0.99) with lower risk of overweight/obesity.

Conclusion

Lifestyle (low physical activity and high sugar intake), age, wealth status, informal employment and marital status were associated with increased risk of overweight/obesity, while consumption of fish and poultry protein was associated with lower risk. The study findings underscore the need to design feasible and high-impact interventions to address physical activity and healthy diets among women in Tanzania.

Socio-demographic factors and health status of adults with disability in Enugu Metropolis, Nigeria

Background

Disability is a major determinant of impaired health and nutritional status. This study aims to assess the health and nutritional status of adults with disability and their relationship with socio-demographic factors.

Methods

A descriptive cross-sectional study of 323 adults with disability in support-centers/schools of disability in Enugu Metropolis, Nigeria was conducted. The participants' socio-demographic factors, behavioural characteristics and 24-hour dietary recall were recorded. Blood pressure and anthropometric measurements of height, weight, waist and hip circumference were obtained. The height and weight measurements of non-ambulatory participants were estimated from knee height and mid-arm circumference. Biochemical analyses of blood samples were also performed. Multiple logistic regression was used to assess the effect of socio-demographic factors on health and nutritional status.

Results

The participants consisted of females (59.3%) within the age of 20 to 30 years (59.1%). The major area of difficulty was in physical mobility (51.1%) and this occurred mostly in females (26.9%). The participants' mean daily intakes of calorie, protein and fat were below the recommended dietary allowances. The participants were overweight (49.2%), obese (4.6%), hypertensive (29.7%) and diabetic (12.1%). Dyslipidemia (81.8%), anemia (63.6%) and zinc deficiency (51.1%) were highly prevalent among the study group. Gender difference was observed in alcohol consumption (p=0.000), smoking habit (p=0.001), waist circumference (WC)(p=0.000), waist-hip-ratio (WHR) (p=0.000), triglyceride (p=0.026) and haemoglobin concentration (p=0.007). Being boarder was a positive predictor of overweight/obesity (OR= 2.974, 95% CI=1.449-6.104), abnormal WHR (OR=2.893, 95% CI = 1.073-7.801) and hypertension (OR=8.381, 95% CI=1.598-13.959). Female gender was associated with abnormal WC (OR=7.219, 95% CI=3.116-14.228) and WHR (OR=3.590, 95% CI=2.095-6.150) whereas older age-group was associated with overweight/obesity (OR=1.908, 95% CI=1.137- 3.202). Being employed was a negative predictor of hypertension.

Conclusion

Overweight/obesity, anemia, zinc deficiency and dyslipidemia were highly prevalent among persons living with disability in Enugu Metropolis.

Prevalence and factors associated with triple burden of malnutrition among mother-child pairs in India: a study based on National Family Health Survey 2015-16

BACKGROUND

Malnutrition in mothers as well as in children is a significant public health challenge in most of the developing countries. The triple burden of malnutrition is a relatively new issue on the horizon of health debate and is less explored among scholars widely. The present study examines the prevalence of the triple burden of malnutrition (TBM) and explored various factors associated with the TBM among mother-child pairs in India.

METHODS

Data used in this study were drawn from the fourth round of the National Family Health Survey (NFHS-IV) conducted in 2015-16 (N = 168,784). Bivariate and binary logistic regression analysis was used to quantify the results. About 5.7% of mother-child pairs were suffering from TBM.

RESULTS

Age of mother, educational status of the mother, cesarean section delivery, birth size of baby, wealth status of a household, and place of residence were the most important correlates for the triple burden of malnutrition among mother-child pairs in India. Further, it was noted that mothers with secondary education level (AOR: 1.15, CI 1.08-1.23) were having a higher probability of suffering from TBM, and interestingly the probability shattered down for mothers having a higher educational level (AOR: 0.90, CI 0.84-0.95). Additionally, mother-child pairs from rich wealth status (AOR: 1.93, CI 1.8-2.07) had a higher probability of suffering from TBM.

CONCLUSION

From the policy perspective, it is important to promote public health programs to create awareness about the harmful effects of sedentary lifestyles. At the same time, this study recommends an effective implementation of nutrition programs targeting undernutrition and anemia among children and obesity among women.

The association between parity and metabolic syndrome and its components in normal-weight postmenopausal women in China

BACKGROUND

Studies analyzing the association between parity and normal-weight metabolic syndrome (MetS) in postmenopausal women of normal weight remain limited, this study aimed to explore the association between parity and MetS among Chinese normal-weight postmenopausal women.

METHODS

In total, 776 normal-weight undiagnosed type 2 diabetes postmenopausal women who visited the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University for a routine health check-up between 1 January 2017 and 31 December 2019 were included in the cross-sectional study. All individuals had fully completed information records encompassing standardized electronic medical records, physical examinations, and biochemical measurements. Metabolic health was defined as fewer than 2 parameters of the MetS were present, in combination with normal weight. Continuous variables which were normally distributed were expressed as means and standard deviation. Comparisons among normally distributed continuous variables were made using one-way ANOVA while that among non-normal distribution parameters were made using Kruskal-Wallis. The association between parity and MetS was analyzed using multivariate logistic regression. All of the analyses were performed with SPSS statistical software (Version 23.0, SPSS, Inc., Chicago, IL, USA) and the statistical software package EmpowerStats ( http://www.empowerstats.com , X&Y Solutions, Inc., Boston, MA).

RESULTS

After adjusting for potential confounding factors including hip circumference, parity was failed to show a significantly relationship with MetS in normal-weight women(P=0.054). Women with a higher parity (≥3) had an increased OR of abdominal obesity, while the OR (95% CI) of the parity 3 group was 2.06 (1.13, 3.77) and that of the parity ≥4 group was 3.08(1.42, 6.66) the P for trend was 0.002 after adjusting for potential confounding factors. No significant differences were detected for other metabolic disorders including high levels of triglycerides (TG), blood pressure, fasting plasma glucose (FPG), and decreased high-density lipoprotein cholesterol (HDL-C) in different parity groups.

CONCLUSIONS

Higher parity was not associated with a higher risk of MetS in normal weight Chinese postmenopausal women. As for the components of MetS, only waist circumference was associated with multiparity even after controlling for hip circumference.

Association of maternal urinary concentration of parabens and neonatal anthropometric indices

PURPOSE

Parabens are used as preservatives in a wide range of products. Although parabens are generally known as safe, but recent evidences indicate that these compounds could lead to potential adverse effects on fetal growth. Thus, this study aimed to investigate the association between maternal parabens level in a sample of Iranian pregnant women with neonatal anthropometric measures.

METHODS

This cross-sectional study was conducted in 2018-2019 in Isfahan city, Iran. Early morning urine samples were collected from 117 pregnant women who were in their first trimester of pregnancy. The urinary concentrations of four parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) were measured by gas chromatography-mass spectrometry. To compensate for variation in urine dilution, the paraben concentrations were adjusted by the creatinine levels. Associations between maternal parabens level and neonatal anthropometric indices were evaluated.

RESULTS

The MeP, EtP, PrP, and BuP were detected in %92, %36, %65, and %89 of the urine samples, respectively. No significant association was observed between maternal parabens level and birth length (p-value>0.05). In adjusted model, the BuP concentration in first trimester urine samples showed significantly negative association with head circumference in female neonates [β = -0.013, 95% CI: -0.024, -0.003], while positive significant association with that index in male neonates [β = 0.019, 95% CI: 0.001, 0.038]. In subgroup analysis by sex, in crude and adjusted analyses BuP was found to be only associated with higher birth weight in female neonates. PrP also showed significant positive association with head circumference and birth weight of male neonates in crude analysis.

CONCLUSION

Findings of this study on the association of urinary parabens of pregnant mothers with birth weight and head circumference suggest that maternal exposure to parabens might impact the fetal growth, However, these findings are based on cross-sectional data, thus the results should be interpreted with caution. The current findings underscore the necessity of providing more strict regulations in industries for limiting parabens use in their products, and the importance of public education for women of reproductive age for using paraben-free compounds.

Association between parity and obesity: a cross sectional study on 6,447 Iranian females

Background

The aim of this study was to determine the relationship between parity and obesity in Iranian women.

Methods

In a cross-sectional study, a total of 6447 urban women aged 40-65 were studied. Parity(number of full-term births), age at menarche, menopausal status, age, height, weight, marital status, education level and occupation were gathered by a checklist. Body Mass Index (BMI) was calculated. Statistical associations between parity and obesity using multiple logistic regression model were examined.

Results

The mean age of the enrolled women was 48.40 ± 6.13 years. The mean BMI was 27.55 ± 4.47 kg/m². Of the total participants enrolled, 3517 (54.55%) had < 3 parities, while 2930 (45.44%) had ≥ 3 parities. The prevalence of obesity (BMI ≥ 30 kg/m²) and overweight (30 > BMI ≥ 25) was 27.50 % (95% CI 26.85-28.15) and 43.70% (95% CI 42.98-44.42), respectively. After adjustment for potential confounders, women with ≥ 3 parities were at higher risk of being obese (OR 1.19, 95% CI 1.05-1.35).

Conclusion

There was a statistically significant positive association between higher parity and obesity. It is recommended that health policymakers plan appropriate weight loss programs for postpartum.

Change in nutritional status among women of childbearing age in India (1998-2016)

Introduction

In absolute numbers, India has more undernourished people than all the countries in sub‐Saharan Africa combined. In parallel with the high rates of hunger and undernutrition, the country has been undergoing rapid demographic and dietary transition marked by an increased prevalence of overweight/obesity, particularly among women.

Objective

To measure the changing prevalence of overnutrition during last two decades, as well as to identify the associated sociodemographic correlates among pregnant and non‐pregnant women in India.

Methods

This was a cross‐sectional study based on data from the latest round of National Family Health Survey (2015–2016) conducted among urban and rural women. Participants were 687,876 women (655,850 non‐pregnant and 32,026 pregnant) aged between 15 and 49 years. Nutritional status was assessed in terms of body mass index (BMI) using the cut‐off for Asian population.

Results

Since 1998–1999, the prevalence of underweight has decreased by 9.2%, while that of overweight (BMI = 23–27.4 kg/m²) and obesity (BMI ≥ 27.5 kg/m²) has increased by 6.7% and 3.4%, respectively. Results of multivariable regression analysis revealed significant association between nutritional status and age, parity residency, educational level, religious affiliation, household wealth quintile, and TV watching behaviour. Of those, age and wealth status appeared to be the strongest predictors among both pregnant and non‐pregnant women.

Conclusion

Since 1998, there has been a considerable drop in the prevalence of underweight and rise in the prevalence of overweight and obesity. Significant sociodemographic variations exist in nutritional status, notably age and financial situation, which should be highlighted in national nutrition policymaking and intervention programmes.

Education and prevalence of overweight and obesity among reproductive age group women in Ethiopia: analysis of the 2016 Ethiopian demographic and health survey data

Background

Globally, the prevalence of overweight and obesity is escalating, particularly among women and wealthier people. In many developed countries, overweight and obesity are more prevalent in persons with lower socioeconomic status. In contrast, studies in developing countries have reported a higher prevalence rate of overweight and obesity among women with higher educational status. Hence, this study aimed to assess the association between education and the prevalence of overweight and obesity among reproductive age group women in Ethiopia.

Methods

This cross-sectional study was done based on the 2016 Ethiopian demographic and health survey (EDHS) data. From the total 15,683 women participants of the 2016 EDHS, 2848 reproductive age group women aged 15–49 years old who had a complete response to all variables of interest were selected and retained for analysis. Data were analyzed using SPSS version 20 software program. Both descriptive and logistic regression models were used for analysis.

Results

The prevalence of overweight and obesity among the study participants was 11.5 and 3.4% respectively. The combined prevalence of overweight and obesity was 14.9%. From the total participants who are overweight and, or obese, majority, 83.3% were urban dwellers and the remaining 16.7% were rural dwellers. Education was positively associated with overweight and obesity among women. Besides, increased age, region, living in urban areas, being in rich quintile, increased frequency of watching television, and frequency of using internet were significantly associated with the odds of being overweight and obese among reproductive age group women in Ethiopia.

Conclusions

The prevalence of overweight and obesity among reproductive age group women in Ethiopia is increasing compared to previous studies. Education was found to be a risk factor for overweight and obesity among women. Hence, context based interventions on the prevention and control methods of overweight and obesity are required.

Marital status and the prevalence of obesity in a Korean population

OBJECTIVE

Previous studies have reported on marital status and the prevalence of obesity; however, few studies have assessed the prevalence of underweight in relation to marital status. This study aimed to explore the association of obesity and abdominal obesity with marital status among Koreans aged 40-69 years.

METHODS

We selected a total of 137,608 participants from the Health Examinees Gem Study for the final analysis. Multinomial logistic regression models were used to estimate odds ratios (OR) and their 95% confidence intervals (CI) for the association of obesity with marital status, with controlling for potential confounders.

RESULTS

The prevalence of underweight was higher in unmarried men (OR: 1.82, 95% CI: 1.25-2.63) and women (OR: 2.16, 95% CI: 1.79-2.61) than in married individuals. Compared to married individuals, a lower prevalence of BMI≥25kg/m² was observed for those who were unmarried (men: OR: 0.71, 95% CI: 0.62-0.81, women: OR: 0.65, 95% CI: 0.58-0.73) or divorced/separated (men: OR: 0.80, 95% CI: 0.69-0.93, women: OR: 0.90, 95% CI: 0.83-0.98). Interestingly, widowed women showed higher prevalence of BMI≥25kg/m² (OR: 1.17, 95% CI: 1.10-1.25) and abdominal obesity (OR: 1.23, 95% CI: 1.16-1.30) compared to married women, and the association persisted only among women in their 50s and 60s.

CONCLUSIONS

Married participants showed a higher prevalence of obesity and abdominal obesity than those in other marriage categories except for widowed women.

Socioeconomic status throughout life and body mass index: a systematic review and meta-analysis

This article aimed to systematically review the association between socioeconomic status according to the life course models and the body mass index (BMI) in adults. A review was performed following the guidelines of the PRISMA. The studies were identified in the MEDLINE/PubMed, LILACS and Web of Science databases. The eligible articles investigated the association between at least one life course model (risk accumulation, critical period or social mobility) and BMI. In order to assess the quality of the selected articles, the NOS checklist was applied to each study. Eleven articles were selected for the systematic review, and seven articles were selected for the meta-analysis. The average score and the median in the NOS checklist were 6.4, within a maximum possible score of 8 points. The most used model was social mobility. Regarding meta-analysis, there was association between lower life course socioeconomic status and BMI among women. BMI mean difference (MD) was higher among those who remained with low socioeconomic status throughout life when compared with those who maintained a high socioeconomic status (MD: 2.17, 95%CI: 1.48; 2.86). Before that, the BMI MD was higher among those with upward mobility, compared with those who maintained a high socioeconomic status throughout life (MD: 1.20, 95%CI: 0.73; 1.68). The risk of overweight was also higher among women who maintained low socioeconomic status (summary RR: 1.70, 95%CI: 1.05; 2.74); however, according to the GRADE, the studies presented very low quality evidence. For men, no association was observed. Having low socioeconomic status sometime during life is associated with higher BMI in adulthood.

Trends in maternal prepregnancy body mass index (BMI) and its association with birth and maternal outcomes in California, 2007-2016: A retrospective cohort study

OBJECTIVE

To determine recent trends in maternal prepregnancy body mass index (BMI) and to quantify its association with birth and maternal outcomes.

METHODS

A population-based retrospective cohort study included resident women with singleton births in the California Birth Statistical Master Files (BSMF) database from 2007 to 2016. There were 4,621,082 women included out of 5,054,968 women registered in the database. 433,886 (8.6%) women were excluded due to invalid or missing information for BMI. Exposures were underweight (BMI < 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥ 30 kg/m2) at the onset of pregnancy. Obesity was subcategorized into class I (30.0-34.9 kg/m2), class II (35.0-39.9 kg/m2), and class III (≥ 40 kg/m2), while adverse outcomes examined were low birth weight (LBW), very low birth weight (VLBW), macrosomic births, preterm birth (PTB), very preterm birth (VPTB), small-for-gestational-age birth (SGA), large-for-gestational-age birth (LGA), and cesarean delivery (CD). Descriptive analysis, simple linear regression, and multivariate logistic regression were performed, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for associations were estimated.

RESULTS

Over the ten-year study period, the prevalence of underweight and normal weight women at time of birth declined by 10.6% and 9.7%, respectively, while the prevalence of overweight and obese increased by 4.3% and 22.9%, respectively. VLBW increased significantly with increasing BMI, by 24% in overweight women and by 76% in women with class III obesity from 2007 to 2016. Women with class III obesity also had a significant increase in macrosomic birth (170%) and were more likely to deliver PTB (33%), VPTB (66%), LGA (231%), and CD (208%) than women with a normal BMI. However, obese women were less likely to have SGA infants; underweight women were 51% more likely to have SGA infants than women with a normal BMI.

CONCLUSIONS

In California from 2007 to 2016, there was a declining trend in women with prepregnancy normal weight, and a rising trend in overweight and obese women, particularly obesity class III. Both extremes of prepregnancy BMI were associated with an increased incidence of adverse neonatal outcomes; however, the worse outcomes were prominent in those women classified as obese.

Prevalence and factors associated with underweight, overweight and obesity among women of reproductive age in India

INTRODUCTION

Although the prevalence of underweight is declining among Indian women, the prevalence of overweight/obesity is increasing. This study examined the prevalence and factors associated with underweight and overweight/obesity among reproductive-aged (i.e., 15-49 years) women in India.

METHODS

This cross-sectional study analyzed data from the 2015-16 National Family Health Survey. The Asian and World Health Organization (WHO) recommended cutoffs for body mass index (BMI) were used to categorize body weight. The Asian and WHO BMI cutoffs for combined overweight/obesity were ≥ 23 and ≥ 25 kg/m2, respectively. Both recommendations had the same cutoff for underweight, < 18.5 kg/m2. After prevalence estimation, logistic regression was applied to investigate associated factors.

RESULTS

Among 647,168 women, the median age and BMI was 30 years and 21.0 kg/m2, respectively. Based on the Asian cutoffs, the overall prevalence of underweight was 22.9%, overweight was 22.6%, and obesity was 10.7%, compared to 15.5% overweight and 5.1% obesity as per WHO cutoffs. The prevalence and odds of underweight were higher among young, nulliparous, contraceptive non-user, never-married, Hindu, backward castes, less educated, less wealthy, and rural women. According to both cutoffs, women who were older, ever-pregnant, ever-married, Muslims, castes other than backwards, highly educated, wealthy, and living in urban regions had higher prevalence and odds of overweight/obesity.

CONCLUSION

The prevalence of both non-normal weight categories (i.e., underweight and overweight/obesity) was high. A large proportion of women are possibly at higher risks of cardiovascular and reproductive adverse events due to these double nutrition burdens. Implementing large-scale interventions based on these results is essential to address these issues.

Number of children and body composition in later life among men and women: Results from a British birth cohort study

BACKGROUND

Although research has found associations between increasing number of children and higher body mass index (BMI), there has been limited research investigating the association with body composition despite abdominal fat being independently associated with cardiovascular and metabolic risk. Most existing research has focussed on women, but investigating the relationship in men can help distinguish biological effects of pregnancy from social pathways related to parenthood.

METHODS

Using the MRC National Survey of Health and Development (NSHD) multiple regression models were applied to test associations between number of children and body composition at age 60-64 years (N = 2229) and body mass index (BMI) and waist circumference (WC) at ages 60-64 and 69 years (N = 2149).

RESULTS

In adjusted models, associations were observed between increasing numbers of children and increasing fat-adjusted lean mass index in women (p = 0.06). Among men, those with children had 0.59kg (95% CI: 0.15 to 1.02) greater lean mass index than those without and fat:lean mass ratio was greater in those with 4+ children because of their slightly higher mean fat mass. Weak evidence of a higher android:gynoid mass ratio among mothers (0.03, 95% CI: 0.00,0.06, p = 0.1) was observed with no associations with fat mass index,android or gynoid fat mass. Increasing parity in women was associated with increasing BMI at 60-64 years and, more strongly, with increasing BMI at 69 years. Associations among men were also observed more clearly with BMI at 69 years.

CONCLUSION

There was little evidence of a consistent association between number of children and body composition in early old age. The strongest associations are observed for lean, rather than fat mass, and in men rather than women, suggesting little evidence of biological effects of pregnancy. The results indicate social pathways associated with parenthood are the likely underlying mechanisms, with suggestion of selection into parenthood among men.

The relationships between timing of first childbirth, parity, and health-related quality of life

PURPOSE

A few studies have investigated the relationship between age at first childbirth and health-related quality of life (HRQoL). This study examined the relationship between age at first childbirth and HRQoL and whether parity mediates this timing of the first childbirth-HRQoL relationship in women aged 50 years or above.

METHODS

The study population included 5146 parous women ≥ 50 years in the cross-sectional survey, the Korea National Health and Nutrition Examination Survey 2010-2012. HRQoL was evaluated by the EuroQol five-dimensional descriptive system. Participants were grouped according to quartiles of age at first childbirth (ranges: 13-21, 22-23, 24-25, and 26-44 years). This study used linear regression analysis to examine the relationship between age at first childbirth and HRQoL and on each dimension. Mediation analysis was used to examine the contribution of age at first childbirth to HRQoL and to each dimension.

RESULTS

This study found the increasing pattern of HRQoL across quartiles of age at first childbirth (P for trend = 0.030). Odds of problems in self-care and anxiety/depression dimensions significantly increased across the quartiles. Women with later age at first childbirth tended to have better HRQoL (B = 0.352, P = 0.003); parity significantly contributed to this relationship. Decreasing parity accounted for 33.5% of the relationship between late first childbirth and increased HRQoL. Early age at first childbirth significantly increased odds of the mobility problem through increasing parity.

CONCLUSIONS

Women of an early age at first childbirth tended to have lower HRQoL through giving more deliveries. Our findings suggest that more attention needs to be given to women with early pregnancy and more delivery to prevent impaired HRQoL.