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Gupta RD, Haider SS, Eusufzai SZ, Hoque Apu E, Siddika N. Differences in Prevalence and Associated Factors of Underweight and Overweight/Obesity among Bangladeshi Adults by Gender: Analysis of a Nationally Representative Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710698. [PMID: 36078414 PMCID: PMC9517755 DOI: 10.3390/ijerph191710698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 05/23/2023]
Abstract
The objective of this study was to find the differences in prevalence and associated factors of underweight and overweight/obesity among Bangladeshi adults by gender, using the nationally representative Bangladesh Demographic and Health Survey 2017-2018 data. To identify the factors associated with underweight and overweight/obesity in both genders, multilevel multivariable logistic regression was conducted. The prevalence of underweight was 19.79% and 15.49% among males and females, respectively. The prevalence of overweight/obesity was 32.67% and 45.60% among males and females, respectively. Among both genders, participants with the highest likelihood of overweight/obesity were aged 30-49 years and 50-69 years, had the highest educational attainment up to primary and secondary level, resided in a household that belonged to the middle, richer, or richest wealth quintiles, and were currently married. On the other hand, among both genders, increased educational attainment and wealth index were inversely associated with being underweight. Health promotion programs in Bangladesh should focus on these high-risk groups to address the burden of underweight and overweight/obesity.
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Affiliation(s)
- Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Shams Shabab Haider
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Sumaiya Zabin Eusufzai
- Department of Biostatistics, School of Dental Sciences, University Sains Malaysia, Kota Bharu 16150, Malaysia
| | - Ehsanul Hoque Apu
- Department of Biomedical Engineering, Institute of Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nazeeba Siddika
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
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Mohanraj J, D’Souza UJA, Fong SY, Karkada IR, Jaiprakash H. Association between Leptin (G2548A) and Leptin Receptor (Q223R) Polymorphisms with Plasma Leptin, BMI, Stress, Sleep and Eating Patterns among the Multiethnic Young Malaysian Adult Population from a Healthcare University. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148862. [PMID: 35886710 PMCID: PMC9316401 DOI: 10.3390/ijerph19148862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023]
Abstract
Relative leptin resistance in childhood to absolute leptin resistance in maturity suggests sleep, eating behaviour, and the psychological state as probable causes. The current body of research provides inconclusive evidence linking G2548A and Q223R to obesity. Furthermore, we could find very little data that have observed the association between the environment and gene polymorphism, especially in the multiethnic population that exists in Malaysia. This study searched for a possible link between sleeping habits, eating behaviour, and stress indicators with plasma leptin and its genetic variation in young adult Malaysian healthcare students. The study involved 185 first- and second-year medical and dental students from a healthcare university. Polymerase Chain Reaction−Restriction Fragment Length Polymorphism(PCR-RFLP) determined the genotype, Enzyme Linked Immunoabsorbant Assay (ELISA) tested the serum leptin, and a self-administered questionnaire evaluated sleep, eating behaviour, and psychological condition. Gender and ethnicity are linked to fasting plasma leptin levels (p < 0.001). Plasma leptin also affects stress, anxiety, and sadness. Leptin (LEP) and Leptin Receptor (LEPR) polymorphisms were not associated with BMI, plasma leptin, sleep, eating behaviour, or psychological state. Young adult Malaysian Indians were obese and overweight, while Chinese were underweight. These findings imply overweight and obese participants were in stage I of leptin resistance and lifestyle change or leptin therapy could prevent them from becoming cripplingly obese as they age.
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Affiliation(s)
- Jaiprakash Mohanraj
- Department of Biochemistry, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia; or
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Urban J. A. D’Souza
- Department of Physiology, Father Muller College of Allied Health Sciences, Father Muller Medical College, Mangalore 575002, India;
| | - Siat Yee Fong
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
- Correspondence:
| | - Ivan Rolland Karkada
- Department of Physiology, Faculty of Medicine, MAHSA Universiti, Jenjarom 42610, Malaysia;
| | - Heethal Jaiprakash
- Department of Pharmacology, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia;
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Kassie Tesema A, Liyew AM, Alem AZ, Yeshaw Y, Tesema GA, Teshale AB. Spatial distribution and determinants of undernutrition among reproductive age women of Ethiopia: A multilevel analysis. PLoS One 2021; 16:e0257664. [PMID: 34543339 PMCID: PMC8452048 DOI: 10.1371/journal.pone.0257664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 09/07/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Malnutrition is one of the most devastating problems in Ethiopia and is inextricably linked with poverty. Women in the reproductive age group and children are most vulnerable to malnutrition due to low dietary intakes, inequitable distribution of food within the household, improper food storage and preparation, dietary taboos, infectious diseases, and care. Therefore, this study aimed to assess the spatial distribution and determinants of undernutrition among reproductive age of Ethiopia. METHODS The study was based on the 2016 Ethiopian Demographic and Health Survey. The study included a total sampled weight of 15,139 women aged 15-49 years. The ArcGIS version 10.7 and SaTScan version 9.6 statistical software were used for exploring the spatial distribution of undernutrition. A multilevel logistic regression model was fitted to determine the individual and community level factors associated with women undernutrition. Finally, the factors which were significant at 95% confidence interval were reported. RESULT The spatial analysis revealed that women undernutrition was significantly varied across the country. The SaTScan analysis identified a total of 144 significant hotspot areas of maternal undernutrition with three significant spatial windows. Of these, 134 clusters were primary. The primary spatial window was identified in the southeast Tigray, northwest Afar, central and north Amhara regions (LLR = 57.48, P<0.01, RR = 1.51). Age at first marriage (AOR = 1.57: CI 1.33, 1.99), middle wealth index (AOR = 3.15: CI 1.4, 6.97), rural residence (AOR = 2.82: CI 1.22, 6.52), being in Afar region, Tigray region and Harari region (AOR = 4.88: CI 1.71, 13.91), (AOR = 4.17: CI 1.57, 11.06) and (AOR = 3.01: CI 1.05, 8.68) respectively were significantly associated with women undernutrition. CONCLUSION In Ethiopia, undernutrition had significant spatial variations across the country. Residence, age at first marriage, wealth index and region were significantly associated with undernutrition. Therefore, public health interventions that reduce reproductive age women undernutrition and enhance women awareness towards undernutrition in hotspot areas of undernutrition is crucial.
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Affiliation(s)
- Ayenew Kassie Tesema
- Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Double burden of underweight and overweight among Indian adults: spatial patterns and social determinants. Public Health Nutr 2021; 24:2808-2822. [PMID: 33875031 PMCID: PMC9884774 DOI: 10.1017/s1368980021001634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study explores the spatial patterns of underweight and overweight among adult men and women in districts of India and identifies the micro-geographical locations where the risks of underweight and overweight are simultaneously prevalent, after accounting for demographic and socio-economic factors. DESIGN We relied on BMI (weight (kg)/height squared (m2)), a measure of nutritional status among adult individuals, from the 2015-2016 National Family and Health Survey. Underweight was defined as <18·5 kg/m2 and overweight as ≥25·0 kg/m2. SETTING We adopted Bayesian structured additive quantile regression to model the underlying spatial structure in underweight and overweight burden. PARTICIPANTS Men aged 15-54 years (sample size: 108 092) and women aged 15-49 years (sample size: 642 002). RESULTS About 19·7 % of men and 22·9 % of women were underweight, and 19·6 % of men and 20·6 % of women were overweight. Results indicate that malnutrition burden in adults exhibits geographical divides across the country. Districts located in the central, western and eastern regions show higher risks of underweight. There is evidence of substantial spatial clustering of districts with higher risk of overweight in southern and northern India. While finding a little evidence on double burden of malnutrition among population groups, we identified a total of sixty-six double burden districts. CONCLUSIONS The current study demonstrates that the geographical burden of overweight in Indian adults is yet to surpass that of underweight, but the coexistence of double burden of underweight and overweight in selected regions presents a new challenge for improving nutritional status and necessitates specialised policy initiatives.
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Williams AM, Guo J, Addo OY, Ismaily S, Namaste SML, Oaks BM, Rohner F, Suchdev PS, Young MF, Flores-Ayala R, Engle-Stone R. Intraindividual double burden of overweight or obesity and micronutrient deficiencies or anemia among women of reproductive age in 17 population-based surveys. Am J Clin Nutr 2020; 112:468S-477S. [PMID: 32743649 PMCID: PMC7396267 DOI: 10.1093/ajcn/nqaa118] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rising prevalence of overweight/obesity (OWOB) alongside persistent micronutrient deficiencies suggests many women face concomitant OWOB and undernutrition. OBJECTIVES We aimed to 1) describe the prevalence of the double burden of malnutrition (DBM) among nonpregnant women of reproductive age, defined as intraindividual OWOB and either ≥1 micronutrient deficiency [micronutrient deficiency index (MDI) > 0; DBM-MDI] or anemia (DBM-anemia); 2) test whether the components of the DBM were independent; and 3) identify factors associated with DBM-MDI and DBM-anemia. METHODS With data from 17 national surveys spanning low- and middle-income countries (LMICs) and high-income countries from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia project (n = 419 to n = 9029), we tested independence of over- and undernutrition using the Rao-Scott chi-square test and examined predictors of the DBM and its components using logistic regression for each survey. RESULTS Median DBM-MDI was 21.9% (range: 1.6%-39.2%); median DBM-anemia was 8.6% (range: 1.0%-18.6%). OWOB and micronutrient deficiencies or anemia were independent in most surveys. Where associations existed, OWOB was negatively associated with micronutrient deficiencies and anemia in LMICs. In 1 high-income country, OWOB women were more likely to experience micronutrient deficiencies and anemia. Age was consistently positively associated with OWOB and the DBM, whereas the associations with other sociodemographic characteristics varied. Higher socioeconomic status tended to be positively associated with OWOB and the DBM in LMICs, whereas in higher-income countries the association was reversed. CONCLUSIONS The independence of OWOB and micronutrient deficiencies or anemia within individuals suggests that these forms of over- and undernutrition may have unique etiologies. Decision-makers should still consider the prevalence, consequences, and etiology of the individual components of the DBM as programs move towards double-duty interventions aimed at addressing OWOB and undernutrition simultaneously.
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Affiliation(s)
| | - Junjie Guo
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - O Yaw Addo
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA,McKing Consulting Corporation, Atlanta, GA, USA
| | - Sanober Ismaily
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | | | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | | | - Parminder S Suchdev
- Department of Pediatrics, Emory University, Atlanta, GA, USA,Emory Global Health Institute, Atlanta, GA, USA,Division of Nutrition, Physical Activity and Obesity, US CDC, Atlanta, GA, USA
| | - Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Rafael Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, US CDC, Atlanta, GA, USA
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The double burden of malnutrition in under-five children at national and individual levels: observed and expected prevalence in ninety-three low- and middle-income countries. Public Health Nutr 2020; 24:2944-2951. [PMID: 32633230 PMCID: PMC7613087 DOI: 10.1017/s1368980020001226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective To assess whether the observed prevalence of the double burden of malnutrition (DBM) would be higher than expected on the basis of chance, through analyses at national, wealth quintile and individual child levels. Design We selected nationally representative surveys from low- and middle-income countries (LMIC) carried out since 2005 with anthropometric measures on children under 5 years of age. Household wealth was assessed through asset indices. The expected prevalence of DBM was estimated by multiplying the prevalence of stunting (low height/length for age) and overweight (high weight for height/length). The WHO recommended cut-offs (20% for stunting and 10% for overweight) that were used to define DBM at national level. DBM at individual level was defined as co-occurrence of stunting and overweight in the same child. Setting Nationally representative surveys from ninety-three LMIC. Participants A total of 825 633 children were studied. Results DBM at national level was observed in five countries, whereas it would be expected to occur in eleven countries. Six countries did not present evidence of DBM at national level but did so in at least one wealth quintile. At individual level, thirty countries (32·3%) showed higher prevalence of DBM than would be expected, but most differences were small except for Syria, Azerbaijan, Albania and Egypt. Conclusions The observed number of countries or socio-economic subgroups within countries with the DBM using recommended thresholds was below what would be expected by chance. However, individual-level analyses showed that one-third of countries presented higher prevalence of DBM than would be expected.
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Bhargava M, Bhargava A, Ghate SD, Rao RSP. Nutritional status of Indian adolescents (15-19 years) from National Family Health Surveys 3 and 4: Revised estimates using WHO 2007 Growth reference. PLoS One 2020; 15:e0234570. [PMID: 32569312 PMCID: PMC7307767 DOI: 10.1371/journal.pone.0234570] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The National Family Health Surveys (NFHS) in India apply adult cutoffs of nutritional status for the estimation of undernutrition/overweight in the 15-19 age group. The prevalence of thinness in boys and girls thus estimated is 58.1% and 46.8% in NFHS-3, and 45% and 42% in NFHS-4 respectively. But the WHO recommends using age and sex-specific reference for adolescents. We reanalyzed the nutritional status of the adolescents using the WHO 2007 Growth Reference to obtain revised estimates of thinness, overweight and stunting across states, rural-urban residence, and wealth quintiles. METHODS AND FINDINGS Demographic information, anthropometric data, and wealth index were accessed from the Demographic and Health Survey (DHS) database. We re-analyzed the anthropometric data using WHO AnthroPlus software which uses the WHO 2007 Growth reference. The revised estimates of thinness assessed by BMI-for-age z-scores in boys and girls was 22.3% (95%CI: 21.6, 23.0) and 9.9% (95%CI: 9.5, 10.3) in NFHS-3 and 16.5% (95%CI: 16.0,17.0) and 9% (95%CI: 8.9, 9.2) in NFHS-4 respectively. Stunting was found to be 32.2% (95% CI: 31.6, 32.9) in boys and 34.4% (95% CI: 34.2, 34.7) in girls in NFHS-4. This was higher than that in NFHS-3; 25.2% (95% CI: 24.4, 26) in boys and 31.2 (95% CI: 30.6, 31.8) in girls. There was a clear socioeconomic gradient as there were higher thinness and stunting in rural areas. There was wide variation among the states with pockets of a double burden of malnutrition. CONCLUSION Using the adult cutoffs significantly overestimates thinness in adolescents in the age group of 15-19 years old in India. Stunting, which is an indicator of long term nutrition is also widely prevalent in them. Future editions of DHS and NFHS should consider adolescents as a separate age group for nutritional assessment for a better understanding of nutritional transition in the population.
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Affiliation(s)
- Madhavi Bhargava
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- * E-mail:
| | - Anurag Bhargava
- Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- Department of General Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Sudeep D. Ghate
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - R. Shyama Prasad Rao
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
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Thompson AL, Nicholas KM, Watson E, Terán E, Bentley ME. Water, food, and the dual burden of disease in Galápagos, Ecuador. Am J Hum Biol 2020; 32:e23344. [PMID: 31642150 PMCID: PMC7114884 DOI: 10.1002/ajhb.23344] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Rapid development in low- and middle-income countries (LMIC) has led to changes in diet that have outpaced water and sanitation improvements, contributing to a dual burden of overweight and noncommunicable disease risk factors (OWT/NCD) and undernutrition and infectious disease symptoms (UND/ID) within individuals and households. Yet, little work has examined the joint impact of water and food exposures on the development of the dual burden. METHODS We use data from Ecuador's nationally representative Encuesta Nacional de Salud y Nutrición (ENSANUT-ECU) to test whether water access and quality and diet quality and security are associated with OWT/NCD and UND/ID among 1119 children and 1582 adults in Galápagos. Adjusted multinomial and logistic models were used to test the separate and joint associations between water and food exposures and the dual burden and its components at the individual and household levels. RESULTS The prevalence of the dual burden of OWT/NCD and UND/ID was 16% in children, 33% in adults, and 90% in households. Diet quality was associated with a higher risk of dual burden in individuals and households. Mild food insecurity was positively associated with the risk of dual burden at the household level. No water variable separately predicted the dual burden. Joint exposure to poor water access and food insecurity was associated with greater odds of dual burden in households. CONCLUSION Our results suggest that unhealthy diets and poor water quality contribute to the dual burden at the individual and household levels. Addressing both food and water limitations is important in LMIC.
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Affiliation(s)
- Amanda L Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Khristopher M Nicholas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elijah Watson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Enrique Terán
- Colegio de Ciencias de la Salud, Universidad de San Francisco Quito, Quito, Ecuador
- Galapagos Science Center, San Cristobal, Ecuador
| | - Margaret E Bentley
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Biswas T, Magalhaes RJS, Townsend N, Das SK, Mamun A. Double Burden of Underweight and Overweight among Women in South and Southeast Asia: A Systematic Review and Meta-analysis. Adv Nutr 2020; 11:128-143. [PMID: 31634389 PMCID: PMC7442413 DOI: 10.1093/advances/nmz078] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/08/2018] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
The double burden of malnutrition (DBM) is characterized by the coexistence of underweight and overweight individuals in a population. The objective of this study was to assess the level of DBM, as well as its main determinants, in women in South and Southeast Asia. We searched scientific literature databases, including PubMed, EMBASE, CINAHL, and Google Scholar; gray literature; and reference lists from primary research published between 1969 and September 30, 2017. In total, 128 studies met our inclusion criteria, representing data of ∼5 million women >15 y of age from South and Southeast Asia. The findings show that prevalence rates of underweight and overweight varied by study from 7.0% to 61.0% and 1.0% to 64.0%, respectively. For the total study period, the pooled prevalence of underweight and overweight was 28% (95% CI: 25%, 31%) and 17% (95% CI: 15%, 19%) in South Asia, respectively, and 20% (95% CI: 15%, 26%) and 20% (95% CI: 15%, 24%) in Southeast Asia, respectively. In both regions, underweight was more prevalent in rural areas, among women of the youngest age group (15-19 y), and among those in the poorest wealth quintile. In contrast, overweight was higher in urban areas, among women of older age, and among those in the wealthiest households. This study also found that prevalence of overweight has recently exceeded that for underweight in this population.
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Affiliation(s)
- Tuhin Biswas
- Institute for Social Science Research, University of Queensland, Indooroopilly, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, Australia
| | - R J Soares Magalhaes
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, University of Queensland, Gatton, Australia
- Children's Health and Environment Program, Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Nick Townsend
- Department for Health, University of Bath, Bath, United Kingdom
| | - Sumon Kumar Das
- Institute for Social Science Research, University of Queensland, Indooroopilly, Australia
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Child Health Division, Menzies School of Health Research, Tiwi, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, University of Queensland, Indooroopilly, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Indooroopilly, Australia
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Anik AI, Rahman MM, Rahman MM, Tareque MI, Khan MN, Alam MM. Double burden of malnutrition at household level: A comparative study among Bangladesh, Nepal, Pakistan, and Myanmar. PLoS One 2019; 14:e0221274. [PMID: 31419251 PMCID: PMC6697370 DOI: 10.1371/journal.pone.0221274] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The coexistence of overweight mother and stunted child at the same household is a type of Double Burden of Malnutrition at Household Level (DBMHL). This particular public health concern is now emerging at an alarming rate among most of the South Asian and its neighboring lower-and-middle income countries which are going through nutritional transition. This study has examined the prevalence rate and the risk factors of DBMHL along with the socio-economic inequality in DBMHL among Bangladesh, Nepal, Pakistan, and Myanmar. METHODS Latest Demographic and Health Survey datasets were used in this study. To identify the significant association of DBMHL with socio-demographic characteristics, a multivariate technique named as logistic regression model, and for measuring socio-economic inequalities in DBMHL prevalence, relative index of inequality (RII) and slope index of inequality (SII) were used. RESULTS The prevalence rates of DBMHL were 4.10% (urban: 5.57%, rural: 3.51%), 1.54% (urban: 1.63%, rural: 1.42%), 3.93% (urban: 5.62%, rural: 3.20%), and 5.54% (urban: 6.16%, rural: 5.33%) respectively in Bangladesh, Nepal, Pakistan, and Myanmar. The risk ratios (RR) obtained from RII for Bangladesh, Nepal, Pakistan and Myanmar were 1.25, 1.25, 1.14, and 1.09, respectively, and β coefficient from SII were 0.01, 0.004, 0.005, and 0.006 unit respectively. In addition to not breastfeeding [Bangladesh (AOR: 1.55; 95% CI: 1.11-2.15), Myanmar (AOR: 1.74; 95% CI: 1.02-2.95)], respondent's older age (in Bangladesh, Nepal, and Myanmar), child's older age (in Pakistan and Myanmar), and middle and rich groups of wealth-index (in Bangladesh and Pakistan) were strong risk factors for DBMHL. On the other hand, female child [Nepal (AOR: 0.50; 95% CI: 0.26-0.95), Pakistan (AOR: 0.58; 95% CI: 0.41-0.84)], higher education [in Pakistan], respondent not participated in decision making [in Bangladesh and Nepal] and media access [Nepal (AOR: 0.44; 95% CI: 0.20-0.98)] had negative association with DBMHL. CONCLUSION The DBMHL persists in all selected countries, with a higher prevalence in urban areas than in rural areas. In order to control the higher prevalence of DBMHL in urban areas, respective countries need urgent implementation of multisectoral actions through effective policies and empowering local communities.
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Affiliation(s)
- Asibul Islam Anik
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Mosfequr Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Mostafizur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Ismail Tareque
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Nuruzzaman Khan
- Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - M. Mahmudul Alam
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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Colozza D, Avendano M. Urbanisation, dietary change and traditional food practices in Indonesia: A longitudinal analysis. Soc Sci Med 2019; 233:103-112. [DOI: 10.1016/j.socscimed.2019.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/01/2019] [Accepted: 06/04/2019] [Indexed: 12/20/2022]
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Varghese JS, Stein AD. Malnutrition among women and children in India: limited evidence of clustering of underweight, anemia, overweight, and stunting within individuals and households at both state and district levels. Am J Clin Nutr 2019; 109:1207-1215. [PMID: 30882139 DOI: 10.1093/ajcn/nqy374] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/07/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In India, the prevalences of stunting and anemia have declined in the last decade, but continue to remain high in many regions, whereas those of overweight and obesity have increased in all age and socioeconomic groups. Determining whether these forms of malnutrition cluster is important for the development of appropriate interventions. OBJECTIVES Our objective was to describe the prevalence of a comprehensive list of dual burdens of malnutrition in individuals and households across the 36 states and 640 districts of India. METHODS We analyzed data from the National Family Health Survey-4, 2015-2016, including 655,156 women aged 15-49 y and 145,653 children aged 6-59 mo in India. We measured the coexistence of 19 combinations of women's anemia, underweight, and overweight and children's stunting, underweight, overweight, and anemia at the individual and household levels. We aggregated this information to the state (n = 36) and district (n = 640) levels. We examined whether the observed dual burden prevalence exceeded the expected prevalence, and whether any such excess was related to household wealth. RESULTS Of the 19 dual burdens examined, 8 had significant excess prevalence at the state level and 5 had significant excess prevalence at the district level. All but 1 of these instances reflected an excess dual burden of undernutrition as opposed to clustering of overweight with a form of undernutrition. Household wealth was not positively associated with any clustering of burdens. CONCLUSIONS While dual burdens of anemia, stunting, and underweight are prevalent, there is no evidence of clustering of overweight with other forms of malnutrition in India.
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Affiliation(s)
- Jithin Sam Varghese
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA
| | - Aryeh D Stein
- Hubert Department of Global Health, Emory University, Atlanta, GA
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Hunger and Obesity as Symptoms of Non-Sustainable Food Systems and Malnutrition. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9061062] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Among the great challenges the world faces are how to ensure food security for its growing population—projected to rise to around 10 billion by 2050—so it can meet their nutritional needs for a healthy life. Current regulations and literature on food security mainly focus on food quantity (i.e., portion sizes), daily calorie intake and methods for increasing food production and too little on food and diet quality and the holistic effects of (mal)nutrition. From a systems perspective, in order to promote innovation policies for more sustainable food systems, food security cannot be viewed independently; rather, it is characterized by the interplay of an extensive network of economic, environmental and social dimensions that should all be taken into account in a comprehensive resilient and sustainable global food system. Here, we highlight one aspect of this vast network that we consider a particular challenge—yet also a great opportunity—for innovative policies geared toward more sustainable food systems: the interplay of hunger and obesity, including resulting policy strategies beyond potential efficiency improvements in farming practices. Future studies need to emphasize the importance of an in-depth understanding of the interdependencies within the global food system and its interrelatedness with societal and natural systems as part of coupled human-environment systems and in the face of continuing population growth and food demand globally. Recommended strategies for achieving sustainable food security systems include innovative educational approaches and stakeholder-driven innovation policies based on mutual learning processes between society, science, industry and policymakers, as well as fostering increased responsibility of all members of society along the agriculture and food value chain.
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Ishikawa M, Yokoyama T, Sagehashi M, Kunugita N, Miura H. Diagnosing the double burden of malnutrition using estimated deviation values in low- and lower-middle-income countries. PLoS One 2018; 13:e0208525. [PMID: 30521645 PMCID: PMC6283532 DOI: 10.1371/journal.pone.0208525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/19/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To examine the possibility of diagnosing the double burden of malnutrition using estimated deviation values in low- and lower-middle-income countries. Methods A modified version of the Japanese Diagnostic Tool was used. Data on 194 countries were analyzed, including data from the United Nations International Children’s Fund, World Health Organization and World Bank. After conducting a Box–Cox transformation, deviation values were calculated. The degree to which the values deviated relative to a deviation cutoff value of 50 was assessed. Focusing on countries with low- and middle-income economic levels, we examined the utility of this tool to show characteristic nutritional problems in each country. Results The deviation values had normal, distorted, bimodal, or trimodal distributions. In the lower-middle-income countries, almost all countries had values ranging from 40 to 60 for education and water environments (urban and rural), and the differences were minimal. However, different causes of noncommunicable disease-related deaths were considered, and the primary cause appeared to be related to lifestyle factors, particularly alcohol consumption and tobacco smoking. In comparison, the deviation values related to death among low-income countries also appeared to be related to differences in education and sanitation in urban and rural areas. Conclusion The study results can help to determine the status of nutritional inequalities and plan country-specific strategies to reduce the double burden of malnutrition.
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Affiliation(s)
- Midori Ishikawa
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
- * E-mail:
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
| | - Masaki Sagehashi
- Department of Environmental Health, National Institute of Public Health, Saitama, Japan
| | - Naoki Kunugita
- Department of Environmental Health, National Institute of Public Health, Saitama, Japan
| | - Hiroko Miura
- Department of International Health and Collaboration, National Institute of Public Health, Saitama, Japan
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Heo J, Yu SY, Yi J, Nam YS, Son DT, Oh J, Lee JK. Wealth gradient-based divergence in the prevalence of underweight among women by marital status in Quoc Oai district, Vietnam. Glob Health Action 2018; 11:1449430. [PMID: 29589996 PMCID: PMC5912430 DOI: 10.1080/16549716.2018.1449430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The prevalence of underweight is high among women in Asian countries, despite nutritional changes in the region. Previous studies have demonstrated independent associations between female body weight, marital status and economic status. However, few studies have investigated possible interaction between marital and economic status in relation to Asian women’s body weight. Objective: This study aimed to test associations between household wealth, marital status and underweight among women living in the Quoc Oai district of Vietnam and to identify wealth–marital status interaction in relation to body weight in these women. Methods: Data from 1087 women aged 19–60 years were collected via a baseline community survey conducted in the Quoc Oai district of Hanoi, Vietnam, in 2016. Underweight was defined using an Asian-specific body mass index cut-off (<18.5 kg/m2). Marital status was dichotomized into ‘never married’ and ‘ever married.’ Economic status was measured using household wealth index quintiles. Multivariable logistic regressions tested association between wealth and underweight after adjusting for marital status and other confounders. An interaction term (wealth index*marital status) was fitted to determine whether the association between wealth and body weight is modified by marital status. Results: Our results show that underweight was independently associated with a wealth status (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.79–0.98, p = 0.026) and ever-married status (OR: 0.50, 95% CI: 0.34–0.75, p = 0.002). A significant interaction effect (OR: 0.67, 95% CI: 0.50–0.90, p = 0.010) indicated that wealthy married women were less likely to be underweight, whereas wealthy never-married women were more likely to be underweight. Conclusions: Our results suggest that the interaction between wealth and marital status has divergent effects on underweight among Asian women. Interventions to reduce underweight among Asian women should simultaneously consider economic and marital status.
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Affiliation(s)
- Jongho Heo
- a JW LEE Center for Global Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Soo-Young Yu
- b College of Nursing , Seoul National University , Seoul , Republic of Korea
| | - Jinseon Yi
- b College of Nursing , Seoul National University , Seoul , Republic of Korea
| | - You-Seon Nam
- a JW LEE Center for Global Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Dinh Thai Son
- c Institute for Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam
| | - Juhwan Oh
- a JW LEE Center for Global Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Jong-Koo Lee
- a JW LEE Center for Global Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
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Jones AD, Mundo‐Rosas V, Cantoral A, Levy TS. Household food insecurity in Mexico is associated with the co-occurrence of overweight and anemia among women of reproductive age, but not female adolescents. MATERNAL & CHILD NUTRITION 2017; 13:e12396. [PMID: 27966839 PMCID: PMC6865937 DOI: 10.1111/mcn.12396] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/31/2016] [Accepted: 10/03/2016] [Indexed: 12/12/2022]
Abstract
We aimed to determine the association between household food insecurity (HFI) and the co-occurrence of overweight and anemia among women of reproductive age in the Mexican population. We analyzed data on 4,039 nonpregnant female adolescents (15-19 years) and 10,760 nonpregnant adult women of reproductive age (20-49 years) from the 2012 National Health and Nutrition Survey of Mexico. The survey uses a two-stage sampling design, stratified by rural and urban regions. The Latin American and Caribbean Food Security Scale was used to assess HFI. We assessed overweight and obesity in women based on World Health Organization classifications for body mass index, and BMI-for-age Z-scores for female adolescents, and defined anemia as an altitude-adjusted hemoglobin (Hb) concentration < 120 g/L based on measurement of capillary Hb concentrations. In multiple logistic regression models adjusting for potential confounding covariates, HFI was not associated with the co-occurrence of anemia and overweight among female adolescents. The adjusted odds of women of reproductive age from mildly and moderately food-insecure households, respectively, experiencing concurrent anemia and overweight were 48% (OR: 1.48; 95% CI: 1.15, 1.91) and 49% (OR: 1.49; 95% CI: 1.08, 2.06) higher than among women from food-secure households. Severe HFI was not associated with concurrent overweight and anemia among female adolescents or women. HFI may be a shared mechanism for dual forms of malnutrition within the same individual, simultaneously contributing to overconsumption and dietary inadequacy.
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Affiliation(s)
- Andrew D. Jones
- School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
| | - Verónica Mundo‐Rosas
- Center of Nutrition and Health ResearchNational Institute of Public HealthMexico CityMexico
| | - Alejandra Cantoral
- CONACYT Research FellowNational Institute of Public HealthMexico CityMexico
| | - Teresa Shamah Levy
- Center of Nutrition and Health ResearchNational Institute of Public HealthMexico CityMexico
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Atsu BK, Guure C, Laar AK. Determinants of overweight with concurrent stunting among Ghanaian children. BMC Pediatr 2017; 17:177. [PMID: 28750614 PMCID: PMC5531099 DOI: 10.1186/s12887-017-0928-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition (undernutrition and overnutrition) is a major public health problem in Ghana –affecting growth and development of individuals and the nation. Stunting and overweight are of particular interest, as recent national surveys show a rising trend of overnutrition and stubbornly high burden of stunting among Ghanaian children. There are currently no data on the simultaneous occurrence of overweight and stunting within individuals in Ghana. This paper presents the burden, the individual-level, and contextual determinants of overweight with concurrent stunting among Ghanaian children. Methods This study analyzed data set of the fourth round of the Ghana Multiple Indicator Cluster Survey (MICS4). Bivariate analyses were used to describe selected characteristics of survey respondents and their children. Hierarchical modelling approach facilitated identification of significant distal, intermediate and proximal factors/determinants of concurrent stunting and overweight. Both crude and adjusted prevalence ratios via a multivariable Poison regression model with their corresponding 95% Confidence Intervals (CI) are reported. Variables with p ≤ 0.25 at the bivariate level were included in the multivariable analysis. An alpha value of 5% was used to indicate significance. Results Of 7550 cases (children) analyzed, the prevalence of stunting was 27.5%; underweight was 17.3%; and wasting was 7.7%. The prevalence of overweight and concurrent overweight and stunting were respectively 2.4% and 1.2%. Children who belonged to the fourth wealth quintile, were more likely to be overweight and concurrently stunted as against children belonging to the poorest quintile (aPR = 1.010; 95% CI, 1.003–1.017). Compared to religious (Christians/Muslim/Traditionalist) household heads, children whose household heads did not belong to any religion had 2 times the rates of the Overweight with concurrent stunting (PR = 2.024; 95% CI, 1.016–4.034). Children with mothers aged 20–34 and 35–49 had an increased though insignificant prevalence ratio of association (aPR = 1.001; 95% CI, 0.994–1.005) and (aPR = 1.001; 95% CI, 0.998–1.012) respectively. Conclusion This analysis determined the prevalence of concurrent stunting and overweight among Ghanaian children to be 1.2%. Four contextual variables (breastfeeding status, religion, geographic region, and wealth index quintile) were associated with overweight with concurrent stunting. We conclude that, only contextual factors are predictive of DBM among children under five living in Ghana.
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Affiliation(s)
- Benedicta K Atsu
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Chris Guure
- Department of Biostastics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Amos K Laar
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
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Kulkarni VS, Kulkarni VS, Gaiha R. "Double Burden of Malnutrition": Reexamining the Coexistence of Undernutrition and Overweight Among Women in India. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 47:108-133. [PMID: 27638762 DOI: 10.1177/0020731416664666] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
India has one of the highest rates of underweight burden, with signs of rising obesity. Coexistence of underweight and overweight persons is symptomatic of the "double burden of malnutrition." The present study throws new light on the "double burden of malnutrition" among Indian women in the age group 22-49 years. The analysis is based on a nationally representative household survey, India Human Development Survey. Our results indicate the continuing pattern of socioeconomic segregation of underweight and overweight/obese women, with a large concentration of underweight women among the low socioeconomic group and of overweight/obese women among the high socioeconomic group. Further, relative food prices of food items like cereals and vegetables are significantly associated with the risk of being underweight and overweight/obese. Additionally, we find notable rural/urban differences. The relationship between socioeconomic factors and the probability of being underweight and overweight/obese is stronger in urban than in rural areas. Given that the health implications of being underweight and overweight/obese are equally grim, provision of healthy food items at affordable prices and implementation of programs for preventive and curative care of plausible illnesses related to underweight and overweight/obese are imperative.
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Affiliation(s)
- Vani S Kulkarni
- University of Pennsylvania and Yale University, Philadelphia, Pennsylvania and New Haven, Connecticut, USA
| | | | - Raghav Gaiha
- Department of Global Health and Population, Boston, Massachusetts, USA
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Jones AD, Acharya Y, Galway LP. Urbanicity Gradients Are Associated with the Household- and Individual-Level Double Burden of Malnutrition in Sub-Saharan Africa. J Nutr 2016; 146:1257-67. [PMID: 27170726 DOI: 10.3945/jn.115.226654] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/17/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The nutrition transition is advancing throughout sub-Saharan Africa (SSA). However, the nutritional risk across urbanicity gradients associated with this transition is not clear. OBJECTIVES We aimed to determine 1) the extent to which overweight and anemia in women of childbearing age (WCBA) and stunting in preschool-age children (PSC) are spatially correlated within countries of SSA; and 2) the association of urbanicity with the individual-level nutritional double burden (i.e., concurrent overweight and anemia within an individual WCBA), the household-level double burden (i.e., overweight WCBA and stunted PSC in the same household), and the 3 components of these double burdens (i.e., overweight, anemia, and stunting). METHODS We used Demographic and Health Surveys (DHS) data for 30 countries in SSA from 2006-2012. We calculated overweight [body mass index (BMI; in kg/m(2)) ≥25] and anemia (hemoglobin concentration <120 g/L) in WCBA, and stunting in PSC aged 12-59 mo (height-for-age z score <-2). We used population density, measured using a high-resolution population distribution dataset, to define gradients of urbanicity. We used geolocated DHS data to calculate cluster-level mean population densities and the Moran's I statistic to assess spatial autocorrelation. RESULTS Cluster-level BMI values and hemoglobin concentrations for WCBA were spatially correlated. The odds of overweight in WCBA were higher in periurban and urban areas than in rural areas (periurban, OR: 1.08; 95% CI: 1.01, 1.16; urban, OR: 1.26; 95% CI: 1.18, 1.36), as were the odds of stunting in PSC in periurban areas (OR: 1.13; 95% CI: 1.06, 1.22). The odds of both double burden conditions were higher in periurban and urban areas than in rural areas (individual-level-periurban, OR: 1.18; 95% CI: 1.05, 1.33; urban, OR: 1.43; 95% CI: 1.27, 1.61; household-level-periurban, OR: 1.24; 95% CI: 1.06, 1.44; urban, OR: 1.24; 95% CI: 1.06, 1.46). CONCLUSION Urban and periurban areas in SSA may be particularly vulnerable to the nutritional double burden compared with rural areas. Clearly differentiating urban environments is important for assessing changing patterns of nutritional risk associated with the nutrition transition in SSA.
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Affiliation(s)
| | - Yubraj Acharya
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI; and
| | - Lindsay P Galway
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
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Maharani A, Tampubolon G. National Economic Development Status May Affect the Association between Central Adiposity and Cognition in Older Adults. PLoS One 2016; 11:e0148406. [PMID: 26863443 PMCID: PMC4749166 DOI: 10.1371/journal.pone.0148406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/16/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Obesity is becoming a global problem, rather than one found only in developed countries. Although recent studies have suggested a detrimental effect of obesity on cognition, studies of the relationship between obesity and cognition among older adults have been limited to developed countries. We aimed to examine the associations between central obesity, as measured by waist circumference, and cognition level in adults aged 50 years and older in England and Indonesia. METHODS We used linear regression models to analyse these associations and multiple imputation to manage missing data. The 2006 English Longitudinal Study of Ageing Wave 3 is the source of data from England, while data from Indonesia is sourced from the 2007 Indonesian Family Life Survey Wave 4. FINDINGS Centrally obese respondents had lower cognition levels than non-centrally obese respondents in England. In contrast, central adiposity had a statistically significant positive association with cognition in Indonesia. Higher levels of education and higher economic status were associated with higher cognitive ability, while age was associated with lower cognition in both countries. Elevated C-reactive protein (CRP) concentrations and smoking behaviour, both linked to higher risk of obesity, were negatively associated with cognitive ability among older adults in England, but they had no statistically significant association with cognition among Indonesians. INTERPRETATION The contradictory findings on obesity and cognition in England and Indonesia not only create a puzzle, but they may also have different policy implications in these countries. Reducing the prevalence of obesity may be the main focus in England and other developed countries to maintain older adults' cognition. However, Indonesia and other developing countries should place more emphasis on education, in addition to continued efforts to tackle the double burden of malnutrition, in order to prevent cognitive impairment among older adults.
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Affiliation(s)
- Asri Maharani
- Medical Faculty, Brawijaya University, Malang, Indonesia
- Cathie Marsh Institute for Social Research, University of Manchester, Humanities Bridgeford Street Building, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Gindo Tampubolon
- Cathie Marsh Institute for Social Research, University of Manchester, Humanities Bridgeford Street Building, Oxford Road, Manchester, M13 9PL, United Kingdom
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The double burden of malnutrition in Indonesia: Social determinants and geographical variations. SSM Popul Health 2015; 1:16-25. [PMID: 29349117 PMCID: PMC5757754 DOI: 10.1016/j.ssmph.2015.10.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 11/23/2022] Open
Abstract
The presence of simultaneous under- and over-nutrition has been widely documented in low- and middle-income countries, but global nutritional research has seen only a few large-scale population studies from Indonesia. We investigate the social determinants as well as the geographical variations of under- and over-nutrition in Indonesia using the largest public health study ever conducted in the country, the National Basic Health Research 2007 (N=645,032). Multilevel multinomial logistic regression and quantile regression models are fitted to estimate the association between nutritional status and a number of socio-economic indicators at both the individual and district levels. We find that: (1) education and income reduce the odds of being underweight by 10-30% but at the same time increase those of overweight by 10-40%; (2) independent from the compositional effect of poverty, income inequality is detrimental to population health: a 0.1 increase in the Gini coefficient is associated with an 8-12% increase in the odds of an individual׳s being both under- and overweight; and (3) the effects that these determinants have upon nutritional status are not necessarily homogeneous along the continuum of body mass index. Equally important, our analysis reveals that there is substantial spatial clustering of areas with elevated risk of under- or over-nutrition across the 17,000-island archipelago. As of 2007, under-nutrition in Indonesia remains a 'disease of poverty', while over-nutrition is one of affluence. The income inequality accompanying Indonesia׳s economic growth may aggravate the dual burden of under- and over-nutrition. A more equitable economic policy and a policy that improves living standards may be effective for addressing the double burden.
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Abstract
Many developing countries have achieved a remarkable improvement in nutrition status in the past decades. However, the prevalence of undernutrition remains a serious problem. At the same time, the prevalence of obesity is increasing substantially, and in some countries, it has approached that of developed countries. This article provides an update on this double burden of malnutrition (DBMN) in developing nations. One hundred countries (lower, middle-lower, and upper-middle income countries) were selected and analysed, and to support the analysis, a systematic review of current published studies was performed. The results show that DBMN already exists in almost all developing countries and that the DBMN ratio (i.e., overweight/underweight) has increased as income per capita has increased. DBMN may manifest within the community, household, or individual. In addition to common factors, poor nutrition in early childhood is suggested as another important driving factor behind the rising obesity rate in most developing countries. A life-course approach has been proposed to prevent undernutrition and overnutrition and should be integrated into the development of health systems to control double burden in developing countries.
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Affiliation(s)
- Asnawi Abdullah
- Department of Biostatistics and Population Health, Faculty of Public Health, University Muhammadiyah Aceh, Jln. Leung Bata, Batoh, Banda Aceh, Indonesia, 23245.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern East, Australia.
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Hoque ME, Long KZ, Niessen LW, Mamun AA. Rapid shift toward overweight from double burden of underweight and overweight among Bangladeshi women: a systematic review and pooled analysis. Nutr Rev 2015; 73:438-47. [DOI: 10.1093/nutrit/nuv003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Socio-economic influences on anthropometric status in urban South African adolescents: sex differences in the Birth to Twenty Plus cohort. Public Health Nutr 2015; 18:2998-3012. [PMID: 25757478 PMCID: PMC4611355 DOI: 10.1017/s1368980015000415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the associations of household and neighbourhood socio-economic position (SEP) with indicators of both under- and overnutrition in adolescents and to explore sex differences. DESIGN Analysis of anthropometric, household and neighbourhood SEP data from the Birth to Twenty Plus cohort born in 1990. Anthropometric outcomes were BMI (thinness, overweight and obesity) and percentage body fat (%BF; low, high). Associations between these and the household wealth index, caregiver education and neighbourhood SEP tertile measures were examined using binary logistic regression. SETTING Johannesburg-Soweto, South Africa. SUBJECTS Adolescents aged 17-19 years (n 2019; 48·2% men). RESULTS Women had a significantly higher combined prevalence of overweight/obesity (26·2%) than men (8·2%) whereas men had a significantly higher prevalence of thinness than women (22·2% v. 10·6%, respectively). Having a low neighbourhood social support index was associated with higher odds of high %BF in women (OR=1·59; 95% CI 1·03, 2·44). A low household wealth index was associated with lower odds of both overweight (OR=0·31; 95% CI 0·12, 0·76) and high %BF in men (OR=0·28; 95% CI 0·10, 0·78). A low or middle household wealth index was associated with higher odds of being thin in men (OR=1·90; 95% CI 1·09, 3·31 and OR=1·80; 95% CI 1·03, 3·15, respectively). For women, a low household wealth index was associated with lower odds of being thin (OR=0·49; 95% CI 0·25, 0·96). CONCLUSIONS The study highlights that even within a relatively small urban area the nutrition transition manifests itself differently in men and women and across SEP indicators. Understanding the challenges for different sexes at different ages is vital in helping to plan public health services.
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Singh PN, Arthur KN, Orlich MJ, James W, Purty A, Job JS, Rajaram S, Sabaté J. Global epidemiology of obesity, vegetarian dietary patterns, and noncommunicable disease in Asian Indians. Am J Clin Nutr 2014; 100 Suppl 1:359S-64S. [PMID: 24847857 PMCID: PMC4144108 DOI: 10.3945/ajcn.113.071571] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
An increase in noncommunicable disease (NCD) in India has been attributed to an epidemiologic transition whereby, due to urbanization, there is an increase in traditional cardiovascular disease risk factors such as obesity. Accumulated biomarker data on the "Asian Indian phenotype" identify central obesity, which occurs at a lower body mass index (BMI), as a particularly potent risk factor in Asian Indians. A revised WHO case definition for obesity in India [BMI (in kg/m(2)) >25] has identified an obesity epidemic that exceeds 30% in some cities and rivals that in Western nations. This review summarizes 2 key lines of evidence: 1) the emergence of an obesity epidemic in urban and rural India and its contribution to the NCD burden and 2) the role of a "nutrition transition" in decreasing the whole plant food content of diets in India and increasing risk of obesity and NCDs. We then present new epidemiologic evidence from Asian Indians enrolled in the Adventist Health Study 2 that raises the possibility of how specific whole plant foods (eg, nuts) in a vegetarian dietary pattern could potentially prevent obesity and NCDs in a target population of >1 billion persons.
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Affiliation(s)
- Pramil N Singh
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Kristen N Arthur
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Michael J Orlich
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Wesley James
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Anil Purty
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Jayakaran S Job
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Sujatha Rajaram
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
| | - Joan Sabaté
- From the Center for Health Research, School of Public Health (PNS, KNA, and WJ) and the Preventive Medicine Residency Program, Loma Linda University, Loma Linda, CA (MJO); the Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India (AP); and the Center for Nutrition, Healthy Lifestyles, and Disease Prevention, Loma Linda, CA (PNS, WJ, JSJ, SR, and JS)
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Mamun AA, Finlay JE. Shifting of undernutrition to overnutrition and its determinants among women of reproductive ages in the 36 low to medium income countries. Obes Res Clin Pract 2014; 9:75-86. [PMID: 24925607 DOI: 10.1016/j.orcp.2014.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/01/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Objectives are to examine the shift away from undernutrition towards overnutrition for low to medium income countries (LMIC) and investigate the potential determinants of this shift using the nationally representative survey data. DESIGN AND SUBJECTS We analysed cross-sectional, representative samples of 540,290 women aged 20-49 years drawn from the Demographic and Health Surveys (DHS) at two time points in 36 LMIC. The ratio of overweight-to-underweight at earliest and latest survey was calculated for each country to illustrate the relative magnitude of the shifting of underweight to overweight. Potential determinants of underweight (BMI < 18.5) and overweight (BMI ≥ 25) were examined. RESULTS In the latest DHS compared to the earliest DHS (mean duration 10 years), the prevalence of underweight significantly declined for one in two countries and the prevalence of overweight significantly increased for 80% of the listed countries. The annual increase of overweight was two folds higher than annual decline of underweight (6.4% vs. 3.3%). Although higher socio-demographic factors were associated with shifting of underweight towards overweight, over time, the risk of the highly educated, wealthy, and urban women being overweight was weakening. CONCLUSIONS Findings of this study suggest that among women of child-bearing age there was a large shift away from undernutrition to overnutrition for most of the LMIC. Overtime, the contribution of higher education, wealth and urbanisation to being overweight was decreasing in the LMIC.
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Atek M, Traissac P, El Ati J, Laid Y, Aounallah-Skhiri H, Eymard-Duvernay S, Mézimèche N, Bougatef S, Béji C, Boutekdjiret L, Martin-Prével Y, Lebcir H, Gartner A, Kolsteren P, Delpeuch F, Romdhane HB, Maire B. Obesity and association with area of residence, gender and socio-economic factors in Algerian and Tunisian adults. PLoS One 2013; 8:e75640. [PMID: 24116063 PMCID: PMC3792975 DOI: 10.1371/journal.pone.0075640] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 08/18/2013] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION The epidemiological transition has resulted in a major increase in the prevalence of obesity in North Africa. This study investigated differences in obesity and its association with area of residence, gender and socio-economic position among adults in Algeria and Tunisia, two countries with socio-economic and socio-cultural similarities. METHODS Cross-sectional studies used stratified, three-level, clustered samples of 35-70 year old adults in Algeria, (women n = 2741, men n = 2004) and Tunisia (women n = 2964, men n = 2379). Thinness was defined as Body Mass Index (BMI) = weight/height <18.5 kg/m(2), obesity as BMI ≥30, and abdominal obesity as waist circumference/height ≥0.6. Associations with area of residence, gender, age, education, profession and household welfare were assessed. RESULTS Prevalence of thinness was very low except among men in Algeria (7.3% C.I.[5.9-8.7]). Prevalence of obesity among women was high in Algeria (30.1% C.I.[27.8-32.4]) and Tunisia (37.0% C.I.[34.4-39.6]). It was less so among men (9.1% C.I.[7.1-11.0] and 13.3% C.I.[11.2-15.4]).The results were similar for abdominal obesity. In both countries women were much more obesity-prone than men: the women versus men obesity Odds-Ratio was 4.3 C.I.[3.4-5.5] in Algeria and 3.8 C.I.[3.1-4.7] in Tunisia. Obesity was more prevalent in urban versus rural areas in Tunisia, but not in Algeria (e.g. for women, urban versus rural Odds-Ratio was 2.4 C.I.[1.9-3.1] in Tunisia and only 1.2 C.I.[1.0-5.5] in Algeria). Obesity increased with household welfare, but more markedly in Tunisia, especially among women. Nevertheless, in both countries, even in the lowest quintile of welfare, a fifth of the women were obese. CONCLUSION The prevention of obesity, especially in women, is a public health issue in both countries, but there were differences in the patterning of obesity according to area of residence and socio-economic position. These specificities must be taken into account in the management of obesity inequalities.
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Affiliation(s)
- Madjid Atek
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Pierre Traissac
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), Tunis, Tunisia
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Unit, Tunis, Tunisia
| | - Youcef Laid
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Hajer Aounallah-Skhiri
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Unit, Tunis, Tunisia
- INSP (National Institute of Public Health), Tunis, Tunisia
- Faculty of Medicine, El Manar University, Tunis, Tunisia
| | - Sabrina Eymard-Duvernay
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Nadia Mézimèche
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Souha Bougatef
- INSP (National Institute of Public Health), Tunis, Tunisia
| | - Chiraz Béji
- INNTA (National Institute of Nutrition and Food Technology), Tunis, Tunisia
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Unit, Tunis, Tunisia
| | | | - Yves Martin-Prével
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Hassiba Lebcir
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Agnès Gartner
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | | | - Francis Delpeuch
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Habiba Ben Romdhane
- Epidemiology and Prevention of Cardiovascular Diseases Unit, Faculty of Medicine, Tunis, Tunisia
| | - Bernard Maire
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
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Khan MMH, Zanuzdana A, Kraemer A. Levels, trends and disparities in public-health-related indicators among reproductive-age women in Bangladesh by urban-rural and richest-poorest groups, 1993-2011. PLoS One 2013; 8:e75261. [PMID: 24086485 PMCID: PMC3783385 DOI: 10.1371/journal.pone.0075261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/13/2013] [Indexed: 11/18/2022] Open
Abstract
Background And Objectives Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. Methods The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. Results The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. Conclusion The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further.
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Affiliation(s)
- Md. Mobarak Hossain Khan
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
- * E-mail:
| | - Arina Zanuzdana
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Alexander Kraemer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
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Subramanian S, Corsi DJ, Subramanyam MA, Davey Smith G. Jumping the gun: the problematic discourse on socioeconomic status and cardiovascular health in India. Int J Epidemiol 2013; 42:1410-26. [DOI: 10.1093/ije/dyt017] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Razak F, Corsi DJ, Subramanian SV. Change in the body mass index distribution for women: analysis of surveys from 37 low- and middle-income countries. PLoS Med 2013; 10:e1001367. [PMID: 23335861 PMCID: PMC3545870 DOI: 10.1371/journal.pmed.1001367] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 11/28/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are well-documented global increases in mean body mass index (BMI) and prevalence of overweight (BMI ≥ 25.0 kg/m(2)) and obese (BMI ≥ 30.0 kg/m(2)). Previous analyses, however, have failed to report whether this weight gain is shared equally across the population. We examined the change in BMI across all segments of the BMI distribution in a wide range of countries, and assessed whether the BMI distribution is changing between cross-sectional surveys conducted at different time points. METHODS AND FINDINGS We used nationally representative surveys of women between 1991-2008, in 37 low- and middle-income countries from the Demographic Health Surveys ([DHS] n = 732,784). There were a total of 96 country-survey cycles, and the number of survey cycles per country varied between two (21/37) and five (1/37). Using multilevel regression models, between countries and within countries over survey cycles, the change in mean BMI was used to predict the standard deviation of BMI, the prevalence of underweight, overweight, and obese. Changes in median BMI were used to predict the 5th and 95th percentile of the BMI distribution. Quantile-quantile plots were used to examine the change in the BMI distribution between surveys conducted at different times within countries. At the population level, increasing mean BMI is related to increasing standard deviation of BMI, with the BMI at the 95th percentile rising at approximately 2.5 times the rate of the 5th percentile. Similarly, there is an approximately 60% excess increase in prevalence of overweight and 40% excess in obese, relative to the decline in prevalence of underweight. Quantile-quantile plots demonstrate a consistent pattern of unequal weight gain across percentiles of the BMI distribution as mean BMI increases, with increased weight gain at high percentiles of the BMI distribution and little change at low percentiles. Major limitations of these results are that repeated population surveys cannot examine weight gain within an individual over time, most of the countries only had data from two surveys and the study sample only contains women in low- and middle-income countries, potentially limiting generalizability of findings. CONCLUSIONS Mean changes in BMI, or in single parameters such as percent overweight, do not capture the divergence in the degree of weight gain occurring between BMI at low and high percentiles. Population weight gain is occurring disproportionately among groups with already high baseline BMI levels. Studies that characterize population change should examine patterns of change across the entire distribution and not just average trends or single parameters.
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Affiliation(s)
- Fahad Razak
- Faculty of Medicine, University of Toronto, Canada
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Corsi DJ, Neuman M, Finlay JE, Subramanian SV. Demographic and health surveys: a profile. Int J Epidemiol 2012; 41:1602-13. [PMID: 23148108 DOI: 10.1093/ije/dys184] [Citation(s) in RCA: 649] [Impact Index Per Article: 54.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Demographic and Health Surveys (DHS) are comparable nationally representative household surveys that have been conducted in more than 85 countries worldwide since 1984. The DHS were initially designed to expand on demographic, fertility and family planning data collected in the World Fertility Surveys and Contraceptive Prevalence Surveys, and continue to provide an important resource for the monitoring of vital statistics and population health indicators in low- and middle-income countries. The DHS collect a wide range of objective and self-reported data with a strong focus on indicators of fertility, reproductive health, maternal and child health, mortality, nutrition and self-reported health behaviours among adults. Key advantages of the DHS include high response rates, national coverage, high quality interviewer training, standardized data collection procedures across countries and consistent content over time, allowing comparability across populations cross-sectionally and over time. Data from DHS facilitate epidemiological research focused on monitoring of prevalence, trends and inequalities. A variety of robust observational data analysis methods have been used, including cross-sectional designs, repeated cross-sectional designs, spatial and multilevel analyses, intra-household designs and cross-comparative analyses. In this profile, we present an overview of the DHS along with an introduction to the potential scope for these data in contributing to the field of micro- and macro-epidemiology. DHS datasets are available for researchers through MEASURE DHS at www.measuredhs.com.
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Affiliation(s)
- Daniel J Corsi
- Harvard Center for Population and Development Studies, Harvard University, Boston, MA 02115, USA
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