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Margozzini P, Tolonen H, Bernabe-Ortiz A, Cuschieri S, Donfrancesco C, Palmieri L, Sanchez-Romero LM, Mindell JS, Oyebode O. National health examination surveys; a source of critical data. Bull World Health Organ 2024; 102:588-599. [PMID: 39070597 PMCID: PMC11276157 DOI: 10.2471/blt.24.291783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 03/31/2024] [Accepted: 05/01/2024] [Indexed: 07/30/2024] Open
Abstract
The aim of this paper is to contribute technical arguments to the debate about the importance of health examination surveys and their continued use during the post-pandemic health financing crisis, and in the context of a technological innovation boom that offers new ways of collecting and analysing individual health data (e.g. artificial intelligence). Technical considerations demonstrate that health examination surveys make an irreplaceable contribution to the local availability of primary health data that can be used in a range of further studies (e.g. normative, burden-of-disease, care cascade, cost and policy impact studies) essential for informing several phases of the health planning cycle (e.g. surveillance, prioritization, resource mobilization and policy development). Examples of the use of health examination survey data in the World Health Organization (WHO) European Region (i.e. Finland, Italy, Malta and the United Kingdom of Great Britain and Northern Ireland) and the WHO Region of the Americas (i.e. Chile, Mexico, Peru and the United States of America) are presented, and reasons why health provider-led data cannot replace health examination survey data are discussed (e.g. underestimation of morbidity and susceptibility to bias). In addition, the importance of having nationally representative random samples of the general population is highlighted and we argue that health examination surveys make a critical contribution to external quality control for a country's health system by increasing the transparency and accountability of health spending. Finally, we consider future technological advances that can improve survey fieldwork and suggest ways of ensuring health examination surveys are sustainable in low-resource settings.
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Affiliation(s)
- Paula Margozzini
- Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hanna Tolonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | | | | | - Luz Maria Sanchez-Romero
- Department of Oncology, Georgetown University Medical Centre, WashingtonDC., United States of America
| | - Jennifer S Mindell
- Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London, WC1E 6BT, England
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
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Sanchez-Macedo L, Vidal-Espinoza R, Minango-Negrete J, Ronque EV, Campos LFCCD, Fuentes-López J, Vargas-Ramos E, Rivera-Portugal M, Cossio-Bolaños M, Gomez-Campos R. Parameters of pubertal growth spurt in children and adolescents living at high altitude in Peru. J Pediatr (Rio J) 2024; 100:189-195. [PMID: 37944907 PMCID: PMC10943288 DOI: 10.1016/j.jped.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES The aim was to estimate the pubertal growth height of children and adolescents living in a high-altitude region of Peru using the Preece-Baines model 1 (1 PB). METHODS A cross-sectional study was conducted in schoolchildren from the department of Puno (Peru) between 3841 and 3874 masl. The age range was between 4 and 17 years. Standing height was evaluated. 1 PB was used to infer the mathematical and biological parameters of stature. RESULTS Mathematical parameters estimated by the 1 PB model reflected small residual standard error (RSE) values in both sexes (0.25 in boys and 0.27 in girls). In boys, the age at which peak velocity was reached (APHV) was estimated at 13.21 ± 0.33years. While in girls it was 9.96 ± 0.26years (p < 0.05). In general, girls reached APHV (y) 3.25 years earlier than boys. On the other hand, the growth velocity of maximum height [APHV (cm/y)] of boys was higher (6.33 ± 6.06 cm/y) relative to girls (6.06 ± 0.32 cm/y). Estimated final adult height (EFAH) in boys was reached at 166.020 ± 0.99 cm and height at maximum growth velocity (HPHV) was 153.07 ± 0.67 cm, while in girls they were significantly lower (EFAH; 153.74 ± 0.44 cm and HPHV: 139.73 ± 0.84 cm). CONCLUSIONS This study showed that girls living in Puno at a high altitude in Peru reached APHV 3 years earlier than boys and at the same time reflected slower PHV. These results suggest that pubertal growth at high altitudes is slower in both sexes and especially in girls. Thus, modeling physical growth may be an important step in understanding the onset of puberty at different latitudes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Marco Cossio-Bolaños
- Carrera de Ciencias de la Actividad Física y del Deporte, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Rossana Gomez-Campos
- Carrera de Ciencias de la Actividad Física y del Deporte, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima, Perú.
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Veile A, Chávez Cabello R, Otárola-Castillo E, Rojas Bravo V, Turner G. Urbanization, migration, and indigenous health in Peru. Am J Hum Biol 2023; 35:e23904. [PMID: 37157872 DOI: 10.1002/ajhb.23904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION We compare demographic, socioeconomic, and anthropometric characteristics and blood pressure (BP), between rural and urban Peruvian indigenous women. These are preliminary results from a project on urbanization, migration, and health. METHODS Data were collected cross-sectionally (2019) and compared between a rural (n = 92) and an urban (n = 93) community. RESULTS Height: μ = 148.3 ± 5.0 cm (range = 137-162), weight: μ = 62.0 ± 11.5 (range = 37.5-108.7), median waist circumference = 89.0 (IQR = 15.8, range = 64.0-126.0), BMI = 28.3 (IQR = 6.2, range = 16.7-40.0), with no significant rural-urban differences. Systolic but not diastolic BP was significantly higher in urban versus rural women (median = 110, IQR = 18, range = 80-170 vs. median = 120, IQR = 10, range = 90-170, p = .002 and median = 70, IQR = 17, range = 50-100 vs. median = 70, IQR = 10, range = 60-100, p = .354), respectively. CONCLUSIONS Despite major lifestyle differences, there were no anthropometric differences between rural and urban women. Higher systolic BP in urban women may reflect social/economic stressors rather than dietary factors.
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Affiliation(s)
- A Veile
- Department of Anthropology, Purdue University, West Lafayette, Indiana, USA
| | - R Chávez Cabello
- Facultad de Ciencias Sociales, Universidad Nacional Hermilio Valdizán, Huánuco, Peru
| | - E Otárola-Castillo
- Department of Anthropology, Purdue University, West Lafayette, Indiana, USA
| | - V Rojas Bravo
- Facultad de Enfermería, Universidad Nacional Hermilio Valdizán, Huánuco, Peru
| | - G Turner
- Department of Anthropology, Purdue University, West Lafayette, Indiana, USA
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Rougeaux E, Miranda JJ, Fewtrell M, Wells JCK. Maternal internal migration and child growth and nutritional health in Peru: an analysis of the demographic and health surveys from 1991 to 2017. BMC Public Health 2022; 22:37. [PMID: 34991546 PMCID: PMC8734138 DOI: 10.1186/s12889-021-12452-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/13/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Peru has historically experienced high rural-to-urban migration. Despite large reductions in undernutrition, overweight is increasing. Elsewhere, internal migration has been associated with differences in children's growth and nutritional health. We investigated how child growth and nutritional status in Peru varied over time and in association with maternal internal migration. METHODS Using data from Demographic & Health Surveys from 1991 to 2017, we assessed trends in child growth (height-for-age [HAZ], weight-for-age [WAZ], weight-for-height [WHZ] z scores) and nutritional health (stunting, underweight, overweight) by maternal adult internal migration (urban [UNM] or rural non-migrant [RNM], or urban-urban [UUM], rural-urban [RUM], rural-rural [RRM], or urban-rural migrant [URM]). Using 2017 data, we ran regression analyses, adjusting for confounders, to investigate associations of maternal migration with child outcomes and the maternal and child double burden of malnutrition. We further stratified by timing of migration, child timing of birth and, for urban residents, type of area of residence. Results are given as adjusted predictive margins (mean z score or %) and associated regression p-values [p]. RESULTS In 1991-2017, child growth improved, and undernutrition decreased, but large differences by maternal migration persisted. In 2017, within urban areas, being the child of a migrant woman was associated with lower WHZ (UUM = 0.6/RUM = 0.5 vs UNM = 0.7; p = 0.009 and p < 0.001 respectively) and overweight prevalence ((RUM 7% vs UNM = 11% [p = 0.002]). Results however varied both by child timing of birth (birth after migration meant greater overweight prevalence) and type of area of residence (better linear growth in children of migrants [vs non-migrants] in capital/large cities and towns but not small cities). In rural areas, compared to RNM, children of URM had higher HAZ (- 1.0 vs - 1.2; p < 0.001) and WAZ (- 0.3 vs - 0.4; p = 0.001) and lower stunting (14% vs 21%; [p < 0.001]). There were no differences by timing of birth in rural children, nor by time since migration across all children. The mother and child double burden of malnutrition was higher in rural than urban areas but no differences were found by maternal internal migration. CONCLUSIONS Migration creates a unique profile of child nutritional health that is not explained by maternal ethnic and early life factors, but which varies depending on the pathway of migration, the child timing of birth in relation to migration and, for urban dwellers, the size of the place of destination. Interventions to improve child nutritional health should take into consideration maternal health and migration history.
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Affiliation(s)
- Emeline Rougeaux
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
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Hasan MM, Magalhaes RJS, Ahmed S, Pervin S, Tariqujjaman M, Fatima Y, Mamun AA. Geographical variation and temporal trend in anemia among children aged 6-59 months in low- and middle-income countries during 2000-2018: forecasting the 2030 SDG target. Public Health Nutr 2021; 24:6236-6246. [PMID: 34103114 PMCID: PMC11148617 DOI: 10.1017/s1368980021002482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine geographical variations, trends and projections in the prevalence of childhood anemia at national and subpopulation levels. DESIGN Repeated cross-sectional Demographic and Health Survey (DHS) conducted during 2000-2018. SETTING Fifty-three low- and middle-income countries (LMIC). PARTICIPANTS Totally, 776 689 children aged 6-59 months. RESULTS During the latest DHS rounds between 2005 and 2018, the prevalence of child anemia was > 20 % in fifty-two out of fifty-three countries and ranged from 15·9 % in Armenia in 2016 to 87·8 % in Burkina Faso in 2010. Out of thirty-six countries with at least two surveys during 2000-2018, the prevalence of child anemia decreased in twenty-two countries, highest in Zimbabwe (-4·2 %) and increased in fourteen countries, highest in Burundi (5·0 %). Based on the trend, eleven and twenty-two out of thirty-six countries are projected to experience, respectively, moderate and severe public health problem according to the WHO criteria (moderate problem: 20-39·9 % and severe problem: ≥ 40 %) due to child anemia in 2030, with the highest prevalence in Liberia (87·5 %, 95 % credible interval 52·0-98·8 %). The prevalence of child anemia varied across the mother's education and age, child sex, wealth quintiles, and place of residence, with the highest rate of child anemia among the poorest, rural and low-educated mothers. These scenarios are projected to continue. The probability of reducing child anemia at < 0·5 % by 2030 is 0 % for all study countries. CONCLUSIONS The prevalence of child anemia varied between and within countries. None of the thirty-six LMIC is likely to eradicate child anemia by 2030.
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Affiliation(s)
- Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD4068, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
| | - Ricardo J Soares Magalhaes
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
- UQ Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sonia Pervin
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD4068, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
| | - Md Tariqujjaman
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Yaqoot Fatima
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD4068, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Abdullah A Mamun
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD4068, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
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Castro-Bedriñana J, Chirinos-Peinado D, De La Cruz-Calderón G. Predictive model of stunting in the Central Andean region of Peru based on socioeconomic and agri-food determinants. PUBLIC HEALTH IN PRACTICE 2021; 2:100112. [PMID: 36101621 PMCID: PMC9461592 DOI: 10.1016/j.puhip.2021.100112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives A limitation in the design and monitoring of public health policies is the lack of conceptual models to explain their results. The objective of this study was to develop a predictive model of stunting in children under 5 years of age in the central Andean region of Peru, using socioeconomic and agro-productive predictors. Study design Cross-sectional data of 380 families in 15 districts of the central region of Peru. WHO criteria were used to define stunting prediction model. Methods An explanatory and predictive study of stunting in children was carried out considering causality criteria through Chi-square tests and bivariate logistic regression. Family food production, maternal education, breastfeeding practices and others determinant related to rural zone conditions were considered as explanatory variables in stunting of children under 5 years old. Three exhaustive models for predicted the presence of stunting was developed. Results Stunting percentage was 40.3. To Hosmer and Lemeshow test, the best fit was the model that considered the level of maternal education, timely consumption of colostrum, birth weight and guinea pig rearing, having high reliability (P < 0.05). Conclusions A predictive model for early detection of stunting risk in rural areas of the Andean region was developed based on simple and easily applied indicators. Effective policies are required to improve the feeding practices of pregnant women, increase breastfeeding and promote guinea pig raising for self-consumption and improve the nutritional status of children.
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Affiliation(s)
- Jorge Castro-Bedriñana
- Specialized Research Center in Nutritional Food Security, Universidad Nacional del Centro del Perú, Huancayo, Peru
| | - Doris Chirinos-Peinado
- Specialized Research Center in Nutritional Food Security, Universidad Nacional del Centro del Perú, Huancayo, Peru
| | - Gina De La Cruz-Calderón
- Professional School of Agroindustrial Engineering, Universidad Nacional Autónoma de Chota, Cajamarca, Peru
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McInvale Trejo K, Shaw-Ridley M. Barriers and enablers to nutrition and physical activity in Lima, Peru: an application of the Pen-3 cultural model among families living in pueblos jóvenes. ETHNICITY & HEALTH 2021; 26:911-921. [PMID: 30870000 PMCID: PMC7117863 DOI: 10.1080/13557858.2019.1591347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Childhood obesity is increasing in Latin America as nutrition status and economies transition. Peru is one such country with an emerging childhood obesity epidemic. The Peruvian Ministry of Health established goals for achieving reductions in overweight and obesity prevalence among children 5 years and younger by 2021. However, specific intervention strategies for achieving these goals are lacking. Culturally appropriate interventions guided by evidence-based theories are needed to address the emerging problem of overweight and obesity among young children. This study utilized the Pen-3 model, a culture-based conceptual framework to explore barriers and facilitators to healthy diet and physical activity for parents of young children in pueblos jóvenes communities. DESIGN A qualitative investigation was conducted as part of a larger cross-sectional survey study of parents of three and four-year-old children at five school sites in the peri-urban slum neighborhoods of southern Lima. Parents were asked to describe barriers and facilitators of healthy diet and physical activity for their preschoolers and families. Thematic analysis guided by PEN-3 model constructs assisted in identifying emergent themes. RESULTS Two domains of the Pen-3 model guided the elucidation of barriers and facilitators of health behaviors deemed essential to healthy diet and physical activity. Parental perceptions about neighborhood safety, lack of community resources, such as parks and recreation spaces, and lack of information about appropriate serving sizes and healthy recipes were identified as barriers. Facilitators to healthy behaviors included mothers' views on their role as nurturers, and personal values for family-centered health behaviors. CONCLUSIONS Parents identified specific barriers and facilitators of eating healthy and physical activity for their preschoolers and families living in resource poor areas of Peru. Health promotion professionals can utilize findings to inform the design of culturally appropriate family-based interventions in Peru's pueblos jóvenes.
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Affiliation(s)
- Kathleen McInvale Trejo
- CRONICAS Centro de Excelencia en Efermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Mary Shaw-Ridley
- Behavioral Health Promotion and Education, Jackson State University, Jackson, MS, USA
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Mendoza‐Quispe D, Hernández‐Vásquez A, Miranda JJ, Anza‐Ramirez C, Carrillo‐Larco RM, Pomati M, Nandy S, Bernabe‐Ortiz A. Urbanization in Peru is inversely associated with double burden of malnutrition: Pooled analysis of 92,841 mother-child pairs. Obesity (Silver Spring) 2021; 29:1363-1374. [PMID: 34148299 PMCID: PMC8361670 DOI: 10.1002/oby.23188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/09/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study assessed the relationship between urbanization and the double burden of malnutrition (DBM) in Peru. METHODS A cross-sectional analysis of the Demographic and Health Survey (2009 to 2016) was conducted. A DBM "case" comprised a child with undernutrition and a mother with overweight/obesity. For urbanization, three indicators were used: an eight-category variable based on district-level population density (inhabitants/km2 ), a dichotomous urban/rural variable, and place of residence (countryside, towns, small cities, or capital/large cities). RESULTS The prevalence of DBM was lower in urban than in rural areas (prevalence ratio [PR] 0.70; 95% CI: 0.65-0.75), and compared with the countryside, DBM was less prevalent in towns (PR 0.75; 95% CI: 0.69-0.82), small cities (PR 0.73; 95% CI: 0.67-0.79), and capital/large cities (PR 0.53; 95% CI: 0.46-0.61). Using population density, the adjusted prevalence of DBM was 9.7% (95% CI: 9.4%-10.1%) in low-density settings (1 to 500 inhabitants/km2 ), 5.9% (95% CI: 4.9%-6.8%) in mid-urbanized settings (1,001 to 2,500 inhabitants/km2 ), 5.8% (95% CI: 4.5%-7.1%) in more densely populated settings (7,501 to 10,000 inhabitants/km2 ), and 5.5% (95% CI: 4.1%-7.0%) in high-density settings (>15,000 inhabitants/km2 ). CONCLUSIONS The prevalence of DBM is higher in the least-urbanized settings such as rural and peri-urban areas, particularly those under 2,500 inhabitants/km2 .
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Affiliation(s)
- Daniel Mendoza‐Quispe
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - Akram Hernández‐Vásquez
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- School of MedicineUniversidad Peruana Cayetano HerediaLimaPeru
| | - Cecilia Anza‐Ramirez
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - Rodrigo M. Carrillo‐Larco
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUK
| | - Marco Pomati
- School of Social SciencesCardiff UniversityCardiff, WalesUK
| | - Shailen Nandy
- School of Social SciencesCardiff UniversityCardiff, WalesUK
| | - Antonio Bernabe‐Ortiz
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
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Bernabe-Ortiz A, Carrillo-Larco RM, Miranda JJ. Association between body mass index and blood pressure levels across socio-demographic groups and geographical settings: analysis of pooled data in Peru. PeerJ 2021; 9:e11307. [PMID: 33976985 PMCID: PMC8067913 DOI: 10.7717/peerj.11307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/29/2021] [Indexed: 01/22/2023] Open
Abstract
Background Understanding the relationship between BMI and blood pressure requires assessing whether this association is similar or differs across population groups. This study aimed to assess the association between body mass index (BMI) and blood pressure levels, and how these associations vary between socioeconomic groups and geographical settings. Methods Data from the National Demographic Health Survey of Peru from 2014 to 2019 was analyzed considering the complex survey design. The outcomes were levels of systolic (SBP) and diastolic blood pressure (DBP), and the exposure was BMI. Exposure and outcomes were fitted as continuous variables in a non-linear quadratic regression model. We explored effect modification by six socioeconomic and geographical variables (sex, age, education level, socioeconomic position, study area, and altitude), fitting an interaction term between each of these variables and BMI. Results Data from 159, 940 subjects, mean age 44.4 (SD: 17.1), 54.6% females, was analyzed. A third (34.0%) of individuals had ≥12 years of education, 24.7% were from rural areas, and 23.7% lived in areas located over 2,500 m above sea level. In the overall sample mean BMI was 27.1 (SD: 4.6) kg/m2, and mean SBP and DBP were 122.5 (SD: 17.2) and 72.3 (SD: 9.8) mmHg, respectively. In the multivariable models, greater BMI levels were associated with higher SBP (p-value < 0.001) and DBP (p-value < 0.001). There was strong evidence that sex, age, education level, and altitude were effect modifiers of the association between BMI and both SBP and DBP. In addition to these socio-demographic variables, socioeconomic position and study area were also effect modifiers of the association between BMI and DBP, but not SBP. Conclusions The association between BMI and levels of blood pressure is not uniform on a range of socio-demographic and geographical population groups. This characterization can inform the understanding of the epidemiology and rise of blood pressure in a diversity of low-resource settings.
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Affiliation(s)
- Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Universidad Cientifica del Sur, Lima, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Can Nepal achieve nutritional targets by 2030? A trend analysis of childhood undernutrition in Nepal from 2001 to 2016. Public Health Nutr 2021; 24:5453-5462. [PMID: 33472717 DOI: 10.1017/s1368980021000240] [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: 11/06/2022]
Abstract
OBJECTIVE This study assesses the prevalence of childhood undernutrition from 2001 to 2016 and estimate projections of undernutrition for 2016-2030 in Nepal. DESIGN The study used data from four rounds of a cross-sectional survey of Nepal Demographic and Health Survey (NDHS) conducted in 2001, 2006, 2011 and 2016. Descriptive analyses were conducted to calculate prevalence, binary logistic regression was used to test the significance of trends over time and autoregressive integrated moving average model was used to forecast the prevalence of childhood undernutrition. SETTINGS The children and household member datasets from four NDHS were merged to assess the trends of childhood undernutrition in Nepal. PARTICIPANTS A total of 16 613 children (8399 male and 8214 female) under 5 years of age were selected for anthropometric measurements using a stratified cluster random sampling method. RESULTS Overall results show a decline in prevalence of stunting from 57·2 % to 35·8 % (P < 0·001), underweight from 42·7 % to 27 % (P < 0·001) and wasting from 11·2 % to 9·7 % (P < 0·05) from 2001 to 2016. However, different population subgroups have a higher prevalence of undernutrition than national average. Further, the analyses show that the prevalence of stunting will decline to 14·3 % and wasting to 8·4 % by 2030. CONCLUSION A remarkable decrease in the prevalence of stunting and underweight has been observed over the last 15 years. Nepal is likely to achieve the nutritional targets for stunting but not for wasting by 2030. Given large subpopulation variations, further improvement in undernutrition require more specific, targeted and localised programmes.
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Stunting Malnutrition Associated with Severe Tooth Decay in Cambodian Toddlers. Nutrients 2021; 13:nu13020290. [PMID: 33498508 PMCID: PMC7909538 DOI: 10.3390/nu13020290] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/18/2023] Open
Abstract
Background: The persistently high prevalence of undernutrition in Cambodia, in particular stunting or chronic malnutrition, calls for innovative investigation into the risk factors that affect children’s growth during critical phases of development. Methods: Secondary data analysis was performed on a subgroup of children who were present at two time points within the Cambodian Health and Nutrition Monitoring Study (CAHENMS) and who were less than 24 months of age at the nominated baseline. Data consisted of parent interviews on sociodemographic characteristics and feeding practices, and clinical measures for anthropometric measures and dental status. Logistic regression modelling was used to examine the associations between severe dental caries (tooth decay)—as indicated by the Significant Caries Index—and the presence of new cases of stunting malnutrition at follow-up. Results: There were 1595 children who met the inclusion criteria and 1307 (81.9%) were followed after one year. At baseline, 14.4% of the children had severe dental caries, 25.6% presented with stunted growth. 17.6% of the children transitioned from healthy status to a low height-for-age over the observation period. Children with severe dental caries had nearly double the risk (OR = 1.8; CI 1.0–3.0) of making that transition. Conclusion: Severe caries experience was associated with poorer childhood growth and, as such, could be an underinvestigated contributor to stunting.
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Pomati M, Mendoza-Quispe D, Anza-Ramirez C, Hernández-Vásquez A, Carrillo Larco RM, Fernandez G, Nandy S, Miranda JJ, Bernabé-Ortiz A. Trends and patterns of the double burden of malnutrition (DBM) in Peru: a pooled analysis of 129,159 mother-child dyads. Int J Obes (Lond) 2021; 45:609-618. [PMID: 33402688 PMCID: PMC7906898 DOI: 10.1038/s41366-020-00725-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/27/2020] [Accepted: 11/25/2020] [Indexed: 12/03/2022]
Abstract
Background This study aims to evaluate trends of DBM in Peru over the last 20 years. Methods Using individual-level data collected in nationally representative household surveys from Peru between 1996 and 2017, we analysed trends in the prevalence and patterning of the DBM. We classified the nutritional status of children and their mothers as undernourished (either underweight, stunted or wasted for children), normal, overweight or obese. Children classified as experiencing the DBM were those undernourished and living with an overweight or obese mother. We also fitted logistic regression models to evaluate the probability of children having an overweight/obese mother across subgroups of socioeconomic status, place of residence and education. Results The overall percentage of children experiencing the DBM in 2016 was 7%, and constitutes ~203,600 children (90% of whom were stunted). Between 1996 and 2016, undernourished children have seen the largest relative increase in the risk of having an overweight mother (31% vs. 37%) or obese mother (6% vs. 17%); however, due to the substantial decrease in the absolute number of undernourished children, the DBM has not grown. Moreover, all children, irrespective of their own nutritional status, are now more likely to live with an overweight or obese mother, a consistent pattern across wealth, location and education subgroups, and all regions of Peru. Conclusions DBM prevalence in Peru has decreased, although the number of DBM cases is estimated to be above 200,000. In addition, all children are now more likely to live with overweight or obese mothers. The basic pattern has shifted from one of undernourished children whose mothers have a ‘normal’ BMI, to one where now most children have a ‘normal’ or healthy anthropometric status, but whose mothers are overweight or obese. This suggest that Peru is on the cusp of a major public health challenge requiring significant action.
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Affiliation(s)
- Marco Pomati
- School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, Wales, CF24 3PG, UK.
| | - Daniel Mendoza-Quispe
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cecilia Anza-Ramirez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Akram Hernández-Vásquez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M Carrillo Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | - Shailen Nandy
- School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, Wales, CF24 3PG, UK
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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Huicho L, Vidal-Cárdenas E, Akseer N, Brar S, Conway K, Islam M, Juarez E, Rappaport AI, Tasic H, Vaivada T, Wigle J, Bhutta ZA. Drivers of stunting reduction in Peru: a country case study. Am J Clin Nutr 2020; 112:816S-829S. [PMID: 32860403 PMCID: PMC7487430 DOI: 10.1093/ajcn/nqaa164] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016. OBJECTIVES We aimed to study factors and key enablers of child stunting reduction in Peru from 2000-2016. METHODS Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca-Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru. RESULTS The distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation. CONCLUSIONS Peru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru's experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors.
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Affiliation(s)
- Luis Huicho
- Research Center for Integral and Sustainable Development, Cayetano Heredia University, Lima, Peru
- Maternal and Child Health Research Center, Cayetano Heredia University, Lima, Peru
- School of Medicine, Cayetano Heredia University, Lima, Peru
| | - Elisa Vidal-Cárdenas
- Research Center for Integral and Sustainable Development, Cayetano Heredia University, Lima, Peru
- Maternal and Child Health Research Center, Cayetano Heredia University, Lima, Peru
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Samanpreet Brar
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kaitlin Conway
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elisa Juarez
- Center for the Promotion and Defense of Sexual and Reproductive Rights (PROMSEX), Lima, Peru
| | - Aviva I Rappaport
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hana Tasic
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jannah Wigle
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
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Abstract
Background: In Peru, anemia has been a persistent health problem that is known to lead to irreversible cognitive and developmental deficits in children. The Peruvian government has recently made anemia a primary health concern by passing legislation in 2017 that makes anemia an intersectoral priority. This new legislation fortifies previous programs while creating new programs that target specific age groups. Objectives: Evaluate the effectiveness of government programs in Madre de Dios, Peru to reduce anemia prevalence and increase hemoglobin levels among children ages 2–11 years old. Methods: Propensity scores are used to match 688 children enrolled in 2018, after the legislation, and 2,140 children enrolled in previous studies our team conducted in the region between 2014 and 2017, based on sex, age (years), intervention status (prior/post), community income, presence of a health post in the community (yes/no), community type (indigenous, non-indigenous rural, non-indigenous urban) and road access (fraction of the number of months out of the year with road access). A pseudo matched case-control analysis to evaluate changes in anemia prevalence and hemoglobin was conducted using t-tests and multivariate models. Program effectiveness is evaluated overall, by age groups (2–4, 5–7 and 8–11 years old), and community type (indigenous vs. urban). Findings: The adjusted odds ratio indicated lower odds of anemia (OR = 0.31, 95%CI 0.17–0.54) for children exposed to the anemia prevention programs vs. those not exposed. The effect was not significantly different across age groups; however, the intervention effects significantly differed by community type among children 8–11 years old, with urban children less likely to benefit from anemia interventions (OR = 0.69, 95% CI 0.38–1.25) compared to indigenous children (OR = 0.21, 95% CI 0.08–0.56). Conclusion: Government programs to reduce anemia in Madre de Dios were found to be associated with reduced anemia prevalence in the study communities. However, the lack of program monitoring precludes the attribution of anemia decline to specific interventions or program components. In addition, regional anemia prevalence remains high according to the 2019 Demographic and Health Survey, suggesting impaired population impact. Program monitoring and evaluation is a key component of health interventions to improve program implementation effectiveness.
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Measured and Perceived Body Weight Status of Women in the Peruvian Amazon. ACTA ACUST UNITED AC 2020; 56:medicina56080375. [PMID: 32722641 PMCID: PMC7466240 DOI: 10.3390/medicina56080375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/17/2022]
Abstract
Background and objectives: The prevalence of obesity among adults has reached epidemic proportions in Latin America, placing large demands on health care systems. Research suggests cultural differences in body weight perceptions may be a barrier during the implementation of weight-loss strategies. The aim of this study was to examine the prevalence of weight misperception in Peruvian women and evaluate contributing factors. Materials and Methods: A total of 236 women were recruited in San Martín, northern Peru. Participants' socio-demographic characteristics and attitudes towards their weight and health were collected. Self-perception of weight status was assessed with a 10-point scale and compared with measured body mass index (BMI). Multiple logistic regression analysis was conducted to identify factors associated with underestimation of weight status. Results: A total of 65.2% of women were classified as overweight/obese by BMI, but only 15.2% perceived themselves so. A total of 70.4% of women underestimated their weight status and no incidence of overestimation was reported. Overweight and obese women were more likely to underestimate their weight status than normal weight women (OR: 34.24, 95%CI: 11.55-101.45; OR: 42.06, 95%CI: 11.17-158.32, respectively). Women who underestimated weight status felt more comfortable with their weight (59.3% vs. 20.6, p < 0.001) and agreed a large stomach is a sign of good health (40.7% vs. 5.9%, p < 0.001) versus those who correctly estimated. Conclusions: Underestimation of weigh status was highly prevalent and associated with unhealthy beliefs. Future public health programs must be culturally sensitive and tailored to specific groups within the population.
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Echevarría-Castro N, Matayoshi-Pérez A, Alvarado GF. Association between Maternal Depressive Symptoms with Overweight/Obesity among Children Aged 0-5 Years According to the 2016 Demographic and Family Health Survey. Child Obes 2020; 16:307-315. [PMID: 32429683 DOI: 10.1089/chi.2019.0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Overweight and obesity among children under the age of 5 have become a public health problem. The worldwide prevalence is 4.9% and 6.0%, whereas in Peru it is 7.4% and 1.9%, respectively. The causes of these problems are multifactorial and must be studied to prevent the multiple consequences on children's health. Methods: Secondary data analysis of the 2016 Demographic and Family Health Survey (DHS). The sample size was 7935 children and their mothers. The dependent variable was childhood overweight/obesity, measured according to the Z-score of the BMI >2 standard deviation (SD), while the main independent variable consisted of the maternal depressive symptoms (DS) (Patient Health Questionnaire-9 score >10 points). The software STATA/MP 14.0 was used for statistical analysis. Results: The prevalence of overweight/obesity among children aged 0-5 years was 4.5% and the prevalence of moderate and severe maternal DS was 7.1%. No maternal depressive symptoms were found to be associated with the outcome [adjusted PR = 1.36 95% confidence interval (CI) = 0.59-3.09 p = 0.47]. An association was found between socioeconomic status (SES) Q3 (adjusted PR = 3.86 95% CI = 1.9-7.6 p < 0.0001), Q4 (adjusted PR = 5.53 95% CI = 2.76-11.1 p < 0.0001), Q5 (adjusted PR = 6.9 95% CI = 3.24-14.7 p = < 0.0001), maternal BMI (adjusted PR = 1.06 95% CI = 1.03-1.08 p < 0.0001), and cesarean delivery (adjusted PR = 1.42 95% CI = 1.01-1.99 p = 0.042). Conclusions: No association was found between maternal depressive symptoms and overweight/obesity among children aged 0-5 years. The upper SES quintiles, maternal BMI, and cesarean delivery were associated with the outcome.
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Affiliation(s)
- Nataly Echevarría-Castro
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Scientific Society of Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Andrea Matayoshi-Pérez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Scientific Society of Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Germán F Alvarado
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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Cossio-Bolaños MA, Sanchez-Macedo L, Lee Andruske C, Fuentes-López J, Limachi-Flores M, Apaza-Cruz J, Mamani-Velásquez D, Mamani-Luque O, Sulla-Torres J, Gomez-Campos R. Physical growth and body adiposity patterns in children and adolescents at high altitudes in Peru: Proposed percentiles for assessment. Am J Hum Biol 2020; 32:e23398. [PMID: 32080945 DOI: 10.1002/ajhb.23398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study's purpose was to compare physical growth (PG) patterns of children and adolescents living at high elevations with those of other geographic regions, relate body adiposity indicators, and develop percentile reference tables for assessing physical growth and body adiposity. METHODS The sample included 1536 children and adolescents ages 5.0 to 17.9 years from Puno (Peru) located between 3821 and 4349 m above sea level. Weight, height, arm and waist circumferences (WC), and three skinfolds measurements were recorded. Body mass index (BMI) and waist-height Index (WHI) were calculated. RESULTS PG patterns for children living at a high altitude reflected similar values for weight, height, and arm circumference (AC) to those of their counterparts living in Puno (Peru) and La Paz (Bolivia). When compared with children living at moderate altitudes in Peru, they showed slightly lower PG values. BMI explained between 41% and 64% of the variance in sum of the skinfolds, while WC explained between 47% and 66%. HWI was not a strong predictor of variation in sum of skinfolds. Percentiles were generated for WC and the sum of skinfolds. CONCLUSION Weight, height, and, arm and waist circumference patterns for children and adolescents living at high altitudes were similar to those of La Paz (Bolivia). WC and the sum of the skinfolds were better indicators for analyzing abdominal obesity compared to BMI and WHI. The percentiles proposed may be a useful tool for identifying high risk of developing overweight disorders in pediatric populations living at high altitudes.
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Affiliation(s)
| | - Lucila Sanchez-Macedo
- Departamento Académico de Educación Física, Facultad de Ciencias de la Educación, Universidad Nacional del Altiplano de Puno, Puno, Peru
| | | | - Jose Fuentes-López
- Departamento Académico de Educación Física, Facultad de Ciencias de la Educación, Universidad Nacional del Altiplano de Puno, Puno, Peru
| | - Mary Limachi-Flores
- Departamento Académico de Educación Física, Facultad de Ciencias de la Educación, Universidad Nacional del Altiplano de Puno, Puno, Peru
| | | | | | | | | | - Rossana Gomez-Campos
- Departamento de Diversidad e Inclusividad Educativa, Universidad Católica del Maule, Talca, Chile
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18
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Malnutrition in all its forms and socio-economic disparities in children under 5 years of age and women of reproductive age in Peru. Public Health Nutr 2019; 23:s89-s100. [PMID: 31791443 DOI: 10.1017/s136898001900315x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the distribution of malnutrition by socio-economic indicators (SEI) in Peruvian children under 5 years and women of reproductive age (WRA). DESIGN We analysed data from the National Demographic and Family Health Survey. WHO criteria were used to define malnutrition indicators (overweight/obesity combined (OW); wasting/underweight; stunting/short stature; anaemia). Linear combination test was used to compare the prevalence of malnutrition by SEI (wealth index as a proxy of socio-economic status (SES); education; ethnicity). Prevalence ratio (PR) was used to describe disparities and associations between malnutrition and SEI. SETTING Peru (2015). PARTICIPANTS Children (n 22 833) under 5 years and WRA (n 33 503; 5008 adolescents and 28 495 adults). RESULTS The most prevalent form of malnutrition was anaemia (32·0 %) in children and OW in adolescent and adult WRA (31·3 and 65·1 %, respectively). Adjusted models showed that stunting and anaemia were significantly lower among children with high SES (PR = 0·25, 0·67), high-educated mothers (PR = 0·26, 0·76) and higher in indigenous children (PR = 1·3, 1·2); conversely, OW was higher among those with high SES and high-educated mothers (PR = 1·8, 1·6) compared with their lowest counterparts. In WRA, stunting/short stature was lower among those with high SES, high education and higher in indigenous adult women. OW in adolescents and adults was higher in high SES (PR = 1·4, 1·1), lower in indigenous adult women (PR = 0·84) and lower in high-educated adult women (PR = 0·86). CONCLUSIONS In the studied population, the distribution of malnutrition was associated with SEI disparities. Effective policies that integrate actions to overcome the double burden of malnutrition and reduce disparities are needed.
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Pettigrew SM, Pan WK, Berky A, Harrington J, Bobb JF, Feingold BJ. In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 687:1046-1054. [PMID: 31412442 DOI: 10.1016/j.scitotenv.2019.05.484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 06/10/2023]
Abstract
Road development has been a major driver of the transition from traditional to calorie-dense processed 'Western' diets in lower and middle-income countries. The paving of the Interoceanic Highway (IOH) facilitated rapid development to the Madre de Dios (MDD) region in the Peruvian Amazon. As traditional foods such as Brazil nuts and fish are known to be rich in the essential micronutrient selenium, people further along the nutrition transition to a Western diet may have lower selenium (Se) intake. To test this hypothesis, in 2014 the Investigacion de Migracion, Ambiente, y Salud (IMAS Study) (Migration, Environment, and Health Study) collected household surveys from 310 households in 46 communities along the IOH and nails for Se analysis from 418 adults. Principal component analysis of 25 commonly consumed food items identified a factor resembling Western diet, which was used to calculate household Western diet weighted sum factor scores (WSFS). WSFS means were interpolated into a 10 km buffer around the IOH using inverse distance weighting. Western diet adoption was higher in urban compared to rural areas (p < 0.0001), and geographic variation was observed between mining and agricultural areas. Mean nail Se was 730 ng/g, SD 198 ng/g (range: 200-1390 ng/g). Generalized estimating equation (GEE) models assessed the association between food consumption and nail Se. Household chicken consumption was positively associated with Se in rural areas only. Urban/rural status modified the effect of western diet adoption on nail Se, and Se was inversely associated with WSFS in urban areas only. Conclusion: In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake. As the essential micronutrient selenium is a vital part of antioxidant proteins, lower intake could compound the chronic health effects that may result from transition to a calorie-dense diet.
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Affiliation(s)
- Stacy M Pettigrew
- Department of Environmental Health Sciences, State University of New York at Albany, School of Public Health, 1 University Place, Rensselaer, NY 12144, United States of America
| | - William K Pan
- Global Health Institute, Duke University, Durham, NC 27710, USA; Nicholas School of the Environment, Duke University, Durham, NC 27710, USA
| | - Axel Berky
- Nicholas School of the Environment, Duke University, Durham, NC 27710, USA
| | - James Harrington
- Analytical Sciences Department, Research Triangle Institute, East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC 27709-2194, United States of America
| | - Jennifer F Bobb
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, #1600, Seattle, WA 98101, United States of America
| | - Beth J Feingold
- Department of Environmental Health Sciences, State University of New York at Albany, School of Public Health, 1 University Place, Rensselaer, NY 12144, United States of America.
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Double burden of underweight and overweight among women of reproductive age in Bangladesh. Public Health Nutr 2019; 22:3163-3174. [PMID: 31544733 DOI: 10.1017/s1368980019002611] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Bangladesh, like many emerging economies of South-East Asia, has started to experience a double burden of continuing high rates of undernutrition and increasing rates of overweight and obesity. A lack of assessment of the nutritional shift leaves a gap in current policies: the growing overweight and obesity is yet to be addressed. The present paper investigates the change in nutritional status, particularly the shift in BMI, of Bangladeshi women of reproductive age (15-49 years) and characterizes the vulnerable households for both underweight and overweight status during a period of 10 years (2004-2014). DESIGN Generalized linear mixed-effect models were fitted for both urban and rural residents to assess underweight and overweight status. SETTING Bangladesh Demographic and Health Surveys. PARTICIPANTS Women aged 15-49 years (n 53 077). RESULTS The proportion of overweight increased during 2004-2014 from 10·7 to 25·1 % and the proportion of underweight decreased from 32·6 to 18·2 %. Prevalence of underweight status remained high in rural areas and prevalence of overweight increased rapidly in both rural and urban areas, creating a double burden. The significant contributors to this double burden were the change in women's level of education, increased household wealth, divisional location and rapid urbanization. CONCLUSIONS The findings indicate that specific cohort- or area-based intervention policy studies in line with the UN Decade of Action on Nutrition are required to address the nutritional double burden in Bangladesh.
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Luis de Moraes Ferrari G, Kovalskys I, Fisberg M, Gomez G, Rigotti A, Sanabria LYC, García MCY, Torres RGP, Herrera-Cuenca M, Zimberg IZ, Guajardo V, Pratt M, Pires C, Solé D. Association of moderate-to-vigorous physical activity with neck circumference in eight Latin American countries. BMC Public Health 2019; 19:809. [PMID: 31234866 PMCID: PMC6591862 DOI: 10.1186/s12889-019-7153-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 06/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity is a cornerstone in the prevention and treatment of obesity. There are relatively few studies that explore the effect of accelerometer-determined moderate-to-vigorous physical activity (MVPA) on neck circumference (NC), most of them confined to single high-income countries. The present study investigated the association of accelerometer-determined MVPA with NC in adolescents and adults from eight Latin American countries, which are mostly upper-middle income countries. METHODS The sample consisted of 2370 participants (47.8% male) from the Latin American Study of Nutrition and Health, a multicenter cross-sectional nutrition and health surveillance study of a nationally representative sample from eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). Times (min/day) in MVPA (defined as time accumulated at ≥1952 activity counts/min) was assessed by ActiGraph GT3X+ accelerometer over 7 days. NC for adolescent was categorized as abnormal if circumference was > 34.5 cm for boys and > 31.25 for girls, whereas for adults the cut-off points for abnormal were > 39 cm for men and > 35 cm women. Multilevel logistic models, including country and region as random effects and adjusted for sex, age, socioeconomic level, and educational level, were used to study the association between MVPA and NC. RESULTS The average time of MVPA was 34.88 min/day, ranging from 31.16 in Venezuela to 40.27 in Chile. Concerning NC, 37.0% of the sample was classified as having elevated NC. Chile was the country with the highest percentage of people with elevated NC (56.9%), and Colombia had the lowest percentage (24.8%). Overall, the MVPA (min/day) was associated with elevated NC (OR = 0.994, CI95% = 0.990-0.998). In Costa Rica and Peru, there were significant associations between MVPA and NC when analyzed by country. CONCLUSIONS The present study provided evidence of significant associations between MVPA and NC in adolescents and adults from Latin America, independent of sex, age, socioeconomic level, and educational level. This analysis of accelerometry data and NC represents the first examination of these associations in eight Latin America countries. Further research is required to understand the differences between countries in the observed associations. TRIAL REGISTRATION ClinicalTrials.Gov NCT02226627 . Retrospectively registered on August 27, 2014.
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Affiliation(s)
- Gerson Luis de Moraes Ferrari
- Centro de Investigación en Fisiologia del Ejercicio-CIFE, Universidad Mayor, José Toribio Medina, 29. Estacion Central, Santiago, Chile
- Disciplina de Alergia, Imunologia Clínica e Reumatologia do Departamento de Pediatria, da Universidade Federal de São Paulo, São Paulo, Brazil
| | - Irina Kovalskys
- Commitee of Nutrition and WellbeingInternational Life Science Institute, Buenos Aires, Argentina
| | - Mauro Fisberg
- Instituto Pensi, Fundação José Luiz Egydio Setubal, Hospital Infantil Sabará, São Paulo, Brazil
- Departamento de Pediatria, da Universidade Federal de São Paulo, São Paulo, Brazil
| | - Georgina Gomez
- Departamento de Bioquímica, Escuela de Medicina, Universidad de Costa Rica, San José, Costa Rica
| | - Attilio Rigotti
- Centro de Nutrición Molecular y Enfermedades Crónicas, Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | | | | | | | - Marianella Herrera-Cuenca
- Centro de Estudios del Desarrollo, Universidad Central de Venezuela/Fundación Bengoa, Caracas, Venezuela
| | - Ioná Zalcman Zimberg
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Viviana Guajardo
- Commitee of Nutrition and WellbeingInternational Life Science Institute, Buenos Aires, Argentina
| | - Michael Pratt
- Institute for Public Health, University of California San Diego, La Jolla, CA USA
| | - Carlos Pires
- Centre for Mathematics of the University of Trás-os-Montes e Alto Douro (CM-UTAD), Vila Real, Portugal
| | - Dirceu Solé
- Disciplina de Alergia, Imunologia Clínica e Reumatologia do Departamento de Pediatria, da Universidade Federal de São Paulo, São Paulo, Brazil
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22
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Araújo FG, Velasquez-Melendez G, Felisbino-Mendes MS. Prevalence trends of overweight, obesity, diabetes and hypertension among Brazilian women of reproductive age based on sociodemographic characteristics. Health Care Women Int 2019; 40:386-406. [PMID: 30986134 DOI: 10.1080/07399332.2019.1570516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The authors estimated the prevalence and trends of overweight, obesity, diabetes and hypertension among Brazilian women of reproductive age. A time series was constructed with Vigitel data from 2008 to 2015 and we analyzed trends of the prevalence of these conditions, considering sociodemographic characteristics. We observed an increasing trend in prevalence of overweight, obesity, and diabetes (for some sociodemographic characteristics), and stationary trends for hypertension. Our results highlight the need for early interventions in lifestyle of this population to reduce the NCDs risk factors burden and potentially contribute to improve maternal and neonatal outcomes and reduce the NCDs load.
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Affiliation(s)
- Fernanda Gontijo Araújo
- a Programa de Pós-Graduação em Enfermagem , Escola de Enfermagem, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Gustavo Velasquez-Melendez
- b Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem , Universidade Federal de Minas Gerais , Belo Horizonte, Minas , Brazil
| | - Mariana Santos Felisbino-Mendes
- b Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem , Universidade Federal de Minas Gerais , Belo Horizonte, Minas , Brazil
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Motedayen M, Dousti M, Sayehmiri F, Pourmahmoudi AA. An Investigation of the Prevalence and Causes of Malnutrition in Iran: a Review Article and Meta-analysis. Clin Nutr Res 2019; 8:101-118. [PMID: 31089464 PMCID: PMC6494749 DOI: 10.7762/cnr.2019.8.2.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is one of the most important health issues in developing countries, which might have adverse effects on the physical and intellectual health of children. The search process was started to find Persian and English articles published until September 2017 regarding the prevalence of malnutrition in children under the age of six in Iran using national and international databases including SID, Magiran, Irandoc, IranMedex, PubMed, Medline, Scopus, and ISI Web of Science. The data were analyzed using meta-analysis methods and the random effects model. The heterogeneity of studies was analyzed using the I2 index. The data were analyzed using R and STATA software (ver. 11.2). Twenty seven articles conducted from 2002 to 2016 were collected to be included in the meta-analysis process. The total sample size was 161,941 patients in an age range of 0-6 years. The final estimate of the prevalence of different forms of malnutrition through meta-analysis of data extracted from studies in Iran was as follows: severe underweight (1%; 95% confidence interval [CI], 1–1), moderate underweight (6%; 95% CI, 5–7), mild underweight (25%; 95% CI, 21–28), severe short stature (3%; 95% CI, 2–3), moderate short stature (8%; 95% CI, 6–9), mild short stature (21%; 95% CI, 17–24), severe slimness (1%; 95% CI, 1–1), moderate slimness (5%; 95% CI, 4–5) and mild slimness (20%; 95% CI, 17–24). Considering that the prevalence of malnutrition is relatively high in Iran, health authorities should plan to improve the nutritional status of children.
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Affiliation(s)
- Morteza Motedayen
- Department of Cardiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan 45156-13191, Iran
| | - Majid Dousti
- Department of Parasitology, Faculty of Medicine, Shiraz University of Medical Sciences, Fars 71348-14336, Iran
| | - Fatemeh Sayehmiri
- Student Research Committee, Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran 19839-63113, Iran
| | - Aziz A Pourmahmoudi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj 75919-51176, Iran.,Department of Nutrition, Yasuj University of Medical Sciences, Yasuj 75918-75114, Iran
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24
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Cantor AR, Chan I, Baines K. From the Chacrato the Tienda: Dietary delocalization in the Peruvian Andes. FOOD AND FOODWAYS 2018. [DOI: 10.1080/07409710.2018.1490376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Allison R. Cantor
- Department of Anthropology, New Mexico State University, Las Cruces, New Mexico, USA
| | - Isabella Chan
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Kristina Baines
- City University of New York, Guttman CC, New York City, New York, USA
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25
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Torres-Roman JS, Urrunaga-Pastor D, Avilez JL, Helguero-Santin LM, Malaga G. Geographic differences in overweight and obesity prevalence in Peruvian children, 2010-2015. BMC Public Health 2018. [PMID: 29540170 PMCID: PMC5852971 DOI: 10.1186/s12889-018-5259-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Childhood obesity is emerging as a major public health problem worldwide. To date, most studies of obesity and overweight in Peru are focused on adults, with few of them involving children, a population at a critical stage of development. The trend in overweight and obesity prevalence in Peruvian children under the age of five has not yet been determined. Thus, the objective of the present study is to evaluate the prevalence rates of overweight and obesity between 2010 and 2015 in children under the age of five, stratified by geographical areas in Peru. Methods Data were obtained from the Nutritional Status Information System of Peru. The total number of children evaluated was 14,155,914. For the Geographic Information Systems (GIS), the program Geo Da 1.8® was used to ascertain the spatial distribution of prevalence rates and was mapped for children under five. To assess the degree of spatial dependence, exploratory spatial data analysis was performed using the Moran’s I statistic and was assessed with the Local Indicators of Spatial Association (LISA) analysis to identify geographic concentrations of high and low of obesity and overweight levels. Results Between 2010 and 2015, the national prevalence of childhood overweight and obesity ranged from 6.2%- 6.8% and 1.5%–2.7%, respectively. The highest prevalence of childhood overweight and obesity was found in 2014 and 2013, respectively. During these years, we observed that obesity decreased, but overweight remained stable. The highest prevalence of overweight and obesity was found in the departments located on the coast. Significant positive spatial autocorrelation was found for both overweight and obesity. The departments with the highest prevalence of overweight and obesity were concentrated in Lima, Callao, Ica, Moquegua and Tacna. The lowest were found in Loreto, Cusco and San Martin. Conclusion The decrease in obesity and the stabilisation of overweight are positive results for the Peruvian childhood. However, in comparison with other Latin American countries, Peru still lags in obesity prevention.
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Affiliation(s)
| | - Diego Urrunaga-Pastor
- Sociedad Científica de Estudiantes de Medicina, Universidad de San Martín de Porres, Lima, Peru
| | - Jose L Avilez
- Faculty of Mathematics, University of Waterloo, Waterloo, Canada
| | | | - German Malaga
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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26
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Abstract
Objectives Different studies have reported the association between perceived stress and unhealthy diet choices. We aimed to determine whether there is a relationship between perceived stress and fat intake among undergraduate medical students. Methods/Principal findings A cross-sectional study was performed including first-year medical students. The outcome of interest was the self-report of fat intake assessed using the Block Screening Questionnaire for Fat Intake (high vs. low intake), whereas the exposure was perceived stress (low/normal vs. high levels). The prevalence of high fat intake was estimated and the association of interest was determined using prevalence ratios (PR) and 95% confidence intervals (95%CI). Models were created utilizing Poisson regression with robust standard errors. Data from 523 students were analyzed, 52.0% female, mean age 19.0 (SD 1.7) years. The prevalence of high fat intake was 42.4% (CI: 38.2%–46.7%). In multivariate model and compared with those with lowest levels of stress, those in the middle (PR = 1.59; 95%CI: 1.20–2.12) and highest (PR = 1.92; 95%CI: 1.46–2.53) categories of perceived stress had greater prevalence of fat intake. Gender was an effect modifier of this association (p = 0.008). Conclusions Greater levels of perceived stress were associated with higher fat intake, and this association was stronger among males. More than 40% of students reported having high fat consumption. Our results suggest the need to implement strategies that promote decreased fat intake.
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27
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Jensen KE, Naik NN, O'Neal C, Salmón-Mulanovich G, Riley-Powell AR, Lee GO, Hartinger SM, Bausch DG, Paz-Soldan VA. Small scale migration along the interoceanic highway in Madre de Dios, Peru: an exploration of community perceptions and dynamics due to migration. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:12. [PMID: 29433484 PMCID: PMC5810066 DOI: 10.1186/s12914-018-0152-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/01/2018] [Indexed: 11/19/2022]
Abstract
Background Madre de Dios, a southern state in the Peruvian Amazon basin, has experienced rapid development as well as an influx of migrants since the construction of the Interoceanic Highway (IOH) connecting Brazil, Bolivia, and the Peruvian coast. We explored perceptions of migration and development in up to eight communities along the IOH in Madre de Dios following construction of the highway. Methods We conducted a multiple methods study involving focus group (FG) discussions and interviews with key informants (KIs) in eight communities in Madre de Dios. The data was used to develop and apply a survey on demographics, financial, personal, social, human, and physical capital in four communities between February 2014 and March 2015. Results We conducted 12 FGs and 34 KI interviews. A total of 522 people participated in the survey. Comparing migrants (those who had moved to the area after construction of the IOH) and non-migrants, we found no difference in food security or access to health services. The majority (67.6%) of respondents from both groups reported that illness was their primary threat to well-being. Non-migrants owned more land than migrants (p < 0.001), were more likely to have piped water directly in their home (p = 0.046), and were more likely to participate in community groups (p = 0.012). Looking at perceptions about migrants, KIs and FGs discussed both positive perceptions of migrants (increased cultural exchange and new technology) and negative perceptions (increased drugs and alcohol in their communities and a lack of investment in the community). Both migrants and non-migrants reported trusting the local government more than the national government. Conclusions Although we hypothesized that migrants would have decreased access to food, water, health services, and land relative to non-migrants, our results show that the only significant differences were in land ownership and water access. Efforts to improve community infrastructure should be carried out at the local level and focus on improving issues reported by both groups, such as potable water, sewage, and increased access to health services. Furthermore, an emphasis on community cohesion, ensuring land rights, and increasing long-term job opportunities should help ease tensions between migrants and non-migrants. Electronic supplementary material The online version of this article (10.1186/s12914-018-0152-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kelly E Jensen
- Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA. .,Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA. .,, Bellevue, USA.
| | - Nehal N Naik
- School of Medicine, Virginia Commonwealth University, 1201 E Marshall St, Richmond, VA, 23298, USA
| | - Christina O'Neal
- Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA.,Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
| | - Gabriela Salmón-Mulanovich
- Naval Medical Research Unit No. 6, Callao, Peru.,Universidad Peruana Cayetano Heredia, Ave Honorio Delgado 430, Distrito de Lima, Peru
| | - Amy R Riley-Powell
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
| | - Gwenyth O Lee
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA.,School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Stella M Hartinger
- Universidad Peruana Cayetano Heredia, Ave Honorio Delgado 430, Distrito de Lima, Peru.,Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
| | - Daniel G Bausch
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA.,Naval Medical Research Unit No. 6, Callao, Peru
| | - Valerie A Paz-Soldan
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA.,Universidad Peruana Cayetano Heredia, Ave Honorio Delgado 430, Distrito de Lima, Peru
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28
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Min J, Zhao Y, Slivka L, Wang Y. Double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases. Obes Rev 2018; 19:49-61. [PMID: 28940822 PMCID: PMC5962023 DOI: 10.1111/obr.12605] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/13/2017] [Accepted: 08/02/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This systematic examination and meta-analysis examined the scope and variation of the worldwide double burden of diseases and identified related socio-demographic factors. DESIGN We searched PubMed for studies published in English from January 1, 2000, through September 28, 2016, that reported on double disease burden. Twenty-nine studies from 18 high-income, middle-income and low-income countries met inclusion criteria and provided 71 obesity-undernutrition ratios, which were included in meta-regression analysis. RESULTS All high-income countries had a much higher prevalence of obesity than undernutrition (i.e. all the obesity/undernutrition ratios >1); 55% of the ratios in lower middle-income and low-income countries were <1, but only 28% in upper middle-income countries. Meta-analysis showed a pooled obesity-undernutrition ratio of 4.3 (95% CI = 3.1-5.5), which varied by country income level, subjects' age and over time. The average ratio was higher in high-income rather than that in lower middle-income and low-income countries (β [SE] = 10.8 [2.6]), in adults versus children (7.1 [2.2]) and in data collected since 2000 versus before 2000 (5.2 [1.5]; all P values < 0.05). CONCLUSIONS There are considerable differences in the obesity versus undernutrition ratios and in their prevalence by country income level, age groups and over time, which may be a consequence of the cumulative exposure to an obesogenic environment.
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Affiliation(s)
- Jungwon Min
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA
| | - Yaling Zhao
- Global Health Institute, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Lauren Slivka
- School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - Youfa Wang
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA.,Global Health Institute, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN, USA
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29
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Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study. LANCET GLOBAL HEALTH 2017; 5:e208-e216. [PMID: 28104187 PMCID: PMC5340725 DOI: 10.1016/s2214-109x(16)30355-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/22/2016] [Accepted: 11/09/2016] [Indexed: 11/20/2022]
Abstract
Background Growth faltering remains common in children in sub-Saharan Africa and is associated with substantial morbidity and mortality. Due to a very slow decline in the prevalence of stunting, the total number of children with stunting continues to rise in sub-Saharan Africa. Identification of effective interventions remains a challenge. Methods We analysed the effect of 36 years of intensive health interventions on growth in infants and young children from three rural Gambian villages. Routine growth data from birth to age 2 years were available for 3659 children between 1976 and 2012. Z scores for weight-for-age, length-for-age, weight-for-length, mid-upper-arm circumference, and head circumference were calculated using the WHO 2006 growth standards. Seasonal patterns of mean Z scores were obtained by Fourier regression. We additionally defined growth faltering as fall in Z score between 3 months and 21 months of age. Findings We noted secular improvements in all postnatal growth parameters (except weight-for-length), accompanied by declines over time in seasonal variability. The proportion of children with underweight or stunting at 2 years of age halved during four decades of the study period, from 38·7% (95% CI 33·5–44·0) for underweight and 57·1% (51·9–62·4) for stunting. However, despite unprecedented levels of intervention, postnatal growth faltering persisted, leading to poor nutritional status at 24 months (length-for-age Z score −1·36, 95% CI −1·44 to −1·27, weight-for-age Z score −1·20, −1·28 to −1·11, and head circumference Z score −0·51, −0·59 to −0·43). The prevalence of stunting and underweight remained unacceptably high (30·0%, 95% CI 27·0–33·0, for stunting and 22·1%, 19·4 to 24·8, for underweight). Interpretation A combination of nutrition-sensitive and nutrition-specific interventions has achieved a halving of undernutrition rates, but despite these intensive interventions substantial growth faltering remains. We need to understand the missing contributors to growth faltering to guide development of new interventions. Funding UK Medical Research Council, UK Department for International Development.
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Huayanay-Espinoza CA, Quispe R, Poterico JA, Carrillo-Larco RM, Bazo-Alvarez JC, Miranda JJ. Parity and Overweight/Obesity in Peruvian Women. Prev Chronic Dis 2017; 14:E102. [PMID: 29072986 PMCID: PMC5662294 DOI: 10.5888/pcd14.160282] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction The rise in noncommunicable diseases and their risk factors in developing countries may have changed or intensified the effect of parity on obesity. We aimed to assess this association in Peruvian women using data from a nationally representative survey. Methods We used data from Peru’s Demographic and Health Survey, 2012. Parity was defined as the number of children ever born to a woman. We defined overweight as having a body mass index (BMI, kg/m2) of 25.0 to 29.9 and obesity as a BMI ≥30.0. Generalized linear models were used to evaluate the association between parity and BMI and BMI categories, by area of residence and age, adjusting for confounders. Results Data from 16,082 women were analyzed. Mean parity was 2.25 (95% confidence interval [CI], 2.17–2.33) among rural women and 1.40 (95% CI, 1.36–1.43) among urban women. Mean BMI was 26.0 (standard deviation, 4.6). We found evidence of an association between parity and BMI, particularly in younger women; BMI was up to 4 units higher in rural areas and 2 units higher in urban areas. An association between parity and BMI categories was observed in rural areas as a gradient, being highest in younger women. Conclusion We found a positive association between parity and overweight/obesity. This relationship was stronger in rural areas and among younger mothers.
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Affiliation(s)
- Carlos A Huayanay-Espinoza
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Renato Quispe
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julio A Poterico
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Carlos Bazo-Alvarez
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Ave Armendáriz 497, 2do piso, Miraflores, Lima 18, Peru. .,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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31
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Corvalán C, Garmendia ML, Jones-Smith J, Lutter CK, Miranda JJ, Pedraza LS, Popkin BM, Ramirez-Zea M, Salvo D, Stein AD. Nutrition status of children in Latin America. Obes Rev 2017; 18 Suppl 2:7-18. [PMID: 28741907 PMCID: PMC5601284 DOI: 10.1111/obr.12571] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/03/2017] [Indexed: 12/30/2022]
Abstract
The prevalence of overweight and obesity is rapidly increasing among Latin American children, posing challenges for current healthcare systems and increasing the risk for a wide range of diseases. To understand the factors contributing to childhood obesity in Latin America, this paper reviews the current nutrition status and physical activity situation, the disparities between and within countries and the potential challenges for ensuring adequate nutrition and physical activity. Across the region, children face a dual burden of undernutrition and excess weight. While efforts to address undernutrition have made marked improvements, childhood obesity is on the rise as a result of diets that favour energy-dense, nutrient-poor foods and the adoption of a sedentary lifestyle. Over the last decade, changes in socioeconomic conditions, urbanization, retail foods and public transportation have all contributed to childhood obesity in the region. Additional research and research capacity are needed to address this growing epidemic, particularly with respect to designing, implementing and evaluating the impact of evidence-based obesity prevention interventions.
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Affiliation(s)
- C Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - M L Garmendia
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - J Jones-Smith
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | | | - J J Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L S Pedraza
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - B M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala
| | - D Salvo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.,Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin Campus, Austin, TX, USA
| | - A D Stein
- Hubert Department of Global Health of the Rollins School of Public Health, Emory University, Atlanta, GA, USA
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32
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The double burden of malnutrition: a threat for Peruvian childhood. GACETA SANITARIA 2017; 31:359-360. [PMID: 28410795 DOI: 10.1016/j.gaceta.2016.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 11/24/2022]
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Cossio-Bolaños M, de Arruda M, Andruske CL, Luarte-Rocha C, Gómez-Campos R. Secular trends of physical growth and abdominal adiposity of school children and adolescents living at a moderate altitude in Peru. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 162:385-392. [DOI: 10.1002/ajpa.23121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/02/2016] [Accepted: 10/06/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Marco Cossio-Bolaños
- Department of Physical Activity Sciences; Catholic University of Maule; Talca Chile
- Faculty of Physical Education; State University of Campinas; São Paulo Brazil
- University Sports Institute, National University of San Agustin; Arequipa Perú
| | - Miguel de Arruda
- Faculty of Physical Education; State University of Campinas; São Paulo Brazil
| | - Cynthia Lee Andruske
- Biological Research Network for Human Development; Arequipa Perú
- Pedagogy in Secondary Education in English, Faculty of Educational Sciences; Universidad de Talca (Campus Linares); Chile
| | | | - Rossana Gómez-Campos
- Faculty of Physical Education; State University of Campinas; São Paulo Brazil
- Universidad Autonoma de Chile; Chile
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34
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Pérez-Lu JE, Cárcamo C, Nandi A, Kaufman JS. Health effects of 'Juntos', a conditional cash transfer programme in Peru. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27549365 DOI: 10.1111/mcn.12348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 05/19/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
Abstract
In some countries, conditional cash transfer (CCT) programmes show an impact on maternal and child health. Juntos, the CCT programme in Peru, has been evaluated several times operationally, but seldom for maternal and child health outcomes. The objective of this study is to evaluate the impact of Juntos on children under 6 years, pregnant women and mothers of children under 17 years. Outcomes evaluated included (1) anaemia in women and children; (2) acute malnutrition in children; (3) post-partum complications in mothers; and (4) underweight and overweight in mothers. We identified Juntos eligible respondents from the Demographic and Health Surveys of Peru for years 2007 to 2013. Propensity score matching was used to identify comparable treatment and control groups, including eligible respondents enrolled in Juntos vs. those not enrolled in Juntos (individual-level analysis), as well as eligible respondents living in Juntos districts vs. those not residing in Juntos districts (district-level analysis). We then used generalized linear models to estimate prevalence ratios. Individual level analysis showed that Juntos reduced underweight in women (PR:0.39, 95%CI:0.18 - 0.85) and anaemia in children (PR:0.93, 95%CI:0.86 - 1.00). In the district level analysis, the programme was associated with a reduction of overweight in women (PR:0.94, 95%CI:0.90 - 0.98) and acute malnutrition in children (PR:0.49, 95%CI:0.32 - 0.73), but an increase in the prevalence of anaemia in children (PR:1.09, 95%CI:1.01 - 1.17). We found that Juntos had an effect on maternal and child health indicators, but further studies are required to overcome some limitations encountered here.
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Affiliation(s)
- José E Pérez-Lu
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Cárcamo
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.,Institute for Health and Social Policy, McGill University, Montreal, Québec, Canada
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.,Institute for Health and Social Policy, McGill University, Montreal, Québec, Canada
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Prevalence and trends in the childhood dual burden of malnutrition in low- and middle-income countries, 1990-2012. Public Health Nutr 2016; 19:1375-88. [PMID: 26905921 DOI: 10.1017/s1368980016000276] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe trends in country- and individual-level dual burden of malnutrition in children <5 years, and age-stratified (<2 years, ≥2 years) country-level trends, in thirty-six low- and middle-income countries (LMIC). DESIGN Using repeated cross-sectional nationally representative data, we calculated the prevalence of malnutrition (stunting, wasting, overweight) at each survey wave, annualized rates of prevalence change for each country over time, and trends before and after 2000, for all children <5 years and separately for those </≥2 years. We examined country- (ratio of stunting to overweight) and individual-level (coexistence of stunting and overweight) dual burden in children <5 years. SETTING Demographic and Health Surveys from thirty-six LMIC between 1990 and 2012. SUBJECTS Children <5 years. RESULTS Overall malnutrition prevalence decreased in children <5 years, driven by stunting decreases. Stunting rates decreased in 78 % of countries, wasting rates decreased in 58 % of countries and overweight rates increased in 36 % of countries. Rates of change differed for children </≥2 years, with children <2 years experiencing decreases in stunting in fewer countries yet increases in overweight in more countries. Countries with nearly equal prevalences of stunting and overweight in children <5 years increased from 2000 to the final year. Within a country, 0·3-10·9 % of children <5 years were stunted and overweight, and 0·6-37·8 % of stunted children <5 years were overweight. CONCLUSIONS The dual burden exists in children <5 years on both country and individual levels, indicating a shift is needed in policies and programmes to address both sides of malnutrition. Children <2 years should be identified as a high-risk demographic.
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Carrillo-Larco RM, Miranda JJ, Bernabé-Ortiz A. Wealth index and risk of childhood overweight and obesity: evidence from four prospective cohorts in Peru and Vietnam. Int J Public Health 2015; 61:475-85. [DOI: 10.1007/s00038-015-0767-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/03/2015] [Accepted: 11/12/2015] [Indexed: 11/24/2022] Open
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Benziger CP, Bernabé-Ortiz A, Gilman RH, Checkley W, Smeeth L, Málaga G, Miranda JJ. Metabolic Abnormalities Are Common among South American Hispanics Subjects with Normal Weight or Excess Body Weight: The CRONICAS Cohort Study. PLoS One 2015; 10:e0138968. [PMID: 26599322 PMCID: PMC4658165 DOI: 10.1371/journal.pone.0138968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Objective We aimed to characterize metabolic status by body mass index (BMI) status. Methods The CRONICAS longitudinal study was performed in an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings: Lima (Peru’s capital, costal urban, highly urbanized), urban and rural Puno (both high-altitude), and Tumbes (costal semirural). Data from the baseline study, conducted in 2010, was used. Individuals were classified by BMI as normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30 kg/m2), and as metabolically healthy (0–1 metabolic abnormality) or metabolically unhealthy (≥2 abnormalities). Abnormalities included individual components of the metabolic syndrome, high-sensitivity C-reactive protein, and insulin resistance. Results A total of 3088 (age 55.6±12.6 years, 51.3% females) had all measurements. Of these, 890 (28.8%), 1361 (44.1%) and 837 (27.1%) were normal weight, overweight and obese, respectively. Overall, 19.0% of normal weight in contrast to 54.9% of overweight and 77.7% of obese individuals had ≥3 risk factors (p<0.001). Among normal weight individuals, 43.1% were metabolically unhealthy, and age ≥65 years, female, and highest socioeconomic groups were more likely to have this pattern. In contrast, only 16.4% of overweight and 3.9% of obese individuals were metabolically healthy and, compared to Lima, the rural and urban sites in Puno were more likely to have a metabolically healthier profile. Conclusions Most Peruvians with overweight and obesity have additional risk factors for cardiovascular disease, as well as a majority of those with a healthy weight. Prevention programs aimed at individuals with a normal BMI, and those who are overweight and obese, are urgently needed, such as screening for elevated fasting cholesterol and glucose.
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Affiliation(s)
- Catherine P. Benziger
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Asociación Benéfica PRISMA, Lima, Peru
| | - William Checkley
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Division of Pulmonary and Critical Care, School of Medicine Johns Hopkins University, Baltimore, MD, United States of America
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
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Cossio-Bolaños M, Campos RG, Andruske CL, Flores AV, Luarte-Rocha C, Olivares PR, Garcia-Rubio J, de Arruda M. Physical Growth, Biological Age, and Nutritional Transitions of Adolescents Living at Moderate Altitudes in Peru. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12082-94. [PMID: 26404334 PMCID: PMC4626956 DOI: 10.3390/ijerph121012082] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 08/19/2015] [Accepted: 09/14/2015] [Indexed: 11/16/2022]
Abstract
Background: Peru is experiencing a stage of nutritional transition where the principal characteristics are typical of countries undergoing development. Objectives: The objectives of this study were the following: (a) compare physical growth patterns with an international standard; (b) determine biological age; and (c) analyze the double nutritional burden of adolescents living at a moderate altitude in Peru. Design: Weight, standing height, and sitting height were measured in 551 adolescents of both sexes (12.0 to 17.9 years old) from an urban area of Arequipa, Peru (2328 m). Physical growth was compared with the international standard of the CDC-2000. Biological age was determined by using a non-invasive transversal technique based on years from age at peak height velocity (APHV). Nutritional state was determined by means of weight for age and height for age. Z scores were calculated using international standards from the CDC-2000. Results: Body weight for both sexes was similar to the CDC-2000 international standards. At all ages, the girls’ height (p < 0.05) was below the standards. However, the boys’ height (p < 0.05) was less at ages, 15, 16, and 17. Biological age showed up in girls at age 12.7 years and for boys at 15.2 years. Stunted growth (8.7% boys and 18.0% girls) and over weight (11.3% boys and 8.8% girls) occurred in both groups. A relationship existed in both sexes between the categories of weight for the age and stunted growth by sex. Conclusions: Adolescents living at a moderate altitude exhibited stunted linear growth and biological maturation. Furthermore, adolescents of both sexes showed the presence of the double nutritional burden (stunted growth and excessive weight).
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Affiliation(s)
- Marco Cossio-Bolaños
- Department of Physical Activity Sciences, Catholic University of Maule, Av. San Miguel 3605, Talca, Chile.
- Faculty of Physical Education, State University of Campinas, Avenida Érico Veríssimo, 701, Cidade Universitária Zeferino Vaz, Barão Geraldo, CEP 13.083-851, Campinas, Brazil.
| | - Rossana Gómez Campos
- Faculty of Physical Education, State University of Campinas, Avenida Érico Veríssimo, 701, Cidade Universitária Zeferino Vaz, Barão Geraldo, CEP 13.083-851, Campinas, Brazil.
- Instituto de Actividad Física y Salud, Universidad Autonoma de Chile, 5 Poniente 1670, Talca, Chile.
- Department of Research, Universidad Científica del Sur, Panamerica Sur Km 19 Villa, Lima, Peru.
- Group of Interdisciplinary Studies in Health Sciences and Sport, Universidad Autonoma de Chile, Talca 5 Poniente 1670, Chile.
| | - Cynthia Lee Andruske
- Research Network on Human Biological Development, Urb. Amauta C-6, Jose Luis Bustamante y Rivero, Arequipa, Peru.
| | - Antonio Viveros Flores
- Education Center Antonio José de Sucre, Leon Velarde Street s/n, Yanahuara, Arequipa, Peru.
| | - Cristian Luarte-Rocha
- Faculty of Physical Activity, San Sebastian University, General Cruz n 1577, Concepción, Chile.
| | - Pedro R Olivares
- Instituto de Actividad Física y Salud, Universidad Autonoma de Chile, 5 Poniente 1670, Talca, Chile.
| | - Javier Garcia-Rubio
- Instituto de Actividad Física y Salud, Universidad Autonoma de Chile, 5 Poniente 1670, Talca, Chile.
| | - Miguel de Arruda
- Faculty of Physical Education, State University of Campinas, Avenida Érico Veríssimo, 701, Cidade Universitária Zeferino Vaz, Barão Geraldo, CEP 13.083-851, Campinas, Brazil.
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Abstract
Objective To evaluate the association between length of residence in an urban area and obesity
among Peruvian rural-to-urban migrants. Design Cross-sectional database analysis of the migrant group from the PERU MIGRANT Study
(2007). Exposure was length of urban residence, analysed as both a continuous (10-year
units) and a categorical variable. Four skinfold site measurements (biceps, triceps,
subscapular and suprailiac) were used to calculate body fat percentage and obesity (body
fat percentage >25% males, >33% females). We used Poisson generalized
linear models to estimate adjusted prevalence ratios and 95 % confidence intervals.
Multicollinearity between age and length of urban residence was assessed using
conditional numbers and correlation tests. Setting A peri-urban shantytown in the south of Lima, Peru. Subjects Rural-to-urban migrants (n 526) living in Lima. Results Multivariable analyses showed that for each 10-year unit increase in residence in an
urban area, rural-to-urban migrants had, on average, a 12 % (95 % CI 6, 18 %) higher
prevalence of obesity. This association was also present when length of urban residence
was analysed in categories. Sensitivity analyses, conducted with non-migrant groups,
showed no evidence of an association between 10-year age units and obesity in rural
(P=0·159) or urban populations (P=0·078). High
correlation and a large conditional number between age and length of urban residence
were found, suggesting a strong collinearity between both variables. Conclusions Longer lengths of urban residence are related to increased obesity in rural-to-urban
migrant populations; therefore, interventions to prevent obesity in urban areas may
benefit from targeting migrant groups.
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Veghari G. The Comparison of Under-Five-Children's Nutrition Status Among Ethnic Groups in North of Iran, 1998 - 2013; Results of a Three Stages Cross-Sectional Study. IRANIAN JOURNAL OF PEDIATRICS 2015; 25:e2004. [PMID: 26396693 PMCID: PMC4575791 DOI: 10.5812/ijp.2004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite improvements in child health, malnutrition still remains one of the main public health challenges in Iran. OBJECTIVES The aim of this study was to compare under nutrition among under-five children with regard to ethnicity in rural area in north Iran. PATIENTS AND METHODS In three cross-sectional studies 7575 subjects in three time-periods including 2339 children in 1998, 2749 in 2004, and 2487 in 2013, were evaluated. All under-five-children in 20 out of 118 villages were chosen by random sampling and assessed. Under nutrition was defined as underweight, stunting and wasting lower than -2 SD (Z < -2 SD). RESULTS Generally, stunting was declined 17.1% and underweight and wasting were increased 0.9% and 1%, respectively during 15 years (1998 - 2013). Underweight increased 0.5% in Fars-natives and 3.2% in Turkmans and it was decreased 0.9% in Sistanis. Statistical difference in Turkman children among the three stages of the study was significant (P = 0.001). Stunting has decreased 28.7% in Fars-natives and 35.1% in Sistanis, it was increased 9.3% in Turkman group. Statistical differences among three stages in inter-ethnic groups were significant (P = 0.001 for all). Compared the group with good economic status, the odds ratio was 1.831 in poor economic group (P = 0.001). The risk of under nutrition in Sistanis was 1.754 times more than in Fars-natives (P = 0.001). CONCLUSIONS Under nutrition remains one of the main health problems in under-five-year children in north Iran being more common in Sistani children. Stunting in Sistani children deeply decreased while in Turkman children slightly increased during the 15-year period study. Poor economic status is a risk factor for under nutrition in this area.
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Affiliation(s)
- Gholamreza Veghari
- Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
- Corresponding author: Gholamreza Veghari, Metabolic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel: +98-9113771432, E-mail:
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Diez-Canseco F, Boeren Y, Quispe R, Chiang ML, Miranda JJ. Engagement of adolescents in a health communications program to prevent noncommunicable diseases: Multiplicadores Jóvenes, Lima, Peru, 2011. Prev Chronic Dis 2015; 12:E28. [PMID: 25742065 PMCID: PMC4353176 DOI: 10.5888/pcd12.140416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Several risk factors for noncommunicable diseases (NCDs), including obesity, are associated with behaviors established in infancy that persist throughout adolescence and adulthood. As such, adolescents should be engaged in the design and implementation of NCD prevention strategies. Community Context In Lima, Peru’s capital, the proportion of adolescents aged 15 to 19 is 9.3% of the city’s population, and school enrollment rates are high. The prevalence of excess weight in Peruvian adolescents is 14.2%, and prevalence has not declined in recent years. Also recently, NCDs and their risk factors have gained more attention in public health and policy areas, with regulatory action focusing on healthful nutrition to address obesity and related NCDs. The Multiplicadores Jóvenes (Young Multipliers) project was conducted among adolescents aged 15 to 17 from 9 public secondary schools in peri-urban areas of Lima, Peru. Methods The project provided basic communication tools and knowledge of NCD prevention and public health research to adolescents during 16 weekly participatory sessions to enable them to design and disseminate healthful lifestyle promotion messages to their school peers. Outcome Thirty of 45 participants finished the program. Seven communications campaigns were designed and implemented in schools, reaching 1,200 students. The participants gained motivation, increased knowledge, and developed communication skills that were combined to implement healthful lifestyle promotion campaigns. Interpretation Engaging young people in public health promotion activities was feasible and advantageous for the design of tailored prevention-related content and its dissemination among peers.
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Affiliation(s)
- Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Yulissa Boeren
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Renato Quispe
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mey Lin Chiang
- School of Communication, Universidad de Lima, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, 2do Piso, Miraflores, Lima 18, Peru.
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Humphries DL, Behrman JR, Crookston BT, Dearden KA, Schott W, Penny ME. Households across all income quintiles, especially the poorest, increased animal source food expenditures substantially during recent Peruvian economic growth. PLoS One 2014; 9:e110961. [PMID: 25372596 PMCID: PMC4220962 DOI: 10.1371/journal.pone.0110961] [Citation(s) in RCA: 9] [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: 01/24/2014] [Accepted: 09/26/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Relative to plant-based foods, animal source foods (ASFs) are richer in accessible protein, iron, zinc, calcium, vitamin B-12 and other nutrients. Because of their nutritional value, particularly for childhood growth and nutrition, it is important to identify factors influencing ASF consumption, especially for poorer households that generally consume less ASFs. OBJECTIVE To estimate differential responsiveness of ASF consumption to changes in total household expenditures for households with different expenditures in a middle-income country with substantial recent income increases. METHODS The Peruvian Young Lives household panel (n = 1750) from 2002, 2006 and 2009 was used to characterize patterns of ASF expenditures. Multivariate models with controls for unobserved household fixed effects and common secular trends were used to examine nonlinear relationships between changes in household expenditures and in ASF expenditures. RESULTS Households with lower total expenditures dedicated greater percentages of expenditures to food (58.4% vs.17.9% in 2002 and 24.2% vs. 21.5% in 2009 for lowest and highest quintiles respectively) and lower percentages of food expenditures to ASF (22.8% vs. 33.9% in 2002 and 30.3% vs. 37.6% in 2009 for lowest and highest quintiles respectively). Average percentages of overall expenditures spent on food dropped from 47% to 23.2% between 2002 and 2009. Households in the lowest quintiles of expenditures showed greater increases in ASF expenditures relative to total consumption than households in the highest quintiles. Among ASF components, meat and poultry expenditures increased more than proportionately for households in the lowest quintiles, and eggs and fish expenditures increased less than proportionately for all households. CONCLUSIONS Increases in household expenditures were associated with substantial increases in consumption of ASFs for households, particularly households with lower total expenditures. Increases in ASF expenditures for all but the top quintile of households were proportionately greater than increases in total food expenditures, and proportionately less than overall expenditures.
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Affiliation(s)
- Debbie L. Humphries
- Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Jere R. Behrman
- Department of Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Benjamin T. Crookston
- Department of Health Science, Brigham Young University, Provo, Utah, United States of America
| | - Kirk A. Dearden
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Whitney Schott
- Department of Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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