Combined effect of short stature and socioeconomic status on body mass index and weight gain during reproductive age in Brazilian women

Co-existence of maternal overweight/obesity, child undernutrition, and anaemia among mother-child pairs in Ethiopia

Ethiopia is currently known to be the most food-insecure country in sub-Saharan Africa, where childhood undernutrition remains endemic. While attention is increasingly being paid to childhood undernutrition in Ethiopia, a current surge of "triple burden of malnutrition" (TBM) has received less attention. The purpose of this study was to determine the prevalence of TBM and identify the associated factors in Ethiopia. Data were from the Ethiopian Demographic and Health Surveys (2005-2016) and a total of 20,994 mother-child pairs were examined in this study. The TBM was our primary outcome variable, which encompasses three types of nutritional problems-when a mother may be overweight/obese, while her child is stunted, wasted, or underweight plus has anaemia under the same roof. A multilevel logistic regression explored the individual- and community-level factors associated with TBM. Our study indicated that children under-five years of age were anaemic, stunted, wasted, and underweight [49.3% (95% CI: 48.7-49.9), 43.1% (95% CI: 42.4-43.7), 10.3% (95% CI: 9.9-10.7), and 27.6% (95% CI: 27.0-28.1)] respectively. The overall prevalence of TBM was 2.6% (95% CI: 2.39-2.83). Multilevel analyses revealed that TBM was more likely to occur among children aged 12-23 months (AOR: 2.54, 95% CI: 1.68-3.83), 24-35 months (AOR: 1.54, 95% CI: 1.03-2.29), children perceived by their mothers to be smaller than normal at birth (AOR: 1.94, 95% CI: 1.48-2.56), who experienced fever in the past 2 weeks (AOR: 1.58, 95% CI: 1.24-2.01), and lived in urban settings (AOR: 1.79, 95% CI: 1.13-2.86). Lower odds of TBM were reported among female children (AOR: 0.59, 95% CI: 0.47-0.72), and those who lived in rich households (AOR: 0.69: 95% CI: 0.49-0.98). TBM was found to be present in almost three percent of households in Ethiopia. Addressing the TBM through double-duty actions will be of critical importance in achieving malnutrition in all its forms in Ethiopia.

Association between maternal stature and household-level double burden of malnutrition: findings from a comprehensive analysis of Ethiopian Demographic and Health Survey

BACKGROUND

Undernutrition among under-five children is one of the intractable public health problems in Ethiopia. More recently, Ethiopia faced a rising problem of the double burden of malnutrition-where a mother may be overweight/obese, and a child is stated as having undernutrition (i.e., stunting, wasting, or underweight) under the same roof. The burden of double burden of malnutrition (DBM) and its association with maternal height are not yet fully understood in low-income countries including Ethiopia. The current analysis sought: (a) to determine the prevalence of double burden of malnutrition (i.e., overweight/obese mother paired with her child having one form of undernutrition) and (b) to examine the associations between the double burden of malnutrition and maternal height among mother-child pairs in Ethiopia.

METHODS

We used population-representative cross-sectional pooled data from four rounds of the Ethiopia Demographic and Health Survey (EDHS), conducted between 2000 and 2016. In our analysis, we included children aged 0-59 months born to mothers aged 15-49 years. A total of 33,454 mother-child pairs from four waves of EDHS were included in this study. The burden of DBM was the primary outcome, while the maternal stature was the exposure of interest. Anthropometric data were collected from children and their mothers. Height-for-age (HFA), weight-for-height (WFH), and weight-for-age (WFA) z-scores < - 2 SD were calculated and classified as stunted, wasting, and underweight, respectively. The association between the double burden of malnutrition and maternal stature was examined using hierarchical multilevel modeling.

RESULTS

Overall, the prevalence of the double burden of malnutrition was 1.52% (95% CI 1.39-1.65). The prevalence of overweight/obese mothers and stunted children was 1.31% (95% CI 1.19-1.44), for overweight/obese mothers and wasted children, it was 0.23% (95% CI 0.18-0.28), and for overweight/obese mothers and underweight children, it was 0.58% (95% CI 0.51-0.66). Children whose mothers had tall stature (height ≥ 155.0 cm) were more likely to be in the double burden of malnutrition dyads than children whose mothers' height ranged from 145 to 155 cm (AOR: 1.37, 95% CI 1.04-1.80). Similarly, the odds of the double burden of malnutrition was 2.98 times higher for children whose mothers had short stature (height < 145.0 cm) (AOR: 2.98, 95% CI 1.52-5.86) compared to those whose mothers had tall stature.

CONCLUSIONS

The overall prevalence of double burden of malnutrition among mother-child pairs in Ethiopia was less than 2%. Mothers with short stature were more likely to suffer from the double burden of malnutrition. As a result, nutrition interventions targeting households' level double burden of malnutrition should focus on mothers with short stature to address the nutritional problem of mother and their children, which also has long-term and intergenerational benefits.

Food insecurity and the double burden of malnutrition in Colombian rural households

OBJECTIVE

This study aimed to examine in Colombian rural households the association between different severity levels of household food insecurity and the presence of the double burden of malnutrition (SCOWT), defined as the coexistence of a stunted child under 5 years of age and an overweight or obese (OWOB) mother.

DESIGN

A secondary data analysis was conducted using cross-sectional data from the Colombian National Nutritional Survey (ENSIN) 2015. Household food insecurity status was assessed by using the Latin-American and Caribbean Food Security Scale (ELCSA). The household SCOWT status (child stunting and OWOB mother) was determined using anthropometric data from a mother and her child.

SETTING

Rural Colombia.

PARTICIPANTS

Totally, 2·350 mother-child pairs living in the same household.

RESULTS

Sixty-two per cent of the households were food-insecure and SCOWT was present in 7·8 % of the households. Moderate (OR: 2·39, 95 % CI (1·36, 4·21)) and severe (OR: 1·86, 95 % CI (1·10, 3·15)) food insecurity was associated with SCOWT in an unadjusted logistic regression. Only moderate food insecurity remained significantly associated with SCOWT in a multivariate logistic regression (adjusted OR: 2·41, 95 % CI (1·24, 4·68)).

CONCLUSIONS

Colombian rural areas are not exempt from the worldwide concern of increasing OWOB rates while stunting is still persistent. These results highlight the need of implementing double-duty rural actions targeting the most vulnerable households to SCOWT, particularly in terms of overcoming food insecurity beyond hunger satisfaction to prevent all forms of malnutrition.

High double burden of child stunting and maternal overweight in the Republic of the Marshall Islands

Many low‐ and middle‐income countries are faced with a double burden of malnutrition characterized by a stagnating burden of undernutrition and an increasing prevalence of overweight and obesity often observed both at population and household levels. We used data from the 2017 National Integrated Child Health and Nutrition Survey in the Republic of the Marshall Islands to explore the prevalence of overweight mother‐stunted child pairs (mother–child double burden, MCDB). We used bivariate analysis, multivariate logistic regression, and multinomial logistic regression analysis to explore associations between child‐, maternal‐, and household‐level variables and both stunting and MCDB and other types of maternal–child pairs. Our results indicate that nearly three out of four mothers were overweight or obese and one in four households is home to an overweight mother with a stunted child. The risk of child stunting and of MCDB were largely associated with maternal characteristics of lower maternal height, maternal age at birth, years of education, and marital status and household economic status as measured by wealth index and number of household members. These findings support the growing body of evidence showing that the coexistence of high maternal overweight and child stunting (MCDB) has linked root causes to early life undernutrition that are exacerbated by the nutrition transition.

Prevalence and factors associated with double and triple burden of malnutrition among mothers and children in Nepal: evidence from 2016 Nepal demographic and health survey

BACKGROUND

Malnutrition in mothers and children is a significant public health challenge in developing countries such as Nepal. Although undernutrition in children has been gradually decreasing, the coexistence of various forms of malnutrition in mothers and children has continued to rise globally. There is a gap in knowledge of the coexistence of such multiple burdens of malnutrition in the Nepalese context. The aims of this study were to explore the coexistence of various forms of malnutrition and associated factors among mother-child pairs residing in the same household.

METHODS

A total sample of 2261 mother-child pairs from the Nepal Demographic and Health Survey (NDHS) 2016 were included in the study. Anthropometric measurements and hemoglobin levels of children and anthropometric measurements of their mothers were collected. Bivariate and multivariable logistic regression models were used to assess the factors associated with the double burden of malnutrition (DBM) and the triple burden of malnutrition (TBM).

RESULTS

Prevalence of DBM and TBM was 6.60% (95% CI: 5.13-8.84) and 7.00% (95% CI: 5.42-8.99) respectively in the same households. In the adjusted multivariable logistic regression models, mothers with short stature (AOR = 4.18, 95% CI: 2.04-8.52), from the richest wealth quintile (AOR = 2.46, 95% CI: 1.17-5.15), aged over 35 years (AOR = 3.08, 95% CI: 1.20-7.86), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.03-4.07) were more likely to suffer from the DBM. Similarly, mothers with short stature (AOR = 5.01, 95% CI: 2.45-10.24), from the richest wealth quintile (AOR = 2.66, 95% CI: 1.28-5.54), aged over 35 years (AOR = 3.41, 95% CI: 1.26-9.17), and those who had achieved at least secondary level education (AOR = 2.05, 95% CI: 1.00-4.18) were more likely to suffer from the TBM.

CONCLUSIONS

Overall, there is a low prevalence of double and triple burden of malnutrition among mother-child pairs in Nepal. Older mothers with short stature and those from richer wealth quintiles were more likely to suffer from double and triple burden of malnutrition.

Waist-to-Height Gain and Triiodothyronine Concentrations in a Cohort of Socially Vulnerable Short-Stature Women: A Four-Year Follow-Up Study

BACKGROUND

Short stature that results from undernourishment during perinatal period is associated with an increased risk of diabetes and cardiovascular diseases in adulthood, particularly in poor populations. The present study investigated changes on anthropometric and metabolic parameters of socially vulnerable women with short stature.

METHODS

A prospective study with 48 women (19-45 years) who were mothers of undernourished children was conducted. Twenty-five of them were short (height ≤150 cm), and 23 were not short, to serve as a control (height >159 cm). Biochemical, anthropometric and dietary intake data were collected, before and after 4 years of follow-up. A mixed within-between analysis of covariance was used to assess the interaction between 'group' and 'time'.

RESULTS

Waist-to-height ratio increased only in the short stature group, with significant interaction (+0.03 ± 0.03 in short group vs. +0.01 ± 0.03 in control; p for interaction = 0.04). The short stature group showed a significant decrease in the plasma triiodothyronine (T3) concentrations, without significant interaction (-0.16 ± 0.23 ng/ml in short group vs. -0.04 ± 0.29 ng/ml in control; p for interaction = 0.20).

CONCLUSION

Women of short stature presented an increase in waist-to-height ratio, with a simultaneous decrease in total plasma T3. These alterations may lead them to increased risk of comorbidities.

Weight gain and reduced energy expenditure in low-income Brazilian women living in slums: a 4-year follow-up study

The present study aimed to investigate the possible changes in anthropometric and biochemical parameters in low-income women living in the outskirts of Maceió (northeast Brazil), and to explore the possible role of dietary intake and physical activity in these changes. A prospective longitudinal study was conducted in a cohort of mothers of malnourished children who attended the Center for Nutritional Recovery and Education, an outreach programme of the Federal University of Alagoas. Socio-economic, anthropometric, biochemical and dietary intake data were assessed at baseline and after a follow-up period of 4 years. Energy expenditure (using doubly labelled water) and physical activity (using triaxial accelerometers) were assessed only in a subgroup of women after 4 years. A total of eighty-five women were assessed. Participants showed an altered biochemical profile, increased systolic blood pressure, decreased thyroid hormone levels, and body-weight gain. However, dietary intakes of the participants did not include large quantities of highly processed and high-glycaemic index foods. The energy intake of the participants did not differ from their total energy expenditure (7990·3 (7173·7–8806·8)v. 8798·1 (8169·0–9432·4) kJ, respectively;P= 0·084). Multivariate analyses showed a significant effect of time spent watching television (β = 0·639 (0·003 to 1·275);P= 0·048) and dietary diversity score (β = − 1·039 ( − 2·010 to − 0·067);P= 0·036) on weight gain. The present study indicates that poor women, who are mothers of malnourished children and have a reasonably balanced dietary intake, exhibit weight gain and are at risk of developing chronic diseases.

Predictors of maternal and child double burden of malnutrition in rural Indonesia and Bangladesh

BACKGROUND

Many developing countries now face the double burden of malnutrition, defined as the coexistence of a stunted child and overweight mother within the same household.

OBJECTIVE

This study sought to estimate the prevalence of the double burden of malnutrition and to identify associated maternal, child, and household characteristics in rural Indonesia and Bangladesh.

DESIGN

A total of 247,126 rural households that participated in the Indonesia Nutrition Surveillance System (2000-2003) and 168,317 rural households in the Bangladesh Nutritional Surveillance Project (2003-2006) were included in the analysis. Maternal and child double burden (MCDB) and its association with individual and household characteristics were determined by using logistic regression models.

RESULTS

MCDB was observed in 11% and 4% of the households in rural Indonesia and Bangladesh, respectively. Maternal short stature [Indonesia (OR: 2.32; 95% CI: 2.25, 2.40); Bangladesh (OR: 2.11; 95% CI: 1.96, 2.26)], and older age were strong predictors of MCDB. Child characteristics such as older age and being female were associated with an increased odds of MCDB, whereas currently being breastfed was protective against MCDB [Indonesia (OR: 0.84; 95% CI: 0.81, 0.84); Bangladesh (OR: 0.55; 95% CI: 0.52, 0.58)]. A large family size and higher weekly per capita household expenditure predicted MCDB [Indonesia (OR: 1.34; 95% CI: 1.28, 1.40); Bangladesh (OR: 1.94; 95% CI: 1.77, 2.12)].

CONCLUSIONS

Double burden is not exclusive to urban areas. Future policies and interventions should address under- and overweight simultaneously in both rural and urban developing country settings.

[Body mass index increase after the age of 20 and associations with risk or protection factors for chronic non-communicable diseases]

OBJECTIVE

To examine sociodemographic risk or protection factors for chronic non-communicable diseases (CNCDs) that may be associated with increase in body mass index (BMI) after the age of 20.

METHODS

Cross-sectional analysis based on data from 769 women and 572 men who participated in the 2005 Surveillance System for Risk factors for CNCDs, Florianópolis, Brazil. BMI increase was defined in percentage as the difference between BMI in 2005 and at age 20.

RESULTS

Since the age of 20, most of the respondents had increased their BMI by more than 10%. In multiples analysis, independent correlates of BMI increase were: advancing age, low education (women), being married (men), not working, low self-rated health, high blood pressure, high cholesterol/triglyceride levels (men), going on a diet, sedentarism and having been a smoker (women).

CONCLUSIONS

Health promotion strategies to prevent weight gain need to be targeted to groups and should mainly consider sociodemographic factors.

Relationship between short stature and obesity in Brazil: a multilevel analysis

To ascertain the association of BMI and obesity with short stature, a cross-sectional telephone survey was conducted in 2006, using a multilevel approach, adjusting for individual- and city-level measures of socio-economic status. The study probabilistic sample consisted of 54 369 adults (>18 years) living in households with access to telephone lines in each urban area of the twenty-six Brazilian state capitals and federal district. Odds of being currently obese and obese at age 20 years were compared between short stature individuals (5th percentile) and those with normal stature. After controlling for individual- and city-level sociodemographic characteristics and behaviours, high BMI was strongly associated with short stature individuals (P = 0·001). Among short stature women the adjusted OR of being obese was 3·0 (95 % CI 2·2, 4·2) compared with those with stature greater than the 5th percentile. Among men this adjusted OR was 2·0 (95 % CI 1·5, 2·6). When comparisons were made for BMI at age 20 years the OR were even larger (6 for men and 8 for women). Despite the growing body of evidence that environmental factors such as poor food choices and physical inactivity are the main determinants of the worldwide obesity epidemic, the greater difference in BMI and prevalence of obesity in the Brazilian capitals was explained mainly by individual factors. We found a strong association between obesity and short stature after adjustment for diet, physical activity, and many environmental factors. Intra- and inter-generational consequences of undernutrition are an alternative explanation for the regional disparities in obesity in Brazil.

Fatness and overweight in women and children from riverine Amerindian communities of the Beni River (Bolivian Amazon)

Obesity is a worldwide public health problem impacting not only industrialized nations but also developing countries. The main objective of this paper was to analyze risk factors for overweight among Amerindian children and their mothers. Data were collected in 15 Amerindian riverside communities from the Beni River (Bolivia). The total sample was of 195 mothers and 452 children, 0-15 years of age. Information about family activity and dietary patterns was collected, and a clinical examination was performed. Stool samples were collected in children for parasitological screening. Anthropometric measurements, including weight, height, arm circumference, and four skinfolds, were taken. A bioelectrical impedance analysis was performed in mothers. In total, 12.2% (95% confidence interval (CI(95%)) 9.1-15.9%) of the children were considered overweight; less than 1% were overtly obese International Obesity Task Force (IOTF) criteria. Among their mothers, 35.3% (CI(95%), 28.7-42.5%) were overweight (BMI (weight/height (2)) >25 kg/m(2)), and 5% (CI(95%), 2.5-5.1%) were obese (BMI >30 kg/m(2)). BMI was moderately related to anthropometric indices of body composition in children, but was highly correlated with fatness in mothers. The risk of overweight was not associated with environmental factors in children. In mothers, there was a significant relationship between BMI, health status, and dietary diversity score. There was a moderate association in boys between fatness and the BMI of their mothers (R(2) = 0.12, P < 0.001), but not in girls. These findings suggest a trend toward accumulation of fat related to possible changes at the economic and agricultural levels, even in remote rural areas.

Relationship between sitting-height-to-stature ratio and adiposity in Brazilian women

Inadequate anthropometric dimensions, such as short leg length or high sitting-height-to-stature ratio (SHSR) in adults, can be considered indices of adverse environmental conditions in early life. Our objective was to describe the association between SHSR, a variable of prepubertal environment, and levels of adiposity in a group of Brazilian women. Six hundred and sixty-nine women aged 20-55 years were studied through a cross-sectional design. Detailed anthropometric measurements were obtained according to standardized procedures. Body mass index (BMI) > or = 30 kg/m2, percent body fat (% BF) measured through bioelectrical impedance >30, and the third tertile of six skinfold sums (SKF sum) were treated as dependent variables. High SHSR was defined as values > or = mean + 1 SD. Data analysis was performed using nonconditional hierarchical multivariate logistic regression, estimating adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the three dependent variables. Thirty-two percent of women who had high SHSR had low stature, compared with 13.8% in the group with normal SHSR (P < 0.000). After adjustment for age, schooling, total family income, parity, and age of menarche, high SHSR was still associated with BMI > or = 30 kg/m2 (OR, 2.46; 95% CI, 1.31-4.60), % BF >30 (OR, 2.07; 95% CI, 1.11-3.61), and SKF sum (OR, 2.11; 95% CI, 1.33-3.35). These results support the hypothesis that high SHSR, a variable of prepubertal adverse environmental conditions, is independently associated with adiposity in this group of Brazilian women. Responsible factors for high SHSR, other than genetics, should be investigated.

Pregnancy increases BMI in adolescents of a population-based birth cohort

Evidence from developed countries suggests that adolescents grow while pregnant and that their growth is associated with increased weight gain and fat storage, but this has never been examined in girls from developing countries. Adolescents born in 1982 in Pelotas, Brazil, are being followed in a birth cohort study. Information on social and biological determinants of nutritional status was collected in early life. Both in 1997 and in 2001, 464 girls were located through household visits, 16% of whom had had a pregnancy in this period. Changes in height, weight, and BMI between 1997 and 2001 were analyzed in relation to the occurrence of pregnancy, after adjustment for previous anthropometric status, as well as social and biological characteristics. The average gains were 2.0 +/- 2.0 cm in height, 3.1 +/- 5.9 kg in weight, and 0.7 +/- 2.2 kg/m(2) in BMI. Each pregnancy was associated with a reduction of 0.46 cm on height gain from 1997 to 2001 (P = 0.02). Girls who became pregnant gained 2.25 kg more than all others (P = 0.004). There was a clear association between pregnancy and BMI change. A single pregnancy was associated with an increase of 0.81 kg/m(2) (P = 0.01) and 2 or more pregnancies were associated with an increase of 1.58 kg/m(2) (P = 0.02). Teenage pregnancy was associated with an important increase in BMI. Given the growing epidemic of obesity in low- and middle-income countries, particularly among women, efforts to reduce teenage pregnancy may also contribute to preventing overweight.

[Regulation of thyrotropin synthesis and secretion]

The set point of thyrotropin (TSH) secretion is determined by the balance of a positive regulation of thyrotropin releasing hormone (TRH) and the strong negative regulation exerted by thyroid hormones. In addition, there are other regulators superimposed on this main axis such as somatostatin and dopamine, which act as inhibitors of TSH secretion, and central alpha-adrenergic pathways that are predominantly stimulatory and involved in the cold-induced thyroid activation. Nutritional status and leptin also regulate TSH by stimulating TRH neurons through direct and indirect mechanisms. Stress is also involved in lowering TRH/TSH secretion possibly through glucocorticoids, cytokines and opioids. Recently, a new regulatory pathway has been proposed, via peptides produced in pituitary, acting in an autocrine/paracrine manner. Among those, more consistent data are available on neuromedin B, gastrin-releasing peptide and pituitary leptin, which act as local inhibitors of TSH release. Neonatal programming of TSH secretion set point is also discussed.