Obesity trends and determinant factors in Latin America

Recent changes in growth trajectories: a population-based cohort study of over 5 million Brazilian children born between 2001 and 2014

Background

There is limited evidence on recent trends in childhood growth trajectories in Low-/middle-income countries. We investigated how age-trajectories for height and Body Mass Index (BMI) have changed among Brazilian children born in two different time periods after 2000.

Methods

We used a population-based cohort (part of the "Cohort of 100-Million Brazilians") created by the linkage of three Brazilian administrative databases: the Cadastro Único of the Federal Government, the National System of Live Births and the National Nutritional and Food Surveillance System. We included longitudinal data on 5,750,214 children who were 3 to <10 years of age and born between 2001 and 2014 (20,209,133 observations). We applied fractional polynomial models with random-effects to estimate mean height and BMI trajectories for children.

Findings

Compared to children born in 2001-2007, the cohort born in 2008-2014 were on average taller, by a z-score of 0.15 in boys and 0.12 in girls. Their height trajectories shifted upwards, by approximately 1 cm in both sexes. Levels of BMI increased little, by a z-score of 0.06 (boys) and 0.04 (girls). Mean BMI trajectories also changed little. However, the prevalence of overweight/obesity increased between cohorts, e.g., from 26.8% to 30% in boys and 23.9%-26.6% in girls aged between 5 and <10 years.

Interpretation

An increase of 1 cm in mean height of Brazilian children during a short period indicates the improvement in maternal and child health, especially those from low-income families due to the new health and welfare policies in Brazil. Although mean BMI changed little, the prevalence of child overweight/obesity slightly increased and remained high.

Funding

This work was supported by National Council for Scientific and Technological Development - CNPq; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES; National Institute for Health Research (NIHR) Great Ormond Street Hospital Biomedical Research Centre; Society for the Study of Human Biology; Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG; Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Complexo da Saúde do Ministério da Saúde - Decit/SECTICS/MS. The study also used resources from the Centre for Data and Knowledge Integration for Health (CIDACS), which receives funding from the Bill & Melinda Gates Foundation, the Wellcome Trust, the Health Surveillance Secretariat of the Ministry of Health and the Secretariat of Science and Technology of the State of Bahia (SECTI-BA).

A Vulnerability Index for Mitigation and Prevention of Diabetes Growth in India: A Disaggregated Analysis

OBJECTIVES

This study aimed to provide a vulnerability index (VI) for identifying vulnerable regions in different states of India, which may serve as a tool for state- and district-level planning for mitigation and prevention of diabetes growth in the country.

METHODS

Using data on 13 indicators under 4 domains, we generated domain-specific and overall VIs at state (36 states/union territories) and district levels (640 districts) using the percentile ranking method. The association of diabetes with individuals' socioeconomic status at different levels of regional vulnerability has also been observed through multivariable logistic regression models.

RESULTS

On a scale of 0 to 1, there are 13 states with an overall VI of >0.70, of which 5 states are from southern regions of India. A low VI has been achieved by socioeconomically backward states. We observed that prevalence rates and vulnerability levels for most of the top and bottom 11 states are in the same line. District-level analysis showed that the 20 most vulnerable and least vulnerable districts are mostly from coastal and socioeconomically backward states of the country, respectively. Furthermore, logistic regression revealed that rural adults and females are less likely to be diabetic in all vulnerability quartiles. The oldest, Muslims, wealthiest, widowed/deserted/separated, and those with schooling ≤12 years are significantly more likely to be diabetic than their counterparts.

CONCLUSION

The constructed VI is vital for identifying vulnerable areas and planners and policy-makers may use this comprehensive index and domain-specific VIs to prioritize resource allocation.

Overweight and obesity in women participating in social feeding programs in Mexico: data from vulnerable population groups in the Mexican National Nutrition and Health Survey 2018

Introduction

Introduction: Mexico is a country with a high prevalence of overweight and obesity. However, social feeding programs often target only undernutrition in vulnerable population groups. Objective: to estimate the association of overweight and obesity (OW) with participation in a conditional cash transfers (CCT) program and other social feeding programs in women 15-49 years of age within the most economically vulnerable population in Mexico. Methods: anthropometric data, as well as information on participation in social feeding programs, household food insecurity and sociodemographic variables, were analyzed for women aged 15-49 living in localities of under 100,000 inhabitants in Mexico. Data was derived from the Mexican National Health and Nutrition Survey 2018. A multiple logistic regression model was applied to estimate the association between OW and participation in social feeding programs, as well as other covariables. Results: the prevalence of OW in women who benefited from CCT was 62 %, while for women who participated in this as well as other programs the prevalence was 72.9 % (p = 0.04). A protective association was observed between the CCT program and OW (OR = 0.72, p = 0.04). Additionally, benefitting from DIF Community Kitchens revealed a risk association with OW (OR = 2.76, p = 0.03). Conclusions: it is critical that the design of public policy and social feeding programs consider the scientific evidence generated through rich experiences in Mexico, such as the program of CCT Prospera. This will allow decision-makers to address the epidemiological health and nutrition problems impacting the Mexican population today.

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

Background

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

Methods

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

Results

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

Conclusion

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

Social position and anthropometric status among adults in the ELSA-Brasil study: a latent class analysis

The objective of the present study was to evaluate the association between social position and anthropometric status in women and men Brazilian adult. This was a cross-sectional study that used baseline data collected from 2008 to 2010 for the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, in Portuguese), in the six major Brazilian state capital cities. A total of 15,105 active and retired civil servants aged from 35 to 74 years. Two latent variables were defined by latent class analysis, social position and anthropometric status. Both constructs and the analyses were separately evaluated by sex. Associations were assessed using multivariate logistic regression analysis with adjustment for age, self-reported skin color/race, and marital status. Around 44% of the women and 26% of the men were classified as overweight or obese. Social position tended to be lower in women (43.2%) and higher among men (40.4%). Heavier women were more likely to be black and brown-skinned, whereas slimmer women were more likely to be white. After adjustment, women's weight increased as social position decreased (OR = 1.52; 95%CI: 1.36-1.70), whereas in men weight decreased as social position decreased (OR = 0.87; 95%CI: 0.76-0.99). Social position affected the anthropometric status of women and men differently, with body patterns also being affected by ethnicity/skin color, showing the potentiality of taking the intersectional perspective when investigating the possible social determinants of the phenomenon.

Framing the Latin American nutrition transition in a historical perspective, 1850 to the present

This paper argues that many of the foundations and trends that led to the rise in obesity and other diet-related health problems in Latin America began to develop in the late nineteenth century. The tendency towards presentism in the nutrition transition literature provides a much abbreviated and limited history of changes in diet and weight. Whereas medical and nutrition researchers have tended to emphasize the recent onset of the crisis, a historical perspective suggests that increasingly global food sourcing prompted changes in foodways and a gradual "fattening" of Latin America. This paper also provides a methodological and historiographic exploration of how to historicize the nutrition transition, drawing on a diverse array of sources from pre-1980 to the present.

Individual- and community-level factors associated with underweight and overweight among women of reproductive age in Bangladesh: a multilevel analysis

The co-existence of under- and overweight at population level around the globe is well documented. However, this has yet to be explored using suitable statistical techniques in the context of Bangladesh. This study aimed to examine the prevalence and risk factors for being underweight and overweight or obese compared with normal weight in ever-married non-pregnant women aged 15-49 years in Bangladesh using data from the most recent Bangladesh Demographic and Health Survey conducted in 2014. Multilevel multinomial logistic regression (MLMLR) and quantile regression models were fitted to examine the associations of socioeconomic and individual-, household- and community-level factors on the nutritional status of women as measured by BMI. Overall, the prevalences of underweight, normal weight, overweight and obese women were 19%, 58%, 19% and 4%, respectively, in 2014. The MLMLR analysis revealed that women of young age, widowed/divorced/separated, having a larger family size and children aged ≤5 years in the household, currently amenorrhoeic and members of non-government organizations were at significantly increased risk of being underweight; those of older age, having higher parity, more educated, frequently watched TV and non-poor were more likely to be overweight or obese relative to normal BMI. Women from more affluent communities and urban areas were more likely to be overweight or obese relative to normal BMI than their counterparts from less-affluent and rural communities. Women's nutritional status was found to be heterogeneous across the regions of the country. The findings indicate that, along with individual-level factors, community-level characteristics are also important in explaining women's BMI in Bangladesh. The issue of under- and overweight or obesity among women in Bangladesh requires the immediate adoption of a public health policy for its mitigation. When developing intervention programmes, important determinants and uniform development of regions should be taken into consideration to combat the dual burden of under- and overweight among women in Bangladesh.

Socioeconomic determinants of excess weight and obesity among Indigenous women: findings from the First National Survey of Indigenous People's Health and Nutrition in Brazil

Objective:

This article assesses the nutritional status of Indigenous women from 14 to 49 years of age in Brazil.

Design:

Sample size was calculated for each region considering a prevalence of 50 % for all disease outcomes, a relative error of 5 % and a CI of 95 %. In the initial data analysis, the prevalence of excess weight and obesity was calculated according to independent variables. Multivariate multilevel hierarchical analyses were conducted based on a theoretical model of two ranked blocks.

Setting:

The 2010 Indigenous population in Brazil was 896 000, with approximately 300 Indigenous ethnic groups, making Brazil one of the most ethnically diverse countries in the Americas and the world.

Participants:

Of the total target sample of 6722 women evaluated by the National Survey, thirty did not participate, 939 were not eligible for analyses due to pregnancy or unknown pregnancy status, and thirty-nine were excluded due to missing anthropometric data.

Results:

The evaluation of nutritional status was completed for 5714 non-pregnant women (99·3 % of eligible participants for this outcome). High prevalence rates were encountered for both excess weight (46·2 %) and obesity (15·8 %) among the sampled women. In the multivariate analyses, higher socioeconomic indicators, market-integrated living conditions and less reliance on local food production, as well as increased age and parity were associated with excess weight and obesity.

Conclusion:

Results point to distinct patterns of associations between socioeconomic indicators and the occurrence of excess weight and obesity among Indigenous women, which have potentially significant implications from a public policy perspective for Indigenous peoples in Brazil.

Food Insecurity during Pregnancy in a Maternal-Infant Cohort in Brazilian Western Amazon

The aim of this study was to determine the prevalence and analyze the factors associated with food insecurity during gestation in a maternal-infant cohort in Brazilian Western Amazon. A population-based cross-sectional study was conducted with parturients from a maternal-infant cohort in Rio Branco, located in the Western Brazilian Amazon. The dependent variable food insecurity (FI) was obtained through the Brazilian Scale of Food Insecurity, and associated factors were identified through multiple logistic regression. The prevalence of FI in pregnancy was of 34.8%. Regarding severity, the prevalence of mild food insecurity was 24.6%, moderate food insecurity was 4.8%, and severe food insecurity was 5.4%. The factors directly associated with FI were the presence of open sewage in the peridomestic environment; belonging to the lower economic classes; being an income transfer program beneficiary, while the factors inversely associated with FI were schooling equal to or greater than 8 years; having a partner; primigestation; and regular consumption of fruits and vegetables during pregnancy. These findings reinforce the need for the ratification of actions aimed at the domestic economy in the income transfer programs and the development of actions of food and nutritional education in the gestational period.

Prevalence of malnutrition among children and women of reproductive age in Uruguay by socio-economic status and educational level

OBJECTIVE

To describe the magnitude and distribution of malnutrition in all forms (stunting, wasting, overweight and obesity) by level of education and socio-economic status (SES).

DESIGN

Representative data from three national surveys were used: the socio-economic characteristics of Uruguayan households the 2012-2013; the Survey of Child Health, Nutrition and Development and the Survey of Chronic Disease Risks. We defined overweight, obesity, wasting/underweight and stunting/short stature according to WHO criteria. We conducted a comparison between malnutrition prevalence values per SES and education level.

SETTING

In total, 1 183 177 households were surveyed, including 2265 children's and 752 women's households, forming a nationally representative sample in urban areas with more than 5000 habitants.

PARTICIPANTS

A total of 3079 children aged <4 years from the National Survey of Child Health, Nutrition and Development 2013 and 752 women aged 20-49 years from the National Survey of Chronic Disease Risks 2013 were included.

RESULTS

Among children aged <4 years, stunting and overweight disproportionately affected low-wealth groups, with 5·45 % of children in the lower income tertile and 3·44 % in the upper tertile presenting stunting (P < 0·05). Overweight and obesity were higher in the third tertile of income. Among the women, 54·8 % (95 % CI 48·0, 61·6) had excess weight (overweight and obesity) and significant differences were found between those with the lowest and highest levels of SES. Regarding excess weight with respect to educational level, significant differences were also found between the low and high levels and between the medium and high levels.

CONCLUSIONS

In Uruguay, there are slight differences in the prevalence of all forms of malnutrition according to SES and education levels in the populations considered. Excess weight in children and women poses the greatest public health nutritional challenge at all levels of SES and education. The fact that more educated mothers are more overweight differs from the findings in other countries and should be studied in more detail. Stunting in children is also important, requiring more focused interventions. Notably, excess weight is higher in more educated mothers, a fact that differs from other countries. Further analysis is important to understand this discrepancy.

Nationally representative surveys show gradual shifting of overweight and obesity towards poor and less-educated women of reproductive age in Nepal

Overweight and obesity are considered major public health concerns all over the world. They have the potential to increase the risk of developing non-communicable diseases in reproductive age women, increasing their risk of pregnancy related complications and adverse birth outcome. This study was carried out to identify the trend of prevalence of overweight and obesity, along with their determinants, among reproductive age women (15-49 years) in Nepal. Data were taken from the nationally representative 2006, 2011 and 2016 Nepal Demographic and Health Surveys (NDHSs). Women were considered to be overweight or obese when their BMI was 23.0-27.5 kg/m2 or ≥27.5 kg/m2, respectively. Univariate, bivariate and multivariate analyses were performed, with significance taken at p<0.05. The prevalences of overweight and obesity both showed rising trends in women of reproductive age in Nepal from 2006 to 2016, particularly among those with no education, only primary education and poor women. The presence of overweight and obesity was found to be significantly associated with the sample women's age, educational status, wealth index, place of residence, ecological zone, developmental region, number of household members, marital status and ethnicity. In 2016 one in every three women of reproductive age in Nepal was either overweight or obese. As overweight and obesity have detrimental effects on women's health, the Government of Nepal, in collaboration with other government and non-government organizations, should take action to halt the rising trends in overweight and obesity in the country.

Hábitos alimentares, atividade física e comportamento sedentário entre escolares brasileiros: Pesquisa Nacional de Saúde do Escolar, 2015

RESUMO: Introdução: A urbanização e a industrialização colaboraram para a alteração nos padrões de alimentação, bem como para o surgimento de comportamentos sedentários e a redução da atividade física. Objetivos: Identificar e descrever a prevalência de hábitos alimentares, prática de atividade física e comportamento sedentário em escolares brasileiros e analisar sua associação com as características sociodemográficas. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde do Escolar de 2015. Foram calculadas prevalências, razões de prevalências e intervalos de 95% de confiança (IC95%). As análises foram ajustadas para idade escolaridade materna. Resultados: A maioria consumia feijão (65,1%) e guloseimas (52,3%), teve mais de três dias de aula de Educação Física escolar (50,7%), realizava atividade física fora da escola por mais de três dias (55,4%), tinha comportamento sedentário (73,3%) e realizava atividade física durante 60 min/dia por menos de quatro dias na semana (72,7%). Em geral, as meninas estavam mais expostas a práticas alimentares não desejáveis e ao comportamento sedentário, e o melhor nível socioeconômico associou-se a maiores prevalências dos indicadores estudados. Elevado consumo de alimentos não saudáveis, aumento do comportamento sedentário e redução na prática de atividade física. Conclusão: Observou-se associação de atitudes não saudáveis com características sociodemográficas entre os escolares. Estratégias que foquem na redução desses comportamentos irão contribuir para ações de promoção da saúde nos ambientes escolar e familiar.

Austerity and the future of the Brazilian Unified Health System (SUS): health in perspective

This article proposes an analysis of the fiscal austerity measures of the Brazilian government and its unfolding in the public health system. It has examined the post-impeachment period of the president of Brazil and the changes of the social policies conduct in opposition to the principle of equity and universality in health with impacts on Brazilian sovereignty. It was a scientific essay on the perspective of the Unified Health System (SUS) and the policy development based on fiscal austerity that is taking place in the Brazilian political scenario, seeking to articulate a diagnosis of the impact of these actions on the structure of the country and the health rights. In this way, we conclude that the SUS is in imminent danger and that austerity policies in Brazil have denied the social gains achieved from previous governments, contributing to the discussion on health systems in the context of the neoliberal economic pressure and its impacts on lifestyles and access to the health services of the Brazilian people.

Variation in dietary intake and body fatness by socioeconomic status among women in the context of Costa Rican nutrition transitions

The Nutrition Transition model posits that vegetable oils, animal source foods (ASFs) and caloric sweeteners contribute to increases in adiposity and hence body mass index. Body mass index (BMI) is increasing more rapidly among Latin American populations of low versus high socioeconomic status (SES). The objectives of this study among Costa Rican women were to: (1) compare indicators of adiposity and dietary intake by SES and (2) evaluate the relationship between intake of foods high in vegetable oils, ASFs or caloric sweeteners and body fatness. This cross-sectional study, conducted in 2014-2015, included 128 low-, middle- and high-SES non-pregnant, non-lactating women aged between 25 and 45 years with 1-4 live births. Anthropometry was used to assess BMI, body composition and body fat distribution. Dietary recalls (n = 379) were used to assess dietary intake. Percentage body fat was greater in low- versus high-SES women (31.5 ± 3.9 vs 28.2 ± 4.7%). Skinfold measurements at four sites on the upper and lower body were greater in low- versus high-SES women. Body mass index did not vary in low- versus high-SES women. Intake frequency of foods high in vegetable oils was greater in low- and middle- (1.8 and 1.8 times/day, respectively) versus high- (1.1 times/day) SES women. For individual foods, intake frequency varied significantly by SES for high-fat condiments, fried vegetables, dairy, sweetened coffee/tea and pastries and desserts. Intake frequency of Nutrition Transition food categories was not associated with percentage body fat after adjustment for energy intake. Indicators of body composition provide additional information beyond BMI that are useful in understanding SES-adiposity associations in Latin America. Approaches to understanding diet and adiposity in Latin America that focus on vegetable oils, ASFs and caloric sweeteners should consider within-country variation in the pace of the Nutrition Transition, especially when explaining variation in adiposity by SES.

Do trends in the prevalence of overweight by socio-economic position differ between India's most and least economically developed states?

Background

India’s economic development and urbanisation in recent decades has varied considerably between states. Attempts to assess how overweight (including obesity) varies by socioeconomic position at the national level may mask considerable sub-national heterogeneity. We examined the socioeconomic patterning of overweight among adults in India’s most and least economically developed states between 1998 and 2016.

Methods

We used state representative data from the National Family Health Surveys from 1998 to 99, 2005–06 and 2015–16. We estimated the prevalence of overweight by socioeconomic position in men (15–54 years) and women (15–49 years) from India’s most and least economically developed states using multilevel logistic regressions.

Results

We observed an increasing trend of overweight prevalence among low socioeconomic position women. Amongst high socioeconomic position women, overweight prevalence either increased to a smaller extent, remained the same or even declined between 1998 and 2016. This was particularly the case in urban areas of the most developed states, where in the main analysis, the prevalence of overweight increased from 19 to 33% among women from the lowest socioeconomic group between 1998 and 2016 compared to no change among women from the highest socioeconomic group. Between 2005 and 2016, the prevalence of overweight increased to similar extents among high and low socioeconomic status men, irrespective of residence.

Conclusions

The converging prevalence of overweight by socioeconomic position in India’s most developed states, particularly amongst urban women, implies that this subpopulation may be the first to exhibit a negative association between socioeconomic position and overweight in India. Programs aiming to reduce the increasing overweight trends may wish to focus on poorer women in India’s most developed states, amongst whom the increasing trend in prevalence has been considerable.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7155-9) contains supplementary material, which is available to authorized users.

Association between ethnicity and changes in weight, blood pressure, blood glucose and lipid levels after bariatric surgery: a systematic review protocol

REVIEW QUESTION

What is the association between ethnicity and changes in weight, blood pressure, blood glucose and lipid levels after bariatric surgery?

Trends in the socioeconomic patterning of overweight/obesity in India: a repeated cross-sectional study using nationally representative data

OBJECTIVES

We aimed to examine trends in prevalence of overweight/obesity among adults in India by socioeconomic position (SEP) between 1998 and 2016.

DESIGN

Repeated cross-sectional study using nationally representative data from India collected in 1998/1999, 2005/2006 and 2015/2016. Multilevel regressions were used to assess trends in prevalence of overweight/obesity by SEP.

SETTING

26, 29 and 36 Indian states or union territories, in 1998/99, 2005/2006 and 2015/2016, respectively.

PARTICIPANTS

628 795 ever-married women aged 15-49 years and 93 618 men aged 15-54 years.

PRIMARY OUTCOME MEASURE

Overweight/obesity defined by body mass index >24.99 kg/m².

RESULTS

Between 1998 and 2016, overweight/obesity prevalence increased among men and women in both urban and rural areas. In all periods, overweight/obesity prevalence was consistently highest among higher SEP individuals. In urban areas, overweight/obesity prevalence increased considerably over the study period among lower SEP adults. For instance, between 1998 and 2016, overweight/obesity prevalence increased from approximately 15%-32% among urban women with no education. Whereas the prevalence among urban men with higher education increased from 26% to 34% between 2005 and 2016, we did not observe any notable changes among high SEP urban women between 1998 and 2016. In rural areas, more similar increases in overweight/obesity prevalence were found among all individuals across the study period, irrespective of SEP. Among rural women with higher education, overweight/obesity increased from 16% to 25% between 1998 and 2016, while the prevalence among rural women with no education increased from 4% to 14%.

CONCLUSIONS

We identified some convergence of overweight/obesity prevalence across SEP in urban areas among both men and women, with fewer signs of convergence across SEP groups in rural areas. Efforts are therefore needed to slow the increasing trend of overweight/obesity among all Indians, as we found evidence suggesting it may no longer be considered a 'diseases of affluence'.

Fluid intake of Latin American children and adolescents: results of four 2016 LIQ.IN 7 National Cross-Sectional Surveys

PURPOSE

The primary aim of this survey was to report total fluid intake (TFI) and different fluid types for children (4-9 years) and adolescents (10-17 years) in Mexico, Brazil, Argentina and Uruguay. The second aim was to compare TFI with the adequate intake (AI) of water from fluids as recommended by the USA Institute of Medicine.

METHODS

Data were collected using a validated liquid intake 7-day record (Liq.In 7 ). Participants' characteristics, including age, sex and anthropometric measurements were recorded.

RESULTS

A total of 733 children and 933 adolescents were recruited. Over 75% of children in Uruguay met the IOM's recommended intake. Fewer children in Argentina (64-72%) and Brazil (41-50%) obtained AI and the lowest values were recorded in Mexico (33-44%), where 16% of boys and 14% girls drank 50% or less of the AI. More adolescents in Argentina (42%) met the AIs than other countries; the lowest was in Mexico (28%). Children and adolescents in Mexico and Argentina drank more sugar sweetened beverages than water.

CONCLUSIONS

Large numbers of children and adolescents did not meet AI recommendations for TFI, raising concerns about their hydration status and potential effects on mental and physical well-being. Given the negative effects on children's health, the levels of SSB consumption are worrying.

Homicides, Public Goods, and Population Health in the Context of High Urban Violence Rates in Cali, Colombia

Obesity and frequent mental and physical distress are often associated with major health problems. The characteristics of the urban environment, such as homicide rates and public goods provision, play an important role in influencing participation in physical activity and in overall mental health. This study aimed to determine whether there was a relationship between homicide rates and public goods provision on the health outcomes of the citizens of Cali, Colombia, a city known for its high urban violence rate and low municipal investment in public goods. We used a linear probability model to relate homicide rates and public goods provision (lighted parks, effective public space per inhabitant, and bus stations) at the district level to health outcomes (obesity and frequent mental and physical distress). Individual data were obtained from the 2014 CaliBRANDO survey, and urban context characteristics were obtained from official government statistics. After controlling for individual covariates, results showed that homicide rates were a risk factor in all examined outcomes. An increase in 1.0 m2 of public space per inhabitant reduced the probability of an individual being obese or overweight by 0.2% (95% confidence interval (CI) = - 0.004 to - 0.001) and the probability of frequent physical distress by 0.1% (95% CI = - 0.002 to - 0.001). On average, the presence of one additional bus station increased the probability of being obese or overweight by 1.1%, the probability of frequent mental distress by 0.3% (95% CI = 0.001-0.004), and the probability of frequent physical distress by 0.02% (95% CI = 0.000-0.003). Living in districts with adequate public space and lighted parks lowers the probability of being obese and high homicide rates, which are correlated with poor health outcomes in Cali, Colombia. Investments in public goods provision and urban safety to reduce obesity rates may contribute to a better quality of life for the population.

Embodiment of social roles and thinness as a form of capital: A qualitative approach towards understanding female obesity disparities in Chile

Obesity in Chile disproportionately affects women of low socioeconomic status (SES). Research has shown that ideals of body size and differences in perceived social pressure for being slim across socioeconomic strata contribute to the social stratification of body size among women in modern societies. Thinness is most valued by high SES women, following western standards of ideal body size. Aiming to understand the link between ideals of body size and SES, this qualitative study explored how 36 Chilean women construct their bodily ideals according to their social position. A purposive sample of women with different profiles with regard to educational attainment, nutritional status and body size (dis)satisfaction was defined, aiming to cover a diverse spectrum of bodily perceptions. Data were collected through semi-structured interviews and approached through a thematic and narrative analysis. Drawing on Bourdieu's concepts of habitus, field, capital and embodiment of the social context, this study explains how ideals of body size and appearance are strongly linked to class-dependent gender roles and social roles. The existing gender and class inequalities in the Chilean social structure have been literally embodied by these women through a 'gendered class habitus'. Compliance with the thin ideal confers women different degrees of power according to their social position in different fields, such as in marriage and on the labour market, which turns thinness into an embodied form of capital. The societal dynamic behind obesity rates cannot be disregarded when approaching possible solutions. Promoting obesity-related lifestyle modification at an individual level might appear an over-simplistic and individualistic approach to a complex social issue. Context-oriented interventions that take cultural constructions of gender and social class into account might yield better results in the long term, while advocating for a more equitable society and social justice as a public health concern.

The rise in obesity in Cuba from 2001 to 2010: An analysis of National Survey on Risk Factors and Chronic Diseases data

Using two waves of the National Survey on Risk Factors and Chronic Diseases in Cuba, we identify demographic and socioeconomic characteristics associated with obesity among urban adults aged 18+ and decompose the change in obesity within this 9-year period using both the mean-based Blinder-Oaxaca decomposition and a nonlinear approach. Our results reveal significant increases in overweight and obesity (2.3, 3.1, and 7.6 percentage points for BMI-based overweight, BMI-based obesity, and abdominal obesity, respectively). Depending on the decompositional approach and obesity measure, our analysis explains between 13% and 51% of the rise in overweight and obesity, with most part attributable to changes in risky behavior, age, and education. Of particular importance are the large decline in smoking and the population's changing age structure.

Double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases

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.

Preventing weight-related problems among adolescent girls: A cluster randomized trial comparing the Brazilian 'New Moves' program versus observation

PURPOSE

To conduct a cluster randomized controlled trial comparing the Brazilian version of the New Moves program (NMP) versus observation among Brazilian adolescent girls.

METHODS

Ten schools were randomly allocated to the Brazilian NMP or the observation arm. Study participants included 12-14-year-old girls. Recruitment occurred between February 2014 and March 2015. The NMP included sports, nutritional support, motivational interviews, collective lunch, and parental information materials. Our main outcome was the Body Shape Questionnaire (BSQ). Secondary outcomes included the Rosenberg Self-Esteem Scale and the Unhealthy Weight-Control Behaviors Index, as well as body mass index. Study results were evaluated through generalized estimating equations.

RESULTS

A total of 270 adolescents participated in the study. At baseline, mean age was 13.4 years, and average BMI was 21.4. The intervention did not result in any statistically significant differences between the NMP and the observation arm, including BSQ (predicted means of 64.33 - IC 95% 59.2-69.47 vs. 62.02 - IC 95% 56.63-67.4), respectively) and our secondary outcomes. Adherence was low during the intervention (32.9%) and maintenance (19.1%) phases of the program.

CONCLUSION

The New Moves program did not lead to significant changes in our measured outcomes. Future studies should investigate whether changes might occur when comprehensive behavioral programs are sustained over longer periods while also being customized to local population characteristics.

Effects of Physical Exercise on the Intestinal Mucosa of Rats Submitted to a Hypothalamic Obesity Condition

The small intestine plays a role in obesity as well as in satiation. However, the effect of physical exercise on the morphology and function of the small intestine during obesity has not been reported to date. This study aimed to evaluate the effects of physical exercise on morphological aspects of the rat small intestine during hypothalamic monosodium glutamate (MSG)-induced obesity. The rats were divided into four groups: Sedentary (S), Monosodium Glutamate (MSG), Exercised (E), and Exercised Monosodium Glutamate (EMSG). The MSG and EMSG groups received a daily injection of monosodium glutamate (4 g/kg) during the 5 first days after birth. The S and E groups were considered as control groups and received injections of saline. At weaning, at 21 days after birth, the EMSG and E groups were submitted to swimming practice 3 times a week until the 90th day, when all groups were sacrificed and the parameters studied recorded. Exercise significantly reduced fat deposits and the Lee Index in MSG-treated animals, and also reduced the thickness of the intestinal wall, the number of goblet cells and intestinal alkaline phosphatase activity. However, physical activity alone increased the thickness and height of villi, and the depth of the crypts. In conclusion, regular physical exercise may alter the morphology or/and functions of the small intestine, reducing the prejudicial effects of hypothalamic obesity. Anat Rec, 299:1389-1396, 2016. © 2016 Wiley Periodicals, Inc.

Beverage intake and obesity in early childhood: evidence form primary health care clients in Northwest Argentina

Sugar sweetened beverages (SSB) are thought to play an important role in weight gain. We examined the relationship between the intake of caloric and noncaloric beverages (SSB and water) and the nutritional status of children. In 2014, we randomly selected 16 public health clinics in four cities of Northwest Argentina and conducted a survey among mothers of children 0-6 years of age. Children's beverage intake was ascertained by 24-h dietary recall provided by the mothers. Children's weight and height measures were obtained from clinic's registries. We calculated the body mass index using the International Obesity Task Force standards. The analysis included 562 children 25 months to 6 years of age with normal or above normal nutritional status. Children's beverage consumption was as follows, water 81.8%, carbonated soft drinks (CSD) 49.7%, coffee/tea/cocoa 44.0%, artificial fruit drinks 35.6%, flavored water 17.9%, natural fruit juice 14.5%. In multivariate logistic regression models the likelihood of being obese v. being overweight or having normal weight doubled with an intake of one to five glasses of CSD (OR=2.2) and increased by more than three-fold with an intake of more than five glasses (OR=3.5). Drinking more than five glasses of water decreased the likelihood of being obese by less than half (OR=0.3). The percentage of children drinking more than five glasses of other beverages was low (3.3-0.9%) and regression models did not yield significant results. The study contributed evidence for reducing children's CSD intake and for promoting water consumption, together with the implementation of comprehensive regulatory public health policies.

Excess weight and disability among the elderly in Argentina

The aim of this paper is to analyze the relationship between excess weight and the condition of disability among elderly people in Argentina and to assess the extent to which a protective factor could be operating that reduces or mitigates the effect of overweight on the loss of functional skills in people over 64 years of age. In order to do so, microdata from Argentina's 2009 National Survey of Risk Factors [Encuesta Nacional de Factores de Riesgo] was utilized. To measure the association among overweight, obesity and disability status, as well as the interaction of weight status and age, logistic regression models were estimated. The results indicate that although overweight and obesity have a positive net effect on the occurrence of disabilities, this effect is lower among people 64 years of age and older. This result could be suggesting that among older people a protective factor is at work that, while not reversing the direct relationship between excess weight and disability, seems to attenuate it.

SURGICAL TREATMENT OF SEVERE OBESITY IN TEENS: LATE RESULTS

Background

: In children is estimated that the prevalence of overweight and obesity has increased up to five times in developed countries and up to four in developing countries. In Brazil, the proportion of children and adolescents who are overweight also increased from approximately 4.1% to 13.9%.

Aim :

To evaluate the surgical results of severe obesity in adolescents.

Methods

: Retrospective descriptive study of 2737 patients with severe obesity that underwent Roux-en-Y gastric bypass selecting from the total 44 patients with mean age of 18.1 years, 14 males and 30 females, most (37) operated by laparotomy. There was follow-up of 20 patients (45.45%). All were followed preoperatively by a multidisciplinary team and had indication confirmed for surgical unanimous approval of all team members.

Results

: Among the 20 adolescent, 14 were female. From five teenagers using anti-hypertension or hypoglycemic drugs before surgery, four (80%) had drug discontinuation and one (20%) reduced the dose in 50% postoperatively. The average weight loss was 45.4 kg after a mean follow up of 60 months. There were no deaths or severe postoperative complications. Among those who underwent postoperative follow-up with a multidisciplinary team, 18 were with BMI<30.

Conclusions

: Adolescents undergoing Roux-en-Y gastric bypass has good response in relation to weight loss and improvement of comorbidities. There was a low rate of complications and no deaths. All patients were satisfied with their personal results.

Non-linear education gradient across the nutrition transition: mothers' overweight and the population education transition

OBJECTIVE

Previous studies found that developed and developing countries present opposite education-overweight gradients but have not considered the dynamics at different levels of national development. An inverted U-shaped curve is hypothesized to best describe the education-overweight association. It is also hypothesized that as the nutrition transition unfolds within nations the shape of education-overweight curve changes.

DESIGN

Multilevel logistic regression was used to estimate the moderating effect of the nutrition transition at the population level on the education-overweight gradient. At the individual level, a non-linear estimate of the education association was used to assess the optimal functional form of the association across the nutrition transition.

SETTING

Twenty-two administrations of the Demographic and Health Survey, collected at different time points across the nutrition transition in nine Latin American/Caribbean countries.

SUBJECTS

Mothers of reproductive age (15-49 years) in each administration (n 143 258).

RESULTS

In the pooled sample, a non-linear education gradient on mothers' overweight was found; each additional year of schooling increases the probability of being overweight up to the end of primary schooling, after which each additional year of schooling decreases the probability of overweight. Also, as access to diets high in animal fats and sweeteners increases over time, the curve's critical point moves to lower education levels, the detrimental positive effect of education diminishes, and both occur as the overall risk of overweight increases with greater access to harmful diets.

CONCLUSIONS

Both hypotheses were supported. As the nutrition transition progresses, the education-overweight curve shifts steadily to a negative linear association with a higher average risk of overweight; and education, at increasingly lower levels, acts as a 'social vaccine' against increasing risk of overweight. These empirical patterns fit the general 'population education transition' curve hypothesis about how education's influences on health risks are contextualized across population transitions.

Effectiveness of a Smartphone application and wearable device for weight loss in overweight or obese primary care patients: protocol for a randomised controlled trial

Background

To evaluate the effectiveness of an experimental intervention based on standard diet recommendations plus free Smartphone application (app) and wearable device for weight loss, compared with the standard diet intervention alone, in primary care patients aged 18 years or older who are overweight or obese.

Methods/design

Multicentre randomized, controlled clinical trial. Location: Primary health care centres in the city of Tarragona and surrounding areas. Subjects: 70 primary care patients, aged 18 years or older, with body mass index of 25 g/m2 or greater who wish to lose weight. Description of the intervention: 12 months of standard diet recommendations without (n = 35) or with (n = 35) assistance of a free Smartphone app that allows the participant to maintain a record of dietary intake and a bracelet monitor that records physical activity. The outcomes will be weight loss at 12 months (primary outcome), changes in physical activity and cardiometabolic risk factors, frequency of app use, and participant satisfaction after 12 months.

Discussion

The results of our study will offer evidence of the effectiveness of an intervention using one of the most popular free apps and wearable devices in achieving weight loss among patients who are overweight or obese. If these new technologies are proven effective in our population, they could be readily incorporated into primary care interventions promoting healthy weight.

The open design and study characteristics make it impossible for the participants and researchers to be blinded to study group assignment. Researchers responsible for data analysis will be blinded to participant allocation.

Trial registration

Clinical Register: NCT02417623. Registered 26 March 2015.

Genome-based nutrition: An intervention strategy for the prevention and treatment of obesity and nonalcoholic steatohepatitis

Obesity and nonalcoholic steatohepatitis are increasing in westernized countries, regardless of their geographic location. In Latin America, most countries, including Mexico, have a heterogeneous admixture genome with Amerindian, European and African ancestries. However, certain high allelic frequencies of several nutrient-related polymorphisms may have been achieved by past gene-nutrient interactions. Such interactions may have promoted the positive selection of variants adapted to regional food sources. At present, the unbalanced diet composition of the Mexicans has led the country to a 70% prevalence rate of overweightness and obesity due to substantial changes in food habits, among other factors. International guidelines and intervention strategies may not be adequate for all populations worldwide because they do not consider disparities in genetic and environmental factors, and thus there is a need for differential prevention and management strategies. Here, we provide the rationale for an intervention strategy for the prevention and management of obesity-related diseases such as non-alcoholic steatohepatitis based on a regionalized genome-based diet. The components required to design such a diet should focus on the specific ancestry of each population around the world and the convenience of consuming traditional ethnic food.

The prevalence and nature of the use of preconception services by women with chronic health conditions: an integrative review

Background

There is growing evidence that preconception care may have an important role in preventing short and long term adverse health consequences for women and their offspring. This is particularly the case for women with chronic health conditions due to the rising prevalence of chronic disease in global populations. With this in mind, this paper presents an integrative systematic review of contemporary research outlining the use of preconception services and practices by women with chronic health conditions.

Methods

A search was conducted through PubMed, CINAHL, AMED, and Maternity and Infant Care databases which identified 672 papers examining preconception care and preconception services for women with chronic health conditions. Fourteen papers which were written in English, presented original research, and reported on the prevalence or nature of use of preconception care by women with chronic health conditions were included in the review. Critical appraisal of study quality and thematic categorical grouping of identified papers was undertaken.

Results

Current research evidence, as identified through this review, examines three major topic areas: the prevalence of preconception care practices, use of services and characteristics of users; knowledge of the value and impact of preconception care and availability of preconception services for women with chronic health conditions; and women’s attitudes, approaches and experiences of preconception care and preconception services. Prevalence estimates of engagement with preconception care range between 18.1% and 45%, with most studies focusing on women with type 1 or 2 diabetes. Significant gaps in women’s knowledge of preconception care for women with chronic health conditions were also identified. Women with chronic health conditions reported experiencing emotional distress as a result of their engagement with preconception care services. They also commonly described feeling a need to employ discipline to comply with preconception care programs, and experiencing a fear of pregnancy complications.

Conclusion

Future research requires a broad and sophisticated approach to research design and analysis, improved consideration of temporal changes to women’s health behaviour, representative samples to more effectively inform health policy, and a deeper understanding of women’s motivations, attitudes and perceptions of preconception care to assist in the development of tailored preconception health services.

Diabetes mellitus referido e fatores associados em idosos residentes em Campina Grande, Paraíba

OBJETIVO: Verificar a prevalência de diabetes mellitus referido e fatores associados em idosos residentes em Campina Grande-PB. METODOLOGIA: Trata-se de estudo transversal, de base populacional e domiciliar, com indivíduos de 60 anos de idade ou mais, de ambos os sexos. O diabetes mellitus referido foi considerado variável dependente para fins de análise e de estudo das possíveis associações. As variáveis independentes avaliadas foram: grupo etário, situação conjugal, nível socioeconômico, estado nutricional, prática de atividade física regular, tabagismo e ingestão de bebida alcoólica. Para identificar os fatores associados ao diabetes mellitus referido, foram realizadas análises de regressão univariada e multivariada, por meio do SPSS 17.0. RESULTADOS: Foram avaliados 806 idosos (69,1% mulheres), com média etária de 72,4 anos (DP=8,76). A prevalência de diabetes mellitus referido foi de 14,7%. Tanto entre homens como entre mulheres, constatou-se maior prevalência do diabetes mellitus referido no grupo etário de 60 a 69 anos (50% e 48,2%, respectivamente). O diabetes mellitus referido esteve associado às variáveis sobrepeso/obesidade (IC95%: 1,028-4,248; p=0,042) e ingestão de bebidas alcoólicas (IC95%: 1,107-3,092; p=0,019) entre as idosas. Entre os homens, houve associação com a doença referida apenas com a ingestão de bebidas alcoólicas no passado (IC95%: 1,082-13,085; p=0,037). CONCLUSÃO: Os resultados deste estudo sugerem influência do estado nutricional e da ingestão de bebidas alcoólicas (atual ou passada) sobre o diabetes mellitus referido em idosos. Conhecer os fatores modificáveis que influenciam essa doença é fundamental para subsidiar o planejamento de ações voltadas para promoção, prevenção e diagnóstico precoce desse agravo.

Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

OBJECTIVE

To examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.

DESIGN

Trend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991-2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban-rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).

SETTING

Peru.

SUBJECTS

Children aged 0-59 months surveyed in 1991-92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007-08 (n 8232) and 2011 (n 8186).

RESULTS

Child stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991-2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).

CONCLUSIONS

The 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

Caregiver perceptions of child nutritional status in Magallanes, Chile

BACKGROUND

We aimed to identify risk factors for childhood overweight and obesity and the accuracy of caregivers'€™ perceptions of their child's nutritional status in the Magallanes region, Patagonia, Chile.

METHODS

Heights and weights of children attending day care centers and elementary schools were collected and caregivers completed questionnaires regarding their child's health and behavior. The child's nutritional status was diagnosed using the 2006 WHO Child Growth Standards (for children under age 6) and the CDC 2000 Growth Charts (for children age 6 and older). Logistic regression was used to evaluate factors related to childhood overweight/obesity and weight underestimation by caregivers of overweight or obese children.

RESULTS

Of the 795 children included in the study, 247 (31.1%) were overweight and 223 (28.1%) were obese. Risk factors for overweight/obesity included younger age and being perceived to eat more than normal by the caregiver. Caregivers were less likely to underestimate their child's weight if the child was older or if the caregiver believed the child ate more than a normal amount.

CONCLUSIONS

There is a high prevalence of overweight and obesity among children in Magallanes and the majority of caregivers underestimate the extent of the problem in their children.

BMI and sociodemographic correlates of body image perception and attitudes in school-aged children

OBJECTIVE

The aim of the present study was to identify correlates of body image perception and dissatisfaction among school-aged children from Colombia, a country undergoing the nutrition transition.

DESIGN

Cross-sectional study. Using child-adapted Stunkard scales, children were asked to indicate the silhouette that most closely represented their current and desired body shapes. Body image dissatisfaction (BID) score was estimated as current minus desired silhouette. Height and weight were measured in all children. Sociodemographic data were collected through questionnaires completed by the children's mothers.

SETTING

Public primary schools in Bogotá, Colombia.

SUBJECTS

Children aged 5-12 years (n 629) and their mothers.

RESULTS

Mean BID score was 0·1 (SD 1·7). The strongest predictor of BID was actual BMI-for-age Z-score (BAZ). Compared with children with BAZ ≥ -1 and < 1, those with BAZ ≥ 2 had a 1·9 units higher BID score (P for trend < 0·0001). BID tended to be higher in girls than boys at any level of BAZ. Other correlates of BID included child's height-for-age Z-score, maternal BMI and dissatisfaction with the child's body, and home ownership.

CONCLUSIONS

Among school-aged children from a country experiencing the nutrition transition, body image perception was associated with the child's weight and height, and with maternal BMI, dissatisfaction with the child's body and socio-economic level.

A cross-cultural comparison of eating behaviors and home food environmental factors in adolescents from São Paulo (Brazil) and Saint Paul-Minneapolis (US)

OBJECTIVE

Describe cross-cultural differences in nutrition-related factors among adolescents from São Paulo, Brazil and St Paul-Minneapolis, US.

DESIGN

Two large-population-based studies with cross-cultural comparisons.

SETTING

Twelve São Paulo and 10 St Paul-Minneapolis high schools in 2009-2010.

PARTICIPANTS

A total of 1,148 adolescents from São Paulo and 1,632 adolescents from St Paul-Minneapolis.

MAIN OUTCOME MEASURE(S)

Meal consumption, family meals, fast-food consumption, and home food availability.

ANALYSIS

Binomial regressions, weighted for age distributions and adjusted for gender, were used to compare identical measures from each sample.

RESULTS

Generally, São Paulo adolescents reported healthier nutritional outcomes than St Paul-Minneapolis adolescents. São Paulo adolescents were 7 times less likely to report high fast-food consumption than St Paul-Minneapolis adolescents (P < .001). Whereas most measures of the home environment indicated healthier home environments in São Paulo, more São Paulo adolescents reported that sugar-sweetened beverages were usually available at home than did St Paul-Minneapolis adolescents (P < .001).

CONCLUSIONS AND IMPLICATIONS

São Paulo youth tended to have healthier eating behaviors and home food environment factors than St Paul-Minneapolis youth. Brazilian eating patterns tend to be healthier and support a connection with food and culture. Interventions are needed to encourage youth and their families to maintain these patterns.

Migrant youth's emerging dietary patterns in Haiti: the role of peer social engagement

OBJECTIVE

The present study examines whether rural-to-urban migrant youth consume a greater diversity of high-sugar beverages and fried snacks (HSBFS) compared with their peers who remain in rural areas. It also tests whether the association between migration and HSBFS diversity is moderated by migrant youth's social engagement with their peers.

DESIGN

Participants were recruited in August and September 2011 following the completion of primary school (6th grade) and shortly before many rural youth migrate to urban areas. Participants were re-interviewed six months later. HSBFS diversity was assessed at follow-up; analyses control for baseline and follow-up characteristics.

SETTING

Baseline interviews occurred in rural Southeast Haiti. Follow-up interviews of migrants occurred at urban destinations in Haiti.

SUBJECTS

The sample includes 215 youth (mean age 15.9 years; 43.3 % female; 21.9 % rural-to-urban migrants) who were interviewed at baseline and follow-up.

RESULTS

Rural-to-urban migrant youth consumed a greater diversity of HSBFS products at follow-up than their rural counterparts (b=0.70, P≤0.05). Moreover, we found that this relationship varied by level of peer social engagement. Youth who migrated and had a high degree of peer social engagement consumed 2.2 additional types of HSBFS products daily than their counterparts who remained in rural areas and had low peer social engagement.

CONCLUSIONS

Higher HSBFS diversity among migrant youth is consistent with the patterns proposed by the nutrition transition. Interactions with peers may have an important influence as migrant youth adopt new dietary preferences. Emerging dietary patterns among youth migrants have important implications for health trajectories and the development of degenerative diseases.

The association between nutrition transition score and measures of obesity: results from a cross-sectional study among Latina/o immigrants in Baltimore

BACKGROUND

Studies suggest that US Latinos have a higher prevalence of obesity than White Americans. However, obesity may differ by pre-immigration factors and Latinos' cultural representations of ideal body image. This paper explores whether country of origin's stage in the nutrition transition is related to Latino immigrants' BMI category and self-perception of weight.

METHODS

Primary data originated from a cross-sectional questionnaire of Latina/o immigrants in Baltimore in 2011. A convenience sample of self-identified Latinos, ≥18 years old, living in Baltimore was recruited from a community-based organization. Data for each country represented in the sample were obtained from the WHO Demographic and Health Surveys and the UN Food and Agriculture Organization. Each country was scored for its stage in the nutrition transition using a six-point scoring system. Descriptive statistics were conducted to characterize the sample. Bivariate analyses were conducted to examine the relationship between the outcome variables and the predictors. Multivariate logistic regressions were conducted to examine whether a country's stage in the nutrition transition increased one's odds of having an obese BMI score (≥30 kg/cm2) and perceiving one's weight as overweight, while controlling for socio-demographic variables.

RESULTS

The sample (n = 149) consisted of immigrants from 12 Latin American countries. Participants lived in the US for x=10.24 years. About 40% of the sample had BMI ≥30 kg/m2 (obese). The longer Latina immigrants' lived in the US, the less likely their country of origin's nutrition transition score would increase their odds of having a BMI ≥30 kg/m2 (OR = 0.97 p < 0.04). The higher the country of origin's nutrition transition score, the more likely BMI influenced Latino immigrants' perception of their weight as above normal (OR = 1.06, p < 0.04). The effect of the nutrition transition score had a stronger effect on females than males.

CONCLUSION

These results suggest that country of origin's nutrition transition score and gender affect Latino immigrants' objective and subjective measures of weight. Future investigation should investigate the relationship between gender and the nutrition transition in Latin America and how the nutrition transition globalizes obesity and weight consciousness.

Nutritional transition in children under five years and women of reproductive age: a 15-years trend analysis in Peru

Background

Rapid urbanization, increase in food availability, and changes in diet and lifestyle patterns have been changing nutritional profiles in developing nations. We aimed to describe nutritional changes in children under 5 years and women of reproductive age in Peru, during a 15-year period of rapid economic development and social policy enhancement.

Materials and Methods

Trend analyses of anthropometric measures in children of preschool age and women between 15–49 years, using the Peruvian National Demographic and Family Health Surveys (DHS) from 1996 to 2011. WHO growth curves were used to define stunting, underweight, wasting and overweight in children <5y. We employed the WHO BMI-age standardized curves for teenagers between 15–19y. In women >19 years, body mass index (BMI) was analyzed both categorically and as a continuous variable. To statistically analyze the trends, we used regression models: Linear and Poisson for continuous and binary outcomes, respectively.

Results

We analyzed data from 123 642 women and 64 135 children, from 1996 to 2011. Decreases over time were evidenced for underweight (p<0.001), wasting (p<0.001), and stunting (p<0.001) in children under 5y. This effect was particularly noted in urban settings. Overweight levels in children reduced (p<0.001), however this reduction stopped, in urban settings, since 2005 (∼12%). Anemia decreased in children and women (p<0.001); with higher reduction in urban (↓43%) than in rural children (↓24%). BMI in women aged 15–19 years increased (p<0.001) across time, with noticeable BMI-curve shift in women older than 30 years. Moreover, obesity doubled during this period in women more than 19y.

Conclusion

Nutrition transition in Peru shows different patterns for urban and rural populations. Public policies should emphasize targeting both malnutrition conditions—undernutrition/stunting, overweight/obesity and anemia—considering age and place of residence in rapid developing societies like Peru.

Trends in overweight by educational level in 33 low- and middle-income countries: the role of parity, age at first birth and breastfeeding

This study examined trends in overweight among women of reproductive age by educational level in 33 low- and middle-income countries, and estimated the contribution of parity, age at first birth and breastfeeding to these trends. We used repeated cross-sectional Demographic Health Surveys of 255,828 women aged 25-49 years interviewed between 1992 and 2009. We applied logistic regression to model overweight (>25 kg m(-2) ) as a function of education, reproductive variables and time period by country and region. The prevalence of overweight ranged from 3.4% in South and Southeast Asia to 73.7% in North Africa West/Central Asia during the study period. The association between education and overweight differed across regions. In North Africa West/Central Asia and Latin American, lower education was associated with higher overweight prevalence, while the inverse was true in South/Southeast Asia and Sub-Saharan Africa. In all regions, there was a consistent pattern of increasing overweight trends across all educational groups. Older age at first birth, longer breastfeeding and lower parity were associated with less overweight, for differences by educational level in overweight prevalence and trends.

Instrumental social support and women's body composition in El Alto, Bolivia

Instrumental social support, or aid in the form of labor or money, may exert a positive influence on economic welfare and food security. Several investigators have found a positive relationship between social support and nutritional status, while others have found a negative association between social support and central adiposity. In the rural Andes, extra-household economic cooperation has long been an important adaptive strategy, and the breakdown of these relationships is one reason for high rates of rural-to-urban migration, including to the Bolivian city of El Alto. This research investigates the influence of instrumental support on women's body composition. Information was collected on individual perception of instrumental support and anthropometric indicators of nutritional status including percent body fat (bioelectrical impedance analysis (BIA)), BMI, and distribution of fat on trunk relative to limbs (Ratio of subscapular to triceps skinfold (STR)), and multiple linear regression analysis used to test the prediction that instrumental social support is positively related to body fat stores. Controlling for age and household socioeconomic status, perceived access to one or more sources of instrumental support was positively and significantly related to overall levels of adiposity. There is no evidence that STR mediates the relationship between instrumental social support and body composition. This analysis offers support for the prediction that economic social support has direct effects on women's energy stores. The interpretation of these results is somewhat ambiguous given the high levels of overweight and obesity in this population.

Worksite interventions: improving lifestyle habits among Latin American adults

CONTEXT

Worksite-based interventions have been shown to result consistently in significant improvements in weight- and health-related outcomes among the working adult population; however, applicability and effectiveness of studies has often been limited by inadequate reporting of age and ethnicity. This study aimed to examine work-based interventions among Latinos in the U.S. and Latin America.

EVIDENCE ACQUISITION

Data were abstracted (and analyzed) from "parent" study Guide to Obesity Prevention in Latin American and the U.S. (GOL), between January 2010 and December 2011. Manuscripts from 1965 to 2010 were evaluated according to inclusion criteria for interventions, including a sample population of at least 50% Latinos or results stratified by ethnicity, at least one obesity-related outcome measure evaluated before and after intervention, and worksite setting and comparison of an intervention group to a non-intervention group (including pre-post designs).

EVIDENCE SYNTHESIS

Of 105 interventions abstracted, five were work-based interventions. The average participant age was 45 years, with an average of 58% women. Four of the five interventions had a pre-post study design that received a fair execution score and lowest design-suitability score, whereas one group RCT intervention had the greatest design suitability and good execution. For two studies, Cohen's d effect sizes ranged from 0.09 to 0.603. Effect sizes could not be calculated for three of the interventions. Three interventions found significant outcomes for BMI, three for weight, two for waist circumference, and one for waist-to-hip ratio.

CONCLUSIONS

Few studies have focused on work-based interventions specifically aimed at Latinos. This review identified promising strategies for reducing obesity in the workplace.

Obesity and its health impact in Africa: a systematic review

Abstract

Obesity and its association with co-morbidities in Africa are on the rise. This systematic review examines evidence of obesity and its association with co-morbidities within the African continent. Comparative studies conducted in Africa on adults 17 years and older with mean body mass index (BMI) ≥ 28 kg/m² were included. Five electronic databases were searched. Surveys, case–control and cohort studies from January 2000 to July 2010 were evaluated. Of 720 potentially relevant articles, 10 met the inclusion criteria. Prevalence of obesity was higher in urban than rural subjects with significant increases in obesity rates among women. Inflammatory marker levels were significantly elevated among Africans compared with Caucasians. The co-relationship between obesity and chronic diseases was also highlighted. This systematic review demonstrates that while obesity remains an area of significant public health importance to Africans, particularly in urban areas, there is little evidence of proper diagnosis, treatment and/or prevention.

THE FRAGILITY OF THE FUTURE AND THE TUG OF THE PAST: LONGEVITY IN LATIN AMERICA AND THE CARIBBEAN

BACKGROUND

Cohorts that will attain age 60 after 2010 in the Latin American and Caribbean region (LAC) are beneficiaries of a massive mortality decline that began as early as 1930. The bulk of this decline is due to diffusion of low-cost medical technology that improved recovery rates from infectious diseases. This changes the composition of elderly cohorts in a distinct way: more among those who could experience the deleterious impact of adverse early conditions as adults survive to attain old ages.

OBJECTIVE

To compute bounds for the size of effects on old age mortality of changes in cohorts' composition by exposure to early conditions. We calculate estimates for countries in the LAC region that span the entire range of post-1950 mortality decline.

METHODS

We use counterfactual population projections to estimate bounds of changes in the composition of cohorts by exposure to early conditions. These are combined with empirical effects of adverse early conditions on adult mortality to generate estimates of foregone gains in life expectancy at age 60.

RESULTS

under somewhat conservative assumptions life expectancy at age 60 will at best increase much more slowly than in the past and at worst reach a steady state or decline. Foregone gains may be as high as 20% of projected values over a period of 30 to 50 years, the time it takes for cohorts that reaped the benefits of the secular mortality decline to become extinct.

CONCLUSIONS

Changing composition of cohorts by early exposures constitutes a powerful force that could drag down or halt short-run progress of life expectancy at older ages.

Academia da Cidade: um serviço de promoção da saúde na rede assistencial do Sistema Único de Saúde

Analisar o perfil de saúde e nutricional dos usuários do Sistema Único de Saúde ingressantes em uma Academia da Cidade, de Belo Horizonte, Minas Gerais durante triênio. Estudo transversal com usuários > 20 anos. Coletaram-se dados sociodemográficos, de saúde, hábitos e consumo alimentar, e antropometria. Realizado testes Kolmogorov-Smirnov, ANOVA, Kruskal-Wallis, Qui-Quadrado e Exato de Fisher. Observou-se elevada prevalência de indivíduos hipertensos (41,6%), com excesso de peso (70,6%) e riscos metabólicos associados à obesidade (67,6%). Cerca de 40% dos ingressantes apresentavam de 1 a 3 doenças crônicas e mais de 65% utilizavam medicamentos diariamente. Houve inadequação no consumo diário de frutas e hortaliças (75,3%), gordura aparente da carne (72,4%) e bebidas açucaradas (54,2%). Apresentavam baixa escolaridade e renda, além de inadequações alimentares e elevadas prevalências de HAS, excesso de peso e riscos metabólicos o que sugere a busca, dos usuários, pelo serviço de promoção da saúde para o tratamento de doenças. O que ilustra a percepção curativista demonstrando ainda a escassez de iniciativas de cuidado à saúde na população. Denota-se a necessidade de se rever as ações nos diferentes níveis de atenção à saúde, visando promover maior integralidade do cuidado prestado.

Desnutrição e excesso de peso em crianças e adolescentes: uma revisão de estudos brasileiros

OBJETIVO: Revisar a literatura brasileira sobre a prevalência e os fatores associados ao déficit de estatura e ao excesso de peso em crianças e adolescentes de cinco a 19 anos. FONTES DE DADOS: A pesquisa foi realizada nas bases de dados PubMed e Bireme, utilizando-se os seguintes descritores: "desnutrição", "déficit estatural", "obesidade", "sobrepeso", "IMC", "criança", "escolar", "adolescente" e "Brasil". Foram considerados os seguintes critérios de seleção: artigo original de base populacional, avaliação dos fatores associados por meio de análise estatística de regressão, e artigos publicados entre 2000 e 2010. SINTESE DOS DADOS: No que se refere ao déficit estatural, apenas dois estudos atenderam aos critérios estabelecidos, apresentando variações de 3,5 a 16,7%, com indicação da condição social e da escolaridade dos jovens como fatores associados. Dos 12 estudos que investigaram o excesso de peso, 67% foram realizados na região Sul do Brasil e nenhum incluiu o Norte do país. A maioria apresentou delineamento transversal. As prevalências variaram de 13,9 a 38,9%, sendo os principais fatores associados: padrões socioeconômicos, influência familiar e estilo de vida sedentário. CONCLUSÕES: As associações das variáveis renda e nível de escolaridade com o déficit de estatura e com o sobrepeso, embora com tendências opostas, chamam a atenção. Sugere-se a realização de mais estudos, em especial nas regiões Norte e Nordeste do Brasil.

Association between commercial and traditional sugar-sweetened beverages and measures of adiposity in Costa Rica

OBJECTIVE

Increasing trends in the consumption of commercial sugar-sweetened beverages (SSB) have occurred in parallel with rising levels of obesity in Latin America, but data showing the relationship between these SSB and obesity are limited. The current study examined the association between commercial and traditional SSB and measures of adiposity in Costa Rica.

DESIGN

A cross-sectional analysis was conducted in which the exposure, SSB intake, was defined as frequency of daily servings of 'fresco' (a traditional home-made beverage), fruit drink (commercially available SSB), soda and fruit juice (made from fruits at home). Multivariate linear regression was used to estimate associations between SSB intake and BMI, waist-to-hip ratio and skinfold thickness.

SETTING

Central Valley, Costa Rica.

SUBJECTS

Controls (n 2045) of a case-control study on diet and heart disease in Costa Rica.

RESULTS

Fresco, fruit drink, soda and fruit juice were consumed ≥1 time/d by 47 %, 14 %, 4 % and 14 % of the population, respectively. One serving/d of soda, fruit drink and fresco was associated with 0·89, 0·49 and 0·21 kg/m2 higher BMI, respectively (all P < 0·05). Fruit drink (≥1 serving/d) was associated with higher waist-to-hip ratio (P = 0·004), while soda and fresco were associated with higher skinfold thickness (P = 0·02 and 0·01, respectively). Associations with fruit juice intake were modest and not statistically significant. Other factors associated with higher BMI were higher income and less education, smoking and physical inactivity (all P < 0·05).

CONCLUSIONS

Increasing intake of commercially available SSB could be in part responsible for the high prevalence of obesity among Hispanic adults.