The Prevalence of Underweight, Overweight/Obesity and Their Related Lifestyle Factors in Indonesia, 2014-2015

Maternal pre-pregnancy body mass index and related factors: A cross-sectional analysis from the Japan Environment and Children's Study

Socioeconomic status and smoking are reportedly associated with underweight and obesity; however, their associations among pregnant women are unknown. This study aimed to investigate whether socioeconomic factors, namely educational attainment, household income, marital status, and employment status, were associated with pre-pregnancy body mass index (BMI) categories, including severe-moderate underweight (BMI ≤ 16.9 kg/m2), mild underweight (BMI, 17.0-18.4 kg/m2), overweight (BMI, 25.0-29.9 kg/m2), and obese (BMI ≥ 30.0 kg/m2) among Japanese pregnant women using data from the Japan Environment and Children's Study (JECS). In total, pregnant women were included 96,751. Age- and parity-adjusted multivariable multinomial logistic regression analyses assessed socioeconomic factors and smoking associations with falling within abnormal BMI categories (normal BMI as the reference group). Lower education and lower household were associated with overweight and obesity, and, especially, lowest education and household income had relatively higher point estimate relative ratios (RRs) of 3.97 and 2.84, respectively. Regarding the risks for underweight, however, only junior high school education had a significantly higher RR for severely to moderately underweight. Regarding occupational status, homemakers or the unemployed had a higher RR for severe-moderate underweight, overweight, and obesity. Unmarried, divorced, or bereaved women had significantly higher RRs for mildly underweight status. Quitting smoking early in pregnancy/still smoking had higher RRs for all four not having normal BMI outcomes; however, quitting smoking before pregnancy had a higher RR only for obese individuals. Lower educational attainment and smoking are essential intervention targets for obesity and severe-moderate underweight prevention in younger women. Lower household income is also a necessary target for obesity.

Side effects of CoronaVac® COVID-19 vaccination: Investigation in North Jakarta district public health center communities in Indonesia

Background

The decreasing prevalence of COVID-19 has highlighted the value of vaccinations. CoronaVac® vaccine was one of the most widely used vaccines in Indonesia, in other Southeast Asian countries, as well as in Latin America. However, to date the safety and side effect profiles of CoronaVac® vaccine among the Indonesian population have not been reported.

Objective

In this study, the CoronaVac® safety profiles were determined in a community of a public health center in North Jakarta, Indonesia.

Method

This is a descriptive cross-sectional questionnaire-based study on vaccine side effects as recorded in the yellow form (MESO). Patients (n = 300) who received CoronaVac® vaccinations between July and August 2021 were enrolled. SPSS was used to analyze the descriptive data.

Results

Most respondents were women (72.7 %) between the ages of 17 and 21 years. A significantly (p = 0.009) positive correlation was established between the vaccine side effects (namely pain at the injection site) with the female gender. Other side effects such as fatigue (p = 0.034) and headache (p < 0.001) were also correlated with disease comorbidity.

Conclusion

Overall, the side effects following the first and the second doses were generally mild and included fever, pain in the injection area, fatigue, headache, drowsiness, diarrhea, cough, and nausea. Regarding vaccine efficacy, CoronaVac® confers better protection following the second dose administration where the percentage of respondents affected with COVID-19 (26.7 %) decreased to only 20.3 % following the second dose.

Who is chronically obese in Indonesia? The role of individual preferences

Numerous studies have confirmed the relationship between individual risk and time preference and obesity. Nevertheless, none has studied the effect of these attitudes on chronic (long-term) obesity. This study used Indonesia Family Life Survey (IFLS) data from 16,366 individuals. It tracked their obesity status in 2007 and 2014 by calculating body mass index, the ratio between body weight and square of height. Besides the conventional risk-averse and risk-tolerant behaviour, the IFLS sample includes people who fear uncertainty related to the status quo bias. The ordered logit regression results show that past impatience, risk tolerance, and status quo bias behaviour (in 2007) are associated with transient or chronic obesity, while only current behaviour of status quo bias (in 2014) is associated with obesity. Furthermore, our study confirms that chronic obesity in Indonesia is prevalent among highly educated, high-income, and urban-centric individuals, exacerbated by impatience, risk tolerance, and uncertainty aversion. Thus, providing information on the risk of obesity and food calories, giving the incentive to avoid obesity, and improving the quality of built environments such as public parks, public transportation, and footpath could help prevent the rising obesity prevalence.

Prevalence and determinants of obesity among individuals with diabetes in Indonesia

Background: Obesity and diabetes mellitus (DM), both individually or simultaneously, increase the risk of morbidity and mortality. The present study aimed to determine the prevalence and determinants of obesity among diabetic individuals in Indonesia. Methods: Data were extracted based on 2018 Indonesian Basic Health Survey (Riset Kesehatan Dasar=RISKESDAS). This study involved all individuals with DM and categorized obesity based on body mass index. After data clearing, this study analyzed 3911 DM subjects of the 33.905 subjects acquired from the 2018 RISKESDAS. The study also observed demographic data, diabetes control parameters, history of hypertension, lipid profiles, and food consumption patterns. These variables were involved in a Chi-square test, and related variables were then involved in the Binary logistic regression to define the independent determinants of obesity among DM subjects. Results: Of the 3911 DM subjects included, the study found an obesity prevalence of 32.9%. This study found that female (prevalence odds ratio [POR]=2.15; 95% CI: 1.76-2.62), age 15-44 years (POR=2.46; 95% CI: 1.83-3.33), urban residence (POR=1.49; 95% CI: 1.25-1.77), history of hypertension (POR=1.25; 95% CI: 1.04-1.51), high diastolic blood pressure (POR=1.90; 95% CI: 1.58-2.29), high LDL (POR=1.44; 95% CI: 1.13-1.84), high HDL (POR=0.60; 95% CI: 0.46-0.78, and high triglycerides (POR=1.27; 95% CI: 1.07-1.50) were the risk factor of obesity  among DM subjects; while higher education (POR=0.64; 95% CI: 0.53-0.78) and married (POR=0.73; 95% CI: 0.59-0.90) were protective factors of obesity among DM subjects. Conclusions: The study concluded that almost one-third of DM subjects in Indonesia were obese. Female, age, urban residence, education level, history of hypertension, diastolic blood pressure, and lipid profiles were all associated with obesity among DM subjects in Indonesia. These findings suggest that monitoring and controlling of related determinants is needed to prevent complications caused by the doubled burden of diabetes and obesity.

Obesity prevalence, physical activity, and dietary practices among adults in Saudi Arabia

Introduction

The current study evaluated obesity prevalence, physical activity, and dietary practices among Saudi adults in the Makkah region of the Kingdom of Saudi Arabia (KSA). The current survey was accomplished between November 2021 and March 2022.

Method

A validated questionnaire, Arab Teens Lifestyle Study (ATLS), was used to evaluate all participants' physical activities, sedentary behaviors, and nutritional habits in addition to demographic data.

Result

A total of 2,115 people [1,238 (58.5%) women and 877 (41.5%) men] participated in this survey. Being overweight was prevalent in 32.8% of the population (41% of men and 28.9% of women), obesity was prevalent in 23% of the population (males 23.1% and females 24.2%). Obese people consumed more soft drinks, and overweight people did not consume enough vegetables (fresh/cooked). Obese people consumed fast food (e.g., burgers, sausage, pizza, or Arabic shawarma) over three times each week. The mean (SD) number of days of practice walking was 2.51 (2.05) vs. 1.3 (1.87) (p < 0.001) for lean and obese individuals, respectively. In addition, individuals with normal BMI had more days of jogging, moderate and high-intensity exercise, dancing, and strength training than those with obesity. The odds of being obese increased with age (OR: 1.07; p < 0.001), in males (OR: 2.16; p < 0.001), in participants earning <5,000 SR/month (1.3 thousand $) and 10-15 thousand SR/month (1.34-2.66 thousand $) (OR: 2.36; P = 0.01). Obesity was inversely associated with moderate-intensity exercise (OR: 0.802; p = 0.009), and regular walking (OR: 0.685; CI: 0.624-0.752; p < 0.001).

Discussion

Overweight and obesity were prevalent in 32.8% and 23% of the population, respectively. Sociodemographic factors associated with obesity. Focused intervention strategies are needed to overcome the obesity issue.

Effects of Walking Exercise Program Based on Duration on the Body Composition and Lipid Profile in Overweight and Obesity Female College Students

The lack of physical activity is one factors that causes the increased prevalence of overweight and obesity in Indonesia. A walking exercise program is a simple strategy for weight loss and the prevention of various chronic diseases. This research aims to analyze the effects of walking exercise programs base on duration which involve an increased number of daily steps on the body's composition and lipid profile. The quasi-experimental design included 40 female university students aged 20–30, whose body mass index (BMI) was ≥25 kg/m2. They are divided into two groups: 60 minutes (WE-60) and 40 minutes (WE-40) walking program. All groups performed the program intervention five times per week, carried out for a total of 12 weeks, with a heart rate of 50%-75%. The results showed that an additional 60-minute walking exercise program led to a greater increase in the total daily steps (P<0.001), and it has a significant effect on weight (P=0.005), BMI (P=0.002), WC (P=0.003), visceral fat (P=0.001), fat mass (P=0.001) and the body fat percentage (P=0.007), compared to the 40 minutes walking group intervention. However, the lipid profiles of both groups were not significantly different. In conclusion, the addition of a 60-minute walking exercise program (WE-60) five times per week, improved the daily steps and significantly affected body composition, but it had no significant effect on the lipid profile.

Health-Related Lifestyles in Relation to Body Mass Index Among Young and Middle-Aged Women in Japan

BACKGROUND

Being underweight, overweight, or obese can lead to adverse health effects. Hence, it is important to understand the specific factors that change the burden of underweight and overweight to target appropriate disease control strategies. This study was designed to examine the prevalence and factors associated with underweight and overweight among young and middle-aged women in Japan.

MATERIALS AND METHODS

A cross-sectional study was conducted among women aged 20-59 years who participated in health checkups at a regional health care center in 2018 and 2019 (N = 1722). The assessments included anthropometric, blood pressure measurements, and a standardized self-administered questionnaire. Multivariable logistic regression analysis assessed lifestyle factors associated with body mass index for underweight <18.5 kg/m²) and overweight/obesity (25.0 kg/m² and above).

RESULTS

The prevalence of underweight and overweight/obesity were 12.3%, and 22.5%, respectively. No lifestyle factors were found to be significantly associated with being underweight. Having dinner within 2 hours before bed was positively associated with being overweight/obese [adjusted odds ratio (AOR): 1.448, 95% confidence interval (CI): 1.014-2.068]. Women who gained 10 kg since their 20s were more likely to fall into overweight/obesity category (AOR: 9.674, 95% CI: 1.014-2.068). Women who were using a lipid-lowering medication (AOR: 3.150, CI: 1.892-5.246) were associated with three times higher risk of being overweight/obese. Hypertension and dyslipidemia were significantly associated with overweight/obesity (AOR: 3.094, 95% CI: 2.201-4.351 and AOR: 2.498, 95% CI: 1.831-3.409, respectively).

CONCLUSION

One in five middle-aged women was overweight or obese, whereas one in eight was underweight. In relation to the prevention of overweight/obesity, specific health promotion messages regarding eating timing should be developed.

A Cross-Sectional Assessment of Dietary Patterns and Their Relationship to Hypertension and Obesity in Indonesia

Background

There is a marked increase in the intake of foods associated with higher risks for hypertension and obesity in Indonesia. However, studies assessing the relationship between dietary patterns and health outcomes are few.

Objective

The purpose of this study was to characterize dietary patterns and investigate their relationship with hypertension and obesity in Indonesia.

Methods

Exploratory factor analysis was used to derive dietary patterns from a brief food scanner filled by 31,160 respondents aged 15 y and older in the Indonesian Family Life Survey wave 5 (IFLS 5). Age- and gender-specific quintiles of consumption were created for each pattern and the association between quintiles of each dietary pattern and the odds for hypertension and obesity were assessed using multivariate logistic regression analyses.

Results

Two dietary patterns were identified: a modern dietary pattern characterized by fast foods, soft drinks, sweet snacks, and salty snacks and a traditional pattern characterized by fish, vegetables, and fruits. Younger age and being male were significantly correlated with higher consumption of the modern pattern (P < 0.0001 and P = 0.03, respectively). Analyses showed no association between hypertension and the modern pattern. However, the traditional pattern revealed lower odds for hypertension among those in the highest quintile compared with the lowest quintile (OR: 0.84; 95% CI: 0.74, 0.95; P-trend < 0.05). Individuals in the highest quintile of each dietary pattern had higher odds of obesity compared with those in the lowest quintile (modern pattern-OR: 1.31; 95% CI: 1.15, 1.49; P-trend < 0.00; traditional pattern-OR: 1.25; 95% CI: 1.10, 1.42; P-trend < 0.01).

Conclusions

More studies using gold-standard measures of dietary intake are needed to better understand the relationship between the modern dietary pattern and hypertension in Indonesia. Also, both modern and traditional dietary patterns in Indonesia may be energy dense, leading to higher risk for obesity.

Malnutrition Prevalence and Nutrient Intakes of Indonesian Community-Dwelling Older Adults: A Systematic Review of Observational Studies

Background

Malnutrition and inadequate nutrient intake are associated with functional decline, frailty, and bad clinical outcomes among community-dwelling older adults. Despite the growing proportion of the elderly population in Indonesia, data on the prevalence of malnutrition and adequacy of macronutrient and micronutrient intakes among Indonesian older adults are scattered and vary between studies. Therefore, our study aims to obtain data on malnutrition prevalence, level and distribution of nutrient intakes, and prevalence of macronutrient and micronutrient inadequacies in Indonesian community-dwelling older adults.

Methods

We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in PROSPERO. A systematic electronic database search of MEDLINE, CENTRAL, EMBASE, ProQuest, HINARI, IMSEAR, GARUDA, and Indonesian Publication Index was undertaken. Additional searches were conducted in gray literature sources, hand-searching, retrospective searching, and personal communication with authors of the relevant publication. Observational studies presenting the malnutrition prevalence of habitual dietary intakes of older adults (60 years or older) were included. The risk of bias of studies was assessed using the Joanna Briggs Institute critical appraisal form. Sex-specific mean (and standard deviation) habitual macronutrient and a selection of micronutrients (calcium, vitamin D, and vitamin B12) intakes were extracted from each article to calculate the percentage of older people who were at risk for inadequate micronutrient intakes using a proxy of estimated average requirement (EAR) cut-point method, which is calculated from the national guideline of recommended dietary allowance (RDA). Prevalence of malnutrition, based on body mass index (BMI) categories and mini-nutritional assessment (MNA) criteria. and the population at risk of malnutrition were presented descriptively.

Results

Nine studies retrieved from electronic databases and gray literature were included in the pooled systematic analysis. According to BMI criteria, the underweight prevalence ranged from 8.0 to 26.6%. According to the MNA, the prevalence of malnutrition ranged from 2.1 to 14.6%, whereby the prevalence of at risk of malnutrition amounted to 18–78%. Our systematic review identified a high prevalence of nutrient inadequacies, most markedly for protein, calcium, vitamin D, and vitamin B12.

Conclusion

We signal a high risk of malnutrition along with poor macronutrients and micronutrients intakes among Indonesian community-dwelling older adults. These findings provide important and robust evidence on the magnitude of malnutrition and nutrient inadequacy concerns that call for appropriate nutrition, as well as public health policies and prompt intervention.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018102268.

Prevalence and factors associated with underweight, overweight and obesity among 15-49-year-old men and women in Timor-Leste

Background

Underweight and overweight both have a long-lasting significant effect on human health at the individual and population levels. However, in the context of Timor-Leste, a country that achieved independence around two decades ago, there is a severe scarcity of evidence regarding the underweight and obesity burden. We conducted this study to find out the prevalence of underweight, overweight and obesity and their associated factors.

Methods

This study used the nationally representative data of Timor-Leste Demographic Health Survey 2016 data. We conducted descriptive analysis followed by multivariable logistic regression analysis to find out the prevalence and investigate the associated factors. Both crude and adjusted odds ratio of covariates were reported with 95% confidence interval (CI).

Results

This study analyzed the data from a weighted sample of 16,488 Timorese aged 15–49 years. The prevalence of normal weight, underweight, and overweight or obesity were found to be 55.2% (95% CI: 54.2%-56.2%), 25.5% (95% CI: 24.4%-26.7%), and 19.3% (95% CI: 18.3%-20.3%), respectively. For underweight, age, sex, type of settlement (urban/rural), township, and wealth, marital, and educational status were found to have a statistically significant relationship (p < 0.05) with Body Mass Index(BMI). After adjustment for the covariates in the logistic regression model age, sex, township, and wealth and marital status were found to be statistically significant correlates (p < .05) of underweight. For overweight and obesity, all the background characteristics included in this study (i.e, age, sex, type of settlement, township, and wealth, marital, and educational status) were found to be statistically significant correlates, after adjustment for the covariates.

Conclusion

This study concludes that Timor-Leste has a significant underweight and overweight burden which needs to be addressed through appropriate interventions. Further studies are also warranted to delve deeper into the complex interplay of factors associated with underweight and overweight.

Towards a Parsimonious Pathway Model of Modifiable and Mediating Risk Factors Leading to Diabetes Risk

Modifiable risk factors are of interest for chronic disease prevention. Few studies have assessed the system of modifiable and mediating pathways leading to diabetes mellitus. We aimed to develop a pathway model for Diabetes Risk with modifiable Lifestyle Risk factors as the start point and Physiological Load as the mediator. As there are no standardised risk thresholds for lifestyle behaviour, we derived a weighted composite for Lifestyle Risk. Physiological Load was based on an index using clinical thresholds. Sociodemographics are non-modifiable risk factors and were specified as covariates. We used structural equation modeling to test the model, first using 2014/2015 data from the Indonesian Family Life Survey. Next, we fitted a smaller model with longitudinal data (2007/2008 to 2014/2015), given limited earlier data. Both models showed the indirect effects of Lifestyle Risk on Diabetes Risk via the mediator of Physiological Load, whereas the direct effect was only supported in the cross-sectional analysis. Specifying Lifestyle Risk as an observable, composite variable incorporates the cumulative effect of risk behaviour and differentiates this study from previous studies assessing it as a latent construct. The parsimonious model groups the multifarious risk factors and illustrates modifiable pathways that could be applied in chronic disease prevention efforts.

Associations of Knowledge, Attitude and Practices of Food Label on Cardiovascular Diseases (CVD) Risk amongst University Students in Selangor, Malaysia

Cardiovascular diseases (CVD) deaths were on the rise in developing countries. In Malaysia, the accelerating economic transition has been accompanied by high prevalence of CVD risk factors which accounts for 35% of total deaths in 2016. This increasing trend involving not only the elderly but also the young adults. Food label reading is reported to be the key to help individual adopt healthy food choice and dietary habits. Hence, the aim of this study is to determine the associations of knowledge, attitude and practices (KAP) of food label on CVD risk amongst university students. A cross sectional study was conducted on 389 university students aged 19 to 35 y old in Selangor. Information on socio-demographic profile, nutrition knowledge, attitude, and practice of food label were collected using self-administrated questionnaires. Anthropometric data of participants were measured using standardize methodology and blood pressure was measured using Omron blood pressure monitor. The data were tested using Chi-Square test. Average age of the respondents were 23 y. Majority of the respondents had no CVD risk (41%) while (59%) had increased CVD risks. There was a significant association between CVD risk factors (BMI, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP) with knowledge and attitude of using food label (p<0.05). The practice of food label usage showed no significant association (p>0.05) with all CVD risk factors. Considering the importance of understanding and usage of food label in the management of chronic diseases, these findings provide useful information to incorporate nutrition education on food labelling in preventing CVD risks.

Underweight and overweight/obesity among adults in Afghanistan: prevalence and correlates from a national survey in 2018

BACKGROUND

The study aimed to estimate the prevalence and correlates of underweight and overweight/obesity among adults in Afghanistan.

METHODS

National cross-sectional survey data of 3779 persons aged 18-69 years were analysed. Multinomial logistic regression was used to estimate factors associated with underweight and overweight/obesity relative to normal weight.

RESULTS

In all, 7.8% of the study sample was underweight (BMI < 18.5 kg/m²), 49.5% had normal weight (BMI 18.5-24.9 kg/m²), 25.5% overweight (25.0-29.9 kg/m²), and 17.2% obesity. In adjusted multinomial logistic regression, factors negatively associated with underweight were male sex (adjusted relative risk ratio (ARRR): 0.30, 95% confidence interval (CI): 0.15-0.58) and hypertension (ARRR: 0.51, 95% CI: 0.27-0.95) and factors positively associated with underweight were sedentary behaviour (ARRR: 1.85, 95% CI: 1.11-3.10) and current tobacco use (ARRR: 2.58, 95% CI: 1.08-6.16). Factors positively associated with overweight/obesity were aged 30-44 years (ARRR: 2.00, CI: 1.51-2.66) and aged 45-69 years (ARRR: 1.58, CI: 1.09-2.31) (compared to 18-29 years) (ARRR: 1.28, CI: 1.14-2.18), hypertension (ARRR: 2.74, CI: 1.89-3.96), and type 2 diabetes (ARRR: 1.82, CI: 1.13-2.94), and high physical activity (ARRR: 0.70, CI: 0.50-0.98) was negatively associated with overweight/obesity.

CONCLUSION

Almost one in ten adult respondents were underweight and more than two in five were overweight/obese, confirming a dual burden of malnutrition in Afghanistan.

Overweight and Obesity among Adults in Iraq: Prevalence and Correlates from a National Survey in 2015

This study aimed to estimate the prevalence and correlates of overweight and obesity among adults in Iraq. Data from a 2015 nationally representative cross-sectional survey of 3916 persons 18 years or older (M (median) age = 40 years, IQR (interquartile range) age = 29–52 years; men: M = 41 years, IQR = 29–54 years; women: M = 40 years, IQR = 30–51 years) who responded to a questionnaire, and physical and biochemical measures were analysed. Multinomial logistic regression was utilised to predict the determinants of overweight and obesity relative to under or normal weight. The results indicate that 3.6% of the participants were underweight (body mass index (BMI) <18.5 kg/m²), 30.8% had normal weight (BMI 18.5–24.9 kg/m²), 31.8% were overweight (25.0–29.9 kg/m²), and 33.9% had obesity (BMI ≥30.0 kg/m²). In the adjusted multinomial logistic regression, being aged 40–49 years (compared to 18–39 years old) (adjusted relative risk ratio (ARRR): 4.47, confidence interval (CI): 3.39–5.91), living in an urban residence (ARRR: 1.28, CI: 1.14–2.18), and having hypertension (ARRR: 3.13, CI: 2.36–4.17) were positively associated with obesity. Being male (ARRR: 0.47, CI: 0.33–0.68), having more than primary education (ARRR: 0.69, CI: 0.50–0.94), and having a larger household size (five members or more) (ARRR: 0.45, CI: 0.33–0.60) were negatively associated with obesity. Approximately two in three adult participants were overweight/obese, and sociodemographic and health risk factors were found that can be utilised in targeting interventions.

Body Mass Index, Waist-Hip Ratio and Fasting Blood Glucose Levels amongst the University Students

Overweight and obesity have been correlated to the higher risk for developing metabolic diseases in later life, i.e. DM type 2. We study the body mass index (BMI), the waist to hip ratio (WHR) and the fasting blood glucose levels (FBG) in the seemingly healthy male and female university students to comprehend these variables amongst the youth in Indonesia in 2019. The BMI and WHR of 150 male and female students aged 18-22 years old of the IIKBW, Kediri were measured by standardised anthropometry. The FBG was measured after 8 hours-minimum of fasting from the capillary blood drop using glucometer. Data was then analysed using SPSS 17 with level of significance of p<0.05. According to Asia-Pacific BMI classification, students were 30.7% obese with males significantly higher than females (p=0.016), 18% overweight (significantly higher in females, p=0.04), 36% normal and 15.3% underweight.When compared between genders, the WHR is significantly higher in males (p<0.001); whilst no significant differences in FBG (p=0.6). Four males and 5 females with FBG ≥ 100 mg/dl, whereas others were within normal limits. There are positive significant correlations between BMI and WHR in males and females (r=0.777, p<0.001; r=0.54, p<0.001, respectively). There is a significant positive correlation between the BMI and FBG with r=0.217, p=0.008; and between the WHR and FBG with r=0.21, p=0.01 amongst all students. In this study, male students have significantly higher BMI and WHR than females. Higher FBG was well observed in students with either higher BMI or WHR.

Spatial distribution and associated factors of underweight in Ethiopia: An analysis of Ethiopian demographic and health survey, 2016

Background

Underweight is one form of indicators of under-nutrition, which results from the poor nutrient intake and underlying health problems. Its impact is beyond an individual and extends to a country level. It has been known from the literature that underweight has a negative effect on income and development of a country. In the context of Ethiopia, factors predicting underweight remain unknown and there is a paucity of evidence on geographical distribution of underweight among individuals aged 15–49 years. Therefore, the aim of this study was to examine the geographic distribution of underweight and its associated factors among individuals aged 15–49 years in Ethiopia.

Methods

Secondary data analysis was done on a data set consisting of 28,450 individuals and obtained from the Ethiopian Demography and Health Survey (EDHS) 2016. The spatial distribution of underweight across the country was identified by ArcGIS software. Hotspots analysis was done using Getis-Ord Gi* statistic within ArcGIS. In SaTScan software, the Bernoulli model was fitted by Kulldorff’s methods to identify the purely spatial clusters of underweight. A binary logistic regression was applied to determine factors associated with being underweight.

Result

In Ethiopia, the spatial distribution of underweight was clustered with Global Moran’s I  =  0.79 at p-value < 0.0001. The highest underweight clusters were observed in Tigray, Gambella, eastern part of Amhara, and western and central part of Afar regions. Male individuals [AOR = 1.21; 95% CI: (1.15 1.28)], never married [AOR = 1.14; 95% CI: (1.05, 1.24)], rural residents [AOR = 1.32; 95% CI: (1.18, 1.47)], rich [AOR = 0.85; 95% CI: (0.76, 0.94)], cigarette smoking [AOR = 1.25; 95% CI: (1.07, 1.46)], drinking treated water [AOR = 0.91; 95% CI: (0.83, 0.99)] and open filed defecation [AOR = 1.17; 95% CI: (1.08, 1.26)] were found to have a significant association with being underweight.

Conclusions

There was a significant clustering of underweight among individuals aged 15–49 years. Gender, age, marital status, place of residence, wealth index, cigarette smoking, using untreated water and types of toilet were the significant factors of being underweight. Therefore, effective public health interventions like building safe and supportive environments for nutrition, providing socio-economic protection and nutrition-related education for poor and rural resident would be better to mitigate these situations and associated risk factors in hot spot areas. In addition, policymakers should strengthen and promote nutrition sensitive policies and activities in order to alleviate the underlying and basic causes of underweight.

Synergistic Effects of Regular Walking and Alkaline Electrolyzed Water on Decreasing Inflammation and Oxidative Stress, and Increasing Quality of Life in Individuals with Type 2 Diabetes: A Community Based Randomized Controlled Trial

Alkaline electrolyzed water (AEW) and walking are strongly recommended for ameliorating oxidative stress and inflammation. Nevertheless, there is a lack of information on the combination of both on alleviating inflammation, oxidative stress, and improving the quality of life (QoL). We investigated the synergistic effects of drinking AEW and walking on advanced glycation end products (AGEs), advanced oxidation protein products (AOPPs), malondialdehyde (MDA), white blood cells (WBCs), neutrophil-lymphocyte ratio (NLR) and QoL. In total, 81 eligible patients with type 2 diabetes (T2DM) were randomly allocated via single blind to four groups: consumed 2 L/day of AEW (n = 20), instructed to walk for 150 min/week (n = 20), received a combination of AEW and walking (n = 20), and continue their habitual diet and activity (n = 21). Data were collected and analyzed before and after 8 weeks of intervention. Our results showed a significant interaction between the group and time, with both AEW and walking independently and synergistically ameliorating AGEs, AOPPs, MDA, NLR and WBCs levels. Moreover, the AEW group had a higher physical and total QoL score. The walking group and the combined group had higher scores in physical, mental and total QoL compared to the control group. The synergistic effect of AEW and regular walking are an advisable treatment for patients with T2DM.

The prevalence and associated factors of underweight and overweight/obesity among adults in Kenya: evidence from a national cross-sectional community survey

INTRODUCTION

the study aimed to investigate the prevalence and factors associated with underweight and overweight or obesity in an adult population in Kenya.

METHODS

data from a cross-sectional nationally representative community-based study in Kenya (N=4283, 18-69 years) conducted in 2015 was utilized. Assessments included anthropometric, interview, blood pressure and biochemistry mesures. Multinomial logistic regression was used to assess the determinants of underweight and overweight or obesity relative to normal weight.

RESULTS

in all, 11.9% of the study sample was underweight (BMI <18.5kg/m2), 60.1% had normal weight (BMI 18.5-24.9kg/m2), 18.9% overweight (25.0-29.9kg/m2) and 9.1% obesity (BMI ≥30.0kg/m2). In adjusted multinomial logistic regression, male sex (adjusted relative risk ratio-ARRR: 1.47, confidence interval-CI: 1.01, 2.13), lower education (ARRR: 0.63, CI: 0.46, 0.88), lower wealth status (ARRR: 0.47, CI: 0.29, 0.78), inadequate fruit and vegetable consumption (ARRR: 1.79, CI: 1.19, 2.70), adding daily sugar into beverages (ARRR: 1.49, CI: 1.01, 2.22) and having no hypertension (ARRR: 0.54, CI: 0.40, 0.74) were associated with underweight. Factors associated with overweight or obesity were middle and older age (ARRR: 2.15, CI: 1.46, 3.80), being female (ARRR: 0.30, CI: 0.22, 0.41), higher education (ARRR: 1.61, CI: 1.26, 2.24), greater wealth (ARRR: 2.38, CI: 1.41, 3.50), being a Kikuyu by ethnic group (ARRR: 1.68, CI: 1.19, 2.37), urban residence (ARRR: 1.45, CI: 1.06, 1.99), no current tobacco use (ARRR: 0.39, CI: 0.24, 0.54), low physical activity (ARRR: 1.49, CI: 1.02, 2.18) and having hypertension (ARRR: 1.96, CI: 1.54, 2.50).

CONCLUSION

more than one in ten were underweight and almost three in ten were overweight or obese among adults in Kenya. Several risk factors, including sociodemographic, lifestyle and health status risk variables, were identified for underweight and overweight or obesity, which can assist in developing intervention strategies targeting both these conditions.

Secondhand Smoke Correlates with Elevated Neutrophil-Lymphocyte Ratio and Has a Synergistic Effect with Physical Inactivity on Increasing Susceptibility to Type 2 Diabetes Mellitus: A Community-Based Case Control Study

Secondhand smoke (SHS) and physical inactivity are thought to be associated with type 2 diabetes mellitus (T2DM), but the synergistic effect of SHS with physical inactivity and their relationships with T2DM–associated inflammation biomarkers have not been estimated. We investigated the roles of SHS exposure and physical inactivity and their synergistic effect on T2DM risk and their relationships with T2DM associated inflammation biomarkers, neutrophil–lymphocyte ratio (NLR) and white blood cells (WBCs). A case–control study was conducted in total 588 participants (294 case T2DM and 294 healthy controls) from five community clinics in Indonesia. Participants completed a standardized questionnaire on demographic information, smoking status, physical activity habits and food consumption. WBCs and NLR levels were determined using an automated hematology analyzer. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were analyzed using multiple logistic regression model. The synergistic effect was analyzed using additive interaction for logistic regression. Physical inactive people exposed to SHS exhibited a synergistically increased 7.78-fold risk of T2DM compared with people who were not exposed to SHS and who were physically active. SHS is significantly correlated with a high NLR, WBCs and has a synergistic effect with physical inactivity on increasing susceptibility to T2DM.

Diet quality, general health and anthropometric outcomes in a Latin American population: evidence from the Colombian National Nutritional Survey (ENSIN) 2010

OBJECTIVE

Colombia is experiencing a nutrition transition, characterised by nutritionally poor diets and an increased prevalence of non-communicable diseases (NCD). We aimed to investigate the association between diet quality and general health outcomes related to the risk of NCD, in a nationally representative sample of Colombian adolescents and adults.

DESIGN

Cross-sectional analysis. The Alternative Healthy-Eating Index (AHEI) was derived to calculate diet quality. Adjusted regressions were used to examine the association between AHEI, self-perceived general health status (GHS) and anthropometric variables (i.e. age-specific z-scores for height, and BMI for adolescents; waist circumference and BMI for adults).

SETTING

Nationally representative data from the Colombian National Nutrition Survey (ENSIN) 2010.

PARTICIPANTS

Adolescents aged 10-17 years (n 6566) and adults aged ≥18 years (n 6750).

RESULTS

AHEI scores were similar between adolescents (mean 29·3 ± 7·2) and adults (mean 30·5 ± 7·2). In the whole sample, a better diet quality (higher AHEI score) was associated with worse self-perceived GHS (adjusted (a) β-coefficient: -0·004; P < 0·001) and with a smaller waist circumference ((a) β-coefficient: -0·06; P < 0·01). In adults, a higher AHEI score was negatively associated with BMI ((a) β-coefficient: -0·02; P < 0·05), whilst in adolescents it was associated with a reduced height-for-age z-score ((a) β-coefficient: -0·009; P < 0·001).

CONCLUSIONS

A better diet quality was associated with reduced prevalence of predictors of NCD and with some indicators of general health in the Colombian population. In light of the high prevalence of overweight, our findings support the need for public health interventions focused on sustainable positive changes in dietary habits in the general population.

Synergistic Effect of Low Neutrophil-Lymphocyte Ratio With Physical Activity on Quality of Life in Type 2 Diabetes Mellitus: A Community-Based Study

BACKGROUND

Physical inactivity and Type 2 diabetes mellitus (T2DM)-associated inflammatory biomarkers are correlated with poor quality of life (QoL). However, no study has investigated the synergistic effect of physical activity (PA) and lower neutrophil-lymphocyte ratio (NLR) on QoL.

OBJECTIVE

We examined the independent and synergistic effects of PA and inflammatory biomarkers on three domains of QoL in T2DM.

METHODS

This cross-sectional study included 294 patients with T2DM from community clinics in Indonesia. The 36-item Short Form Survey and a questionnaire about PA engagement were used to measure QoL and metabolic equivalent of task (MET)-hr/week, respectively. Inflammatory biomarkers were measured in fasting blood. Adjusted coefficients β and 95% confidence interval (CI) were estimated using multiple linear regression. The synergistic effect was analyzed using additive interaction for linear regression.

RESULTS

Patients with PA ≥ 7.5 MET-hr/week exhibited significantly higher total QoL (β = 8.41, 95% CI = [6.04, 10.78]) and physical component score (PCS; β = 13.90, 95% CI = [10.52, 17.29]) than those with PA < 7.5 MET-hr/week. Patients with NLR < 1.940 had significantly higher total QoL (β = 4.76, 95% CI = [3.41, 6.11]), mental component score (MCS; β = 2.62, 95% CI = [0.75, 4.49]), and PCS (β = 6.89, 95% CI = [4.97, 8.82]) than patients with NLR ≥ 1.940. PA ≥ 7.5 MET-hr/week and NLR < 1.940 exhibited a synergistic effect on total QoL, MCS, and PCS.

CONCLUSIONS

High PA level and low NLR had a positive synergistic effect on QoL among patients with T2DM.

The prevalence of underweight and overweight/obesity and its correlates among adults in Laos: a cross-sectional national population-based survey, 2013

PURPOSE

The study aimed to assess the prevalence of underweight and overweight or obesity and their sociodemographic, lifestyle, and health factors in a national adult population in Lao People's Democratic Republic (PDR) (Laos).

METHODS

A national cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The total sample included 2531 individuals 18-64 years, (females = 59.3%; mean age 38.7 years, SD = 12.8) from Laos. Questionnaire interview, blood pressure and anthropometric measurements, and biochemistry tests were conducted. Multinomial logistic regression was utilized to determine the association between sociodemographic, lifestyle and health status factors, and underweight and overweight or obesity relative to normal weight.

RESULTS

Using Asian criteria for body mass index (BMI) classification, 9.7% of the population was underweight (BMI < 18.5, kg/m²), 47.5% had normal weight (BMI 18.5-22.9 kg/m²), 17.5% overweight (23.0-24.9 kg/m²), 19.6% class I obesity (BMI 25.0-29.9 kg/m²), and 5.6% class II obesity (BMI ≥ 30.0 kg/m²) (or 42.8% overweight, class I or class II obesity). In adjusted multinomial logistic regression, female sex (adjusted relative risk ratio-ARRR 0.67, confidence interval-CI 0.45, 0.99), current tobacco use (ARRR 1.57, CI 1.02, 2.41), and having no hypertension (ARRR 0.50, CI 0.26, 0.97) were associated with underweight, and middle and older age (ARRR 1.79, CI 1.41, 2.25), being Lao-Tai (ARRR 1.37, CI 1.06, 1.76), urban residence (ARRR 1.62, CI 1.20, 2.17), having meals outside home (ARRR 1.36, CI 1.04, 1.77), no current tobacco use (ARRR 0.57, CI 0.34, 0.59), low physical activity (ARRR 1.39, CI 1.01, 1.92), having hypertension (ARRR 2.52, CI 1.94, 3.26), and dyslipidaemia (ARRR 1.56, CI 1.21, 2.00) were associated with overweight or obesity.

CONCLUSION

A dual burden of both adult underweight and overweight or obesity was found in Laos. Sociodemographic, lifestyle, and health status risk factors were identified for underweight and overweight or obesity, which can help in guiding public health programmes to address both these conditions.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Behaviors toward Noncommunicable Diseases Prevention and their Relationship with Physical Health Status among Community-dwelling, Middle-aged and Older women in Indonesia

We aim to clarify the behaviors toward noncommunicable diseases (NCDs) prevention focusing on lifestyle-related diseases and physical health status and examine their relationship among community-dwelling women in Indonesia. This cross-sectional study included women aged 45 years and older. Data were collected through an interview using a structured questionnaire; the following parameters were also measured: height, weight, body mass index (BMI), blood pressure (BP), handgrip strength, and 10 m gait speed. This study found that the majority of women adopted one or more healthy behaviors to prevent NCDs, while few women practiced comprehensive behaviors. Age, satisfaction with house income, living alone, social support, social participation, and household decision making were the determinant factors for behaviors toward NCDs prevention. A high prevalence of underweight (26.4%), overweight (31.9%), obesity (5.6%), high systolic blood pressure (SBP) (62.5%), and low muscle strength (54.2%) were frequently observed. Eating well-balanced meals, avoiding fatty foods, and undergoing blood cholesterol testing had significant correlations with physical health status. It is concluded that the activities at Posyandu Lansia (health village posts for older adults) are necessary to help women with unhealthy eating behaviors and lower physical activity and unawareness of health checkups to maintain focus and to develop a more practical approach to NCDs prevention.

Association between body mass index and ready-to-eat food consumption among sedentary staff in Nay Pyi Taw union territory, Myanmar

BACKGROUND

Ready-to-eat (RTE) food consumption has become popular in the working community with the increase in full-time jobs and the limited time to prepare food. Although RTE food is essential for this community, its consumption causes obesity. In Myanmar, obesity is a modifiable risk factor for non-communicable diseases, causing increases in morbidity and mortality. This study aimed to identify the association between body mass index (BMI) and RTE food consumption among sedentary staff in Nay Pyi Taw Union Territory, Myanmar.

METHODS

A cross-sectional study was conducted in 2018, in which 400 respondents participated in face-to-face interviews. The study area was selected using simple random sampling and drawing method. Measuring tape and digital weighing scale were used to measure the height and weight of the respondents. BMI was calculated by dividing the weight by height squared (kg/m2). Overweight and obesity were categorized by World Health Organization cut-off points. The collected data were analyzed using multiple logistic regression to estimate the adjusted odds ratio (AOR), and the 95% confidence interval (CI).

RESULTS

This study revealed that sedentary staff who consumed RTE food once or more per month were nearly five times more likely to be overweight and obese (AOR = 4.78, 95% CI 1.44-15.85) than those who consumed RTE food less frequently. In addition, five factors namely being older than 32 years (AOR = 3.97, 95% CI 1.82-8.69), preference for RTE food (AOR = 8.93, 95% CI 2.54-31.37), light-intensity of physical exercise (AOR = 3.55, 95% CI 1.63-7.73), sedentary leisure activities (AOR = 3.32, 95% CI 1.22-9.03), and smoking (AOR = 5.62, 95% CI 1.06-29.90) were positively associated with overweight and obesity.

CONCLUSION

Frequent consumers of RTE food and less physically active sedentary staff were more likely to be overweight and obese. This study highlights the urgent need to raise awareness regarding healthy lifestyle behaviors among the working community to reduce the burden of obesity-related chronic diseases. Moreover, sedentary workers should be aware of the food-based dietary guidelines of the country. Policy makers should strictly enforce nutritional labeling of RTE food, and strictly prohibit over-branding of RTE food.

Association between life-style behaviors and health outcomes in Adventist and non-Adventist adolescents in Mexico: a pilot study

Background

Identifying lifestyle-related health predictors affecting adolescent behaviors is a matter of interest and study for diverse audiences, including the religious sphere. The Adventist religion recommends their followers to adopt a healthy diet, adequate rest, physical activity, sufficient water intake, and non-use of addictive substances such as alcohol, tobacco, and drugs, as well as fostering faith and hope to give meaning to life.

Methods

A cross-sectional and observational study was conducted among adolescent students aged 13 to 19 years old in Montemorelos City, Nuevo León, Northern Mexico, between September 14, 2017 and February 13, 2018. This study included 363 Mexican adolescents, consisting of 202 Adventists and 161 non-Adventists. The binomial logistic regression analysis was performed to examine the relationships between religious affiliation and life-style behaviors and evaluate the effect of life-style behaviors on health outcomes by religious affiliation. Age, gender, type of residence, and place of birth were controlled.

Results

We found that Adventist adolescents were more likely to be watching TV for 2 h or less per day (p < 0.001), have enough sleeping time for 7 h or more (p < 0.001), go to bed early at 11 o’clock or before (p < 0.001), and have breakfast (p = 0.006) than non-Adventist adolescents significantly. It indicates that Adventist students are more likely to have healthier life-style behaviors than non-Adventist students. The multiple binomial regression models showed that in the group of Adventist adolescents sporting activity and hours watching TV were significantly associated with obesity risk (p = 0.001) and risky eating patterns (p = 0.044), respectively, controlling for age, gender, type of residence, and place of birth. No relationship was found between life-style behaviors and health outcomes in non-Adventist adolescents.

Conclusions

Religious affiliation could serve as a predictor of healthy behaviors among adolescents. This study concluded that Adventist adolescents are more likely to have a healthier lifestyle behavior than non-Adventist adolescents and various health-related behaviors were specifically identified among Adventist participants.

Epidemiology of Overweight and Obesity in Adults Living in Cameroon: A Systematic Review and Meta-Analysis

OBJECTIVE

This study aimed to summarize current data on overweight and obesity among adults living in Cameroon.

METHODS

PubMed, Embase, Web of Science, Global Index Medicus, African Journals Online, and local databases were searched for population-based cross-sectional studies conducted in the general population from January 2000 to December 2017. A random-effects model was used to pool data.

RESULTS

Overall, 26 studies (55,155 participants) were included. The prevalence of overweight was 26.0% (95% CI: 17.6%-35.3%) based on BMI. Furthermore, the overall prevalence of obesity was 15.1% (95% CI: 9.3%-22.1%) based on BMI, 16.4% (95% CI: 10.8%-22.8%) based on waist circumference ≥ 102 cm for males and ≥ 88 cm for females, 36.7% (95% CI: 26.8%-47.2%) based on waist circumference ≥ 94 cm for males and ≥ 80 cm for females, 32.6% (95% CI: 26.9%-38.7%) based on waist to hip ratio ≥ 0.90 for males and ≥ 0.85 for females, and 31.9% (95% CI: 27.8%-36.2%) based on percent body fat ≥ 25% for males and ≥ 35% for females. Overall, the burden was higher in females compared with males; there was no difference between urban and rural settings or between studies conducted in 2000 to 2009 and 2010 to 2016.

CONCLUSIONS

The burden of overweight and obesity is high among adults in Cameroon, putting many at increased risk for developing associated metabolic and cardiovascular complications.

Loneliness correlates and associations with health variables in the general population in Indonesia

Background

Loneliness has been commonly reported in high-income countries, while less is known about loneliness in Association of the Southeast Asian Nations (ASEAN) member states, in particular in Indonesia.

Objective

The aim of the study was to estimate the prevalence of loneliness, its correlates and associations with health variables in a national survey in the general population in Indonesia.

Methods

In the Indonesia Family Life Survey (IFLS-5) in 2014–2015, 31,447 participants 15 years and older (median age 35.0 years, interquartile range = 22.0) were interviewed and examined in a national population-based cross-sectional study. The self-reported prevalence of loneliness, blood pressure, body height and weight, physical and mental health, health behaviour and psychosocial variables were measured. Multinomial logistic regression analyses were used to estimate determinants of loneliness and logistic and linear regression analyses were applied to estimate the associations of loneliness with physical, mental and health risk behaviour variables.

Results

The self-reported prevalence of loneliness (occasionally or all of the time or 3–7 days per week) was 10.6% (11.0% for females and 10.1% for males), and 8.0% reported sometimes (1–2 days/week) to be lonely. Loneliness was distributed in a slight U-shaped form, with adolescents and the oldest old having the highest prevalence of loneliness. In adjusted multinomial logistic regression analysis, lower education, lower economic status, adverse childhood experiences, having one or more chronic conditions, functional disability and low neighbourhood trust were associated with loneliness. Loneliness was significantly associated with most health variables, including self-reported unhealthy health status (AOR 1.70, CI 1.57, 1.84), cognitive functioning (Beta: − 0.72, CI − 0.90 to − 0.54), having one or more chronic medical conditions (AOR 1.25, CI 1.16, 1.35), having had a stroke (AOR 1.58, CI 1.08, 2.29), depression symptoms (Beta: 5.19, CI 4.98–5.39), sleep disturbance (Beta: 0.34, CI 0.31–0.37), sleep related impairment (Beta: 0.69, CI 0.64–0.73), low life satisfaction (AOR 1.78, CI 1.64, 1.93), out-patient health care utilization in the past 4 weeks (AOR 1.11, CI 1.01, 1.21), current tobacco use (AOR 1.42, CI 1.28, 1.58), and one or more days in the past week soft drink consumption (AOR 1.20, CI 1.10, 1.31).

Conclusion

Loneliness was found to be prevalent across the life span and was associated with a number of poorer health variables. Several factors associated with loneliness were identified, which warrant further research in Indonesia.

Prevalence and correlates of underweight and overweight/obesity among women in India: results from the National Family Health Survey 2015-2016

Objective: The study aimed to assess the prevalence and correlates of underweight and overweight or obesity among women in India. Subjects and methods: In a population-based cross-sectional 2015-2016 National Family Health Survey, ever married non-pregnant women (18-49 years) were interviewed and assessed with anthropometric, blood pressure and biochemical measures. Results: The total sample included 5,82,320 non-pregnant women 18-49 years, median age 31 years, interquartile range =16 years, from India. Overall, 20.1% of the women were underweight [body mass index (BMI) <18.5 kg/m²] and 36.3% were overweight, or had class I or class II obesity (BMI ≥23.0 kg/m²). In adjusted multinomial logistic regression, younger age, lower education, lower wealth status, not eating daily fruits, vegetables, fried food, belonging to the scheduled tribe and tobacco use were associated with underweight, while older age, higher education, higher wealth, belonging to other backward class or other, urban residence, daily fruit consumption, daily fried food consumption, having hypertension, heart disease and high or very high blood glucose levels were associated with overweight or obesity. Belonging to the scheduled caste and tobacco use were negatively associated with overweight or obesity. Conclusions: A high dual burden of both underweight and overweight or obesity was observed among women in India. Sociodemographic and health variables were identified as risk factors for both underweight and overweight or obesity, which can be utilized in informing intervention strategies.