24-hour movement guidelines and weight status among preschool-aged children in Bangladesh: A community-level cross-sectional study

BACKGROUND

Increasing levels of urbanization and digitization in Bangladesh may be adversely associated with children's weight status and related movement behaviors. This study examined the prevalence of obesity, physical activity (PA), sedentary behavior, and sleep among young children from a district town in northern Bangladesh and identified factors associated with unhealthy weight status.

METHODS

Population-based cross-sectional study involving all kindergarten schools in Jamalpur District town. Schools and children aged 4-7 years were randomly selected and had their weight and height measured. Mothers completed a questionnaire on their child's PA, recreational screen time, and sleep and sociodemographic factors. Children's weight status was based on World Health Organization (WHO) categories. Meeting the PA recommendation was based on the WHO guidelines for children and adolescents, and meeting the sedentary behavior and sleep recommendations was based on the Canadian/Australian 24-hour movement guidelines for children and young people.

RESULTS

A total of 585 children and their parents were included in the study. Overall, 15% of children were overweight or obese. Three-quarters of children met the sleep guideline, and 50% met the PA guideline. Less than one third of children (31%) met the recreational screen time guideline, whereas 15% met all three guidelines. However, when adjusted for all predictors in the model, maternal education, family income, and child's age were significantly associated with overweight/obesity. Children with higher maternal education level were 2.3 times (AOR = 2.33, 95% CI: 1.19-4.78) more likely to be overweight/obese. Children in families with a higher monthly income had 1.9 times (AOR = 1.95, 95% CI: 1.14, 3.35) higher risk of being overweight/obese.

CONCLUSIONS

Prioritizing maternal education (mother-centric interventions) can help address the high levels of childhood obesity in Bangladesh.

Determinants of Double Burden of Malnutrition Among School Children and Adolescents in Urban Dhaka: A Multi-Level Analyses

Background

Bangladesh faces a double burden of malnutrition, with a rising prevalence of overweight and obesity among children and adolescents parallel to existing undernutrition.

Objective

The current study was designed to assess the determinants of double burden of malnutrition among urban school children and adolescents from Dhaka, Bangladesh.

Methods

A cross-sectional survey was conducted among 2,690 students from 14 schools in Dhaka city from January to June 2018. Anthropometric measurements were taken during school hours, and self-administered questionnaires were sent to the parents. We performed multi-level multiple logistic regression analyses to assess the determinants of underweight, overweight, and obesity.

Findings

The prevalence of overweight (33%) and obesity (23%) was highest among children and adolescents from high tuition schools but the prevalence of underweight (4%) was lowest compared to those from low (underweight 19%, overweight 17%, and obesity 6%) and medium (underweight 18%, overweight 15%, and obesity 6%) tuition schools. Children and adolescents from high-tuition schools had higher odds of being overweight/ obese (AOR: 2.92; 95% CI: 1.90, 4.49). Parental NCDs and overweight were negatively associated with underweight but positively associated with overweight and obesity among children and adolescents. Lack of physical activity inside schools was positively associated (AOR: 1.26; 95% CI: 1.02, 1.55) with overweight and obesity among school children and adolescents.

Conclusion

Our results point to opportunities in and outside schools to address the rising prevalence of underweight, overweight, and obesity among urban school children and adolescents.

The New Urban Profession: Entering the Age of Uncertainty

The context of urbanism is changing rapidly. The context for working in the field of urban design and planning is influenced by the pace of change; uncertainty; and massive transitions. The urban professional, however, is still used to planning for small changes and repeating traditional approaches. In this paper, we have investigated major future tasks and problems that require rethinking the skills required from people working in the urban arena. By conducting in-depth conversation with leading thinkers in the field, the tension between idealism and the urgency to act versus realism and the trust in current systems dominated by economic laws is present. This results in the conclusion that a different skillset is required in order to face future complexities and to be able to connect design creativity with process sensitivity in short- and long-term periods and at small and large scales.

Diabetes mellitus and high blood pressure in relation to BMI among adult non-pregnant women in Bangladesh

PURPOSE

To investigate the association between overweight and obesity (in terms of BMI) and diabetes, HBP and diabetes-HBP comorbidity among adult women non-pregnant in Bangladesh.

METHODS

Information about demographics, socioeconomic, blood pressure and blood glucose levels were collected for 2022 women ageing above 35 years were collected from Bangladesh Demographic and Health Survey (BDHS 2011). The primary outcome variables were diabetes and high blood pressure. Diabetes was defined as fasting plasma glucose value ≥7.0mmol/L and HBP as systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg. Blood pressure and plasma glucose measurement were performed by standard clinical procedures. Data were analysed using cross-tabulation, chi-square tests and logistic regression methods.

RESULTS

Mean age of the participants was 41.42 (SD=4.37). 38.7% of the women had BMI values ≥25. The prevalence of HBP, diabetes, and diabetes-HBP comorbidity was respectively 18% and 5.1%, and 2%. The adjusted odds of having diabetes, HBP and Diabetes-HBP comorbidity were respectively 2.14 (p=0.002; 95%CI=1.31-3.48), 2.3 (p=<0.0001; 95%CI=1.70-2.98), and 3.4 (p=0.004; 95%CI=1.47-7.81) times higher among overweight/obese women compared to those with normal weight.

CONCLUSIONS

Overweight and obesity account for a major proportion of diabetes, HBP and the comorbidity of these two among non-pregnant women. There remains a considerable risk for future expansion of diabetes and HBP as the prevalence of overweight/obesity is rising constantly. Maintaining a healthy BMI needs to be regarded as among the most important diabetes and HBP preventive strategies among Bangladeshi women.

Overweight and obesity among children and adolescents in Bangladesh: a systematic review and meta-analysis

OBJECTIVES

The increasing prevalence of overweight and obesity among children (0-12 years) and adolescents (13-19 years) has emerged as a major public health threat in Bangladesh. Unfortunately, there is a serious paucity of credible data on these issues that can be used for policy and programmatic development. This article presents a systematic review of studies on overweight and obesity to present a more accurate estimate by pooling results.

STUDY DESIGN

Systematic review.

METHODS

The study systematically reviewed relevant literature published between 1998 and 2015 using predefined inclusion/exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to identify relevant studies. Measures of heterogeneity and variability were calculated, and a random effect model was used to report pooled prevalence rates of overweight and obesity.

RESULTS

The findings show that prevalence rates of overweight and obesity among children and adolescents varied widely from 1.0% to 20.6% and 0.3% to 25.6%, respectively. The pooled prevalence rates of overweight and obesity were 7.0% (95% confidence interval [CI] 5.0-10.0) and 6.0% (95% CI 4.0-8.0), respectively. The pooled prevalence rate of overweight increased substantially over the years, from 3.6% during 1998-2003 (95% CI 0.3-29.2) to 5.7% during 2004-2009 (95% CI 0.8-30.2) and 7.9% by 2010-2015 (95% CI 5.1-12.1). However, the pooled prevalence rate of obesity registered a sharp decline between 1998-2003 and 2004-2009 - from 9.7% (95% CI 5.7-16.2) to 2.0% (95% CI 0.3-11.1) - and subsequently increased significantly to 9.0% by 2010-2015 (95% CI 5.3-14.6).

CONCLUSIONS

This review identified increasing trends in the prevalence of overweight and obesity among children and adolescents in Bangladesh. This study underscores the urgent need to promote healthy lifestyles among children and adolescents with a view to effectively address the increasing problem of overweight and obesity. This would also help to prevent the development of chronic non-communicable diseases in adulthood.

Overweight and abdominal obesity as determinants of undiagnosed diabetes and pre-diabetes in Bangladesh

BACKGROUND

Type 2 diabetes and pre-diabetes are an increasing pandemic globally and often remain undiagnosed long after onset in low-income settings. The objective of this study is to assess the determinants and prevalence of undiagnosed diabetes and pre-diabetes among adults in Bangladesh.

METHODS

In an exploratory study, we performed oral glucose tolerance test on 1243 adults ≥20 years of age from urban Mirpur, Dhaka (n = 518) and rural Matlab, Chandpur (n = 725) who had never been diagnosed with diabetes or pre-diabetes. We collected data on socioeconomic, demographic, past medical history, physical activity, and measured weight, height, waist and hip circumferences, and blood pressure. Risk factors associated with undiagnosed diabetes and pre-diabetes were examined using a multiple logistic regression model.

RESULTS

Overall prevalence of diabetes and pre-diabetes was 6.6 % (95 % CI 5.3, 8.1) and 16.6 % (14.5, 18.7) respectively, with both being significantly higher in urban than rural populations (diabetes 12.2 % vs 2.6 % respectively, p < 0.000; pre-diabetes 21.2 % vs 13.2 %, p < 0.001). After adjustment the variables, urban residence (OR 2.5 [95 % CI 1.02, 5.9]), age group 40-59 y (2.9 [1.7-5.2]), ≥60 y (8.1 [2.8-23.8]), overweight (2.2 [1.3-3.9]), abdominal obesity (3.3 [1.8-6.0]) and high WHR 5.6 (2.7-11.9) were all significant predictors of diabetes. Significant predictors of pre-diabetes included age group 40-59 (1.6 [1.1-2.2]), female sex (1.5 [1.0-2.2]), abdominal obesity (1.7 [1.2-2.4]) and high WHR (1.6 [1.2-2.3]).

CONCLUSION

Both overweight and abdominal obesity contribute to the hidden public health threat of undiagnosed diabetes and pre-diabetes. Awareness raising and screening of high risk groups combined with a tailored approach are essential for halting the epidemic of diabetes and pre-diabetes in Bangladesh.

Prevalence of obesity in a rural Asian Indian (Bangladeshi) population and its determinants

Background

Obesity has reached epidemic proportions worldwide including Bangladesh. To assess the prevalence and associated factors of general and central obesity in a rural Bangladeshi population based on newly proposed cut off level for Asian population.

Methods

2293 subjects aged ≥20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey, conducted in 2009. Both socio-demographic and anthropometric measurements were recorded. Age adjusted data for anthropometric indices were examined.

Results

The age standardized prevalence of overweight (BMI 23-24.9 kg/m²) and obesity (BMI ≥25 kg/m²) were 17.7 (95 % confidence interval (CI): 16.1, 19.2 %) and 26.2 % (95 % CI: 24.4, 27.9 %), respectively. The age standardized prevalence of central obesity based on WC (M ≥90 & F ≥80 cm) and WHR (M ≥0.90 & F ≥0.80) were 39.8 % (95 % CI: 37.9, 41.7 %) and 71.6 % (95 % CI: 69.8, 73.4 %) respectively. The result shows that prevalence of central obesity was more in female than male. Study shows middle age, medium and high socioeconomic status (SES), low education levels, physical inactivity, high consumption of carbohydrate, protein and fat, were significant risk indicators for general and central obesity. Smoking was shown as protective factor for both general and central obesity.

Conclusions

In rural Bangladeshi population, the prevalence of both general and central obesity was high among both sexes with the use of newly proposed cut off points for Asian population. Gender, diet, physical activity, education levels and SES were associated with the increase prevalence of obesity.

Obesity and overweight in Bangladeshi children and adolescents: a scoping review

BACKGROUND

Obesity and overweight in children and adolescents is an emerging public health concern alongside under-nutrition in low and middle income countries. Our aim was to conduct a scoping review of literature to ascertain what is known about childhood and adolescent overweight and/or obesity in Bangladesh.

METHOD

Using the scoping review based on York methodology, a comprehensive search of published academic articles, conference proceedings and grey literature was carried out through PubMed, BanglaJOL, Google and Google scholar limited to English-written papers. We summarized prevalence, risk factors and health outcomes of obesity/overweight in young children and adolescents aged between 0 to 19 years old in Bangladesh and highlighted use of different reference standards to measure childhood obesity.

RESULTS

In total 21 studies met the inclusion criteria. Nearly all of the reviewed articles used data from cross sectional studies, while only two used case-control design. Overall thirteen studies (62%) were primary research and eight (38%) included secondary data. Studies indicated an increasing trend in childhood obesity over time. Prevalence ranged from less than 1% to 17.9% based on different reference standards, with higher percentage amongst urban children across different age groups and sexes.

CONCLUSION

This review demonstrated paucity of comprehensive literature on childhood obesity in Bangladesh, which might be explored through population-based prospective studies based on strong methodology and uniform reference standards. Sustainable and scalable preventative measures targeting high risk groups are required to avoid further rise.