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Lyu W, Yu L, Lv H. Gender wage gap and child malnutrition in Ethiopia: A probit instrumental variable method. Heliyon 2024; 10:e37000. [PMID: 39286201 PMCID: PMC11403523 DOI: 10.1016/j.heliyon.2024.e37000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/19/2024] Open
Abstract
Objective: Child malnutrition is a widespread concern in Sub-Saharan Africa. Previous studies mainly focus on the association between women's employment status and child malnutrition, however, the aim of this study is to examine the causal effect of household gender wage gap on child malnutrition in Ethiopia. Methods: This study relies on a data set consisting of 2066 children under 5 years of age using 2018/19 Living Standards Measurement Study data for Ethiopia. A probit instrumental variable (IV) method is applied to determine the causal effect. Results: Persistent gender wage gap of approximately 35% has been observed across various sectors in Ethiopia. Estimated results show that the decrease in household gender wage gap significantly enhances child growth outcomes, especially for younger girls and children in households with limited access to market. Specifically, one percentage point increase in gender wage gap is associated with a 0.74% ( p < 0.05 ) increase in the probability of stunting and a 0.42% ( p < 0.05 ) increase in the likelihood of wasting. Three mechanisms have been identified as contributing factors: more allocation of health resources to children, improved dietary diversity in the household, and increased household income. Conclusions: Policy interventions aiming at improving the children nutrition status in Ethiopia are expected to narrow down gender wage inequality accordingly. Further research is needed to explore the association using reliable and large-scale data source in other countries.
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Gulyas BZ, Mogeni B, Jackson P, Walton J, Caton SJ. Biofortification as a food-based strategy to improve nutrition in high-income countries: a scoping review. Crit Rev Food Sci Nutr 2024:1-22. [PMID: 39269149 DOI: 10.1080/10408398.2024.2402998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Biofortification (increasing the micronutrient content of food before harvest) has been successfully used to nutritionally improve staple foods in low- and middle-income countries. This approach could also help address micronutrient shortfalls in at-risk populations in high-income countries (HICs), however, the potential of biofortification interventions in this context is not well understood. The aim of this scoping review is to assess the nature and extent of available research evidence on biofortified foods in relation to human consumption in HICs. Literature searches were conducted in MEDLINE, WoS, ProQuest, CINAHL, AGRIS and Epistemonikos. Forty-six peer-reviewed articles were included. Most research was conducted in the USA (n = 15) and Italy (n = 11), on cereal crops (n = 14) and vegetables (n = 11), and on selenium (n = 12) and provitamin A (n = 11). Seven research domains were identified in the literature: bioavailability (n = 17); nutrient stability (n = 11); opinions and attitudes (n = 9); functionality (n = 9); sensory properties (n = 2); safety (n = 1); and modeling (n = 1). Evidence from HICs in each domain is limited. There is a need for more research particularly in areas sensitive to the cultural and socio-economic context.
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Affiliation(s)
- Boglarka Z Gulyas
- Sheffield Centre for Health And Related Research, Division of Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Brenda Mogeni
- Sheffield Centre for Health And Related Research, Division of Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Peter Jackson
- Institute for Sustainable Food, University of Sheffield, Sheffield, UK
| | - Jenny Walton
- Commercialization and Scaling, HarvestPlus, International Food Policy Research Institute, Washington, DC, USA
| | - Samantha J Caton
- Sheffield Centre for Health And Related Research, Division of Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Xu Z, Amakye WK, Ren Z, Xu Y, Liu W, Gong C, Wong C, Gao L, Zhao Z, Wang M, Yan T, Ye Z, Zhong J, Hou C, Zhao M, Qiu C, Tan J, Xu X, Liu G, Yao M, Ren J. Soy Peptide Supplementation Mitigates Undernutrition through Reprogramming Hepatic Metabolism in a Novel Undernourished Non-Human Primate Model. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2306890. [PMID: 38816931 PMCID: PMC11304262 DOI: 10.1002/advs.202306890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/23/2024] [Indexed: 06/01/2024]
Abstract
In spite of recent advances in the field of undernutrition, current dietary therapy relying on the supply of high protein high calorie formulas is still plagued with transient recovery of impaired organs resulting in significant relapse of cases. This is partly attributed to the inadequacy of current research models in recapitulating clinical undernutrition for mechanistic exploration. Using 1636 Macaca fascicularis monkeys, a human-relevant criterion for determining undernutrition weight-for-age z-score (WAZ), with a cutoff point of ≤ -1.83 is established as the benchmark for identifying undernourished nonhuman primates (U-NHPs). In U-NHPs, pathological anomalies in multi-organs are revealed. In particular, severe dysregulation of hepatic lipid metabolism characterized by impaired fatty acid oxidation due to mitochondria dysfunction, but unlikely peroxisome disorder, is identified as the anchor metabolic aberration in U-NHPs. Mitochondria dysfunction is typified by reduced mito-number, accumulated long-chain fatty acids, and disruption of OXPHOS complexes. Soy peptide-treated U-NHPs increase in WAZ scores, in addition to attenuated mitochondria dysfunction and restored OXPHOS complex levels. Herein, innovative criteria for identifying U-NHPs are developed, and unknown molecular mechanisms of undernutrition are revealed hitherto, and it is further proved that soypeptide supplementation reprogramed mitochondrial function to re-establish lipid metabolism balance and mitigated undernutrition.
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Affiliation(s)
- Zhenzhen Xu
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - William Kwame Amakye
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Zhengyu Ren
- The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory DiseaseGuangzhou510182China
- State Key Laboratory of Quality Research in Chinese MedicineInstitute of Chinese Medical Sciences (ICMS)University of MacauMacau999078China
| | - Yongzhao Xu
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Wei Liu
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
- Huazhen Laboratory Animal Breeding CenterGuangzhou510900China
| | - Congcong Gong
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Chiwai Wong
- Huazhen Laboratory Animal Breeding CenterGuangzhou510900China
| | - Li Gao
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Zikuan Zhao
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Min Wang
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Tao Yan
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Zhiming Ye
- The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory DiseaseGuangzhou510182China
| | - Jun Zhong
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Chuanli Hou
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Miao Zhao
- Center for Medical Genetics and Hunan Key Laboratory of Medical GeneticsSchool of Life ScienceCentral South UniversityChangsha410013P. R. China
| | - Can Qiu
- Center for Medical Genetics and Hunan Key Laboratory of Medical GeneticsSchool of Life ScienceCentral South UniversityChangsha410013P. R. China
| | - Jieqiong Tan
- Center for Medical Genetics and Hunan Key Laboratory of Medical GeneticsSchool of Life ScienceCentral South UniversityChangsha410013P. R. China
| | - Xin Xu
- College of Food Science and EngineeringYangzhou UniversityYangzhou225127China
| | - Guoyan Liu
- College of Food Science and EngineeringYangzhou UniversityYangzhou225127China
| | - Maojin Yao
- The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory DiseaseGuangzhou510182China
| | - Jiaoyan Ren
- School of Food Science and EngineeringSouth China University of TechnologyGuangzhou510640China
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Ijaiya MA, Anjorin S, Uthman OA. Quantifying the increased risk of illness in malnourished children: a global meta-analysis and propensity score matching approach. Glob Health Res Policy 2024; 9:29. [PMID: 39085934 PMCID: PMC11290152 DOI: 10.1186/s41256-024-00371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Childhood morbidity and mortality continue to be major public health challenges. Malnutrition increases the risk of morbidity and mortality from illnesses such as acute respiratory infections, diarrhoea, fever, and perinatal conditions in children. This study explored and estimated the magnitude of the associations between childhood malnutrition forms and child morbidity. METHODS We performed an individual participant data (IPD) meta-analysis and employed propensity score matching to examine crude (unadjusted) and adjusted associations. Our analysis utilized demographic and health datasets from surveys conducted between 2015 and 2020 in 27 low- and middle-income countries. Our objective was to quantify the risk of morbidity in malnourished children and estimate the population-attributable fraction (PAF) using a natural experimental design with a propensity score-matched cohort. RESULTS The IPD meta-analysis of child morbidity across three childhood malnutrition forms presented nuanced results. Children with double-burden malnutrition had a 5% greater risk of morbidity, which was not statistically significant. In contrast, wasted children had a 28% greater risk of morbidity. Overweight children exhibited a 29% lower risk of morbidity. Using the matched sample, children with double-burden malnutrition and overweight children had lower morbidity risks (1.7%, RR: 0.983 (95% CI, 0.95 to 1.02) and 20%, RR: 0.80 (95% CI, 0.76 to 0.85), respectively), while wasting was associated with a 1.1 times (RR: 1.094 (95% CI, 1.05 to 1.14)) greater risk of morbidity. Eliminating double-burden malnutrition and wasting in the four and seven countries with significant positive risk differences could reduce the child morbidity burden by an estimated average of 2.8% and 3.7%, respectively. CONCLUSIONS Our study revealed a correlation between specific childhood malnutrition subtypes-double-burden malnutrition and wasting-and increased risks of morbidity. Conversely, overweight children exhibited a lower risk of immediate morbidity, yet they may face potential long-term health challenges, indicating the necessity for nuanced approaches to childhood nutrition.
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Affiliation(s)
- Mukhtar A Ijaiya
- Jhpiego, Plot 971, Rueben Okoya Crescent, Off Okonjo Iweala Street, Wuye District, Abuja, FCT, Nigeria.
| | - Seun Anjorin
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Olalekan A Uthman
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Viana RS, Nascimento-Ferreira MV, Schaan BD, Bloch KV, de Carvalho KMB, Cureau FV, De Moraes ACF. Prevalence of the Double Burden of Malnutrition among Adolescents: Associations with Lifestyle Behaviors and Clusters of Social Determinants. CHILDREN (BASEL, SWITZERLAND) 2024; 11:620. [PMID: 38929200 PMCID: PMC11201642 DOI: 10.3390/children11060620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
The double burden of malnutrition (DBM) is a condition in which malnutrition coexists with overweight, reflecting a new layer of malnutrition. Our objectives were to assess prevalence; test associations between DBM and 24-hour movement behaviors; and investigate whether DBM is associated with clusters of social determinants. Methods: This multicenter cross-sectional study included 1152 adolescents (12 to 17 years old) from four Brazilian cities. Body mass index (BMI, kg/m2) was used to estimate overweight, and the adopted cutoff points took into account the curves established for age and sex: Z-score > 1 and ≤2 (overweight) and Z-score > 2 (obesity). The serum concentration of 25-hydroxyvitamin D [25(OH)D] was stratified into three levels: vitamin D deficiency ≤ 20 ng/mL; vitamin D insufficiency = 21-29 ng/mL; optimal vitamin D ≥ 30 ng/mL. We used multilevel Poisson regression models to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95%CI) and to analyze the association between DBM and covariates. A significance level of p < 0.05 was considered. Cluster analyses were performed by applying a combination of hierarchical and non-hierarchical methods. Results: A population prevalence of DBM of 7.3% (95% CI: 5.9-8.9) was revealed. A percentage of 19.2% (95% CI: 17.0-21.6) of adolescents were overweight, and 8.3% (95% CI: 6.8-10.1) were obese. A total of 41.5% (95% CI: 38.7-44.4) had vitamin D deficiency, and 25.8% (95% CI: 23.4-28.4) had vitamin D insufficiency. However, 24-hour movement behaviors were not associated with DBM. Adolescents living in the southern region of the country, from public schools whose mothers have higher education, have a 1.94 [PR = 2.94 (95% CI: 1.20-7.23)] times greater chance of developing DBM. These results highlight the importance of specific factors to improve the nutritional health of adolescents, considering the specific social determinants identified in this study.
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Affiliation(s)
- Raytta Silva Viana
- Postgraduate Program in Public Health, Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil;
- YCARE Research Group (Youth/Child Cardiovascular Risk Environmental Research Group), Faculdade de Medicina, University of São Paulo, São Paulo 01246-903, Brazil
| | - Marcus Vinicius Nascimento-Ferreira
- YCARE Research Group (Youth/Child Cardiovascular Risk Environmental Research Group), Faculdade de Medicina, University of São Paulo, São Paulo 01246-903, Brazil
- Research Group on Health, Physical Activity and Behavior (HEALTHY-BRA), Federal University of Tocantins, Miracema do Tocantins 77650-000, Brazil
| | - Beatriz D. Schaan
- Faculty of Medicine, Postgraduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
- Faculty of Medicine, Postgraduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035003, Brazil
| | - Katia Vergetti Bloch
- Institute of Studies in Public Health, Federal University of Rio de Janeiro, Rio de Janeiro 21941-592, Brazil
| | | | - Felipe Vogt Cureau
- Faculty of Medicine, Postgraduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
| | - Augusto César Ferreira De Moraes
- The University of Texas Health Science Center at Houston, School of Public Health in Austin, Department of Epidemiology, Michael & Susan Dell Center for Healthy Living, Texas Physical Activity Research Collaborative (Texas PARC) 1836 San Jacinto Blvd., Ste. 510, Austin, TX 78701, USA
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Chen S, Shimpuku Y, Honda T, Mwakawanga DL, Mwilike B. Dietary diversity moderates household economic inequalities in the double burden of malnutrition in Tanzania. Public Health Nutr 2024; 27:e141. [PMID: 38751248 PMCID: PMC11374552 DOI: 10.1017/s136898002400106x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Improved food availability and a growing economy in Tanzania may insufficiently decrease pre-existing nutritional deficiencies and simultaneously increase overweight within the same individual, household or population, causing a double burden of malnutrition (DBM). We investigated economic inequalities in DBM at the household level, expressed as a stunted child with a mother with overweight/obesity, and the moderating role of dietary diversity in these inequalities. DESIGN We used cross-sectional data from the 2015-2016 Tanzania Demographic and Health Survey. SETTING A nationally representative survey. PARTICIPANTS Totally, 2867 children (aged 6-23 months) and their mothers (aged 15-49 years). The mother-child pairs were categorised into two groups based on dietary diversity score: achieving and not achieving minimum dietary diversity. RESULTS The prevalence of DBM was 5·6 % (sd = 0·6) and significantly varied by region (ranging from 0·6 % to 12·2 %). Significant interaction was observed between dietary diversity and household wealth index (Pfor interaction < 0·001). The prevalence of DBM monotonically increased with greater household wealth among mother-child pairs who did not achieve minimum dietary diversity (Pfor trend < 0·001; however, this association was attenuated in those who achieved minimum dietary diversity (Pfor trend = 0·16), particularly for the richest households (P = 0·44). Analysing household wealth index score as a continuous variable yielded similar results (OR (95 % CI): 2·10 (1·36, 3·25) for non-achievers of minimum dietary diversity, 1·38 (0·76, 2·54) for achievers). CONCLUSIONS Greater household wealth was associated with higher odds of DBM in Tanzania; however, the negative impact of household economic status on DBM was mitigated by minimum dietary diversity.
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Affiliation(s)
- Sanmei Chen
- Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima734-8553, Japan
| | - Yoko Shimpuku
- Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima734-8553, Japan
| | - Takanori Honda
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dorkasi L Mwakawanga
- Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima734-8553, Japan
| | - Beatrice Mwilike
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Sagastume D, Barrenechea-Pulache A, Ruiz-Alejos A, Polman K, Beňová L, Ramírez-Zea M, Peñalvo JL. Quantifying Overlapping Forms of Malnutrition Across Latin America: A Systematic Literature Review and Meta-Analysis of Prevalence Estimates. Adv Nutr 2024; 15:100212. [PMID: 38493876 PMCID: PMC11015105 DOI: 10.1016/j.advnut.2024.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Estimating the prevalence of double burden of malnutrition (DBM) is challenging in the Latin American and Caribbean (LAC) region where various DBM typologies (e.g., obesity and stunting) are heterogeneous and estimates are scattered across literature This study aimed to assess the prevalence of DBM typologies in the LAC region. We searched PubMed, Embase, Scopus, and Web of Science to identify studies on the prevalence of DBM published between 1 January, 2000, and 23 January, 2023. Outcomes were the prevalence of the identified DBM typologies at the household, individual, or across life course levels. Random-effect meta-analyses of proportions were used to estimate pooled period prevalence for all outcomes. Heterogeneity was explored using meta-regressions. From 754 records identified, 60 (8%) studies were eligible, with a median of 4379 individuals. Studies reported data from 27 LAC countries collected between 1988 and 2017. Most studies used nationally representative surveys (68%) and scored as low risk of bias (70%). We identified 17 DBM typologies for which 360 estimates were analyzed. The prevalence of the identified DBM typologies ranged between 0% and 24%, with the DBM typology of "adult with overweight and child with anemia" having the highest prevalence (24.3%; 95% CI: 18.8%, 30.2%). The most frequently reported DBM typology was "adult with overweight and child with stunting," with a prevalence of 8.5% (95% CI: 7.7, 9.3). All prevalences carried large heterogeneity (I2>90%), modestly explained by subregions and countries. DBM across the life course could not be estimated owing to insufficient estimates. In conclusion, using available data, our study suggests that the burden of DBM in the LAC region ranges between 0% and 24%. In the most frequent DBM typologies, overweight was a common contributor. Substantial progress can be made in curbing the burden of DBM in the LAC region through strategies addressing excess weight within these population groups. This study was registered at PROSPERO as CRD42023406755.
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Affiliation(s)
- Diana Sagastume
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Global Health Institute, University of Antwerp, Wilrijk, Belgium.
| | | | | | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Department of Health Sciences, Vrije Universiteit (VU) Amsterdam, Netherlands
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - José L Peñalvo
- Global Health Institute, University of Antwerp, Wilrijk, Belgium; National Center for Epidemiology, Carlos III Institute of Health (ISCIII), Madrid, Spain
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Amoadu M, Abraham SA, Adams AK, Akoto-Buabeng W, Obeng P, Hagan JE. Risk Factors of Malnutrition among In-School Children and Adolescents in Developing Countries: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:476. [PMID: 38671693 PMCID: PMC11049343 DOI: 10.3390/children11040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Malnutrition among in-school children is a complex issue influenced by socio-economic, environmental, and health-related factors, posing significant challenges to their well-being and educational trajectories in developing countries. This review synthesized evidence on the multifaceted aspects of child malnutrition within the educational setting in developing countries. This review followed the six steps outlined by Arksey and O'Malley's framework. Four main databases (PubMed, CENTRAL, JSTOR, and Scopus) were searched. Additional searches were conducted in WHO Library, ProQuest, HINARI, Google Scholar, and Google. Reference lists of eligible papers were checked. This review found that low family income, varying family sizes, parental employment status, and educational levels significantly impact malnutrition among in-school children and adolescents. Environmental elements, including rural/urban residence, household sanitation, and living conditions, also influence malnutrition. In addition, nutrition knowledge, dietary habits, nutrient deficiencies, physical activity, and prevalent health conditions compound the risk of malnutrition. This study underscores the extensive health impact of malnutrition on general health, specific nutrient deficiencies, fetal/maternal health concerns, and overall morbidity. Also, malnutrition affects school performance and attendance, impacting cognitive abilities, and academic achievements. Addressing these challenges requires comprehensive policy actions aligned with Sustainable Development Goals, emphasizing poverty alleviation, health literacy, and gender equity.
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Affiliation(s)
- Mustapha Amoadu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
| | - Susanna Aba Abraham
- Department of Public Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast PMB TF0494, Ghana;
| | - Abdul Karim Adams
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
| | - William Akoto-Buabeng
- Department of Education and Psychology, University of Cape Coast, Cape Coast PMB TF0494, Ghana;
| | - Paul Obeng
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
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Birhanu F, Yitbarek K, Bobo FT, Atlantis E, Woldie M. Undernutrition in children under five associated with wealth-related inequality in 24 low- and middle-income countries from 2017 to 2022. Sci Rep 2024; 14:3326. [PMID: 38336795 PMCID: PMC10858243 DOI: 10.1038/s41598-024-53280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Undernourishment is a persistent public health problem contributing to increased mortality in children under five in low-income countries, likely exacerbated by socio-economic disparities within communities. This paper aimed to examine the effect of wealth-related inequality on undernutrition in children under five in low, lower-middle, and upper-middle-income countries (LMICs). We analyzed cross-sectional data from the demographic and health survey program collected between 2017 and 2022 from 24 LMICs. Children born within 5 years preceding the survey were included in the analysis. Child undernutrition was the dependent variable (measured by stunting, wasting, and underweight) and country-level wealth-based inequality was the independent variable assessed by concentration index values stratified by the World Bank's income categories. Within country inequality of child undernutrition was determined by concentration index (C) values with 95% confidence intervals (95% CI) and sub-group analysis by place of residence and sex of the child. We then fit bootstrapped meta-regression to check the variation in inequality of child undernutrition across different income category countries. The analysis was controlled by potential confounding variables. From the total sample size of 334,502 children included in the study, 35% were undernourished. Wealth-related inequality in child undernutrition was observed in 11 countries, consistently across income categories. Child undernutrition was highly concentrated among the poor households of Türkiye [C: - 0.26, 95% CI - 0.31 to - 0.20], and Cameroon [C: - 0.19, 95% CI - 0.22 to - 0.17], and relatively it was less concentrated among the poor in Liberia [C: - 0.07, 95% CI - 0.11 to - 0.04], and Gambia [C: - 0.07, 95% CI - 0.11 to - 0.04]. There is no difference in undernutrition associated with inequality between the three broad LMIC categories. The wealth-related inequality in child undernutrition within many of the included countries is still very significant. However, the economic category of countries made no difference in explaining wealth-related inequality in child undernutrition. Inter-sectoral collaboration to fight poverty and render special attention to the disadvantaged population segments would potentially help to address the observed inequity.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Amana, Ethiopia
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Institute of Health, Jimma University, Jimma, Ethiopia.
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Firew Tekle Bobo
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Evan Atlantis
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
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10
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Ma G, Meyer CL, Jackson-Morris A, Chang S, Narayan A, Zhang M, Wu D, Wang Y, Yang Z, Wang H, Zhao L, Nugent R. The return on investment for the prevention and treatment of childhood and adolescent overweight and obesity in China: a modelling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100977. [PMID: 38456086 PMCID: PMC10920044 DOI: 10.1016/j.lanwpc.2023.100977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/05/2023] [Accepted: 11/08/2023] [Indexed: 03/09/2024]
Abstract
Background The rapid increase in child and adolescent overweight and obesity (OAO) in China has a significant health and economic impact. This study undertook an investment case analysis to evaluate the health and economic impacts of child and adolescent OAO in China and the potential health and economic returns from implementing specific policies and interventions. Methods The analysis estimates the reduction in mortality and morbidity from implementing a set of evidence-based interventions across China between 2025 and 2092 using a deterministic Markov cohort model. Modelled interventions were identified by literature review and expert recommendation and include fiscal and regulatory policies, eHealth breastfeeding promotion, school-based interventions, and nutritional counselling by physicians. The study applies a societal costing perspective to model the economic impact on healthcare cost savings, wages, and productivity during adulthood. By projecting and comparing the costs between a status quo scenario and an intervention scenario, the study estimates the return on investment (ROI) for interventions separately and in combination. Findings Without intervention China will experience 3.3 billion disability-adjusted life years (DALYs) due its current levels of child and adolescent OAO and a lifetime economic impact of CNY 218 trillion (USD 31.6 trillion), or a lifetime CNY 2.5 million loss per affected child or adolescent (USD 350 thousand). National implementation of all five interventions would avert 179.4 million DALYs and result in CNY 13.1 trillion of benefits over the model cohort's lifetime. Implementing fiscal and regulatory policies had the strongest ROI, with benefits accruing at least 10 years after implementation. Scaling up China's current school-based interventions offers China significant health and economic gains, however, the ROI is lower than other modelled interventions. Interpretation Effective prevention and treatment of child and adolescent OAO is critical to China's health and economic development. Multiple interventions offer a comprehensive approach to address the various factors that increase risk of child and adolescent OAO. Nonetheless, fiscal and regulatory policies offer the strongest health and economic gains. Funding Funding was provided by UNICEF China.
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Affiliation(s)
- Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Christina L. Meyer
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | | | | | | | - Man Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Daphne Wu
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Youfa Wang
- International Obesity and Metabolic Disease Research Center, Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an, Shannxi, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
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11
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Levi J, Fairhead C, Hill A. Intersections between HIV and obesity in emerging economies. Curr Opin HIV AIDS 2024; 19:35-44. [PMID: 37922195 DOI: 10.1097/coh.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
PURPOSE OF REVIEW HIV epidemics are increasing in many emerging economy countries, whilst the very process of 'economic emergence' is obesogenic. Annual deaths related to obesity and overweight are now four times more than for HIV globally. We describe the intersections between HIV and obesity in emerging economies, and highlight potential mitigation options, including antiobesity medications (AOMs), which are safe and effective, but inaccessibly priced. RECENT FINDINGS We summarize what is known about weight-change in HIV and review strategies including public health policies and clinical interventions for emerging economy countries to fight obesity. We also illustrate the landscape from a selection of 'emerging economy' countries with available data from UNAIDS, World Bank and World Obesity Federation to visualize the developing challenges faced. AOM course prices are high in many countries, but could be manufactured and sold profitably for much less. We present lessons from the early HIV/AIDS movements on how to improve access and pricing for AOMs for people with HIV with obesity in emerging economy countries. SUMMARY We illustrate the complex intersectional issues that 'emerging economy countries' may experience, with a 'double burden' of increasing HIV and obesity epidemics, and explore potential mitigation options, focussing on AOM access and pricing.
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Affiliation(s)
- Jacob Levi
- Charité University Hospital, Berlin Institute of Tropical Medicine and International Health, Südring 2-3, Berlin, Germany
| | - Cassandra Fairhead
- Charité University Hospital, Berlin Institute of Tropical Medicine and International Health, Südring 2-3, Berlin, Germany
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, Liverpool University, Liverpool, UK
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12
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Norov B, Cristobal-Maramag C, Van Minh H, Long KQ, Huse O, Nkoroi A, Luvsanjamba M, Phuong DH, Kupka R, Lobstein T, Jewell J, Castro MC, Oliver N, Watson F. Prevention of childhood overweight and obesity in Mongolia, the Philippines and Vietnam: identifying priority actions. Health Promot Int 2023; 38:daad187. [PMID: 38156876 PMCID: PMC10756053 DOI: 10.1093/heapro/daad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Low- and middle-income countries are increasingly faced with a triple burden of malnutrition: endemic underweight, micronutrient deficiencies and rising prevalence of overweight. This study aimed to address existing knowledge gaps and to identify priority policy options in Mongolia, the Philippines and Vietnam. A landscape analysis approach was adopted using methods set out in a UNICEF global toolkit. Quantitative and qualitative data were compiled from a range of global and national sources on childhood overweight and obesity, risk factors and policy responses. Key informant interviews and validation workshops were undertaken with key food and nutrition stakeholders from government and non-government organizations to identify priority policy options for the prevention of overweight and obesity among children. Overweight and obesity among children are increasing in all three countries. Associated risk factors are related to maternal nutrition, birthweight, breastfeeding, as well as diets and physical activity shaped by increasingly obesogenic environments. Key informants identified undefined policy approaches, poor community understanding and food and beverage industry influence as barriers to addressing overweight and obesity. Key policy priorities include restricting the marketing of unhealthy food and beverages, unhealthy food and beverage taxation, introduction of front-of-pack nutrition labels and improving school nutrition environments. Mongolia, the Philippines and Vietnam are all facing an increasing burden of childhood overweight and obesity. Despite differing national contexts, similar environmental factors are driving this rise. A suite of evidence-based policies can effectively be introduced to address obesogenic environments.
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Affiliation(s)
- Bolormaa Norov
- Nutrition Department, National Center for Public Health, Peace Ave 46, Ulaanbaatar 13381, Mongolia
| | - Cherry Cristobal-Maramag
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Hoang Van Minh
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Khương Quỳnh Long
- Hanoi University of Public Health, 1A Đ. Đức Thắng, Đông Ngạc, Bắc Từ Liêm, Hà Nội, Vietnam
| | - Oliver Huse
- Deakin University, Geelong Australia, Global Obesity Centre for Preventive Health and Nutrition, Institute for Health Transformation, 1 Gheringhap St 3220
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Alice Nkoroi
- Philippines Country Office, UNICEF, 14th Floor, North Tower, Rockwell Business Center Sheridan, Sheridan Street corner United Street, Highway Hills, Mandaluyong City 1550, Philippines
| | - Munkhjargal Luvsanjamba
- Mongolia Country Office, UNICEF, UN House, United Nations street-14, Ulaanbaatar 14201, Mongolia
| | - Do Hong Phuong
- Vietnam Country Office, UNICEF, The Green One UN House, 304 Kim Ma, Ba Dinh District, Hanoi, Vietnam
| | - Roland Kupka
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
| | - Tim Lobstein
- Policy Section, World Obesity Federation, 5th Floor, 38 Chancery Lane, London, WC2A 1EN, UK
- The Boden Initiative, University of Sydney, John Hopkins Dr, Camperdown, Sydney, 2050, NSW, Australia
| | - Jo Jewell
- Nutrition Section, UNICEF, 3 United Nations Plaza, New York, NY 10017, USA
| | - Mary Christine Castro
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Nikka Oliver
- Health and Nutrition Unit, Nutrition Center of the Philippines, Launchpad Coworking 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, The Philippines
| | - Fiona Watson
- East Asia and Pacific Regional Office, UNICEF, 19 Pra Athit Rd, Chana Songkhram, Pra Nakhon, Bangkok 10200, Thailand
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13
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Li S, Nor NM, Kaliappan SR. Long-term effects of child nutritional status on the accumulation of health human capital. SSM Popul Health 2023; 24:101533. [PMID: 37916186 PMCID: PMC10616551 DOI: 10.1016/j.ssmph.2023.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/09/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
Research on the impact of childhood nutrition on adult health and human capital has been extensively studied in developed countries, but research in China on this topic is limited. Nowadays, for children's nutritional status, while significant progress has been made in addressing childhood undernutrition in China, regional disparities persist, conversely, the prevalence of childhood overweight continues to rise. For adults' health human capital, the burden of chronic non-communicable diseases among Chinese residents is gradually increasing, over 50% of Chinese residents are overweight or obese, with obesity being one of the risk factors for other chronic diseases. Therefore, this study uses national representative data from 1991 to 2015 China Health and Nutrition Survey (CHNS), matched with individual information from their childhood, to examine the relationship between childhood nutrition and adult health human capital. Based on the two-way fixed effects models and logit models, the study finds that childhood nutrition status measured by height-for-age z score (HAZ) significantly and continuously has been influencing adult health human capital measured by height, BMI, self-rated health (SRH), whether have been sick in last four weeks (SH). BMI-for-age z score (BMIZ) significantly and continuously influence adult health human capital measured by BMI, blood pressure, and perceived stress (PS). Among that, this study places special emphasis on the long-lasting effects of late childhood and adolescence (ages exceeding 6) on the progressive height accumulation and sustained presence of elevated blood pressure. In conclusion, reducing childhood overweight and promoting linear growth and development throughout the whole childhood can reduce the future burden of disease on the nation.
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Affiliation(s)
- Sa Li
- School of Business and Economics, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
| | - Norashidah Mohamed Nor
- School of Business and Economics, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
| | - Shivee Ranjanee Kaliappan
- School of Business and Economics, Universiti Putra Malaysia, 43400, UPM, Serdang, Selangor, Malaysia
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14
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He Q, Qi X, Zhang T, Tang K. Trends in socioeconomic inequalities in malnutrition among children under 5 in the Democratic Republic of the Congo from 2001 to 2018. Nutrition 2023; 115:112182. [PMID: 37573792 DOI: 10.1016/j.nut.2023.112182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Malnutrition in the Democratic Republic of the Congo (DRC) has declined over the past 2 decades. However, malnutrition inequality persists. Evaluating trends of socioeconomic disparities in malnutrition among children under 5 y of age in the DRC can help target meaningful interventions. METHOD Data from the Multiple Indicator Cluster Survey (2001, 2010, 2018) assessed the prevalence of underweight, stunting, and wasting among children under 5. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) measured socioeconomic inequalities. We evaluated trends in the entire national sample and stratified subsamples based on place of residence and wealth index quintiles. The final sample included 42 976 children. RESULTS The national prevalence of underweight and wasting decreased from 31% to 26% and 13% to 6% in rural and urban areas. However, trends in stunting prevalence varied between the two areas. Nutritional disparity widened between low- and high-income families (stunting RIIs: 0.61 in 2001, 0.37 in 2018; stunting SIIs: -0.20 in 2001, -0.40 in 2018; underweight RIIs: 0.53 in 2001, 0.35 in 2018; underweight SIIs: -0.21 in 2001, -0.28 in 2018). Urban areas experienced greater inequality than rural areas (stunting in urban RIIs: 0.41 in 2001, 0.33 in 2010, 0.25 in 2018). CONCLUSION Despite progress in reducing malnutrition, persistent socioeconomic disparities, particularly in urban areas, remain a serious public health concern in the DRC. Addressing the root causes of malnutrition and ensuring socioeconomically equitable access to nutrition is critical to promote the full potential of children.
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Affiliation(s)
- Qiwei He
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of International Development Cooperation, Chinese Academy of International Trade and Economic Cooperation, Beijing, China
| | - Xinran Qi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tiange Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China.
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15
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Pradeilles R, Landais E, Pareja R, Eymard‐Duvernay S, Markey O, Holdsworth M, Rousham EK, M. Creed‐Kanashiro H. Exploring the magnitude and drivers of the double burden of malnutrition at maternal and dyad levels in peri-urban Peru: A cross-sectional study of low-income mothers, infants and young children. MATERNAL & CHILD NUTRITION 2023; 19:e13549. [PMID: 37485734 PMCID: PMC10483951 DOI: 10.1111/mcn.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
Multiple forms of malnutrition coexist in Peru, especially in peri-urban areas and poor households. We investigated the magnitude of, and the contribution of, dietary and socio-demographic factors to the double burden of malnutrition (DBM) at maternal (i.e., maternal overweight/obesity with anaemia) and dyad (i.e., maternal overweight/obesity with child anaemia) levels. A cross-sectional survey was conducted among low-income mother-child (6-23 months) dyads (n = 244) from peri-urban communities in Peru. Dietary clusters and the minimum dietary diversity score (MDD) were generated for mothers and infants, respectively. A composite indicator using the maternal dietary clusters and the MDD was created to relate to dyad level DBM. Two dietary clusters were found: (i) the 'high variety (i.e., animal-source foods, fruit and vegetables), high sugary foods/beverages' (cluster 1) and (ii) the 'high potato, low fruit and vegetables, low red meat' (cluster 2). DBM prevalence among mothers and dyads was 19.9% and 36.3%, respectively. Logistic regression analyses revealed that the only socio-demographic factor positively associated with maternal DBM was maternal age (aOR/5 years: 1.35 [1.07, 1.71]). Mothers belonging to diet cluster 1 were less likely to experience the DBM (aOR = 0.52 [0.26, 1.03]), although CIs straddled the null. Socio-demographic factors positively associated with dyad level DBM included maternal age (aOR/5 years: 1.41 [1.15, 1.73]), and having ≥ two children under 5 years (aOR = 2.44 [1.23, 4.84]). Diet was not associated with dyad-level DBM. Double-duty actions that tackle the DBM are needed given that one-third of dyads and a fifth of mothers had concurrent overweight/obesity and anaemia.
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Affiliation(s)
- Rebecca Pradeilles
- Centre for Global Health and Human Development School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | - Edwige Landais
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | | | - Sabrina Eymard‐Duvernay
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | - Oonagh Markey
- Centre for Global Health and Human Development School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri‐Food Systems)Univ Montpellier, CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro, IRDMontpellierFrance
| | - Emily K. Rousham
- Centre for Global Health and Human Development School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
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16
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Jobarteh ML, McCrory MA, Lo B, Triantafyllidis KK, Qiu J, Griffin JP, Sazonov E, Sun M, Jia W, Baranowski T, Anderson AK, Maitland K, Frost G. Evaluation of Acceptability, Functionality, and Validity of a Passive Image-Based Dietary Intake Assessment Method in Adults and Children of Ghanaian and Kenyan Origin Living in London, UK. Nutrients 2023; 15:4075. [PMID: 37764857 PMCID: PMC10537234 DOI: 10.3390/nu15184075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Accurate estimation of dietary intake is challenging. However, whilst some progress has been made in high-income countries, low- and middle-income countries (LMICs) remain behind, contributing to critical nutritional data gaps. This study aimed to validate an objective, passive image-based dietary intake assessment method against weighed food records in London, UK, for onward deployment to LMICs. METHODS Wearable camera devices were used to capture food intake on eating occasions in 18 adults and 17 children of Ghanaian and Kenyan origin living in London. Participants were provided pre-weighed meals of Ghanaian and Kenyan cuisine and camera devices to automatically capture images of the eating occasions. Food images were assessed for portion size, energy, nutrient intake, and the relative validity of the method compared to the weighed food records. RESULTS The Pearson and Intraclass correlation coefficients of estimates of intakes of food, energy, and 19 nutrients ranged from 0.60 to 0.95 and 0.67 to 0.90, respectively. Bland-Altman analysis showed good agreement between the image-based method and the weighed food record. Under-estimation of dietary intake by the image-based method ranged from 4 to 23%. CONCLUSIONS Passive food image capture and analysis provides an objective assessment of dietary intake comparable to weighed food records.
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Affiliation(s)
- Modou L. Jobarteh
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Megan A. McCrory
- Department of Health Sciences, Boston University, Boston, MA 02215, USA;
| | - Benny Lo
- Hamlyn Centre, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK; (B.L.); (J.Q.)
| | - Konstantinos K. Triantafyllidis
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2BX, UK; (K.K.T.); (J.P.G.); (G.F.)
| | - Jianing Qiu
- Hamlyn Centre, Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK; (B.L.); (J.Q.)
| | - Jennifer P. Griffin
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2BX, UK; (K.K.T.); (J.P.G.); (G.F.)
| | - Edward Sazonov
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL 35487, USA;
| | - Mingui Sun
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA; (M.S.); (W.J.)
| | - Wenyan Jia
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA; (M.S.); (W.J.)
| | - Tom Baranowski
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Alex K. Anderson
- Department of Nutritional Sciences, University of Georgia, Athens, GA 30602, USA;
| | | | - Gary Frost
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2BX, UK; (K.K.T.); (J.P.G.); (G.F.)
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17
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Jana A, Dey D, Ghosh R. Contribution of low birth weight to childhood undernutrition in India: evidence from the national family health survey 2019-2021. BMC Public Health 2023; 23:1336. [PMID: 37438769 DOI: 10.1186/s12889-023-16160-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Infants born with low birth weight (LBW), i.e. less than 2500g, is considered an important factor of malnutrition in Asia. In India, research related to this issue is still neglected and limited. Evidence exists that a large number of child deaths occur in India due to maternal and child malnutrition-related complications. Moreover, it has been found that the cost of malnutrition in India results in a significant reduction of the country's Gross Domestic Product (GDP). Thus, in this current context, this study aims to explore the contribution of low birth weight to childhood undernutrition in India. METHODS The study used data from the 5th round of the National Family Health Survey (NFHS-5), a large-scale survey conducted in India. The survey collected information from 176,843 mothers and 232,920 children. The study used the last birth information (last children born 5 years preceding the survey) due to the detailed availability of maternal care information. Univariate and bivariate analyses were conducted to determine the percentage distribution of outcome variables. Multivariate logistic regression was employed to examine the association between LBW and undernutrition (stunting, wasting, and underweight). The study also used the Fairlie decomposition analysis to estimate the contribution of LBW to undernutrition among Indian children. RESULTS The results show that childhood undernutrition was higher in states like Uttar Pradesh, Bihar, Jharkhand, Gujarat, and Maharashtra. The results of the logistic regression analysis show that infants born with low birth weight were more likely to be stunted (OR = 1.46; 95% CI: 1.41-1.50), wasted (OR = 1.33; 95% CI: 1.27-1.37), and underweight (OR = 1.76; 95% CI: 1.70-1.82) in their childhood compared to infants born without low birth weight. The findings from the decomposition analysis explained that approximately 14.8% of the difference in stunting, 10.4% in wasting, and 9.6% in underweight among children born with low birth weight after controlling for the individuals' selected characteristics. CONCLUSION The findings suggest that LBW has a significant contribution to malnutrition. The study suggests that policymakers should prioritize strengthening maternal and child healthcare schemes, particularly focusing on antenatal and postnatal care, as well as kangaroo mother care at the grassroots level to reduce the burden of LBW and undernourished children.
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Affiliation(s)
- Arup Jana
- Research Scholar, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Deepshikha Dey
- MPhil., International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Ranjita Ghosh
- PhD Scholar, Institute for Social and Economic Change, Karnataka, 560072, India.
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18
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Watson D, Mushamiri P, Beeri P, Rouamba T, Jenner S, Proebstl S, Kehoe SH, Ward KA, Barker M, Lawrence W. Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000401. [PMID: 36996036 PMCID: PMC10062616 DOI: 10.1371/journal.pgph.0000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Patience Mushamiri
- SAMRC Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Paula Beeri
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Sarah Jenner
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Simone Proebstl
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sarah H Kehoe
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Kate A Ward
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
- School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, United Kingdom
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
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Mrejen M, Cruz MV, Rosa L. [The Food and Nutrition Surveillance System (SISVAN) as a tool to monitor the nutritional status of children and adolescents in Brazil]. CAD SAUDE PUBLICA 2023; 39:e00169622. [PMID: 36856228 DOI: 10.1590/0102-311xpt169622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/29/2022] [Indexed: 02/12/2023] Open
Abstract
In Brazil, the Food and Nutrition Surveillance System (SISVAN) is the main tool in collecting and consolidating information on the nutritional status and the feeding habits of the population encompassed by primary health care services of the country. This study explores data from SISVAN to analyze the system's potential as a tool for monitoring the nutritional status of children and adolescents in the country. We seek to evaluate the evolution of the system's coverage rate in relation to the population regarding different age groups and geographic regions, how this coverage rate varies according to the characteristics of the Brazilian municipalities, and to what extent the results from SISVAN differ from representative sample surveys of the population. We present four main results. First, we documented that from 2008 to 2019, SISVAN significantly expanded its coverage; with a significant decrease, however, in 2020, reaching levels similar to those at the beginning of the series. Second, our results indicate that coverage is not homogeneous, being higher in the North and Northeast regions and among underage children. Third, there is a systematic association between the characteristics of the municipalities and the level of coverage of the system. Finally, SISVAN results differ from those presented by surveys representative of the general population. Jointly, the results of this study point to the need to refine the nutritional surveillance instruments on children and adolescents in Brazil.
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Affiliation(s)
- Matías Mrejen
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brasil
| | - Maria Vitória Cruz
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brasil.,Universidade de São Paulo, São Paulo, Brasil
| | - Leonardo Rosa
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brasil
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20
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High prevalence of malnutrition and vitamin A deficiency among schoolchildren of rural areas in Malaysia using a multi-school assessment approach. Br J Nutr 2023; 129:454-467. [PMID: 35506400 DOI: 10.1017/s0007114522001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Childhood malnutrition is known as a public health concern globally. The present study aims to assess the anthropometry and blood biochemical status of rural primary schoolchildren in Malaysia. A total of 776 children (7-11 years old) from ten rural primary schools from five states were included in this study. Nutritional outcomes were assessed based on sex, age group and school categories among the children (median age: 9 years (P25:8, P75:10)). The overall prevalence of malnutrition was 53·4 %. Vitamin A deficiency (VAD) was recorded at 20·6 and 39·8 % based on retinol and retinol-binding protein (RBP) levels, respectively. Anaemia, iron deficiency (ID), iron-deficiency anaemia (IDA) and elevated inflammation were found at 14·9, 17·9, 9·1 and 11·5 %, respectively. Malnutrition, VAD, anaemia, ID, IDA and elevated inflammation were more prevalent among Orang Asli (OA) schoolchildren compared with Non-Orang Asli schoolchildren. Higher occurrences of VAD and anaemia were also found among children aged <10 years. Retinol, RBP, α-carotene, ferritin and haemoglobin levels were lower among undernourished children. Besides, overweight/obese children exhibited a higher level of high-sensitivity C-reactive protein. Multivariate analysis demonstrated that OA school children (adjusted OR (AOR): 6·1; 95 % CI 4·1, 9·0) and IDA (AOR: 3·6; 95 % CI 1·9, 6·6) were associated with stunting among this population. The present study revealed that malnutrition, micronutrient deficiencies and anaemia are prevalent among rural primary schoolchildren in Malaysia, especially those from OA schools and younger age children (<10 years). Hence, more appropriate and targeted measures are needed to improve the nutritional status of these children.
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Galvis Y, Pineda K, Zapata J, Aristizabal J, Estrada A, Fernandez ML, Barona-Acevedo J. Consumption of Eggs Alone or Enriched with Annatto ( Bixa orellana L.) Does Not Increase Cardiovascular Risk in Healthy Adults-A Randomized Clinical Trial, the Eggant Study. Nutrients 2023; 15:nu15020369. [PMID: 36678239 PMCID: PMC9865189 DOI: 10.3390/nu15020369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Most atherosclerotic cardiovascular diseases can be prevented by modifying lifestyles, including unhealthy diets. Eggs contain important carotenoids that may impact cardiovascular risk. The lipid nature of eggs can improve the bioavailability of other carotenoids, such as Annatto (Bixa orellana L.), with reported antioxidant properties. Although numerous studies have shown that there is no association between egg consumption and cardiovascular risk, there is still controversy. In addition, there is limited information about Annatto's effects on human health. This study evaluated the association between egg consumption and its enrichment with Annatto in lipid biomarkers of cardiovascular disease. In a parallel clinical trial, one hundred and five (n = 105) men and women were randomized by age, sex, and body mass index (BMI), and distributed into three groups. Subjects consumed daily, for 8 weeks, either two eggs, two eggs with Annatto, or two egg whites. Plasma lipids were measured by enzymatic colorimetric methods, plasma apolipoproteins and lipoprotein subfractions and size by nuclear magnetic resonance. There were no differences between groups in age, sex, and BMI. No significant changes were found over time or between groups in plasma triglycerides, LDL cholesterol, HDL cholesterol, apolipoprotein (apo) A1, apo B, or lipoprotein subfraction concentrations. In healthy adults, the intake of two eggs a day, or two eggs with Annatto for eight weeks, did not generate adverse changes in cardiovascular risk markers.
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Affiliation(s)
- Yeisson Galvis
- Research Group of Toxinology, Food and Therapeutic Alternatives, Universidad de Antioquia UdeA, Medellín 050010, Colombia
- School of Microbiology, Universidad de Antioquia UdeA, Medellín 050010, Colombia
| | - Keilly Pineda
- Research Group of Toxinology, Food and Therapeutic Alternatives, Universidad de Antioquia UdeA, Medellín 050010, Colombia
| | - Juliana Zapata
- Research Group of Toxinology, Food and Therapeutic Alternatives, Universidad de Antioquia UdeA, Medellín 050010, Colombia
| | - Juan Aristizabal
- School of Nutrition and Dietetics, Universidad de Antioquia UdeA, Medellín 050010, Colombia
- Physiology and Biochemistry Research Group-PHYSIS, Universidad de Antioquia UdeA, Medellín 050010, Colombia
| | - Alejandro Estrada
- School of Nutrition and Dietetics, Universidad de Antioquia UdeA, Medellín 050010, Colombia
| | - María Luz Fernandez
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ 85721, USA
| | - Jacqueline Barona-Acevedo
- Research Group of Toxinology, Food and Therapeutic Alternatives, Universidad de Antioquia UdeA, Medellín 050010, Colombia
- School of Microbiology, Universidad de Antioquia UdeA, Medellín 050010, Colombia
- Correspondence:
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Phiri M, Mulemena D, Kalinda C, Odhiambo JN. Contextual factors and spatial trends of childhood malnutrition in Zambia. PLoS One 2022; 17:e0277015. [PMID: 36327254 PMCID: PMC9632925 DOI: 10.1371/journal.pone.0277015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Understanding the national burden and epidemiological profile of childhood malnutrition is central to achieving both national and global health priorities. However, national estimates of malnutrition often conceal large geographical disparities. This study examined the prevalence of childhood malnutrition across provinces in Zambia, changes over time, and identified factors associated with the changes. METHODS We analyzed data from the 2013/4 and 2018 Zambia demographic and health surveys (ZDHS) to examine the spatial heterogeneity and mesoscale correlates of the dual burden of malnutrition in children in Zambia. Maps illustrating the provincial variation of childhood malnutrition were constructed. Socio-demographic and clinical factors associated with childhood malnutrition in 2013 and 2018 were assessed independently using a multivariate logistic model. RESULTS Between 2013/4 and 2018, the average prevalence of stunting decreased from 40.1% (95% CI: 39.2-40.9) to 34.6% (95% CI:33.6-35.5), wasting decreased from 6.0% (95% CI: 5.6-6.5) to 4.2% (95% CI: 3.8-4.7), underweight decreased from 14.8% (95% CI: 14.1-15.4) to 11.8% (95% CI: 11.2-12.5) and overweight decreased from 5.7% (95% CI: 5.3-6.2) to 5.2% (95% CI: 4.8-5.7). High variability in the prevalence of childhood malnutrition across the provinces were observed. Specifically, stunting and underweight in Northern and Luapula provinces were observed in 2013/14, whereas Lusaka province had a higher degree of variability over the two survey periods. CONCLUSION The study points to key sub-populations at greater risk and provinces where malnutrition was prevalent in Zambia. Overall, these results have important implications for nutrition policy and program efforts to reduce the double burden of malnutrition in Zambia.
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Affiliation(s)
- Million Phiri
- Department of Population Studies, University of Zambia, School of Humanities and Social Sciences, Lusaka, Zambia
- Department of Demography and Population Studies, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Mulemena
- Ministry of Mines and Minerals Development, Lusaka, Zambia
| | - Chester Kalinda
- University of Global Health Equity (UGHE), Bill and Joyce Cummings Institute of Global Health, Institute of Global Health Equity Research (IGHER), Kigali, Rwanda
- Institute of Global Health Equity Research (IGHER), University of Global Health Equity, Kigali, Rwanda
| | - Julius Nyerere Odhiambo
- Ignite Global Health Research Lab, Global Research Institute, William and Mary, Williamsburg, Virginia, United States of America
- * E-mail:
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Evaluation of School Children Nutritional Status in Ecuador Using Nutrimetry: A Proposal of an Education Protocol to Address the Determinants of Malnutrition. Nutrients 2022; 14:nu14183686. [PMID: 36145057 PMCID: PMC9502477 DOI: 10.3390/nu14183686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
The education sector is a cornerstone in the battle against malnutrition in children. However, there are still no consolidated protocols that outline strategies for how nutrition programs in low- and middle-income countries can be delivered through the education sector. Establishing the correct community diagnosis is essential prior to the elaboration of an intervention plan for a school population that takes into account more than just traditional variables related to the nutritional status. A total of 574 boys and girls aged 3–11 years from three educational institutions in different municipalities in Ecuador participated in the study. Sociodemographic, anthropometric (weight and height) and coproparasitological data were obtained. Nutrimetry, which is a combination of two classical anthropometrics indicators, was used for the analysis of the nutritional status, and the indicators’ frequencies varied among the schools. In order to improve the nutritional status of children, we proposed a framework mainly focusing on establishing alliances with the education sector and taking into account gender equality; respect for the environment; and the customs, beliefs and traditions of each population. The results obtained from the analyses of other variables demonstrated the importance of an adequate diagnosis prior to any type of intervention at the nutritional level, since characteristics could vary by local area and have an impact on the successfulness of the intervention.
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Dos Reis Araujo T, Lubaczeuski C, Carneiro EM. Effects of double burden malnutrition on energetic metabolism and glycemic homeostasis: A narrative review. Life Sci 2022; 307:120883. [PMID: 35970240 DOI: 10.1016/j.lfs.2022.120883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/15/2022]
Abstract
Rapid changes in the food process led to greater consumption of ultra-processed foods which, associated with reduced physical activity, increased the number of overweight and obese individuals worldwide. However, in low and middle-income countries (LMICS) the growth of the obesity epidemic took place despite the high prevalence of undernutrition in children. This generated the coexistence of these two nutritional patterns, currently defined as double burden malnutrition (DBM). Several reports have already described the social, political, and economic aspects related to the causes and possible solutions for the control of DBM. Here, we highlight the metabolic alterations, related to fat deposition and glycemic homeostasis, described in experimental models of DBM and the differential effects of therapeutic strategies already tested. Therefore, this work aims to help the scientific community to understand how the DBM can lead to the development of obesity and type 2 diabetes through different mechanisms from traditional models of obesity and highlights the need to study these mechanisms and new therapeutic strategies to improve damages caused by DBM.
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Affiliation(s)
- Thiago Dos Reis Araujo
- Obesity and Comorbidities Research Center (OCRC), Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, SP, Brazil
| | - Camila Lubaczeuski
- Department of Medicine, Division Endocrinology, Metabolism and Diabetes, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Everardo Magalhães Carneiro
- Obesity and Comorbidities Research Center (OCRC), Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, SP, Brazil.
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Yang WY, Ong SH, De Lee Y, Yen PL, Lim KY, Naumoskvi N, Jani R. Exploration of Malaysian school-children's food preferences: what do we know? J Trop Pediatr 2022; 68:6724365. [PMID: 36166753 DOI: 10.1093/tropej/fmac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Feeding practices exert a definite influence over children's experiences. This article aims to explore parental feeding practices and investigate the prediction domain of food preference from parent-child perspectives. METHODS Two individual studies were conducted on Malay families with children aged 7-12 years. In Study 1, mothers (n = 17) participated in semi-structured focus group interviews on their knowledge of foods and feeding practices. In Study 2, parent-child pairs (n = 14) answered a 36-item, 5-point Likert scale Food Preference Questionnaire followed by virtual structured qualitative interviews. The interviews were digitally recorded, transcribed verbatim, back-translated and analysed according to the framework analysis technique. RESULTS In Study 1, mothers perceived vegetables, chicken, fish and plain water as healthy foods and drinks while discretionary options were snacks, fast foods and carbonated drinks. The mothers defined healthy foods as foods handled safely with health benefits. They used 'healthy' cooking methods to prepare preferred foods and overtly controlled the child's access to discretionary food. In Study 2, the food groups reported by parent-child pair's report were consistent for the most preferred foods [snacks, median (interquartile range), parent: 4.5 (1.0) vs. child: 4.5 (0.0), p > 0.05] and least preferred food [legumes, parent: 2.0 (1.0) vs. child: 2.0 (1.0), p > 0.05]. Parents emphasized taste as the key determinant of food preference. CONCLUSION These studies were the first to qualitatively explore parents' perceptions of foods affecting their feeding practices among the Malaysian community to highlight the cultural contribution. Key insights into children's food intake and factors influencing their food preferences were identified.
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Affiliation(s)
- Wai Yew Yang
- Division of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Shu Hwa Ong
- Institute of Research, Development and Innovation, International Medical University, Kuala Lumpur 57000, Australia
| | - Yi De Lee
- Division of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Pei Ling Yen
- Division of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Kah Yen Lim
- Division of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Nenad Naumoskvi
- Discipline of Nutrition and Dietetics, School of Rehabilitation and Exercise Sciences, Faculty of Health, University of Canberra, Canberra, ACT, Australia.,Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, Ngunnawal Country, ACT, Australia
| | - Rati Jani
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4215, Australia
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Cong N, Zhao A, Kwan MP, Yang J, Gong P. An Indicator Measuring the Influence of the Online Public Food Environment: An Analytical Framework and Case Study. Front Nutr 2022; 9:818374. [PMID: 35845771 PMCID: PMC9281549 DOI: 10.3389/fnut.2022.818374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/23/2022] [Indexed: 12/03/2022] Open
Abstract
The online public food environment (OPFE) has had a considerable impact on people's lifestyles over the past decade; however, research on its exposure is sparse. The results of the existing research on the impact of the food environment on human health are inconsistent. In response to the lack of food elements in the definition of the food environment and the lack of a clear method to assess the health attributes and the impact degree of the food environment, we proposed a new analytical framework based on the latest disease burden research, combining the characteristics of China's current food environment, from the perspective of environmental science. We redefined the food environment and proposed that food and its physical space are two core elements of the food environment. Accordingly, we extracted four domains of characteristics to describe the basic components of the food environment. Using the sales records, we designed an approach by referring to the standard process of environmental health indicators, including the health attributes and the impact degree of the food environment, to measure the OPFE of takeaway food outlets. Further, we conducted a case study and extracted three domains of characteristics for more than 18,000 effective takeaway meals from 812 takeaway food outlets located in 10 administrative subdivisions in the Haidian District and Xicheng District of Beijing Municipality. The results showed that more than 60% of single meals sold by takeaway food outlets were considered as healthy, and only 15% of takeaway food outlets sold healthy meals exclusively. Additionally, there were significant differences in health effects among different types of food environments, and high-risk areas of different types of food environments can be spatially identified. Compared with the counting method in the availability of food environment, the proposed new approach can depict food environment characteristics not only in the macro-scale like the counting method but also in the meal-scale. The indicators could be useful for large-scale and long-term monitoring of food environmental changes due to their simple calculation and design depending on the food delivery platform.
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Affiliation(s)
- Na Cong
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Ecological Field Station for East Asian Migratory Birds, Tsinghua University, Beijing, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Mei-Po Kwan
- Department of Geography and Resource Management and Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jun Yang
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Ecological Field Station for East Asian Migratory Birds, Tsinghua University, Beijing, China
| | - Peng Gong
- Ministry of Education Ecological Field Station for East Asian Migratory Birds, Tsinghua University, Beijing, China
- Department of Geography and Earth Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
- *Correspondence: Peng Gong
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Steyn NP, Nel JH. Prevalence and Determinants of the Double Burden of Malnutrition with a Focus on Concurrent Stunting and Overweight/Obesity in Children and Adolescents. Curr Nutr Rep 2022; 11:437-456. [PMID: 35715686 DOI: 10.1007/s13668-022-00417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE OF THE REVIEW To determine the prevalence and determinants of concurrent stunting and overweight/obesity (CSO) in the same child or adolescent. RECENT FINDINGS After searching PubMed and the Web of Science, 26 articles comprised the prevalence and/or determinants of concurrent stunting and overweight/obesity. Most of the articles were published from 2018 onwards. There is great variation in the prevalence of concurrent stunting and overweight/obesity across the globe. For children under five years the prevalence of CSO is higher among children under two years compared with those 2-<5 years. The main determinants of this condition appear to be associated with gender, age, and urban versus rural ones. Income varied greatly between studies. However, a few additional variables were mentioned including having a mother with a short stature, time of weaning, having an improved toilet facility, being dewormed in the past few months, and the level of education of the mother.
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Affiliation(s)
- Nelia P Steyn
- Department of Human Biology, University of Cape Town, Anzio Road, Observatory, South Africa.
| | - Johanna H Nel
- Department of Logistics, University of Stellenbosch, Stellenbosch, South Africa
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Kumar M, Mohanty P. Does maternal overnutrition carry child undernutrition in India? PLoS One 2022; 17:e0265788. [PMID: 35714070 PMCID: PMC9205528 DOI: 10.1371/journal.pone.0265788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background and objectives Studies in low-and middle-income countries where nutrition transition is underway provides mixed evidence of double burden of maternal overnutrition and child undernutrition among mother-child pairs. Shifting dietary pattern and rapid increase in overweight/obesity among adults with persistent child undernutrition indicate that India is experiencing nutrition transition and double burden of malnutrition. Hence, the study explores the presence of and the factors associated with mother-child dyads of over- and undernutrition in India. Methods and materials The study uses National Family Health Survey 2015–16 data. The analytic sample consists of 28,817 weighted mother-child pairs where an overweight/obese mother is paired with an undernourished child. The nutritional status of children is defined according to WHO 2006 child growth standards as underweight (i.e., low weight-for-age), stunting (i.e., low height-for-age) and wasting (i.e., low weight-for-height). Maternal overweight/obesity (i.e., BMI ≥ 25 kg/m2) is defined using adult BMI criterion. Descriptive, bivariate, and adjusted multivariable logistic regression analysis are conducted. Results Of the overweight/obese mothers, 21.3%, 26.5%, and 14% have underweight, stunted, and wasted children respectively. In adjusted models, maternal short stature (aOR: 2.94, 95% CI: 2.30–3.75), age of child (aOR: 3.29, 95% CI: 2.76–3.92), and poorest wealth status (aOR: 2.01, 95% CI: 1.59–2.54) are significant predictors of overweight/obese mothers and stunted child pairs. Similarly, poor wealth status (aOR: 1.68, 95% CI:1.32–2.14), maternal stature (aOR: 2.70, 95% CI: 2.08–3.52), and child aged 2–5 years (aOR: 1.77, 95% CI:1.51–2.08) are also significantly associated with higher occurrence of overweight/obese mother and-underweight child pairs. Conclusion Findings of the study are consistent with the phase of nutrition transition and double burden of malnutrition. The paper concludes with suggestions to improve the socioeconomic condition, more strategic nutrition specific investments and policy interventions to eliminate all forms of malnutrition for achieving SDGs.
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Affiliation(s)
- Mukesh Kumar
- Department of Humanities and Social Sciences, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, India
| | - Pratap Mohanty
- Department of Humanities and Social Sciences, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, India
- * E-mail:
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Marume A, Mahomed S, Archary M. Evaluation of the child growth monitoring programme in two Zimbabwean provinces. Afr J Prim Health Care Fam Med 2022; 14:e1-e8. [PMID: 35924624 PMCID: PMC9350461 DOI: 10.4102/phcfm.v14i1.3373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background The child growth monitoring (CGM) programme is an important element of nutrition programmes, and when combined with other child health programmes, it can assist in successful management and control of malnutrition in children. Aim This study aimed to assess the extent to which the CGM programme is able to identify instances of childhood malnutrition and how much this contributes towards malnutrition reduction in Zimbabwe. Setting The study was conducted in Manicaland and Matabeleland South provinces of Zimbabwe. The two provinces were purposively selected for having the highest and least proportion of children affected by stunting in the country. Methods The CGM programme in Zimbabwe was evaluated using the logic model to assess the ability of the programme to identify growth faltering and link children to appropriate care. Results Records from 60 health facilities were reviewed. Interviews were conducted with 60 nurses, 100 village health workers (VHWs) and 850 caregivers (300 health facility exit interviews, 450 community based). Nearly all (92%) health facilities visited had functional measuring scales. Twelve health facilities (20%) had no functional height board, with five using warped height boards for measuring children’s height. Less than a quarter (21%) of the children had complete records for weight for age and height for age. A large proportion of children eligible for admission for the management of moderate (83%) and severe malnutrition (84%) were missed. Conclusion The CGM programme in Zimbabwe is not well equipped for assessing child height for age and management of children identified with malnutrition, thus failing to timely identify and manage childhood stunting.
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Affiliation(s)
- Anesu Marume
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and, Ministry of Health and Child Care Zimbabwe, Health Promotion, Government of Zimbabwe, Harare.
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The co-occurrence of overweight/obesity and anaemia among adult women, adolescent girls and children living in fifty-two low- and middle-income countries. Public Health Nutr 2022; 25:1595-1606. [PMID: 34103123 PMCID: PMC9991775 DOI: 10.1017/s1368980021002512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the magnitude and distribution of concurrent overweight/obesity and anaemia among adult women, adolescent girls and children living in low- and middle-income countries (LMIC). DESIGN We selected the most recent Demographic and Health Surveys with anthropometric and Hb level measures. Prevalence estimates and 95 % CI of concurrent overweight/obesity and anaemia were calculated for every country, overall and stratified by household wealth quintile, education level, area of residence and sex (for children only). Regional and overall pooled prevalences were estimated using a random-effects model. We measured gaps, expressed in percentage points, to display inequalities in the distribution of the double burden of malnutrition (DBM). SETTING Nationally representative surveys from fifty-two LMIC. PARTICIPANTS Adult women (n 825 769) aged 20-49 years, adolescent girls (n 192 631) aged 15-19 years and children (n 391 963) aged 6-59 months. RESULTS The pooled prevalence of concurrent overweight/obesity and anaemia was 12·4 % (95 % CI 11·1, 13·7) among adult women, 4·5 % (95 % CI 4·0, 5·0) among adolescent girls and 3·0 % (95 % CI 2·7, 3·3) among children. Overall, the DBM followed an inverse social gradient, with a higher prevalence among the richest quintile, most educated groups and in urban areas; however, important variations exist. The largest inequality gaps were observed among adult women in Yemen by household wealth (24·0 percentage-points) and in Niger by education level (19·6 percentage-points) and area of residence (11·9 percentage-points). Differences were predominantly significant among adult women, but less among girls and children. CONCLUSIONS Context-specific, multifaceted, responses with an equity lens are needed to reduce all forms of malnutrition.
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Galeana-Pizaña JM, Verdeja-Vendrell L, Díaz-Trejo LI, Anzaldo C, Figueroa D, Jiménez-Ortega AD. Spatiotemporal patterns of mortality associated with chronic non-communicable diseases and child malnutrition at the municipal level in Mexico. GEOSPATIAL HEALTH 2022; 17. [PMID: 35579246 DOI: 10.4081/gh.2022.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
Malnutrition is one of the main risk factors related to chronic non-communicable diseases and child undernourishment on a planetary scale. Mexico is one of the countries with the highest levels of malnutrition, but there is also an accelerated increase in overweight or obesity. This study explored the spatiotemporal behaviour of mortality associated with chronic non-communicable diseases such as type II diabetes mellitus, hypertension, ischemic heart disease and cerebrovascular disease. The analysis was carried out at the municipality level for the 2000-2020 period targeting two age groups: ≥60-year olds and 20-59-year olds. In addition, 0-4-year olds were investigated with respect to undernourishment. National databases were gathered and standardized for each disease and SaTScan spatiotemporal cluster analyses were performed. We found that mortality associated with most of the diseases evaluated has increased since 2016 except for mortality caused by child undernourishment, which showed a downward trend during the study period. To focus on active conglomerates of diseases is important as they currently represent a threat to public health. Our results contribute to the potential spatial prioritization of the allocation of resources and campaigns for prevention and treatment of chronic non-communicable diseases and child undernourishment. Generally, geographical studies are fundamental for the discovery of disease aetiology and they provide valuable and timely information to multiple stakeholders.
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Affiliation(s)
| | - Leslie Verdeja-Vendrell
- Research Centre for Geospatial Information Sciences, National Autonomous University of Mexico, Mexico City.
| | - Lizbeth Ixchel Díaz-Trejo
- National Centre for Disease Control and Prevention Programs, National Autonomous University of Mexico, Mexico City.
| | - Carlos Anzaldo
- Research Centre for Geospatial Information Sciences, National Autonomous University of Mexico, Mexico City.
| | - Daniela Figueroa
- Institute of Geography, National Autonomous University of Mexico, Mexico City.
| | - Aldo Daniel Jiménez-Ortega
- Research Centre for Geospatial Information Sciences, National Autonomous University of Mexico, Mexico City.
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Sakai Y, Rahayu YYS, Araki T. Nutritional Value of Canteen Menus and Dietary Habits and Intakes of University Students in Indonesia. Nutrients 2022; 14:1911. [PMID: 35565878 PMCID: PMC9105855 DOI: 10.3390/nu14091911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
A comprehensive assessment of the dietary status of university students in Indonesia is lacking. Hence, this study aims to assess students' dietary habits, status, and the nutritive value of meals offered at university canteens. This was a cross-sectional study based on the dietary habits of 333 students, 26 of whom were interviewed for the dietary survey. The nutritional value of canteen menus used by nearly half of the students (44%) was also examined. Most menus lacked macro and micronutrients (i.e., calcium, 15.5%) and were high in salt (181.5%). BMIs showed malnutrition among students (38.5%). The protein, fat, carbohydrate (PFC) ratio showed a high proportion of fat (32.4%) in the diets of female students. The level of salt intake (96.2%) was above the Indonesian recommended dietary allowance (RDA). Most students had unhealthy dietary patterns, including a high consumption of sweet beverages and instant noodles and a low intake of fruits, vegetables, animal protein, and milk. The lack of nutrients in canteen menus might lead to a nutrient deficiency among the students, which underlines the important role of canteens in the students' dietary intake. Optimizing the nutritional profile of menus, labeling based on nutrient profiling, and promoting nutrition education should be addressed to improve students' diets.
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Affiliation(s)
- Yui Sakai
- Department of Global Agricultural Sciences, Graduate School of Agricultural and Life Science, The University of Tokyo, 1-1-1 Yayoi, Bunkyo Ward, Tokyo 113-8657, Japan;
| | - Yen Yen Sally Rahayu
- Tokyo College, The University of Tokyo, 7-3-1 Hongo, Bunkyo Ward, Tokyo 113-0033, Japan;
| | - Tetsuya Araki
- Department of Global Agricultural Sciences, Graduate School of Agricultural and Life Science, The University of Tokyo, 1-1-1 Yayoi, Bunkyo Ward, Tokyo 113-8657, Japan;
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Tilahun AG, Fufa DA, Taddesse RD. Undernutrition and its associated factors among pregnant women at the public hospitals of Bench-Sheko and Kaffa zone, southwest Ethiopia. Heliyon 2022; 8:e09380. [PMID: 35592665 PMCID: PMC9111893 DOI: 10.1016/j.heliyon.2022.e09380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/05/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Undernutrition in pregnant women, expressed as low mid-upper arm circumference, is responsible for maternal mortality and morbidity, adverse birth outcomes, subsequent childhood malnutrition, and mortality. As a result, the purpose of this study was to determine the prevalence of maternal undernutrition and associated factors during pregnancy in public hospitals in the Bench-Sheko and Kaffa zones of southwest Ethiopia. Methods A facility-based cross-sectional study design was employed among 566 women who received antenatal care from March-May 2021 at the public hospitals of the Bench-Sheko and Kaffa zones, Southwest Ethiopia. A systematic random sampling technique was used to select the research unit. Undernutrition was measured by mid-upper arm circumference. The data were entered into Epi- Data version 3.1 and then exported to Statistical Package for Social Science (SPSS) version 21 software for analysis. Multivariate logistic regression models were constructed using variables with a P-value <0.25 in bivariate logistic regression analysis. Finally, in multivariate logistic regression analysis, the variable with a (P-value < 0.05) is considered statistically significant. Results A total of 566 pregnant women participated in our study with a response rate of 98.3%. The overall prevalence of undernutrition among pregnant women was 42.4% (95% CI: 38.3, 46.5). In multivariate logistic regression, the age of mothers between 16-24 years old (AOR = 3.9, 95% CI: 1.60, 9.70), household food insecurity (AOR = 1.81, 95% CI: 1.04, 3.15), and poor dietary knowledge (AOR = 3.25, 95% CI: 1.94, 5.47) were the factors significantly associated with undernutrition among pregnant women. Conclusion According to this study finding, the prevalence of undernutrition was very much high in the study area, which was significantly associated with the age groups of 16-24 years older women, poor dietary knowledge, and household food insecurity. Therefore, the strategies and programs targeted towards reducing and preventing undernutrition among pregnant mothers should be made at all levels to improve their nutritional status, and also health information, nutrition counseling, and food assistant should be provided.
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Affiliation(s)
- Abel Girma Tilahun
- School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Dinaol Abdissa Fufa
- School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Rahel Dereje Taddesse
- School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Wun J, Kemp C, Puett C, Bushnell D, Crocker J, Levin C. Measurement of benefits in economic evaluations of nutrition interventions in low- and middle-income countries: A systematic review. MATERNAL & CHILD NUTRITION 2022; 18:e13323. [PMID: 35137531 PMCID: PMC8932707 DOI: 10.1111/mcn.13323] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/24/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Abstract
Economic evaluation of nutrition interventions that compares the costs to benefits is essential to priority-setting. However, there are unique challenges to synthesizing the findings of multi-sectoral nutrition interventions due to the diversity of potential benefits and the methodological differences among sectors in measuring them. This systematic review summarises literature on the interventions, sectors, benefit terminology and benefit types included in cost-effectiveness, cost-utility and benefit-cost analyses (CEA, CUA and BCA, respectively) of nutrition interventions in low- and middle-income countries. A systematic search of five databases published from January 2010 to September 2019 with expert consultation yielded 2794 studies, of which 93 met all inclusion criteria. Eighty-seven per cent of the included studies included interventions delivered from only one sector, with almost half from the health sector (43%), followed by food/agriculture (27%), water, sanitation and hygiene (WASH) (10%), and social protection (8%). Only 9% of studies assessed programmes involving more than one sector (health, food/agriculture, social protection and/or WASH). Eighty-one per cent of studies used more than one term to refer to intervention benefits. The included studies calculated 128 economic evaluation ratios (57 CEAs, 39 CUAs and 32 BCAs), and the benefits they included varied by sector. Nearly 60% measured a single benefit category, most frequently nutritional status improvements; other health benefits, cognitive/education gains, dietary diversity, food security, knowledge/attitudes/practices and income were included in less than 10% of all ratios. Additional economic evaluation of non-health and multi-sector interventions, and incorporation of benefits beyond nutritional improvements (including cost savings) in future economic evaluations is recommended.
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Affiliation(s)
- Jolene Wun
- Independent ConsultantWashingtonDistrict of ColumbiaUSA
| | - Christopher Kemp
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Chloe Puett
- Program in Public HealthStony Brook UniversityStony BrookNew YorkUSA
| | - Devon Bushnell
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Jonny Crocker
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Carol Levin
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
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Acute Inflammation Is a Predisposing Factor for Weight Gain and Insulin Resistance. Pharmaceutics 2022; 14:pharmaceutics14030623. [PMID: 35335996 PMCID: PMC8954490 DOI: 10.3390/pharmaceutics14030623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
In the course of infection and intense endotoxemia processes, induction of a catabolic state leading to weight loss is observed in mice and humans. However, the late effects of acute inflammation on energy homeostasis, regulation of body weight and glucose metabolism are yet to be elucidated. Here, we addressed whether serial intense endotoxemia, characterized by an acute phase response and weight loss, could be an aggravating or predisposing factor to weight gain and associated metabolic complications. Male Swiss Webster mice were submitted to 8 consecutive doses of lipopolysaccharide (10 mg/kg LPS), followed by 10 weeks on a high-fat diet (HFD). LPS-treated mice did not show changes in weight when fed standard chow. However, when challenged by a high-fat diet, LPS-treated mice showed greater weight gain, with larger fat depot areas, increased serum leptin and insulin levels and impaired insulin sensitivity when compared to mice on HFD only. Acute endotoxemia caused a long-lasting increase in mRNA expression of inflammatory markers such as TLR-4, CD14 and serum amyloid A (SAA) in the adipose tissue, which may represent the key factors connecting inflammation to increased susceptibility to weight gain and impaired glucose homeostasis. In an independent experimental model, and using publicly available microarray data from adipose tissue from mice infected with Gram-negative bacteria, we performed gene set enrichment analysis and confirmed upregulation of a set of genes responsible for cell proliferation and inflammation, including TLR-4 and SAA. Together, we showed that conditions leading to intense and recurring endotoxemia, such as common childhood bacterial infections, may resound for a long time and aggravate the effects of a western diet. If confirmed in humans, infections should be considered an additional factor contributing to obesity and type 2 diabetes epidemics.
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Abstract
The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the 'patient voice'. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.
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Chakraborty PA, Talukder A, Haider SS, Gupta RD. Prevalence and factors associated with underweight, overweight and obesity among 15-49-year-old men and women in Timor-Leste. PLoS One 2022; 17:e0262999. [PMID: 35143506 PMCID: PMC8830684 DOI: 10.1371/journal.pone.0262999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 01/10/2022] [Indexed: 01/22/2023] Open
Abstract
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.
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Affiliation(s)
- Promit Ananyo Chakraborty
- Department of Public Health, North South University (NSU), Dhaka, Bangladesh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Animesh Talukder
- Center for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Shams Shabab Haider
- Center for Science of Implementation & Scale Up, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Rajat Das Gupta
- Center for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
- Center for Science of Implementation & Scale Up, BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
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Hasan MM, Ahmed S, Soares Magalhaes RJ, Fatima Y, Biswas T, Mamun AA. Double burden of malnutrition among women of reproductive age in 55 low- and middle-income countries: progress achieved and opportunities for meeting the global target. Eur J Clin Nutr 2022; 76:277-287. [PMID: 34040202 PMCID: PMC8152189 DOI: 10.1038/s41430-021-00945-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine trends and projections of underweight (Body Mass Index, BMI < 18.5 kg/m2) and overweight (BMI ≥ 25.0 kg/m2) in women of reproductive age in 55 low- and middle-income countries (LMICs). METHODS We used data from 2,337,855 women aged 15-49 years from nationally representative Demographic and Health Survey conducted between 1990 and 2018. Bayesian linear regression analyses were performed. RESULTS During 1990-2018, the prevalence of underweight decreased in 35 countries and overweight increased in 50 countries. The highest underweight increase was in Morocco (5.5%) and overweight in Nepal (12.4%). In 2030, >20% of women in eight LMICs will be underweight, with Madagascar (36.8%), Senegal (32.2%), and Burundi (29.2%) projected to experience the highest burden of underweight. Whereas >50% of women in 22 LMICs are projected to be overweight, with Egypt (94.7%), Jordan (75.0%), and Pakistan (74.1%) projected to have the highest burden of overweight. 24 LMICs are projected to experience the double burden of malnutrition (both underweight and overweight >20%) in 2030. Noticeable variations in underweight and overweight were observed across wealth, residence, education, and age of women, with a higher rate of overweight in high-income, high-education, and urban women. These inequalities have widened in many countries and are projected to continue. The probability of eradicating overweight and underweight is nearly 0% for all countries by 2030, except Egypt is on track to eradicate underweight. CONCLUSIONS Although the prevalence of underweight declined, this decline has been superseded by the dramatic increase of overweight. None of the 55 LMICs is likely to eradicate malnutrition in women by 2030.
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Affiliation(s)
- Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia.
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia.
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ricardo J Soares Magalhaes
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Yaqoot Fatima
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, 4825, Australia
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
| | - Abdullah A Mamun
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
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Liu H, Zhang M, Fu P, Chen Y, Zhou C. Dual Burden of Malnutrition Among Adolescents With Hunger Aged 12-15 Years in 41 Countries: Findings From the Global School-Based Student Health Survey. Front Med (Lausanne) 2022; 8:771313. [PMID: 35083236 PMCID: PMC8784550 DOI: 10.3389/fmed.2021.771313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/15/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Hunger is a pandemic among adolescents, resulting in both underweight and obesity, and posing a substantial health challenge. Objective: To estimate the dual burden of malnutrition among adolescents with hunger. Design: Data were from the Global school-based Student Health Survey (GSHS). In total, data from 26,986 adolescents with hunger across 5 regions and 41 countries between 2010 and 2015 were analyzed in this study. Weighted prevalence and mean estimates of underweight, overweight, and obesity were calculated by gender, age, and country. Prevalence and 95% confidence intervals (CI) were calculated for regional and country-level income. Results: The total prevalence of underweight, overweight and obesity among young adolescents with hunger was 6.2% (95% CI: 4.4–8.0%), 25.1% (95% CI: 20.3–29.9%) and 8.9% (95% CI: 6.5–11.3%), respectively. Southeast Asia had the highest prevalence of underweight (17.2%; 95% CI: 7.3–27.0%). America had the highest regional prevalence of obesity (11.1%; 95% CI: 7.2–15.1%) and overweight (28.9%; 95% CI: 21.9–35.9%). Low income countries had relatively high prevalence of underweight (11.5%; 95% CI: 3.2–19.9%). High income countries had the highest prevalence of obesity (17.4%; 95% CI: 14.9–19.9%) and overweight (38.7%; 95% CI: 32.0–45.4%). The co-existence of underweight and overweight among adolescents with hunger was highest in the Eastern Mediterranean region, and in upper-middle and high-income countries. Conclusions: There is a dual burden of underweight and obesity among adolescents with hunger aged 12–15 years, which differs between geographical regions. The integration of targeted interventions and policies is required to simultaneously address both underweight and increasing rates of obesity among adolescents with hunger in different regions.
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Affiliation(s)
- Huaqing Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,School of Public Health, Bengbu Medical College, Bengbu, China
| | - Min Zhang
- School of Health Management, Bengbu Medical College, Bengbu, China
| | - Peipei Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yan Chen
- School of Public Health, Wannan Medical College, Wuhu, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
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Emmert-Fees KMF, Karl FM, von Philipsborn P, Rehfuess EA, Laxy M. Simulation Modeling for the Economic Evaluation of Population-Based Dietary Policies: A Systematic Scoping Review. Adv Nutr 2021; 12:1957-1995. [PMID: 33873201 PMCID: PMC8483966 DOI: 10.1093/advances/nmab028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/24/2020] [Accepted: 02/24/2021] [Indexed: 01/02/2023] Open
Abstract
Simulation modeling can be useful to estimate the long-term health and economic impacts of population-based dietary policies. We conducted a systematic scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guideline to map and critically appraise economic evaluations of population-based dietary policies using simulation models. We searched Medline, Embase, and EconLit for studies published in English after 2005. Modeling studies were mapped based on model type, dietary policy, and nutritional target, and modeled risk factor-outcome pathways were analyzed. We included 56 studies comprising 136 model applications evaluating dietary policies in 21 countries. The policies most often assessed were reformulation (34/136), taxation (27/136), and labeling (20/136); the most common targets were salt/sodium (60/136), sugar-sweetened beverages (31/136), and fruit and vegetables (15/136). Model types included Markov-type (35/56), microsimulation (11/56), and comparative risk assessment (7/56) models. Overall, the key diet-related risk factors and health outcomes were modeled, but only 1 study included overall diet quality as a risk factor. Information about validation was only reported in 19 of 56 studies and few studies (14/56) analyzed the equity impacts of policies. Commonly included cost components were health sector (52/56) and public sector implementation costs (35/56), as opposed to private sector (18/56), lost productivity (11/56), and informal care costs (3/56). Most dietary policies (103/136) were evaluated as cost-saving independent of the applied costing perspective. An analysis of the main limitations reported by authors revealed that model validity, uncertainty of dietary effect estimates, and long-term intervention assumptions necessitate a careful interpretation of results. In conclusion, simulation modeling is widely applied in the economic evaluation of population-based dietary policies but rarely takes dietary complexity and the equity dimensions of policies into account. To increase relevance for policymakers and support diet-related disease prevention, economic effects beyond the health sector should be considered, and transparent conduct and reporting of model validation should be improved.
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Affiliation(s)
- Karl M F Emmert-Fees
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Florian M Karl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Peter von Philipsborn
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Ayenan MAT, Aglinglo LA, Zohoungbogbo HPF, N'Danikou S, Honfoga J, Dinssa FF, Hanson P, Afari-Sefa V. Seed Systems of Traditional African Vegetables in Eastern Africa: A Systematic Review. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.689909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traditional African Vegetables (TAV) play an important role in the livelihoods, food and nutritional security of local populations. Access to high-quality seeds of improved varieties is a foundation for increasing crop productivity. TAV seed systems have received little attention. We systematically reviewed the literature to assess the sustainability (seed quality, availability, accessibility, affordability, and profitability of seed businesses) of TAV seed systems in Eastern Africa. The review revealed that the private sector mediated seed system (i.e., formal) offered higher potential for seed quality, and profitability for seed growers. The community-based seed system showed higher potential in ensuring a better access to seeds. The quality of TAV seeds was partially addressed in the studies with a focus on germination percentage and purity, which varied across systems, crops, and geography. While there was a trend of poorer seed quality in the informal system, seed quality in the formal and community-based systems was not necessarily better. The affordability of seed from the various systems (private sector mediated, community based and informal) needs further investigation. Because TAV seed systems are localized and differ significantly among and within countries, tailored interventions are required when promoting a given TAV seed system. We identified inter-regional gaps in TAV seed systems studies, with all the studies concentrated in Eastern Africa, mainly in Tanzania and Kenya. Filling these gaps will require more investment in other regions in sub-Saharan Africa to document existing initiatives or initiate interventions seeking to promote access to high-quality TAV seeds. This review sheds light on existing gaps in research on TAV seed systems to guide future interventions.
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Estecha Querol S, Iqbal R, Kudrna L, Al-Khudairy L, Gill P. The Double Burden of Malnutrition and Associated Factors among South Asian Adolescents: Findings from the Global School-Based Student Health Survey. Nutrients 2021; 13:2867. [PMID: 34445025 PMCID: PMC8399808 DOI: 10.3390/nu13082867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 01/22/2023] Open
Abstract
The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12-15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associated with adolescent malnutrition were: age, hygiene behaviours, social support, sedentary behaviour, and tobacco use. A substantial proportion of stunting, thinness and overweight was found among school-going South Asian adolescents, indicating that the double burden of malnutrition is present in this population. Future research should seek to further understand the relationship between all forms of malnutrition and its associated factors in the adolescent population.
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Affiliation(s)
- Sara Estecha Querol
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan;
| | - Laura Kudrna
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK;
| | - Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;
| | - Paramijit Gill
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;
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Sembiring D, Aritonang EY, Purba A, Lubis R. Enrichment of Biscuits with Andaliman and Fermented Buffalo Milk Biscuits for the Intervention of Malnutrition in Children Under Five. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Nutritional problems in children under 5 in Indonesia are very large and need effective intervention. Local ingredient is potential to create enrichment biscuits.
AIM: This study aims to produce biscuits enriched with Andaliman (Zanthoxylum acanthopodium) and fermented buffalo milk and to perform organoleptic tests on the taste, color, aroma, and texture of the biscuits.
METHODS: Three types of biscuits were made, namely, biscuits without Andaliman and fermented buffalo milk, biscuits with 2 g of Andaliman and 200 g of fermented buffalo milk, and biscuits with 3 g of Andaliman and 200 g of fermented buffalo milk. The all three biscuits were then tested organoleptically in the form of preferences by a panel of expert teachers to see choices for taste, color, aroma, and texture. The biscuits are then tested in a laboratory to assess their nutritional content.
RESULTS: Biscuits with 2 g of Andaliman and 200 g of fermented buffalo milk had the greatest preference. Statistically, the three groups of biscuits differed in taste, aroma, and texture (p < 0.05). The nutritional content of biscuits is above the standards set by the Ministry of Health.
CONCLUSION: Biscuits containing 2 g of Andaliman and 200 g of fermented buffalo milk have the potential to be produced as one of the intervention methods for under 5-year-old children malnutrition in Indonesia.
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de Juras AR, Hsu WC, Hu SC. Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey. Nutrients 2021; 13:2339. [PMID: 34371849 PMCID: PMC8308505 DOI: 10.3390/nu13072339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 01/20/2023] Open
Abstract
The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.
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Affiliation(s)
- Aileen R. de Juras
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan; (A.R.d.J.); (W.-C.H.)
- Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines Los Baños, Laguna 4031, Philippines
| | - Wan-Chen Hsu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan; (A.R.d.J.); (W.-C.H.)
| | - Susan C. Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan; (A.R.d.J.); (W.-C.H.)
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Double burden of underweight and overweight among Indian adults: spatial patterns and social determinants. Public Health Nutr 2021; 24:2808-2822. [PMID: 33875031 PMCID: PMC9884774 DOI: 10.1017/s1368980021001634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study explores the spatial patterns of underweight and overweight among adult men and women in districts of India and identifies the micro-geographical locations where the risks of underweight and overweight are simultaneously prevalent, after accounting for demographic and socio-economic factors. DESIGN We relied on BMI (weight (kg)/height squared (m2)), a measure of nutritional status among adult individuals, from the 2015-2016 National Family and Health Survey. Underweight was defined as <18·5 kg/m2 and overweight as ≥25·0 kg/m2. SETTING We adopted Bayesian structured additive quantile regression to model the underlying spatial structure in underweight and overweight burden. PARTICIPANTS Men aged 15-54 years (sample size: 108 092) and women aged 15-49 years (sample size: 642 002). RESULTS About 19·7 % of men and 22·9 % of women were underweight, and 19·6 % of men and 20·6 % of women were overweight. Results indicate that malnutrition burden in adults exhibits geographical divides across the country. Districts located in the central, western and eastern regions show higher risks of underweight. There is evidence of substantial spatial clustering of districts with higher risk of overweight in southern and northern India. While finding a little evidence on double burden of malnutrition among population groups, we identified a total of sixty-six double burden districts. CONCLUSIONS The current study demonstrates that the geographical burden of overweight in Indian adults is yet to surpass that of underweight, but the coexistence of double burden of underweight and overweight in selected regions presents a new challenge for improving nutritional status and necessitates specialised policy initiatives.
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Jiwani SS, Gatica-Domínguez G, Crochemore-Silva I, Maïga A, Walton S, Hazel E, Baille B, Bose S, Bosu WK, Busia K, Ca T, Coulibaly-Zerbo F, Faye CM, Kumapley R, Mehra V, Somda SMA, Verstraeten R, Amouzou A. Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study. BMJ Glob Health 2021; 5:bmjgh-2020-002948. [PMID: 33033052 PMCID: PMC7545504 DOI: 10.1136/bmjgh-2020-002948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/14/2020] [Accepted: 08/09/2020] [Indexed: 01/27/2023] Open
Abstract
Introduction Evidence on the rate at which the double burden of malnutrition unfolds is limited. We quantified trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa. Methods We analysed 102 Demographic and Health Surveys between 1993 and 2017 from 35 countries. We assessed regional trends through cross-sectional series analyses and ran multilevel linear regression models to estimate the average annual rate of change (AARC) in the prevalence of underweight, anaemia, anaemia during pregnancy, overweight and obesity among women by their age, residence, wealth and education levels. We quantified current absolute inequalities in these indicators and wealth-inequality trends. Results There was a modest decline in underweight prevalence (AARC=−0.14 percentage points (pp), 95% CI −0.17 to -0.11). Anaemia declined fastest among adult women and the richest pregnant women with an AARC of −0.67 pp (95% CI −1.06 to -0.28) and −0.97 pp (95% CI −1.60 to -0.34), respectively, although it affects all women with no marked disparities. Overweight is increasing rapidly among adult women and women with no education. Capital city residents had a threefold more rapid rise in obesity (AARC=0.47 pp, 95% CI 0.39, 0.55), compared with their rural counterparts. Absolute inequalities suggest that Ethiopia and South Africa have the largest gap in underweight (15.4 pp) and obesity (28.5 pp) respectively, between adult and adolescent women. Regional wealth inequalities in obesity are widening by 0.34 pp annually. Conclusion Underweight persists, while overweight and obesity are rising among adult women, the rich and capital city residents. Adolescent girls do not present adverse nutritional outcomes except anaemia, remaining high among all women. Multifaceted responses with an equity lens are needed to ensure no woman is left behind.
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Affiliation(s)
- Safia S Jiwani
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Inacio Crochemore-Silva
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Abdoulaye Maïga
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shelley Walton
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Hazel
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Sujata Bose
- Alive & Thrive/FHI Solutions, Washington, DC, USA
| | - William K Bosu
- Department of Public Health and Research, West Africa Health Organization, Bobo Dioulasso, Burkina Faso
| | - Kofi Busia
- Department of Healthcare Services, West Africa Health Organization, Bobo Dioulasso, Burkina Faso
| | - Tome Ca
- Department of Planning and Health Information, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | | | - Cheikh Mbacké Faye
- West Africa Regional Office, African Population and Health Research Center, Dakar, Senegal
| | - Richard Kumapley
- Data and Analytics Section, Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, New York, USA
| | - Vrinda Mehra
- Data and Analytics Section, Division of Data, Analysis, Planning and Monitoring, UNICEF, New York, New York, USA
| | - Serge M A Somda
- Department of Planning and Health Information, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso
| | - Roosmarijn Verstraeten
- Division of Poverty, Health and Nutrition, International Food Policy Research Institute, Dakar, Senegal
| | - Agbessi Amouzou
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Martín-Turrero I, Lescure Rodríguez J, Lora Pablos D, López-Ejeda N, Vargas Brizuela A, Martínez Álvarez JR, Marrodán Serrano MD. Growth patterns of normo-nourished Afghan, Haitian and Congolese children aged 6-59 months: A comparative study. Am J Hum Biol 2021; 34:e23620. [PMID: 34042248 DOI: 10.1002/ajhb.23620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/24/2021] [Accepted: 05/07/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Irene Martín-Turrero
- EPINUT Research Group, Department of Biodiversity, Ecology and Evolution, Complutense University of Madrid, Madrid, Spain.,Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Javier Lescure Rodríguez
- EPINUT Research Group, Department of Biodiversity, Ecology and Evolution, Complutense University of Madrid, Madrid, Spain
| | - David Lora Pablos
- Research Institute Hospital 12 de Octubre (i+12), CIBER Epidemiology and Public Health (CIBERESP), Department of Statistics and Data Science, Faculty of Statistical Studies, Complutense University of Madrid, Madrid, Spain
| | - Noemí López-Ejeda
- EPINUT Research Group, Department of Biodiversity, Ecology and Evolution, Complutense University of Madrid, Madrid, Spain.,NGO, Action Against Hunger, Madrid, Spain
| | | | - Jesús Román Martínez Álvarez
- EPINUT Research Group, Department of Biodiversity, Ecology and Evolution, Complutense University of Madrid, Madrid, Spain
| | - María Dolores Marrodán Serrano
- EPINUT Research Group, Department of Biodiversity, Ecology and Evolution, Complutense University of Madrid, Madrid, Spain.,Institute of Environmental Sciences (IUCA), Complutense University of Madrid, Madrid, Spain
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Chen G, Jia W, Zhao Y, Mao ZH, Lo B, Anderson AK, Frost G, Jobarteh ML, McCrory MA, Sazonov E, Steiner-Asiedu M, Ansong RS, Baranowski T, Burke L, Sun M. Food/Non-Food Classification of Real-Life Egocentric Images in Low- and Middle-Income Countries Based on Image Tagging Features. Front Artif Intell 2021; 4:644712. [PMID: 33870184 PMCID: PMC8047062 DOI: 10.3389/frai.2021.644712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Abstract
Malnutrition, including both undernutrition and obesity, is a significant problem in low- and middle-income countries (LMICs). In order to study malnutrition and develop effective intervention strategies, it is crucial to evaluate nutritional status in LMICs at the individual, household, and community levels. In a multinational research project supported by the Bill & Melinda Gates Foundation, we have been using a wearable technology to conduct objective dietary assessment in sub-Saharan Africa. Our assessment includes multiple diet-related activities in urban and rural families, including food sources (e.g., shopping, harvesting, and gathering), preservation/storage, preparation, cooking, and consumption (e.g., portion size and nutrition analysis). Our wearable device ("eButton" worn on the chest) acquires real-life images automatically during wake hours at preset time intervals. The recorded images, in amounts of tens of thousands per day, are post-processed to obtain the information of interest. Although we expect future Artificial Intelligence (AI) technology to extract the information automatically, at present we utilize AI to separate the acquired images into two binary classes: images with (Class 1) and without (Class 0) edible items. As a result, researchers need only to study Class-1 images, reducing their workload significantly. In this paper, we present a composite machine learning method to perform this classification, meeting the specific challenges of high complexity and diversity in the real-world LMIC data. Our method consists of a deep neural network (DNN) and a shallow learning network (SLN) connected by a novel probabilistic network interface layer. After presenting the details of our method, an image dataset acquired from Ghana is utilized to train and evaluate the machine learning system. Our comparative experiment indicates that the new composite method performs better than the conventional deep learning method assessed by integrated measures of sensitivity, specificity, and burden index, as indicated by the Receiver Operating Characteristic (ROC) curve.
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Affiliation(s)
- Guangzong Chen
- Department of Electrical and Computer Engineering, University of Pittsburgh, PA, United States
| | - Wenyan Jia
- Department of Electrical and Computer Engineering, University of Pittsburgh, PA, United States
| | - Yifan Zhao
- Department of Electrical and Computer Engineering, University of Pittsburgh, PA, United States
| | - Zhi-Hong Mao
- Department of Electrical and Computer Engineering, University of Pittsburgh, PA, United States
| | - Benny Lo
- Hamlyn Centre, Imperial College London, London, United Kingdom
| | - Alex K. Anderson
- Department of Foods and Nutrition, University of Georgia, Athens, GA, United States
| | - Gary Frost
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Modou L. Jobarteh
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Megan A. McCrory
- Department of Health Sciences, Boston University, Boston, MA, United States
| | - Edward Sazonov
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL, United States
| | | | - Richard S. Ansong
- Department of Nutrition and Food Science, University of Ghana, Legon-Accra, Ghana
| | - Thomas Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Lora Burke
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mingui Sun
- Department of Electrical and Computer Engineering, University of Pittsburgh, PA, United States
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, United States
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Deteriorated Dietary Patterns with Regards to Health and Environmental Sustainability among Hungarian Roma Are Not Differentiated from Those of the General Population. Nutrients 2021; 13:nu13030721. [PMID: 33668386 PMCID: PMC7996132 DOI: 10.3390/nu13030721] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
Nutritional epidemiology studies on Roma people are scarce and, to date, their nutrient-based dietary patterns with regards to both healthy and sustainable dietary considerations have never been reported. We report, for the first time, adherence to healthy and sustainable dietary patterns using scoring and regression models, based on recommendations defined by the World Health Organization, in the Dietary Approaches to Stop Hypertension (DASH) study and the EAT-Lancet report, as well as dietary quality based on Dietary Inflammatory Index (DII) among the Hungarian Roma (HR) population living in North East Hungary, with Hungarian general (HG) adults as reference. Data were obtained from a complex, comparative health survey involving dietary assessment, structured questionnaire-based interview, physical and laboratory examinations on 359 HG and 344 HR subjects in Northeast Hungary. Poisson regressions were fit to models that included DASH, EAT, DII and Healthy Diet Indicator as dependent variables to assess the influence of ethnicity on healthy and sustainable nutrient-based patterns. Adjusted models controlled for all relevant covariates using the residual method indicated poor dietary quality with regards to the selected dietary patterns. These associations were not ethnicity-sensitive, except for DII, where Roma ethnicity was linked to a decrease of DII score (β = −0.455, 95%CI: −0.720; −0.191, p < 0.05). Currently, HR dietary patterns appear to be relatively unhealthy and unsustainable, rendering them vulnerable to elevated risk of ill-health. Nevertheless, their dietary patterns did not strongly differ from HG, which may contribute to Hungarians being one of the most obese and malnourished nations in Europe. Further prospective research on the potential public and environmental health effects of these findings is warranted.
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Xu YY, Sawadogo-Lewis T, King SE, Mitchell A, Roberton T. Integrating nutrition into the education sector in low- and middle-income countries: A framework for a win-win collaboration. MATERNAL AND CHILD NUTRITION 2021; 17:e13156. [PMID: 33590645 PMCID: PMC8189246 DOI: 10.1111/mcn.13156] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 12/01/2022]
Abstract
Malnutrition—both undernutrition and overnutrition—is a public health concern worldwide and particularly in low‐ and middle‐income countries (LMICs). The education sector has high potential to improve immediate nutrition outcomes by providing food in schools and to have more long‐term impact through education. We developed a conceptual framework to show how the education sector can be leveraged for nutrition. We reviewed the literature to identify existing frameworks outlining how nutrition programs can be delivered by and through the education sector and used these to build a comprehensive framework. We first organized nutrition programs in the education sector into (1) school food, meals, and food environment; (2) nutrition and health education; (3) physical activity and education; (4) school health services; and (5) water, sanitation, and hygiene (WASH) sector. We then discuss how each one can be successfully implemented. We found high potential in improving nutrition standards and quality of school foods, meals and food environment, especially through collaboration with the agriculture sector. There is a need for well‐integrated, culturally appropriate nutrition and health education into the existing school curriculum. This must be supported by a skilled workforce—including nutrition and public health professionals and school staff. Parental and community engagement is cornerstone for program sustainability and success. Current monitoring and evaluation of nutrition programming in schools is weak, and effectiveness, including cost‐effectiveness, of interventions is not yet adequately quantified. Finally, we note that opportunities for leveraging the education sector in the fight against rising overweight and obesity rates are under‐researched and likely underutilized in LMICs.
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Affiliation(s)
- Yvonne Yiru Xu
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Talata Sawadogo-Lewis
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shannon E King
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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