Changing patterns of diet, physical activity and obesity among urban, rural and slum populations in north India

Reported food-related symptoms and food allergen sensitization in a selected adult population in Hyderabad, India: A hospital-based survey

Background

Research on reported food-related triggers of atopic disease in South Asian adults is lacking despite the region's large population and the global significance of allergic diseases.

Objectives

The study aimed to identify prevalent local food items and assess allergic sensitization rates to potential trigger foods for atopic diseases via skin prick and specific IgE testing.

Methods

The study began with a pilot survey of 100 subjects recruited from 4 hospitals in Hyderabad, India, focusing on foods perceived to relate to asthma, allergic rhinitis, atopic dermatitis, urticaria, and gastrointestinal allergic symptoms. A subsequent main study evaluated 2010 participants, 1754 of whom were diagnosed with an aforementioned atopic disease and who reported allergic symptoms related to any of 77 foods identified in the pilot study. Ultimately 1622 patients who consented to skin prick and specific IgE testing and who reported at least 1 food item triggering allergic diseases were included in the final analysis.

Results

Among 1622 patients (average age, 42.6 ± 12.9 years; 55.5% male), asthma was the most commonly diagnosed atopic disease (26.4%), with itching and rash being frequently reported symptoms (22.7%). Notably, 94.9% of patients had total serum IgE > 144 kU/L. Chickpea, cabbage, eggplant, walnut, cumin, and betel leaf were the most commonly reported trigger foods.

Conclusion

In this sample of South Indian adults diagnosed with allergic disease, reported food triggers were most commonly local dietary staples, while reported reactions to priority allergens like peanut and sesame were conspicuously absent. Observed concordance between patient-reported food triggers and sensitization to reported food triggers was low, highlighting the need for improved clinical evaluation of suspected triggers.

Residence-based inequalities in overweight/obesity in sub-Saharan Africa: a multivariate non-linear decomposition analysis

BACKGROUND

Overweight/obesity remains a major risk factor for non-communicable diseases and their associated morbidities and mortalities. Yet, limited studies have comprehensively examined factors contributing to the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa. Thus, our study sought to decompose the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa (SSA) using nationally representative datasets.

METHODS

We performed a cross-sectional analysis of data from the Demographic and Health Surveys of 23 sub-Saharan African countries conducted from 2015 to 2022. A sample of 177,329 women was included in the analysis. Percentages with confidence intervals (CIs) were used to summarize the prevalence of overweight/obesity per rural-urban strata and pooled level. A multivariate non-linear decomposition analysis was used to identify the factors contributing to the rural-urban disparities in overweight/obesity. The results were presented using coefficients and percentages.

RESULTS

The pooled prevalence of overweight/obesity among the women was higher in urban areas (38.9%; 95% CI = 38.2-39.6) than rural areas (19.1%; 95% CI = 18.7-19.6). This pattern was observed in all the countries surveyed, except in South Africa, where women in rural areas (53.1%; 95% CI = 50.0-56.4) had a higher prevalence of overweight/obesity than those in urban areas (46.0%; 95% CI = 43.2-48.9). Approximately 54% of the rural-urban disparities in overweight/obesity was attributable to the differences in the women's characteristics or explanatory variables. More than half of the rural-urban disparities in overweight/obesity would be reduced if the disparities in women's characteristics were levelled. Among the women's characteristics, frequency of watching television (29.03%), wealth index (26.59%), and level of education (9.40%) explained approximately 65% of the rural-urban differences in overweight/obesity.

CONCLUSION

The prevalence of overweight/obesity among women in SSA remains high and skewed towards women in urban areas. Increased frequency of watching television, high wealth index, and higher educational attainment contributed largely to the rural-urban disparities in overweight/obesity among women in SSA. Thus, interventions aimed at reducing overweight/obesity among women in SSA could be targeted at reducing the frequency of television watching as well as promoting physical activities among wealthy women and those with higher education, particularly in urban areas.

Gender-specific determinants of overweight and obesity among older adults in India: evidence from a cross-sectional survey, 2017-18

BACKGROUND

A major societal trend of the twenty-first century is the rapidly ageing population as a consequence of the decline in fertility and increase in life expectancy. Along with the rise in ageing population, the burden of obesity and related non-communicable diseases is also equally rising. In this study, we aimed to investigate the potential gender-specific determinants of overweight and obesity among older adults in India.

SUBJECTS AND METHODS

The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 25,952 older adults (≥ 60 years) was selected for the study. Descriptive statistics, bivariate chi-square test, and logistic regression estimation were applied to accomplish the study objectives. Body mass index (BMI) has been classified in this study according to the WHO criteria.

RESULTS

The prevalence of overweight was higher among women (18.15% in rural areas and 46.62% in urban areas) compared to men (12.9% in rural areas and 30.61% in urban areas). Similarly, obesity was higher among women than men who were residing in urban areas (17.07% vs. 5.37%), had secondary or above education (32.38% vs. 6.1%) belonged to richest strata (16.37% vs. 4.50%), or had mobility impairment (9.2% vs. 2.8%). Despite adjustment for several confounders, women were more likely to be overweight (OR: 2.18; CI: 1.86, 2.55) and obese (OR: 3.79; CI: 2.86, 5.03) than men. However, among both the elderly men and women, those who were highly educated were 2.29 times (OR: 2.29; CI: 1.80, 4.11) and 2.71 times (OR: 2.71; CI: 1.78, 4.11), respectively more likely to be overweight than their illiterate counterparts. Older adults living in urban areas were more likely to suffer from obesity compared to rural men (OR: 1.47; CI: 1.07, 2.02) and women (OR: 2.58; CI: 1.85, 3.60). Both men and women, who were highly educated were 2.64 times (OR: 2.64; CI: 1.71, 4.09) and 2.94 times (OR: 2.94; CI: 1.40, 6.20), respectively, more likely to be obese than their illiterate counterparts. Older men and women who were richest (OR: 1.60; CI: 1.19, 2.14 & OR: 2.12; CI: 1.63,2.76), or had mobility impairment (OR: 1.33; CI: 1.09,1.61 & OR: 1.72; CI: 1.42,2.08) were more likely to be overweight than their counterparts who were poorest or did not have any mobility limitation, respectively.

CONCLUSIONS

This study found increased vulnerability of overweight and obesity among older women than men irrespective of their socioeconomic, demographic, and health status. The present study suggests that introducing preventative measures such as campaigns to encourage physical activity, and community awareness may help reduce the high burden of overweight and obesity. Finally, the findings are important for better functioning of any public health programme and suitable intervention techniques to maintain a healthy body in order to lower the prevalence and risk factors of non-communicable diseases in later life.

Prevalence and risk factor of diabetes among the elderly people in West Bengal: evidence-based LASI 1st wave

BACKGROUND

The complication of Diabetes is one of the important health issues among the older adult population in any region. The higher risks of diabetes prevalence among older adult people in the countries was due to social-cultural changes such as increasing urbanization, dietary changes, without physical activity, and unhealthy lifestyle behavior. The present study examines the prevalence and associated risk factors of diabetes among older adults in the state of West Bengal.

METHODS

The first wave of the Longitudinal Ageing Study in India 2017-18 was used to achieve the study objectives. Descriptive statistics with multinomial logistic regression models were used to carry out crude and adjusted odds ratios with 95% confidence intervals and examine the associated risk factors of diabetes prevalence among older adults.

RESULTS

The findings of the study indicate that the overall prevalence of diabetes among the study participants was found to be 12.4% which was significantly higher in urban areas (19%) compare to rural areas (6%). The socio-economic and bio-demographic factors like educational status, richest background family, marital status, obesity, and family history of diabetes were significantly associated with higher risks of diabetes prevalence among the older adult population in West Bengal. The risks of diabetes in the richest adult people were significantly higher than in the poorest adult people (OR = 2.78; 95% CI: 1.974-3.917). The higher risks of diabetes mellitus among the richest wealthy people are because of lifestyle behavior, smoking, and tobacco consumption respectively.

CONCLUSION

The study needs to policy and awareness program to reduce economic inequality and prevention of diabetes care and treatment-seeking behavior, especially for the older adult population in West Bengal.

Heterogeneity of Dietary practices in India: current status and implications for the prevention and control of type 2 diabetes

Diet is one of the important modifiable factors in prevention of type 2 diabetes (T2D), making it important to understand geographical variations of food consumption pattern, their similarities and differences across various regions. Asian Indian diet patterns are mostly carbohydrate-based and with vast regional diversity. Staple food, food groups consumed, meat consumption pattern, type of fermented foods, food preparations, type of cooking oil used and food ingredients vary with different regions of India. There has been a slow transition from consumption of coarse grains to refined grains owing to socio-economic, cultural and other factors. Consumption of fruits and vegetables, fats, ready-to-eat foods and sugar is higher in urban population whereas consumption of carbohydrates in the form of cereals and millets is higher among the rural population. Cereal grains followed by pulses and legumes are main sources of protein, given that the frequency of meat consumption is low even among non-vegetarians in India compared to other countries. Overall, there is a tendency towards consumption of calorie-dense foods at the cost of food diversity, which may also result in micronutrient deficiencies as well as development of T2D and related metabolic diseases. Public health strategies and policy level decisions involving stakeholders with diet and lifestyle modification as focal points are absolute priorities to prevent and manage the burden of obesity and T2D in India.

Effects of social determinants of health on obesity among urban women of reproductive age

Obesity is a major global public health problem. It is spreading very fast in low- and middle-income countries and has reached world record levels in some of them. In Ghana, it has increased by over 65% among urban women in the past three decades. This study investigated the effects of social determinants of health on obesity among women in urban Ghana. The study analyzed the Ghana demographic and health survey data. These are nationally representative data collective every five years across low- and middle-income countries. A total of 1,204 urban women were included in the analysis. Body mass index was the outcome variable of interest. We used logistic regression to model the effects of the various social determinants of health on obesity. The results showed that 40% (95% confidence interval (CI) = 25.4, 57.0) and 36.7% (95% CI = 25.6, 49.3) of women who had higher education and those whose partners had higher education suffered from obesity, respectively. Women living in rich households had a five times higher prevalence of obesity than those in poor households (28.8% vs 5.7%). Further, 33.4% (95% CI = 18.5, 19.3) of women who occupied managerial positions were obese. The results from the multivariable logistic regression analysis suggested that compared to women in poor households, those in rich households were 3.4 times (95% CI = 1.31, 8.97) more likely to suffer from obesity. Women whose main occupation was agriculture were 81% (aOR = 0.19; 95% CI = 0.034, 0.99) less likely to suffer from obesity compared to those with no occupation. The results suggest that the various social determinants of health (SDH) included in the analysis significantly influence obesity outcomes. Women and partner education levels, occupying a managerial position, and living in rich households increase the risk of obesity. Interventions to address the rising obesity in urban Ghana should have specific packages targeted at these sub-groups.

Spatial inequality and explaining the urban-rural gap in obesity in India: Evidence from 2015-16 population-based survey

OBJECTIVE

This study assessed the spatial dimension of urban-rural disparity in obesity prevalence and identified the determinants explaining the urban-rural gap in obesity prevalence in India.

METHODS

Using cross-sectional survey data from the 2015-16 National Family Health Survey, the prevalence rates of obesity were calculated for aged 15-49 years. Two multiscale geographically weighted regressions were performed separately from rural and urban spaces for Indian districts to examine the spatial relationship of the outcome variable and covariates at different geographical scales. Fairlie decomposition analysis was carried out to explore the contribution of each variable in the urban-rural gap.

RESULTS

The rural-urban obesity prevalence difference has increased in a decade time for India from 13.0 to 14.6. Urban counterparts tended to have more people with excess weight. 15 states had an urban-rural prevalence ratio of 2 or higher. The MGWR model showed that varying covariates operated at different scales, i.e. global, regional and local scales, and determined the spatial heterogeneity of obesity prevalence. The only variable, i.e. age (9.49 per cent), had contributed in reducing the gap. Conversely, the socioeconomic variables, i.e. income (96.39 per cent), education (4.95 per cent), caste (4.78 per cent) and occupation (3.11 per cent), had widened the gap.

CONCLUSIONS

Even though this study evidenced the rural-urban gap in obesity prevalence, it indicated the gap's closing shortly, as it was witnessed in a few states. It is urgent to address the obesity epidemic, especially in urban India, due to its higher prevalence and prevent the further increase of prevalence in rural India, mainly because it shelters nearly 70 per cent of the Indian population.

Obesity-related measures and successful ageing among community-dwelling older adults in India: a cross-sectional study

Obesity is a chief lifestyle disease globally and causes a significant increase in morbidities. Overweight/ obesity prevalence has been rising faster in India compared to the world average. Therefore, the study examined the association between overweight/ obesity and successful ageing among older population in India. We also explored the gender difference in risks posed by obesity on successful ageing and the different socio-economic correlates associated with successful ageing. This study utilized data from India's first nationally representative longitudinal ageing survey (LASI-2017-18). The effective sample size for the present study was 31,464 older adults with a mean age of 69.2 years (SD: 7.53). Overweight/ obesity was defined as having a body mass index of 25 or above. The study carried out a bivariate analysis to observe the association between dependent and independent variables. Further, multivariable analysis was conducted to examine the associations after controlling for individual socio-demographic, lifestyle and household/community-related factors. The study included 47.5% men and 52.5% women. It was found that the prevalence of obesity/overweight was higher among older women compared to older men (23.2% vs 15.5%). Similarly, high-risk waist circumference (32.7% vs 7.9%) and high-risk waist-hip ratio (69.2% vs 66.5%) were more prevalent among older women than older men. The study found significant gender differences (men-women: 8.7%) in the prevalence rate of successful ageing (p < 0.001). The chances of successful ageing were significantly higher among older adults who were not obese/overweight [AOR: 1.31; CI 1.31-1.55], had no high-risk waist circumference [AOR: 1.41; CI 1.29-1.54], and those who had no high-risk waist-hip ratio [AOR: 1.16; CI 1.09-1.24] compared to their respective counterparts. Interaction results revealed that older women who were not obese/overweight had a lower likelihood of successful ageing compared to the older men who was not obese/overweight [AOR: 0.86; CI 0.80-0.93]. Similarly, older womens who had no high-risk waist circumference [AOR: 0.86; CI 0.80-0.96] and no high risk-hip ratio [AOR: 0.81; CI 0.73-0.89] were less likely to have successful ageing compared to their counterparts, respectively. Being overweight/ obese and having high-risk waist circumference and waist-hip ratio were found to be significant factors associated with less successful ageing among older adults, especially women in this study. The current findings highlight the importance of understanding the modifiable factors, including nutritional awareness and developing targeted strategies for promoting successful ageing.

Knowledge, attitude and practice regarding diabetes and hypertension among school students of Nepal: A rural vs. urban study

Background

The burden of non-communicable diseases like diabetes and hypertension is increasing worldwide including low-and middle-income countries. Good knowledge of such diseases among young people will make them adopt a healthy lifestyle from an early age, which will, in turn, prevent them from developing such non-communicable diseases. This study aimed to assess the knowledge, attitude, and practice of rural and urban school students regarding diabetes and hypertension. We also aimed to see the differences in the knowledge, attitude, and practice of students from rural vs. urban communities.

Methods

A school-based cross-sectional study was conducted from May 1 2021 to June 30, 2021, in four schools in Nepal (1 from a metropolitan city, 2 from an urban municipality, and 1 from a rural municipality). The study was conducted among the secondary-level students of classes 9 and 10 in each school. The data were collected from the participants via pre-tested questionnaires and analyzed in the Statistical Packages for Social Sciences (SPSS) version 20.0. Logistic regression analysis was carried out to determine the determinants of knowledge and attitude regarding diabetes and hypertension.

Results

Of 380 respondents, 35.5% were residents of metropolitan city, 37.4% were from the urban municipality and 27.1% were from the rural municipality. The mean age of respondents was 15.61±0.99 years and 51.1% were male. Respondents having a family history of diabetes and hypertension were 21.1% and 37.9% respectively. Respondents from the metropolitan city had significantly higher mean knowledge scores than the respondents from the urban and rural municipality (p<0.001) while there was no significant difference in mean attitude scores. There was significantly higher daily consumption of fruits and vegetables among the participants from rural municipality (p<0.01) while no significant difference was seen in salt consumption and time spent on physical activity. In univariate regression analysis, place of residence, family occupation, parental education, and family history of diabetes and hypertension were significantly associated with good knowledge level. In multivariate analysis, only a higher grade of study (grade 10 in comparison to grade 9) was an independent predictor of a student’s good attitude level.

Conclusion

In general, there was a good attitude towards diabetes and hypertension despite poor knowledge. The mean knowledge scores were lower in urban municipality and rural municipality compared to metropolitan city. Low knowledge scores on diabetes and hypertension among the students show an urgent need for school-based interventional programs focusing on non-communicable diseases and lifestyle modification with more emphasis on rural communities.

Prevalence and potential determinants of chronic disease among elderly in India: Rural-urban perspectives

Chronic diseases are the leading causes of disability and premature death among the elderly population in India. The study, using data from the 75^th round of the NSSO survey (N = 44,631), examined the prevalence and determinants of chronic diseases among the population aged 60+ in India by applying bivariate and logistic regression analyses and used a non-linear decomposition technique to understand the urban-rural differences in the prevalence of chronic diseases. About 21% of the elderly in India reportedly have at least one chronic disease. Seventeen percent elderly in rural areas and 29% in urban areas suffer from a chronic disease. Hypertension and diabetes account for about 68% of all chronic diseases. The prevalence of chronic diseases is the highest in Kerala (54%), followed by Andhra Pradesh (43), West Bengal (36), and Goa (32). Those with higher levels of education, staying in urban areas, those who are economically dependent on others, staying alone or without spouse and children, and belonging to wealthy households have a higher likelihood of having a chronic disease. The probability of having a chronic disease is 1.15 times higher among urban residents as compared to their rural counterparts. Elderly rural women, compared to elderly rural men, and never-married, widowed, and divorced elderly urban women, compared to married elderly urban men, are significantly more likely to suffer from chronic ailments. Differences in education, wealth status, and caste are the three most significant contributors to the urban-rural gap in chronic diseases. The high risk of chronic diseases among certain subsets of the elderly population must be recognized as a key public health concern. The findings of our study will likely help promote healthy ageing in India.

Decomposing rural-urban differences in successful aging among older Indian adults

The modernization and shift towards urbanized lifestyles have triggered several diseases, and the context of aging varies in urban and rural settings in India. The study aimed to investigate the urban-rural differences in successful ageing among older adults in India and the contributing factors in those differences. The study utilizes data from nationally representative Longitudinal Ageing Study in India (LASI, 2017-18). The analytical sample size for the study was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were carried out to present the initial results. Multivariable logistic regression and decomposition analysis was used to find the associations between explanatory variables and successful aging and to identify the contributions of covariates that explain the rural-urban differences in successful ageing. A proportion of 32% and 24% of older adults from rural and urban areas were successful agers with an urban disadvantage. Urban-dwelling older adults had 0.67 times [95% confidence interval (CI): (0.64, 0.71)] lower unadjusted odds of successful ageing than rural older adults. Again, after adjusting for the effect of other explanatory variables, urban older adults had 0.92 times [CI: (0.87, 0.98)] lower odds of being successful agers than their rural counterparts. The major contributors to the rural-urban inequality in successful aging were differences in regional distribution (17% contribution), waist circumference (16%), working status (16%), body mass index (13%) and physical activity (8%) among rural and urban older adults. The urban disadvantage in aging successfully may reflect the higher prevalence of adverse lifestyle behaviours in urban dwellers and under-diagnosis and under-reporting of many diseases in rural areas, particularly non-communicable diseases, suggesting the need for further investigation.

Decomposing urban-rural differences in multimorbidity among older adults in India: a study based on LASI data

BACKGROUND

Multimorbidity is defined as the co-occurrence of two or more than two diseases in the same person. With rising longevity, multimorbidity has become a prominent concern among the older population. Evidence from both developed and developing countries shows that older people are at much higher risk of multimorbidity; however, urban-rural differential remained scarce. Therefore, this study examines urban-rural differential in multimorbidity among older adults by decomposing the risk factors of multimorbidity and identifying the covariates that contributed to the change in multimorbidity.

METHODS

The study utilized information from 31,464 older adults (rural-20,725 and urban-10,739) aged 60 years and above from the recent release cross-sectional data of the Longitudinal Ageing Study in India (LASI). Descriptive, bivariate, and multivariate decomposition analysis techniques were used.

RESULTS

Overall, significant urban-rural differences were found in the prevalence of multimorbidity among older adults (difference: 16.3; p < 0.001). The multivariate decomposition analysis revealed that about 51% of the overall differences (urban-rural) in the prevalence of multimorbidity among older adults was due to compositional characteristics (endowments). In contrast, the remaining 49% was due to the difference in the effect of characteristics (Coefficient). Moreover, obese/overweight and high-risk waist circumference were found to narrow the difference in the prevalence of multimorbidity among older adults between urban and rural areas by 8% and 9.1%, respectively. Work status and education were found to reduce the urban-rural gap in the prevalence of multimorbidity among older adults by 8% and 6%, respectively.

CONCLUSIONS

There is a need to substantially increase the public sector investment in healthcare to address the multimorbidity among older adults, more so in urban areas, without compromising the needs of older adults in rural areas.

Trends and risk factors for non-communicable diseases mortality in Nairobi slums (2008-2017)

INTRODUCTION

Tracking progress in reaching global targets for reducing premature mortality from non-communicable diseases (NCDs) requires accurately collected population based longitudinal data. However, most African countries lack such data because of weak or non-existent civil registration systems. We used data from the Nairobi Urban Health and Demographic Surveillance System (NUDSS) to estimate NCD mortality trends over time and to explore the determinants of NCD mortality.

METHODS

Deaths identified in the NUHDSS were followed up with a verbal autopsy to determine the signs and symptoms preceding the death. Causes of death were then assigned using InSilicoVA algorithm. We calculated the rates of NCD mortality in the whole NUHDSS population between 2008 and 2017, looking at how these changed over time. We then merged NCD survey data collected in 2008, which contains information on potential determinants of NCD mortality in a sub-sample of the NUHDSS population, with follow up information from the full NUHDSS including whether any of the participants died of an NCD or non-NCD cause. Poisson regression models were used to identify independent risk factors (broadly categorized as socio-demographic, behavioural and physiological) for NCD mortality, as well as non-NCD mortality.

RESULTS

In the total NUHDSS population of adults age 18 and over, 23% were assigned an NCD as the most likely cause of death. There was evidence that NCD mortality decreased over the study period, with rates of NCD mortality dropping from 1.32 per 1000 person years in 2008-10 (95% CI: 1.13-1.54) to 0.93 per 1000 person years in 2014-17 (95% CI: 0.80-1.08). Of 5115 individuals who participated in the NCD survey in 2008, 421 died during the follow-up period of which 43% were attributed to NCDs. Increasing age, lower education levels, ever smoking and having high blood pressure were identified as independent determinants of NCD mortality in multivariate analyses.

CONCLUSION

We found that NCDs account for one-quarter of mortality in Nairobi slums, although we document a reduction in the rate of NCD mortality over time. This may be attributed to increased surveillance and introduction of population-wide NCD interventions and health system improvements from research activities in the slums. To achieve further decline there is a need to strengthen health systems to respond to NCD care and prevention along with addressing social factors such as education.

Validation of New Interactive Nutrition Assistant - Diet in India Study of Health (NINA-DISH) FFQ with multiple 24-h dietary recalls among pregnant women in Pune, India

Adequate dietary intake is critical to prevent adverse pregnancy outcomes. India has a high burden of maternal and child morbidity and mortality, but there is a lack of adequate tools to assess dietary intake. We validate an FFQ, New Interactive Nutrition Assistant - Diet in India Study of Health (NINA-DISH), among pregnant women living with and without HIV in Pune, India. Women were selected from a cohort study investigating immune responses to HIV and latent tuberculosis during pregnancy. The FFQ was administered during the third trimester and validated against multiple 24-h dietary recalls (24-HDR) collected in second and third trimesters. Data for analysis were available from fifty-eight women out of seventy enrolled into this sub-study, after excluding those with incomplete data or implausible energy intake. The median (Q1, Q3) age of study participants was 23 (20, 25) years. Median (Q1, Q3) daily energy intakes were 10 552 (8000, 11 958) and 10 673 (8510, 13 962) kJ by 24-HDR and FFQ, respectively, with FFQ overestimating nutrient intake. Pearson correlations between log-transformed estimates from FFQ and 24-HDR for energy, protein, carbohydrate, fat, Fe and Zn were 0·47, 0·48, 0·45, 0·33, 0·4 and 0·54, respectively. Energy-adjusted and de-attenuated correlations ranged from 0·41 (saturated fat) to 0·73 (Na). The highest misclassification into extreme tertiles was observed for fat (22 %), saturated fat (21 %) and Na (21 %). Bias existed at higher intake levels as observed by Bland-Altman plots. In conclusion, NINA-DISH is a valid and feasible tool for estimating dietary intakes among urban pregnant women in Western India.

Rural-Urban Differences in Adult Life Expectancy in Indonesia: A Parametric g-formula-based Decomposition Approach

BACKGROUND

Evidence on rural-urban differences in adult mortality in low- and middle-income countries (LMICs) is limited and mixed. We examined the size of and factors contributing to rural-urban life expectancy differences among adults in Indonesia, the third most populous LMIC.

METHODS

Data come from the 2000, 2007, and 2014/2015 waves of the Indonesian Family Life Survey, a population-representative longitudinal study with mortality follow-up. We used Poisson regression and life tables to estimate rural-urban differences in life expectancy among 18,867 adult respondents ≥30 years. We then used a novel g-formula-based decomposition to quantify the contribution of rural-urban differences in blood pressure (BP), body mass index (BMI), and smoking to life expectancy differences.

RESULTS

Compared with urban adults, life expectancy at age 30 was 2.2 (95% confidence interval [CI] = 0.4, 3.9) years higher for rural men and 1.2 (95% CI = -0.4, 2.7) years higher for rural women. Setting the BMI and systolic BP distribution equal in urban and rural adults reduced the urban mortality penalty by 22% for men and 78% for women, with the majority of this reduction coming from the contribution of rural-urban differences in BMI. Smoking did not contribute to the urban mortality penalty for either men or women.

CONCLUSIONS

Adult life expectancy is lower in urban than in rural areas in Indonesia and we estimate that this difference is partly related to differences in BMI and systolic BP.

Novel Cell-Based Assay to Investigate Monoacylglycerol Acyltransferase 2 Inhibitory Activity Using HIEC-6 Cell Line

The dietary triacylglycerol (TAG) gets absorbed and accumulated in the body through the monoacylglycerol (MAG) pathway, which plays a major role in obesity and related disorders. The main enzyme of this pathway, monoacylglycerol acyltransferase 2 (MGAT2), is considered as a potential target for developing antiobesity compounds. Hence, there is a need for in vitro cell-based assays for screening the potential leads for MGAT2 inhibitors. Because of synthetic inhibitor's side effects, there is an increased interest in natural extracts as potential leads. Hence, we have optimized a 2-MAG-induced TAG accumulation inhibitory cell-based assay to screen natural extracts using the HIEC-6 cell line. A concentration-dependent TAG accumulation was observed when the HIEC-6 cells were fed with exogenous 2-MAG. The TAG accumulation was confirmed by in situ BODIPY staining and was quantified. However, no TAG accumulation was seen when the cells were fed with exogenous DAG or TAG, suggesting MGAT2-mediated MAG uptake and its conversion to TAG. We demonstrated the utility of this assay by screening five different plant-based aqueous extracts. These extracts showed various inhibition levels (25% to 30%) of 2-MAG-induced TAG accumulation in the HIEC-6. The MGAT2 inhibitory potential of these extracts was confirmed by an in vitro MGAT2 assay. This cell-based assay adds a new methodology for screening, developing, and evaluating MGAT2 inhibitors for addressing obesity and related disorders.

Profile of risk factors for Non-Communicable Diseases (NCDs) in a highly urbanized district of India: Findings from Puducherry district-wide STEPS Survey, 2019-20

INTRODUCTION

Rapid urbanization and industrialization drives the rising burden of Non-Communicable Diseases (NCDs) worldwide that are characterized by uptake of unhealthy lifestyle such as tobacco and alcohol use, physical inactivity and unhealthy diet. In India, the prevalence of various NCDs and its risk factors shows wide variations across geographic regions necessitating region-specific evidence for population-based prevention and control of NCDs.

OBJECTIVE

To estimate the prevalence of behavioral and biological risk factors of NCDs among adult population (18-69 years) in the Puducherry district located in Southern part of India.

METHODOLOGY

We surveyed adults using the World Health Organization (WHO) prescribed STEPwise approach to NCD surveillance (STEPS) during February 2019 to February 2020. A total of 2560 individuals were selected from urban and rural areas (50 clusters in each) through multi-stage cluster random sampling method. STEPS instrument was used to assess behavioral and physical measurements. Fasting blood sample was collected to estimate biochemical risk factors (Diabetes, Hypercholesterolemia) of NCDs.

RESULTS

Among men, alcohol use 40.4% (95% CI: 37.4-43.4) was almost twice higher compared to tobacco use 24.4% (95% CI: 21.7-26.9). Nearly half of the population was physically inactive 45.8% (95% CI: 43.8-47.8) and obese 46.1% (95% CI: 44-48.1). Hypertension and diabetes mellitus were present among one-third 33.6% (95% CI: 31.6-35.5) and one-fourth 26.7% (95% CI: 24.1-29.1) of the population which were significantly higher among men (37.1% vs 30.8% and 31.6% vs 23.2% respectively). Physical inactivity and overweight/obesity increased with increasing education levels. Tobacco and alcohol use was more common among men, whereas physical inactivity with obesity and hypercholesterolemia was higher among women.

CONCLUSION

We found high prevalence of various NCDs and its risk factors among the adult population of Puducherry district.

Defining pathways to healthy sustainable urban development

Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development.

Correlates of Domain-Specific Physical Activity Among Older Adults in Six Low- to Middle-Income Countries: Analysis of Nationally Representative Samples From Study of Global Aging and Adult Health (SAGE) (Wave 1)

The correlates of physical activity differ across domains. The authors explored the contribution of domain-specific physical activity to total physical activity and examined how different sociodemographic and social capital-related variables are associated with different physical activity domains in older adults, using nationally representative samples from six low- to middle-income countries. Activity at work and home combined plays an important role in contributing to total physical activity, while leisure-time physical activity accounted for an extremely small proportion. Some correlates of physical activity were similar across countries, such as working status and structural social capital, while other associations were country specific. Promoting structural social capital, trust, and perceived safety may confer positive benefits on older adults' activity.

A Comparison of Predictive Performances between Old versus New Criteria in a Risk-Based Screening Strategy for Gestational Diabetes Mellitus

Background

The definition of the high-risk group for gestational diabetes mellitus (GDM) defined by the American College of Obstetricians and Gynecologists was changed from the criteria composed of five historic/demographic factors (old criteria) to the criteria consisting of 11 factors (new criteria) in 2017. To compare the predictive performances between these two sets of criteria.

Methods

This is a secondary analysis of a large prospective cohort study of non-diabetic Korean women with singleton pregnancies designed to examine the risk of GDM in women with nonalcoholic fatty liver disease. Maternal fasting blood was taken at 10 to 14 weeks of gestation and measured for glucose and lipid parameters. GDM was diagnosed by the two-step approach.

Results

Among 820 women, 42 (5.1%) were diagnosed with GDM. Using the old criteria, 29.8% (n=244) of women would have been identified as high risk versus 16.0% (n=131) using the new criteria. Of the 42 women who developed GDM, 45.2% (n=19) would have been mislabeled as not high risk by the old criteria versus 50.0% (n=21) using the new criteria (1-sensitivity, 45.2% vs. 50.0%, P>0.05). Among the 778 patients who did not develop GDM, 28.4% (n=221) would have been identified as high risk using the old criteria versus 14.1% (n=110) using the new criteria (1-specificity, 28.4% vs. 14.1%, P<0.001).

Conclusion

Compared with the old criteria, use of the new criteria would have decreased the number of patients identified as high risk and thus requiring early GDM screening by half (from 244 [29.8%] to 131 [16.0%]).

Socio-demographic patterning of the individual-level double burden of malnutrition in a rural population in South India: a cross-sectional study

BACKGROUND

The double burden of malnutrition is the co-occurrence of undernutrition (e.g. underweight, stunting, and micronutrient deficiencies) and over-nutrition (e.g. obesity, type 2 diabetes, and cardiovascular disease) at the population, household, or individual level. The objectives of this study were to determine the extent and determinants of individual-level co-morbid anemia and overweight and co-morbid anemia and diabetes in a population in rural Tamil Nadu, South India.

METHODS

We undertook a cross-sectional study of adults (n = 753) in a rural region of Tamil Nadu, South India. A survey assessed socio-demographic factors, physical activity levels, and dietary intake. Clinical measurements included body-mass index, an oral glucose tolerance test, and blood hemoglobin assessments. Multivariable logistic regression analyses were used to determine associations between risk factors and two co-morbid double burden pairings: (1) anemia and overweight, and (2) anemia and diabetes.

RESULTS

Prevalence of co-morbid anemia and overweight was 23.1% among women and 13.1% among men. Prevalence of co-morbid anemia and diabetes was 6.2% among women and 6.3% among men. The following variables were associated with co-morbid anemia and overweight in multivariable models [odds ratio (95% confidence interval)]: female sex [2.3 (1.4, 3.85)], high caste [3.2 (1.34, 7.49)], wealth index [1.1 (1.00, 1.12)], rurality (0.7 [0.56, 0.85]), tobacco consumption [0.6 (0.32, 0.96)], livestock ownership [0.5 (0.29, 0.89)], and energy-adjusted meat intake [1.8 (0.61, 0.94)]. The following variables were associated with co-morbid anemia and diabetes in multivariable models: age [1.1 (1.05, 1.11)], rurality [0.8 (0.57, 0.98)], and family history of diabetes [4.9 (1.86, 12.70).

CONCLUSION

This study determined the prevalence and factors associated with individual-level double burden of malnutrition. Women in rural regions of India may be particularly vulnerable to individual-level double burden of malnutrition and should be a target population for any nutrition interventions to address simultaneous over- and undernutrition.

Correlates of sedentary behaviour in Asian adults: A systematic review

The objective of this study is to systematically review the evidence on correlates of sedentary behaviour (SB) among Asian adults. We searched for studies that examined individual, environmental, and political/cultural correlates of total and domain-specific SB (transport, occupation, leisure, and screen time) in Asian adults published from 2000 onwards in nine scientific databases. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis that considered differences based on SB measurements, regions, and population characteristics (PROSPERO: CRD42018095268). We identified 13 249 papers of which we included 49, from four regions and 12 countries. Researchers conducted cross-sectional analyses and most relied on SB self-report for SB measurement. Of the 118 correlates studied, the following associations were consistent: higher age, living in an urban area (East Asia), and lower mental health with higher total SB; higher education with higher total and occupational SB; higher income with higher leisure-time SB; higher transit density with higher total SB in older East Asians; and being an unmarried women with higher SB in the Middle East. We encourage more research in non-high-income countries across regions, further exploration of important but neglected correlates using longitudinal designs and qualitative research, and the use of objective instruments to collect SB data.

Factors affecting the frequency of consumption of domestic and foreign fast food brands

The rapid pace of life in recent years has led to an increase in the consumption of fast-food in all age and social groups, and in this regard to an increase in the number of newly opened fast-food restaurants. Previously conducted research work in this field has shown that various factors influence an individual's decision (not) to consume fast-food, and the following five factors have stood out: convenience, brand reputation, quality, consistency and cost. Therefore, the aim of this research was identifying the key factors that influence the frequency of consumption of domestic and foreign fast-food brands. The sample included 146 subjects of different gender, age, qualifications, and employment status. The preliminary online research was carried out using the anonymous three-section questionnaire. Based on the data obtained through ordinal logical regression, the primary hypothesis was confirmed, as it was found that there was a statistically significant factor in the frequency of fast-food consumption, that factor being a convenience. It has been confirmed that convenience factor implies utility and time saving, the possibility of easy access to fast-food, almost 24 h working hours of fast-food restaurants and their relative proximity to the respondents. From the market point of view, a significant research result is that respondents gave preference to domestic versus foreign fast-food brands.

Development of Dietary Knowledge and Adherence Questionnaires for Lebanese Adolescents and Their Parents

The availability of practical tools to assess dietary knowledge and adherence is essential to evaluate the effectiveness of dietary interventions. The aims of this paper were to develop reliable dietary knowledge and adherence questionnaires, suitable for Lebanese adolescents and their parents, and to estimate the feasibility of conducting studies involving such participants in the school-based setting. Eight Lebanese high schools participated in this study (involving 220 adolescents aged 15–18 years). Self-administered dietary knowledge and adherence questionnaires (the Dietary Knowledge Questionnaire (DKQ) and the Dietary Adherence Questionnaire (DAQ), respectively) were completed by the high school students and their parents. A 24 h recall was additionally administered for the adolescents by a dietitian and a trained interviewer at school, in order to validate the adolescents’ answers in the DAQ. The cognitive interview method was used to qualitatively evaluate the questionnaires. The resulting Cronbach’s alpha ranged from 0.61 to 0.78 for the adolescent questionnaires and from 0.46 to 0.89 for the parental ones. In addition, 23 items (out of 25) of the adolescent DAQ matched with the administered 24 h recall. A significant negative correlation was found between the knowledge score (DKQ) and the unhealthy items of the adolescent DAQ. There was a significant positive correlation between the DKQ of the parents and the knowledge score of their children. This is the first study of dietary questionnaires involving Lebanese high school students from different regions, while also including their parents.

Age, period and birth cohort effects on prevalence of obesity among reproductive-age women in India

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Cohort effect shows that obesity for recent cohort has narrowed down.

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Our study shows as age increases the risk of obesity also increases.

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Cohort relative risk is higher among women in rural area than women in urban area.

Trends and Correlates of Overweight among Pre-School Age Children, Adolescent Girls, and Adult Women in South Asia: An Analysis of Data from Twelve National Surveys in Six Countries over Twenty Years

Overweight has become a global pandemic and is associated with a rise in diet-related non-communicable diseases and associated co-morbidities. Most of the world’s undernourished people live in South Asia, yet the number of overweight and obese individuals in this region is growing. This study explores trends and correlates of overweight among pre-school age children, adolescent girls, and adult women in South Asia. Using pooled data from 12 national surveys in six countries, generalized linear mixed models were run to analyze relationships. Overweight children had significantly higher odds than non-overweight children of having an overweight mother (Adjusted Odds Ratio: 1.34, p < 0.01). Overweight adolescent girls were more likely to come from a wealthier household (Adjusted Prevalence Ratio (APR): 2.46, p < 0.01) in an urban area (1.74, p < 0.01), and have formal education (1.22, p < 0.01), compared to non-overweight girls. Similar relationships were seen among overweight vs. non-overweight adult women. In Bangladesh, India, and Nepal, overweight among girls and women increased over time, while differentials associated with household wealth, urban residence, and formal education attenuated over time. Overweight and obesity are becoming more prevalent across South Asia in a context of persisting undernutrition. Once a condition of the wealthier, more educated and urban, rates of overweight are increasing among poorer, less educated, and rural women. This requires immediate attention to ‘multi-use’ policies and programmes.

Non-communicable diseases in Indian slums: re-framing the Social Determinants of Health

Background: The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability. The Social Determinants of Health (SDH) framework has been used to understand the social dynamics and impact of NCDs, especially in poorly resourced communities. Whilst the SDH has helped to discredit the characterisation of NCDs as diseases of affluence, its impact on policy has been less definite. Given the multitude of factors that interact in the presentation of NCDs, operationalising the SDH for policies and programmes that account for the contextual complexity of slums has stalled.

Objective: To organise the complex networks of relations between SDH in slums so as to identify options for Indian municipal policy that are feasible to implement in the short term.

Methods: The study reviews the literature describing SDH in Indian slums, specifically those that establish causal relations between SDH and NCDs. Root cause analysis was then used to organise the identified relations of SDH and NCDs.

Results: Although poverty remains the largest structural determinant of health in slums, the multi-dimensional relations between SDH and NCDs are structured around four themes that describe the dynamics of slums, namely scarce clean water, low education, physical (in)activity and transportation. From the reviewed literature, four logic trees visualising the relations between SDH in slums and NCDs were constructed. The logic trees separate symptomatic problems from their more distal causes, and recommendations were formulated based on features of these relationships that are amenable to policy intervention.

Conclusion: Root cause analysis provides a means to focus the lens of examination of SDH, as evidenced here for Indian slums. It provides a guide for the development of policies that are grounded in the actual health concerns of people in slums, and takes account of the complex pathways through which diseases are socially constituted.

Comparison of domains of self-reported physical activity between Kenyan adult urban-slum dwellers and national estimates

BACKGROUND

Non-communicable diseases (NCDs) - largely the result of modifiable behavioral risks such as physical inactivity that gradually develop into physiological risks - are a main cause of morbidity and mortality worldwide. In Kenya, a nationally representative STEPwise survey of risk factors for NCDs established that 10.8% of Kenyans accumulated low levels of total physical activity.

OBJECTIVES

The goal of our analyses was to compare domains of self-reported physical activity in two Nairobi slums to national estimates.

METHODS

Levels and time of self-reported activity in three domains (work, transport, and recreation), collected as part of a SCALE-UP study conducted in Korogocho and Viwandani slums in Nairobi, were compared to STEPwise findings.

RESULTS

The samples included a total of 10,128 participants (5,628 slum, 4,500 national). Only 7.1% and 4.0% of slum dwellers reported low levels of work and transport physical activity, respectively, but 95.9% reported low levels of recreation-related activity. Slum residents reported higher mean daily minutes of total activity than the national estimate (499 minutes versus 291 minutes), however, both samples spent similar proportions of total activity on work (79.0% slum, 78.3% national), transport (20.4% slum, 18.1% national), and recreation (0.6% slum, 3.6% national) activities.

CONCLUSIONS

While the total amount of time spent in different domains of self-reported activity differs between urban slum residents and the national Kenyan population, proportions of time in each of the three domains are similar. It is important that such differences or similarities be considered when addressing NCD risk factors in these populations.

Food Choice Drivers in the Context of the Nutrition Transition in Delhi, India

OBJECTIVE

To understand factors that influence the process of food decision-making among urban Indian women in the context of the nutrition transition.

DESIGN

Mixed methods.

METHODS

Semistructured interviews and sorting of 12 a priori hypothesized drivers into categories of always, sometimes, and never influencing food choice.

SETTING

Delhi, India.

PARTICIPANTS

Thirty-eight women aged 20-35 years selected from the roster of a prospective cohort study.

PHENOMENON OF INTEREST

Drivers of food choice.

ANALYSIS

Interviews were transcribed verbatim and translated, then analyzed using an iterative, constant comparative process. Differences in pile sort rankings across tertiles of body mass index and wealth index were tested using Fisher exact tests.

RESULT

Four primary themes emerged: (1) family influence; (2) cultural perceptions, with 3 subthemes of beliefs relating to (a) outside food and less healthful food, (b) seasonality, and (c) hometown food; (3) convenience, with 3 subthemes of (a) decisions regarding procurement of food, (b) not having time to cook, resulting in eating out or purchasing premade foods, and (c) eating whatever is available at home or is left over from previous meals; and (4) habit, with 2 subthemes of (a) subconscious decisions and (b) food roots. Responses from the pile sort activity revealed perceptions that food safety and health most influence food choice whereas marketing and advertisements least influence it.

CONCLUSIONS AND IMPLICATIONS

Young adult women in Delhi seem to rely on preferences of their families, habits and perceptions established in childhood, convenience, and food safety and health when making choices about food. These aspects of decision-making should be targeted in future interventions aimed at improving dietary intake in this population.

Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis

AIMS

Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India.

METHODS

We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias.

RESULTS

We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% [15.5, 23.6], p < 0.05) than the WHO 1999 criteria (10.13% [8.17, 12.50]) and DIPSI criteria (7.37% [5.2, 10.16]). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33-79%). Studies specifying time of GDM diagnosis showed that patients (11-60%) develop GDM as early as the first trimester, but many GDM cases (16-40%) are missed if screened only at first visit.

CONCLUSIONS

In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients' needs and correlate screening criteria with pregnancy outcomes.

Nature cure treatment in the context of India's epidemiological transition

Scholars have argued that theoretical insights of critical medical anthropology should be applied to the analysis of complementary and alternative medicine in order to develop more critically engaged integrative medicine. In this essay we focus on nature cure in the context of India's contemporary epidemiological transition as an example of why engaged integrative medicine is important for public health, and how the institutionalization of nature cure treatment in India provides a critical framework for the development of programs focused on holistic treatment and prevention. After providing an overview of the epidemiological transition in contemporary India, we develop this argument through an examination of illustrative cases in a clinic that operates within the structure of India's Central Council for Research on Yoga and Naturopathy. Based on a review of recent history and contemporary practice we describe how a system of medicine that makes use exclusively of air, earth, sunlight, water and food has been institutionalized and professionalized in India. Whereas biomedical treatment for chronic non-communicable diseases is focused on the problem of curing individual diseases, nature cure establishes a regimen of personalized public healthcare for the integrated management of symptoms. We argue that nature cure is based on an ecological understanding of health, thus providing treatment that reflects a broad appreciation for the risk factors that characterize India's current crises of public health.

Physical Environment Correlates of Physical Activity in Developing Countries: A Review

BACKGROUND

Noncommunicable diseases and obesity are considered problems of wealthy, developed countries. These conditions are rising dramatically in developing countries. Most existing research on the role of the physical environment to support physical activity examines developed countries only.

OBJECTIVES

This review identifies physical environment factors that are associated with physical activity in developing countries.

METHODS

This review is modeled on a highly cited review by Saelens and Handy in 2008. The current review analyzes findings from 159 empirical studies in the 138 developing countries.

RESULTS

Results discuss the association of physical environment features and physical activity for all developing countries and identify the patterns within regions. The review supports the association of traffic safety with physical activity for transportation. Rural (vs urban) residence, distance to nonresidential land uses, and "composite" features of the physical environment are associated with general physical activity. Rural (vs urban) residence is associated with physical activity for work.

CONCLUSIONS

More research is needed on associations between the physical environment and physical activity in developing countries. Research should identify specific physical environment features in urban areas that are associated with higher activity levels.

Prevalence and time trends in overweight and obesity among urban women: an analysis of demographic and health surveys data from 24 African countries, 19912014

OBJECTIVE

To examine the prevalence and trends in overweight and obesity among non-pregnant urban women in Africa over the past two and a half decades.

DESIGN

Cross-sectional surveys conducted between 1991 and 2014.

SETTINGS

Demographic and Health Surveys (DHS), repeated cross-sectional data collected in 24 African countries.

PARTICIPANTS

Adult non-pregnant women aged 15-49 years. The earlier DHS collected anthropometric data on only those women who had children aged 0-5 years. The main analyses were limited to this subgroup. The participants were classified as overweight (25.0-29.9 kg/m²) and obese (≥30.0 kg/m²).

RESULTS

The prevalence of overweight and obesity among women increased in all the 24 countries. Trends were statistically significant in 17 of the 24 countries in the case of obesity and 13 of the 24 for overweight. In Ghana, overweight almost doubled (p=0.001) while obesity tripled (p=0.001) between 1993 and 2014. Egypt has the highest levels of overweight and obesity at 44% (95% CI 42%, 46.5%) and 39% (95% CI 36.6%, 41.8%), respectively, in 2014 and the trend showed significant increase (p=0.005) from 1995 levels. Also, obesity doubled in Kenya, Benin, Niger, Rwanda, Ivory Coast and Uganda, while tripled in Zambia, Burkina Faso, Mali, Malawi and Tanzania. Ethiopia and Madagascar had the lowest prevalence of both obesity and overweight, with overweight ranging from 7% to 12% and obesity from 1% to 4%.

CONCLUSIONS

Overweight and obesity are increasing among women of reproductive age in urban Africa, with obesity among this age group having more than doubled or tripled in 12 of the 24 countries. There is an urgent need for deliberate policies and interventions to encourage active lifestyles and healthy eating behaviour to curb this trend in urban Africa.

Sleep and dietary habits in the urban environment: the role of chrono-nutrition

The urban environment has changed vastly over past decades, which also has had an impact on our sleep and dietary patterns and possibly health outcomes. Some studies have shown that sleep duration and sleep quality has declined over past decades, especially in children. In parallel, our lifestyle and dietary patterns have also changed including more shift work, more meals outside the home or family setting and more irregular eating patterns, including breakfast skipping and late-night eating. This new area of research in nutritional sciences studying the impact of the timing of eating on health outcomes is called chrono-nutrition, and combines elements from nutritional research with chrono-biology. The objectives of this paper were to discuss secular trends in sleep patterns and related dietary patterns, introduce basic concepts and mechanisms of chrono-nutrition and discuss the evidence for the importance of sleep and chrono-nutrition in relation to health outcomes. Overall, chrono-nutrition could mediate the effects between sleep, diet and urbanisation, and more research is needed to elucidate the importance of chrono-nutrition for metabolic health and its impact on public health.

Associations between Greenness, Impervious Surface Area, and Nighttime Lights on Biomarkers of Vascular Aging in Chennai, India

BACKGROUND

India is undergoing rapid urbanization with simultaneous increases in the prevalence of cardiovascular disease (CVD). As urban areas become home to an increasing share of the world's population, it is important to understand relationships between the built environment and progression towards CVD.

OBJECTIVE

We assessed associations between multiple measures of the built environment and biomarkers of early vascular aging (EVA) in the Population Study of Urban, Rural and Semiurban Regions for the Detection of Endovascular Disease and Prevalence of Risk Factors and Holistic Intervention Study (PURSE-HIS) in Chennai, India.

METHODS

We performed a cross-sectional analysis of 3,150 study participants. EVA biomarkers included systolic and diastolic blood pressure (SBP and DBP), central pulse pressure (cPP) and flow-mediated dilatation (FMD). Multiple approaches were used to assign residential exposure to factors of the built environment: Moderate Resolution Imaging Spectroradiometer (MODIS)-derived normalized difference vegetation index (NDVI), a measure of vegetation health and greenness; Landsat-derived impervious surface area (ISA); and Visible Infrared Imaging Radiometer Suite (VIIRS)-derived nighttime lights (NTL). Multivariable regression models were used to assess associations between each built environment measure and biomarkers of EVA, adjusting for age, body mass index (BMI), cooking fuel type, energy intake, sex, physical activity, smoking, socioeconomic status, and stress.

RESULTS

Residing in areas with higher ISA or NTL, or lower greenness, was significantly associated with elevated SBP, DBP, and cPP, and with lower FMD, adjusting for age, BMI, sex, smoking status, and other CVD risk factors. An interquartile range decrease in greenness had the largest increase in SBP [4.3 mmHg (95% CI: 2.9, 5.6)], DBP [1.2 mmHg (95% CI: 0.4, 2.0)] and cPP [3.1 mmHg (95% CI: 2.0, 4.1)], and the largest decrease in FMD [-1.5% (95%CI: -2.2%, -0.9%].

CONCLUSION

Greenness, ISA, and NTL were associated with increased SBP, DBP, and cPP, and with reduced FMD, suggesting a possible additional EVA pathway for the relationship between urbanization and increased CVD prevalence in urban India. https://doi.org/10.1289/EHP541.

Lifestyles in suburban populations: A systematic review

BACKGROUND

Lifestyle and suburban population are important issues in the field of health. The living conditions of informal settlements can lead to acquisition of an unhealthy lifestyle.

OBJECTIVE

This study has been designed to investigate the articles that have been published regarding lifestyle in suburban populations.

METHODS

The present research was a systematic review of studies in databases including Iranmedex, Magiran, SID, Irandoc, PubMed, Google Scholar, Science Direct and Scopus, in 2017. All Persian and English papers written from 2000 to 2017 were evaluated by two reviewers using an advanced search of the databases with keywords related to lifestyles and suburban population. After completion of the search, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to evaluate the articles.

RESULTS

In total, 19 articles were found to have addressed the lifestyle in suburban populations. The results of these studies showed an unhealthy lifestyle in the most informal settlements. There was no food diversity. Malnutrition was common, especially overweight. The majority of the people did not have enough physical activity, and smoking and alcohol consumption were common, especially in men.

CONCLUSION

Studies showed that suburban populations are among the groups that have unfavorable environmental conditions to acquiring healthy lifestyle and maintaining appropriate health. Therefore, developing infrastructure, improving health services (environment, treatment of diseases, reduction of malnutrition and infant mortality, access to safe drinking water and sanitation, improving waste disposal and recycling it), improving education and smoking prevention programs in improving lifestyle is recommended.

Factors associated with body mass index among slum dwelling women in India: an analysis of the 2005-2006 Indian National Family Health Survey

BACKGROUND

Urbanization is increasing around the world, and in India, this trend has translated into an increase in the size of slum dwellings whose environments are suspected of being associated with poor health outcomes, particularly those relating to women's nutritional status. With this study, we sought to determine the factors associated with Indian women's body mass index (BMI) in slum environments, with special attention paid to women with tribal status.

METHODS

A multiple linear regression analysis was performed on data from the Indian National Family Health Survey (2005-2006), modeling demographic and behavioral factors suspected of being associated with BMI, with additional focus on the measures of social class, specifically caste and tribal status.

RESULTS

Increasing BMI is significantly and positively associated with frequency of watching television, having diabetes, age, wealth index, and residency status in the areas of New Delhi, Andhra Pradesh, or Tamil Nadu.

CONCLUSION

Although belonging to a scheduled tribe was not associated with changes in BMI, unadjusted rates suggest that tribal status may be worthy of deeper investigation. Among slum dwellers, there is a double burden of undernutrition and overnutrition. Therefore, a diverse set of interventions may be required to improve the health outcomes of these women.

The history, geography, and sociology of slums and the health problems of people who live in slums

Massive slums have become major features of cities in many low-income and middle-income countries. Here, in the first in a Series of two papers, we discuss why slums are unhealthy places with especially high risks of infection and injury. We show that children are especially vulnerable, and that the combination of malnutrition and recurrent diarrhoea leads to stunted growth and longer-term effects on cognitive development. We find that the scientific literature on slum health is underdeveloped in comparison to urban health, and poverty and health. This shortcoming is important because health is affected by factors arising from the shared physical and social environment, which have effects beyond those of poverty alone. In the second paper we will consider what can be done to improve health and make recommendations for the development of slum health as a field of study.

Sleep Quality and Body Composition Variations in Obese Male Adults after 14 Weeks of Yoga Intervention: A Randomized Controlled Trial

Background:

Obesity is a big challenge all over the world. It is associated with many noncommunicable diseases. Yoga known to be add-on treatment may be effective for obesity control.

Aim:

To assess the effect of integrated approach of yoga therapy (IAYT) for body composition and quality of sleep in adult obese male.

Subjects and Methods:

A randomized controlled trial was conducted for 14 weeks on obese male of urban setting. Eighty individuals were randomly divided into two groups, i.e., yoga group (n = 40; age; 40.03 ± 8.74 years, body mass index [BMI] 28.7 ± 2.35 kg/m²) and control group (age; 42.20 ± 12.06 years, BMI 27.70 ± 2.05 kg/m²). The IAYT was imparted to yoga group for 1½ hour for 5 days in a week for 14 weeks. The control group continued their regular activities. The body composition by InBody R20 and sleep quality by Pittsburgh Sleep Quality Index (PSQI) were assessed. Statistical analysis was done for within and between groups using SPSS version 21. The correlation analysis was done on the difference in pre-post values.

Results:

The results showed that weight (P = 0.004), BMI (P = 0.008), bone mass (P = 0.017), obesity degree (P = 0.005), and mineral mass (P = 0.046) were improved in yoga group and no change in control group (P > 0.05). The global score of PSQI improved (P = 0.017) in yoga group alone.

Conclusion:

The results indicate the beneficial effects of IAYT on body composition and sleep quality in obese males. The yoga practice may reduce obesity with the improvement in quality of life.

Yoga Practice for Reducing the Male Obesity and Weight Related Psychological Difficulties-A Randomized Controlled Trial

INTRODUCTION

Obesity is a health disorder and increasing all over the world. It is also a cause for many non-communicable diseases. Yoga practice reduces the stress level which may improve the eating habits and help in weight reduction.

AIM

To assess the final outcome of the effects after 3 months of the 14 weeks yoga training on obesity of adult male in an urban setting.

MATERIALS AND METHODS

This was a randomized controlled trial with parallel groups (Yoga and Control groups) on male obese. Total 80 subjects with Body Mass Index (BMI) between 25 to 35 kg/cm² were enrolled and randomized into two equal groups in which 72 subjects (yoga n = 37 and control n=35) completed the trial. Yoga group mean age ± SD was 40.03±8.74 and Control group mean age±SD was 42.20±12.06. A 14 weeks special IAYT (Integrated Approach of Yoga Therapy) yoga training was given to the Yoga group and no specific activity was given to Control group. The interim results of this study at 14 weeks were covered in another article which is under process. After the 14 weeks of yoga training the Yoga group was asked to continue the yoga practice for the next 3 months and the Control group was not given any physical activity. The final outcome is covered in this paper. The assessments were anthropometric parameters of body weight (Wt), BMI (Body Mass Index), MAC (Mid-upper Arm Circumferences of left and right arm), WC (Waist Circumference), HC (Hip Circumference), WHR (Waist Hip Ratio), SKF (Skin Fold Thickness) of biceps, triceps, sub scapular, suprailiac and cumulative skin fold thickness value), Percentage body fat based on SKF and Psychological questionnaires of PSS (Perceived Stress Scale) and AAQW (Acceptance and Action Questionnaire for Weight related difficulty). Assessments were taken after 3 months of yoga training, for both Yoga and Control groups. Within group, between group and correlation analyses were carried out using SPSS 21.

RESULTS

Improvement in anthropometric and psychological parameters such as Wt, Percentage body fat, PSS were observed in the final outcome. Also, some of the improvements such as AAQW score were lost in the final outcome, compared to interim results.

CONCLUSION

The yoga practice is effective for obesity control for adult male in an urban setting.

Effect of Integrated Approach of Yoga Therapy on Male Obesity and Psychological Parameters-A Randomised Controlled Trial

INTRODUCTION

Obesity is a growing global epidemic and cause of non-communicable diseases. Yoga is one of the effective ways to reduce stress which is one of the causes of obesity.

AIM

To assess the effect of Integrated Approach of Yoga Therapy (IAYT) yoga module on adult male obesity in an urban setting.

MATERIALS AND METHODS

RCT (Randomized Controlled Trial) was conducted for 14 weeks on obese male subjects with yoga and control groups. Total number of subjects were 72 and they were randomized into two groups (Yoga n=37, Control n=35). The subjects were from an urban setting of Mumbai and were doing yoga for the first time. Special yoga training of IAYT was given to yoga group for one and half hour for 5 days in a week for 14 weeks. The control group continued regular physical activities and no specific physical activity was given. The assessments were anthropometric parameters of weight, Body Mass Index (BMI), MAC (Mid Upper Arm Circumferences) of Left and Right Arm, Waist Circumference (WC), HC (Hip Circumference), WHR (Waist Hip Ratio), SKF(Skin Fold Thickness of Biceps, Triceps, Sub scapular, suprailiac and cumulative), Percentage body fat based on SKF and Psychological Questionnaires of Perceived Stress Scale (PSS) and AAQW (Acceptance and Action Questionnaire for Weight Related Difficulty). These were taken before and after intervention for both yoga and control groups. Within and between group analysis & correlation of differences from post to pre readings among the variables, were carried out using SPSS 21.

RESULTS

The anthropometric and psychological parameters were improved in both the groups but changes were significant in yoga group.

CONCLUSION

Incorporating the IAYT for obese male in urban setting will be effective for obesity treatment and for reducing the obesity related problems.

A multianalytical approach to evaluate the association of 55 SNPs in 28 genes with obesity risk in North Indian adults

OBJECTIVES

The aim of the study was to investigate the association of 55 SNPs in 28 genes with obesity risk in a North Indian population using a multianalytical approach.

METHODS

Overall, 480 subjects from the North Indian population were studied using strict inclusion/exclusion criteria. SNP Genotyping was carried out by Sequenom Mass ARRAY platform (Sequenom, San Diego, CA) and validated Taqman^® allelic discrimination (Applied Biosystems^® ). Statistical analyses were performed using SPSS software version 19.0, SNPStats, GMDR software (version 6) and GENEMANIA.

RESULTS

Logistic regression analysis of 55 SNPs revealed significant associations (P < .05) of 49 SNPs with BMI linked obesity risk whereas the remaining 6 SNPs revealed no association (P > .05). The pathway-wise G-score revealed the significant role (P = .0001) of food intake-energy expenditure pathway genes. In CART analysis, the combined genotypes of FTO rs9939609 and TCF7L2 rs7903146 revealed the highest risk for BMI linked obesity. The analysis of the FTO-IRX3 locus revealed high LD and high order gene-gene interactions for BMI linked obesity. The interaction network of all of the associated genes in the present study generated by GENEMANIA revealed direct and indirect connections. In addition, the analysis with centralized obesity revealed that none of the SNPs except for FTO rs17818902 were significantly associated (P < .05).

CONCLUSIONS

In this multi-analytical approach, FTO rs9939609 and IRX3 rs3751723, along with TCF7L2 rs7903146 and TMEM18 rs6548238, emerged as the major SNPs contributing to BMI linked obesity risk in the North Indian population.

Urban rural differences in diet, physical activity and obesity in India: are we witnessing the great Indian equalisation? Results from a cross-sectional STEPS survey

BACKGROUND

The rising morbidity and mortality due to non-communicable diseases can be partly attributed to the urbanized lifestyle leading to unhealthy dietary practices and increasing physical levels of inactivity. The demographic and nutrition transition in India has also contributed to the emerging epidemic of non-communicable diseases in this country. In this context, there is limited information in India on dietary patterns, levels of physical activity and obesity. The aim of the present study was thus to assess the urban rural differences in dietary habits, physical activity and obesity in India.

METHODS

A household survey was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals using the WHO STEPS questionnaire.

RESULTS

No rural urban difference was found in dietary practices and prevalence of overweight and obesity except the fact that a significantly higher proportion of respondents belonging to rural area (15.6 %) always/often add salt before/when eating as compared to urban area (9.1 %). Overall 95.8 % (94.6-97.0) of participants took less than 5 servings of fruits and/or vegetables on average per day. No significant urban rural difference was noted in both sexes in all three domains of physical activity such as work, transport and recreation. However, rural females (19.1 %) were found to be engaged in vigorous activity more than the urban females (6.3 %). Males reported high levels of physical activity in both the settings. Absence of recreational activity was reported by more than 95 % of the subjects. Higher prevalence of obesity (asian cut offs used) was seen among urban females (34.3 %) as compared to their rural counterparts (23.2 %). Abdominal obesity was found to be significantly higher among females in both the settings compared to males (p < 0.001).

CONCLUSIONS

Poor dietary practices and physical inactivity seems to fuel the non-communicable disease epidemic in India. Non communicable disease control strategy need to address these issues with a gender equity lens. Rapid urbanization of rural India might be responsible for the absence of a significant urban rural difference.

A new approach to sex estimation using the mandibular canine index

Rao et al.'s mandibular canine index (MCI) is a simple odontometric method which uses the mandibular canine as the key to sex estimation. This index is defined as the ratio between the right canine mesiodistal dimension and the mandibular canine arch width. The aim of this study was to contribute to sex estimation using dental techniques by analysing the MCI efficiency, and to propose a new approach for its use. Measurements were taken from 120 plaster casts (70 females) in the 16-30 year age group. Although statistically significant sexual dimorphism was observed in both the mesiodistal dimension and the mandibular canine arch width, the MCI showed a low accuracy in sex classification (54.2% correct identifications). This accuracy was improved to 64.2% using receiver operating characteristics curve analysis. Yet, despite the better accuracy, these results reinforce the idea that the MCI may not be particularly useful in sex prediction, since it may not reflect the same degree of sexual dimorphism as its absolute measures.

Genetics of Obesity

Numerous classical genetic studies have proved that genes are contributory factors for obesity. Genes are directly responsible for obesity associated disorders such as Bardet-Biedl and Prader-Willi syndromes. However, both genes as well as environment are associated with obesity in the general population. Genetic epidemiological approaches, particularly genome-wide association studies, have unraveled many genes which play important roles in human obesity. Elucidation of their biological functions can be very useful for understanding pathobiology of obesity. In the near future, further exploration of obesity genetics may help to develop useful diagnostic and predictive tests for obesity treatment.

Behavioral and psychosocial correlates of adiposity and healthy lifestyle in Asian Indians

AIMS

Adiposity is an important diabetes risk factor, and Asian Indians have elevated diabetes risk. This analysis assessed the relationship between behavioral and psychosocial factors and adiposity among Asian Indians to better understand factors driving elevated weight/waist circumference in this population.

METHODS

This study used screening data (N=1285) from the D-CLIP study, a randomized controlled diabetes prevention trial in Chennai, India. Correlation tests and linear regression models were done to describe relationships among exposure variables (weight loss/exercise self-efficacy, fruit/vegetable intake, weekly exercise, past weight loss experience) and between these exposures and BMI or waist circumference.

RESULTS

Exercise and weight loss self-efficacy were positively correlated with average minutes per week exercising (R=0.26, p<0.0001) and fruit (R=0.07, p<0.05) and vegetable intake (R=0.12, p<0.0001). Weekly fruit consumption, past weight loss experience, and weight loss self-efficacy, along with sex, age, and marital status, explained 13.6% and 25.9% in the variation in BMI and waist circumference, respectively.

CONCLUSIONS

Low fruit consumption, unsuccessful past weight loss attempts, and low self-efficacy for weight loss are associated with higher BMI and waist circumference in this population. Understanding factors related to adiposity is important for preventing and treating weight gain.

The co-occurrence of anemia and cardiometabolic disease risk demonstrates sex-specific sociodemographic patterning in an urbanizing rural region of southern India

Background/Objectives

To determine the extent and sociodemographic determinants of anemia, overweight, metabolic syndrome (MetS), and the co-occurrence of anemia with cardiometabolic disease risk factors among a cohort of Indian adults.

Subject/Methods

Cross-sectional survey of adult men (n=3,322) and non-pregnant women (n=2,895) aged 18 y and older from the third wave of the Andhra Pradesh Children and Parents Study that assessed anemia, overweight based on Body Mass Index, and prevalence of MetS based on abdominal obesity, hypertension, and blood lipid and fasting glucose measures. We examined associations of education, wealth and urbanicity with these outcomes and their co-occurrence.

Results

The prevalence of anemia and overweight was 40% and 29% among women, respectively, and 10% and 25% among men (P<0.001), respectively, while the prevalence of MetS was the same across sexes (15%) (P=0.55). The prevalence of concurrent anemia and overweight (9%), and anemia and MetS (4.5%) was highest among women. Household wealth was positively associated with overweight and MetS across sexes (P<0.05). Independent of household wealth, higher education was positively correlated with MetS among men (OR (95% CI): MetS: 1.4 (0.99, 2.0)) and negatively correlated with MetS among women (MetS: 0.54 (0.29, 0.99)). Similar sex-specific associations were observed for the co-occurrence of anemia with overweight and MetS.

Conclusion

Women in this region of India may be particularly vulnerable to co-occurring anemia and cardiometabolic risk, and associated adverse health outcomes as the nutrition transition advances in India.

Quantitative estimates of dietary intake with special emphasis on snacking pattern and nutritional status of free living adults in urban slums of Delhi: impact of nutrition transition

BACKGROUND

The nutritional landscape of India is experiencing the fallout of urbanization and globalization. The changes are manifest in dietary patterns as well as health outcomes. The study aimed at assessing household dietary intake pattern with special emphasis on snacking pattern, anthropometric and lipid profiles in low socio-economic status households in an urban slum of Delhi.

METHODS

Community based cross-sectional study in 260 households of a purposively selected urban slum in North-East district of Delhi, India. Family dietary surveys including consumption pattern of commercial food products rich in Partially Hydrogenated Vegetable Oils (PHVOs), 24 h dietary recall and assessment of dietary diversity using Household Diet Diversity Scores (HDDS) were done. Assessment of nutritional status using anthropometric and lipid profile on a subsample (n =130) were also conducted.

RESULTS

Median energy and fat intake were adequate. Micronutrient intake was found to be inadequate for vitamin A, riboflavin, calcium and folate. PHVO usage was low (<20 % households). Milk (39 %), green leafy vegetables (25 %) and fruits (25 %) intake were below recommendations. Mean HDDS was 7.87. Prevalence of overweight/obesity was high (66.7 %). Lipid profile showed mean HDL-C levels lower than recommendations for females.

CONCLUSION

Community based awareness programs for prevention of non-communicable diseases should incorporate healthy diet and lifestyle practices with emphasis on quantity and quality of nutrient intake. This must be considered as an integral part of chronic disease prevention strategy for underprivileged communities in urban India.