Maternal obesity trends in Egypt 1995-2005

Incidence of obese parturients and the outcomes of their pregnancies: A nationwide register study in Finland

OBJECTIVES

We analyzed the incidence of obese and severely obese parturients and the impact of maternal obesity on mode of delivery, perinatal and neonatal mortality, and neonatal health.

STUDY DESIGN

We included all singleton births from the medical birth register of Finland from 2004 to 2018 (n = 792 437). Maternal body mass index (BMI) was categorized into three classes: non-obese (BMI < 30 kg/m²), obese (BMI 30 - 39.9 kg/m²), and morbidly obese (BMI 40 kg/m² or more). The yearly incidence of obese and severely obese parturients per 10000 births was calculated. Logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI).

RESULTS

Between 2004 and 2018, the incidence of obese and morbidly obese parturients increased by 44% and 103%, respectively. Cesarean section rates were 23.6% and 30%, respectively (aOR 1.63 CI 1.61 - 1.66 and 2.33 CI: 2.23 - 2.44). Neonates born to morbidly obese parturients had an increased need for intensive care unit treatment (aOR 2.21 CI: 2.10 - 2.32), higher perinatal mortality (aOR 1.65 CI: 1.28 - 2.14), and higher neonatal mortality (aOR 1.68 CI: 1.04 - 2.72). The need for neonatal intensive care (aOR 1.50 CI: 1.47 - 1.53), perinatal mortality (aOR 1.25 CI: 1.13 - 1.39), and neonatal mortality (aOR 1.33 CI: 1.09 - 1.62) increased also among obese parturients.

CONCLUSIONS

We report a worrying increase in obese and morbidly obese parturients. Neonates born to these parturients were more likely delivered by cesarean sections and had higher rates of perinatal and neonatal mortality, and intensive care unit treatment. This highlights the importance of preventing obesity among fertile-aged females.

Complete genome sequence and bioinformatics analysis of nine Egyptian females with clinical information from different geographic regions in Egypt

Egyptians are at a crossroad between Africa and Eurasia, providing useful genomic resources for analyzing both genetic and environmental factors for future personalized medicine. Two personal Egyptian whole genomes have been published previously by us and here nine female whole genome sequences with clinical information have been added to expand the genomic resource of Egyptian personal genomes. Here we report the analysis of whole genomes of nine Egyptian females from different regions using Illumina short-read sequencers. At 30x sequencing coverage, we identified 12 SNPs that were shared in most of the subjects associated with obesity which are concordant with their clinical diagnosis. Also, we found mtDNA mutation A4282G is common in all the samples and this is associated with chronic progressive external ophthalmoplegia (CPEO). Haplogroup and Admixture analyses revealed that most Egyptian samples are close to the other north Mediterranean, Middle Eastern, and European, respectively, possibly reflecting the into-Africa influx of human migration. In conclusion, we present whole-genome sequences of nine Egyptian females with personal clinical information that cover the diverse regions of Egypt. Although limited in sample size, the whole genomes data provides possible geno-phenotype candidate markers that are relevant to the region's diseases.

Parity and Overweight/Obesity in Peruvian Women

Introduction

The rise in noncommunicable diseases and their risk factors in developing countries may have changed or intensified the effect of parity on obesity. We aimed to assess this association in Peruvian women using data from a nationally representative survey.

Methods

We used data from Peru’s Demographic and Health Survey, 2012. Parity was defined as the number of children ever born to a woman. We defined overweight as having a body mass index (BMI, kg/m²) of 25.0 to 29.9 and obesity as a BMI ≥30.0. Generalized linear models were used to evaluate the association between parity and BMI and BMI categories, by area of residence and age, adjusting for confounders.

Results

Data from 16,082 women were analyzed. Mean parity was 2.25 (95% confidence interval [CI], 2.17–2.33) among rural women and 1.40 (95% CI, 1.36–1.43) among urban women. Mean BMI was 26.0 (standard deviation, 4.6). We found evidence of an association between parity and BMI, particularly in younger women; BMI was up to 4 units higher in rural areas and 2 units higher in urban areas. An association between parity and BMI categories was observed in rural areas as a gradient, being highest in younger women.

Conclusion

We found a positive association between parity and overweight/obesity. This relationship was stronger in rural areas and among younger mothers.

Factors associated with early growth in Egyptian infants: implications for addressing the dual burden of malnutrition

Optimal nutrition is critical to the attainment of healthy growth, human capital and sustainable development. In Egypt, infants and young children face overlapping forms of malnutrition, including micronutrient deficiencies, stunting and overweight. Yet, in this setting, little is known about the factors associated with growth during the first year of life. A rise in stunting in Lower Egypt from 2005 to 2008 prompted this implementation research study, which followed a longitudinal cohort of infants from birth to 1 year of age within the context of a USAID-funded maternal and child health integrated programme. We sought to determine if growth patterns and factors related to early growth differed in Lower and Upper Egypt, and examined the relationship between weight loss and subsequent stunting at 12 months of age. Growth patterns revealed that length-for-age z-score (LAZ) decreased and weight-for-length z-score (WLZ) increased from 6 to 12 months of age in both regions. One-quarter of infants were stunted and nearly one-third were overweight by 12 months of age in lower Egypt. Minimum dietary diversity was significantly associated with WLZ in Lower Egypt (β = 0.22, P < 0.05), but not in Upper Egypt. Diarrhoea, fever and programme exposure were not associated with any growth outcome. Weight loss during any period was associated with a twofold likelihood of stunting at 12 months in Lower Egypt, but not Upper Egypt. In countries, like Egypt, facing the nutrition transition, infant and young child nutrition programmes need to address both stunting and overweight through improving dietary quality and reducing reliance on energy-dense foods.

The rise in stunting in relation to avian influenza and food consumption patterns in Lower Egypt in comparison to Upper Egypt: results from 2005 and 2008 Demographic and Health Surveys

Background

A 2006 avian influenza (AI) outbreak resulted in mass removal of chickens in Lower Egypt, which decreased the household supply of poultry. Poultry, a key animal-source food, contains nutrients critical for child growth. This paper examines determinants of stunting between 2006 and 2008 in children 6 to 59 months of age within the context of the AI outbreak.

Methods

The 2005 and 2008 nationally representative Egypt Demographic and Health Surveys (EDHS) were used to analyse anthropometric data from 7,794 children in 2005 and 6,091 children in 2008. Children, 6–59 months of age, with length for age Z-score < −2 S.D. were categorized as stunted. Predictors of stunting were examined by bivariate and multivariable analyses, focusing on Lower Egypt, where a rise in stunting occurred, and Upper Egypt, where stunting declined.

Results

Between 2005 and 2008, Upper Egypt experienced a significant decline in stunting (28.8 to 21.8%, P < 0.001). Lower Egypt experienced a significant rise in stunting (16.6 to 31.5%, P < 0.001), coinciding with the 2006 AI outbreak. In Lower Egypt (2008), households owning poultry were 41.7% less likely to have a stunted child [aOR 0.58; 95% CI (0.42, 0.81) P = 0.002], and 12–47 month old children were 2.12-2.34 times [95% CI (1.39 – 3.63) P ≤ 0.001] more likely to be stunted than 6–11 month old children. Older children were likely affected by AI, as these children were either in-utero or toddlers in 2006. In Upper Egypt, stunting peaked at 12–23 months [aOR 2.62, 95% CI (1.73-3.96), P < 0.001], with lowered risk (22-32%) of stunting in 24–47 month old children [aOR1.65, 95% 1.07-2.53, P = 0.022, 24–35 month old] and [aOR 1.57, 95% CI 1.01-2.43, P = 0.043 36–47 months old]. A two-fold increase in child consumption of sugary foods between 2005 and 2008 was found in Lower Egypt (24.5% versus 52.7%; P < .001).

Conclusions

Decreased dietary diversity, reduced poultry consumption, substitution of nutritious foods with sugary foods paralleled a reduction in household raising of birds, following the AI outbreak in Lower Egypt and not Upper Egypt. Increased feeding of sugary foods due to fear of illness or greater penetration of these foods may be related to stunting. Advice on infant and young child feeding is needed to improve dietary intake and reduce sugary food consumption.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1627-3) contains supplementary material, which is available to authorized users.

Education modifies the association of wealth with obesity in women in middle-income but not low-income countries: an interaction study using seven national datasets, 2005-2010

BACKGROUND

Education and wealth may have different associations with female obesity but this has not been investigated in detail outside high-income countries. This study examines the separate and inter-related associations of education and household wealth in relation to obesity in women in a representative sample of low- and middle-income countries (LMICs).

METHODS

The seven largest national surveys were selected from a list of Demographic and Health Surveys (DHS) ordered by decreasing sample size and resulted in a range of country income levels. These were nationally representative data of women aged 15-49 years collected in the period 2005-2010. The separate and joint effects, unadjusted and adjusted for age group, parity, and urban/rural residence using a multivariate logistic regression model are presented.

RESULTS

In the four middle-income countries (Colombia, Peru, Jordan, and Egypt), an interaction was found between education and wealth on obesity (P-value for interaction <0.001). Among women with no/primary education the wealth effect was positive whereas in the group with higher education it was either absent or inverted (negative). In the poorer countries (India, Nigeria, Benin), there was no evidence of an interaction. Instead, the associations between each of education and wealth with obesity were independent and positive. There was a statistically significant difference between the average interaction estimates for the low-income and middle-income countries (P<0.001).

CONCLUSIONS

The findings suggest that education may protect against the obesogenic effects of increased household wealth as countries develop. Further research could examine the factors explaining the country differences in education effects.

Trends in Breast Cancer Incidence Rates by Age and Stage at Diagnosis in Gharbiah, Egypt, over 10 Years (1999-2008)

Background. This study was undertaken to evaluate trends in breast cancer incidence in Egypt from 1999 to 2008 and to make projections for breast cancer occurrence for the years 2009–2015. Patients and Methods. We utilized joinpoint regression and average annual percent change (AAPC) measures with 95% confidence intervals (CI) to describe the trends in breast cancer incidence rates from the Gharbiah Cancer Registry by age and stage at diagnosis and to estimate expected breast cancer caseloads for 2009–2015. Results. From 1999 to 2008, the AAPC in breast cancer incidence rates in Gharbiah significantly increased among women 50 years and older and among localized tumors (AAPC %, 95% CI, 3.1% to 8.0%). Our results predict a significant increase in breast cancer caseloads from 2009 to 2015 among women aged 30–39 (AAPC %, 95% CI, 0.9% to 1.1%) and among women aged 40–49 years (AAPC %, 95% CI, 1.0% to 2.6%). Conclusion. These results have important implications for allocating limited resources, managing treatment needs, and exploring the consequences of prior interventions and/or changing risk factors in Egypt and other developing countries at the same stages of demographic and health transitions.